Urgent Warning on Saint Lucia Healthcare Crisis: Merle Clarke’s Scathing Letter to OKEU Board

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A System on the Brink Amid the Saint Lucia Healthcare Crisis

The letter begins by setting the context of the Saint Lucia healthcare crisis, highlighting an aging population burdened with chronic non-communicable diseases, alongside victims of violent crime and road accidents. These factors have placed an enormous strain on the healthcare system, which, according to the letter, is severely under-resourced.

One of the most alarming issues raised is the lack of basic medical supplies and equipment, which has hampered the ability of healthcare professionals to provide adequate care. The situation has become so dire that physicians have had to bring in their own supplies to treat life-threatening conditions such as Diabetic Ketoacidosis. Essential tools for diagnosing and managing critical conditions, such as ECG machines and cardiac biomarkers, are often unavailable, forcing reliance on private sector resources, further compounding the Saint Lucia healthcare crisis.

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Toxic Work Environment and Leadership Failures Amid the Saint Lucia Healthcare Crisis

The letter does not mince words regarding the role of the hospital’s Board of Directors in this crisis. It accuses the board of failing in its duty to draft and implement policies that ensure the efficient running of the hospital. Instead, it alleges that the board has focused on micromanagement and has fostered a toxic work environment, detracting from the primary goal of patient care—a key issue in the broader Saint Lucia healthcare crisis.

The issue of a lack of bed space, which forces critically ill patients to be managed in chairs and leaves emergency room physicians unable to treat new patients adequately, is cited as a glaring example of the board’s neglect. This situation, the letter argues, has contributed to the mental health strain on clinical staff, who are not only overwhelmed by the lack of resources but also by the abusive treatment they receive from frustrated patients—a dire reflection of the Saint Lucia healthcare crisis.

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A Call to Action Amid the Saint Lucia Healthcare Crisis

The letter ends with a powerful demand for change, urging the board to either address these critical issues or step aside for those capable of doing so. It emphasizes that the citizens of Saint Lucia deserve better and that the current conditions are unacceptably dangerous, exacerbating the ongoing Saint Lucia healthcare crisis.

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Full Text of the Letter

For those interested in reading the full content of the letter, it has been provided below:

ST. LUCIA MEDICAL & DENTAL ASSOCIATION

PRESIDENT: Merle Clarke, MD
VICE PRESIDENT: Dianne Ferdinand-Walcott, MD
SECRETARY: Samantha Mathurin, MD
TREASURER: Christopher Beaubrun, MD
ASSISTANT SECRETARY: Christi Gerald, MD
PRO: Delphina Vernor, MD

July 31, 2024

Mrs. Joanna Reynold-Arthurton
Chairperson
Board of Directors
Millennium Heights Medical Complex
Castries

Dear Mrs. Reynold-Arthurton,

I write on behalf of the Physician body of the Owen King European Union hospital to express our utter dismay/disgust with the current state of affairs at the island’s main hospital and by extension our Healthcare system. The problems are truly too numerous to quantify but we will attempt to highlight the most salient points coming out of a meeting of the consultant body. It is to be noted that these issues are not new and you have been made aware of them, but the situation has been allowed to deteriorate to such an extent that it is simply untenable at this point.

LET ME FIRST PUT INTO CONTEXT SAINT LUCIA’S CURRENT PATIENT PROFILE

• An aging population
• A high burden of chronic non communicable diseases
• Victims of unchecked violent crime
• Victims of road (motor vehicular/motorcycle) accidents

The consensus of the physician body is that the board of directors, ostensibly tasked with drafting policy to allow for the efficient running of the hospital, has failed miserably in said task. The focus of a significant proportion of the board’s membership appears to be solely on micromanagement and creating a toxic work environment as opposed to ensuring that conditions are in place to guarantee the best possible care to the patients who present to our institution; our fellow Saint Lucians.

As stated above, the reality that we face here in our beloved island is that we have an aging population, one with a very high burden of chronic non communicable disease. Violence and crime and road accidents also affect our population and deplete healthcare resources significantly.

With this being contextualized how then can the hospital function or can we adequately do what we are trained to do; SAVING LIVES, without basic resources. How are we to manage Diabetes and its complications without glucometers to monitor blood sugars? Are you aware that physicians have had to bring in their own supplies to ensure that patients with Diabetic Ketoacidosis (a life threatening complication of Diabetes) are monitored and managed?

How are physicians expected to make critical life and death decisions in a patient with presumed Myocardial Infarct (Heart Attack) without basic things like ECGs (whether it be due to lack of ECG paper or not enough functioning ECG machines) or Cardiac biomarkers (Troponin)?

How are physicians expected to treat life threatening illnesses without the basic drugs that allow us to provide standard of care management?

When the proverbial wheel falls off the wagon and these critical decisions have to be made or the necessary drugs have to be sourced, it is the private sector (Tapion Hospital, Tapion Pharmacy) which has stepped in all too often, providing supplies free of cost or trusting that the family will dig up the funds from somewhere to pay for it later. The same private sector which is so often vilified.

We have often lamented the lack of research in our region including Saint Lucia. Critical research which can be used to guide policy and patient management. It is therefore incomprehensible that at least three colleagues have taken the initiative to do research projects, have received clearance from the Ethics committee of the Medical and Dental Council but the Chair of the Quality and Patient Safety Board Sub Committee adamantly refuses to allow said projects to proceed with the absolutely ridiculous claim that it has to go through a NON EXISTENT (supposedly yet formed) hospital ethics committee?

Be assured that there is no member of the board that is in any way qualified enough in the field of ethics to make a determination to overturn a decision made by trained and experienced persons in the field, as are those who form the ethics committee of the MDC. We truly are at a loss as to why any right thinking board would attempt to block the progress of the hospital and demotivate already severely demoralized staff.

Then there is the chronic issue of lack of bed space that every Saint Lucian knows about. Critically ill patients being managed in chairs, Emergency room physicians with no space to manoeuvre or treat patients. How is resolving that problem not a major priority? The sad reality is that the wrath of the average Saint Lucian who makes contact with our healthcare institutions is towards the frontline healthcare workers, as we are seeing people at their most vulnerable.

The sheer frustration of not being able to provide the best care because there is simply no space to provide it, or inadequate nursing and physician staff to meet the demand or basic supplies to work with, is undoubtedly taking a significant toll on the Mental Health of clinical staff. This board has made no effort to find out from them how they are faring much less to provide necessary Psychological support given what is faced on a daily basis.

Is it that you don’t understand the importance of this? Staff members have anxiety at the thought of entering an Emergency room which has dozens of patients who have already been admitted but cannot be sent to the wards because there are no beds and the resultant abuse that they will surely be subjected to as a result. Even more concerning is the fact that when the emergency room is housing upwards of thirty to forty admitted patients (an all too common scenario) there is no place to examine patients coming in with emergencies.

YOU ARE ALL WELL AWARE OF THIS. When is a definitive and sustainable solution to prevent premature loss of life going to be proposed? Or is the board satisfied with the blame being placed squarely at the feet of the inordinately convenient scapegoats, the clinical staff?

Many of us have worked and sacrificed tirelessly at VH/OKEUH for close to or more than 20 years and we can categorically say NEVER HAS IT BEEN THIS BAD. We have always been under resourced, understaffed and overworked but for its myriad of problems, there was a sense of community at VH. Staff did not feel ostracized and vilified. Going above and beyond at the height of the Covid 19 pandemic and countless other critical periods was just a natural thing to do as there was an innate understanding that it was in service to our community.

This current climate however has caused so much unrest and frustration that many feel helpless and at their wit’s end and are ready to resign. Is the board at all concerned about the fact that four senior consultants and multiple junior physicians have resigned over the last few months? Or about the continued mass migration of our beloved nurses? What measures have been put in place to halt this exodus of clinical staff? Or is the board of the view that saying that the “Physicians dropped the ball” will suffice?

How do you justify the monies spent on expensive Billboards all over the hospital, new vehicles but the concurrent lack of drugs including but not limited to Panadol, Ibuprofen, Omeprazole, Dilantin, antibiotics; lack of equipment, shortages of lab supplies, anaesthetics and the list goes on? What alternate Universe are we existing in that priorities are this skewed?

There is a lot more that can be said but as mentioned before you are all well aware of the issues. We strongly urge you for the sake of the people of Saint Lucia, those of you who truly understand what this call to service is about, to get your act together and start running the hospital as a hospital should be run or allow a team which is up to the task to do so.

THE CITIZENS OF SAINT LUCIA DESERVE BETTER. The current conditions are unacceptably dangerous and inevitably will lead to undesirable outcomes. Are you aware or do you even care that many patients, when referred are uttering the heart wrenching words “I prefer to go home and die than go to OKEU? How can we sleep knowing that this is the plight of our people?

Equitable, accessible and affordable healthcare is a FUNDAMENTAL HUMAN RIGHT to which every citizen of Saint Lucia is entitled. The current situation on the ground at OKEUH cannot be allowed to continue. WE DEMAND BETTER, SAINT LUCIA DEMANDS AND DESERVES BETTER. We will not continue to stand by and “make do with what is available” only to then be publicly maligned by some of your own members when outcomes are less than favourable.

We reiterate you need to STEP UP OR STEP OUT!

Yours sincerely,

Dr. Merle Clarke
President

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A Moment of Reckoning in the Saint Lucia Healthcare Crisis

This letter from the Saint Lucia Medical & Dental Association serves as a wake-up call to all stakeholders in the island’s healthcare system. The urgency and gravity of the situation at OKEUH cannot be overstated. It is a critical moment for the leadership to reflect on the fundamental human right to accessible, equitable, and affordable healthcare. The current state of affairs at Saint Lucia’s main hospital, as described in this letter, is not just a crisis; it is a call to action for immediate reform amidst the Saint Lucia healthcare crisis.