Conclusion of an investigation in the state of medical care in Trinidad and Tobago

The Medical Board and Association maintained a stoic silence these past six weeks, despite repeated calls to answer questions over accountability, education and ethics in the medical profession.

But vice-president of the Medical Board, Dr Fuad Khan, last week passed the buck onto the Ministry of Health, saying the Board remains a “Toothless Bulldog” because the ministry failed for the past four years, to approve of proposed changes to the Medical Board Act that would give it teeth to discipline doctors and ensure general accountability.

This week, however, the minister, Dr Hamza Rafeeq refuted these charges by saying that actually, the Medical Board failed to respond to him for two years over correspondence regarding the proposed changes to the Medical Board Act.

Minister Rafeeq added that, according to law, the Medical Board is not answerable to him, or anyone else for that matter. He agreed the Board’s systems to deal with complaints were “unclear” both to him and the public. The minister added that in order to ensure accountability, his ministry was in the process of drafting a Health Services Act, which would give the minister the power to license all health institutions, impose standards, create a disciplinary body, educate the patient population, and hold all health professionals accountable. But technocrats in the ministry say this Act is in its embryonic stages and could take years to get to parliament.

In other words, neither the ministry, nor the Medical Board, currently has the power to successfully investigate charges of malpractice. Neither institution has the power to enforce standards, or continuing education, or monitor the running and charges of private health institutions. And you and I, the patients of this country, have no recourse against malpractice but a very clogged-up, and expensive legal system.

The deafening silence by the Medical Board and Medical Association, after six weeks of repeated calls for answers, has led me to conclude that the lack of accountability and systems in this profession is a symptom of a deadlier disease faced by Third World and developing countries.

It is about bottleneck, top-heavy executives in every profession - from politics, law, and business, to sport, and medicine  - that rely on, indeed, actively encourage the lethal cocktail of lethargy, fear and ignorance in people in poorer nations to maintain their supremacy.

It is about an elite brotherhood that uses rank, education and power to further exploit peoples who, already bowed and weakened with a history of exploitation, are unused to asking questions relating to their welfare, a people who don’t expect answers.

It is about the new colonisation that comes with globalisation, where the gap between the elite and the impoverished is so wide, that 99 per cent of the world’s wealth and power is in the hands of a tiny minority. So much for the democracy of capitalism.

It is about people who are so un-empowered, so defeated and unused to asking questions, they will spend six hours in a doctor’s office, without expecting anything more.

About a people who are too afraid to admit to their doctors they would like a second opinion, about accepting medication and treatment without question, about helplessly nodding their heads when handed a hefty bill or bad news about a relative, about a people who are too scared to publicly criticise doctors because they are terrified of victimisation.

This backbone of this series was a group of doctors, here and abroad, who, using me as a mouthpiece (that is all a journalist can be - a conduit, a pipeline for the voices of the voiceless) are agitating for accountability and change.

They are forward-thinking because they recognise that systems in their profession will enforce high standards, push excellence, ensure their continuing education, yield better-informed patients, protect not just patients but themselves against people who have wrongfully, in the midst of their grief perhaps over a dying relative, cast aspersions on their professionalism.

This issue is not about me, the columnist, attacking you, the doctor. If this was perceived as a personal attack, I apologise. I understand by mentioning the names of a few doctors in my first column, off the top of my head, I alienated many excellent doctors from this cause, and for that, too, I apologise.

The technical competence of the vast majority of doctors in this country was never under question. I am aware of people who are actually coming to Trinidad to be treated by members of your fraternity.

What I am calling for, now, ad-infinitum, on behalf of your own colleagues, is systems, such as the setting of high standards for your noble vocation of caring for and healing the sick, for transparency, that will invigorate your profession, push you to fulfil your entire potential as a doctor.

But even you, the doctors who have actively helped me do this series, are victims of our widespread rot. You are afraid that if you speak out openly you will be ostracised from the brotherhood, seen as traitors. Do you want to live amidst fear? Not to be able to speak your mind for the public good or comment on your profession because this is Trinidad, or a small country or your boss is a powerful man and can deprive you of work? Do you want this self-censorship - a slow disintegration of your integrity? Do you want to be represented by stagnant bodies such as the Medical Board and Medical Association, who won’t push for your continuing education, won’t educate the public you serve, won’t defend you, who instead, perpetuate a self-interested Third World-type inertia of fatalism? Do you want to be part of a fraternity where you, doctors, won’t stand up and testify for and against what is right, be it patient or doctor? Don’t you know ultimately, the truth, speaking out, will free you from fear?

Finally, to patients, I say that in the absence of a Patients Bill of Rights, or a circulating Code of Ethics for doctors, you must, each one of you, seize back the power that was always yours.

Change cannot, and will not be imposed from the top. It has to come from you and me. Ask questions, research your medical problems on the Internet, shop around for prices, be responsible in taking your medication, educate yourselves in primary health care.

You are the market forces. And if you demand change, it will come.