of an investigation in the state of medical care in Trinidad and Tobago
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.
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.
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
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.
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.
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.
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
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.
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.
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.
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.
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
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
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.
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.
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.
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?
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.
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.
are the market forces. And if you demand change, it will come.