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Jul 30, 2001

Hospital: The paths to progress

Eleven years ago, in November of 1990, some 500 people gathered outside the Hospital de Bruyn's meeting room to protest the fact that the island's only maternity ward had been laid idle by administrative decision makers in distant shores. The demonstration was occasioned by the visit of Prefect Jean-Paul Proust, the government's key administrator in the department of Guadeloupe. He had come to attend the hospital's board meeting, and to pronounce the official policy as to the eventual reopening of the maternity ward. In a perfect world, he would have told islanders that there had been a big mistake. He would have denounced the decision to strip the maternity ward of its right to function. He would have proposed that a solution be sought. Instead, the government's spokesman announced that the maternity ward might one day reopen if certain criteria were met. One day, indeed! The crowd was so furious about Monsieur le Prefet's announcement that he was forced to -ahem- make a sudden change in travel plans. His precipitated departure was facilitated by police escort.
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On June 29, 2001, the director of the regional hospital agency serenely explained to the local hospital board that islanders should not count on the maternity ward reopening. Furthermore, the existing maternity beds would be snuffed out for good. This time, no one raised so much as an eyebrow. There was no street protest, no negative reaction, not even a heated editorial. In fact, one of the local newspapers praised the agency's decisions concerning not only the maternity ward but, more globally, the hospital's future as well as the future functioning of the island's healthcare system, as history-making breakthroughs.
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It took just over a decade to wear down the islanders' feisty temperament and fighting spirit, to shift their expectations and the perspectives that create them.
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St. Barth people, it is generally said, care deeply about their hospital. Built at the beginning of the last century on the initiative of a Dutch priest, Father Irenée de Bruyn, and with the substantial help of many local residents, it was the first and only hospital establishment to be erected in St. Barth. Renovated in 1986, the hospital has suffered from a chronic lack of means, and despite the health care services that it is able to provide, it has been consistently reproached for failing to meet the healthcare needs of islanders. Dissatisfaction mushroomed into rancor at the beginning of the 90's when administrative decisions made in Guadeloupe and in the motherland prohibited the island's expectant mothers from delivering their babes in their local hospital. The prohibition extended to all surgical interventions.
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In time, the anger subsided, and residents learned to make do. Since 1991, women go have their babies in St. Martin, Guadeloupe, Martinique, or on the continent. Patients requiring surgery go for their operations either in Martinique or in France. As for medical evacuations, despite the existence of a private insurance company that sells policies by guaranteeing its subscribers that, should an emergency health situation requiring an airlift arise, they'll come running. It's a hit-or-miss system, one that is understandably so, if you take into account that there is no designated air carrier to assure these airlifts, above all at night, when the St. Jean airport is closed.
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Of course, over the many years, different solutions have been sought to resolve the problem. Fed up with the inertia and the steady stream of obstacles that both metropolitan and Guadeloupe public health administrators provided in such constant and steady number, local elected officials and a handful of civic-minded entrepreneurs decided to bypass the public health sector and go private. Dr. Stephane Ledée, a native son practicing dermatology in France, decided to return to his island to push through his project for the island's first private healthcare clinic. First accepted, the project was later rejected by France's then- health minister, Simone Veil, whose intentions to support the island's push for more effective healthcare crumbled when challenged by disgruntled unions and Guadeloupe's hospital sector. The good Dr. Ledée died from a stroke just weeks after learning that the approval for his clinic had been withdrawn. That was in September of 1994.
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Subsequently, two other health care projects were elaborated, and both were eventually scrapped. With the path to private temporarily out of the picture, attention has now shifted back to the public sector. The decisions made during the hospital's board meeting on June 29 indicate that the French administration has taken a renewed interest in St. Barth. One of the principal measures announced by the director of the regional hospital agency is the creation of an out-patient surgical unit that would allow a certain number of the minor, elective surgical procedures currently performed in Guadeloupe and neighboring St. Martin to be available locally. The hospital's intervention menu would be limited to pre-scheduled acts, all grouped together to occur once a week. If all goes according to plan, elective surgery procedures may become available in one year. The other principal decision has been the opening of a peri-natal ward which would serve to prepare expectant mothers for delivery as well as to provide postnatal support. Despite these welcome improvements which will no doubt enhance island healthcare, the big question still remains: What to do about the medical emergency evacuations? As far as this eye can see, there's nothing in the looming horizon that even hints of an applicable solution.
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On November 7, 1990, Jean-Paul Proust announced the creation of a "sophisticated system of emergency evacuations that would be in place within two or three months." Let's see. That would have rendered operational the promised and much-awaited airlift system sometime during the first quarter of 1991. More than 10 years later, why don't we skip the part about 'sophisticated' and move right on to the practical. At this point, we'd happily settle for a functioning, simple and reliable system of medical evacuation in times of need.

Yves Bourel

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