Ernest Madu, MD, FACC and Paul Edwards, MD, FACC
Heart Institute of the Caribbean (HIC) and HIC Heart Hospital
Correspondence to firstname.lastname@example.org or call 876-906-2107
Last week, we explored the historicity of inequity in healthcare access in Jamaica resulting in poorer segments of the society often lacking access to optimal healthcare services. We believe that we have a unique opportunity to find creative solutions that will take advantage of the capacity within the entire healthcare ecosystem to provide a more equitable healthcare system for all Jamaicans. The COVID-19 pandemic has reshaped the way the world operates and has given us unique opportunity to re-imagine our healthcare system, but we must draw from the lessons learned, be willing to improve and be bold and imaginative to change the way we do things for the benefit of the larger society.
What lessons have we learned?
- Need to develop high quality healthcare in Jamaica
The lockdown necessitated by the coronavirus pandemic with severe limitations to foreign travels exposed the illogical thinking underpinning the desire by some to depend solely on overseas facilities for their healthcare needs. While it is an individual’s prerogative to seek healthcare wherever they chose; self-preservation is a basic human instinct and that instinct would suggest that individuals should be vested in developing adequate healthcare systems and facilities locally. The logic that it is ok to depend on an overseas territory exclusively for routine medical care has been torpedoed by the COVID-19 pandemic which resulted in the shutting down of borders. The lesson is that when we fail to develop or support the growth of appropriate healthcare delivery systems and facilities at home, we unwittingly imperil ourselves.
- Innovation is key to progress
In the mid-1990s, one of us served on the faculty of Telemedicine at the University of California (UCLA). The Division of Telemedicine at UCLA was the first of its kind to be established in any US medical institution. It was considered groundbreaking and we did seminal work establishing the role of Telemedicine in the delivery of cardiovascular care. Subsequently, we parlayed that understanding about 20 years ago to the establishment of Echo Doctors of America, one of the earliest companies in the USA based on telemedicine. We learned early that Telemedicine is an excellent tool for delivery of care across geographic boundaries and that this technology was actually most cost effective for the low resource nations of the world where access to care is often limited and the relative cost of care is often higher because of limited access to capital, infrastructural deficits, maintenance gaps and severe human capital deficits in specialized areas of medicine. Unfortunately, the innovation of telemedicine has seen very slow and limited adoption in low resource settings like Jamaica, places that would benefit the most. Telehealth can be effectively used for patient triage and screening, pre- and post-operational care, and remote patient monitoring. Jamaica now has a unique opportunity to plan for long-term telehealth and virtual delivery of healthcare services. Inconsistent access to reliable broadband internet services and the lack of internet enabled devices, especially among patients in lower income brackets and rural settings remain formidable obstacles that must be overcome to make telehealth possible for the majority. We remain available to assist the nation at no direct cost in leveraging this innovation to expand access to care for the majority and optimizing the utilization of limited human capacity in healthcare.
- Supply Chain and Logistics; Need for National Stockpiles of critical supplies
The supply chains around the world have been severely disrupted by the COVID-19 pandemic with severe limitations in transshipment of goods and services. At one stage during the pandemic, personal protective equipment designated for many poorer countries were either stopped or impounded by the richer countries of the world. Countries like Jamaica that depended almost exclusively on the importation of those products were left scurrying to find supplies for the country. We now know that we have an opportunity to manufacture some of those products at home to avoid being put in a similar situation of disadvantage in the future. There is an opportunity for countries within the Caribbean region to increase regional cooperation and expand the serviceable market for companies engaged in the manufacture of critical medical supplies. We also had severe disruptions in the supply of life saving equipment and medications for our citizens from overseas suppliers. We were deficient in the projected ventilator needs for the country based on estimates from the impact in New York and Italy. Unless a solution is found, the lack of a predictable supply chain for essential materials will continue to hobble healthcare facilities and impede the delivery of quality care for Jamaican patients. While it is neither feasible nor practical for Jamaica to manufacture most medications at home, what is doable is a private-public sector initiative to develop a centralized larger purchasing power to engineer a global purchasing agreement with the major suppliers. A global purchasing agreement will drive down the unit cost of essential products and make it feasible to keep national stockpiles of lifesaving medications and equipment that can be activated in times of national emergencies as we witnessed in the early stages of the COVID-19 pandemic. This requires a more robust and cooperative relationship between the public and private sector healthcare ecosystems and a recognition by bureaucrats of their responsibility and obligation to support healthcare development across the board and not just in the public system.
- Human Capital Needs in Healthcare
Jamaica remains under resourced at all levels in healthcare. Most nurses trained in Jamaica end up leaving the island because of the perception of better career opportunities in the USA and other countries. Many doctors also leave the Island. Despite the voluntary departures for greener pastures, we now have a situation in which there is limited capacity to absorb those who wish to stay. It was recently reported that about 100 doctors waiting for appointment with the government could not be absorbed. In a statement credited to the Minister of Health (for which he later apologized), the doctors were advised to seek employment in other CARICOM territories or in the private sector. It would have been acceptable advice if Jamaica were already saturated with doctors for the population. However, there are multiple reports that junior doctors in the public sector are overworked because there is a deficit in staffing to match the demand. The private sector would be a viable option but for that to be an option, the sector would need further development, support, and resilience to be able to create those employment opportunities. There is need to continue to grow both the public and private healthcare systems, to create the infrastructure and capacity that would attract Jamaican healthcare providers abroad to return home and to discourage those in Jamaica from leaving. A more robust system will also improve the career trajectory for healthcare providers locally and lead to better retention of those who leave the Island in search of better career options overseas.
In our subsequent articles, we will further explore these issues and review additional opportunities for healthcare reimagination in Jamaica post-COVID
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