Fixing healthcare starts with toilet seats

THE nonagenarian looked defeated. A World War II veteran, he was more sickened by the idea of being bound to a hospital bed than by his actual ailment – a hip fracture. “Could you tell us what happened?” the young doc asked. The vet recalled his early-morning bathroom struggles, ending with a commando crawl to his phone to call for help.

The conversation was wrapping up when the consultant chimed in, “How low is your toilet seat?” It was low, too low, and cost the elderly man his left hip. With a broken hip, this previously active patient now faced a myriad of problems: infection, pain, confusion, blood clots, depression – just to name a few. His risk of dying in the next year was anywhere between ten and 40 per cent.

A tragedy caused by a toilet seat. We live in unprecedented times – and I am not talking about covid. In 2018, for the first time in recorded history, the number of people over 65 outnumbered those under five. Globally, between 1990 and 2019, the number of people over 80 tripled from 54 million to 143 million and is expected to triple again between 2019 and 2050.

In TT, between 1950 and 2020, the number of people over 60 sextupled from 38,000 to 237,000, according to WHO data. Our expanding ageing population is no doubt a consequence of advancements in medicine and public health over the last century. But now that humans are living longer, what’s next? Anyone who has cared for an elderly person knows: ageing is complicated.

In December 2020, the WHO declared 2020-2030 the Decade of Ageing, an initiative aimed at ensuring “that we…not only add years to life, but also life to years,” Director General Dr Tedros Ghebreyesus said.

As we kick off the decade of ageing in TT, a good start is fixing our aged healthcare system, which, unlike some senior citizens who effortlessly pass me on the running track, has been lagging behind.

Governments, past and present, seem to think 21st-century healthcare is all about fancy buildings and high-tech machines; hence the occasional flurry of ribbon-cutting. If an election is around the corner, expect a blizzard. But healthcare is so much more.

When I started training in Canada, one thing that stood out to me was the robust, well-oiled allied health department in the hospital.

Every clinical department includes a physiotherapist to strengthen and mobilise the patient; an occupational therapist to train the patient in the activities of daily living such as eating, dressing, bathing, toileting; a social worker to advocate for a patient disadvantaged by society; a home care co-ordinator to arrange health services at home; and a patient care facilitator to hold everything together.

These professionals participate in rounds and decision-making, and it is not uncommon for doctors and nurses to step back while they run the show.

The result is an integrated and holistic approach to health, a concept promoted by the WHO in its Decade of Healthy Ageing initiative. The investment is worth it: more jobs in the health sector, fewer readmissions to hospital, and a better quality of life for patients, especially if they are elderly.

But allied health is not the only issue. As a specialty, geriatric medicine – the area of medicine focused on providing specialised care to the elderly – is almost non-existent in our public health system. Ideally, every major public hospital should have a geriatric service staffed with allied health professionals and a geriatrician.

Geriatricians, doctors specialised in geriatric medicine, work in inpatient and outpatient settings and pay attention to the five big Ms: mobility, mind, what matters most, medications, and multi-complexity. In the next decade, we must invest heavily in geriatrics – we have no choice.

It’s about time our politicians stop playing mas with healthcare. People are fed up of the beads, glitter, and costume jewellery. Time to invest where it matters most: in people’s lives. If the government doesn’t know where to start, may I suggest higher toilet seats for our seniors?

Taureef Mohammed is a graduate of UWI and an internal medicine resident at Western University, Canada.