Which we will come to in a moment. Today was yet another busy day and the culture shock landed itself right in the middle.
We started our day later (9:30 thank God!) to go to the National Board of Insurance. The Bahamas has a national health insurance program, which works very well. Since they don't pay income taxes the deduct a certain amount out of their weekly pay, which then goes to the government. They pay out for injuries, pension, maternity leave, workers comp, everything. And the system actually holds together, which is hopeful. Unfortunately it's rife with fraud, because there's no national credit bureau there is no way to track who is paying into the plan, who isn't injured anymore, etc, etc. Anyway, nothing else exciting happened so we're moving on.
Lunch was at a native Bahamian cafe called Steve's. It's a cafeteria style deal, which is apparently popular places like here. They served chicken in various froms of cooked, the obligatory conch, and lamb curry. I had the lamb. I also had a dessert that's purley Bahamian called Guava Loaf. It's obviously guava fruit backed into a bread and then covered in a cream cheese icing. It's like a cinnamon bun, only replace cinnamon with guava fruit.
The culture shock came with our visit to the hospital. There are two hospitals on New Providence (one public and one private), with multiple satellite clinics scattered throughout the islands. We were visiting the public hospital and I'm not sure I have the words to adequately describe how it was. We'll start with facts, then move to what I actually saw. The public hospital of the Bahamas is divided into public and private sectors within the hospital. Private costs more but you get better care and the rooms are better. In the public hospital they follow the Florence Nightingale style of care, this means that the treatment rooms are large open spaces with upwards of 20 beds all crowded in. Therefore, paying for private means you get your own room and nursing staff, much more like our hospitals here. Amazingly, the Hospital is a level 1 Trauma center (Which means they are equipped to handle the highest levels of trauma, they have a 24 hour surgical and doctoral staff). They also have an Neonatal Intensive Care Unit, a Pharmacy, and dental and Eye care all included in the hospital proper.
Now, onto my observations. Myself and the PA student on this trip were allowed to take control of the tour. Our guide was incredibly friendly and showed us around the hospital happily, answering our questions as best she could, and finding those who could when she couldn't. The first thing that strikes you when you enter, is the heat... the air conditioning does not work very well. The second, is it's dirty, not like slum or gas station bathroom dirty, but no where near the levels of sanitation you'd expect in a US hospital. The third, is it's crowded. There are people and families packed in everywhere. Because upwards of 20 patients can be in one room the rooms are barely navigable, and people can die en route to care centers when they code because of the congestion. Fourth, and perhaps the most astounding, is that they do not have privacy laws like we have in the US. Patient protection is a joke, we were allowed to walk the hospital, without name tags, and poke our heads into any wing/room/unit that interested us. We walked through the maternity wards and ER without any trouble. I could see patient names and charts out in the open. It floored me that the Bahamians are so laid back that they allow this to happen.
We visited the entire hospital, but the places that stood out the most to me were the surgical waiting room, the pediatric wing, and the emergency room. (they have physical therapy in an outside building that we didn't have time to go see) The surgical rooms are a mess of families and patients anxiously awaiting their operations. Some are in obvious pain, others are frightened out of their wits. And they are all crowded together in a hot, dirty space.
The pediatric center is home to all levels of children, some have been abandoned at birth and have become wards of the state. They must stay at the hospital until they can find homes for them. Some stay until they're 18 years old. Shea (PA student) and I also got to go into the NICU. This is my first time into ANY NICU and it hurt to go there. There were at least 4 babies to a room, each in their own incubator, and each so small; you watch them breathe and your heart aches for them. Some are under UV lights, some under incubators, and almost all have needles and tubes running into and out of them. They don't cry, it's silent except for the steady beeping and humming of the machines. The NICU is nice, it's the best in the caribbean, the success rate still isn't good simply because of the nature of the unit.
The emergence room was astounding. Again, it's hot, crowded, and people are afraid. It reminded me of shelters after natural disasters, the press of people and the feeling in the air of trying to survive and being fearful. The ER had 18 beds, all slammed against one wall with narrow walkways between them. People were piled in everywhere they could be, nurses and doctors had so squeeze through to care for the people. Our guide said that when someone codes they take them to a separate room, but they sometimes cannot get them out fast enough. There is no other way for them to operate however, they have no more space and a high volume of people coming through daily.
The hospital is growing, and the government recognizes the need for more space and staff to accommodate the needy population. So hopefully these conditions will not last. I cannot imagine going to that hospital, or working there. It is unlike anything I have ever seen and I am grateful now for even the smallest hospitals (PCH).
We finished our day shopping on Bay Street and I am happy to announce that I have finished shopping for everyone! I still haven't managed to make it to the Marley Resort but I hope to soon! Tomorrow we go to changing of the guards and on a tour of Atlantis. Then hopefully (Please God Please!) we will have the rest of the day off for the beach after 1:30! Finger's crossed!
No comments:
Post a Comment