DOCTORS OPTIMISTIC ABOUT IMPROVEMENT IN WORK HOURS, CONDITIONS AFTER DISCUSSION WITH QEH ADMIN
By Shamar Blunt

Junior doctors at the Queen Elizabeth Hospital (QEH) are hoping that talks with officials at the state-run institution will bring an end to the excessive workloads that have resulted in some of their colleagues quitting and even seeking mental health intervention.
And as the medical professionals warned that the current state of affairs created room for medical errors, the Barbados Association of Medical Practitioners (BAMP) expressed support for a reduction in their work hours to protect the public from harm.
In a statement sent to Barbados TODAY, the ‘Concerned Junior Doctors’ identified themselves among those who Government Senator Dr Crystal Haynes and consultant physician at the QEH and Deputy Dean of the Faculty of Medical Sciences at the University of West Indies Cave Hill Campus Dr Kenneth Connell said were forced to work 32 hours or more on a stretch.
“While we remain dedicated to providing the best care for the patients under our charge, the vicious cycle of long work days and even longer on-call shifts continues to take a negative toll on our physical and mental
well-being,” they said, noting that burnout and long sick leave are commonplace.
“As of today, several of our colleagues have either migrated to the US, UK or Canada – creating brain drain –, resigned from their posts, taken protracted sick leave periods or even require mental health counselling for physician burnout and the sequelae thereof.”
Senator Haynes, speaking in the Upper House during the debate on the Appropriation Bill, 2023 earlier this week, and Dr Connell in an interview with Barbados TODAY on Wednesday called for an end to the long workdays that were putting strain on the medical professionals and had the potential to also put members of the public at risk.
“We join with Senator Dr Crystal Haynes to make a valiant effort to come to a reasonable, safe and practical approach to regulation of working hours for the medical staff employed at the institution,” the non-consultant doctors said.
They further expressed optimism that discussions with hospital management would bear fruit soon.
“We have been in communication with the administration of the QEH to implement measures that lead to the restructuring of our various departments to ensure both patient and doctor satisfaction as well as safety in the administration of our medical care to our charges,” they disclosed.
“It is, therefore, our hope, in the year 2023, that with the drafting of legislation, the times of 32-hour shifts, severely sleep-deprived physicians – [a situation] affecting our cardiovascular health – and the resultant risk of medical errors from the above is fully abolished and put behind us.”
Highlighting their “arduous plight”, the doctors said while the general public may not be fully aware of their working conditions, some patients could attest to the long hours they were on the job.
“On several occasions, patients remark in awe that the same speciality doctor that attended to them at 8 a.m. while waiting in the Accident & Emergency Department remains on active duty until 4 p.m. the subsequent day, oftentimes without lunch [or] dinner breaks and little to no sleep,” they wrote.
“This equates and corroborates the 32-hour shifts mentioned [by Senator Haynes] that junior doctors in almost all specialities – including Internal Medicine, General Surgery, Obstetrics & Gynecology and Pediatrics – experience once every four days. Added to this, on average, a standard workday can easily go beyond the recommended eight hours due to the persistent issue of increasing patient loads, perpetuated by delays in both investigations and administration of treatment.”
The doctors also noted that in 2019, with the advent of the COVID-19 pandemic, “an already mentally and physically exhausted workforce from critical departments were split in two to attend [to] the dynamic needs of the Harrison Point facility while still meeting their contractual obligations at the Queen Elizabeth Hospital”.
“Thankfully, with the significant reduction in the number of severely ill COVID patients needing specialist care, our efforts no longer need to be strained in providing care to two facilities,” the doctors noted.
However, they said, they remain overworked and have made it a priority to take their physical and mental health more seriously than ever before.
Their call for that to change was supported by BAMP president Dr Lynda Williams who welcomed “an urgent examination of the hours that junior doctors now work”.
“We fully support the need to transition to an ideal number of working hours that will allow them to have safe, productive and fulfilling lives and that will protect the public from harm,” she said in a statement sent at the request of Barbados TODAY.
Noting the dangers posed by doctors working excessive hours, she referred to several studies, saying: “Fatigue causes significant negative physical and psychological effects. For every hour that a doctor works beyond 11 hours of continuous work, there is a measurable decline in cognitive performance, psychomotor skills, clinical acumen and prescribing accuracy. Depression and burnout, risks to physical health and fear of litigation also affect junior doctors disproportionately.”
Dr Williams acknowledged that the costs associated with expanding the allotment of junior doctors at the QEH would be significant, but said allowing the current situation to continue without intervention would be even more costly.
“In order to reduce junior doctors’ working hours, as Senator Dr. Haynes pointed out, a large influx of new staff would be required. This requires careful investigation because increasing junior staff also increases the need for supervision and training.
“BAMP appreciates that in a developing nation such as ours, a large increase in staff at once will have a significant economic cost. However, we also believe that no cost is greater than the safety of our junior doctors and, ultimately, the lives they care for,” the doctor said.
Though noting that the practice of doctors working 30 hours or more per shift was “a longstanding and complex problem which is not unique to Barbados”, Dr Williams pointed out that other jurisdictions had proven the situation could be addressed.
Even so, she acknowledged, reducing doctors’ working hours was only part of the solution.
“Several developed countries have introduced restrictions on the number of hours that junior doctors can work; however, organisational cultures of working long or antisocial hours often exist and doctors in training reported being unofficially expected to work extra hours voluntarily, even when working time restrictions were implemented,” the BAMP president noted.
“Furthermore, lack of resources available for work, lack of nursing staff and ancillary staff, poor workflow, poor shift design, lack of adequate facilities as well as interdepartmental pressures may mean that simply restricting the number of work hours may be insufficient to address issues relating to stress, fatigue and their consequences for the junior doctor. In short, reducing junior doctors’ working hours only partially addresses the problem.”
Dr Williams gave BAMP’s commitment to working with the Ministry of Health and Wellness and the QEH to find “workable solutions to the highlighted problems”.
Up to late Thursday, QEH officials could not be reached for comment.
shamarblunt@barbadostoday.bb

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By Marlon Madden

The COVID-19 pandemic can no longer be used as an excuse for the performance of the tourism industry, says Chairman of the Barbados Hotel and Tourism Association (BHTA) Renee Coppin.
In fact, she is concerned about the slow pace of recovery and calls for greater information sharing.
Coppin said while she was encouraged by the industry’s performance for 2022 which showed signs of a comeback following the height of the COVID-19 pandemic, more must be done to bring Barbados back to 2019 levels.
“In order to have your best performance you have to train hard, prepare fully, set aggressive goals and go up against your best competition. So Barbados has to be prepared to do all of these things because we have no more room for excuses. We can’t be here at the end of this year. It is time for us to get in the game,” said Coppin.
She was delivering her report during the BHTA’s first quarterly meeting for 2023 at the Accra Beach Resort on Wednesday, which had as its theme Women in Tourism: Making a Difference.
“We were very excited to see that in December, for the first time since the pandemic, arrivals exceeded our last normal year, 2019. While we ended the year 250,082 persons down on 2019 levels, what we are optimistic about is a sustained revival of our sector as we claw our way back to consistent performance,” said Coppin.
However, indicating that the issue of information sharing will be key to the industry’s continued recovery, Coppin said it will be important to get “good information and use it logically and intelligently”.
“Doing the right analyses, asking the tough questions and being prepared to face hard truths will be very important. When we look at our performance for 2022 relative to the rest of the world and the rest of the region, we are very aware that Barbados fell below global and regional averages in our pace of recovery,” she said.
Barbados’ tourism recovery was estimated to be around 66.2 per cent of 2019’s performance at the end of last year while the Caribbean recovery was recorded at 83.7 per cent and the global recovery at around 62.6 per cent at the end of 2022 compared to 2019.
“It is important that we look at these numbers and that we are very frank and very real as to where we are and do what we need to do to get back on track. We no longer have COVID as a justification and so we will need to interrogate our information even more rigorously to ensure that we are staying ahead of our competitive set and so that we in the industry are bringing our “A” game to the table,” she cautioned.
Coppin, whose report came a day after the Caribbean Tourism Organisation (CTO) reported that visitor arrivals to the region could surpass 2019 record levels, reported that for January this year, Barbados welcomed 58,492 stay-over visitors, or 81.8 per cent more visitors than the same period last year.
(MM)

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AUTHORITIES RAMP UP EFFORTS TO KEEP AFRICAN SWINE FLU, BIRD FLU OUT

By Anesta Henry

Cabinet has approved the resources to bolster efforts to prevent African swine fever or bird flu outbreaks on the island.
Although not saying exactly how much had been provided, Chief Veterinary Officer Dr Mark Trotman said that in addition to monitoring outbreaks in other countries, the Ministry of Agriculture has been working closely with farmers to ensure they are implementing preventative measures to protect their pigs and birds.
There have been outbreaks of African swine fever across Europe and bird flu in parts of Asia.
Speaking from the well of Parliament as the Estimates Debate continued on Friday, Dr Trotman said the ministry has also been producing public service announcements to inform Barbadians about the two “serious” diseases, including the damage they had the potential to cause.
“At the end of the day, it is up to the farmers to put measures in place to prevent the entry of the viruses, whether it be bird flu or African swine fever. From an entry standpoint, we are doing some monitoring of landing sites because the bird flu is a highly pathogenic avian influenza, to use the correct term.
“This particular outbreak seems to be transmitted through migratory birds which is a little different from the previous episodes, which makes it a totally different beast to deal with,” Dr Trotman said.
He added: “So we are monitoring sites where wild birds come into the country. Barbados, as you know, is right in the middle of the Atlantic flyway; birds travelling south in the winter do rest in landing sites in Barbados and that poses a risk of entry of the disease into the country. So monitoring those landing sites becomes important, so if we do get birds that are potentially coming in we can pick that up.”
The Chief Veterinary Officer said officials have also been creating a database on the poultry and pork industry to identify where farms are situated and what risk factors exist, particularly if they are close to landing sites for birds.
He said that while there is an ongoing community outreach programme to register farms, there is evidence of a significant number of unregistered farmers.
Dr Trotman pointed out that these farmers do not access the services of the Ministry of Agriculture for technical support or veterinary assistance because they do not consider themselves farmers.
“We are putting GPS points on each of these farms so we have a good overview of where they are, not only so that we can identify them, but in the event of an outbreak we can map it and identify how the disease can possibly spread from there outwards.
“We have found that we have well over 1 500 pig holding areas, which were a lot more than we thought there were. The poultry industry, they are such a diverse group of farmers – you have your commercial entities, you have your small holders, you have your backyard farmers – and each of them has to have a tailored approach in terms of what they can do to protect their farms,” he explained.
With respect to the importation of pork and poultry products, Dr Trotman said as the need arises and outbreaks widen within certain countries, restrictions are being implemented to prevent the entry of the viruses.
“We put restrictions to prevent it from entering through passenger baggage, through commercial entries, while trying our best to safeguard a certain level of trade. We have had to take a more surgical approach to this rather than an outright ban on all poultry and pork products.
“We have done that quite successfully with countries such as the United States and Canada, and so we are looking to try to do it with the United Kingdom as well,” the Chief Veterinary Officer said.
anestahenry@barbadostoday.bb

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