Motion for an Inquiry into Health and Medical Care Delivery
Tuesday 26th May 2020
Motion in the name of NFP Leader Hon. Professor Biman Prasad
CHECK AGAINST DELIVERY
I move that
“That Parliament forms a Special Committee under Standing Order 129 to conduct a holistic inquiry into all aspects of health and medical care service and delivery at our public hospitals and centres and the Committee shall comprise the following –
(a) Hon. Dr Salik Govind (Chairperson);
(b) Hon. Alexander O’Connor;
(c) Hon. Jale Sigarara; and
(d) Hon. Lenora Qereqeretabua."
Mr Speaker before I go on to the Motion proper, I was shocked to learn this morning through social media that one year on from the mysterious death of American couple David and Michelle Paul, their families haven’t heard from the honourable Minister for Health or anyone from the Ministry on what caused their deaths.
If this is true, it is tarnishing our image. It is simply unacceptable and I do hope that the Minister communicates with the family so that they can have peace of mind and bring a closure to this tragedy.
Mr Speaker, the sad but unmistakable reality is that there is a serious deterioration of our health services and medical care.
Our extremely poor health service is a blight on our nation. There is no other way to put it. Go to any hospital in the country and you will see the pathetic conditions.
The physical condition of many hospitals is shameful. There has been no improvement despite raising this each year.
Our hospitals should never run out of essential medicines or basic equipment such as syringes for blood tests. I need not go into examples because there is an endless list of grievances that we receive daily.
But one thing is for sure Mr Speaker, when relatives and friends of patients admitted in hospital have to take beddings, dressings, bandages etc., then something is drastically wrong.
But why are we even experiencing Healthcare Fragilities and that too during a pandemic like COVID19?
The answer is simple. Fiji’s Healthcare system fragility pre-dates COVID-19. Repeated waves of structural reform have not created an improved level of health’s care services in both Public Health and clinical services despite some minor bumps in the last 20 years.
Mr Speaker, all of us know that Health is a basic human right internationally and constitutionally.
Our Health to GDP remains below regional WHO standards at 4.9%. Our Health to Total Budget ratio is 9%--well below international and WHO standards and achieving the SDG (2030) targets will be a steep fiscal and national development exercise.
Additionally, the health and economic impact of COVID-19 will adversely affect the marginalized, rural and those below and around the poverty line dramatically in the next few months. The inequity in fiscal distribution will create economic chaos.
Mr Speaker, The Public Health impacts are already visible. Outbreaks of Dengue and Leptospirosis are already a matter of grave concern. Typhoid will surface in the not too distant future with hygiene matters unresolved in rural Fiji.
While we may have Enhanced awareness and Screening, poor follow up at community level with major public health nursing restraints drag us back into the quagmire.
Mr Speaker, to illustrate the gravity of the situation, I will outline many issues at Fiji’s major hospital, CWM.
The clinical services is a matter for great concern and this is why. I hope the honourable Minister for Health explains to us why these fundamental problems are crippling delivery of quality health and medical care. Based on the information that we have received, corroborated with the stories of hospital patients and those denied proper care and diagnosis, we are raising issues that necessitate the formation of the Committee : -
Diagnostic services such as Radiology is often crippled without X-ray reagents and films. The CT and MRI machines occasionally break down and become non-operational. Why has this been happening for a few years? Doesn’t the Ministry stock software and parts needing urgent repair? Don’t they undergo six-monthly servicing? We are told that urgent cases are selectively referred to the private sector for such diagnostic tests and reports. I was astounded to learn that in one case, a patient hasn’t received her MRI report 18 months after the MRI was conducted. These issues have been raised many times on the floor of this parliament since October 2014 but no improvements are in sight.
The General Pathology Laboratory ran out of reagents in January 2020 and tests in area of serology, endocrinology and biochemistry couldn’t be undertaken as per clinician’s request. Several of the large Laboratory machines need servicing and this is a pre-requisite for them to operate smoothly. Was a budget allocation for Government procurement drastically cut by 66%? Why are our clinicians working without substantial laboratory support? I even know of an incident when towards the end of last year after TC Sarai, blood donors answered a call to donate blood to a patient urgently needing transfusion. They had to be turned away because the blood bank had limited supply of blood storage bags.
The National Cytology Laboratory for cancer screening had broken-down. Is it operational? We want to know this. Is a modern “Cytology Analyzer” procured in 2013 now non-operational for cervical cancer screening? Wasn’t this equipment procured to improve methods of screening and increase the testing load to 50,000 annually from the projected current screenings of 20,000?
The situation is likewise grave in all paramedical areas without reagents, consumables inclusive of the dental services. The question remains why does such a situation arise when each budget showcases the presence of $1million for maintenance of important technological equipment and the need to put in place post-warranty service agreements. Allocation for reagents which are the equivalent of “software” to run technology is separately provided for in each budget.
The burnt-out Laundry has not been commissioned: Outsourcing option has had no cost-analysis undertaken even to date. We are told that a local private company is attending to the laundry at much greater cost and no costing analysis made known.
National Dialysis Centre – We are told that the Health Ministry is paying $12,000 per month as rental since 2018 or around that Budget period for a non-operational facility for the last 2years: There is gross wastage of finances if it is being done. The Honourable Minister told Parliament on 17th February this year in response to a question by honourable Lenora Qereqeretabua and supplementary question by honourable Viliame Gavoka that the nephrologist working on the project had resigned and the Ministry had recruited someone from overseas who would arrive in 6 weeks’ time. More than 3 months have lapsed since that assurance. There is apparently no sign of the Consultant. Here we can give the Minister the benefit of the doubt because of travel restrictions. But what about paying rent for an empty space at a rate of $12,000 per month – which is in Nadera? In February, the Minister said government needed to be absolutely sure that those patients coming from a family income of less than $30,000 per annum paid only $75 for one session of dialysis treatment and that is why they were not subsidizing it in Central and Western Divisions. A totally ridiculous explanation!
No additional Dialysis Units established anywhere - Consumable items procured in 2017-18 now probably close to expiring because of non-action by the Ministry because of resignation of the only qualified local nephrologist – and that too for a reason – and non-arrival of the expert from abroad. The local nephrologist had resigned within the first three months of 2019. Are we to accept that it took the Ministry a year to identify someone from abroad despite kidney dialysis being a matter of life and death?
CWM Hospital Based Dialysis Units – We are told piecemeal repairs are done locally. The Minister should answer if only 1 unit is operational out of 4 units. That would essentially mean 25% operational capacity.
CWM Hospital operating Theatres: We are told there are 9 theatres in the East Wing, one Eye theatre and 3 theatres in the West Wing. We must know if all 13 operating theatres are fully functional because late last year, break-down of air-conditioning, shortage of equipment and lack of medical consumables were making most theatres non-operational. It is important for all theatres to be fully operational to ensure there is no backlog of cases. We don’t want our surgeons to perform only elective surgeries.
Cardiac Catheterization Laboratory (Angiograms/Stenting/Pacemaker insertion) Is a shortage of equipment/medical consumable impacting this important clinical capacity? Lack of reagents, medical consumable, un-serviced and unrepaired equipment naturally make the medical staff very uncomfortable but they cannot raise concerns for fear of victimization. And mind you, I am aware of this.
Standards of Hygiene within the Hospital environment: Public toilets, rest facilities are below any public standard:(Smelly, Broken seats, taps, no toilet paper). The portrait of a toilet/wash/bath door tied with a intravenous tube was highlighted by honourable Pio Tikoduadua during last year’s budget debate.
Wasn’t the Public Health Act of 1934 sent for review and updating in 2012-13. Is it being addressed or does it still sit quarantined in the AGs’ chambers because the lawmakers have probably socially distanced and isolated the draft!
Mr Speaker, this is only the real picture at CWM – supposedly Fiji’s largest and premier health and medical facility.
Mr Speaker, only 9 days ago on Monday 18th May, both honourable Tikoduadua and I were at the CWM’s A & E or the Accident and Emergency Centre to visit NFP’s 2nd longest serving President Mr Raman Pratap Singh who took his last breath in front of us.
We saw for ourselves how stressed the doctors, nurses and other medical personnel were – not by seeing us walk in but because of their inability to provide decent, quality and life-saving care to those in A & E. They are professionals. They have been trained to do a job. They have taken an oath to save lives. They know who will survive and who will not.
But a decent work environment will help. A stench-free environment will help. Availability of adequate life-saving equipment will help. A fresh coat of paint and clean polished tiles will help.
Simply, the availability of basic medical needs will boost the morale and confidence of our health professionals.
Mr Speaker, I haven’t even touched the state of other hospitals and health centres, especially the Public Private Partnership between Fiji National Provident Fund and ASPEN Australia to manage and provide healthcare and medical services at the Lautoka and Ba hospitals.
This PPP is doomed. Lautoka hospital, once the pride of our nation and appearing on government calendars – a gift from the British government post-Independence – is now as good as only the walls of a building.
Gone are the well-polished and shiny tiled floors – simply gone are every single bit of hygiene, health and medical care facility that used to lead the way for our healthcare delivery.
Worse still, the new Ba hospital remains closed long after it has been built. Because it’s not up to ASPEN’s standards. And a company – Healthcare Services Limited – formed in a partnership with FNPF that has 80% stake in it – is struggling to find its feet.
Why are we neglecting our healthcare and medical services Mr Speaker? Why are we putting our health professionals under severe strain due to a lack of clinical diagnostic equipment?
We may be paying our doctors and nurses well but for them, a successful outcome of a medical treatment they induced is far greater and in conformity to their respective oaths. As a health professional himself, the honourable Health Minister perfectly understands this.
Mr Speaker, COVID-19 may have taught the world what the new normal is in terms of socializing. But we still have to learn about what decent health and medical care is.
Especially in the present days when even those who can afford the best care privately or overseas, cannot do so. I am sure all of us in Parliament can afford decent health and medical care. But it will drain our finances if we are to undergo dialysis. It will kill us financially if we don’t have personal medical insurance and claim refunds for treatment and medication.
Therefore, the plight of our ordinary citizens is much more crucial than ours. We owe it to them and their families.
Mr Speaker, this Committee is not about making allowances, waste of money or for political gain.
It is about the betterment of the healthcare and medical service delivery.
Honourable Dr Salik Govind is a health professional himself. Honourable Alexander O’Connor is the Assistant Minister for Health. Honourable Sigarara is also an Assistant Minister.
Honourable Lenora Qereqeretabua’s mother has been a reputable nurse practitioner.
So this is not a political gimmick but a genuine attempt to arrive at real and meaningful solutions collectively. Because this is what working together is about – protecting the interest of our people.
I sincerely commend the Motion.