Advances in the health sector of Guyana (Part 1)

Dear Editor,
A letter appearing in a section of the media under the title “The healthcare system in Guyana is fractured and needs major surgery” provides an opportunity to highlight some advances made in the health sector of Guyana.
In several public engagements over the last two years, much information has been provided in regard to Government’s plans for the health sector, all being relevant to the matters the letter-writer raised. The MoH does need to improve communication with the public; because, clearly, the information we have been repeatedly sharing does not seem to be reaching persons who are interested in its receipt, including the media.
Further information on the Pediatric and Maternal Hospital would be provided in a few days’ time, when the President and the Minister of Health turn the sod in a matter of days.
From information already publicly provided by the President, the VP, and the Minister of Health in several public statements, the pediatric and maternal hospital would be staffed and equipped to provide specialised services to deal with a wide scope of medical interventions for children and pregnant women, and for complicated gynaecological conditions. The hospital would respond to children with cardiology, neurology, nephrology, oncology and other major complicated medical conditions. With this hospital, there ought to be little to no need for children with complicated medical conditions and women with complicated ob/gyn conditions to seek overseas medical care. Diagnostic imaging would include MRI.
Six new regional hospitals being constructed would be staffed and equipped to provide all Level 4 Package of Services that Guyana articulated and have publicly presented at several public events, the last one being on Monday and Tuesday, July 18/19. The PAHO/WHO have affirmed that the Level 4 Package of Services for Guyana is a comprehensive package. These hospitals would add 450 high-quality beds to Regions 2,3,4,5 and 6, with operating theatres, ER, ICU, HDU and NICU services.
There are major upgrades that would begin soon at the GPHC and at Linden and New Amsterdam hospitals, bringing their standards to being among the highest in Caricom. Similarly, the Bartica, West Demerara and Suddie hospitals are to be replaced by new hospitals, and resources are being mobilised for a new National Psychiatric Hospital. Already, major rehabilitation work has occurred at Leonora, Mabaruma, Port Kaituma and Lethem hospitals.
All these hospitals – the new ones and the ones for upgrade – are being built to international standards. International codes and standards such as IBC, Eurocodes, ASHRAE, NFPA, etc., are required in their construction. While most persons would not have knowledge about such codes and standards, it is reassuring that international standards are being enforced for the construction of all new hospitals in Guyana.
All hospitals would be equipped with elevators, and HVAC, hot water, steam etc., wherever required for services, would be available as part of the infrastructure. Whether hot water would be available in non-clinical areas is a policy issue Guyana would need to determine.
Health facilities must meet the highest possible standards. Indeed, old hospitals in Guyana did not meet those standards. Some of the newer constructions, such as the GPHC Emergency Building, the In-Patient Medicine Building, and The National Public Health Reference Lab, were in accordance with these standards, but periods of poor maintenance have affected optimal functioning. Additional resources are now permitting Guyana to demand higher standards.
While building standards are indispensable for quality healthcare, clinical, medical and nursing standards are also important. Gradually, Guyana moved towards introducing and delivering healthcare in accordance with treatment guidelines that have been tested, tried, and improved in developed countries. By 2010, most diagnosis and treatment followed international guidelines, but for Guyana, this is a work in progress. Much effort went into enshrining these standards between 2000 and 2015. Much of the progress was stymied for a period of time, but the public health sector is working towards ensuring that standards and protocols that work well in jurisdictions such as the USA are standardised in Guyana. It will take time to get it all right.
To accelerate progress towards the highest standard of clinical practice, Guyana has entered partnerships with world-class institutions such as Mount Sinai, Northwell, Vanderbilt, McMaster etc. Regular clinical audits are now being conducted to ensure standards and guidelines are being implemented.
EMS is a work in progress at this time. An Emergency Medical Service (EMS) that is well equipped with ambulances and staffed with Emergency Medicine Technicians (EMT), such as the EMS in the USA, is a significant need. We expect a fully functional EMS in Guyana by 2025. Before 2001, there was not even a semblance of an EMS or EMT service in Guyana. Although efforts were made after 2001, EMS remains, by and large, an underdeveloped service.
Recent efforts have accelerated advances that began in 2001 towards a high-quality National EMS. The majority of patients picked up in Region 4 in 2021 and 2022 so far have been by an EMT-led ambulance service operated by GPHC and the Fire Service. Since the start of EMS in Guyana, more than 20,000 persons have been served by an EMT-led ambulance service, with an average of 5,000 per year in the last three years.

This training programme and introduction of an EMT-led ambulance service is being presently rolled out in Regions 3 and 5, and would be introduced in Region 6 in January 2023. Training of personnel is presently being conducted.
With the help of Vanderbilt University, one of the renowned universities and medical centres in the USA, Guyana established an Emergency and Trauma Medicine Residency programme. This post-graduate training programme is presently headed by Dr. Zulfikar Bux. There are now several Guyanese specialists in ER medicine who work at the GPHC, New Amsterdam, Diamond and West Demerara hospitals; and, hopefully, in the years to come, more ER-certified specialists would be managing every ER Department in Guyana.
Guyana introduced the first-ever Caricom Residency Programme for ER Nurses. This programme is being expanded, and more of these certified nurses would be assigned to ER Departments around the country. Several doctors from several Caricom countries have completed their ER and other residencies in Guyana. The ER programme in at least one Caricom country is led by a doctor who completed residency in Guyana.
The GPHC’s Institute for Health Science Education (IHSE), in collaboration with UG and many of the top universities in the world, presently conducts post-graduate training in 16 areas. ER medicine is only one area. General Medicine (Internal Medicine), Ob/Gyn, General Surgery, Orthopedics, Radiology, Psychiatry are among the many post-graduate programmes at the IHSE. The IHSE also leads post-graduate training in Nursing, with such programmes as anesthetic nursing, neonatology and cardiology.
Like many hospitals around the world, GPHC has many problems. But for those who know the hospital before 2000, the GPHC is a far different hospital.

Dr Leslie Ramsammy