Healthcare nightmare: COVID-19 and our economic woes

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Dr Alphonsus St Rose is a consultant physician (internal medicine), internist and gastroenterologist. He is a member of the American College of Gastroenterology and can be reached at: stroserae@gmail.com

By Dr Alphonsus St Rose

As a past president of the Saint Lucia Medical and Dental Association (SLMDA), a senior practicing physician and more important a citizen of this land we love, few might appreciate the pain it is for me to continue witnessing with no end in sight; inhumane, unconscionable and undignified healthcare delivery system in a rapid downward spiral. This is now compounded by an uncertain yet rapidly evolving COVID-19 pandemic, never-mind that we brag of only three positive cases to date.

The national economic and healthcare development strategies are meant to provide fair and equitable returns and relief to you the people, to improve and sustain your daily lives; but not to make your lives a living hell, plain and simple.

COVID-19 in this context has caught us flat-footed and it is my cautiously guarded hope that it will not be a financial and humanitarian nightmare, especially for the vast majority of our citizens who, after 41 years of independence, have by and large been felt left out of the wealth and growth equity of this country. There can be no moral, social, ethically or humanitarian justification for that and COVID-19 will further expose the ever-widening fault-lines in our democracy and structure of governance.

And so, it was some three years ago when I started advocating a paradigm shift for better healthcare on behalf of the public, we at SLMDA were labelled (as being) political. That is the deliberate narrative of false equivalence, much like comparing apples and oranges.

The enemies of the poor seem quite incapable it appears, of appreciating the difference between a clear core political issue (healthcare), which, when being expressed and advocated, ought not to be partisan but rather constructed and conducted in a national context.

No matter what the issue being articulated, it must be viewed in the context of all the citizens and the country rather than from a strictly partisan point of view. I was convinced of that in much the same way as I have come to appreciate that in this life some things (like healthcare) do transcend politics.

Today, the public is validating our expressed concerns while building momentum in openly expressing its anxiety, disgust, and horror at what obtains and passes as a healthcare delivery system in this country. It then begs the rhetorical question, are the people going to be labelled political too?

Healthcare is the single most important issue threatening survival today. Let me explain why this is so important. Healthcare is an expression of the respect and humanity we share for each other. Your health is your life. Without proper healthcare jobs are at stake; the welfare of your families is at risk.

Epidemiology principles dictate that the best prevention and containment strategy in a pandemic crisis is;

  • Robust border restrictions with swift and enforceable isolation/quarantine measures;
  • Community-wide education/awareness campaign;
  • Rapid and early mass-testing capabilities for quick identification of positive cases to help frame/manage an appropriate public health pandemic response, which is critical for saving lives and buffering the economy.

Physicians, nurses, and healthcare workers risking our lives on the frontline took an oath to serve the public and we will do just that. But to the authorities I say, caution, don’t you dare sacrifice us on the frontline by failing to provide us with proper standardized, protective supplies and equipment. There can be no acceptable rolling back of the standards here for us on the frontline as we too have loved ones, families and friends.

We must also learn from preceding crises, such as in the case of the USA, for example, where the tardiness of its response mechanism to preparation, isolation, and testing has placed a severe social, humanitarian and economic cost burden, not only on itself but also on an interconnected world.

The battle-front cannot be economic stimulation over disease prevention and protection of especially the healthcare workers on the frontline. COVID-19 is what will flatten the economy, not the other way around. Lack of preparation, non-transparency, dishonesty and mistakes/missteps will be the COVID-19 culture-dish for disaster.

This is a time for strong and decisive leadership with a clear goal of closing our borders, promoting social distancing, diverting resources towards containing and fighting COVID-19; and carefully creating a plan for fiscal and monetary incentives backed by transparent legal and regulatory oversight. Any quantitative easing to stop the economy from free-fall and especially with regard to deregulation should be weighed carefully against weakening the war on COVID-19.

Our smallness in size, population, and resources ought not to be a reason to do badly and should not deter us from doing our best in this moment of mass crisis. The strategy, response, and narrative must be medically/epidemiologically driven rather than being politically /economically framed.

The COVID-19 pandemic serves to highlight the conflict of interest between the health of the nation and corporate wealth, with public health policy sandwiched in-between. Corporate Saint Lucia is now attempting to navigate the inherent contradictions, its goals as a corporation presents, especially its conflict with public health at this moment. Can there be a point of reconciliation between corporate Saint Lucia’s wealth ambitions and public health policy designed to protect society?

As long as corporate Saint Lucia is not held to act responsibly, and continues to influence governments, legislation and political processes for their own good, and anti-corruption laws that are not enforced fairly, it remains a purveyor of the status quo working against the greater social and public good; and the reconciliation construct will remain at best an oxymoron.

I believe the prime minister probably means well in his pronouncements on strategies to protect the citizens and homeland, but his actions are much weaker than his words. Much is being touted about a long-awaited economic stimulus package. And yes, unlike markets that respond to confidence, the economy is taking a direct and heavy hit because of non-diversification, the low resiliency and redundancy it has to withstand the shock and impact of COVID-19.

Undoubtedly the pressure he is subjected to by the business community is tremendous. I, however, warn against corporate greed as well as resource(s) control and distribution inequities nationwide in providing any economic and other relief packages. Healthcare workers and the complimentary supply chain must be adequately and appropriately stimulated. The working class, the poor, vulnerable, challenged, indigent and senior citizens must all be highly prioritized and fairly represented. Small and medium-sized businesses must not be sacrificed at the altar of corporate expediency or over-exuberance.

The disturbing reality of Saint Lucian citizens today confronting COVID-19 while having to openly disparage the healthcare system as broken and dehumanizing, in crisis and unconscionable has become, the cancer that will destroy this nation’s soul and its human dignity.

It is therefore important that when we rise out of post-COVID-19 ashes, there will be a moment for deep reflection, for rebuilding, for a reset and course correction on a personal and national level.

One of the national priorities will be economic diversification, productivity, and growth, which should be connected to a social progress index. This should include a reduction of poverty, addressing inequality and economic exclusion, increased environmental protection and a sustainable economy that contributes to the social progress demands.

There must be a better balance between economic growth and social development, environmental stability and cultural preservation, backed by good governance, all of which must positively impact national well-being, the lack of which contributes to the national chaos that we presently see.

The urgency with which we prepare and take action will determine how well we do in this critical moment. Prevention and containment are always better than attempting to cure a sick nation and rebuilding a flattened national economy; more so, in a nation of diminishing economic returns, immersed in a high debt to GDP ratio, unemployment, illiteracy, inequality, poverty and where corruption is now a norm.

Our leaders must not only model what they are expecting us to do, but there must also be honesty and transparency regarding information shared with the public. Good governance is poor and lacking. Businesses exploit the populace with impunity and no one sees it fitting to defend the public interest.

Our governments have been poor negotiators on our behalf; they have negotiated our lands, monies, sovereign instruments, beaches and even our future, which they outsource to big businesses leaving us vulnerable to exploitation.

Governments set policies that affect the lives of its citizens and must place the national interest of the people above politics and profiteering.  We must welcome the private sector to assist with nation-building, but our leaders must ensure that they operate with a measure of social conscience. It is high time the citizens become the major priority of any government that wants to lead them.

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