Midterm report: Health and Social Development

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SPECIAL REPORT: MIDTERM, PART 3 OF 5

Hospital the key for health hopes

Minister: Much groundwork has been laid

By CHRYSTALL KANYUCK ckanyuck@bvibeacon.com

Health and Social Development Minister Ronnie Skelton has a lot riding on the new hospital.

National Democratic Party campaign promises could dramatically change the way health care is delivered in the territory, but without the new hospital, many of the more ambitious goals won’t be possible.

Mr. Skelton said recently that the facility, which was handed over to government on Oct. 31, will be ready to open in April. But after five years of construction de-

Midterm see page 28

INSIDE Beacon Business..........................12 Vol. 29 No. 24 • 2 sections, 56 pages Road Town, Tortola, British Virgin Islands © 2013, The BVI BEACON

The light that comes from wisdom never goes out.

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Biwater project to kick into high gear in Jan. Several million dollars in works to begin soon

By JASON SMITH jsmith@bvibeacon.com Three shovel-wielding construction workers stood in a deep pit in Paraquita Bay Tuesday afternoon as a backhoe noisily scraped away

Anegada event dubbed a success

mud at the pit’s bottom.

The pit, located on Crown land currently leased to the United Kingdom-based firm Biwater, will soon house a seawater pump station that will link intake pipes with a new desalination plant that has yet to be completed.

That plant will produce the 2.3 million imperial gallons of water per day that government has agreed to purchase from the firm. It is expected to become operational midway through

next year, according to Richard Smith, Biwater’s Virgin Islands project manager. It will be followed by the installation of two sewage treatment plants, repaired pump stations, and more than 600,000 feet of 12-inch sewer mains.

All aspects of the project are set to be completed by November 2014, Mr. Smith said, adding that several million dollars’ worth of construction works to be performed by local

Biwater see page 20

Lobster for sale

By NGOVOU GYANG ngyang@bvibeacon.com “My name is Sam, with the capital S. I am the man with the plan,” Chef Claudius Sam told a group of visitors who stopped at Potter’s by the Sea on Saturday during the first Anegada Lobster Festival.

Mr. Sam was serving lobsters wrapped in foil from a nearby grill.

“I can’t share my secret with you,” he told patrons. “My secret is different from everyone. I am the lobster specialist.”

Chefs at several restaurants around Anegada had a similar routine as they offered samples of lobster dishes to the nearly 800 people who visited the sister island on ferries for the two-day festival.

The first-time event, which was sponsored by the BVI Tourist Board, was scheduled to coincide with the end of Restaurant Week.

Saturday’s event

As guests arrived at the Anegada ferry dock on Saturday, they were served rum and fruit punch, and given maps to participating restaurants.

For most visitors, the first stop was Potter’s by the Sea, where Mr. Lobster see page 17

Photo: NGOVOU GYANG Claudius Sam, a chef at Potter’s by the Sea, shows off lobsters from his fish pot on Saturday during the first Anegada Lobster Festival.

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lays and other promises, many residents are sceptical.

“We are not where we’d like to be, but we are making some progress,” Mr. Skelton said in an interview last month.

The hospital is the cornerstone for many of the government’s promises: improved emergency care, better health screening services, more specialist care, and National Health Insurance, for example.

All of these goals fall under Mr. Skelton’s portfolio as HSD minister, as do many social services, from garbage collection to the autism programme; from aid for needy families to services for seniors.

Progress on the hospital is easy to see. And, if things go according to Mr. Skelton’s plans, the facility will be a foundation on which to build.

“It will have a much higher level of equipment,” he said.

“With that comes recruitment of a higher level of staffing.”

Hospital critics

But critics have questioned whether or not the territory really needs so much hospital.

“I’ve made no secret about it: I think it’s foolishness,” said Alred Frett, managing director of B&F Medical Clinic. Mr. Frett, a former legislator and the minister of health, education and welfare from 1995-1997, advocated for a much smaller new hospital during his time in office.

“What I proposed was a $24 million hospital,” Mr. Frett said.

The costs for the new hospital are expected to total more than $100 million, a cost Mr. Frett said the government can’t afford.

According to Mr. Skelton, however, the goal is not only to modernise services for residents, but to begin the process of turning the territory into a destination for medical tourists.

NDP leaders floated the idea of medical tourism during their last term in office. During a 2006 state of the territory address, then-Chief Minister Dr. Orlando Smith said it would be one part of his government’s strategy to ensure “a more stable flow of visitors.”

In 2010, after government had changed hands, leaders commissioned a study into the feasi-

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Special Report

A MIDTERM PROGRESS REPORT FOR THE 2011 ELECTION PLEDGES: MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT HEALTH NEW HOSPITAL

YES

NO

PARTIAL

DISABLED TAX CONCESSIONS

HEALTH SCREENING

PLEDGE: Institute a regime of tax concessions on devices and apparatus used by the disabled.

The 2010 Customs Act exempts prosthetic devices and some medical equipment from duty charges, but no “regime” or new concessions have been established.

PLEDGE: Ensure that selected early screening and secondary prevention services are available to residents.

As in the past, public health facilities provide mammograms and screenings for ailments like prostate cancer and diabetes, Mr. Skelton said, adding that the new hospital, with its imaging wing, will provide additional screening services.

YES

NO

PARTIAL

EMERGENCY CARE YES

NO

PARTIAL

PLEDGE: Finish the new hospital, bring health care into the 21st Century, and build a culture of volunteerism to support caregivers.

Construction is finished at the hospital, and the facility was handed over by the contractor on Oct. 31. Health and Social Development Minister Ronnie Skelton said so far it’s on target to be equipped and opened in March. Officials have said that the new hospital is the key to modernising the territory’s health sector.

NO

AIDS EDUCATION YES

NO

PARTIAL

PLEDGE: Continue to focus on the AIDS epidemic and the treatment of residents affected by the disease.

The ministry collaborated with Pan American Health Organisation to publish a set of national protocols on HIV and AIDS treatment in 2012, and training with health care providers on the new standards is ongoing, according to National AIDS Programme Coordinator Noelene Levons-Clarke.

ALLIED HEALTH YES

NO

PARTIAL

PLEDGE: Provide specialist health services such as physiotherapy, medical imaging, and laboratory testing.

Some of the required equipment already has been installed at the new hospital, and the rest is scheduled to come on stream when the facility opens, according to Mr. Skelton. Some specialist care is already provided by government’s partnership with HIMAHealth, and the ministry is also in discussions with possible partners to provide more specialist services.

CHRONIC DISEASES YES

NO

PARTIAL

PLEDGE: Improve the methods and efficiency of educating the public regarding chronic and acute health conditions.

Mr. Skelton appointed a Health and Wellness Council to help educate the public in line with the previous government’s 2011 strategy for chronic non-communicable diseases, he said, adding that the council includes representatives from the health care, education and other sectors.

PARTIAL

HELIPADS

YES NO PARTIAL PLEDGE: Build helipads for emergency evacuation from Anegada and Jost Van Dyke.

Government has prioritised medical evacuation services in the form of an ambulance boat, and plans have been drawn up for a JVD helipad, Mr. Skelton said.

YES NO PARTIAL PLEDGE: Establish community-based care for the mentally ill.

The territory has offered a community-based mental health care programme for many years. In October, government published a Mental Health Policy, its strategy for continuing and improving these services.

PARTIAL

PLEDGE: Develop and implement the National Health Insurance scheme.

A major administrative component of NHI, an amendment to the Social Security Act, was introduced in the House of Assembly Nov. 19. Mr. Skelton said he expects the second piece of legislation needed to implement the programme to come by the end of the year, with the system taking effect by mid year.

NO

MENTAL HEALTH

NHI YES

YES

OVERSEAS PROVIDERS

YES

PLEDGE: Build a modern, efficient emergency health care system that is responsive and cost efficient.

The emergency wing of the new hospital will be a state-ofthe-art facility, Mr. Skelton said.

IMPROVE CLINICS YES

NO

PARTIAL

PLEDGE: Make clinics more functional in local communities in terms of structure and services provided. Extend clinic hours and create a network to enable onsite diagnostics and information sharing.

Clinic hours are still under review, with the goal being to have one clinic open on the eastern and western ends of Tortola in the evenings, with an ambulance stationed at each for emergency transport to Peebles Hospital, Mr. Skelton said. The BVIHSA’s new patient cards enable public health care providers to see patient care records, but the system isn’t in place at all locations.

FREE MEDICATIONS YES

NO

PARTIAL

PLEDGE: Provide free prescription drugs and eyeglasses for seniors in financial need.

Prescription medications, like all regular health care services for seniors, children, and some other groups, continue to be free at public health facilities, as they were in the past.

HEALTH CARE TRAINING

YES NO PARTIAL PLEDGE: Focus on training more doctors, nurses and allied health professionals for a variety of roles within the health services.

Students pursuing health care get priority when it comes to government scholarships, Mr. Skelton said. He added that a more robust training regime is in the works as government prepares to add staff for the new hospital. Some critics have questioned the government’s ability to properly staff the facility.

NO PARTIAL PLEDGE: Review and streamline existing relationships with overseas health care providers.

In addition to the territory’s formal partnership with Puerto Rico-based HIMA Health, government is in talks with other providers with a view toward establishing a system of “tele-medicine,” so that health care professionals overseas can treat VI patients by phone or Internet, Mr. Skelton said.

REVIEW BVIHSA

YES NO PARTIAL PLEDGE: Review the BVI Health Services Authority with a view to making it more efficient and responsive to the needs of the community.

The process is ongoing, and started with appointments of a new chairman of the board, John Cline, and a new CEO, Darlene Carty-Baptiste. The organisation has made strides to modernise medical records and make bill collecting more efficient, among other moves, according to the minister.

VG HEALTH CARE

YES NO PARTIAL PLEDGE: Add an emergency wing to the Iris O’Neal Clinic on Virgin Gorda, as the first phase of development of the new mini-hospital for that island.

After presenting concept designs earlier this year and sending the project out to tender, a builder has been selected for the new mini-hospital on VG, Mr. Skelton said. He added that plans will be presented at a public meeting “very soon.”

JVD DOCTOR

YES NO PARTIAL PLEDGE: Secure the services of a medical doctor to be stationed on Jost Van Dyke.

As in the past, the BVIHSA employs a doctor who rotates between Cappoons Bay, Cane Garden Bay and Jost Van Dyke.

GERIATRIC WARD

YES NO PARTIAL PLEDGE: Establish a Geriatric Ward in the hospital Hospital wards continue to be divided based on types of services being provided, not on the age of the patients.

Special Report

The BVI Beacon | Thursday, December 5, 2013

A MIDTERM PROGRESS REPORT FOR THE 2011 ELECTION PLEDGES: MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT ENVIRONMENTAL HEALTH

YES

NO

PARTIAL

PLEDGE: Review the current environmental health strategy, and improve related public education measures.

The Caribbean Public Health Agency commissioned a Caricom body called the Caribbean Centre for Development Administration to assess the VI Environmental Health Division this year. The assessment report, when finished, is to guide planning of a new environmental health strategy.

RECYCLING

YES

NO

PARTIAL

NO

PRESCRIPTION DRUGS YES

NO

PARTIAL

PLEDGE: Ensure that essential prescription medications are always available to the public at affordable prices.

As in the past, the territory participates in group purchases with other Caribbean states, which means it gets bulk-rate prices, according to the minister.

ASSISTANCE PROGRAMMES

YES

NO

PARTIAL

PLEDGE: Review the current system of assistance programmes, which allows the public to seek funds from three sources: the Social Development Department, the Ministry of Health, and members of the House of Assembly. Redefine the “poor and destitute” to include coverage for physically disabled and other challenged persons.

A draft of a new Public Assistance Act was introduced in the HOA on Nov. 19. Mr. Skelton said the law would help standardise the process of granting aid, so that public assistance for those in need is managed under the Social Development Department. The law also includes a new definition of “destitute.”

COMMUNITY CENTRES

YES

NO

PARTIAL

PLEDGE: Utilise the community centres to implement programmes directed at assisting senior citizens in the various districts.

As in the past, some community centres, such as those in East End and Carrot Bay, have continued to offer programmes for seniors a few days a week, but Mr. Skelton said he thinks the centres can be better utilised. He added that he hopes that private individuals will step forward to offer additional programmes from the centres.

NEW SENIORS’ HOME

YES

NO

YES

PARTIAL

PLEDGE: Ensure that people with disabilities enjoy full equality, especially in the areas of education, employment and accessibility to services and transportation.

Although a draft disability policy was completed under the previous administration, it still hasn’t been adopted by government. No law designed specifically to guarantee the rights of the disabled exists in the territory, though officials have acknowledged that much needs to be done in this area. Advocates say that the disabled routinely face discrimination in the territory.

PARTIAL

PLEDGE: Build a new home for the elderly at Spooners Estate.

Site preparation such as grading has already taken place, and the full home went out to bid in May. Tenders have been submitted, and the ministry is working on selecting a firm now, Mr. Skelton said.

NO PARTIAL PLEDGE: Change the territory’s “approach to young males,” and have a dialogue about how to help them feel less marginalised.

The Ministry of Education and Culture appointed a Youth Policy Committee in October 2012. A draft policy was submitted to the MEC in March and is under review.

UNEMPLOYMENT INSURANCE

HANDICAP ACCESS YES

YOUNG MEN

YES

PLEDGE: Commission a feasibility study on the establishment of a recycling programme in the territory.

As part of studying the feasibility of a territory-wide recycling programme, a pilot programme began in Virgin Gorda in August, according to the minister. The Department of Waste Management will be installing additional recycling bins around Road Town soon, he added.

NO

PARTIAL

PLEDGE: “Explore the feasibility of enabling the introduction of unemployment insurance benefits to workers, particularly those in the hospitality industry, who are unemployed for extended periods during the off-season.”

No feasibility study has occurred. This year, however, some seasonally employed workers were given informal assistance through the Premier’s Office, said Permanent Secretary Rosalie Adams.

SENIOR BUREAU YES

NO

PARTIAL PLEDGE: Develop a Senior Citizen’s Bureau to offer services such as home assessment and repair, to advocate for the elderly, and to develop a system of volunteers to help the elderly with errands.

No such bureau has been created, according to MHSD Permanent Secretary Petrona Davies.

ELDERLY CARE YES

NO

PARTIAL

PLEDGE: Institute “incentives and concessions” to ensure that the elderly have access to alternative care and flexible and residential services.

Through the Social Development Department, government does offer some home-care services for seniors and other homebound residents, and has training programmes to certify in-home caregivers, but no special incentives or concessions have been established.

INCINERATOR POWER

YES

NO

PARTIAL

PLEDGE: The new incinerator will be reviewed with a view to exploring the possibility of using the steam generated by the facility to generate electricity.

Although a study concluded that getting power from the incinerator isn’t practical for government to do, officials are in negotiations with firms interested in taking on the project as a private enterprise, Communications and Works Minister Mark Vanterpool said.

VG SOLID WASTE

YES

NO PARTIAL PLEDGE: Review the disposal of solid waste on Virgin Gorda with a view to utilising the extra capacity of the new incinerator on Tortola and closing the Virgin Gorda dumpsite.

A recycling and sorting programme is the first step in this process, Mr. Skelton said, adding that the plan is for the dump at Jost Van Dyke to be closed as well, with waste being compacted and shipped to Pockwood Pond.

BENEFITS CHANGE

YES NO PARTIAL PLEDGE: Create a seamless system of retirement for the public sector where eligibility for pension and social security benefits would be at the same age.

The ministry is working with the Social Security Board to review the current age to receive benefits, which is 65. Pension availability begins at age 60 for government employees who have worked 25 years in public service.

FAMILY SUPPORT YES

NO

PARTIAL

PLEDGE: Encourage the rehabilitation of the extended family, with a view to building better social and economic support for the elderly.

No formal programmes have been launched, although rebuilding extended family ties has been recommended as a factor that could help deter crime and anti-social behaviour in youth at community meetings and other public forums like last year’s crime conference.

SENIOR ACTIVITIES YES

NO

PARTIAL

PLEDGE: “Create opportunities to utilise the skills and energies of an increasingly healthy and active senior citizens population.”

Many territory seniors participate in volunteer programmes through their churches or other non-profit organisations, but no new government programmes have been started to supplement such efforts, said the Social Development Department’s Annie Malone-Frett.

SENIOR DIRECTOR YES NO PARTIAL PLEDGE: Appoint a director of senior citizens programmes and services to ensure the coordination of the all programmes and services established for senior citizens.

As in previous years, the SDD has a head of seniors and disability programmes, but no new position has been created, Ms. Malone-Frett said.

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bility of hosting a medical school at the new hospital.

Although the study was never made public, Mr. Skelton said during last year’s Standing Finance Committee meeting that the idea isn’t off the table, telling fellow legislators that his ministry would be working with the Ministry of Education and Culture to create a legal framework for medical schools in the territory.

At the time, opposition member Andrew Fahie (R-D1) supported the idea of a medical school, which he said could be a source of revenue for the BVI Health Services Authority.

In keeping with the goal, Mr. Skelton said he wants to see “a significant name associated with Peebles.”

“If you can get the Mayo Clinic to partner with you on the hospital, it says a lot about the place and quality of services you’re going to get,” he said, adding, “It’s going to take time, though.”

In a statement in the House of Assembly in November, Mr. Skelton elaborated on this plan. According to the minister, a combination of modern facilities and partnerships with United States-based healthcare institutions would attract a high volume of patients from the Caribbean and the US, and help the territory carve out a piece of the $100 billion international medical tourism market.

National Health Insurance

Like the hospital, the other marquee NDP pledge under Mr. Skelton’s portfolio, National Health Insurance, predates the current administration and has been delayed several times before. The latest estimate from Mr. Skelton is that the system will start by “midyear” in 2014.

Social Security Board Deputy Director Roy Barry’s estimate, however, was more conservative. Asked on a radio programme in October when he thought NHI would begin, Mr. Barry said he didn’t expect it until the third quarter of 2014.

When the NDP went “On the Road” with district meetings this year, along with crowds came criticism of NHI. Residents said they were concerned about a range of topics.

Some rose to say they were small business owners who couldn’t see how they could afford to pay 3.5 percent of their employees’

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wages into the system and still stay in business.

Others questioned whether the government can afford the system, or questioned the methods of the actuarial study carried out by a team from the University of the West Indies. Officials said the costs are derived from that study.

Other NHI critics said the plan would leave no work for private insurance companies.

For his part, Mr. Frett said he doesn’t see how the system can work with such a small population, and he questioned why, if detailed actuarial studies have been done, these studies haven’t been made public.

“We must find out. Show us how it’s going to be beneficial and sustainable,” Mr. Frett said, calling the proposed system a “massive financial burden.”

In February at a meeting in Carrot Bay Mr. Skelton countered that that the plan was needed for the “greater good” of the territory.

Public meetings

In last month’s interview, Mr. Skelton said the ministry changed tack in August. Instead of public meetings, which he said can get taken over by “loudmouths,” a series of smaller meetings aimed at businesses or specific industries has been held.

“Based on my talking to a couple of them, they basically have bought in,” the minister said. He later added that some people will resist change no matter what.

“There will always be those who have no intention of getting on board,” Mr. Skelton said. A bit of opposition doesn’t mean the plan isn’t “workable,” he added.

“I was a young professional when we were getting the social security system started and we had the same fights,” he said. “They thought it couldn’t work, and now it’s one of the success stories of this country.”

November saw the introduction of the first legal change to set up NHI in the House of Assembly: an amendment to the Social Security Act. Mr. Skelton said at the time that another piece of legislation would also be necessary before NHI can launch.

At that HOA meeting, opposition legislators called for more public input into NHI. Julian Fraser (R-D3) said at least one public hearing should be held after the bill is published.

Mr. Fahie agreed, urging gov-

ernment not to continue marketing NHI to the public until the bill is released.

“Let us make sure what is being marketed is what’s going to be in the legislation,” Mr. Fahie said.

One key NHI detail yet to be finalised is the start-up funding, Mr. Skelton explained. The plan calls for residents pay into the system for a period of three months before accessing any services. He acknowledged the gap is “not a good selling point” for NHI. “How can you cancel your insurance or pay twice for insurance?” Mr. Skelton said. In years past, he added, VI residents’ national pride would have led them to pay ahead on the system.

“Long ago we would have paid it, knowing full well that there was this transition period that we must assist with,” he said.

He added that he is working with Premier Dr. Orlando Smith, who is the minister of finance, to “bridge the gap.” He said officials first need to determine how much the system will cost to administer in the first few months. Government would then take out a loan to cover the costs, to be paid back as residents pay into the system, he said.

VG, clinics

Other NDP pledges deal with healthcare at the community level.

Plans have been drawn up and met with approval by the Virgin Gorda community for the “minihospital” promised for the sister island in the NDP manifesto. The project may be behind, but it is still on track, according to the minister.

“It is a long overdue project,” Mr. Skelton said.

In the House of Assembly in April, Mr. Skelton said drawings for the clinic were done. Plans included an ambulance bay, modern laboratory facilities, procedure and treatment rooms, and emergency rooms with “state-of-the art equipment to assist with stabilising patients for transfer as needed,” he said then.

Residents had called previous plans for the clinic too elaborate, and sent designers back to the drawing board, MHSD Permanent Secretary Petrona Davies said at a May meeting. The planned $4.5 million, two-storey structure will include a helipad, a back-up generator and plenty of parking, architect Avaline Potter said at the meeting.

Gesturing to some of the drawings of the proposed clinic in his office, Mr. Skelton said last month

Special Report that the project was ready to go out to tender. It’s expected to take about 18 months to complete.

Encouraging the public to make better use of the various community clinics has been a challenge of his time in office, Mr. Skelton said.

Some of the problem has to do with the clinic hours, a problem he plans to address by setting up “open late” clinics on the eastern and western sides of Tortola.

“We want to see a couple of clinics open till 8 or 9 o’clock at night,” Mr. Skelton said. “People with minor issues can go there instead of rushing to the emergency room.”

As with other plans, however, “It’s going to take some money and it’s going to take some time.”

For VG residents whose ailments are more serious, Mr. Skelton said that the ambulance boat (first purchased as a firefighting vessel during the NDP’s previous term) is “almost ready to go.” The boat will be stationed on the sister island, but won’t run until a captain is hired to operate it.

Elderly, other issues

Activities and care for seniors, responsibilities that also fall under the MHSD, received a lot of attention in the NDP’s 2011 manifesto, but progress in this area is much harder to see.

Most visible is the plan for a home in Spooners Estate to replace the current Adina Donovan Home for the Elderly in Road Town. Annual reports from the facility have called attention to the home’s change in recent years from an elder care facility to a nursing home. The Road Town home is not staffed with the medical professionals needed for a proper nursing home, the reports say.

Meanwhile, some paving has already taken place at the Spooners Estate site, and requests for tenders first went out in June, Mr. Skelton said. A technical issue in the plans caused the request for tenders to be reissued with an extended deadline.

Once a bidder is selected and construction begins, the new home should take about 24 months to complete, according to the minister.

“But the government is committed to finishing that project,” Mr. Skelton said.

Opposition legislators have said that putting the elderly so far away from town and Peebles Hospital is a mistake, but according to the minister, the planned facility will be much larger and better fit

for the purpose.

He added that once the new home is completed, plans are to convert the Road Town home into a long-term mental health care facility, something he said the territory has never had.

Social issues

Also less visible is the territory’s progress in setting policies to guide leaders when it comes to making decisions about health care and other social issues. According to Mr. Skelton, the territory has put in place many of the recommendations called for in the 2010 Non-communicable Diseases Strategy, such as naming a Wellness Council made of residents from the education, health and other sectors.

The minister also cited the survey on Youth Health and Sexuality, which he said uncovered

some troubling things about the behaviour of some youth in the territory but set leaders on a path to tackle some of the issues raised head-on. He added that his ministry will collaborate with the Ministry of Education and Culture on the coming Youth Policy to address those issues.

MHSD Permanent Secretary Petrona Davies added that the ministry is also “actively working” on a healthy aging policy and a report on a recently completed environmental health assessment.

Although he can’t say for sure what the next two years will bring, Mr. Skelton said he hopes any subsequent government wouldn’t halt projects in progress just for spite.

“These things like health, education, social policy are much too important to be playing politics with,” he said.