That Prime Minister Keith Rowley recognises something ought to be done about our health service delivery should be lauded. But that commendation is not from the point of view of recognition of the inherent non-systems—we who access public service health could each write a volume—but it’s that in his capacity as PM he is undertaking reform.
I should be optimistic about the news that the RHAs are to be reviewed and that doctors who straddle both private and public care should have some kind of code of governance. Really, I should be gathering my years of notes and begin preparing for the national consultations that must come from such an exercise.
I do not profess to know much of anything about the committee leadership and members but I trust the decision-making of Dr Rowley unambiguously.
I congratulate chairman Dr Winston Welch, on his appointment. I’m certain that T&T’s own Howard University president Dr Wayne Frederick will bring the appropriate perspective in the male-dominated team—one woman included to talk about nationally healthcare.
So why do I feel so heavy-hearted?
First, because whenever the emphasis on health does not include mental health with parity to physical health it is always concerning.
The WHO says: “Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life. On this basis, the promotion, protection and restoration of mental health can be regarded as a vital concern of individuals, communities and societies throughout the world.”
It could be that in the remit of the committee mental health reform is entrenched and I’m going to be accused of speaking out of turn.
But I speak from the past experience of every other health review in this country and I suspect without seeing efforts towards gathering the required evidence/statistics, the “burden of mental disorders is likely to be underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions” and other reasons.
Secondly, Gerry Kangalee, writing for the National Workers Union, listed some of my health sector burnout and others from before my time, all of which I’m sure is/was necessary so that someday, sometime, hopefully in my lifetime, we’d get it right.
I was around for The Toby Commission Report of 1982, and the Gafoor Commission of 2006 of which Kangalee made mention. The decentralisation of public health system in the 1990s as “a condition of the health sector loan (US$192 million) (which) the government accessed from the Inter-American Development Bank (IDB),” was in my time too (http://www.workersunion.org.tt/).
The latter saw the birth of the regional health authorities, a concept that never evolved into better healthcare and one which totally tossed mental health as the responsibility of no one in particular in T&T.
For my 50-odd years here, there’s really been no positive difference in the delivery of care for all kinds of reasons and under all kinds of administrations and that accounts for my committee burnout.
More than that, is an underlying grievance for the lack of prominence of public mental healthcare in all of the permutations, an error we may well repeat in 2015 given the main focus enunciated for this health review committee.
I need to be optimistic but I may be having a mood swing to the “south pole” of my emotions with the pressures I feel from my own life circumstances.
T&T has never once bothered with mental healthcare and if we think the pint-size efforts here and there by those who do not hold the power of a Rowley, Deyalsingh, and Khan et al, before them would get us to a better place, we may end up disappointed.
Mental healthcare would have done well to feature as a separate issue of equal prominence when the Welsh committee was presented with its RHA reform and doctors’ private/public care headlines.
It may well be in the committee’s remit, but I daresay, if it’s there, it should been a headliner in 2015. Then we would know that we are being governed by people with an understanding of the clear and present danger of sweeping mental healthcare under the rug. Or simply walking over and talking over it hoping somehow it would get some attention.
I wish I did not feel as humdrum as I do but I constantly carry the anxiety that I will have to live here without the enshrined rights and freedom that my constitution promises; that in a country of equal place I’ll remain less equal and people would continue to take opportunity to let me know either by commission or by omission.
In this country of put-downs, this contemplation may also just be put down to a “mad man rant.”
Again, I may be heading off the discourse but I take that risk to say that there is no health without mental health and therefore there is no health reform without proper mental health reform. Not tokenism. Reform.
I wait with bated breath.