Editorial: Health care priorities

When the Mount St John’s Medical Centre (MSJMC) performed its first kidney transplant, we, like the rest of the citizenry, were elated.  Today, we are again happy to hear of the resumption of pacemaker implantations and the planned upgrades of the cardiac care facilities at MSJMC.
These announcements are good news for the nation as it opens up new avenues for better care for our locals as well as revenue opportunities for our local hospital.  It would seem that we have been talking about medical tourism forever but little has been done.  Now we are a few steps closer to a small realisation of that dream.
For this, we would like to congratulate the government, the Minister of Health, Molwyn Joseph and all the hard-working staff at MSJMC for getting these initiatives off the ground.  If we continue to press ahead in this manner, we will one day realise the dream of being the number one medical destination in the Caribbean.
At the same time, we need to keep in mind that an ounce of prevention is worth a pound of cure.   We cannot concentrate on the headline making facilities and treatments and ignore the front-line defense against preventable non-communicable diseases – our health centres.
Shortly after Minister Joseph had announced a number of major developments in the field of cardiac medicine in Antigua & Barbuda, he revealed several buildings and units that fall under the Ministry of Health have been earmarked for either demolition or repairs – including two units at the Fiennes Institute and some community health centres.  As the minister stated, they do not meet the standards that his government desires for the delivery of health care.
While we care about all the institutions that were mentioned, in the area of preventable care, we are particularly concerned about our health centres.  As we said, these are the first line of defense against non-communicable diseases.  These are the places that people visit before they reach MSJMC.  These are the places that are most accessible to people and where they can go to get information and advice about obesity, hypertension, diabetes, etc. Places that greatly assist in reducing the need for things like pacemakers and other cardiac procedures.
The minister stated, “We have to close the Central Board of Health on All Saints Road. That building has not been maintained for decades.”  He added that a representative from PAHO recently visited the country and witnessed the deplorable condition of the building. “This is egregious that the people of Antigua & Barbuda have been so badly served … the lack of maintenance, the walls, the infestation. The top floor is uninhabitable…,” he said.
For the purposes of this conversation, the issue is, the CBH building also houses the St John’s Health Centre where a large percentage of the public access a number of medical services and which the minister said will now have to be outsourced to other community health centres.
That right there is the balance that we as a community (and the government) must find.  The health centres cater to large numbers of population while the cardiac care unit and the high-end treatments will cater to a small fraction of those numbers.  As well, the health centres provide care and information that can reduce the numbers that may eventually seek this more extreme care. 
Right now, the minister is attempting to do both, and while that is admirable, we wonder if our limited resources will allow him to be successful in that lofty pursuit.  Will the minister be successful in trying persuading his colleagues to provide the resources to boost the offerings at both the MSJMC and the community health care facilities?  We sure hope so and we wish him luck. 
Just in case he has to make a decision and prioritise where the money has to be spent, we would like to suggest that the community health centres occupy the top spot.  They impact the lives of more people, they relieve the strain on MSJMC, and ultimately they can have a bigger impact on the health care services provided to the nation – both in terms of cost and effectiveness.
Non-communicable diseases represent the greatest health risks and ultimately costs to our nation.  The statistics are staggering and the trends are worrisome.  With the limited resources available to us, we think that spending on community level health care will reap greater rewards than investing in equipment and expertise to treat these disease later on.  Prevention rather than cure should be our motto.
If both can be achieved at the same time, then please press on.  We will be back to congratulate everyone if that goal is achieved.