Alfred Dawes | What next for healthcare?

The past two years have been the most health-conscious period in recent history. One only has to give a “pandemic baby” a bottle of sanitiser and they will automatically rub their hands together. Mask wearing and the awareness of droplets and spittle in the air and on common surfaces led to more masking and cleaning than we could imagine. I still get anxiety when the birthday boy or girl blows out the candles on the cake I’m supposed to be eating. Coughing is not seen as threatening as before but still causes unease. Fortunately for society, things are back to some semblance of normality.

I still don’t understand why there are still mask requirements in place for some public places. Why we are still being encouraged to take the vaccine “to protect yourself and your loved ones”. Or why it is even a requirement to fly to some countries for that matter. Some residual habits are hard to break especially when they have been incorporated as core beliefs or there is a financial incentive to their continuation. Our preoccupation with the COVID-19 pandemic is ending now as we pivot to address the other pandemic that was worsened under the burden of the virus. I refer to the chronic diseases’ pandemic.

As the pandemic waned in Europe, there was an increase in the numbers of excess deaths per year in several countries. One would have expected that with a pandemic ending, there would be a fall in the total deaths recorded in a country. This was not so. The occurrence of a heatwave across the continent and the subsequent increase in deaths of the more susceptible elderly contributed significantly to the total number of deaths in 2022. Added to this was the surge in deaths from chronic diseases. This was expected by many experts who warned that resources were being shifted away from chronic diseases care and into COVID-19 programmes. Less primary care meant that these chronic diseases were less monitored and controlled, leading to increased incidences and the severity of complications.

AVOID A STROKE

The best way to avoid a stroke if you are hypertensive is to at first know that your blood pressure is elevated and then ensure that you have it under control. The same is true for diabetic complications and heart disease – know your numbers and use them as a guide. This was not the case during the pandemic as clinics were cancelled or scaled down and ran by burnt-out staff. The numbers were not known and treatments were not guided. Increased complications and deaths were inevitable. For those seeking emergency care at hospitals that treated every coincidental positive result as a primary COVID-19 patient, the management of chronic diseases became secondary even when they were the main reason for the hospital visit. And that is if the patients could even make it into the crowded emergency rooms.

The situation was not very different in Jamaica although we never saw much of an increase, if any at all, in excess deaths during and after the pandemic. For whatever the reason, and it’s definitely not a high vaccination rate, we never really experienced the devastating effects of the pandemic as in other countries. The death rate was never high enough to cause a significant increase in the numbers of excess deaths year on year. The neglect of our chronic disease patients was not that much more during the pandemic to be statistically significant, because we were always ignoring the primary care aspect of chronic disease anyway. In essence, we never had an increase in the number of excess deaths, because our standard of care for the patients who would die from the COVID-19-related chronic disease neglect was not that significantly changed by the pandemic. This can be interpreted in two ways. Either our COVID-19 response was so awesome that we were able to manage the outbreaks effectively and at the same time deliver our regular medical care to the chronic disease population as equally effective as before the pandemic.

HEALTHCARE DELIVERY

Or our healthcare delivery to the chronic disease patients was so bad before the pandemic, that it was hard for even a global pandemic to make it any worse. I tend to agree with this assessment. When half of the 33 per cent of hypertensives do not know that there blood pressure is high, that is not evidence of a healthcare system that is resilient to a pandemic stress. The situation is similar with diabetics where far too many, maybe a half as well, do not know that they’re walking around with elevated blood sugar levels causing organ damage silently. That more than two thirds of colon cancers are diagnosed at an advanced stage and a similar figure for breast cancers, speaks to the fact that our primary care system needs a complete overhaul to address the major threats of this and the next decade.

The World Health Organization and far too many health authorities are tunnel visioned on outbreaks and vaccines to realise that the greatest threats to an ageing and weightier population are chronic diseases. The key to treating these chronic diseases is early detection through comprehensive screening programmes and active surveillance in the primary care setting. When a chronic disease patient reaches a hospital, the system has already failed them. That must be the approach to healthcare in a post-COVID-19 world. This is so especially in a broke country that provides free healthcare without staff or supplies. Prevention cheaper than cure, nuh true?

- Dr Alfred Dawes is a fellow of the American College of Surgeons, and CEO of Windsor Wellness Centre. Follow him on Twitter @dr_aldawes. Send feedback to columns@gleanerjm.com and alfred.dawes@gmail.com