Accountability and the health system in Guyana

Free medical attention
Article 24 of the dysfunctional constitution of Guyana states that Every citizen has the right to free medical attention and also to social care in the case of old age and disability.

I learned that the public health system in Guyana, with all of its problems, provides free medical attention  - not only to citizens of Guyana - but to whoever asks - and no queries about citizenship.

Richer countries in the world do not so readily provide free medical attention to their citizens, or to anyone who walks in.

The right though, is not a gift or patronage or something for which citizens should be grateful to the political parties in power.  The political parties, the State has a DUTY to provide the medical attention, not only free, but of good quality.


Accountability
I am at the health centre. I like the vibe there, the staff are friendly. Some doctors are working in the open because there are not enough rooms.  I understand the limitations.
The older doctor who has been very helpful to me is not working. The older doctor who on her day off still answers my questions even when I ask her when she is resuming work. 

I tell a young doctor that I have an abscess and she starts writing the prescription for antibiotics.


I tell the young doctor - 'aren't you going to check it first, to see what is needed? "
The doctor says okay, and she checks it and refers me to the nurses for dressing.  I don't worry to tell anyone.  Who can I tell ?

I go to the health centre, for one month, for the dressings. The nurses are busy, some days 20 dressings before lunch. One day I tell one to take a five before she deals with me, as I am in no rush and she looks exhausted. The abscess heals. I am grateful. 

Another patient tells me she had been referred to this health centre after going 'private' for dressings because the nurses were good. And her foot is healing.


It is hit and miss , this access to health care.   There is no recourse when things mess up.  I search the Ministry of Public Health website for 'accountability', and for 'complaint'. 0 results.

Curwayne Edwards, Roshani Seegobin and Sharezer Mendonca,
The taxi driver is angry with me after I said that I wished the President could have gotten his cancer treatment in Guyana. 'What stupidness you talking, if your family was sick you wouldn't want the best for them.. let the President go and get his treatment outside.. all of dem does do dat , you would have done that".

Not all Guyanese can go to Cuba and get treatment.


Three children Curwayne Edwards, Roshani Seegobin and Sharezer Mendonca have died after receiving treatment at GPHC.  There is no indication from GPHC of what measures they have put in place to ensure quality free cancer treatment for those who go.  Have other patients died or suffered because of inappropriate treatments?


Have they suspended cancer treatments pending the results of the investigation? Has the government made arrangements for cancer patients to get care elsewhere?  What should cancer patients expect?
Can GPHC investigate itself? Should Guyanese doctors investigate their friends and colleagues? 
Should there be a Commission of Inquiry into the deaths of these children?

There are complaints of problems with maternal care.

The Minister of Public Health has approached PAHO/WHO for assistance for transparency in the investigation. This is surprising since PAHO/WHO is not independent of the Government of Guyana.

Their mandate is not for regulation of Guyana's health and the quality of health services for Guyana.



Accountability and the health system
The Medical Council of Guyana is supposed to handle complaints against registered medical practitioners. They list the patients rights on their website, but there  is nothing on their website about what the public can expect from the Council, and what patients can do when the rights have been violated. There are  no reports of the complaints they have investigated.

Accountability is complex in health care. That is no excuse though, as there are standards being developed, procedures and processes all over the world. There are people and entities who would resist accountability eg re are interests from the medical industry who would not want too many questions asked as it relates to cost of medications, or procedures.

 The health system in Guyana should make public the standards they use. Citizens should know what to expect.  The health system includes  doctors,  nurses, pharmacists, administrators, inventory managers, security guards, medical officers, primary health care workers. The public needs to know what they are doing to ensure good quality healthcare, and what they do to deal when health care workers/professionals cause harm.

Whose responsibility?
 I am waiting for treatment at the GPHC. The doctor is available early. He is waiting too. The problem is that the nurse responsible for the records is late. It seems no one else can open the filing cabinet. I offer to help the receptionist to sort out the files. I am told , no no, only the person who is late can open the filing cabinet. So we all wait until she arrives, an hour later. I have no one to ask what if the woman could not come in for the day?

In another health centre, I am waiting on treatment. A nurse asks me to help to move some items which have just come in, some boxes. It seems she has to sort out space for the boxes herself, there are no  porters or attendants.
I have no problems helping. I and others need the care, and want her to be comfortable as she provides the care.

The private health system is a competition with the public health system.  Both of them though, don't have much recourse for complaining or inquiring. I have wondered whether there was collusion in the health system since some of the doctors and health professionals have interests and stakes in both the private and public health system.  The hustle is real.

So it is up to every person - PNC or PPP or other-  who has to use the health system, to demand greater accountability from the system.