During its first high-level meeting with the Ministry of Health in three years, the Bahamas Sickle Cell Association pushed for solutions that an ageing public health care facility seemed ill-equipped to tackle.
However, Health Minister Dr Michael Darville offered hope that a multi-purpose bay for chronic disease patients in acute distress – like sicklers, individuals with a painful, inherited blood disorder – could receive treatment sooner, by way of prefabricated facilities that should arrive in the country sometime in November.
Establishing a sickle cell bay at the Princess Margaret Hospital (PMH) was one of the association’s top four concerns.
Dr Darville said he’s disassembling the Pathogens Unit to make way for the new unit at PMH which will assist Accident & Emergency with its overflow.
“Every individual or group who have a specific modality of illness are demanding certain things in care and that’s good, but we need to overhaul the system to be realistic on how we can provide it. You want a special bay, okay [but] the system is crumbling. We do not even have enough space in the Accident and Emergency to provide the services we need,” said the Health Minister who sought to manage the expectation of the non-profit during the hour-long meeting held at the ministry.
He explained that long term solutions to vexing public health care problems included the construction of a new $200 million hospital for Grand Bahama which should break ground by year’s end and a new hospital for New Providence. The site of the latter was selected “in principle,” he said, and should break ground next year during the country’s 50th Independence celebrations.
In the short and medium-term, the government is working to improve efficiency at both PMH and Grand Bahama’s Rand Memorial, according to Dr Darville.
Pointing to PMH, he noted staff deficiencies, wards under renovation, inoperable elevators and the hospital’s lay-out that is far from ideal.
“We are renovating the Accident and Emergency. Half of it is not in operation and so we are trying to manage the Accident and Emergency with half of its size which has created major problems for us right now.”
“We are putting up some modules where we can debundle what’s going on in the Accident & Emergency while we begin to do the renovations at the Princess Margaret Hospital and the Rand,” he noted.
“I have some modular, hurricane resistant facilities that’s coming that will give me some capabilities and more space to do a lot more things. I will consider a multi-purpose bay, not specifically for sicklers, but for people in acute distress with these kinds of chronic situations. These facilities will be here in about five weeks.”
According to the Bahamas Sickle Cell Association’s president, Kristin Beneby, the current A & E experience for warriors in crisis is woefully inadequate and puts patients at serious risk of death or permanent disability.
BSCA found that sickle cell patients wait up to two hours for an ambulance to take them to the hospital. Patients may then wait additional hours before seeing a doctor, receiving oxygen, given hydration and pain medication.
“Patients requiring more intervention may be sent home due to lack of hospital beds. For children in crisis, this experience can cause lasting physical and emotional trauma,” said Beneby.
The association wants the health ministry to adopt a 20-minute protocol for sickle cell warriors to receive medical attention. In fact, Beneby believes the policy is “halfway in motion.”
“Currently, when sickle cell warriors present themselves at the triage counter, they are allowed to register immediately and go to the back. The issue arises when we get to the back. There is a long delay in being seen by a doctor, put on oxygen and receiving fluids,” she noted.
“I am not saying that everything should come to a standstill when a sickle cell warrior enters A & E, but we should be given immediate attention as this is a life-threatening disease. We can’t underestimate what this disease really can do.”
Sicklers have abnormal hemoglobin, the substance in red blood cells that carries oxygen throughout the body. It leads to deformed, crescent-shaped blood cells that do not carry oxygen well. They also have a shorter life span than normal. To make matters worse, when these C-shape, red blood cells move through small blood vessels, they could stick together and clog them, causing pain, organ damage and strokes.
Additionally, Beneby pointed out more must be done to remove the stigma, particularly within the medical community, that warriors are drug addicts seeking to get high.
“We are cognizant that physicians can find themselves before a tribunal having to explain a patient’s death due to ‘inappropriate’ drug dosage, but it is a matter of concern, and we must find ways to [alleviate] painful crisis.”
Beneby got emotional and began to cry while recounting her most recent experience with a private hospital back in July. At the time she requested medicine that worked well for her in the past, but instead received something new which made her hallucinate. She recovered to find an army of physicians surrounding her.
“We live with this disease. We know what medications work for us and what doesn’t. It’s not that we’re just seeking drugs. We don’t want to waste time,” Beneby told Dr Darville and his team, which consisted of high-ranking public hospital officials.
Still, Dr Darville was adamant that doctors should not rubber stamp medication for patients seeking pain relief.
“If you’re my patient, I have to manage you, taking into consideration the receptors in the brain and the physical dependency associated with a lot of the drugs that work well for sickle cell anemia. I have to manage that in the long term. I have to teach you about ways to prevent crisis, not just to treat you in that clinical setting.”
He noted that community clinics were equipped to manage sicklers in crisis to provide immediate relief. Most clinics are open from 9am to 9pm.
For the BSCA – who last met with Ministry of Health officials back in 2019, when Dr Duane Sands served in the top post – they want more than just this month’s one-off meeting.
Said Beneby: “We have to put action behind what we hope to achieve.”
Writer: Tosheena Robinson BSc, MSc