T&T’s public health sector has been described as organised chaos by chairman of the North Central Regional Health Authority (NCRHA) Dr Nalini Kokaram-Maharaj. The newly appointed chairman said her first priority would be to meet the major stakeholders to get a grip on operations at the NCRHA.
A radiologist with 17 years experience in the sector, Dr Kokaram-Maharaj is contending that people in T&T today need to be more health-conscious, as failing to do so has serious consequences.
Q: Dr Kokaram-Maharaj, what is your initial task as chairman of the NCRHA?
(At the Ministry of Health head office Thursday morning) That would be to hold discussions with my team, including the executive, board members and staff, to get a good idea or handle on what’s happening at the facilities operated by the authority.
A: What are some of the negative aspects of the public health sector?
Our health sector, like the rest of the world, has its inherent problems with respect to management and staff shortages.
I am aware that we are trying hard within the ministry to deal with the issues in the interest of a healthy and productive nation.
If we could explore the compassionate side of medical doctors, how do you all detach yourselves emotionally from the real pain of the sick and their relatives in the everyday discharging of your duties?
(A bright smile) As doctors, we are supposed to keep a certain amount of detachment from any given situation. But we are mothers, fathers, aunts, uncles, brothers, sisters, and this detachment helps us to function and to think clearly. But inevitably it is very difficult to, let’s say, deal with a child with cancer, to see that child deteriorating right before your very eyes. You have to separate your human side.
So on a day-to-day basis doctors go through that emotional stress and emotional baggage. And what we are witnessing today is the dramatic increasing number of patients who are presenting themselves to the public health institutions, as recently remarked upon by the Health Minister.
So it is safe to assume that Trinbagonians are sicker today than ever before?
Yeah. And a lot of it has to do with our lifestyles—we do not exercise as we used to, we do not eat properly, we work longer hours, we reach home late after a very stressful period of commuting every working day.
Some may say if people do not wish to take care of their health, the time has come for the legislating of what we eat and what we don’t eat?
(Chuckling) I think if they understand that there is a penalty at the end for what they do...What we need to do is to instill at a very young age proper eating habits, starting from kindergarten, and that the penalty for consuming improper foods is damaging one’s health. The cost of drugs, medication, is not worth it, so you might as well take that extra time preparing proper meals, buying vegetables and so on.
Very well, doctor, after that very short discourse on proper eating habits, let’s get back to the NCRHA. You have to be concerned about the numerous complaints from our institutions, particularly with reports of loss of lives at health facilities under the aegis of the authority...
(Hands on table edge leaning forward) Right. To tackle health issues in any region or countries in the world it has to be a multi-pronged approach and a collaborative effort where all stakeholders must be on board working as a team in order to achieve what the State has set out to do.
I am acutely aware that we need to get back to more patient-oriented service, to be more sensitised to the patients’ point of view and their expectations, patients’ education, patients’ awareness, and a lot of patients’ stress can be alleviated or reduced significantly by just proper communication. Holding their hands, giving them a hug. That little bit to show that we really care.
You have been a medical practitioner for the past 17 years. Is there truly a lack of compassion by some of your colleagues towards their patients?
You are always going to have a few bad apples, always. (Sombre expression) That is human nature. I have worked in the public service 17 years and the majority of the doctors are driven, committed to making a positive transformation in patients. But a heavy workload can frustrate any worker and there is only so much you can give a patient in terms of quality time. When you have 100 people to handle between 8 and 12 pm, tremendous effort is required there.
We need to beef up our primary health facilities so that minor ailments such as coughs or cold can be addressed there before reaching the hospital.
What about the accusation that some doctors cover up for their colleagues in matters of litigation?
(Half smiling and almost immediately breaking out laughing aloud) Boy, what are you asking me? You like cantankerous situations, eh? But yes, doctors have been sued and there may be some element of truth in that, but, like I say, the majority of practitioners are committed to helping their patients. I cannot speak about the minority...it has to be addressed. That is a tough question, and I do no not know exactly how they are going to deal with those bad apples.
Isn’t it a fact that almost all of them work on contracts?
Yes, and at the end of the contracted period you are appraised by your superiors and that is one way of tackling the problem. If at your evaluation you are found to be a poor performer or deficient in any way, it would show up in your performance appraisal.
Is there anything like a psychological test doctors have to undergo before going to work in the hospitals?
No such testing, and it is the same situation at all the campuses at UWI, but when the performance appraisal shows a poor performing standard you may not get your contract renewed and that has happened, eh...based on the performance appraisal.
So there is a mechanism to deal with this issue?
Yes. We do not publish that, for obvious reasons.
Doctor, what do you think would be your biggest challenge in this new position?
The biggest challenge, I guess, would be getting the various stakeholders to work together towards achieving the goal of having an efficient and delivery-conscious NCRHA, but I look forward to boldly and courageously tackling those challenges ahead of all of us.
Doctor, I always like to refer to this conversation I had with the then Minister of Health Kamaluddin Mohammed, who told me in the 1970s that the ministry was like a mental institution and if anybody was to fix it, it was him. Do you agree with that assessment of the ministry made so many years ago?
(Cupping her chin and sighing) You know what I would call the health sector? Organised chaos. This high energy, fast pace, extreme higher adrenaline levels in their wards and casualty, everybody doing their duty towards their patients, but somehow or the other working together as a team to achieve one goal.
That is the only way, you know...everybody has a specific skill and duty that they bring to the institution and they have to work together, which is the way I knew it, coming out as an intern, that you have to respect people more experienced than you, even if they were not doctors but valid members of the health team.
Is organised chaos the ideal way to run a health institution?
(Heavy chuckles) It has to be fast-paced. Medicine not only has to be precise and accurate, but you have to be quick on your feet, because it is lives you are dealing with. Chaos in that everybody is doing different things at the same time, so it is not necessarily a negative thing. In fact, most hospitals exist like that, but it is organised, and once you have good leadership it works.
