QEH 50th Anniversary by Nation Publishing Co. Limited

24-PAGE FEATURE NOVEMBER 23, 2014

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Message from Joseph King, Chairman of the Queen Elizabeth Hospital, on the occasion of its 50th anniversary.

JOSEPH KING

HISTORY HAS SHOWN that this great institution, the Queen Elizabeth Hospital, having reached the age of 50 years, remains a resolute, dependable, and capable institution. An institution which continues that line of success and dependability expected of the premier

(RC)

Message from Dr Dexter James, chief executive officer of the Queen Elizabeth Hospital, on the occasion of its 50th anniversary. NOVEMBER 14, 1964, marked the official opening of our “rock of health” situate at Martindale’s Road. In this 50th year of existence, we celebrate with thousands of patients and families who have trusted their health, lives and future to the Queen Elizabeth Hospital (QEH). Today, we provide a comprehensive package of

services to the public of Barbados (and elsewhere) and with excellent outcomes. This package covers most disease conditions from “the brain to the toe” – neurology to footcare – with only a few medical conditions referred overseas for further treatment. During this year of celebrations, we wish to show immense appreciation and thanks to the employees, volunteers, boards of management, and our health partners, who have served this institution with distinction and support. Celebrating 50 years of

health-care institution in the country. The Queen Elizabeth Hospital opened in November 1964, and has achieved the distinction of being the only health institution that provides the total package in health care, and because of its multiplicity of services may claim to have reached that pinnacle of excellence and delivery of services second to none among the developing countries in the world.

continuous service is an amazing accomplishment for any business. The QEH is opened for service 24 hours a day, 365 days a year. This achievement means that the hospital has not closed its doors to the public in 50 years. To sustain such a business as a going concern against the backdrop of different political administrations, with different ideologies, different governance arrangements, and many changes in health-care administrators is by no means a small feat. In spite of our many achievements, we face the challenge of having to do more

Its efforts to be recognised as a fully accredited hospital should soon be achieved. Its management and staff must be congratulated for their efforts and the high levels of professionalism, dedication and achievements reached. The board of directors appreciates these attributes and offers its thanks to all staff past and present, who contributed to this significant achievement.

with less. Innovation must therefore be a key driver of sustainability within this context of dwindling resources. We must not fear the future but embrace it. In charting our vision for the future, let us all recommit to a legacy of quality care while preserving the philosophy of Universal Health Coverage – access to care by all. May God continue to bless us and oversee the future of the QEH as we continue to devote and extend ourselves to this labour of love: saving lives and strive towards Getting Better Together.

DR DEXTER JAMES

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SINCE OPENING in 1964, the Queen Elizabeth Hospital has expanded its bed capacity from 464 beds to the current 600 beds and can perform most surgeries, and specialised care. THE QUEEN ELIZABETH HOSPITAL (QEH), situated at Martindale’s Road, St Michael, opened its doors on November 14, 1964, to address the medical, surgical, clinical and treatment needs of Barbados and the Caribbean and to serve as a teaching hospital for those seeking a career in the medical profession. It is Barbados’ primary acute care medical facility and is an accredited teaching hospital affiliated with the University of the West Indies, Cave Hill Campus. Since its inception, the hospital has expanded its bed capacity from 464 beds to the current 600 beds and can perform most surgeries, and specialised care in the areas of gynaecology, paediatrics, obstetrics, cardiac surgery, psychotherapy, radiology, radiography and ophthalmology – among others. The hub of the QEH can be considered the Accident and Emergency Department, formerly known as the QEH Casualty, which in 1990 was transformed into the new Accident and Emergency Department. This department which was pioneered by Dr Irvine Brancker and Dr Van Tyne, opened with a team of initially 12 junior doctors and two consultants. Today there are over 20 doctors. As the busiest department in the QEH, doctors there attend to approximately 45 000 patients each

year. Operational plans for the QEH continue to focus on strengthening the delivery of quality health care with strategic direction guided by the 10-year plan for Health and the QEH Care Excellence Programme (CEP). The hospital’s vision statement is to be an accredited healthcare institution by embracing a culture of innovation, technology advancement and continuous improvement through research training and

education. Its mission statement is to be a high quality provider of safe, compassionate patient centred care delivered by a team of well trained and dedicated healthcare workers, while its motto is Irrupta tenet copula, which means “An unbroken chain unites us.” Among the hospital’s goals are: To be a centre of excellence for Continued on next page.

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From Page 3. trained and dedicated healthcare workers, while its motto is Irrupta tenet copula, which means “An unbroken chain unites us.” Among the hospital’s goals are: To be a centre of excellence for the delivery of secondary and tertiary medical care for Barbadians, visitors and persons referred from the region. To be a centre of excellence for undergraduate and postgraduate teaching of health care disciplines for Barbados and the region. To provide equality of health care and respect for the rights of individuals, irrespective of class, colour, creed, religion or sexual orientation. To have a continuing evaluation of the continuing evaluation of the cost-effectiveness of all aspects of health care delivery, to reduce wastage and enhance performance. To develop a complement of highly

THE QUEEN ELIZABETH HOSPITAL (QEH) offers the following surgical services:

THE DEPARTMENT OF PAEDIATRICS continues to provide optimal quality care for patients of the Queen Elizabeth Hospital. (RC) motivated employees, of services and the To harness new dedicated to the promotion of positive developments as principle that the patient interaction between required in accordance comes first in all health care workers in with the strategic deliberations and the community and the direction of the hospital. activities. hospital. To establish and To provide, develop To make the best use maintain standards and maintain a working of modern information which are internationally environment which is technology to enhance acceptable. clean, healthy and and sustain the To foster community conducive to team operations of the linkages in the overall building. hospital. development of the To commit to the To provide access to all hospital. upliftment of health available services and To empower all services in the timely vide access to all employees in the community through the available services and decision-making process. training of the training of timely response to To provide all services personnel, the provision referring practitioners in a timely manner.

Anaesthesia and Surgical Intensive Care Unit (SICU) Cardiovascular Services Ophthalmology Orthopaedics Otolaryngology (ENT) Surgery – General, urology, plastic surgery and neurosurgery Women and children Children – Paediatrics, Perinatal Intensive Care Unit (PICU) and Neonatal Intensive Care Unit (NICU) Women – Obstetrics and gynaecology Medicine and A&E Medicine – Neurology, Gastrointestinal Unit,

Respiratory Unit, EEG/EMG Unit, dialysis, general medicine, Medical Intensive Care Unit (MICU) Emergency Services – Accident and Emergency, Emergency Ambulance Service Rehabilitation – Occupational therapy, physiotherapy, prosthetics and orthotetics Psychiatry Diagnostic Services – Laboratory – Clinical chemistry, anatomical pathology, Blood Collection Unit, lab administration, haematology, microbiology and sociology, blood bank, cytology Radiology Radiotherapy Pharmacy

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THE CARDIAC CARE UNIT at the Queen Elizabeth Hospital (QEH) has been instrumental in helping to manage and treat heart disease which is the No.1 one killer in Barbados. In 2013, this unit conducted 10 000 electrocardiograms and 2 000 echocardiograms. These tests which the unit offers are instrumental in the diagnosis and treatment of cardiovascular disease. In addition, the following tests are available for adult and paediatric patients: Ambulatory holter monitoring Echocardiography Exercise stress testing Stress echocardiography (exercise and pharmacological) Tilt table testing Electrocardiography

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The range of services now being offered by the Cardiac Unit are what Professor Sir Trevor Hassell envisioned when he first launched it back in 1971. Along with the cardiological services, it was Sir Trevorâ&#x20AC;&#x2122;s goal to provide a cardiac clinic for patients with heart disease. In the mid 1980s, the Heart Foundation of Barbados commissioned a report on the feasibility of providing open-heart surgery at the QEH. Prior to that, patients who needed heart surgery had to travel overseas to get it done. However, the report written by Professor Mickey Walrond led to the planning and development of cardiac catheterisation services and the selection and training of the team for the Cardiac Department. Sir Trevor has seen phenomenal growth

because of the continued training and development of the team in the Cardiac Department. Some of that training was provided by North Shore University Hospital in Long Island, New York, which is an affiliate of Cornell University. Stephanie Bryan, a nurse, was among the cardiac team that received training in perfusion technology there. That training by cardiac personnel led to the formation of the Department of Invasive Cardiology and Cardiac Surgery in 1994, with a team that included Dr Richard Ishmael, Dr J. Massey, Dr Michael Fakoory, and Anthony Harris. In May of 1994, the first cardiac surgery was performed in Barbados. Along with cardiac surgery, the team also provides thoracic surgery, vascular

surgery, pacemaker implantation, pacemaker implantable cardiac defibrillators, and advanced cardiological diagnostic tests. The team has performed more than 1 000 open heart cases over the last 20 years. Earlier this year, members of the team were on hand for the opening of the new state-of-the-art cardiac suite located in the Lions Eye Care Centre. The development and completion of that new cardiac suite came about after a paper written by Harris and Professor Hassell in 2001, about the advancement of cardiac services in Barbados, attracted funding from the European Union through the European Development Fund. The new Cardiac Suite, which also features its own operating theatre, is the result of this paper.

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STEPHANIE BRYAN is ready to take proper care of her patients. (RC)

STEPHANIE BRYAN can remember a time not that long ago when the Queen Elizabeth Hospital couldn’t perform cardiac surgery. All heart patients that needed open-heart surgery had to go overseas. “We started open-heart surgery in 1994, and the open-heart surgery

team was a home-grown team if you can call it that,” said Bryan, senior perfusionist in the Cardiac Unit. "We trained everybody overseas and then they came back to the QEH to work. Mr

• Continued on next page.

joseyjosewaste@hotmail.com

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• From Page 6. Harris was the first to go off to train. We had a plan and we worked towards it.” That plan worked because for the past 20 years, cardiac surgery and perfusion technology have been performed at the QEH. The first open-heart surgery was done in 1994, and since then they’ve been doing 50-60 cases of open-heart surgery a year. Perfusion is the injection of fluid into a blood vessel to reach an organ, usually the heart. Bryan, who is a nurse, was sent overseas to train in perfusion technology and is one of two perfusionists at the hospital. Patients at the QEH aren’t the only ones to benefit from the specialised skills of the cardiac team. According to Bryan, they’ve also done surgery on patients in Trinidad, Guyana, Antigua, St Lucia, and other countries in the region. Bryan who has been at the QEH since 1974, can personally attest to the growth and development of the Cardiac Unit, which now has its own state-of-the-art suite at the hospital. She regularly assists the two surgeons Anthony Harris and Dr Alan Smith in cardiac surgery. “Even though we’ve started doing some cardiac surgeries off pump or not using the bypass machine, I still have to be there in case something happens and we have to use one of the machines," she said. Bryan and those involved in cardiac care are happy that the cardiac suite is there and hopes that they will be able to fully move into the unit soon. “The suite is partially opened and we do the cardiac catherisations there. There is a cardiac catherisations lab as well as a cardiac operating room,” Bryan said. “If we get our own suite which includes the catherisations lab, the operating theatre, the recovery room, the step down unit, we would have everything in one place.” Bryan is hoping that the cardiac suite will soon be fully opened. She hopes that with that suite, they can continue to improve on the management of patients. “I just want to see cardiac care at the QEH maintain its momentum and the high standards continue,” Bryan said. “What I would like to see is more staff in the cardiac area because we don’t have enough.”

STEPHANIE BRYAN (RC)

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THE QUEEN ELIZABETH HOSPITAL now boasts a state-of-the-art medical intensive care unit (MICU) thanks to the generous donations of the World Bank, Broadway to Barbados Charitable Trust, and Rotary Barbados. The 11-bed unit which was officially opened in July features the latest medical equipment, monitors, computerised beds that help to adequately treat and manage patients. While the plans for expansion started back in 2006 when the MICU was only a six-bed unit and catered primarily for cardiac care, the modern and well designed facility can accommodate a wide range of patient needs. “We are getting our doctors to the point where they are practising medicine on par with the United States, and we have the equipment we need to make quick decisions,” said intensive care physician and head of the MICU and the QEH’s Department of Medicine, Dr Anne-Marie Hassell. “I brought doctors in from overseas to train them on the machines which proved to be a cheaper alternative than going overseas to do a course which is US$6 000 a person and there are three parts to the course. “The doctors will come in again next year to do the second level of training so that all of my junior staff will be trained up to a certain level using the machines. “They will be able to do invasive procedures safely on patients, they’ll be able to assess cardiac function and certain radiology things so that we don’t have to wait and depend

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on other services. ” Hassell, who has worked in the MICU since returning to Barbados back in 1999, is extremely pleased with the growth of the unit since the early days. Upon her arrival, the MICU, which was originally opened in 1976 by the late Dr Richie Haynes, was only a six-bed unit. But the demand for care in the unit was always great and very often they ended up having too many patients but not enough space to treat them. Back then, Hassell was the only intensivist on staff and now she has two other intensive care doctors, one like herself that was trained in the United States. “In the States, you have to recertify every ten years, so you have to keep up with what’s going on and that has helped us bring the standard up constantly,” Hassell said. “As soon as something new comes up and we feel that we can afford to get the equipment, we do the training and then we get our doctors trained. So we’re keeping the level of expertise up to par. We may not be able to do everything that they do overseas but we can give a significant level of care here.” According to Hassell none of the new equipment in the MICU would be possible without the help of the Broadway to Barbados Charitable Trust and the World Bank. “The World Bank had funds for HIV/AIDS and we take care of a lot of HIV patients in the

DR ANNE-MARIE HASSELL, head of the MICU. (FP)

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CONGRATULATIONS & heartfelt thanks!

Happy 50th Anniversary

The Management and Staff of Exclusive Lighting & Electrical Supplies Ltd are proud to join with fellow Barbadians in recognizing the love and care that the QEH has provided us and our loved-ones for the past 50 years.

to the Queen Elizabeth Hospital Manor Lodge Complex, Lodge Hill, St. Michael Tel: (246) 421-6946 Fax: (246) 421-6907 E-mail: elcock@elcock.com

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CARDIAC SUITE NURSES Vanda Lashley and Lisa Herbert. (RC)

• From Page 8. MICU and I approached them to get funding and they bought a lot of the equipment you see in here,” Hassell said. “Broadway to Barbados Charitable Trust also gave us. “The World Bank gave us about $800 000 worth of equipment and Broadway to Barbados is surpassing that. Rotary’s contribution was in terms of the outfitting of the unit, and the architect Marissa Huck was amazing in her design of the facility.”

Hassell also added that the Broadway to Barbados Charitable Trust has also provided a special fund for the maintenance of the equipment to ensure that the machinery is always in good condition. “The trust understands how important the equipment is to the MICU, but also how important it is to maintain the equipment,” Hassell said. “They’re not just giving, but they’re giving with the understanding that they’re holding back for maintenance which I thought showed phenomenal foresight.”

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FOR YEARS the Lions Eye Care Centre sat vacant not realising its true potential. Today, the newly renovated state-of-the-art facility is bustling with patients, who regularly see the 12 consultants “We always had a dream that we could have this unit or department as good as any in the first world. All those places are good because they have subspecialties so anybody with any problem can be seen. “We developed a plan to have subspecialists services offered right here,” said Dr David Callender, head of the Lions Eye Care Centre. “Between then and now, we have every major subspecialty that you can find in any first world hospital. “We have general ophthalmologists, paediatric ophthalmologists, we have vitriol retinal specialists, vitriol retinal surgeon, glaucoma specialist, an ocular plastic surgeon, a neuro-ophthalmologist Dr Gopwani, she just trained and came back, that bridges the gap between opthamology and neurology, then we have a cornea specialist. “In addition to that, we have a constant influx of young doctors who want to be trained in ophthalmology.” Seeing the facility now as opposed to when Callender joined the eye care centre in 1988, is testament to the

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growth that has occurred over the years. Back then there were four consultants, three general opthalmologists and a retinal specialist. As technological advances in eye care developed and doctors were trained in the various subspecialties, it meant that more patients in Barbados had more surgical options for their eye care. “Most of our surgery now is day case surgery where

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THE LIONS EYE CARE CENTRE is a full service facility offering services from paediatric to ocular plastic surgery. Here, Dr David Callender, head of the centre, prepares to examine the eyes of a child. (RC)

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THE LIONS EYE CARE CENTRE can hold its own against any other facility in the first world. (RC)

• From Page 10. patients come and go home the same day. When I first started, patients would spend days in the hospital. Now we do very small incision surgery where you don’t even need to stitch the wound,” Callender explained. “Even the surgery on the back of the eye is a small incision where patients go in and out. There is no bed stay unless there is a problem. “The healing process is relatively quick because the incisions are small and there are good drugs on the market that aid healing so the results have been pretty good so far.” The only drawback that the consultants in the eye centre face is that the top floor is still unfinished because of budgetary constraints. That has impacted on the number of surgeries that can be performed each week. “We have three operating theatres on that top floor which were used before. But then we had to move out in 2003 for air-conditioning reasons. We have one operating theatre in the old theatre suite so we have to share theatre time. There are only ten sessions a week, so each person has a half-day session once a week,” Callender said. “So we have a half day theatre list which means you really can’t do as much surgery per team as you would like to because you don’t have enough time. That means there is a waiting list for surgery at the moment because the funds to complete the top floor aren’t really there.” Callender is confident that when the top floor of the Lions Eye Care Centre is completed and the operating theatres are fully operational, they’ll be able to double their surgical output. Another issue that impacts on the consultants’ ability to do surgery is that with monies being owed to some suppliers, they may not get the supplies they need in a timely manner to deal with public patients. With limited or no supplies, it means that some surgeries for the public patients have to be dropped. “We have tried innovative ways to deal with that. Some doctors bring the supplies for the patients to have surgery; some public patients are willing to pay for the supplies they need to get the operation,” Callender said. “It’s a free surgery but if you don’t have the supplies, we can’t do it. If they’re willing to buy the supplies, then they can have the operation and some patients are willing to do that.” Despite the ongoing challenges, Callender is happy with the growth that he has seen in the department over the years. According to him the care being offered now is on par with any eye care centre in the first world. It is his desire to continue to build on that. “I’ve been toying around with the idea of having the Eye Department as a formal training institution for subspecialists,” he said. Unlike in the past where doctors who wanted to specialise would go overseas for training. “I think there is enough expertise within the department to train them so that would eliminate the need to go anywhere.”

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A SECTION OF THE Emergency Ambulance team.

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(RC)

FOR HIS 37 years of service to the Queen Elizabeth Hospital, Thani Haresh (left) receives award from Anthony Harris. (RC)

DR DAVID BYER, head of the EAS department

THE EMERGENCY AMBULANCE SERVICE (EASresponds to approximately 15 000 calls per year, an average of 1 250 calls per month or 45 calls per day. This figure is considerably high, when one considers that the Queen Elizabeth Hospital (QEH) has a fleet of just nine ambulances and one response vehicle. According to head of the Emergency Ambulance Service, medical

THE ACCIDENT AND EMERGENCY (A&E) DEPARTMENT remains committed to the provision of quality, timely emergency care, to acutely sick and injured people – both citizens and visitors alike. Formerly known as QEH Casualty, the department was transformed in 1990 into the new A&E Department. The department was pioneered by Dr Irvine Brancker and Dr Van Tyne, who set up the new department, transforming the former QEH Casualty which was basically a clinic treating patients with both major and minor cases, into a dedicated A&E Department handling urgent

consultant, Dr David Byer, the QEH has recognised the need for a fleet of ten to 12 ambulances with six to eight ambulances in operation at any one time to allow for adequate rotation and preventative maintenance. Byer disclosed that December, January, the Crop Over season, and the summer months were considered peak seasons for ambulance usage. However, he said this

cases only. It opened with a team of initially 12 junior doctors and two consultants. As the busiest department in the hospital, the staff attend to more than 40 000 patients each year. Offering patient care on par with

varied, depending, of course, on mass casualty incidences or disease outbreaks of any type. Byer, who began his tenure at the QEH as a junior doctor in 1995, has headed the Emergency Ambulance Service since 2006. A specialist in emergency medicine and pre-hospital care, he is responsible for all prehospital care as well as the training of all paramedics and emergency medical technicians (EMTs).

some first world countries. In its early days of operation, the A&E Department saw about 60 000 patients a year, but the advent of new private emergency medical facilities saw that number reduced to between 40 000 and 45 000 a year.

AMBULANCE DESPATCH DEPARTMENT: Obena Duncan and Wayne Garnes empowered them to do The task of developing more, so that we have a medical protocols for EMTs better clinical outcome. and paramedics also falls Health care starts before squarely on his shoulders hospital care so they both as well as managing mass complement each other. casualty incidences, both “In addition, we have from a planning and provided lots of training for response perspective. Byer mass casualties, cases is also intrinsically involved in planning for mass events involving extrication [where patients must be removed such as Crop Over. from vehicles], training on According to him, how to deal with hazardous management has worked materials and training in feverishly over the past obstetrics.” decade to provide According to Byer, the advanced training for Emergency Ambulance ambulance personnel Service in collaboration thereby improving the level with the Ministry of Health of services offered by the “is currently working on Emergency Ambulance developing legislation which Service. will govern the standards of “We provide advanced both private and public training at a paramedic ambulance services. level to EMTs and this has “This legislation is about increased the level of to be drafted, documents medical interventions that have been vetted and it will both the EMT and soon be dealt with at the paramedic provide. parliamentary level. “For instance, we have The Emergency introduced them to the Ambulance Service setting up of drips and employs a team of 60 have empowered them to paramedics and EMTs who work with patients who work on a four-shift basis, suffer from asthma. In with 15 on any one shift. other words, we have

NOVEMBER has been a special month for the Queen Elizabeth Hospital family. For the now 50-year-old institution this month celebrated five decades of providing health care services to the nation. On Friday, November 14, the QEH family celebrated with the first baby born at the institution when they hosted Rhonda Taylor at a special anniversary function. Last Wednedsay, it was time to celebrate its own as long-serving staff and associates were honoured for their years of dedicated service to the institution, some being honoured for service exceeding 45 years.

PROFESSOR MARGARET ANNE ST JOHN is all smiles while receiving her award from Anthony Harris for giving 40 years of service to the Queen Elizabeth Hospital. (RC)

CAPTURING THE MOMENT FOR POSTERITY. Queen Elizabeth Hospital long-serving staff members posing with their awards after the prize-giving ceremony.

(RC)

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A SECTION OF THE Emergency Ambulance team.

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(RC)

FOR HIS 37 years of service to the Queen Elizabeth Hospital, Thani Haresh (left) receives award from Anthony Harris. (RC)

DR DAVID BYER, head of the EAS department

PROFESSOR MARGARET ANNE ST JOHN is all smiles while receiving her award from Anthony Harris for giving 40 years of service to the Queen Elizabeth Hospital. (RC)

CAPTURING THE MOMENT FOR POSTERITY. Queen Elizabeth Hospital long-serving staff members posing with their awards after the prize-giving ceremony.

(RC)

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MAKING A DIFFERENCE through nutrition. That’s the mantra that registered dieticians Sheila Forde and Meshell Carrington have implemented to get patients at the Queen Elizabeth Hospital (QEH) on the road to good health and nutrition by leading the Food & Nutrition Department at the Martindale’s Road, St Michael institution. Diet and nutrition are crucial in the prevention and treatment of disease. As dieticians working in the hospital setting their primary role is to assess, diagnose, treat, evaluate and monitor nutritionrelated conditions to maintain health and manage disease. The dieticians, who have all been trained overseas and are members of professional organisations in those countries and locally, are working hard to change the eating patterns of patients who pass through the QEH to get them on the road to healthier lifestyles. Acknowledging that Barbadian diets have a high fat and added sugar content as well as large portion sizes, they’ve been working with patients in and outside the hospital to make positive nutrition changes. The department provides two services to the Barbadian population, a food service and a clinical nutrition service. The food service section provides meals for all inpatients. On average it provides 25 000

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meals a month. Managing a staff of 85 people along with approving the menus – regular and modified diets for those suffering from different ailments, Forde, after returning to QEH in 2001, has worked to make food services more efficient despite facing budgetary cutbacks. “There is a menu that we follow — a four-week cycle menu which is planned according to the availability of food,” Forde said. “That’s something that we have to be cognisant about in this current economic time that we’re going through. Fortunately, we do have an assistant procurement officer and the director of finance who work very closely with us, trying their best to get things done in such a manner that you would scarcely notice the financial problems that we might be

experiencing.” In the clinical services the team of three registered dieticians offer medical nutrition therapy to inpatients and provide nutrition counselling and education on an outpatient basis, and are assisted by a dietary technician. To that end, the dieticians are working closely with physicians, nurses, and other paramedical professionals in providing the proper nutrition care to patients, adults and children, suffering from diabetes, kidney failure, cancer and a host of other conditions. Both Forde, the administrative dietician and Carrington, a clinical dietician, will admit that getting the hospital to this point hasn’t been easy, especially since they don’t have the personnel. But for them, it was a combination of hard work and commitment to yield the

THE FOOD AND NUTRITION TEAM. Seated: Meshell Carrington, clinical dietician (left) and Sheila Forde, administrative dietician. Standing: (from left) Sade Haynes and Kerri-Ann Best; dietary technician clinical services, Georgina Hall, and secretary Nicole Forde. Missing are relief clinical dietician Wendy Clarke and dietary technician, food services, Cheri Elcock. (RC) streamline the nutrition care at the hospital on every level. One of their goals is to have all newly admitted patients at the hospital screened within 24 hours of admission to determine their nutrition risk. results that are now being “This will be a proactive produced. “Our challenge is staff. We have approach to care. Poorly nourished patients (both underweight and three established clinical dietician overweight patients) are a huge posts to a 600-bed hospital which expense to a hospital”. is unheard of really,” Carrington Together with their colleagues, admitted. “A hospital of this size the clinical dietitians are trying to would take ten to 12 dieticians, so ensure the management and we have to prioritise the care. But treatment of diseases of patients we’ve done a lot. in the hospital. They are on the “Through our collaborations we multidisciplinary teams at the QEH have been able to get two Barbadians trained in nutrition and where they would do rounds on the dietetics. One has joined our team intensive care units, stroke units, in the last five months, the other the medical and surgical wards, is going to be completing her and other areas in the hospital to registration examination shortly. ensure that patients are “Another person will be maintaining adequate nutrition commencing studies in January levels. For example, the dietitians 2015. So we are pleased to be are instrumental in tube feedings having persons trained in this and intravenous feedings for already locally deficient patients who cannot ingest food profession”. Continued on next page. Their team has sought to

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are failing to thrive; they’re not growing the way they are instrumental in tube should grow.” This is feedings and intravenous concerning because FTT can feedings for patients who affect a child’s development. cannot ingest food orally. While the dietitians have However, the dietitians been trained to spot diseases revealed that they are seeing with nutrition implications, a worrying trend in childhood they’ve also extended that obesity and several children nutrition training to other are failing to thrive (FTT) areas in the hospital. because they are not “We also do a lot of receiving adequate nutrition. training with our nursing “The pediatric unit works very colleagues,” Carrington said. closely with us to help “We’ve trained over 500 manage this”. nursing professionals in “It’s obviously a sign of the terms of nutrition including economic times because I nurses from the geriatric hadn’t seen failure to thrive in hospital and student nurses. the QEH so often until 2010,” Why we chose the nurses first Carrington said. “If you had a is that they are the ones failure to thrive child it was interacting with the patients because of some disease 24 hours state but not anymore. You’re a day.” seeing normal children that According to Carrington,

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initially it was a battle to break people into the whole clinical nutrition forum because it was a new way of practising. “People just saw the food service component, they didn’t see the therapeutic/clinical aspect of it,” she said. “But overall we’ve done very well. We gotten commendations, our North American colleagues wonder how we do it, many of our colleagues in the other islands have started to model us, some have even asked to complete traineeships with us. “We are seriously considering this as a revenue generating means for QEH, but of course we would need the hands to expand” noted Carrington. “We have an

internship programme set up with McGill University in Canada where their students come to Barbados to do part of their clinical rotation. “We’ve also been approached by another private university to work with them. So what we’ve done with our little has accomplished a lot and shown that we can do it”. “We have a comprehensive nutrition improvement plan for QEH and we are quite eager to implement it.”

PATRICIA MANNING (left) and Marva Sobers preparing a nutritious lunch. (RC)

Website: www.barbadosivf.com

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THE PROCUREMENT DEPARTMENT is responsible for the Queen Elizabeth Hospital’s (QEH) annual stock intake which has a value exceeding $17 million. This department’s key role is to procure medical supplies, food, pharmaceuticals, engineering supplies and laboratory supplies, at the most cost-effective prices while ensuring that the set quality standards are adhered to and that patient care meets best practice standards. Under the management of procurement manager Anthony Grandison, the department also aims to make sure there is zero stock outs in all areas. Inventory management is also a big function of this department and staff employ supply chain management strategies, including lead time analysis, with minimum to maximum quantity, for all supplies. Cycle counting is also employed to keep inventory balances accurate. Grandison, who has

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spent over 30 years in the accounting and hospitality management fields, manages a staff of 40. His senior staff is comprised of senior procurement officer Jenny Welch, procurement officer Ezra Murray, acting procurement officer Dwayne Forde; assistant procurement officers Deborah Pilgrim, Joanne Murrell and Keisha Gill (Ag). Steward in charge of food supplies, Yvonne Burke, and accounting aide supervisor, engineering, Christopher Inniss round up the team. According to Grandison: “We ensure each hospital ward is adequately stocked on a weekly basis with the necessary medical supplies and use a top-up system to ensure supplies do not run low. The same thing goes for the Food Department.” Under Grandison’s leadership, the Procurement Department works closely with local suppliers who are invited to tender. Close attention is paid to cost effectiveness and the ability of suppliers to deliver on all

supplies tendered, including uniforms, food, and medical supplies. Each application for tender is received by Grandison who analyses and makes recommendation to the Tenders Committee for

THE PROCUREMENT DEPARTMENT team. Inset left is manager Anthony Grandison. (RCs)

approval. Grandison believes the process of tendering promotes competitive purchasing, gives people the

opportunity to secure significant contracts and allows the hospital to obtain the highest quality products. He is also of the view that

local purchasing promotes job security and makes for

• Continued on Page 19.

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A CADRE OF 120 capable orderlies work under the supervision of supervisor of the Orderlies Department, Roger Rice, to provide assistance to medical and nursing staff throughout the Queen Elizabeth Hospital (QEH). While their duties are often classified as routine, these 119 men and lone woman, complement the day-to-day smooth operations at Barbados’ leading health-care facility. Rice, who joined the QEH 28 years ago, recalled the days when orderlies were casually referred to as watchers, who watched out for patients. Some departments today are provided with at least five to seven orderlies per shift who function according to the needs of the respective departments to which they are assigned. Orderlies also have a pool system in place. Those assigned to the pool are capable of working in any of the hospital’s 29 departments, at any given time. While the duties of orderlies vary, there are specific tasks which they perform. These include the transporting of oxygen tanks and supplies to departments, and the moving of patients from and to various wards. Each orderly understands the importance of adapting to the expectations and functions of departments and must possess a keen knowledge of the department to which they have been assigned. According to Rice: “Many adapt well to their respective departments, but a normal day can be brain taxing.” Rice, who has spent 17 years in the field of social services, believes he has found his niche and as such always seeks to ensure that he and those whom he supervises, including the hospital’s seven drivers, perform at the highest level. He has been exposed to advanced health and social care training and has contributed to many of the hospital’s health seminars as well as its internal publication, The Pulse magazine. Rice has also increased the level of camaraderie among staff through the staging of lunchtime concerts and other social events. “Being involved at the level at which I am involved has caused me to see myself playing a more effective role at the hospital. I always dreamt about making a mark and I believe I have made it here,” he said. With a clear understanding of the need to properly mentor and encourage his team, Rice was the driving force behind an appreciation ceremony on December 11, last year, which was held to recognise 26 members of his department for their sterling contributions to health care. It was the first time the department had hosted an appreciation ceremony for its workers. Among those receiving accolades was recently retired senior orderly supervisor Rudolph Alleyne, who spent 40 years assigned to the Orderlies Department. Rice is assisted in his daily duties by fellow orderly supervisors O’Neal Deane, Carlyle Best, Cyril Taylor, Franklyn Alleyne and James Gaskin.

SUNDAY SUN SPECIAL. 17.

ROGER RICE, supervisor of the Orderlies Department. At left, tending to a patient’s needs. (RC)

18. SUNDAY SUN SPECIAL

SOME OF THE MOST essential services of the Queen Elizabeth Hospital (QEH) are those provided by its Housekeeping Department. The 133person staff helps to keep all the wards, operating theatres, and every area of the hospital clean and functioning in a sterile environment. No one knows this better than Betty Boyce, Housekeeper 1 or head of Housekeeping at the QEH and her deputy Susan Murrell. “I say to my staff that we are one of the most important parts of this hospital because we are responsible for every aspect of cleaning in the hospital,” Boyce said. “We are responsible for the bins being empty, for the operating theatres being carbolised, we’re responsible for the ledges being clean, scrubbing the corridors, making sure the floors are clean, changing of the curtains, cleaning the wards, allocating the general workers and the maids in Housekeeping,” Boyce said. Since the hospital never closes, the Housekeeping Department has two 24-hour staff systems that work different shifts in the Accident and Emergency and Operating Theatre Departments only. “We have a call-out system in place where if we have flooding, we have to call out people,” Boyce said. “So our job doesn’t end when we leave here. Our job sometimes entails them calling us at one in the morning, but we don’t have a problem.” Boyce and Murrell are seasoned veterans in their

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department with more than 20 years of experience between them, having worked their way up through the ranks. Whether they are off or on holiday if the hospital calls for help in any area of Housekeeping, Boyce and Murrell will assist because they know the importance of their roles to the smooth functioning of the hospital. But it isn’t only about cleaning and performing their jobs that make the Housekeeping Department essential. It is also about having the right attitude for the job. “I have seen a change and improvement in the overall attitudes of people,” Boyce said. “I always tell my staff to see themselves as the patient and not only as the employee because you may come in as an employee and by the end of the day, you may be a patient, and I’ve seen it happen. That’s why you have to do the things that are right and clean the place to the best of your ability because you’re in that environment.” A big reason for the effective running of the Housekeeping Department is the camaraderie between Boyce and Murrell, who have maintained a good working relationship over the years. Both women constantly consult each other in day-today decisions and effectively play to each other’s strengths. “Even in terms of shifting or moving staff, I

HEAD OF HOUSEKEEPING Betty Boyce and her deputy Susan Murrell. (RC)

of the bacteria to other wards. In cases like that heavy-duty cleaning solvents for the eradication of infections are used. Cleaning personnel are trained in handling such procedures, wearing the proper gowns, gloves and masks to perform the necessary tasks. “Once there is any level of bacterial infection in the hospital, Infection Control Department runs training sessions and the Housekeeping Department always sends persons for training,” Boyce said.

While not every bacterial outbreak may require Housekeeping personnel to wear protective gowns, Boyce and Murrell make sure their staff is adequately covered in the event of any emergencies. That also includes the Ebola virus, the Housekeeping staff has been trained in the proper clean-up management of the deadly virus. According to Boyce, some of their Housekeeping staff have even volunteered to work with the new facility in the event any cases of Ebola surface on the island.

Keeping one or two would say, ‘Sue, look, who do you think I should put staffers in such a situation here?’ I’m not saying all the helps to prevent the spread supervisors are like that,” Boyce said. “You’ll get people who, don’t care what you try to do, will try to undermine you but she’s not like that. She’s always worked with me in building up the department.” Effective departmental functioning becomes key whenever the hospital may have a bacterial outbreak on the wards. “It impacts on Housekeeping because we are the ones who have to make sure that the outbreak is kept to a minimum, infection levels are down,” Boyce said. “We work in collaboration with infection control so they would give us the guidelines, because there is a policy in place, so that you don’t allow the person who is on that ward HealthCare@armstrong.com.bb to work anywhere else but that ward.”

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PRIOR TO BEING housed in the precincts of the Queen Elizabeth Hospital (QEH), the Laundry Department operated from a separate location at the Florence Nightingale Hospital (commonly referred to as the Old Hospital), at Jemmotts Lane, St Michael. Today, with a full-fledged staff of 38, this department which is currently headed by laundry superintendent Richard Mapp and his assistant, linen keeper Sylvia Belgrave, can be depended on to meet all the laundry needs of this health institution. The daily tasks of the Laundry Department are to ensure that all linen, inclusive of pillowcases, bed sheets, blankets, towels, dressing gowns, operation and surgical gowns, staff uniforms and doctors’ attire are properly sanitised, washed, pressed, folded, sorted, stored, and delivered daily to all wards and clinics. This process begins with the general workers who collect the linen from all chutes located in the basement of the main building and transport them to the laundry where they are sorted by a team of four people. The linen is then weighed by a supervisor, placed into trolleys and transported to the washers where they are loaded by a laundry operator for the various washing cycles. Another operator retrieves them from the machine after which they go through another sorting process. Some items are dried in the dryers, while the sheets, pillowcases, and other pieces are fed into the flat iron press machine to be pressed as a finished product. Two employees take up their position to retrieve them from the press machine after which they are folded according to a special coding system, packed into a trolley and taken to the linen room to be sorted and shelved until ready for use. On any given day, the Laundry Department handles between 2 400 and 3 000 pounds of laundry during the usual Monday to Friday from 7 a.m. to 3 p.m. working hours, as well as on Saturdays when staff work overtime. The Laundry Department is linked directly to the boiler room which supplies steam, water and air. Without these, the Laundry Department cannot function effectively or efficiently. The department also works closely with the Sewing Department, which is responsible for making operation gowns, wash towels, disbursing uniforms/scrubs repairing linen and sewing all crests and colour coding distinctions on linen and uniforms. This department is headed by Ermine Millar. Both Mapp, who has been an employee of the QEH for the past 24 years, and Belgrave, who has served this health institution for 42 years, believe that the dedication shown by the Laundry Department team is tantamount to an understatement. According to Mapp: “Some staff can be found on the job as early as 5:30 a.m and many go above and beyond their duties to ensure linen is available for use. “Most give of their free time and volunteer to assist wherever possible. Each staff member is multitalented and can work in any section of the department.” The commitment of the Laundry team can also be witnessed in their years of service to the QEH. Some 15 staff members have given 25 years plus service to the department. The full laundry departmet team comprises 25 laundry workers; six laundry operators, two general workers, three supervisors, one linen keeper and one superintendent.

• From Page 16. better and closer working relations between the QEH and the business community. “When we buy locally we know that we are supporting jobs and there is a plowing back into the community. We also keep our eyes on what is happening in the international market, so that we buy externally only when we have difficulty sourcing various supplies or when the local pricing is significantly higher than what is being offered in the external markets.” Grandison’s role as procurement manager also extends to him being responsible for creating improvement strategy planning goals for the department, overseeing staff appointments and evaluations and putting performance guidance recommendations in place. The management of the uniform tender and its analysis is also a function performed by Grandison and his senior staff. While the general Procurement Department staff is not on duty each day, senior staff officers are always on call, with officers manning the Engineering and Food Departments at least eight hours daily.

SUNDAY SUN SPECIAL. 19.

THE QEH laundry department is under the watchful leadership of from left, Acting Superintent Sylvia Belgrave, and supervisors Janice Yearwood, Leroy Burke and Monica Morris. (RC)

20. SUNDAY SUN SPECIAL

“WE’VE REALLY COME A LONG WAY.” Those words of pride were from the Queen Elizabeth Hospital’s (QEH) chief pharmacist Basil Bradshaw, reflecting on the growth of the hospital’s pharmacy division over the past 50 years. No one would know that better than Bradshaw, who has been with the hospital for 45 years starting as a student dispenser and working his way through the ranks to his current position at the helm. Calling the functioning of the Pharmacy now and its offerings a dream, Bradshaw stated that it went from zone of confusion to the orderly, well run facility it is now where patrons sit quietly and wait to be served. “In those early days, people would fight in the line because the QEH was the sole source of free medicine,” Bradshaw said. “There were no polyclinics. We had to have a police presence in the waiting area to try to keep order.” Back then, those seeking medication would arrive and line up at the QEH by six in the morning. The early arrival time was of no effect because many people went away without being served and had to return two or three days sometimes just to receive their medicine. Unlike the facility now that has an abundance of pharmacists, Bradshaw started when there were seven pharmacists. Seven students – of which he was one – were brought in to assist them and ease the backlog that occurred when hundreds of people were seeking medications. “In 1971, we did not have a wide variety of drugs nor did we carry the expensive drugs that would have come on stream in 43 years,” Bradshaw said. He credits the advent of the polyclinics and the Barbados Drug Service for revolutionising the pharmaceutical care at the hospital. The polyclinics around the island provided alternatives for patients to get medication and ease the crowds that would regularly congregate at the hospital. The Barbados Drug Service helped to provide a better and wider variety of medications for patients at the hospital. They helped to establish a tendering process through the hospital whereby medications can be obtained at cheaper rates. “The Drug Service was a blessing for Barbadians because the prices we got through the tendering process were fantastic,” Bradshaw said. “Sometimes we were getting better prices for drugs than in the United States. Without the tendering process, we could not have the wide variety of medications that we have, particularly asthma medicines and inhalers.” While Bradshaw didn’t benefit from a formal education in pharmaceutical studies like many of those currently employed at the QEH, he learned on the job through the apprentice system. Over the 43 years of his tenure, he rose through the ranks to become chief pharmacist. He also helped to establish certain services that helped the pharmacy run more efficiently. Most notably within the last three or four years, they have computerised the system which was a gift from LASCO Barbados, which meant no more handwritten labels for prescriptions or records. “This is the only department in the hospital that has a special window for staff so they can get their medications,” Bradshaw said. “We don’t want staff who need medicine standing in line with members of the public. The renal patients are taken care of separately and those who suffer with cancer don’t have to come and stand up in a line, those drugs are delivered.” Bradshaw is also particularly proud of the advances that have occurred with chemotherapy drugs. In previous years, nurses would mix the chemotherapy drugs for cancer patients. Now that process is all done within the Pharmacy division in a sterile room which proves to be a safer and more effective alternative than what was done in the past at the hospital. “Years ago, nurses were mixing the drug so if spray came out when they added water to the vial, it was a problem. Obviously, anti-cancer drugs could cause cancer if you’re exposed to them in the wrong way,” Bradshaw revealed. “These drugs are now mixed by the staff in the pharmacy who are required to wear special gloves and gowns, and nurses have to be outfitted too when handling that medication.” Even though other outlets are available, the QEH pharmacy still sees a high number of patients, approximately 600 or more, which has nothing to do with the patients it has to serve on the wards or staff members seeking medicines.

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THE QEH pharmacy has seen much improvement over the years.

(RC)

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WITH A LONE PUBLIC HOSPITAL, the Social Services Department caters to the entire Barbadian community specifically with medical issues. The Social Services Department with its nine-person staff, inclusive of six medical social workers, is not the biggest, but it is certainly one of the busiest departments at the Queen Elizabeth Hospital. Its mission is to empower MECHELLE patients and their families while WEBB-BURKE meeting their medically related, SENIOR MEDICAL SOCIAL social, physical and emotional needs WORKER (AG.) by facilitating treatment, recovery, and safe transition from one care environment to another. The department, which is headed by acting senior medical social worker Mechelle Webb-Burke, often carries out various forms of investigations that are referred to them to determine the right course of action. “All of our cases are referred by medical doctors and other social agencies. We also see people that may walk in seeking information,” Webb-Burke said. “We don’t turn anyone away.” Daily the staff handles a wide range of cases dealing with psychosocial assessments of inpatients and outpatients who have been referred by doctors, or with elderly patients who have been discharged but may be faced with issues where family members are unable to adequately care for them, or issues dealing with children who are abused or mistreated in some way. In cases of abused children or those admitted to the hospital with problems, the Social Services Department works closely with the Child Care Board to provide the necessary interventions. The Social Services Department is also responsible for the administration of the Medical Aid Scheme where patients may be recommended for treatment that is not available in the hospital, but may be available outside or overseas. Socio-economic assessments are also done for patients requiring MRIs, dialysis treatments, or specially authorised drugs, to determine how much of a financial contribution the patient would be able to make towards their care or if a grant or other financial

SUNDAY SUN SPECIAL. 21.

SOCIAL SERVICES Department team. (RC)

measures should be sought. Another big aspect of the Social Services Department is counselling – bereavement counselling for loved ones whose family members have died, antenatal and postnatal counselling for teenagers, financial counselling and crisis intervention related to emergency overseas transfers, mass casualties, and hurricane disasters. With every day bringing different challenges to the Social Services Department, the team is committed to bringing the best patient care and service delivery. However, when an emergency situation does arise, the department has to drop everything and adequately deal with the crisis to bring the best resolution possible. “Illness is stressful on patients and families and I am happy that our department can give them support,” WebbBurke said. “Once the patients have received the best treatment we can give them, then I am contented.”

22. SUNDAY SUN SPECIAL

DIRECTOR OF THE Queen Elizabeth Hospital’s (QEH) Engineering Department, Paula Agbowu, has a vision to engage in more preventative and cost-effective maintenance measures as a means of decreasing costs and maintaining smooth operations in this key department. With hopes of also establishing a “proper capital replacement programme,” Agbowu admitted that both programmes would require major funding. “Both programmes would require efficient funding, but we want to reach the stage where we can get to our equipment before it breaks down and to be more effective. In addition to seeing after the replacement of all non-medical and medical equipment such as the hospital’s boilers, oxygen plant, generators, medical air plant, distil plant, vacuum, water and plumbing system, the sewerage pump system, fleet of nine vehicles and ten ambulances, the Engineering Department services equipment on a regular basis, particularly all life-support equipment. This department also handles small construction projects to better utilise available space. The upkeep and maintenance of the hospital’s external grounds, gardening, cleaning, drainage, painting, installation of floor sheeting and general building structure also fall into the capable hands of Agbowu and her team of 85 employees. This team is comprised of senior technical officers, a technical officer, supervisory and general staff, which including plumbers, air-condition technicians, carpenters, masons, painters, incinerator attendants, gardeners, general workers, electricians, mechanical fitters, biomedical attendants, clerical staff, and mechanics. While ongoing certified training is provided for all technicians, the hospital is sometimes forced to outsource work to service contractors. According to Agbowu, outsourcing is sometimes needed to service life-

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DIRECTOR OF THE Engineering Department, Paula Agbowu. (RC) support equipment such as anaesthetic machines, ventilators, cardiac monitors, xray machines and CT (CAT) Scan equipment. She said: “As newer brands of equipment come on stream, it is imperative that training is provided. In many instances, we recommend on-site training rather than overseas training. Given the economic constraints this is more cost effective and ensures the training of a greater number of individuals,” Most of the hospital’s 12 000 biomedical and non-medical pieces of equipment are in keeping with those in the first world and the island can still boast of providing top health care at the QEH.

THE TASKS which fall under the hosptial’s engineering are wide and varied from small construction project projects to better utilise space to ensuring all machinery is properly functioning. (RCs)

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SUNDAY SUN SPECIAL. 23.

THE Medical Records Department team. EVERY PERSON in Barbados who has ever entered the Queen Elizabeth Hospital (QEH) has a number that has been assigned to them for life. That revelation came from Ms Best, who is in charge of the Medical Records Department and has been with the hospital for 35 years. “We have something called a master index so everybody is put in this master index, and everybody is placed on that with a registration number,” Best said. “That number you keep for life so when you come back to the hospital for treatment, we have to look for those old notes and join the new ones with them.” Over the past 50 years since the opening of the hospital, hundreds of thousands of patients have been treated at the Martindale’s Road, St Michael facility, and those files are still in existence. “When this hospital opened in 1964,

(RC)

the files from the general hospital came over so we have files from 1959 to present,” Best said. Such a large volume of medical files means that there is some congestion in terms of storage. Initially, when Best first started at the hospital, there was only one area of storage for all files, now there are three areas including those for Accident & Emergency. The older files are stored in containers on the hospital compound. In an effort to further streamline the Medical Records Department, the hospital is working with the Ministry of Health in the implementation of a new computerised records system. Currently, the hospital only has demographic data on its computer system, not a full medical chart. When the files become computerised, they said they would start with the current file system first and then go back to the older files.

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