Patrick Martin, MD
August 2, 2018
Journeying long distances from rural areas to health facilities can be problematic especially in acute medical circumstances, and at night. Thus, placing 24/7 primary care facilities close to where people live reflects sound health policy execution. Such is the legacy of successive governments on both islands since Universal Adult Suffrage in 1952.
For health planning purposes, St. Kitts can be divided into two rural zones and a capital area zone. Each of the former has 25% of the island’s population while 50% live in the Basseterre/St. Peters area.
Mary Charles Hospital (MCH) was the realization of a political promise to serve rural East St. Kitts akin to Pogson Hospital’s coverage of rural West.
MCH’s service profile is the same today as it was when first commissioned in 1986. It has always been a 24/7 emergency service staffed by nurses with a doctor on-call, with a few in-patient beds, a delivery area, an ambulance bay and a dental clinic.
However, by about 2000, there was irrefutable evidence of changing population preferences and conditions. Use by area residents declined. Case in point: deliveries became very few – 1 or 2 in a good year.
Some offered opinions but truth was found in survey and epidemiological data. Residents knew a hospital must have an in-house doctor. Physical disrepair of a health facility is a deterrent to use. Chronic diseases, addictions and injuries are the major causes of sicknesses, disabilities and premature (< 70 years) death.
Over the years, awareness of these determining factors prompted campaign promises and plans to rebuild and reorient the management of health centers and hospitals. Matters became more urgent after the devastation of Hurricane Georges in 1998.
After JNF Hospital was rebuilt in 2001, attention turned to the rural institutions. Pogson Hospital was recommissioned in 2009 as the Pogson Medical Center. For the first time in the nation’s history, prevention and health promotion, environmental health, emergency and inpatient care, dental clinic, pharmacy, diagnostics and an ambulance bay, were under a single roof.
The next step was Mary Charles. However, the 2008-2012 global recession hit. Renovation and reorientation progress was delayed but remained high priority in the Ministry of Health’s annual capital project list.
Fast forward to August 2016 and July 2018: with physical works completed, MCH reopened followed by a 23-month roll-out of the dental clinic and ambulance station.
A Jamaican Prime Minister famously said, “It takes cash to care.” A rejoinder from Nevis politics is, “If you care, you find the cash.”
There is work to be done at Mary Charles. Pogson is the model of integrated care delivery i.e. multiple services provided by a team working under a single roof.
Integration is key to delivering high quality and cost-effective health services to communities. The better the services in communities, the less the need for expensive hospital care.
Service fragmentation and resource breakdowns cause dissatisfaction among voters such as care-seekers and care-providers. Prediction: Although the Molineaux Health Center is a stone’s throw from Mary Charles, acute staff crises and ongoing supply chain weaknesses will force their functional and structural merger, sooner or later.