In a continuation of yesterday’s Q&A with Dr Lall Sawh, who was the consultant urologist at Port of Spain General Hospital for 19 years before he took VSEP at the end of 2007, the specialist surgeon describes the day-to-day difficulties of running his department and the resulting poor quality of service offered to patients.

Dr Sawh describes the claim by Dr Tim Gopeesingh that there was ’ethnic cleansing’ of Indian doctors at the institution as ’bizarre’, but admits that the furore has highlighted the fact that many of the senior doctors, most of whom were Indian, have left the hospital.

Dr Sawh emphasised that he was speaking about his department, and the conditions that prevailed.

He dealt with surgical diseases of the urinary and genital tract in men, his forte being prostate cancer and the focus was on catching the disease before it had breached the capsule of the prostate.

NM: Doctor, when you left Port of Spain General Hospital, were you still doing surgeries?

LS: Yes, I was. The waiting list was getting longer and longer because the service was not built to expand nor to absorb this increasing demand placed on the service. In a typical week we would have a clinic where most of the catchment area was seen. The patients would have been referred by GPs who suspected they may have prostate cancer. All were seen by the registration department and we would proritise the letters. Anything with cancer, they would get an appointment within a week or two weeks. Non-urgent issues would be seen according to the waiting list.

I would then do the basic examination and screening. The problem starts there. I see the guy, I suspect he has cancer; I now need support services to confirm the diagnosis. That is where the problem starts. I send the patient to the appropriate radiology department, to get the appropriate study done. He gets an appointment months down the road simply because some equipment is not working, there’s some problem with staff or there’s some issue that prevents that patient from having his study promptly.

So he eventually gets the study, he comes back to you in the clinic and you have further suspicion now that this guy has possibly cancer and you need to go ahead and do a biopsy, which you go ahead and do.

Now you confirm the diagnosis. When you do the biopsy [a sample of tissue from the area is taken and analysed], it goes to pathology because the final diagnosis comes from the pathologist. That’s another issue we don’t have enough pathologists and I will also say we don’t have enough good pathologists at Port of Spain and the waiting time is too long to get a confirmatory biopsy.

NM: What kind of numbers are we looking at for pathologists? There are only two and there should be ten?

LS: Not as many as ten. I’d say there should be at least four to five pathologists in a hospital. There were two when I was there and I understand one has since retired so there may be only one there now. I’m not sure about the complement; you’d have to check. The trouble with pathology is that you need dedicated pathologists, who know what they’re doing because they make or break the surgeon. You’re now going to rely on their report to be able to do a very major operation on a patient, or to tell the patient he has no cancer, or he has cancer. So a surgeon is only as good as his pathologist. That’s the problem this country has, we only have, in my estimation, two very good pathologists, in the whole country.

NM: And where do they work?

LS: One is in south, and one is at Mt Hope. That is my personal bias based on my years of knowing the pathologist and knowing their results.

NM: How many people die, would you say, what kind of percentages are we talking about - who could have lived if things had gone as they were supposed to?

LS: It’s very difficult to answer that question. What I can tell you, if you link all that I’m telling you, from the time you see the patient to the time you get their radiology studies done, then you needed to get the pathology report. We have not reached the other nightmare yet! We have to go to the operating theatre now. That’s another nightmare by itself. Simple things: you go to the theatre, you have limited operating time. You may get a day per week, or a day and a half per week because you have so many surgeons and so few operating theatres.

You go to operating theatre now - they have no this, no that, no linen. So you’re waiting now to get stuff done. You can’t get a trolley to go for the patient on the ward because the trolleys are used and occupied in Casualty by the overnight patients who came in from accidents and they have no beds so they lie down on trolleys.

When you do get a trolley, you can’t find the attendant. When you find him and the trolley, send for the patient on the ward, but before you get there, the person who is dispatching that attendant to the ward is the most senior nurse in the operating theatre! Why is that nurse not scrubbed and getting the operating list going? The more senior you become in nursing in this country, the more paperwork and administrative work you do! You don’t assist the surgeon anymore, which is crazy!

NM: But there are so many young management or other graduates who could be doing that work.

LS: You need a clerk! I went to the Mayo Clinic where they were operating operating theatres and the person dispatching trolleys for each theatre was a clerk, with two phones - one to call the ward, one to call the operating theatre.

So the trolley goes to the ward and the porter has to wait now because the nurse who is supposed to prepare that patient, get all the essentials together and put on that trolley is busy because they are short-staffed and she’s doing something else and you have to wait.

When the patient comes down now - inefficiency in the system - the blood reports are not there, the blood is not available, X-rays can’t be found, and so it goes.

NM: Oh. My. God.

LS: You can’t operate unless you have those things.

NM: So instead of doing seven surgeries in one day, you can only get four done?

LS: One! Sometimes one. So what happens at the end of the day, your time finishes because you have to depart because they have emergencies piled up now. They need the operating theatre for all the accidents and all the people whose appendix rupture and all that kind of stuff. You gotta’ get out because they need that theatre for the evening staff to do the emergencies which were piling up all morning, eh.

NM: So that’s why people are spending all those hours waiting in Casualty?

LS: Precisely. It’s a vicious cycle. So what you do with those six patients you didn’t operate on? You as the surgeon now have to go and tell them, Look, I’m sorry we couldn’t do it today. That patient made arrangements for his children to be kept by somebody, made arrangements to get time off their job, went through all the stress of waiting for the surgery, with all the nail-biting and worrying about what will happen to the surgery. And now you have to tell him I going to have to put you back on the waiting list because now where you going to put this patient? Remember, the next list already has patients booked from months before.

Tomorrow: Outdated equipment and claims of greed