Seismologists say a new children's hospital being planned for Couva, in Trinidad, is located near a fault line. According to one report, 67 per cent of hospitals in the Caribbean and Latin America are located in areas at high risk for natural disasters. Credit: Jewel Fraser/IPS

By Jewel Fraser
PORT OF SPAIN, Trinidad, Sep 21 2014 (IPS)

When floods overwhelmed the Eastern Caribbean in December last year, St. Vincent’s new smart hospital, completed just a few months earlier, stood the test of “remaining functional during and immediately after a natural disaster.”

The floods, later dubbed the Christmas rains, killed more than a dozen people and caused millions of dollars in infrastructural damage. However, the Georgetown Hospital in St. Vincent weathered the natural disaster, living up to the definition of a smart hospital in that it continued to serve the community without interruption.“We had the Christmas floods on Dec. 24 and the island’s water supply system was down whereas the hospital’s water supply remained functional. The community bought into it [after that]." -- Shalini Jagnarine of PAHO

According to a report by the UK’s Department for International Development (DFID), “More than 67% of hospitals in the Caribbean and Latin America are located in areas of higher risk of disaster.

“Enormous economic losses occur (including lost income and work days) when health facilities are destroyed or damaged by natural disasters — they must be re-built and downtime limits their ability to provide emergency care to victims and ongoing healthcare for their communities.”

The report adds, “Building resilience of communities and critical buildings like hospitals and schools delivers better results in terms of lives saved and livelihoods protected than simply through responding to the effects of disasters or climate variability.

“Establishing an integrated and forward looking approach to hospital design is essential if health facilities are to be safe, green and sustainable.”

Dr. Dana Van Alphen, the regional advisor for PAHO’s Disaster Risk Management Programme, told IPS that during a meeting of PAHO officials there were discussions about “how we could include climate change adaptation measures into our safe hospital initiative.”

The safe hospital initiative was launched in the Caribbean about a decade ago and has become a global standard for assessing the likelihood a hospital can remain functional in disaster situations.

PAHO worked with the DFID to launch the Smart Hospital Initiative. The DFID agreed to fund the initiative from its International Climate Fund for one year, citing “building resilience to climate change and disasters [as] a central pillar” of its 2011-2015 Operational Plan for the Caribbean.

Dr. Van Alphen said the Georgetown Hospital was chosen as one of two demonstration hospitals for the Smart Hospital Initiative because PAHO wanted “to convince policy makers that there are tangible measures for safety and natural disasters, there are practical measures that one can take and still see a benefit” without the costs being prohibitive.

Georgetown Hospital and the Pogson Hospital in St. Kitts were chosen as the two demonstration hospitals, after surveying 38 hospitals in the region. Of the 38 surveyed, 18 per cent were found to have structural and functional issues that required urgent measures to protect the lives of patients and staff.

“We took [those] two hospitals where we got support from the community and support from the government to implement the project. We wanted to do a success story,” Dr. Van Alphen said.

Some 350,000 dollars was allocated to retrofit Georgetown Hospital, which had structural and functional deficiencies including an unsafe roof, no backup power supply, and no water storage system.

The hospital, built in the 1980s, is a 25-bed facility in the parish of Charlotte that serves a population of almost 10,000.

The work done on the hospital included the renovating of the roof, waterproofing of the windows, installation of photovoltaic solar panels to ensure an alternative power supply, and the introduction of a rainwater harvesting system. The hospital was generally refurbished and upgraded to make it a more comfortable and pleasing environment for working and convalescing.

As a result of the retrofitting, there was a 60 percent reduction in energy consumption, said Dr. Van Alphen.

The DFID in its “Intervention Summary: Smart Health Care Facilities in the Caribbean”, notes that “according to Environmental Protection Agency (EPA) calculations, every dollar a hospital in the United States saves on energy is equivalent to generating 20 dollars in new revenues.

“Therefore, investing in activities that help reduce the health sector’s climate footprint will ultimately liberate money for allocation towards a hospital’s genuine purpose — improving overall patient care and health in the community.”

Since energy costs in the Caribbean are among the highest in the world, reduction in hospitals’ energy bill would free up significant resources, the DFID noted.

While the community was generally happy with the upgrades — according to the results of surveys conducted before and after the retrofitting that showed a significant increase in patients’ and staff’s satisfaction levels — there remained some concerns.

One of these was the community’s reluctance to accept the use of harvested rainwater. Shalini Jagnarine, a structural engineer with PAHO’s Disaster Management Unit, told IPS that that reluctance melted away with the Christmas floods.

“We had the Christmas floods on Dec. 24 and the island’s water supply system was down whereas the hospital’s water supply remained functional. The community bought into it [after that],” she said.

Another issue, according to the cost-benefit analysis of the project, was the financial sustainability of the project. The cost-benefit analysis report stated that “the cost of maintenance and operation [needs to be] minimized and other sources of revenue schemes…identified to financially support the project over its lifespan.”

The retrofitting of St. Kitt’s Pogson Medical Centre in Sandy Point village focused on showing how small changes can make a new and otherwise safe hospital more efficient, safe and environmentally friendly.

The work done included the installation of emergency exits, better access for the disabled, and upgrade of the plumbing fixtures and electrical systems.

Jagnarine said, “When you have a hospital that is already built, to make it safe you have to be smart about the financial decisions you make. To make it 100 per cent green may be too expensive.”

Dr. Van Alphen added, “The cost-benefit analysis is very important…What is the cost of not implementing these measures? What is the cost to your country and community if you do not make your health facility green and you are impacted by a natural disaster? The decision we take depends on the money we have, but there are simple things that can be done.”

Edited by: Kitty Stapp

The writer can be contacted at jwl_42@yahoo.com

The Cameroon government says that the uncontrolled number of health clinics and training institutions are responsible for the death and worsening medical conditions of many here. Credit: Monde Kingsley Nfor/IPS

By Monde Kingsley Nfor
YAOUNDE, Jan 23 2014 (IPS)

The Cameroonian government has begun a crackdown on illegal medical facilities and plans to shut down more than 524 medical training centres and 600 private clinics operating unlawfully in this Central African nation. 

“We are starting activities to bring order to the medical sector that has gone out of control. Most of [the illegal medical institutions] lack the training, appropriate staff, equipment and infrastructure to operate either as a medical training institution or a clinic,” Biwole Sida, the national health inspector in the Ministry of Public Health, told IPS.

“The uncontrolled number of clinics and training institutions are responsible for the death and worsening medical conditions of many innocent Cameroonians,” Sida added.

In the student residential area of Bonamusadi, in Cameroon’s capital, Yaounde, IPS visited one such clinic that is open 24 hours a day and which provides a wide array of medical services, including prenatal and paediatric care.

But a patient who was rushed to this private clinic with burn wounds was turned away and taken to the nearby government hospital, Yaounde Central Hospital, as the clinic has stopped admitting emergency patients.

“We now operate only by appointment since the government announced [it was] closing down clinics,” Helen Evinga, the clinic attendant, told IPS.

Francois Penda, a medical officer at the emergency unit of the Yaounde Central Hospital, who attended to the burn patient transferred there by the private clinic, explained that it would not be a bad thing if the illegal clinics were shut down.

“Most patients come to the hospital on the verge of death after they wasted time in small private clinics, which are not even equipped technically and professionally to handle emergency cases,” he told IPS.

“A [burn] accident like this is so complicated and requires very delicate and sophisticated medical resources. Any unprepared attempt [to treat the wound] will complicate the patient’s chances of recovery,” Penda said.

Costs of Public Health Care Prohibitive

However, some private clinic operators claim they are providing a much-needed service as the cost of medical care in government hospitals and clinics is prohibitive.

“There is a great need for the services of private clinics in Cameroon. The government structures fell short to satisfy all classes of patients, and are usually saturated with patients, making it difficult for them to receive fair treatment,” Maxwel Fonyu, a laboratory technician and owner of small clinic in Yaounde, told IPS.

He argued that millions of people living in urban slums depend on the affordable medical assistance provided by these private clinics.

“In my clinic, for example, instead of demanding 10 dollars for a malaria test like in big hospitals, I only charge them one dollar to conduct malaria tests, and prescribe and sell medicines that are affordable and vital for their treatment,” Fonyu said.

Illegal Clinics Government’s Fault

Bidjogo Atangana, secretary-general of Cameroon’s National Medical Council, told IPS that the existence of the illegal and ill-equipped clinics was partially because of the government’s liberalisation of the sector some two decades ago.

“In the 1990s people were authorised to open health clinics as a Common Initiative Group (CIG) [a non-profit], which is one of the easiest means to acquire a licence for such ventures,” Atangana said.

Today the National Medical Council wants all medical centres that have been operating as CIGs to close down and obtain proper qualifications and medical licences, which many do not have.

“Nobody will hence own such a structure without authority from the Cameroon National Medical Council, and the training offered in some health institutions must also be checked,” Atangana said.

But according to Etienne Tsou from the health science faculty at Cameroon’s Catholic University, there is a need to regulate more than just the clinics, as most training institutions operate illicitly.

“I don’t see how a medical professional can be trained on the job and not have a formal education. Most retired nurses and doctors think they are qualified to open their own centres and train others when they don’t have what it takes,” he told IPS.

“The sector may lack qualified professionals, but putting the lives of innocent citizens in the hands of charlatans will lead to a bigger public health problem. There are, however, many Cameroonians with good graduate diplomas but their services are exported to countries that pay higher [salaries].”

Lack of Trained Staff

According to the Ministry of Health, about 5,000 Cameroonian medical doctors are currently plying their trade abroad.

Tetanye Ekoe, the vice president of the National Order of Medical Doctors in Cameroon, said that out of 4,200 medical doctors residing in Cameroon, only about half are practicing as medical doctors.

Of the other half, about 1,000 are on secondment to the Ministry of Health where they perform mostly administrative tasks. The remaining 1,100 are either with the Faculty of Medicine and Biomedical Sciences at the University of Yaoundé I, with NGOs or the private sector.

More than 500 medical doctors and 5,000 nurses graduate annually in Cameroon.

But Ekoe explained that the limited number of practicing medical doctors in the country makes the World Health Organisation doctor-patient ratio of one doctor per 10,000 inhabitants unrealistic in Cameroon – a country of about 21 million people.

“The real ratio is closer to one doctor per 40,000 inhabitants, and in remote areas such as the Far North and Eastern Provinces, the ratio is closer to one doctor per 50,000 inhabitants,” Ekoe said.