It sometimes takes a major tragedy of some sort for us to stop and reflect on a situation that we all have probably just been taking for granted. And with all the ballyhooed progress that we have supposedly seen in our government-provided healthcare services, what with the introduction of NHI services in more and more districts, there remain some glaring shortcomings in healthcare provision, mostly for the less financially able members of our communities. Notwithstanding the Ministry of Health’s boast that “GOB removes fees from public hospitals,” in reality, a medical crisis in these times when private health care is strictly business, often means financial devastation or death, or both for a poor family. And that is not something that government should brush off as beyond their capability; it is an issue that needs to be addressed.
The privatization phenomenon swept across the globe in the 1990s, and Belize quickly jumped on the band wagon, only to regret it later, leading our government to re-acquire our water, electricity, and telecommunications companies, in addition to the International Business Companies Registry, and of late even our major sea port – Port of Belize Limited. In private hands, these vital services to the public had become all about profits for the private owners, and the citizens of Belize, a captive market to be fleeced. It had long been argued that bad management in government hands, would be transformed to much greater efficiency under private control, and the nation would benefit; but it led to higher costs for the citizens, as the profit motive trumped any concern for the poor in society. One other area that GoB had been toying with during the privatization spree was health care at the old Belize City Hospital, but a pushback from certain quarters allowed it to remain in government hands.
Back then, the cry from some interests to privatize our main public hospital was made with the argument that annually, the Belize City Hospital had traditionally been in the red, and government had to cover many unpaid bills, mainly of poor citizens; and that trend continued when it was moved to the new location on Princess Margaret Drive as the Karl Heusner Memorial Hospital (KHMH) in 1995.
When it was determined that a compromise arrangement could retain government ownership while instilling greater efficiency with a quasi-government management system, the newly re-acquired essential utility services – BEL, BWSL, and BTL (and more recently the Port of Belize) – were all put under the management of statutory boards, so that government retained ownership, but the day-to-day running was under a private-style management system. And it worked. But then the same was implemented with the KHMH; and the jury is still out on that one, where middle and lower-income citizens are concerned.
Most citizens of Belize know that one day we will end up at the KHMH. Even if some of us have good insurance or resources to foot the bill for a major health matter abroad or at one of our local private hospitals, when the funds run low we are obliged to make the move to the KHMH. And the staff at the KHMH have been doing their best, even with limitations in supplies, equipment, infrastructure or personnel.
In the “good old days” before “progress” got the better of Belize, our teachers used to be trained at the “Teachers Training College”; our aspiring technicians would get a solid grounding at the “Belize Technical College”; and the best nurses in this region were nurtured at the “Belize Nurses Training School”. It is questionable whether the academic degrees achieved at the current University of Belize have prepared our young professionals as well as those defunct institutions. (The planned University Hospital may be a big plus there.) Perhaps the talent drain to the north has something to do with it, but there have been citizen complaints from time to time about lack of attention and quality of service from certain nurses at the KHMH general medical wards, who may be overworked or undertrained; but generally, patients don’t make complaints publicly, because we all know that one day we may be back there. To be fair, there are also many very uplifting stories of wonderful treatment received by poor citizens who have the KHMH and its industrious staff to thank for saving their lives.
Perhaps, there are times when our KHMH staff is overwhelmed with the number of critical cases they are called upon to deal with. Indeed, in recent decades a major portion of the KHMH effort has had to be focused on the many emergency cases from gun shots and vehicle accidents. Aside from the many difficult cases of citizens suffering from diabetes and hypertension-related health problems, the doctors and nurses at the KHMH are taxed with handling a barrage of emergency cases that stem from reckless or unlawful citizen behavior. And along with all of these troubles, the board of management has to battle with costs, the payment of fees by patients, and its limited budget allocations. With our main public health provider operating under this kind of operational and financial pressure, the inevitable casualty becomes the patient/citizen when a bed is needed, or the costs become exorbitant for a slowly recuperating patient in the I.C.U. (intensive care unit), where reportedly the best recuperative care is administered to every patient, regardless of their financial status.
But, if there were not so many victims of violence and reckless drivers being brought by ambulance to the KHMH, maybe the hospital staff would not be as stressed, the available beds might not be all used up, and the worry about the high unpaid bills of slowly recovering patients in I.C.U. would not become such a major concern, causing one to be prematurely transferred to the general “medical ward,” where the quality of service and attention is significantly reduced.
When the bottom line is checked by the KHMH board at a fiscal year’s end, the unpaid patient bills will likely be highlighted. What may not be highlighted are the outcomes of financially stressed patients who are prematurely transferred out of “emergency” or who “self-discharge” from the medical ward in frustration with the inadequate attention, only to soon succumb at home where limitations are even greater for adequate treatment of their condition.
As a nation, Belize has to decide on what level of importance we will assign to health care, both in terms of the facilities and services provided to our regular citizens who can’t afford private facilities, as well as in regard to subsidizing costs so families are not crippled financially by hospital bills. Despite a sixty-year U.S. trade embargo, our Caribbean sister nation Cuba reportedly provides free basic health care and regular home doctor visits for its citizens. We may not get there right now, but how about follow-up home visits by medical personnel to ensure that discharged patients with serious health situations have the wherewithal to receive the vital care necessary at home? How many times have we heard of patients being sent home, seemingly recovering well, only to quickly pass away, even though they did not have a “terminal” condition? Our priority must be “Life” first, and cost-cutting later, even if as a nation we all have to share the bill, whether by Boledo profits, Social Security contribution, or some other method that does not involve “house and lot” and bankruptcy for poor people. We just lost an ailing superstar football legend at home a week after he was discharged from the KHMH, and we hope all is well with a reportedly quickly discharged and convalescing superstar softball legend. Come on, Belize!