Episode Transcript
[00:00:01] Speaker A: The best insight, instant feedback, accountability, the all new Talk Radio Freedom 106.5.
[00:00:08] Speaker B: It's time to switch gears and turn our attention over to the president this morning of the Nurses association of Trinidad and Tobago and we are chatting with Edie Stewart. Good morning to you, sir, and welcome to the Morning Rumble.
[00:00:23] Speaker A: Thanks so much for having me. Pleasant morning to you and your listeners. I trust you are hearing me.
[00:00:33] Speaker B: All right. I'm hearing you.
[00:00:34] Speaker A: Okay, great.
[00:00:35] Speaker B: All right.
Good morning. Yeah, got it. Thank you so much.
All right. Good morning again. EDIE stewart, President Good morning. Good morning. Some of the election goodies are bearing fruit this morning as you talked about. One of the things is the extended hours when it comes to the the health care system in the country with health centers and so forth. Is that what that is it what we we must discuss this morning? And with that happening? Well, I shouldn't say 20. Is it 24 hours, by the way, Eddie?
[00:01:05] Speaker A: No, no, no, it's not 24 hours. It's just three additional hours from what I saw.
[00:01:11] Speaker B: Additional. So let's first talk about the operational hours of health centers in this country.
What are the operational hours?
[00:01:20] Speaker A: The majority are 8 to 4. Really. Majority are 8 to 4.
And majority of the services delivered during that period.
Generally, health centers would not open on a weekend except specific health centers like St. Joseph Health Facility. So most of the health facilities would open on weekends, but the health centers themselves would only open Monday to Friday, 8 to 4. And they would deliver the routine services, the routine clinics, the diabetes clinic, all of the chronic disease clinic, the mother to child clinics. So that is what generally happens.
From what I'm seeing, particularly in south I am seeing that they have added three centers that they would go from not E to 4 but E to 8 and also they will begin opening on Saturdays.
So this is again, we are getting this third hand information via the media. It's not something that we were consulted on. It is a policy, I guess that would have been thought of before by the incoming government and they have just simply implemented it.
We have some challenges with it, but I guess we would get into that eventually.
[00:02:52] Speaker B: Let me ask you a question. What is the association's position about the improved healthcare hours in Trinidad and Tobago? What is your take? What is the association's take on it?
Should we increase these hours or are we to stick to the 8 to 4 regime? Monday to Friday?
[00:03:11] Speaker A: Well, first begin this is not something new and I would want to put out there. It is not something new. It has something that have been tried by previous Governments, including this government prior and each and every time it would have failed. Each and every time it would have failed for various reasons. One, we don't have the complement of staff to run extended hours and additional hours and all of those things. Two, what are you extending the hours to do?
So you have a situation where the clinics would continue to operate in its normal time.
So it is not that if you have a diabetic, you are diabetic and you are accustomed to going to the diabetic clinic twice for the month that remains in the normal operating time. You can go seven o' clock in the night for this diabetic clinic.
So it is really. It will not ease the bulk of persons attending those clinics and it would not facilitate somebody who is coming off work in the evening to go to the health center. So that is not going to happen.
The health centers, as persons would know, are limited in what they can offer.
They can't offer X rays, they can't offer the majority of the additional support that someone may assume that it can provide. So you would still have to go to the major hospital or district health facility to get any added emergency service because that would not be offered at the health center.
What I'm understanding because of the government's difficulty in getting staff and also the, I guess the financial arrangements, you now would have wonders on duty. Prior to that you would have a difficult visitor, a registered nurse, an enrolled nursing assistant. They have done away with all that. It's just going to be oneness in this health facility. A very strange phenomenon understanding how nursing operates. It would be a very strange phenomenon for a nurse to be placed alone in a health center and they expect to have, from what I'm understanding is one doctor, one nurse and maybe one pharmacist and one medical records person.
So it is really a skeleton staff they're trying to create. It's not a full service.
So I'm still trying to wrap my head because again, we won't consult it. So I'm not sure what they are trying to achieve.
One of the next major shortcomings. Why prior to this new development, it would have failed in the past when they would have watched the data in terms of the number of persons who access care between 4 and 8, what have you. It was very minute amount, very minute amount. And in most of the cases they still had to refer that person to the ANA department at another facility. So I'm not really sure what they are trying to achieve. I know it's these manifesto promises you must try to fulfill it because the public is expecting it but I'm not sure what evidence, what data generated, what data was utilized to come up with this policy that yes it's going to cost taxpayers so I'm not sure what is the end goal no data has been provided for one to make an assessment Certainly the information we have is that it failed on the previous occasions and I'm seeing well let's wait and see what happens.
[00:07:11] Speaker B: You see for me it is the odd and I thank you very much for stating some of the highlighting some of those concerns for me I think general practice, general care is necessary on a 24 hour basis and I'll tell you why when persons go to AE at around 11 o' clock in the night their child has an asthma attack or something is happening and they get to the triage for example you see people what we just call in TorontoBago scrubbing benches because their need is not as dire as remember it's all on a priority in terms of the criticalness of your illness and what you come what you came there for now under the what I would consider the new working conditions if they extend it even to 1212 hours of the day, you know until 12 midnight and then it reopens 8 until I don't know. However I think those smaller things can be addressed at the health center level as opposed to taking your baby your child to the triage and then sitting for hours. In some instances people get there at 11 and never leave till 910 o' clock the next morning because they've been waiting all night for help and they uncomfortable so I heard your calls and one voice note came in as you made a mention of something about what it will do and what you think this is what one of our texters had to say.
[00:08:34] Speaker C: Take a listen Good morning Davy and Good morning to Mr. Stewart. Davy, I am thinking if somebody have a cold or if somebody get a small cut or if somebody have a diarrhea it will be plausible to go in the health center as to go into the the those hospitals So I think I, I, I listen to him but I am just getting the gist it is not solely on if you are diabetic if you have to go there for your clinic beat I listen.
[00:09:08] Speaker B: But your response yeah so so.
[00:09:14] Speaker A: And that is really why I try to speak from data by evidence, by history.
I know persons are just pulling stuff from the air and making their comments but there's no facts to what they are saying unfortunately first beginning like diarrhea and something as the gentleman said Those things are overly counter. You can go in a pharmacy to get some of those things if required. In any event, there are district health facilities that operate in most jurisdictions. Those currently run 24 hours. District health facilities. Yeah. Send you a number of those. And those either they operate 24 hours like in Cuvo, they will have an accidental emergency attached to it. So you don't need to go to hospital.
And then the other district health facilities which have already extended hours and a full complement of service, something like asthma.
You don't ever scrub bench for emergency situations like asthma children, those are given first priority.
So that is not a situation that will happen. You will never see anywhere in Trinidad and Tobago at child scrubbing bench for asthma. That's madness. And if that is happening, the staff has to be discipline because that's totally against the policy.
So again, if the information could have been provided and then I could have given a response. One of the areas we would have suggested, even with our meeting with the Minister of Health is to focus on what a health center really supposed to do. A health center, a health facility, you in the community really supposed to target persons who are healthy and keep them healthy. So if the plan and I. And that is not the plan, currently we are lobbying the government to really introduce that as we have lobbied the last government is to ensure if this extended hours, okay, utilize this extended hours to do outreach and get out to the public and ensure that each person in our community, if our health center targets 20,000 persons, make sure you have a list of all those 20,000 persons. Make sure they come in for annual health assessments on a yearly basis. The week before your birthday, you are carded to come into this health facility and we'll give you a complete physical health assessment. And this will be your date constantly. And you can come in between Your was of 4 and 8. So that will be a better use of resources. You are not trying to continuously treat the sick and allowing persons to get unwell and get unhealthy. And then you would try to interact with them, which is what is causing the overcrowding of our hospitals, which is what is causing the delays in treatment.
We are waiting on persons to get unhealthy. So if we do what WHO has recommended that all countries do, which is focus on keeping persons healthy, then that would be a good use of resources that is data driven. That would redound to a reduction in our overall healthcare expenditure. Our healthcare expenditure now comprise the largest parts of of our budget. Largest parts. And, and it's definitely not only, not only it cannot be due to salaries because we continue to work on 2013 salaries. David, let me tell you one more thing. Look what is happening right now as we increase our expenditure because that is what it's going to do. Because you're going to have to pay a doctor, doctor work on overtime. So you're going to have to pay the doctor for the extra hours that he's working. You have to pay the district health visitor, you have to pay the medical lab and all of these persons. Look what is happening. So you're going to extend your health care bill in the face of extending our health care bill. You know what is happening?
Every single working ERHA as we speak has not been paid their June salary.
That is the first time that has ever happened.
ERHS workers have not been paid their salaries for the month.
That is what we are dealing with right now. And NCRHA as we speak right now, have restricted hiring ncrhs as we right now, currently, NCRHA is the most understaffed facilities in the country.
It is within ncrha. That is where we have most of our issues. And the public knows that because that is where they get the most complaints coming from NCRH facilities because they are woefully understaffed. So they generally supplement their poor staffing levels by bringing on extra duty. They have limited extra duty now. So a crisis that is already on the landscape by not having enough staff, the staff that you do have there, that you require them to work extra duty, they are limited in that extra duty. Nwrha, they are workers on temporary employment. I see. Thankfully they brought on, they were woefully understaffed and they brought on a significant number of nurses recently.
But those workers coming to work on temporary employment. So we have a number of systemic problems currently. And what we do, instead of resolving those issues, we have decided to increase expenditure even more.
I'm not really getting a debate with the public. The public would feel the negative impacts of some of these policies that are being just thrown out without it being data driven. We, me, you, when we go to the hospital and we don't have the required tools to be able to treat us, you don't have the required human resource. Because we are trying to fulfill campaign promise that has no basis in data, no basis in data, no basis in evidence. As I said, you can go back, you can ask the ministry officials how many persons actually come between four and eight to receive care. And of those persons, if it is four persons come of those persons, do you send three of those persons back to the A department in any event.
So how many people we are really going to benefit? No, I. The Minister of Health.
Let me tell you, I have worked with him over the last nine years when he was the Shadow Minister and I know he has a good heart and I know he wants the health sector to work. And that is why we put out three priority areas. Many things to be done in health sector, but three priority areas. One of them, I beg of him, focus on health sector accreditation. It makes no sense. You have a facility operating where the public believes they're getting quality care, yet the care is substandard.
Who is responsible for that? The Ministry of Health. And by default the Minister of Health is responsible for regulatory control to make sure every public and private healthcare facility is operating to a standard. That is where the focus should be. I also told him one of the main focus is the national health insurance system.
Make sure we get that national insurance system NIS which we currently have, which was supposed to be converted over to national health insurance system where you can go not only to public but you can go to private and be paid for, partly paid for by the National Health Insurance system. This was on the cards more than two decades since health sector reform in 1994. We are approaching three decades actually three decades since this is outstanding health sector accreditation, national health insurance system. The other thing I used to talk to him is about patient to staff ratio. You're going into a ward where there's one who's seen about 20, 30 patients, unacceptable, unsafe, it is madness.
And we have that situation that needs to be brought back in line. You need to properly staff the units so our patients would not die when they come to the hospital. They will die because you just don't have the required staff. That is happening as we speak. And thankfully that is in the manifesto also of the unc. That is in the manifesto. Once I see steps being made towards achieving those steps, sustainable long term, evidence based goals, then I'll be happy.
These, these. I don't want to say gimmicks, but these surface type of issues.
You just open health center for 4 hrs. That would not improve the health care system. That would not improve it. Let's not fool ourselves.
Yes, health centers, I don't know if people know they don't even have dangerous drugs.
[00:18:42] Speaker D: There.
[00:18:42] Speaker A: So you can go, if you, you have a severed arm or something, you can't go there because they have no morphine. They don't keep Petadine there. They don't keep those types of drugs there. And in Any event, one nurse can dispense dangerous drug. You need two nurses and they're only hiring one. For these extended hours, you need two nurses to confirm what is being pulled up and what is being dispensed. So major set of services that is going to take place there. The labs is still going to be open either for. So you can't get no blood tests, you can't get X rays, you can't get all of these things that would allow a doctor to make an informed diagnosis.
[00:19:22] Speaker B: So let me ask you a question.
Let me ask you a question.
I would be very honest and straightforward for a minute there. It almost comes across as though these incentives and initiatives, these are situations where they are attempting to improve the health sector is being put down by yourself because you seeing that to do this we need so much more. What type of conversations have you engaged in and plan to engage in in the not too distant future to bring some of these things that you talked about to the full and ensure that it is readily available at the health center because it makes them. It makes no sense to open a health center for two more hours or three more hours and we can't get blood works.
I agree. All right. What is the association plans to address these issues and how fast are you all going to get to the table with these talks?
[00:20:12] Speaker A: Well, we have already met with the Minister of Health and the minister in the Ministry of Health and we would have laid out actually 21 points to the three ministers. So we met with them already Permanent Secretary, chief nursing officer and the ministers. Unfortunately, the Dr. Lacrambudo had to go to another meeting. So he wasn't there for the entire meeting. But Dr. Richard Sicharan stayed the entire course, which we are thankful and we would have gone through each point point by point. None of those 21 points involved opening a health center for two, three more hours.
[00:20:51] Speaker B: Did you all. Did you all on the cuff of that question? I run another time, so I want to get these things in. Did you all speak with the last administration, the last Minister of Health, Dr. Terrence Diaz?
Could we. Could you tell me what the. I mean it's 10 years that that gentleman sat there at the Ministry of Health and some of these concerns are very damning concerns and very serious concerns. Would you how was the conversations with the previous minister addressed with these issues Now?
[00:21:21] Speaker A: The previous Minister of Health was a complete failure, complete failure. He was more on public relations, focusing on stuff that the administrative staff and staff and the ministry should be dealing with. You know, dengue and all of These things, these things that the normal ministry workers could deal with, the RHA workers could deal with.
We want a Minister of health to understand his purpose. His purpose is to improve and provide safe, efficient, patient centered care to our citizens.
Unfortunately, last minister was totally out of his league. I mean he was a pharmacist. Yes. He never really worked in the public sector and he couldn't really understand because he didn't have that big picture. And that is one of the reasons why even the idb, International Development bank and Power and all of them created a program at utt, the Masters in Health Administration for all senior management managers to be enrolled and be part of. So you will begin to understand a larger aspect. I was part of that program so I have my Masters in Health Administration.
So I don't think in these silos which has proven to be ineffective, you think the bigger picture and how, what every step you take should be towards that bigger picture, not these superficial actions that yes, the public may open for two, three hours but it really does nothing, you know and this is where I again as I said, I have a very good working relationship with Dr. Lakram Bodo and expect to continue having a good relationship with him because we were lobbying through because we couldn't get through to the substantive minister. So we were lobbying through La Krembudo for the last nine, ten years. And so he's fully aware of the shortage of staff of nursing person. He fully aware of the inefficiency in the education system. And thankfully we have a meeting this Wednesday with the Minister Tertiary education, Prakash Prasad and we look forward to that to highlight that here what we want to open a children's health facility, a children's hospital here. What we don't have a single training institution in Trinidad and Tobago which teaches nurses pediatric nursing, neonatal nursing, not a single one is doing that right now. But we want to open our next major children's hospital.
So all of these things, it sound nice, yes, you maturities, hospitality, care for the children but there's no training program for nurses as we speak, no training program.
So these are some of the fundamental things we want to get across and say look, if you want to achieve some of these goals, we are not fighting, you know, if you want extended hours, this is what the extended hours should be used for. This is how the institution should be properly staffed because we on the ground, we work in there and I always remind the public hear what Just as Terence Diancing has left and gone home to enjoy his pension of a minister for the Rest of his life.
The health.
The health system is still in crisis.
The health system is still in crisis. So it has been left for us again still to talk about these issues?
[00:24:57] Speaker B: I think so if.
Yeah, all right. I didn't mean to cut you. Let me take one call before we go through if you're open to it. Yes, Hello.
[00:25:05] Speaker D: Good morning, David.
And morning to your honorable, honorable guest.
This is one of the most important health. And everything is here some doctors and they cannot tell the public what's going on. But it's bad. It's bad. And we need now, as he's saying, a doctor that understands our situation because this has to do. I help.
And what he's saying, the public is now more than aware. And I'm glad he's here. He's speaking from the horse's mouth. The problems to be done in this country.
Ten years ago, the PNN promised a public health national insurance system. He can never do it.
They promised two facilities for angiogramma angioplasty years ago. They never did it. We want our myth. You see, the point is we have to do things differently now.
We have to do things differently on Derby. And I'm glad you are having this interview. So the world is understanding our health system and what has to be done. Thank you.
[00:26:14] Speaker B: A few moments ago I quoted the man as Dr. Terrence. As Mr. Terrence.
[00:26:18] Speaker A: Yeah.
[00:26:18] Speaker B: Saying I. I don't know why I keep saying doctor. Especially fact that he was, I keep forgetting it, keep dropping. And he was a pharmacist. Indeed. Well, still is. And I mean the healthcare system seems to be.
I tell you honestly, if I could avoid going to the hospital, I totally avoid it.
I will try to remedy the situation as best as I can. I rather run to a pharmacy very quickly and get back. I would have taken my son earlier this year to the health center out there by the priority bus route in Mount Hope.
And I sat there for what is what I deemed as a 8 minute doctor visit. 8 minutes I spent in the doctor's office with my son. But I purposefully went through the system and I sat there for over three.
[00:27:07] Speaker A: Hours.
[00:27:09] Speaker B: Three hours waiting to see a doctor about a situation with my son.
And that is madness.
I'm watching people sitting down there and we, and I mean some of us, they really can't do better. They can't afford to pay a private doctor, a general practitioner GP to see them. So they have to go in the health center, sign up by one desk, go to the next desk, give them, then sit down and wait, get a number, call your name, listen. I gotta listen good because the PA system ain't walking 100. And then if they, if you miss your name and you go back, will you know why I was calling you? Look, go by this one here and then sit on the next side. And I went through at least three different sitting down areas before I see this doctor for eight minutes.
And I said to myself wow. And this happened a few months ago, Mr. Ed Stewart.
So the people I strongly implore you to get with the ministry and iron up these issues because I think four hours is not enough or three hours extra is not enough. I think the time has come where we can provide 24 hour healthcare services at all health centers, not just a selected few, but all because accidents and incidents happen.
And sometimes to get to the major health facility could be a challenge for many persons. But if I can reach the health center, let's say I'm in border area, I may not have transport per se but I could get somebody to just drop me by Aruka Health center as opposed to taking me all the way down to the Eric Williams Medical Science center or Upper Rima side. I'm just saying. And I can get down to right audio to Aruka. I can get a car to take me there. It's easier for me to travel. But I mean I. That's my thoughts. In conclusion your. Your final recommendations to government and those that listening as to how you feel on your association plans for the future in terms of dealing with this issue.
[00:29:08] Speaker A: Let me say the Trans Amagos don't have infinite resources.
We don't have infinite resources. We need to strategize and use resources wisely. It ought to be based on evidence, evidence based practice.
And when a government is bringing a policy they should also marry it with the evidence that they have utilized to inform their decisions. Gone are the days where we just fritter away finances. Even if it will benefit nurses who will be getting additional sums because they will get extra. That is not our main goal. Our main goal is to ensure the scarce resources that every government speaks about is used in the best interest.
Everyone will be glad if they have a health center or a police station or a school right outside of the house.
Everybody will be glad. But doesn't make economic sense. It does not make economic sense. So we already have a situation where Trin Tobago has the most secondary healthcare facilities in the world.
When you speak about demographics, population base, you would not find another country with 1.2 million with 14 secondary healthcare facilities.
Check you check for yourself. All right. 1.2 million. You check if you see for that demographic, you major health facilities.
And we are struggling to staff those. So trying to staff extended hours will place even further burden on the already existing shortage of human and physical resources that we have.
[00:30:57] Speaker B: All right.
President Stewart, I want to thank you very much for chatting with us this morning. I must leave it here at this time, as we are running out of time. We will chat again in the not too distant future. I hope your meeting is successful on Wednesday and maybe next week. You can come and tell us some of these, what came out of that meeting and what the plans are until the next one. Thank you so much. And take care.
[00:31:14] Speaker A: The best insight, instant feedback, accountability. The all new Talk Radio Freedom 106.5.
