	Ministry of Health
	Health Sector Reform Programme of Trinidad & Tobago Bringing Healthcare closer to you !

Eastern Regional Health Authority

CURRENT ISSUES

1. CRITICAL STAFF SHORTAGES

1.1 Doctors

Locally trained doctors are absorbed by the two larger hospitals: San Fernando and Port of Spain and at Eric Williams Medical Sciences Complex, as those offer a wider range of services and provide better opportunities for specialization.

Current level of graduates remaining in Trinidad does not meet the country’s demand for doctors.

The Authority as well as other institutions depend on Foreign Doctors who are subject to approval by (1) The Medical Board and (2) Work Permit Division of the Ministry of National Security.

Those two requirements always slow down the process particularly registration with the Medical Board.

Even when foreign doctors are registered and approved and after always advising of their interest in working for the ERHA they sometimes opt to work at the larger institutions, particularly in areas where they wish to specialize.

Foreign Doctors are employed on contract basis. Many of them use the Trinidad experience to pursue further studies in the U.S.A.

With the assistance of the Ministry of Health, the RHAs are negotiating an improved compensation for all categories of doctors. Negotiations with doctors’ representatives are expected to recommence shortly. This may not necessarily impact on our ability to retain Foreign House Officers, who use Trinidad as a conduit to career development

Given the remoteness of Sangre Grande Hospital and Mayaro District Hospital (as well as at Community Level) Doctors at the Eastern Region will enjoy additional compensation.

The Authority will continue to explore all available avenues to attracting doctors.

1.2 Nurses

The exodus of nurses to European and North American destinations has significantly affected services that the Authority provides. At present, a significant shortage exist at the Hospital and to a lesser extent the Community Services.

The Ministry of Health in attempting to deal with the continued exodus has committed to the following:-

Assisting the RHAs in arranging better terms and conditions of employment
Improving the environment of work
Increasing the take-in of students and therefore increasing the graduating pool of nurses

The Authority has also taken some steps to reduce the impact including -:

- Working with the Nursing Council to obtain accreditation for nursing students to train at the Sangre Grande Hospital.

- The introduction in January 2000 of a new category of staff called Patient Care Assistants (PCA) to relieve Nursing staff from the more mundane activities, to allow the nursing staff to concentrate on clinical care. This has already proved to be successful and a further batch of twenty five PCAs are being considered for employment throughout the Health Facilities.

- The introduction of a Nursing Pool system at premium rates, which also allow for some relief to the nursing shortages.

- The Authority will continue to seek out ways to address the shortage of nurses and will work closely with the Ministry of Health.

1.3 Pharmacists

Within recent times the shortage of Pharmacists has improved with the recruitment of additional Pharmacists.

Due to the remoteness of the Eastern Region, improved compensation packages are being considered especially for areas such as Toco, Rio Claro and Mayaro.

* See Item 10 – "Drugs Supplies"

2. HOSPITAL SERVICES

Critical shortages especially in the area of Doctors have impacted on the quality of care at the Sangre Grande Hospital.
Currently there is a shortage of four Junior Doctors (House Officers) and one Obstetrics and Gynecology Specialist Doctor (Registrar).
This has forced closure to the Paediatrics Ward (for over six months now) and more recently the Obstetrics Ward.
Accident and Emergency has remained opened 24 hours although waiting times have deteriorated from thirty minutes to as long as two hours (and more in some cases).
There is ongoing efforts to recruit House officers and it is not likely that the required four Doctors will be attracted in the next two - three weeks. However, the Authority is committed to reopening the Paediatrics Ward once there is an adequate supply of Doctors.
In the area of Obstetrics we are very close to recruiting the required Obstetrician and that ward should re-open by the end of July 2001.
Notwithstanding, the ability to sustain an adequate compliment of House Officers is questionable but we will work towards keeping all services open, at all times.

3. DENTAL SERVICES

The Authority recognizes that existing services at Health Centres are not reaching a large enough population both in terms of children and adults.

Plans are however being pursued to commence a comprehensive Dental Outreach programme which with the cooperation of Parents and Schools will allow for the Authority to transport school children from their schools to the various health centres, across the Eastern Region.

The Dental Outreach Programme aimed at preschools and Primary schools will start in September 2001.

In terms of the secondary school children and Adults, a programme will be pursued and implemented within six months to provide additional services to these population.

4. UPGRADE OF HEALTH FACILITIES

All 15 Health Centres and both Hospitals are earmarked for major renovations under the Health Sector Reform Programme.

8 Centres are currently under major renovations including:- Biche, Brothers Road, Cumana, Grand Riviere, Matelot, Matura, Rio Claro and Toco.

These Health Centres will be re-opened by September / October 2001, starting with the newly rebuilt Cumana Health Centre which will recommence services on July 10^th 2001.

*See item #6 for specific plans for Rio Claro.

These Centres are presently overdue by as much as six months due to cash flow problems experienced. However, to date there has been no cost overruns.
On completion of these Centres major renovations would commence on the remaining seven (7) facilities including:- Coryal, Cumuto, Valencia, Manzanilla, Guayaguayare, Sangre Grande Hospital and Mayaro District Hospital.
The existing Sangre Grande Health Centre was recently refurbished to address some defects. This centre will be replaced by the Sangre Grande Enhanced Health Centre, where some services would be integrated with the Sangre Grande Hospital. Construction of the Sangre Grande Enhanced Health Centre should commence by March 2002.
During this project, the Sangre Grande Hospital will also be upgraded to include expanded Accident and Emergency Services and Optical Care.
All Health facilities will be equipped with new and modern equipment.

5. HEALTH SERVICES / CLINICS AT HEALTH CENTRES

5.1 Additional Health Clinics

As a result of continuous calls from the various communities consideration is currently being paid to at least one additional Health Clinic Day at areas such as Cumuto, Valencia, Manzanilla and Coryal. We are currently exploring the options available to us bearing in mind the shortage of Medical staff. Additional services will be introduced on recommissioning of Centres on completion of the upgrade works.

The Toco Health Centre and the new Sangre Grande Enhanced Health Centre will offer a General Practitioner service on five days a week, at a minimum eight hours per day.

* See item # 6 for Rio Claro.

5.2 Chronic Disease

The Authority recognizes the need to place more emphasis on Chronic Diseases such as Diabetes and Hypertension.

As a result a comprehensive Diabetes Clinic will be piloted for one year at the Valencia Health Centre from August 2001. All plans are on target for smooth and timely start-up.

Upon completion of the one year project the Programme will be introduced throughout the Eastern Region.

In the meantime existing Chronic Disease Clinics at Health Centres will continue.

5.3 School Health Programmes

With the recruitment of additional Community Nursing Staff (District Health Visitors and District Nurses) over the past year, significant improvement in our School Health Programme was achieved, in particular in the areas of immunization and general health, as nursing staff has increased visitations to schools.

5.4 Accommodation for Early Arrivals at Health Centres

The Authority has agreed that outdoor sheltered accommodation is required for patients who due to transportation availability may arrive at the Health Centre before it is opened. This has been taken into consideration in the new designs of the renovation programme already in progress.

5.5 Wellness Centres / Public Education Programmes

In addition to keen attention to the comprehensive Diabetes Clinic, each Health Centre will be outfitted with dedicated space for Wellness Activities including exercise, lifestyle clinics and Nutrition Management. Each Wellness Centre will be commissioned as each Health Centre is re-opened.

The Wellness Centre is a Community operated facility and will also allow for increased Public Health Education and Programmes designed to assist Communities and individuals in altering lifestyles and promoting wellness.

6. RIO CLARO HEALTH SERVICES

The Authority has embarked on introducing additional services once renovations are completed at the Rio Claro Health Centre.

These services will include:-

(Return to) 40 hour per week General Practitioner Clinic

Add X-Ray Services
Add Ultrasound services
Expand Dental services with additional Dental Suite and staff

Emergency services will be offered up to 4 pm initially. Within six months of re-opening the Centre, Accident and Emergency services will be offered to 10 pm, and monitored on an ongoing basis, with a long term view of 24 hr. Emergency Service.

EHS will continue to operate out of Rio Claro (in addition to Toco, Mayaro and Sangre Grande).

Emergency Maternity Services will be offered at Rio Claro.

7. MENTAL HEALTH

Clinics currently conducted at Rio Claro Health Centre and at the Extended Care Unit at Sangre Grande Hospital.

Recent Cabinet Approval of a National Mental Health Plan will push the Authority into upgrading and expanding Mental Health Services / Clinics.

A working Committee is being convened with the assistance of the Ministry of Health.

8. CANCER SCREENING – CERVIX, BREAST, PROSTATE

8.1 Cervical Cancer

The Authority is currently training nursing staff to perform Papsmears.

Arrangements also in place to train lab technicians at the Sangre Grande Hospital to read the slides.

By January 2002 cervical screening would be available throughout the Eastern Region.

The Ministry of Health is finalizing plans for treatment of positive cases.

8.2 Breast Cancer

Increased education on self-examination of breast will be provided by the Medical and Nursing staff to facilitate detection of breast lumps.

Mammography is however not currently available at Public Institutions, but the Authority is currently undertaking a feasibility study to consider introduction in the Eastern Region.

8.3 Prostate Cancer

Prostatic Specific Enzyme Assays (PSAs) have recently been made available at the Sangre Grande Hospital Laboratory.

Other procedures such as Prostatic Ultrasound and Biopsy services will also be introduced and will contribute significantly to the early diagnosis of prostate cancers.

9. DENGUE FEVER

Dengue fever remains endemic in Trinidad and Tobago. The Public Health staff is intensifying efforts to remind the population of their role in reducing mosquito breeding and preventing dengue infection and in ensuring more frequent spraying programmes.

10. DRUG SUPPLIES

The Ministry of Health has a Contractual Agreement with NIPDEC for the supplies of Drugs to all Public Institutions.

The National Drugs budget has almost doubled in the last six (6) years. A similar increase has been passed on to the Authority with the budget increasing from $2.9 million in 1995 to $5.5 million in 2000.

The Authority is attempting to further improve internal administrative issues as it relates to the availability of Drugs.

11. OPTICAL CARE

The Authority is considering the introduction of Optical Care both at the Community level, for screening and for surgical procedures at the Sangre Grande Hospital.

This service will be introduced once the new Sangre Grande Enhanced Health Centre and the development works at the Sangre Grande Hospital are completed. A rough time frame is one to two years.

12. NATIONAL HEALTH INSURANCE SCHEME (NHIS)

The Ministry of Health and the Ministry of Finance are together exploring the introduction of a National Health Insurance Scheme in order to better and more efficiently finance the Health Sector. The introduction of the NHIS will bring equity and access to care by all.

13. HEALTH CARE SERVICES FOR PLUM MITAN AND RAMPANALGAS

The residents of Plum Mitan and Rampanalgas have requested Health Centre Services.

The Authority is currently determining its options and would very soon be arranging Community Meetings at the areas for open discussions and decisions on the best way forward.

14. SOME FUTURE PLANS

Look out for the following additional Health Services:-

Improved Dental Care – both Children and Adults
Community Wellness Centres / Programmes at all Health Centres
Additional HIV / AIDS Programmes
Forty hour per week Doctor (General Practitioner) service at Rio Claro, Toco and Sangre Grande.
Additional Doctor (Health Clinics) sessions at Cumuto, Valencia, Manzanilla.
X-ray and Ultrasound Services at Rio Claro.
Gradual introduction of twenty four hour Emergency Service at Rio Claro.
More emphasis on School Health.
Optical Care (one to two) years.
Cancer Screening (Cervix, Breast, and Prostate)
Further upgrading of the Laboratory Services at the Sangre Grande Hospital.

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