HEALTH Minister Terrence Deyalsingh is a pharmacist finding himself frequently talking the language of doctors.
He speaks with confidence suggesting that he is well briefed as he habitually takes his discourse into the technical and scientific sphere.
He is proactive when it comes to public health threats — H1N1, Zika, dengue and coronavirus.
His consistent urgings of the public on an annual basis to have themselves inoculated against the flu is all part of his ministerial activism, an activism which at times is viewed by some as the minister being somewhat didactic.
When told of his schoolmasterish style, the minister confessed that he once taught at the School of Pharmacy.
When you first announced the travel restrictions on people coming from China at the January 23 Cabinet news conference, I and other many persons got the impression that all people, including Trinbagonians, coming from China, were subject to the 14-day ban.
“It is law that you cannot debar a citizen of Trinidad and Tobago from coming into the country. So when I made the statement — (that ‘persons living in China, or visiting China, regardless of your nationality, will not be allowed entry into Trinidad and Tobago for 14 days after leaving China’) — I was talking about people other than nationals because it is common knowledge and law, which I assumed people would understand. But it was a wrong assumption for which I accept responsibility. You cannot debar a citizen and what the Cabinet took a decision to do, which was implied, was to debar anybody else. But I accept the responsibility (for the misinterpretation).”
Are you worried about the coronavirus, especially at this point in time when we are in the middle of the Carnival season?
“Of course I am worried. That is why we are taking the measures that we have taken. But the timing of Carnival had little to do with the decision. As a Minister of Health when you are faced with a global health infectious disease issue, you have an implied sworn duty to do everything you can to prevent the entry of that virus into your country, whether it is Carnival time or not.”
You have said that most of the people who have died from the coronavirus are the elderly?
“Of all the people who have died from the coronavirus around the world, which is 700-odd deaths, only two have occurred outside of mainland China. Second fact: of all the 30,000-plus cases, only one per cent is outside of mainland China and is scattered among 23 countries. We tend to lose sight of these two facts and when we do, it drives fear and panic and when you drive fear and panic into a population it can hamper your ability to prevent the virus from coming into your country. “Right now because of fear and panic you see people, including in Trinidad and Tobago, and other countries, wearing masks. They go to pharmacies and buy these masks, which provide little or no protection against coronavirus, and what is happening is that you have a shortage of masks where medical personnel who are at the frontline and who need these masks (when treating persons with a variety of ailments) can’t get them. So as Minister of Health I am very concerned but we must never panic. We must take all reasonable steps to protect our local population and this is what the Government is doing.
“When you look at the profile of those who have died, similar to the influenza virus deaths in Trinidad and Tobago, they tend to be people over 65 — the elderly with pre-existing conditions such as diabetes, hypertension and other conditions which compromise the immune system. The same demographic of the 39 influenza deaths in Trinidad and Tobago is the exact demographic of the coronavirus deaths in China. Many people in China may not even know they have the coronavirus, but like any virus, it tends to hit the elderly and children disproportionately.”
So H1N1 remains a bigger threat in T&T?
“As a country we have had 39 deaths so far (from H1N1) which can be prevented by taking a vaccine. The United States currently has 12,000 deaths for this year’s flu season. So which is the bigger problem as far as the potential for causing death is concerned — coronavirus or influenza? You have to contextualise what is happening with coronavirus with what is happening with the influenza.”
So you have been very proactive on the viruses — influenza, dengue, Zika, etc?
“That is why our dengue numbers have declined significantly under my watch. You realise you don’t hear about dengue any more. However I need to say that when we look back over the last ten years, the world has been assaulted (by virus), starting in 2009 with the global pandemic of H1N1, in 2013, it was chikungunya virus, 2014 it was the Ebola virus, which continues to this date. Fast forward to 2016, there was Zika, and fast forward to 2019, we have coronavirus.
This past decade has seen a literal explosion in the global public health landscape with the emergence of these new diseases.
And all the scientific literature and thinking is that this is going to become the new normal, every two to three years, you are going to have a new disease that threatens public health and life. In addition, there will be the NTDs (Neglected Tropical Diseases such as dengue). For example, right now the bubonic plague (an ancient bacterial illness) is making a comeback in some countries around the world. So the world has to get accustomed to a new normal where diseases of the past, plus new and emerging diseases like coronavirus are present.
“In view of this new reality, I took two notes to Cabinet last week. One dealing with the travel restriction. And another note to implement a graded response system to predict and respond to public health threats. In this, threats would be graded depending on the severity of the event, its potential for lethality, and its ability to spread out of a local environment.”
(He said Cabinet also gave its approval to submit this system to Caricom, recognising that Caribbean states must work together in these matters.
Deyalsingh is proud of his successes in the low maternal death rate and the low infant mortality rate.
He said the turnaround has been remarkable.
He noted that WHO had given the country some sustainable development goals with targets for 2030. “Trinidad and Tobago has met and exceeded those targets as early as 2017, 12 to 13 years ahead of schedule.”
He praised the obstetricians, gynaecologists, the midwives and all those medical personnel who treat pregnant women and newborn babies).
There are growing demands on the health sector, fuelled by our lifestyle choices, in particular our dietary preferences. The Government, in an effort to meet this growing demand is building additional hospitals. But how do you get people to make the cultural shift and adopt healthy lifestyles so that the demand for medical services as not as great as it is?
“The issue of NCDs (non-communicable diseases) is a global problem and it is very acute in Trinidad and Tobago. I keep preaching that the way to tackle our problem of delivery of healthcare is not necessarily to build more hospitals and hire more doctors and nurses but to provide more health to the individual. The top five NCDs we are battling in T&T are diabetes, hypertension, high cholesterol, cancers and, to some extent, dementia, which is a serious non-communicable disease.
Our Accident and Emergency Departments have been traditionally overcrowded not because of gunshot wounds, stab wounds and other conditions, but because people present to the A&E with high blood sugar, low blood sugar, high blood pressure and cardiovascular diseases like strokes.
Since we launched the NCDs project the A&E numbers have fallen by around two per cent, because we have isolated what we call ‘our frequent flyers’, our loyal customers and placed them aside into separate clinics and we focus on teaching them how to take care of their health. Two per cent of 100,000 is a lot of people, that’s 2,000 less coming to A&Es because you are treating them in a primary care setting. The challenge is that Trinbagonians tend to believe that everything needs to be treated in a tertiary care institution — hospitals.
“You would remember for instance that after every Christmas and New Year’s you would hear about overcrowding in the A&E. Did you hear anything like that this year? No. We started to teach people not to come off their diet and not to stop taking the medication over the Christmas holidays. That is the kind of model we are following — it is called behaviour change modification. Other examples are the diabetes wellness clinics where we have seen people’s HbA1c levels (test which tells you your average blood sugar level over the past two to three months) move from high of 13 points to four to six, in short going from an unregulated to a regulated controlled diabetic. We are doing the same thing for hypertension and early cancer screening. We are holding special days for cancer screening, men’s wellness days. The men’s wellness day we did two or three Saturdays ago, we had 1,300 men coming for screening and we were able to capture ten per cent of those men who needed to be pulled aside because we found abnormalities. If we didn’t do that, under the old model they would have presented a year to two years later with full blown prostate cancer and the taxpayers would have to spend hundreds of thousands of dollars to radiate them, to give them chemotherapy, to give them drugs, put them on a bed.
But because of these types of preventive initiatives we are catching them early, even at the pre-cancerous stage so that they don’t demand more health care.
And we are doing the same thing for lung cancer, for breast cancer, for cervical cancer (along with prostate cancer), which are the main cancers we are targeting. In terms of prostate cancer, we are now using blood tests and we have a special programme to use MRI testing and the men find that a more user-friendly approach than the old time digital rectal exam, so the response has been overwhelming.
I was shocked when I walked in (the clinic) to see men in their thousands volunteering for the first time in this country to be tested. The old model was they don’t know (if they have cancer), they don’t want to know and by the time they find out, it is too late and they have to be hospitalised.
When we put on these drives, it is not only a test. We do lectures, we put on entertainment, we have Nikki Crosby coming in, we don’t put patients in a classroom, but in an environment where they are relaxed, there is entertainment, dancing, calypso, chutney, which end with the messages of behaviour change modification.”
There is another cultural/attitudinal shift that needs to take place. There is far too often on the part of health care providers a lack of professionalism, a lack of empathy, there is a lack of consequences for a failure on their part to provide efficient care to patients. It is part of the problem which plagues the broader public service.
“It is not only a public service problem. I think if we are honest, I think as a society, in both public and private sectors, our customer service could be improved.
I am not going to deny the fact that there are occasions when we do not live up to the high standards we set. But all the RHAs have been engaged in serious programmes of training and re-training and I must say that the number of complaints coming to me are declining. I must also pay tribute to a new class of healthcare professionals — doctors and nurses and others — who are in their 30s and 40s now, who deliver health care, a new generation that is stepping up to the plate in a significant way. You have the exceptions and I freely admit that, but empirically the number of complaints has been declining. But it is an ongoing process and as a country in both public and private sectors, we could all improve our approach to the customer.
In the public health sector, we estimate that we do about 1.5 to 2 million patient interactions per year. When you consider the size of that and the number of complaints you get, it is a relatively small number. So we get it right the vast majority of times, even though we don’t get credit for it.”
(The Minister stressed that it is the instances of alleged poor service which make the news, in which the allegations are often one-sided and sometimes inaccurate).
Do you think that there are health care professionals who have a vested interest in running down the public health sector so that the private health care sector could thrive?
“Oh yes. What has been allowed to evolve in the public health care system is an over-dependence on the private health care system in which for years we did not develop the capacity within the public sector to deal with certain things and we adopted the approach to referring the matter to the private sector and paying for it.
Under my watch we have started to reverse that. For example, the great cataract initiative in which we hardly send anyone to the private sector for cataract surgery any more, and we have also brought down the waiting list. We are ramping up our ability to do things like angiograms, catheterisation, in house. We are doing much more dialysis now in house because we have invested in more and more dialysis suites in San Fernando especially, Port of Spain and Sangre Grande and Mount Hope to a lesser extent.
By the end of my tenure as Minister of Health we would have doubled our dialysis capacity within the public sector, relying less and less on outsourcing.”
The delivery of elective surgeries has been affected by the shutting down of the Central Block and its replacement with the construction of a new facility. Many people who are on the elective surgery list are having difficulties to receive their surgery.
“Correct. That inconvenience would be coming to an end in the next month. We would be opening two new facilities within the next month — one at Port of Spain with about 67 beds and one at St James with 70-something beds and with new operating theatres to address the displacement that has come from the shutting down of the Central Block. And that cost the taxpayer about $56 million. Those who had the wheels of power previously did not attend to Central Block.”
What about shortages in CDAP?
Have you heard of any shortages recently?
I know within the last few weeks there was a problem of shortage with (an anti-seizure drug) Epilium.
“That is because there is a global shortage. With the exception of that, have you heard about any shortage of CDAP drugs? I chair a monthly meeting with the Ministry of Health, the chief pharmacist and NIPDEC.”
(Deyalsingh said the chronic shortages had disappeared because the Ministry has paid particular attention to this issue.
“We pay attention to all the essential drugs especially ...and we have done remarkably well but we still have to depend on the global supply chain for drugs and if there is a global shortage we are going to be affected as will other countries. But you hardly hear of chronic drug shortages (in CDAP) any more because of the close relationship I have with NIPDEC.”)
Are you willing to offer yourself as a candidate for re-election in the upcoming general election?
“You would be the fourth to know. The first to know would be my family, the second, the political leader; the third, my constituency, and if I decide and I am accepted by the screening committee, to run, the fourth would be, the media.”
The PNM’s chances of returning to Government rests with winning the marginal seats, including St Joseph. How do you see the party’s chances?
“I rate the party’s chances in St Joseph as excellent and of winning the next election as excellent as well. I think the population has accepted with a certain degree of honesty, the difficult times we faced and they have appreciated the work the Prime Minister has done in being forthright. The population understands that we have had to take some difficult decisions and that we are beginning to see a lot of light at the end of the tunnel. And I have absolutely no doubt that Dr Keith Rowley is going to be the next Prime Minister of Trinidad and Tobago.”