Michael Abrahams | Our troubled health sector

Anna-Shay Campbell should be at home with her baby today. But she is not because she is no longer with us. I first heard the news on Friday when I was at my office. A journalist contacted me to hear my opinion on Anna-Shay’s case, but I was unaware of the incident. When the journalist related the story to me, I shed tears. Fourteen-year-old Anna-Shay was taken to the Spanish Town Hospital on Monday December 9, in labour. However, by the next day, she was dead, and her baby was admitted to the nursery after a complicated vaginal delivery.

I cannot reasonably blame the hospital or its staff at this time as I am unaware of the details of the case. I know that even under the best of circumstances, with optimal management, maternal deaths and serious complications can occur. I recall an incident many years ago when I went to see a patient on a maternity unit at a private hospital. The patient of a colleague of mine was in labour. While in the second stage (the pushing phase), the patient suddenly lost consciousness, collapsed, and died. The cause of death was amniotic fluid embolism, a condition that is unpredictable and unpreventable, with a significant mortality rate.

I do not know why little Anna-Shay died, and I offer my sincere condolences to her family and other loved ones at this time. What I do know is that too many pregnant and recently delivered women are dying in this country. Our maternal mortality rate (measured as deaths per 100,000 live births), when last measured in 2022, was 156.7, one of the country’s highest in recent decades. A harsh reality is that a pregnant or recently delivered woman in Jamaica is more likely to die today than in the 1980s when our rate was between 110 and 116.

TERRIBLE NEWS

This is terrible news, not only for pregnant women in Jamaica, but for all of us. Why? Because an unacceptable maternal mortality rate is a reflection of a country or region’s health system. According to the National Institutes of Health (NIH), “Maternal death during pregnancy, childbirth or postpartum is a tragedy with catastrophic impact on families and serves as an important indicator of the quality of a health system.” The World Health Organization states: “The high number of maternal deaths in some areas of the world reflects inequalities in access to quality health services and highlights the gap between the rich and the poor.” So if our maternal mortality rate today is significantly higher than it was four decades ago, it is an indictment of our public-health sector.

In my opinion, there are too many people in positions of authority in health who do not genuinely care about the health of our populace. Some situations in the public-health sector perplex me. One of them is the absence of certain radiological machines at the Bustamante Hospital for Children (BCH). This institution is the only hospital dedicated to children in the English-speaking Caribbean. However, in 2024, with all the technological advances in medicine, the hospital has never had a CT or an MRI machine. This situation is unacceptable.

If, for example, a child sustains a head injury and requires radiological imaging to determine the site and extent of the injury, for this to be done, an ambulance has to be used for transportation, and one may not be immediately available. Also, a nurse, and often a physician, will need to accompany the child, taking these medical personnel away from other patients under their care. Travelling to and from the institution where the machines are located, in addition to the process of registering the child, takes up valuable time, potentially prolonging the interval between the admission to the hospital and the initiation of appropriate management, especially if it is surgical. How can this be okay?

SPEND DAYS IN EMERGENCY ROOMS

How can public healthcare in Jamaica be acceptable when it is not uncommon for seriously ill patients to spend days sitting in chairs in emergency rooms? When patients are lying on the floor in some hospitals waiting to be seen? When there are unacceptably long wait times for certain elective operations? When there are chronic shortages of some drugs, supplies, and equipment? When our maternal mortality rate is as high as it is?

It is easy to blame the Ministry of Health and Wellness (MOHW) under this administration for the sector’s shortcomings. But to apportion culpability solely to the organisation would be unfair. Mismanagement, corruption, and incompetence have been plaguing our public-health system for decades under different administrations, and all tiers of the health sector must be scrutinised. Collective responsibility must be accepted at all levels: by the MOHW, the regional health authorities, the hospital CEOs, chief doctors, consultants, junior doctors and nurses, and other health professionals. We are all responsible.

Too often, there are reports of senior colleagues being absent when they are supposed to be at the public hospitals they are assigned to, to not only manage patients but also to supervise junior doctors who require guidance. Too often, there are reports of medical personnel displaying nonchalant, dismissive, and unempathetic attitudes. Too often, there are complaints of labouring women being manhandled by nurses and midwives on maternity units. Too often, we tolerate incompetence and fail to advocate for those under our care.

All of us involved in the health system need to take a good look at ourselves. We must review our attitudes, work ethic, and levels of compassion and empathy and not be afraid to speak out and demand better for those under our care when conditions in our public hospitals and health centres are suboptimal. Our people deserve better.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams.