fp Turks and Caicos

Monday marked a historic occasion in the Turks and Caicos Islands as the first government hospitals celebrated their one year anniversaries. No one was more grateful than Diovanni Fulford.

Just four hours after the Cheshire Hall Medical Center on Providenciales opened its doors at midnight on April 10, 2010, the first trauma patient was rushed into the emergency room. Fulford was knocked down by a car in Blue Hills and suffered serious multiple injuries and immediately underwent life-saving surgery.

Once stable, he was flown to Florida for further treatment before returning to Cheshire Hall to undergo an intense physiotherapy programme.

Fulford has the InterHealth Canada staff to thank today for his life, and he did so humbly as he cut the cake to celebrate the occasion.

“It has been a challenging year,” Roger Cheesman, CEO InterHealth Canada TC, told the gathered staff and invited guests on hand to mark the occasion.

InterHealth Canada was granted the contract to manage the two hospital facilities on Providenciales and Grand Turk in 2008. It has been a bumpy road since, with highs and lows both for InterHealth Canada and the Ministry of Health which manages the project for the government.

“This has been a transformation year for health care in the TCI,” said Permanent Secretary in the Ministry of Health Judith Campbell. “Never before has health care been so visible and subject to such public scrutiny, as there is not a day that goes by the hospitals or (the National Health Insurance Program) is not seen in the news.”

Campbell recognized the many successes, such as Fulford, which have been made possible through these new ventures, but she also noted the ongoing work all participants in local health care have faced.

“We in the ministry, InterHealth Canada, the (National Health Insurance Board), private practitioners and the medical providers overseas have all had to plan for, react to and adjust for the many difficulties and unexpected issues which the provision of modern health care processes and procedure brings in its wake,” Campbell said.

Staffing and turnover

One of the largest challenges faced by the hospital administrators and the ministry have been staffing the facilities. Finding qualified staff with the multitude of specialties prepared to come to a small center in the Caribbean was a tall order for InterHealth.

Cheesman said the hospitals have been fortunate and pleased with the staff they have attracted and who have done a tremendous job throughout the year.

However, it is all not without its trials, Cheesman told the fp.

Managing staff expectations has been one of the most difficult areas. With staff from across the globe, each working at different facilities, he continues to encourage staff to stop thinking “in the last place we used to” and start thinking “in this place we need to.”

Over the first year, staff turnover was relatively low, but recent events have seen several staff in senior positions leaving the island. These are mostly due to personal reasons, Cheesman says, but finding the right replacements is difficult.

“We will not just employee anybody to fill a position,” he says. Due to the small size of the facility, it is important that staff have many skills and can be flexible, he explained. Many doctors and nurses are required to be proficient in several areas, which only can come from years of experience, he says.

Attracting Belonger staff

This can pose challenges attracting Belongers who first need to gain experience in larger centers and come back possessing multiple skill sets in order to work in the smaller hospital environment.

“It has always been our aim to employee as many Belongers as possible,” Cheesman said. “More than 25 percent of our staff are local people, and that bodes well for the future of the hospital.”

During the anniversary celebration, Cheesman recognized several Belongers who have made a significant contribution to the organization, including Leila Lawrence, the longest serving Belonger on staff, and Eleanor Hall, former matron at Myrtle Rigby who assisted enormously in the transition from the old to the new facility.

InterHealth is also currently investigating Canadian links for training jobs for TCI doctors. “If we are able to tap into this resource, this could provide us with a whole new generation of Belonger consultants in due course,” Cheesman said.

The hospital also regularly welcomes students from local schools on work experience exercises. Cheesman says he is confident a number of these students will return as staff members in the not too distant future.

Overwhelming the ER

Another major challenge for hospital staff is the overwhelming number of patients entering through the emergency room.

About 2,800 people are walking into the ER each month. This is up significantly from the 1,500 when the hospital opened one year ago.

Cheesman says he believes this is partly due to the reputation the hospital now has for offering quality care.

However, people need to make an appointment with a primary care physician and not think it will be quicker to walk into the emergency department, he says.

“The vast majority of people coming through there should not be in an emergency room,” he said, noting that the problem is not unique to the TCI. But it has a large affect on the overall care the hospital can provide.

An upsurge in births over the winter also put an additional strain on the center on Providenciales.

Over the Christmas period, the Providenciales center was working well above 100-percent occupancy. The facility is staffed for 75-percent occupancy, and with average occupancy at 99-percent in December with peaks above, it meant some people had to wait for a bed to open up.

InterHealth is working together with the Ministry of Health to address this growing problem, trying to find solutions to the need for more staff.

Accreditation

Despite all the ups and downs, the hospital has received high marks from patients who overwhelmingly regard the facility as providing quality service.

The hospital provides patients with a survey to determine how they are doing and Cheesman says they take the results very seriously. The results are also passed on to the Ministry of Health, in order to keep tabs on the progress and performance of the hospitals.

The accreditation committee that visited in October, just six months after it opened, also gave InterHealth high scores in many areas for work being done well. “We have tried to be hypercritical of ourselves,” Cheesman says.

InterHealth says it is not only part of their contract with the government, but it’s also their goal to achieve accreditation. The accreditation is an independent standard that indicates a facility is providing good health care, something that is recognized throughout the world.

The accreditation process does not end with the acceptance of the standards, but is an ongoing process that continually checks in on the facilities to ensure they are providing the highest level of care.