The THA Secretary of Health and Social Services, Claudia Groome-Duke, recently visited health centres in Tobago. Among other things, she wanted to assess their capacity to provide good primary health care ("the first step," she said, "towards achieving health and wellness") and to ascertain "the status of the delivery system to expand its services...to deepen the fight against chronic non-communicable diseases".
Not a moment too soon, because the July 2012 T&T Human Development Atlas (HDA) says that, of the 15 administrative areas of the country, Tobago ranks tenth in terms of the percentage of the population having at least one chronic illness. ("Chronic illness" is defined in the Atlas as, inter alia, heart disease, cancer, HIV/AIDS, epilepsy, lupus, etc. Strangely, hypertension and diabetes, among the leading causes of illness and death in Tobago, are not mentioned.)
Tenth of 15 is bad enough, but what is worse is that, with San Juan/Laventille, Tobago is at the bottom of the country (if I may without irony use the phrase) where its population without access to improved sanitation facilities is concerned.
Even worse, Tobago, with Sangre Grande and, surprisingly, Port of Spain, is described as having the highest "loss in human development in long and healthy life dimension due to inequalities in chronic illness". There is some comfort, though: in T&T, Tobago has the highest life expectancy at birth – 76.8 years. (The lowest, again surprisingly, are Port of Spain and San Fernando. Why?)
Secretary Groome-Duke may wish to know that in January 2003, nearly 10 years ago, I wrote the THA setting out two pages of health issues in Tobago that needed attention, among them the primary health care and lifestyle ailments that command her notice today.
I wrote again a month later detailing five concerns: the delivery of health care and services (including the relationship among the Ministry of Health, the THA and the Tobago Regional Health Authority [TRHA]), health centres, HIV/AIDS, the acute shortage of district health personnel, and the composition of boards.
In that letter I also underlined the need for an updated health needs assessment (which I hope has since been put in place and, if so, is being continuously monitored). A 1997 assessment had, I said, "indicated a shift in predominance from infectious diseases to chronic, lifestyle diseases such as diabetes and hypertension."
In a third letter, March 2003, I again spoke of the crucial importance of a health needs assessment. "How," I had asked the previous month, "can (Tobago) seriously be intending to put up hospital and health centres and so on without any clear idea of what kinds of patients are to be treated and for what, the types of equipment that are therefore needed, the configuration of the buildings, etc.?"
The 2006/10 Comprehensive Economic Development Plan for Tobago raised some of the very issues I had three years earlier: the THA/TRHA divide, lifestyle diseases, human resource constraints, and health services delivery. It spoke of the marketing of wellness and recommended a "health situation audit" – what I had called a "health needs assessment".
The June 2012 review of the Plan is bullish: "(p)rimary care services of high quality are available in the new or upgraded health centres"; "(n)eo-natal deaths have been reduced to zero in most years, and the country" – the country! And you thought Tobago was not an independent state! – "has achieved 100 per cent immunisation rates"; "(e)mergency services have been upgraded"; kidney dialysis, oncological and ophthalmological services, etc. are now on tap; and so on.
Excellent, but the review also points out that chronic diseases remain problematic, and are now afflicting children (not only now, actually); sustainability of wellness programmes is difficult. No wonder: obsession with fast and greasy food, coupled with unwillingness to exercise, militates against progress. You see too many obese people in the streets of Scarborough, their knees creaking below their Sumo-wrestler weight, their pillows of fat quivering and heaving and rolling like a demented sea – men, women and children. They are not a pretty sight. And they don't realise the damage they are doing both to themselves and to Tobago. Sustainability of wellness programmes may be difficult, but it is vital.
I must also mention what are basically two other lifestyle diseases: alcohol abuse and HIV/AIDS. The former, as we know, is also a national scourge, leading often to death on the roads. The latter has been a hush-hush affair in Tobago – "bad for tourism," one is told, as if visitors are of more consequence than locals (well, yes, for some people they are). The subject must nonetheless be confronted. I am told that in the last few years there has been an uptick in the infection rate. Is the HIV/AIDS programme well-thought out, coordinated, funded and managed? Is public and school education structured and consistent? What is the level of individual responsibility? Or does the ostrich rule?
To sum up my two articles, I would say that Tobago has a long-living population, but one that is neither as well-educated as it should be and needs to be nor, largely because of its own lifestyle choices, as healthy. The HDA sombrely concludes that Tobago, Point Fortin and Tunapuna/Piarco "had the greatest percentage losses in human development (in T&T) due to inequality in health, education and income".
Given the additional responsibilities that internal self-government is expected to confer, this situation brings me no comfort.
Part 1 appeared on August 22
* Reginald Dumas is a former ambassador and former head of the Public Service