The donation of two ambulances by the Maria Holder Memorial Trust to the Queen Elizabeth Hospital (QEH) has led to the Emergency Ambulance Service (EAS) now being equipped with nine vehicles to respond to the 14 000-16 000 emergency calls it receives annually.

The trust handed over the two ambulances during a ceremony at the EAS Wildey, St Michael headquarters on Monday, where trustee, King’s Counsel, Peter Symmonds, announced that in order to help the service achieve its ideal target of 12 functioning ambulances, the registered charity had agreed to purchase two ambulances in 2024, provided that the QEH purchases one this year.

Symmonds noted that in addition to the two fully-equipped ambulances, the trust also donated two additional stretchers, safety vests, helmets and dispatcher headsets. He said the entire donation cost an estimated $400 000.

“In order to make the appropriate intervention, with equipment should also come training and we have agreed to assist with funding the training of up to 15 dispatchers by April 2023 so that when you call 511 you should be assured that you are speaking to personnel who are continually trained to carry out their duties. This is therefore seen as a complement to the provision of the ambulances and equipment which we fervently expect will be immediately put to good use,” Symmonds said.

The trustee also indicated that the staff of the trust has received presentations on healthcare from EAS Medical Consultant, Dr David Byer.

Dr Byer said while the service responds to 50 to 60 calls per day, the additional ambulances allow for the fleet to last longer while undergoing the necessary servicing and preventative maintenance.

“This bolsters our fleet. Our target is between 10 to 12 vehicles and this allows for the fleet to last longer because it allows us to do the necessary maintenance. I mean not all 10 to 12 would be off the road at the same time, but we would be able to pull them out and do the necessary servicing and the necessary preventative maintenance to allow them to last for a very long time.

“We are working with the trust in terms of supporting training with respect to the dispatchers and that is something that we are looking at in 2023. And further down the road, that is basically very preliminary, we are going to be looking at paramedic training as well as possibly driver training for emergency drivers of the vehicles so that they can function a lot safer,” Dr Byer said.

Sales Director of NASSCO Limited, Roger Moore, who sourced the ambulances, said that a down payment for an additional vehicle has already been made and suppliers have already started manufacturing it.

“In the next couple months you should be receiving that. We hope that it would not take as long as these last two took, but this is a quieter time, the end of the year is always a busy time, so I think that this time you should be receiving it much sooner so that you can get the other one ordered before the year is out,” Moore said.

Minister of State in the Ministry of Health and Wellness, Dr Sonia Browne, extended gratitude to the Trust for the donation and the pledge to train staff of the EAS.

She said the trust’s contribution adds to the care and treatment of patients, specifically due to the decrease in waiting times and availability of ambulances and provision of-well trained staff.

“All these of course will impact positively on morbidity and mortality rates from injury and illness throughout the island,” Dr Browne said. (AH)

The post Boost for ambulance service appeared first on Barbados Today.

By Shamar Blunt

A leading medical consultant believes the impact of Barbados’ growing Non-communicable Disease (NCD) epidemic has become an even more dire problem for the island’s acute healthcare facility because of COVID-19.

Dr Kenneth Connell said: “I probably would have said it is more dramatic than that,” in response to recent assertions by Acting Director of Medical Services Dr Chaynie Williams that NCD sufferers were contributing significantly to delays in the Accident and Emergency Department. 

Dr Connell, the Deputy Dean in the Faculty of Medical Sciences at the University of West Indies Cave Hill Campus and Consultant Physician at the QEH, noted:

“The emergency [department] pre-COVID was already a difficult place in terms of waiting time… What has happened post-COVID, is an increase in the NCD emergencies – stroke, heart attack and heart failure. COVID has been the propellent for a lot of this. So patients admitted with emergencies can sometimes remain in A&E department for two, three days waiting to be placed on the ward,” he explained.

Dr Williams recently told the radio call-in programme Down to BrassTacks on which callers raised the issue of the delivery of service at the hospital: “The emergency department’s challenges are a health system challenge as it represents one geographic location. We have many complications of non-communicable diseases – kidney, heart, and others – that patients need in-patient care [for] and many times persons spend days in the Accident and Emergency Department trying to access in-patient care because they are very ill or in hospital and can’t get out of hospital because they are not well enough.”

Agreeing that the NCD situation at the Queen Elizabeth Hospital is severely impacted by the NCD situation, Dr Connell said this is due directly to the influences of the pandemic. In fact, he suggested to Barbados TODAY that the pressure being placed on the island’s healthcare system from Barbadians being treated for NCDs is being understated.

Noting the importance of expanding the A&E Department in order to cater to the island’s emergency health needs, Dr Connell insisted that any such expansion would not be the answer to Barbados’ out-of-control NCD war.

“Expanding the A&E Department, which there has been a lot of talk about, I am not sure is the actual solution. What would happen, the beds from the expanded department would just be basically holding more patients with NCD emergencies.

“I think that the country needs to have a serious conversation with all stakeholders – from the Ministry of Health and Wellness, civil society organisations, patient advocate groups – so that we can decide how best we can manage or better manage NCDs before they reach the hospital. If we do not do that, then what we are likely to see is what I would describe as a slowly growing pandemic.”   

The World Health Organisation’s (WHO) 2022 Non-communicable Disease Progress Monitor report states that the percentage of deaths from NCDs in Barbados in 2019 stood at 83 per cent or 2,800 total NCD deaths, which is above the world average of 74 per cent.

Dr Connell suggested that education surrounding the nation’s NCD fight needed to be increased significantly if the current situation at the QEH and other healthcare facilities is to ever be addressed.  shamarblunt@barbadostoday.bb

The post Expert believes bad situation at QEH made worse by COVID-19 appeared first on Barbados Today.

Denmark: Adding a dash of milk to a cup of coffee can have anti-inflammatory effects, a recent study from the University of Copenhagen has shown. The study appeared in the Journal of Agricultural and Food Chemistry on January 30, 2023. 

The study investigated how polyphenols behave when combined with amino acids, the building blocks of proteins. The results have been promising.

Is it not amazing that something as simple as a cup of coffee with milk has an anti-inflammatory effect in humans? A combination of proteins and antioxidants doubles the anti-inflammatory properties in immune cells. The researchers hope to be able to study the health effects on humans.

Whenever bacteria, viruses and other foreign substances enter the body, our immune systems react by deploying white blood cells and chemical substances to protect us. This reaction, commonly known as inflammation, also occurs whenever we overload tendons and muscles and is characteristic of diseases like rheumatoid arthritis.

Antioxidants known as polyphenols are found in humans, plants, fruits and vegetables. The food industry also uses this group of antioxidants to slow the oxidation and deterioration of food quality and thereby avoid off flavours and rancidity. Polyphenols are also known to be healthy for humans, as they help reduce oxidative stress in the body, giving rise to inflammation.

But much remains unknown about polyphenols. Relatively few studies have investigated what happens when polyphenols react with other molecules, such as proteins mixed into foods that we then consume.

In a new study, researchers at the Department of Food Science, in collaboration with researchers from the Department of Veterinary and Animal Sciences, at University of Copenhagen investigated how polyphenols behave when combined with amino acids, the building blocks of proteins. The results have been promising.

"The study shows that as a polyphenol reacts with an amino acid, its inhibitory effect on inflammation in immune cells is enhanced. As such, it is clearly imaginable that this cocktail could also have a beneficial effect on inflammation in humans. We will now investigate further, initially in animals. After that, we hope to receive research funding which will allow us to study the effect in humans," says Professor Marianne Nissen Lund from the Department of Food Science, who headed the study.

Twice as good at fighting inflammation

To investigate the anti-inflammatory effect of combining polyphenols with proteins, the researchers applied artificial inflammation to immune cells. Some of the cells received various doses of polyphenols that had reacted with an amino acid, while others only received polyphenols in the same doses. A control group received nothing.

The researchers observed that immune cells treated with the combination of polyphenols and amino acids were twice as effective at fighting inflammation as the cells to which only polyphenols were added.

"It is interesting to have now observed the anti-inflammatory effect in cell experiments. And obviously, this has only made us more interested in understanding these health effects in greater detail. So, the next step will be to study the effects in animals," says Associate Professor Andrew Williams of the Department of Veterinary and Animal Sciences at the Faculty of Health and Medical Sciences, who is also a senior author of the study.

Found in coffee with milk

Previous studies by researchers demonstrated that polyphenols bind to proteins in meat products, milk and beer. Another new study tested whether the molecules also bind to each other in a coffee drink with milk. Indeed, coffee beans are filled with polyphenols, while milk is rich in proteins.

"Our result demonstrates that the reaction between polyphenols and proteins also happens in some coffee drinks with milk that we studied. The reaction happens so quickly that it has been difficult to avoid in any of the foods we've studied so far," says Marianne Nissen Lund.

Therefore, the researcher does not find it difficult to imagine that the reaction and potentially beneficial anti-inflammatory effect also occur when other foods consisting of proteins and fruits or vegetables are combined.

"I can imagine that something similar happens in, for example, a meat dish with vegetables or a smoothie if you make sure to add some protein like milk or yogurt," says Marianne Nissen Lund.

Industry and the research community have noted the major advantages of polyphenols. As such, they are working on adding the right quantities of polyphenols in foods to achieve the best quality. The new research results are promising in this context as well:

"Because humans do not absorb that much polyphenol, many researchers are studying how to encapsulate polyphenols in protein structures which improve their absorption in the body. This strategy has the added advantage of enhancing the anti-inflammatory effects of polyphenols," explains Marianne Nissen Lund.

Polyphenol Facts

• Polyphenols are a group of naturally occurring antioxidants important for humans.

• They prevent and delay the oxidation of healthy chemical substances and organs in our bodies, thereby protecting them from damage or destruction.

• Polyphenols are found in various fruits and vegetables, tea, coffee, red wine and beer.

• Due to their antioxidant properties, polyphenols are used in the food industry to minimize the oxidation of fats in particular and the quality deterioration of foods, to avoid off flavours and rancidity.

Reference:

Jingyuan Liu, Mahesha M. Poojary, Ling Zhu, Andrew R. Williams, Marianne N. Lund. Phenolic Acid–Amino Acid Adducts Exert Distinct Immunomodulatory Effects in Macrophages Compared to Parent Phenolic Acids. Journal of Agricultural and Food Chemistry, 2023;

DOI: 10.1021/acs.jafc.2c06658

Santo Domingo, DR
With the introduction of the cholera vaccine, it can be expected that cases will be brought under control. Still, the country must maintain active disease surveillance to prevent new outbreaks.

This is the opinion of the epidemiologist Manuel Colomé, professor of the Masters in Public Health and Epidemiology of the Instituto Tecnológico de Santo Domingo (INTEC) and epidemiology manager of the Dr. Hugo Mendoza Pediatric Hospital, where children are treated for cholera. This disease, in recent weeks, has generated two major outbreaks in sectors of Greater Santo Domingo, one in La Zurza and the other in Villa Liberación.

The specialist understands that the success and the extent of these control measures carried out by the Ministry of Public Health, which he considers adequate, will depend a lot on social and environmental factors, health care, human behavior, public health infrastructure, adaptation, and microbial changes and food management, among others.

Answering questions for Listin Diario, the epidemiology expert, considering that solid waste management, access to drinking water, and proper excreta disposal could be improved at the local level. “I also want to emphasize that the humanitarian crisis that Haiti is experiencing can be an important risk factor because it increases the migratory flow,” he added. He noted that both countries must address Public Health measures to deal with cholera. He pointed out that this gap must also be overcome since cholera is a disease of poverty and social inequality.

Colomé said that society must also support the government in prevention and health promotion activities within the community, as knowledge of the signs and symptoms and the mode of transmission is vital to ensure timely care.

Statement on the fourteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic

Cristina Mitchell

30 Jan 2023

After writing to the authorities and pointing out that around 10,000 NEET PG aspirants were ineligible to appear for the exam, now a delegation of Federation of All India Medical Association (FAIMA) is going to meet the Union Health Minister Mansukh Mandaviya tomorrow.

Sharing this detail on Twitter, FAIMA mentioned, "A delegation of #FAIMA will be having meeting with Hon'ble Health Minister Shri @mansukhmandviya Ji regarding #NEETPG2023 Postponement issue on 31st January! We hope Sir will listen to our demands & will provide some solution!"

Earlier FAIMA had written to the Union Health Minister and pointed out that around 10,000 NEET PG aspirants will not be able to appear for the entrance test. Therefore, the association had urged the authorities for postponing the exam by 2-3 months and reconsider the eligibility criteria.

National Board of examinations (NBE) had earlier announced that NEET PG 2023 will be held on 5th March 2023. The result will be declared By 31st March 2023. As per the previous eligibility criteria announced by NBE, the NEET PG 2023 candidates must complete their mandatory one-year MBBS internship on or before March 31.

However, Medical Dialogues had earlier reported that due to this Internship Deadline, hundreds of students were facing year loss since they were unable to fulfill the eligibility criteria of completing the MBBS internship within March 31.

Also Read: Around 3,000 NEET PG Aspirants ineligible: KNRUHS Medicos approach State Health Minister seeking postponement of exam

After various representations from doctors and organizations, finally NBE offered to relief to the NEET PG aspirants and extended the Internship Deadline to June 30, 2023.

Even after postponement of the exam, several thousands of candidates remained ineligible for the exam. In Telangana alone, altogether 3000 students remained ineligible since the Kaloji Narayana Rao University of Health Sciences (KNRUHS) extended the internship completion date of MBBS students till August 11. Kakatiya Medical College (KMC) alone has about 200 interns who are now ineligible for writing the PG medical entrance test.

On January 24, 2023, taking up the issue of such candidates, FAIMA had written to the Union Health Minister. "Every year lakhs of post MBBS doctors appear in this exam chasing their dream. Each Medical Specialist doctors add to strength on ground doctor which helps the patient & society in their best possible ways they could they can and also who plays a significant role in providing strength to existing health care system of this country which has also been proved during the Covid Pandemic."

"If the exam is conducted on the official said date, there will be around 10000 potential eligible MBBS doctors who won't be able to write the life deciding exam and will be back in their career for around 1 year which will be a huge loss to the existing resident doctors, work hours, patient load and healthcare system of the country," the letter further added.

Requesting Hon'ble Union Health Minister Shri @mansukhmandviya Ji to work on the basic issues beside opening new Medical colleges!10000 of #Doctors are left ineligible to appear for #NEETPG2023 Exam!Kindly Postpone #NEETPG2023 exam by 2-3 Months!#PostponeNEETPG2023@ANI pic.twitter.com/CmrOqwvcEn

— FAIMA Doctors Association (@FAIMA_INDIA_) January 24, 2023

"Recently regarding NEET PG 2022, stray round counselling was conducted on 10/01/2023 in which many NEET PG aspirants participated in attending the counselling, due to which lots of NEET PG aspirants participated in attending the counselling, due to which lots of NEET PG aspirants aren't able to give ample amount of time to prepare for the said exam on 5th March 2023. We have also noticed a helpful decision by MOHFW in 2022, where NBEMS rescheduled NEET PG on 21/05/2022 & also additionally extended the eligibility criteria for interns due to which lots of intern students of various states were eligible of NEET PG 2022. Even the similar scenario was seen in Covid Pandemic where the NEET PG 2021 was rescheduled from 15/04/21 to 11/09/21," FAIMA had mentioned in the letter.

Therefore, requesting the authorities for postponing the NEET PG exam, the association had mentioned, "Sir, considering the above mentioned facts, FAIMA requests the concern authority to kindly consider the request and do the needful by postponing the exam by 2-3 months & re consideration of eligibility criteria of interns to make them eligible for NEET PG 2023."

Now, in a recent Tweet, FAIMA has informed that a delegation of the association is going to meet the Union Health Minister and request him to postpone the exam.

A delegation of #FAIMA will be having meeting with Hon'ble Health Minister Shri @mansukhmandviya Ji regarding #NEETPG2023 Postponement issue on 31st January! We hope Sir will listen to our demands & will provide some solution!@ANI @PTI_News @DghsIndia@DrAjayRML @MoHFW_INDIA

— FAIMA Doctors Association (@FAIMA_INDIA_) January 27, 2023

"NEET PG Internship Deadline has been extended till June 30. So obviously, the counselling process cannot start before July. So, even after appearing in the NEET PG exam on March 5, the students will have no choice but to sit idle for three to four months. They won't even get hired for such a short period of time. I hope that the Honourable Health Minister takes cognizance of the matter and the exam gets postponed," Dr. Rohan Krishnan, the National Chairman of FAIMA told Medical Dialogues.

"The authorities should consider the case of the PG dental students as well since they are facing the similar kind of problems regarding the eligibility criteria," he added.

Also Read: NEET PG 2023 Applications Edit Window now open, Details

This was announced to Diario Libre by Dr. Yocasta Lara, director of Hospitals of the National Health Service (SNS), after confirming that yesterday three other patients were discharged because they tested negative for the disease, of which 36 cases have been registered at the national level from October to date.

The doctor explained that they are awaiting the results of the tests performed on those hospitalized to confirm or rule out the disease and recalled that stool cultures take three days to conclude.

Of the seven patients, five are at the Dr. Felix Maria Goico Hospital in the National District, one at the Dr. Rodolfo De La Cruz Lora Hospital in Pedro Brand, and one at the Dr. Hugo Mendoza Pediatric Hospital in Santo Domingo East.

Yocasta Lara said that the balance of patients admitted for suspicion of the disease is done every day at 8:00 a.m., so she cannot say if more people have been revealed this Saturday.

Since October 2022, 8,700 cholera tests have been applied in the country. However, so far, the health authorities have not provided information on the post-mortem tests used on five residents of the Villa Liberation sector, Santo Domingo East, who, according to their relatives, died of symptoms associated with cholera.

It is recalled that the authorities began to apply the Euvichol-Plus cholera vaccine to people from one to 60 years of age, residents of vulnerable areas where cases have already been detected.

The immunologic is a liquid formula for oral application, single dose, and protects against serotypes 01 and 0139, with protection for three years. It is being applied in the Goico Hospital, the mobile hospitals of La Zurza and Villa Liberación, and the Moscoso Puello Hospital.

It will also be distributed in selected schools in these sectors, including Capotillo and Villas Agrícolas.

At the provincial level, it will be applied in Elías Piña, Dajabón, Independencia, and Pedernales, provinces bordering Haiti, where health authorities have reported 511 deaths from cholera in the last four months.

The main issue at hand, is the amount of time spent on the toilet while using the cellphone. It is likely that the practice will result in one sitting for a longer period of time and simultaneously using the cellphone, which often results in losing track of time. This puts pressure on the veins of the anus in the lower rectum, resulting in haemorrhoids or piles. These often cause severe pain, swelling and/or bleeding.

General, laparoscopic and bariatric surgeon Dr Alfred Dawes told Your Health Your Wealth that using a smartphone isn't the problem, rather it is sitting on the toilet and using the phone for a prolonged period of time.

Veins both on the inside of and just on the outside of the anus become the majority of the swollen mass of tissue we call haemorrhoids. These enlarged veins are filled with blood and stretch the lining of the anus, leading to fleshy looking tissue that protrude from the anus. If the veins in the inside of the anal opening are enlarged, we call them internal haemorrhoids. If it is the veins on the outside of the anus that are enlarged, they form external haemorrhoids. Internal haemorrhoids usually cause painless bleeding when you wipe, but if they get trapped in the anal opening this can lead to excruciating pain. External haemorrhoids become painful when the blood in their veins clot, leading to inflammation and even death of the overlying skin. Long periods of time spent on the toilet can unquestionably result in haemorrhoids. According to Dr Dawes, staying longer and straining to pass stool may cause the haemorrhoids to fill up with blood and create pain, swelling, or bleeding.

Dr Dawes also mentioned the possibility of contaminating one's phone with faecal bacteria when using the restroom. When you flush the toilet, tiny droplets of water may get in the air and contaminate nearby surfaces. E. coli and other microbial nasties may be present on phones and research shows that a smartphone screen is dirtier, on average, than a toilet seat.

While you might take pride in keeping your home spotless, you never know how clean public restrooms are, especially in areas where lots of people congregate, like offices or other workplaces.

So, how should you use the john? Below Dr Dawes gives some tips.

1. Only use the restroom for as long as you need to. Don't force a bowel movement if it doesn't come after a few minutes on the toilet. Get up and move on to something else instead. Return to the bathroom whenever the urge strikes.

2. The time it takes to poop should be between one and fifteen minutes; any longer may be a sign of constipation. Spend as little time as possible sitting still and tensing. If you find yourself becoming sidetracked, try setting a timer to alert you when it's time to stand up and continue if nothing has, so to speak.

3. Invest in a bidet to clean your bottom after using the bathroom (or straining). Your anal muscles may feel better with the help of warm, pressured water from the bidet.

Of course, not just after a bowel movement, you should wash your hands thoroughly after using the restroom.

4. After using, wash your hands with running water for at least 20 seconds.

5. Finally, if you must use your smartphone in the restroom, be sure to close the seat after you flush since every time you flush, faeces contaminated water droplets fly into the air and land on your phone, body parts, even your toothbrush.

6. Use Lysol or Clorox wipes to regularly clean your phone.

For the private sector to play a meaningful role in improving access to health care, we must understand the critical factors that impede access to care and create new sustainable models of care that recognise the existing impediments to inclusive care and health equity. Impediments to access and inclusive health care include poverty and its correlates, geographic area of residence in a poor or low-resource country or community, race and ethnicity, sex, age, occupational status, socio-economic status, education, and disability status. Accessing care— whether it is available, timely, convenient, and affordable — affects health care utilization. Any structure that delays access to care is an impediment to care.

Private sector role in facilitating access to care in a resource-constrained environment

Current models of care are primarily based on methods developed in more affluent societies with more formal economies and robust Government-funded programmes and social safety nets. These models of care are devoid of our cultural context and socio-economic realities and so are mostly unsuitable for lower-resource countries like Jamaica, where most members of the society are engaged in the informal sector and so lack the leverage of large corporations to negotiate inclusive health care coverage with insurance companies or serve as third-party guarantors of payment. Unfortunately, in low-resource nations with poor regulatory oversight, access to reliable and affordable health insurance products is limited for many citizens. While many reputable health insurance companies operate within ethical boundaries, a few are blinded by profits and tend to overreach, especially when they enjoy a relative monopoly, and regulatory oversight is weak or lax. For a health insurance product to be useful in improving access, health insurance companies cannot be directly involved in influencing the utilisation of services by the insured, either by actively encouraging patients to decline services, providing medical advice by untrained agents, or directing patients to facilities that may not be appropriate for their treatment simply to save money. This unacceptable interference with patient care represents a significant conflict of interest and poses a major impediment to access. Furthermore, a health insurance agent engaging in the practice of medicine under any guise is unlawful, unethical, and inappropriate.

The private health-care market is not immune to these calculations. Suppose the goal is inclusive health care that is sustainable. In that case, we can argue that a system that is designed to serve only the minority in the population with adequate health insurance is flawed, especially in a low-resource country like Jamaica, since there is no default position for the majority of the citizens who do not have access to coverage such as Medicare in the USA or NHS in the UK.

A system that ensures that access to care is inaccessible to most citizens in the informal sector is not in our best national interest. Fortunately, out-of-the-box and imaginative health systems innovators are beginning to design new disruptive systems of care that improve access, such as cross-subsidisation models, direct patient care models, capitation models, value-based care models, pay-for-performance models, etc. What these innovations have in common is improving the pool of people with reliable and affordable access to care while also tying compensation to performance and outcomes while limiting the interference from third parties that are more focused on profit rather than patient well-being.

The Heart Institute of the Caribbean (HIC) has been globally recognised as a pioneer and global leader in this reimagination of health-care delivery systems to ensure health equity, universal access, and inclusion. While citizens with health insurance and third-party guarantors of payment, for example, are expected to and must pay the full rate for services and procedures at HIC, we consistently subsidise the uninsured to ensure that most citizens have access to our services. While this does not sit well with some of the wealthy who disdain our subsidisation model for the poor and less affluent, we remain undeterred as we believe that our approach is anchored on a sound moral responsibility to ensure inclusive and equitable health care for all Jamaicans. We cannot justify extending such subsidies to the wealthy or to highly profitable cooperations seeking even more profit. We hope more providers will embrace these new approaches to extend care to the most vulnerable in our society. It must be remembered that the physician's primary role is to the patient. Not to the insurance company or any third-party payer. The centrepiece of what we do as physicians must be the patient, which means all patients and not just a few. This is the basis of inclusive care and health equity. Therefore, we must embrace models of care like cross subsidisation and direct patient care models that ensure expanded access to services beyond those with third-party guarantors. The farmer in the country, the vendor at Coronation Market, the widow, and the pan chicken man, all benefit from subsidised care that grants access to high-quality care.

The physician must not be intimidated into doing what is not in the patient's best interest to please the payer or enhance the profit for the payer. This principle is as old as time and is enshrined in the Hippocratic Oath. The Hippocratic Oath is an oath of ethics dating back to AD275, historically taken by physicians. The oath is the earliest expression of medical ethics in the Western world, establishing several important principles that continue to guide and inform medical practice today. All modern versions of the oath encompass the principle of responsibility to patients and equitable distribution of care. A current version administered by Tufts University, for example, includes as follows:

"...I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm... May I always act so as to preserve the finest traditions of my calling, and may I long experience the joy of healing those who seek my help."

If the economics of providing appropriate and inclusive care is impractical for Jamaica, then the only access that a Jamaican patient can have is if he is willing and able to foot the financial costs of travelling abroad for care. This again widens the access gap as only the very rich can access the service. Furthermore, the access gap is exacerbated as our limited funds are transferred from Jamaica to a more affluent society like the USA, UK, or Canada by the rich in search of services not accessible in Jamaica.

The effect of resources available for health care spending and access to care can be seen when comparing low- and high-income countries. The United States consistently vaccinates more than 90 per cent of it's children. Across sub-Saharan Africa, complete childhood vaccination averages 56.5 per cent, from a low of 24 per cent in Guinea to 95 per cent in Rwanda. In Jamaica, an upper lower-middle-income country, our childhood vaccination rates are approximately 90 per cent.

If we were to consider manpower issues in terms of the cardiologists, the continent of Africa (54 countries) has approximately 2,000 cardiologists for their 1.2 billion population or one cardiologist for 600,000 people. The United States of America has approximately 26,000 cardiologists for a population of 331 million or one cardiologist for 13,000 people. In Jamaica, we estimate about one cardiologist per 150,000 people. Our next article will look at other issues affecting healthcare access.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107