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Commentary: Dominica's new hospital should mean new and improved services
Published on January 2, 2017 Email To Friend    Print Version

By Dr Emanuel Finn

All Dominicans should share in Health Minister Dr Darroux and his government’s efforts and excitement over the proposed construction of the new $40 million, 372-bed government- and China-funded hospital in Goodwill. But at the same time, some pressing questions need to be asked. Will management, clinical care, patient treatment and customer service be different? In past statements Darroux said that new hospital will be fully functional upon completion. Will there be a kinder and gentler paradigm shift in bedside manners at the new hospital? But what does ‘fully functional’ mean regarding cost of services, accessibility, affordability and delivery of quality care?

Dr Emanuel Finn holds a Bachelors degree in Chemistry, a Doctor of Dental Surgery Degree and a Masters in Health Policy and Administration. He holds certificates in Executive Non-Profit Management from Georgetown University Public Policy Institute and Emerging Leadership in Public Health from the University of North Carolina at Chapel Hill-Kenan-Flagler Business School. He spent the 2000-2001 Congressional year on Capitol Hill in Senator Ron Wyden’s office (D-Oregon) as the American Dental Association Health Policy Fellow.
Is Dr Darroux trying to have it both ways? He seems to be playing the role of cautious overnight watchman (batsman) while playing politics. He told a recent gathering that the new hospital will not “cut it” unless there is universal health coverage. Well, sir, your government has an overwhelming majority in parliament and so what is the problem with legislation to ensure and enact universal health coverage?

He is quoted as saying, “These gains that we made in terms of the new infrastructure, the new specialized services and the new cancer center have to be accessible to each and every body, from the rural community – from Joe Farmer in the rural communities to Joe Minister in the capital of each of the countries. The new hospital should be accessible to one, all and sundry.” Also, Mr Minister, the new facility should be for all Dominicans regardless of their constituencies, politics, political stripes and colours.

Due to Darroux’s boss reported micromanagement style, the minister may be unable or allowed to be responsible for all aspects of the business of ‘running things’ and hiring the right people for the management positions for the new hospital. This includes operations, finance, quality assurance, personnel, marketing and training and client patient services. These highly visible and critical positions should bestowed on a highly qualified and experience professionals whose marching orders are to work in a team-setting to drive the delivery of quality of patient treatment and customer service.

As a highly trained medical professional, Darroux’s focus should be positive results oriented. But in order to achieve these goals, he will have to aggressively employ and prescribe a heavy dosage of health policy and best practices. Embracing the same old myopic political calculus, considerations and expediencies will almost certainly guarantee failure. If the latter is the order of the day as is all things in Dominica today, then the new building will not worth a penny of its large price tag.

But then again, with all due respect to the health minister, he most likely does not have the last word on all things health and probably on matters relating to the new hospital. In fact he may just be operating as a technical advisor given the sad and sorry governance structure that regrettably has engulfed Dominica today. Why one must ask? Is it because of too much money, too much arrogance, lack of confidence, and/or too much insecurity on his boss’ (the PM) part? There are even strong allegations that Darroux’s boss exhibits narcissistic behaviours.

Given these compelling and prevailing opinions in the country, one can therefore bet the mortgage and the farm that there will most likely be ‘square pegs in round holes’ running things at the new digs.

Dr Kenneth M. Darroux
In addition to operations and management, another area the health minister should be seriously concerned about and plan to address (if he can), is in the area and availability of specialty care especially as it relates to everyday Dominicans – the ‘Joe Farmer’ as he put it. The media recently reported on the shameful, sad and undignified health care needs of a former police commander who is gravely ill. The gentleman has now depleted his life savings and resources from exorbitant repeated trips abroad for specialty care.

But the Cuban trained health minister should be less concerned about the ‘Joe Ministers’, the politically connected and well positioned nouveau-riche (new-rich). He should also not be too concern with the mercenary lawyers who have become passport agents and sellers and are now vocal supporters of the selling of Dominica’s sovereignty.

The health needs of members of this privileged club can (as is often the case) be taken care of with dignity at top notch hospitals and medical facilities either in Forte-de-France, Bridgetown, Kingston, and Miami or in NYC. In the case of the passport agents, their medical needs can be taken care of on their next trip to Dubai or in some other distant capital where Dominica is bought and sold at bargain prices. Despite that reality, we should agree with the doctor that the hospital should be for all regardless of socio-economic standing.

Finally, what plan does the health ministry have to beef up its advanced nurse practitioner numbers in specialty care? Will more resources be placed for training these nurses to accommodate the needs of Dominicans? Today the nursing profession is dynamic and is constantly changing. An advanced level practice encompasses aspects of education, management and is firmly grounded in direct care provisions. These highly trained mid-level health professionals are expected to lead, design and deliver new care pathways and services. They are also involved in the development and implementation of policy, standards, guidelines, and patient treatment and hospital protocols.

Now that the headline grabbling announcements, press conferences, the political drum beats about the wonders of the new hospital are out of the way, the real work of planning should begin in earnest. But one thing for sure, in order for the full benefits of this huge investment to realized by all, it cannot be business as usual. Otherwise, this undertaking will be a colossal failure of monumental proportions. Should that come to reality, then Kenneth Darroux’s reputation will and should be severely tarnished.
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Maria K Todd MHA PhD:

Seems such a tragedy to have a new facility lay dormant when interim contract management could be positioned too open, prepare for accreditation by an ISQua-accredited, international accrediting body and get started serving the people. A modest tax increment financing program could be used to charge foreigners to access care there - even a small TIF tourism tax could fund self-sustainable management and international health services marketing.

Maria K Todd MHA PhD:

Seems such a tragedy to have a new facility lay dormant when interim contract management could be positioned too open, prepare for accreditation by an ISQua-accredited, international accrediting body and get started serving the people. A modest tax increment financing program could be used to charge foreigners to access care there - even a small TIF tourism tax could fund self-sustainable management and international health services marketing.


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