Alfred Dawes | Time for a paradigm shift in healthcare

The US Government is giving out free early treatment kits for COVID-19. This at the tail end of the pandemic. In Jamaica, like most countries, we largely ignored early treatment options in favour of a large spend on boosting hospital capacity. Anyone with a passing familiarity with healthcare knows that this approach was destined to be more expensive financially and in human lives. Prevention and early treatment are easier and cheaper than late cures. The world went mad during the pandemic and the lessons learned from our collective insanity should guide our policies aimed at combating diseases that are the greatest threat to us once more.

Chronic non-communicable diseases are the leading causes of death worldwide. Locally, the complications of diabetes mellitus, hypertension, heart disease, stroke and kidney disease maim or kill thousands of Jamaicans annually – far more than crime and COVID-19. Cancers affecting the breast, prostate and colon continue to needlessly claim the lives when early detection and treatment have been proven to be very effective in limiting their harm. The principles of early treatment are based on common sense. Put out the fire in the kitchen before it spreads to the rest of the house. Even better, have smoke detectors to out it on the stove.

QUESTIONS

For much of the pandemic, the questions asked of the Ministry of Health and Wellness concerned the numbers of ventilators, oxygen capacity and field hospitals to accommodate the expected influx of the sick and dying. The metrics of success were confined to how fast and how many of these benchmarks could be fulfilled. There again was the serious flaw in the approach to healthcare threats. Countless studies and anecdotal reports showed a far superior outcome if early treatment was initiated in COVID-19. That led to less hospitalisation, oxygen requirements and deaths. We were focused on healthcare too far up the treatment ladder. Primary care would have saved many more lives. It is a mistake rooted in our psyche and we continue to make with our approach to our major healthcare issues.

In the latter part of the 20th century, Jamaica’s healthcare system was rated highly. We had rid ourselves of the scourge of infectious diseases and had achieved life expectancy rates comparable to developed countries. This was largely due to our focus on vaccinations, hygiene and other public health measures. Yaws, tuberculosis, polio, measles, cholera and dysentery were eradicated or reduced significantly. However, in the 1990s there were new threats emerging that would primarily affect the ageing populations of countries that were successful in combating infectious diseases. They were collectively called chronic non-communicable diseases (CNCDs). Today, these conditions formerly called western diseases kill more people in developing countries than they do in first-world countries where they first reached epidemic proportions. This has been blamed on the lack of resources in those countries to offer ‘first-world’ treatments. This is only one reason. More significant is the focus on tertiary-level care rather than shifting focus to primary care.

UNDERAPPRECIATED

The primary care physician is greatly underappreciated by colleagues who work in hospitals and specialised units. It is a monotonous job heavily reliant on a close personal relationship with each patient. There is hardly any scope for innovation or growth beyond bureaucratic roles. Those who crave excitement and prestige naturally gravitate towards hospital medicine. This leaves huge staffing gaps in clinics. Public health nurses and nurse practitioners are called on to fill these gaps but they, too, are in short supply. Public health inspectors, who were instrumental in the eradication of infectious diseases, are poorly equipped to help in the fight against CNCDs.

The public health system is still designed to fight against malaria and yaws. We have failed to adapt to face our greatest threats. We have no working mammograms in the public health system when Jamaica is one of the few countries in the world where breast cancer deaths are increasing, most countries are seeing a decline. We do not have a screening programme for colon cancer, the third-leading killer cancer. Jamaican men die at higher rates of prostate cancer because they present with far more advanced disease than in other countries. There is no national approach to address this phenomenon. Half of those with high blood pressure do not know their hypertension, very treatable, is silently damaging their arteries, kidneys, eyes and heart. Diabetic men get their legs cut off because they present sicker than diabetic women who mostly get their toes cut off. We have thousands almost ready or already waiting to get on dialysis machines when simple tests can identify that risk and guide timely interventions from 10 years out. Cervical cancer still kills young women in the age of vaccines and Pap smears.

Our focus is wrong.

We measure the quality of our healthcare system by dialysis chairs, open heart surgeries, ICU beds and laparoscopic procedures. Instead, we need to measure success with how empty the wards and morgues are and how many are living with mild or no diseases. That will require a change in our mindsets and a strong national campaign to effect a cultural change. The best time for this was 20 years ago, the second-best time is now.

If we do not act now, given the current trajectory, the next 20 years will be disastrous for our healthcare system and our nation.

- Dr Alfred Dawes is a fellow of the American College of Surgeons, CEO of Windsor Wellness Centre, and medical spokesman for Lifespan Spring Water. Follow him on Twitter @dr_aldawes. Send feedback to columns@gleanerjm.com and adawes@ilapmedical.com