A Healthy Message For Our Lavenir
— TD Fuego
The health of the people is really the foundation upon which all their happiness and all their powers as a state depend.
A healthy population is a productive population and good health is probably the most important asset we possess, both individually and collectively as a nation.
It is, therefore, not very surprising that governments across the globe spend part of their income on health care provision for their people. According to WHO, out of 191 countries, Mauritius ranks a dismal 84th in this area — not a very flattering position for a country that has pretensions of becoming a Medical hub!
Presently, government spends some Rs 8bn on the National Health Service (NHS), which equates to 3 percent of GDP. And a further Rs 2.5bn is spent in the private sector, which brings the total to 4 percent. In comparison, the UK and France spend around 10 percent of their GDP on health care. I have purposely chosen these two countries because it is nonsense to compare with the (habitual) worse. If we want to advance, we must compare ourselves with the best. After all, potential Derby winners do not benchmark themselves with three-legged donkeys.
Anyone who has ever been a “customer” of our NHS, especially as an in-patient, knows that it is in need of improvement and modernization on a massive scale. Among other things, it could do with more and modern infrastructure, new equipment and, above all, more — a lot more! — well-trained personnel. It is no secret that, at present, we have got only one cardiac surgeon in the NHS. What happens if, Heaven forbid, he is taken ill during a bypass operation or he has gone on overseas leave when an operable emergency arises? An isolated case this may be, but it demonstrates the point vividly.
However, if we are to achieve the necessary enhancements, we obviously need to find extra cash — and fast — because it is all a question of money. As Tawney in his treatise on Equality has observed, “Health is a purchasable commodity, of which a community can possess… as much or as little as it cares to pay for it.” And, he goes on to make his point by adding, “It can turn its resources in one direction and 50,000 of its members will live who would otherwise have died; it can turn it in another direction and 50,000 will die…”
The people at the Ministry of Finance will no doubt tell us that, with other ministries also needing funds, there is no more additional cash available for the NHS. And, no doubt they would be (partly) right. Government has a finite income with which to finance its debts and fund its many projects, both present and future.
So, the extra money has to come from elsewhere.
- One obvious source is the CSR, whereby Corporates are required to donate 2 percent of their profits to NGOs. But, government already helps NGOs through various subsidies, even going as far as “paying people to pray.” Furthermore, several Funds and Trusts worth billions have been set up in recent years to help the poor and the vulnerable. The 2 percent of company profits, therefore, could be directed solely towards enhancing the NHS budget.
- 58 percent of Loto’s gross (or is it net?) income is supposed to go into four national projects, namely education, culture, health and sport. If necessary, for a while at least, all of this could be ploughed into the NHS. It is all a question of priorities, and health surely comes top of everybody’s priority list.
3. Latest figures suggest that there are 8m visits per year to the NHS. If we were to charge a minimum Rs50 per visit, that alone would raise an additional Rs 400m. A nominal charge of Rs 1,000 per surgical intervention would also considerably enhance this figure.
- In spite of all the constraints faced by the NHS, we continue to give free health care to every visitor to our shores. Much money could be raised by charging non-nationals, including white-collar guest workers.
- Last, but not least, it is high time we thought of consolidating all the various employer/employee contributions, with some necessary modifications, into a National Insurance Scheme for the funding of the Welfare state.
In their manifesto, the outgoing MMM-MSM government (2000-05) had mooted the idea of a family doctor system. This was repeated in the Alliance du Coeur (AdC) programme this year. It is such a laudable idea that whoever occupies Government House would do well to copy it. A good idea remains a good idea, even if it comes from an adversary and there is no shame in borrowing it, if it is for the well-being of our society.
To begin with, and as a minimum, every citizen should be given a medical file to carry from cradle to grave. This would facilitate diagnosis and save much valuable time. At present, in formulating his diagnosis, the doctor has to ask a lot of questions, some of which the patient is unable to comprehend or answer. In many cases, given the heavy workload, the medic simply dispenses with some of the questioning.
As a consequence, very common, avoidable errors can and do occur — like contraindicated medication being prescribed or prescription being simply duplicated, sometimes with serious consequences.
A Hospital for the West
This was another proposition of the same MMM-MSM government, a proposition that found itself in some dark drawers at the MoH. This was also repeated in the AdC manifesto this year. It is worth noting that the West is the only region of the country that does not have a hospital of its own. A hospital in that part of the country would not only free up a lot of space and time at Candos but, more importantly, be a real boon to the inhabitants of that region.
In some cases, like a myocardial infarction, lives would be saved as treatment would be administered within a reasonable time. I know of several heart cases who were saved and are leading reasonable lives because they happened to live close to a hospital and were given resuscitative treatment fast. I am myself one of those lucky people!
Special Wards, not Hospitals
Since our NHS was founded when all sick people were treated in more or less the same ward, medical science has advanced by several quantum leaps. Gone are the days when the same doctor would treat several types of disease. Now, we have specialisation in every field — from heart to lungs, from gynaecology to oncology, from paediatrics to geriatrics.
For instance, it has long been recognized that the elderly have special needs and, therefore, should be treated in a separate ward by specialist geriatricians and specially trained geriatric nurses. After a lifetime hard work, our old folk deserve the best; conning them with a monthly picnic or a couple of nights stay at the SSR recreation centre will no longer do.
In their 2010 manifesto, both Alliances had proposed to build a separate hospital for some specialities, including geriatrics. This is not only very costly — and, therefore unlikely to see the light of day anytime soon — but, given the shortcomings of our public transport system, also not very practical for patients and visiting relatives. Adding an extra ward to an existing hospital makes more sense because it can be implemented quite quickly and cheaply.
Good ideas need not always cost a lot of money. Indeed, sometimes they cost nothing at all, yet can make the life of the patient (and staff!) a lot easier. Health Minister Mrs Hanoomanjee’s laudable initiative to stagger appointments is a good example of a simple idea that costs nothing, but one that will be welcomed by the public, who have to wait for long hours in over-crowded, stuffy OPDs.
At the moment, once a patient leaves hospital, there is very little in the way of help for him or his family on how to manage his illness at home. For example, most laymen do not appreciate that leaving a bed-ridden patient in the same position for long hours can result in horrendous bedsores. Most do not have any idea how to cope when the latter is suffering from constipation.
Not knowing any different, some relatives use their fingers to extract the offending substance. Yet, the simple answer to the problem is an enema. But knowing about a treatment is not sufficient; one needs to be adept at administering it, too. A district nurse would be of invaluable help in such situations. And to many, many others, including the growing number of NCD sufferers.
The above, by no means, pretends to be an exhaustive list. I am sure the professionals, as well as ordinary folks concerned with the well being of the old and sick, can think of other areas that need implementation or enhancement. But, a beginning could be made with these for starters. And, now is time!
Because, with the advent of medical tourism and the arrival of Apollo and others, time is not really on our side. Unless we act promptly, we could end up with the kind of grotesque situation that has become a common feature of the other tourism sector; where flimsy squats stand cheek by jowl with five-star palaces.