The politicisation of healthcare

Taureef Mohammed

“THE MINISTER coming,” the nurse said, a hint of disdain in her voice.

It was a celebratory occasion – maybe New Year’s, Christmas, or Mother’s Day: the observation room of the postpartum ward in the public hospital was decorated with blue and white balloons. Standing at the entrance of the room was a newly placed retractable banner which displayed the name of the regional health authority. The colours of the banner matched the blue and white balloons.

Situated near the nursing station, the observation room was air-conditioned and reserved for postpartum patients who needed closer monitoring, particularly those who had had a caesarean section.

There was always a degree of seriousness in that room, as with any room in a hospital where patients were closely monitored. But on that morning, the room looked like a party room in Pizza Hut, thanks to the silliness of public relations.

The minister, the trail of government officials and the media came and left, and work resumed. The decorations no longer had any purpose – after all, the decorations were for the minister and government officials, not the mothers and their newborn babies.

I was a junior doctor at the time, working on the postpartum ward. It wasn’t the first time “the minister” came up in a public hospital.

“The minister” had appeared everywhere in the public health system: at the entrance of the Children’s Hospital, there he was, along with the prime minister and president, their pictures in ascending order; his name was engraved, it seemed, on every plaque in every hospital, except the plaque that commemorated the opening of the “San Fernando Colonial Hospital by Her Royal Highness Princess Margaret on the 4th February 1955.”

Once, his name had even come up on a surgery-ward rounds in a public hospital.

It was the weekend, and our team was on our way out of the ward when we stopped in the corridor to discuss a matter. A patient we had just seen had connections with “the minister.” The patient needed surgery urgently and the team sensed some pressure from above to get the surgery done quickly.

There was a problem, though: a poor man – he might have been homeless – was in the emergency room with a perforated bowel, and also needed surgery urgently. It was the weekend, and there was only one operating theatre available.

The surgeon, in his typical animated manner, grabbed one of the medical students by the arms, and, looking straight into his eyes, asked: “What you think, doc?” The student fumbled. “I have no problem with (name of government official) advocating for their relative, you know. I would advocate for my relative, too. But who advocating for the man in the emergency room?"

“You and me,” the surgeon said.

The man with the perforated bowel went to the operating theatre first.

“The minister” had lingered like a ghost in the hospital corridor, and the surgeon, on that day, was a ghostbuster. But alas, the ghost returned. After all, the public healthcare system was designed for ghosts to roam freely in every hospital corridor.

Nothing has been more damaging to healthcare in Trinidad and Tobago than politics. Politicising healthcare has not just been normalised. Thanks to the RHA system, politics and politicians are allowed to thrive in the public healthcare system in the most brazen and uncontrollable of ways.

Intended to “decentralise” healthcare, the RHA system allowed politics to metastasise like a cancer through the entire system: instead of one minister, we had several ministers, each controlling their own little dominion, looking for an opportunity to get a shiny plaque. Every five or ten years, a new cancer replaced the old cancer, and the metastasis repeated. And like a real cancer, politics infiltrated every nook and cranny, so much so that “the minister” could be a topic on a teaching-ward rounds on the weekend.

Nobody trusts politicians. But trust is at the centre of healthcare. When healthcare is politicised – when hospitals are opened just before elections, like the Couva Hospital in 2015, and the soon-to-be-opened Port of Spain General Hospital Central Block – it makes delivering healthcare extremely difficult.

But politicians don’t deliver healthcare – they only talk about healthcare. So they are unable to recognise this. And the RHA, an entity that is forever trying to save its face, engages in silly PR stunts to build trust in a system that is inherently mistrustful.

At times, it all felt like a big circus. And for a junior doctor, nothing was more demoralising.

Taureef Mohammed is a physician from TT working in Canada

E-mail: taureef_im@hotmail.com