I have watched the debate about the 24-hour clinics from a distance for all of the time that we have been having the discussion. I think that may be at least eight years of collective national discussion. While I started firmly in the corner of the nurses, I now find myself struggling to understand the issues that are hindering the start of the 24-hour mechanism.
Perhaps this article will get me into a minefield because I will be seen as not supporting a profession that is almost 90 per cent female in its composition. Still, I feel the need to make some points and I will venture to that as systematically as possible and hope not to be misrepresented.
Let me start by saying that I believe the nurses of Barbados deserve a lot more than we give them. I think, in many cases, they have not gotten their due because the profession is feminized and thus suffers from the expectation that the work of nurses is care work and does not require adequate remuneration. If that is the type of discussion we want to have with respect to allowances for nurses, then I am open to that.
However, let us understand that that discussion is a global one, and it does not have to be the type of discussion that hinders us as a nation from more effectively utilizing the resources we have within the healthcare system. The nurses at the polyclinics are overworked and underpaid; the nurses at the Queen Elizabeth Hospital are more overworked and more underpaid. It is for this reason that I struggle to understand why the polyclinic nurses seem so resistant to more fairly divvying up the work to be done.
When the national discussion first started, the issue of access to services, such as day care for nurses, was highly touted. I agreed that these were major concerns deserving of address before the nurses should be asked to start the 24-hour system. Even these considerations have taken a back seat to the seeming fight for more money and a general resistance to facilitating the start of the initiative.
These issues I continue to support. But if these are the things impeding the process of the national 24-hour polyclinic initiative, the nurses are doing a poor job at articulation in the media and losing support because of that. Frankly, the cross talk is making the nurses of Barbados seem unwilling to answer the call of duty and that, to my mind, is an unfortunate characterization.
The discussion about nurses opting to go into polyclinic service to not have to work 24-hour shifts is a nonsensical one. Polyclinic nursing always took the nurses involved beyond the polyclinic walls. These nurses visited the poor and elderly in communities. They visited new mothers and newborns and they were some of the first eyes to detect social ills such as domestic violence and poverty that are now causing social decay in Barbados.
I think that some of the gaps that we have with social issues in Barbados could be alleviated if we return to a stronger community intervention. This may need the facilitation of social workers and other case management personnel. If the nurses are advocating for those types of support, then I can continue to support their concerns. Although, I must admit that I prefer them starting the implementation with the kinks to be ironed out.
With the levels of violence and gun play that we have in our society today, I think that the nurses are justified in requesting sufficient and adequate security at clinics. I am not just talking about a security guard ‘in a government uniform’. There needs to be adequate screening and lock mechanisms as well as a plan to ensure the safety of personnel and patients. I want to say that I would be surprised if the Government had not already been able to ensure this at the just gone implementation date. I also want to say – I live in Barbados so I will leave the point on the table.
Finally, I take the point that many of our polyclinics are in dire need of upkeep and repair. This is not, in any way, new or restricted to the polyclinics. We all know about the challenges with the primary care facility, the Queen Elizabeth Hospital. To use the state of the polyclinics as a primary reason for stopping the move to 24-hour service seems unrealistic.
If we all waited for best case medical facilities, the QEH would be closed and we would airlift Barbadians for medical treatment. With our financial situation being what it is, this reality is not going anywhere anytime soon. Thus, it will require ingenuity and a willingness to serve from our nurses. That is the bottom line – it is the price of post-colonial small island openness – but, at least it comes with beaches and good rum!
Can this be a reality check for all those involved? I hope that it can guide talks back to openness and a move in the best direction for Barbados as a whole. We simply must talk less and move our country in the direction we wish it to go. We all agreed that a child having an asthma attack in St John should not have to get to QEH to have a fighting chance. Let us start there and come forward again.
(Marsha Hinds is President of the National Organization of Women.