A nation’s health system – one step forward, two steps backward

Remains of the Naval Hospital in Port Royal, rebuilt 1818 - 2
Remains of the Old Naval Hospital in Port Royal, Jamaica, last rebuilt in 1881.

I was most surprised when informed that next to Cuba, Jamaica has the best health system in the Caribbean.

I knew that Jamaica’s primary health services were first rate; that its immunization and prenatal and postnatal programs were close to first world standards. But I’ve always been suspicious of the quality of the secondary health care system, the country’s hospitals. This came out of bitter experience and what I’ve learned from others.

My father suffered much from the inadequacies of hospital services, having been misdiagnosed and subjected to a useless surgery that resulted from the misdiagnosis, and being verbally abused by hospital nurses, which seems to be a manifest problem in many hospitals. Why are Jamaican nurses so aggressive and mean?

Then, about two decades ago, I rushed the household helper of a neighbor to the Falmouth Hospital who had slipped into a coma from a spike in her blood pressure. This was about 8 o’clock in the morning. No doctor was at the hospital. The nurse on duty checked her blood pressure and confirmed that “it is very high,” and tried several times to contact the doctor. After succeeding to get him after about an hour or so, he said he “will soon be there.” The nurse kept checking the lady’s pressure and kept saying, “The pressure is very high.” After being at the hospital for up to two hours, with no doctor in sight, I had to leave to make my own engagements. We heard that the doctor did not arrive at the hospital until close to 1 p.m., some five hours after the lady-in-a-coma was admitted. She, of course, died.

Sometime after that, my heart swelled with anger when I had to stand over the casket of a 15 year old high school student and pronounced “earth to earth, dust to dust.” She died from bacterial meningitis. She was rushed to the Falmouth Hospital in the night, but was told nothing serious was wrong with her and sent home. When her condition deteriorated the family took her back to the hospital, who again said nothing serious was wrong with the child and sent her back home. When desperate family members saw that the child was really ill and seemed to be dying, they took her back to the hospital a third time, upon which, way too late, they diagnosed meningitis. It was one of the most painful funerals I had to preside over.

A friend, now a cardiologist in the United Kingdom, told me of problems in the health system during his residency in the 1980s. They were doing rounds on a ward at the Kingston Public Hospital. There were nine patients who needed intravenous fluid but there was none on the ward. A nurse was asked to try source the precious fluid from other wards. After a long while, she returned with one bag. “Eron, we had to begin to play God,” my friend, a devout Christian, said to me. “We started to check their ages, who had families, who had young children, and so on, to decide which of the nine should get the one bag.”

So, one can understand how massively surprised I was to learn that next to Cuba, Jamaica’s health system is the best in the region.

I got a hint of this from a Guyanese graduate from the medical school at the University of the West Indies, Mona, who was doing her residency at the Spanish Town Hospital in the early 1990s. When I apologetically said to her how challenging it must be to work in a system with so many flaws and a hospital with a history of so many problems, she looked at me with surprise. “No, no, no” she shook her head emphatically. “In my country, this would be an A class hospital.”

I was dumbstruck.

Very few new hospitals
It is interesting that since the 1800s, not many new public hospitals have been built in Jamaica, and one wonders if this is a partial explanation as to why hospitalization in the country is such a major issue. At the very least, public hospitals have not kept pace with increasing population demands. Jamaica had a population of about 820,000 in 1900, compared to 2.6 million in the year 2000 and 2.8 million today. Some of the slack has been filled by private hospitals, but not many Jamaicans can afford the high fees. There is woefully inadequate health insurance coverage around the country.

Between 1870 and the end of that century, eight new public general hospitals were built to add to what existed before, including what is now the Kingston Public Hospital, the “Lunatic Asylum” (presumably Bellevue Hospital), and the “Kingston small pox hospital.” By 1900, there were some 21 public hospitals on the island, excluding Bellevue. It is now 22, but it includes Hope Institute, a hospice, and the Sir John Golding Rehabilitation Center, which treats those with permanent physical disabilities.

Hospitals at Buff Bay in Portland and Cave Valley in St. Ann have long since been closed. St. Thomas has one public hospital whereas there were two by the end of the 19th century, the 60-bed Morant Bay Hospital and the 150-bed Hordley Hospital, later known as Isaac Barrant Memorial Hospital. The Dry River Hospital, likely in St. Mary, is long gone.

Beginning in the 1860s, a number of the hospitals in the colony were built specially for “coolies,” a not very kind term for East Indian indentured servants and their descendants. These included the Hordley and the Dry River hospitals, the hospital and dispensary in Lucky Hill, St. Mary, the Savanna-la-Mar and Little London hospitals in Westmoreland, and the Pusey Hall hospital in Vere parish, now part of Clarendon.

It appears those in the military had their own hospitals, as sources speak of a hospital up at Newcastle in the Blue Mountains, as well as the Naval Hospital in Port Royal. A military hospital was among facilities destroyed by the 1907 Kingston earthquake and fire.

In the 1870s, a “lepers’ home” with 127 beds were opened in Spanish Town, as well as a special facility for prisoners who suffered from leprosy. Leprosy was indeed a problem, as during the 1901-1902 year, more than 130 cases of leprosy were treated.

Interestingly, the largest hospitals, in terms of bed count, were, in order, Hordley, Lionel Town, Sav-la-mar, Anotto Bay and Dry River, all “coolie hospitals,” suggesting that the East Indian community had particularly high infection rates, or received special medical attention for other reasons. Cave Valley was the smallest with six beds with Lucea the next smallest with 25.

The Bumper Hall Infectious Diseases Hospital in Kingston, built in 1895, destroyed by arsonists in 1943. (Photo courtesy of Jamaica History Weebly)

Jamaica had almost 1,200 public hospital beds in the year 1900, excluding KPH, Bellevue and the Victoria Jubilee maternity hospital, which was built to mark the jubilee of England’s queen in 1887.

In answer to a question posed in the British parliament in August 1913, the Secretary of Colonies reported that “the total provision of hospital beds in the Colony, so far as can be ascertained, amounts to 1,504, of which 207 are in the coolie wards of the various hospitals.”

This answer is puzzling in light of the many “coolie hospitals” mentioned earlier. Were they referred to as coolie hospitals despite the fact that only some of the beds were designated to East Indians, or did some of these coolie hospitals cease operation by 1913? And why were there coolie wards in hospitals, separate from others?

And here’s a curious question posed to the Secretary of Colonies in the same session by a Dr. Chapple. “Are the natives not now excluded from the hospital?” Who are the natives? The Hansard report has hospital in the singular, but the rest of the report suggests the question concerned hospitals in general. Was it being suggested that blacks were excluded from hospital care?

In any case, even if there was discrimination in care, the questions and answers above suggest there were roughly 1,500 hospital beds in 1913 for a population of some 830,000. This worked out to about 1.8 beds per 1,000 in population, slightly more than the 1.7 beds per 1,000 persons in population today, which includes both public and private hospitals. Where is the improvement in capacity and adequate delivery in hospital care?

The following sentiments expressed to the Jamaica Legislator by Sir Charles Darling, governor of Jamaica from 1857-1862, may resonate in the island, more than 150 years after they were uttered:

The want of a sufficient number of Medical Practitioners was universally felt throughout the island by almost the entire body of inhabitants, whether high or low, rich or poor. In some of the districts medical advice was not to be procured at all; in others only after a long delay and at a cost which virtually rendered it unattainable by the majority of the inhabitants…. The loss of life alone (and the consequent loss of labour) which annually resulted from this deficiency was in itself a sufficient ground to justify any expenditure which it might be necessary to incur in placing the means of obtaining medical assistance within reach of the people generally.

Nuff said.

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