Do we not have a large medical school here in this small island, which graduates close to 100 Trinidadian doctors every year? Why then do we need to import so many doctors from Cuba, India, Africa, et cetera?
And so, a bit of history. In 1966-67 it was decided that because of the large size of the classes in Mona, Jamaica, the clinical teaching and clerkships there would be decentralised and there would be clinical teaching in Trinidad and Tobago and Barbados. This was called the Eastern Caribbean Medical Scheme. When it started here in 1967 there was a potpourri of students from all the Caribbean islands.
Eventually, after overtures were made to him, Dr Eric Williams decided that Trinidad and Tobago would finance a full medical school with both pre-clinical and clinical training, hence the name The Eric Williams Medical Sciences Complex. The Mt. Hope Hospital was originally carded to be a so-called tertiary care hospital, but teaching would still be maintained in Port of Spain (and in time San Fernando).
Now, several thousands of doctors have graduated here since 1967,and so, in addressing the question of the need to import doctors from abroad, the search for answers to that situation must therefore include the role of the medical school in Trinidad and Tobago, and the question must also be raised as to whether it is serving its purpose and worth its expense.
Several years ago, Dr Kameel Mungrue, a specialist in the public health field, did some research in tracking graduates of the Faculty of Medical Sciences from 1994-1999, and came to the conclusion that ’the Faculty, in spite of its intended mission, has not been able to meet the demands of the current medical labour market.’
Indeed, I recall once asking the administrative office of the Faculty of Medical Sciences about this and that statistic, but at that time the office was unable to answer several of the questions, which I posed. For example, does the Faculty of Medical Sciences know how many of its graduates have emigrated abroad ever since 1967 and for what reason and in what fields do they practice abroad? In similar vein, it would be interesting to know what branches of medicine were chosen by those who stayed here; how many of them chose to be general practitioners; and how many chose to be specialists in this or that field and how many chose to practice in the urban as opposed to the rural areas, et cetera.
One would also like to know, as another example, why is it that over the past four decades, this medical school here has not also been able to provide the government services and the university hospitals with a sufficient cadre of well-qualified pathologists, specialists in sexually transmitted diseases, and haematologists, all of which are so desperately needed. But to make matters worse, I am told that at the Port of Spain General Hospital there is no nephrologist, consultant ophthalmologist, neurologist, cardiologist, no haematologist and not enough pathologists. But, according to a letter to the editor yesterday, there is an overworked gastroenterologist.This is fourth-world medicine!
To compound matters further, there has also been a major problem particularly in the departments of medicine in all the hospitals for decades now. I am referring to the grade of medical officer called the registrar in the UK system and chief resident in the North American. As one overwrought consultant recently complained: ’It is with the registrar that the junior doctors interact the most. As things stand, the departments of medicine are weak as the result of the lack of such a cadre of well-qualified doctors.’
In fact, as a young doctor abroad, I have sometimes learnt more from my registrar, who was always on spot,than from my consultant physician. In the UK and North America, he is not allowed private practice and usually moves on eventually into a consultant post in some hospital or in consultant private practice after a few years. However, in Trinidad and Tobago, the relatively few who have obtained a higher degree but need more years experience, quickly set up private offices and are almost as elusive to find as some of the consultants. And nothing is done about it!
Look, had you been to a large hospital in the US, you would then be able to appreciate what I am saying. There you would see doctors in action from 7 o’clock in the morning to 5 o’clock in the evening and who are so busy that they have no time to relax in a Doctors’Common Room!
Have you ever been, for example, to the Accident and Emergency Department of, say, The Jackson Memorial Hospital in Miami? I chose this hospital because many years ago I had to visit a BWIA airhostess, who was in an unfortunate accident on board the aircraft, and had to be rushed there. What I saw can only be described as a ’war zone’ with numerous doctors and nurses all smartly dressed in white rushing here and there with an array of equipment and with six operating theatres in action simultaneously.
But, you see, the problem with many (not all) of the doctors here,including some of the senior staff, is that they have never been trained in a major (teaching) hospital in the UK or North America and therefore have little appreciation of standards of care and what is meant by professional efficiency, discipline and teamsmanship.
To be continued in two weeks
