Our precious health workers

I don’t know about you, but I think a much bigger deal needs to be made of the fact that this is WHO-designated World Health Worker Week (April 2-8).

I saw one estimate that with a world population of close to 8 billion, there are an estimated 59 million health workers – 70% of whom are women. This includes the full range of professionals and other staff who work in a health or social care setting – both private and public.

The statistics for T&T are not entirely unimpressive but subject to numerous levels of interpretation and important nuances. For example, in 2019 there were between 3.5 and 4.0 nurses and midwives per 1,000 population.

I have seen different figures in different places, and the Registered Nurses Association has pointed to some negative qualitative values such as the low number of ICU and specialist nurses and the well-known flight of knowledge and skill.

But this is not all about the numbers, as important as they are. The focus must remain on the environment in which these people work, including low official priority, poor infrastructure, overcrowding, and occasional lack of supplies. Important as it is, it’s not just the money.

Over the past three years, we have had special cause to recognise the important role of healthcare workers and to pay tribute to their strength and resilience through a most difficult period in human history.

Yet, on Thursday April 9, 2020, when in T&T we were asked to spend a minute or so to stand and applaud these people for their work as we faced a pandemic, there were those who chose “scamdemic” theory, the “overkill” narrative, unforgotten sourness, and partisan hubris to shun the call.

We stood at the neighbour’s fence and joined with little Isabella and Milan clapping and cheering for the people on a frontline that has since witnessed the loss of over 4,300 lives, including some of theirs.

My sister, Vanda, has been a nursing heroine all her working life and I am aware that she has not been alone. Our first round of applause went to this group of healthcare workers.

Our system places a majority of workers in the sector under state employment. This means that governments have a high level of control over conditions for the proper execution of duties - both the enabling “hardware” (infrastructure and tools) and “software” (appropriate management systems and regimes for compensation and rewards).

Years ago, a former minister of health confessed to me, privately, that his portfolio had been subjected to a high degree of “benevolent neglect.” It was around the time I was noting the move to encourage “customer service” as linguistic substitute for the notion of “patient care” in the public health system.

I am not sure if this “customer” thing still prevails (though I visited the superb Arima General Hospital as recently as Saturday), but to me at the time it did not help the cause of the state health system to mimic the predisposition of private facilities.

Most of us can rattle off the private healthcare stories – that time a family member on the eve of major surgery was made to await the proceeds of a substantial ATM withdrawal before being attended to et cetera, et cetera.

There might be a good argument for moving toward “customership” in the state sector but so many years later, I am yet to witness any substantial benefit arising from prior efforts – not the least being the plight of healthcare workers.

It did not require a sense of “customership” on Saturday when I visited a relative at AGH to witness high-quality care and professionalism in the work of the nurses and attendants on duty.

But it did occur to me that clean, comfortable, and well-maintained premises play a role in worker satisfaction and, resultingly, a positive attitude toward the jobs at hand. Even more should be adequate remuneration and benefits in keeping with one of the most important jobs in any society.

Under such circumstances, private medicine would have no real advantage over socialised medicine – whatever the dogmatic ideologues and millionaire practitioners contend.

Hopefully, when the UN High-Level Meeting on Universal Health Coverage (UHC) convenes in September, countries of the Caribbean will have something to offer to the ongoing discussions on proper health care for all. In the process, we should report on what has been done to benefit workers in the sector and to encourage better quality service and care.