A private sector business has been commended for staging an initiative to promote a healthier Barbados, even as the Minister of State in the Ministry of Health and Wellness touted an all-of-society approach to tackle the non-communicable disease (NCD) crisis facing the country.

At the prize-giving ceremony for the 10,000-Step Challenge, facilitated by Dr Emma Dash of the Livewell Clinics, Minister Davidson Ishmael said the NCD challenge must be faced head-on.

“It is not just government that has a responsibility for tackling this issue. Non-governmental organisations, charities, clinics, and individuals at a very personal level, at the household level, all need to take responsibility for us being able to tackle the problem in our country,” he said.

The challenge, which encouraged participants to walk 10,000 steps daily for 90 days, came against a backdrop of startling statistics, with the Barbados government spending around $64 million annually to fight hypertension and diabetes.

Minister Ishmael said this meant $64 million less for investment in education and other areas, while an estimated $145 million was lost annually in productivity due to NCDs. Eight out of 10 deaths in Barbados are attributed to these conditions.

“It is a simple investment in your future, in your health, in your well-being and, of course, a very massive investment in our well-being as a country, because the health of a nation is indeed the wealth of a nation.”

Meanwhile, Dr Dash said the ceremony on Saturday was about more than awarding prizes – it was about celebrating movement, commitment, and a shared vision for a healthier Barbados.

She explained that the mission for the challenge was to provide large incentives for Barbadians to move.

“In a world where convenience keeps us sitting, we wanted to remind our community that every step matters, every movement counts, and every choice to be active is a step towards a longer, stronger, and healthier life.”

Underscoring the impact of NCDs, Dr Dash said, “They claim too many of our loved ones, reduce our quality of life, and place an enormous burden on our healthcare system. We believe that through collective action, education, and consistent movement, Barbados can set an example for the world.”

Prizes for the challenge included discounted services at Bayview Hospital, a range of electronic devices, and a portable air-conditioning unit by Coast to Coast Cooling. (STT)

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The Queen Elizabeth Hospital has secured a major boost to its climate resilience with the installation of a new 50 000-gallon water storage tank, part of a regional project to safeguard essential services against drought and other impacts of climate change.

The tank, donated by the Caribbean Community Climate Change Centre (CCCCC), was formally handed over on Thursday, with hospital and regional officials hailing the investment as a critical safeguard for the country’s main health institution.

QEH Chief Executive Officer Neil Clark thanked the CCCCC team for their support in making the project a reality, and said the facility must be prepared for the growing threats posed by climate change.

“This is a significant step forward in strengthening the resilience of our hospital, our health services, and indeed our country,” he said. “Rising temperatures, prolonged droughts, and increasing variability in rainfall are already affecting the natural supply of fresh water across our region. For a critical institution like the QEH, where water is not just essential but life-sustaining, these realities present very real risks.

“This investment is not simply a piece of infrastructure, it’s a safeguard. It helps us ensure continuity of care in times of drought, during emergencies, and whenever demand is at its highest.”

The tank forms part of the Water Sector Resilience Nexus for Sustainability in Barbados (WSRN-S) project, jointly implemented by the Barbados Water Authority and the CCCCC, with financing from the Green Climate Fund.

Head of Project Management at the CCCCC, Diane Wade, said the development should be seen as a milestone for the region.

“It is of significance not only because of what it means for Barbados in realising its ambitions of climate resilience, but also for the reach of its impacts across the Caribbean,” Wade noted. “The WSRN-S Barbados Project, approved in 2018 and launched in 2019, was the first full-size project for the Caribbean by the Green Climate Fund. It has since inspired a growing number of initiatives. Directly, project investments benefit an approximate 189 000 Barbadian citizens.”

While the original budget for the tank was $860 000, logistical challenges and global shipping costs pushed bids to more than $1m. A needs assessment carried out in 2020 determined that a 50 000-gallon tank would effectively double the QEH’s storage capacity.

QEH Director of Engineering Services, Paula Agbowu, said the hospital is now storing more than 150 000 gallons of water.

“The hospital installed a 50 000-gallon tank in 2018–19, which significantly increased capacity. This second tank from the CCCCC is an additional 50 000 gallons. So now we have in excess of 150 000 gallons of water storage,” she explained.

She stressed that while the figure may sound large, the hospital’s daily demand is substantial: “We need water for hand washing, for cooking, for steam supply, for sterilisation, for surgeries … there are nearly 200 toilets and sinks, plus many other facilities. We use an enormous amount of water on a daily basis.”

Agbowu added that the hospital hopes to eventually add a third tank to match its level of preparedness in electricity supply.

“At this juncture we would like to become a little bit more self-sufficient. With a third tank we would be at the point where we could be comfortable. In terms of our electrical capacity, we are at the point where we have two full weeks of capacity, and we would really love to be at that same comfort level as it relates to our water capacity,” she said. (SB)

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Patients arriving at the Queen Elizabeth Hospital’s Accident and Emergency Department are now being registered in as little as three minutes, the hospital said Monday, with overall triage waiting times cut by 40 per cent, following sweeping efficiency reforms.

Registration, once one of the major bottlenecks, is now down to as quick as three minutes, while wait times for triage have fallen by almost half.

Service Improvement Manager Dr Ayja Clarke said on the hospital’s Pulse Radio show that new digital self-registration kiosks have made a significant difference.

“The first thing we’ve been looking at is decreasing that time to registration,” she said. “So once you get through the door of the Accident and Emergency Department, you will be screened with security. What you will see now is you are going to be directed to a digital kiosk, so a self-registration kiosk.

“So now we have decreased registration time. So once you come into the department, we have registration time sometimes as low as three minutes. Sometimes it’s ten minutes during peak times when things are really, really busy.”

Clarke said triage has also been restructured with the addition of a senior doctor working alongside nurses.

“Since introducing the changes, especially with the introduction of the physician-assisted triage, the wait times between patients coming through the door and getting to triage are down by 40 per cent,” she said.

Other measures include advanced triage, where tests and scans can be ordered earlier; nurse-initiated medication to provide pain relief on arrival; and plans for a minor case unit to fast-track patients with less severe conditions.

Head of Accident and Emergency Dr Anne Marie Cruikshank said the digital changes were also helping staff act faster.

“As [the nurses] enter digitally into the system, that information goes directly to the medical records officer. … We have physician-assisted triage, and we can now start the investigations, the pain meds, the imaging’s being ordered. Everything can start from screening or triage,” she said.

Dr Clarke also revealed that the hospital has introduced Estimated Date of Discharge boards on wards, giving teams and relatives a clear plan for getting patients home.

“Overall in the hospital, I’m happy to report that so far the average length of stay in the hospital is down in all of the wards by 1.2 days, but in the wards that we piloted the boards on, we have noted that the average length of stay is down even further, down by 2.9 days,” she said.

QEH Chief Executive Officer Neil Clark said the introduction of service improvement managers earlier this year was designed to allow departments space to rethink service delivery.

“They’ve been focused on the A&E pathway and what I call the Unplanned Care Pathway, A&E, inpatient flow and discharge planning, and we’ll move them at some point in the future to the Planned Care Pathway,” he said.

He cited oncology as one area where staff-led improvements were delivering results.

“You would have seen the cancer waiting times at 140 days for your first outpatient appointment. We’re now down to three weeks. We’re down to 21 days from 140 days. And that’s that team in the Oncology Department just taking the initiative and saying they’re going to fix this, we’re going to improve this for the population.”

Clark added: “What I sense when I walk around is that there’s a change coming. I feel that change in people who are speaking to me. I feel people are getting permission to do things. And it feels like it was always that they were waiting for the CEO to say yes you can do this and I keep saying it’s your department, if you think that works better, try it, and that’s happening.” (SM)

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The Caribbean’s medical response to hurricanes, floods and other crises is set to get a major boost with the launch of a regional disaster medicine centre here, aimed at strengthening health systems and training frontline responders, university officials said Wednesday.

The Emergency and Disaster Medicine Centre (CEDMed) of the Ross University School of Medicine (RUSM), is a regional hub dedicated to strengthening medical preparedness and resilience in the face of natural disasters and other crises.

Senior Associate Dean of External Affairs Dr Rhonda McIntyre told the launch at the university’s Lloyd Erskine Sandiford Centre campus that CEDMed was born out of a clear and urgent need to address medical deficits when natural disasters strike the region.

“Resilience must be built into every layer of our societies, our infrastructure, our institutions, and our people,” she said. “Even in the face of disaster, we have seen a level of unity and cooperation unmatched at other times in our history. It is the spirit of resilience, solidarity, and hope that defines us and fuels the launch of the Ross University School of Medicine, Caribbean Emergency and Disaster Medicine Centre (CEDMed) – a new hub for building capacity across the region.”

Between 2000 and 2023, the Caribbean endured 793 climate events, according to the Central Bank of Barbados’ 2023 Financial Stability Report. Tropical storms made up just over half, and floods accounted for 32 per cent. Dr McIntyre pointed to staggering costs – more than US$181bn ($362bn) in storm-related losses.

“Here in Barbados, 14 recorded events over that period caused nearly US$300m [$600m],” she said, noting that disasters such as hurricanes exacerbate diseases, create lasting mental health challenges, and repeatedly stall regional development.

Senior Associate Dean of External Affairs at RUSM, Dr Rhonda McIntyre. (SB)

Reflecting on Hurricanes Maria and Irma, as well as the strain the COVID-19 pandemic placed on health systems, Dr McIntyre stressed that “institutional preparedness, trained responders, and community resilience are critical”.

While acknowledging that existing frameworks are in place, she said CEDMed offered something “transformative; a commitment to help build knowledge, train hands, and equip healthcare and emergency workers with the skills and strategies our region can rely on when disaster strikes”.

Through specialised training such as emergency cardiovascular care courses, expert partnerships, and disaster medicine programmes, CEDMed aims to fortify regional health systems and improve outcomes during crises, she said.

“The RUSM CEDMed Centre is more than a hub, it’s a beacon of a safer, stronger, and more sustainable Caribbean,” Dr McIntyre declared.

The first phase of the project will focus on establishing the centre and refining training programmes geared towards disaster response. Phase two will expand its offerings, and phase three will deepen partnerships with stakeholders. The centre’s objectives include developing a highly skilled workforce, providing regular refresher training, producing impactful research to guide policy, and building strong community engagement.

“Our vision is a resilient Caribbean health sector ready to meet the demands of emergencies and future disasters. Our mission is to build regional strength through advanced education, hands-on skills development, and pioneering research,” Dr McIntyre said. (SB)

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The Queen Elizabeth Hospital (QEH) is stepping up security in response to recent violent incidents targeting healthcare workers — with plans to fill key vacancies, enhance officer training, and explore the introduction of batons and body cameras.

Chief Executive Officer Neil Clark confirmed the measures in an interview with Barbados TODAY, saying the hospital is actively recruiting to fill ten security posts and reviewing options to better equip its frontline security personnel.

The move comes amid concerns over staffing shortages, delayed training and a lack of resources for security personnel. 

“There are some vacancies in the security team,” Clark said. “I think there are ten vacancies, and we’re out to recruitment for those, so hopefully that will be addressed. So, I have the posts, the posts have been approved, and I can recruit to those posts, and that’s active recruitment.”

Discussions are also ongoing about equipping security personnel with batons and restraints to improve safety for staff, patients and officers themselves.

“We’ve had discussions with the security team about batons and how they can protect themselves, protect the patients, protect the staff, about restraints, how they can restrain patients, and we’re working with our security team and with the police force to understand what the rules and regulations are pertaining to giving those services or those tools to our security team,” Clark explained.

The hospital CEO also revealed plans to introduce body-worn cameras. 

“I’ve also asked about giving the security team body cams, which gives them a little bit of protection and a little bit of overview of what’s happening on the ground, and after any incident, there’s a clear indication of what happened,” he said.

The security team has been conducting security awareness sessions for nurses and staff.

“They engage with us very actively in providing some awareness sessions as to how to keep themselves safe,” Clark said, adding that improvements often stem from frontline staff.

“Any issues that the security staff have… they know my door’s open. They come and see me and we discuss this, and they’ve come forward with a number of ideas, and a number of those ideas that they come forward with, we take forward. All the ideas for any of my departments come from the staff who work within them.”

He encouraged officers to bring concerns directly to him.

Regarding the Barbados Nurses Association’s call for panic buttons on wards, Clark confirmed a review is underway.

“There’s something that we need to review about how we keep the staff safe on the wards. So that’s a piece of action that we’re in now, given the recent attack on some of the nurses on one of our wards.”

louriannegraham@barbadostoday.bb

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A leading cancer specialist has warned of a worrying rise in liver disease among non-drinkers, as poor diets and widespread use of unhealthy cooking oils fuel an increase in non-alcoholic fatty liver disease (NAFLD).

Consultant radiation oncologist Dr Lalitha Sripathi raised the alarm on Friday.

“Initially we used to see liver disease only in alcoholics, and we used to attribute that to alcoholism,” she told journalists.

“Now we see something called non-alcoholic fatty liver disease on the rise, and we see that in people who are not alcoholics.”

Sripathi singled out seed oils such as canola and sunflower oil as a contributing factor, noting that these oils are commonly used in cheap, processed and deep-fried foods.

“What is causing the liver disease in them is those seed oils… the cheap ones,” said Dr Sripathi. “There definitely needs to be a lot of education.”

The oncologist’s comments formed part of a broader message on lifestyle-related diseases, including cancer, diabetes and hypertension.

She warned that too many people in Barbados are relying on highly processed, readily available foods that are packed with preservatives, chemicals and unhealthy fats.

“It’s unfortunate that they’re so easily available, so affordable… but they are to be avoided at all means,” she cautioned.

Dr Sripathi advised people to reduce their intake of deep-fried foods and instead use healthier alternatives such as olive or avocado oil – occasionally, and in moderation.

“If you need to have it, please have it in a healthy way—like you can use substitutes like olive oil and avocado oil for your cooking,” she said. “But only as a cheat-day diet, not on a regular basis.”

Dr Sripathi also cautioned against the use of plastics, non-stick cookware, and aluminium pots at high temperatures, which she said can leach harmful chemicals into food.

She recommended using steel, cast iron or earthenware alternatives.

“Ultimately, it all narrows down to living as naturally as possible and avoiding all the things that are convenient, easily available, but are ultimately harming your health,” she said.

The senior oncologist’s remarks at a hospital news briefing come at a time when health authorities across the region are paying closer attention to non-communicable diseases and their links to modern diets and lifestyles.

She called for greater public awareness and education, particularly for younger people and families making daily food choices that could affect long-term health outcomes. (SM)

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Cancer patients in Barbados are now being seen within just two weeks of diagnosis at the Queen Elizabeth Hospital (QEH), a dramatic improvement from previous wait times that stretched to nearly five months.

Hospital officials on Friday hailed the development as a major step forward in cancer care, bringing the QEH in line with — and even exceeding — international standards.

“We’re achieving better than world standards,” declared QEH Chief Executive Officer Neil Clark.

“Fourteen days is the standard the NHS in the UK aspires to and often doesn’t achieve. I’m so proud of what the team has done.”

The announcement came on Friday at a media briefing where doctors and senior staff outlined a sweeping overhaul of the hospital’s oncology services.

The transformation, they said, wasn’t driven by any drop in demand — quite the opposite. It was the result of deliberate decisions to expand clinic capacity, clear patient backlogs, and increase frontline staffing.

Consultant radiation oncologist, Dr Lalitha Sripathi, said the difference has been dramatic: “Once a new cancer patient is registered with us, the time to see the patient used to be around 140 days. Now it has come down to just a couple of weeks.”

The number of new patients seen each month has also doubled, from around 25 to nearly 50, while follow-up visits now top 700.

Officials further reported that the department is on track to exceed 800 visits this month, following a campaign to bring forward patients who were previously scheduled for later in the year.

“We had patients who were registered in March and weren’t scheduled to be seen until September,” said senior radiation therapist Ian Weithers.

“We made adjustments to bring them in earlier,” he added, clarifying that the new numbers do not necessarily represent a spike in new cases, but an intentional move to become more efficient.

Weithers, who also serves as operations manager, acknowledged that the shift required more than just rescheduling.

“Our staff are sometimes here from early in the morning, pressing on until 5 p.m. to handle new consultations,” he said.

“It’s intense work, but there’s deep commitment in this department. We all have family and friends who have been through this system.”

The team credited much of the progress to new leadership and structural changes within the oncology unit, noting that the department is preparing to deliver even more advanced treatment with the linear accelerator set to be commissioned soon.

“We’re gearing up to provide world-class radiation treatment and we’re also adding a clinical oncologist, a haematologist, a medical oncologist, physicists, and radiographers to make this a comprehensive cancer service,” Dr Sripathi said.

The specialist didn’t just focus on treatment. She used her time at the podium to deliver a blunt and passionate message about cancer levels in Barbados, encouraging prevention.

“The most common cancers I see in women are breast cancer. In men, it’s colon cancer, followed by prostate,” she said. “And sadly, we’re seeing them in younger people, including a 20-year-old recently diagnosed with breast cancer.”

She warned against red and processed meats, sugary drinks, and canned foods, calling them proven carcinogens, while also urging Barbadians to stay active, cut alcohol and tobacco use, and undergo regular screening.

“Most cancers are preventable,” she said. “And once mutations happen, they can become hereditary. That’s when we start seeing cancer in the next generation.”

Dr Sripathi encouraged women to begin annual mammograms at age 40 and also advised men to start prostate screening by age 40.

She further recommended colonoscopies from age 50, or earlier in cases of family history.

Her warnings were solidified by a simple but profound statement: “Cancer is becoming a lifestyle disease.” (SM)

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Faced with questions about gaps in specialist care, the Queen Elizabeth Hospital (QEH) on Friday defended the continuity of services at its haematology clinic, noting that there has been no significant disturbance to patient treatment, even as it scrambles to fill key vacancies.

Officials acknowledged that the sudden resignation and retirement of senior doctors had led to some clinic cancellations in recent weeks, but they insisted no patients were turned away and treatment for those with blood cancers and other serious disorders has continued without major disruptions. 

“There has been some sensationalism out there,” said Chief Operations Officer at the Queen Elizabeth Hospital, Dr Christine Greenidge, in a press briefing at the QEH boardroom. 

“Our job is to make sure that information currently and accurately reflects the efforts to keep this vulnerable population as safe as possible and to ensure their treatments are of the highest quality.”

Haematology deals with blood diseases such as leukaemia, lymphoma, myeloma, anaemia, and haemophilia. 

Patients typically attend the QEH clinic three times a week – twice for treatment and once for monitoring and medication management.

“These patients are a very vulnerable population,” said Dr Greenidge. 

“Our goal is to keep them healthy and preserve their life status.”

The COO noted that the departures were unexpected, but swift steps were taken to avoid service gaps.

“Immediately, all efforts were focused on ensuring that the continuity of care would not miss a beat,” she said. 

“We ensured cross-coverage to meet the needs of this patient population, and our clinics have continued successively over the last three weeks.”

Officials revealed that the hospital is now in the final stages of hiring new haematologists, with Dr Greenidge stating that most of the recruits – including junior and consultant-level staff – are expected to be in place by the first or second week of August.

Acting Director of Medical Services Dr John Gill further confirmed the strain on the clinic, noting: “It is now well known that the haematology clinic has suffered some punctuations in its functions.

“We’ve had a few cancellations because of the retirement and resignation of the senior medical staff,” he added. 

Remaining doctors within the QEH, along with volunteers, have helped to keep the clinic running in the interim, said Dr Gill.

“I must commend those who volunteered and the Department of Medicine for readily assisting us to convene the clinic on a weekly basis,” he said.

The acting director told reporters that the QEH is also looking regionally, tapping into the University of the West Indies’ network for help. 

Two graduates of the UWI Mona’s postgraduate haematology programme have been interviewed for consultant roles, with one expected to begin work shortly. 

A retired specialist has also come on board temporarily.

QEH is additionally working to contract local private haematologists for specific cases, he said, adding that it remains open to referring patients overseas if necessary.

“Our aim is no one who requires specialist attention should go unserved,” said Dr Gill. 

“Where it’s within the hospital’s capacity to seek these services, either directly or by sending the patient abroad, that’s what will be done.” (SM)

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A senior ambulance official has defended Queen Elizabeth Hospital (QEH) emergency crews after public criticism of an apparent delay in rushing a young motorcyclist to hospital, insisting that stabilising patients at the roadside now takes priority over speed.

Senior ambulance officer Trevor Bynoe stressed that what bystanders saw as a delay was in fact adherence to essential on-scene treatment protocols rather.

Responding to criticism after a serious collision on Baxters Road involving a young motorcyclist, Bynoe said what looked like inaction was actually a full patient assessment and stabilisation at the roadside.

“Pre-hospital emergency care doesn’t start when the ambulance pulls up, it begins with dispatch,” Bynoe explained to journalists at a press briefing on Friday.

“Our dispatchers ask scripted questions so that by the time we’re en route, EMTs and paramedics already have a mental picture of what they’re going into.”

Bynoe referred to concerns from onlookers, who said the injured man remained in the ambulance for what seemed an extended period before being taken to hospital. Bystanders questioned why he was not immediately rushed away, but Bynoe said that notion is outdated.

“Once upon a time it was all about speed. Now, it’s about treatment, care, and getting there safely,” he said.

“We don’t do ‘load and go’ anymore. That was over 40 years ago when [EMTs] had no formal training.”

“It’s not about delay, it’s about doing a full assessment before moving the patient. That includes spine, neck, chest, abdomen, pelvis. If you miss one thing, it can be detrimental.”

The crew on scene consisted of EMTs who are trained to conduct thorough examinations, administer oxygen, dress wounds and stabilise injuries prior to moving a patient.

Paramedics, where available, can conduct more invasive procedures, such as treating cardiac conditions, starting intravenous feeds (IVs) and assisting diabetics.

Bynoe noted that in this case, the patient had abrasions.

“So they dressed all [the wounds], and then they communicated to [Accident & Emergency] so that staff there would know what to expect…,” he said.

He also stressed that every scene begins with a safety survey, both for the crew and the patient.

The QEH’s Chief Operations Officer Christine Greenidge added that much of the misunderstanding stems from the public not being familiar with how emergency services prioritise treatment.

“It’s not understood by the general public. It’s the whole idea of triaging,” she said.

“There’s going to be certain levels of priorities and that process of triaging allows the medical practitioner to discern whether your injuries are life or death and you become priority.”

Bynoe acknowledged that public perception has not caught up with the realities of modern emergency care.

“People think we just throw the person in and go. No. That was before 1984. Today, EMTs are trained in CPR [cardio-pulmonary resuscitation], oxygen delivery, even childbirth,” he said.

“And our teams work hard to constantly improve the service.”

He also revealed that the hospital has implemented speed caps on ambulances in the interest of safety.

“At a certain speed, say 100 kilometres, the vehicle gives an alert. If it’s exceeded for a justified reason, I’m alerted, and I review it. But there’s a cap. It’s not all about speed anymore.”

Hospital officials urged the public and media not to rush to judgement or portray emergency crews unfairly.

“Sometimes the environment is hazardous. Sometimes the patient is unstable. The goal is to treat, not just to move fast,” Bynoe said.

“There’s a reason we ask questions, assess on scene, and communicate clearly with A&E.”

The condition of the motorcyclist injured in the Baxters Road collision was not revealed up to the time of publication. Police investigations into the crash are ongoing. 

shannamoore@barbadostoday.bb

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The Queen Elizabeth Hospital (QEH) is set to begin delivering advanced cancer treatment on its long-awaited linear accelerator as early as September, senior officials confirmed on Friday.

Corey Drakes, project coordinator and QEH physicist, said the installation of the state-of-the-art radiotherapy machine is scheduled for mid-August.

“We can expect a final site visit at the end of July. After that, once everything is satisfactory, we will proceed with the rigging and installation. That’s scheduled to take place in the middle of August, and we can expect our first treatment somewhere between mid to late September 2025,” Drakes told a media briefing at the hospital’s boardroom.

Chief Executive Officer Neil Clark acknowledged recent public concern over delays in the project and explained that the hospital intentionally imported the equipment early to avoid shipping and customs delays, while site preparations were still underway.

“Progress has been impacted by two key factors… the extended timeline associated with the procurement of the necessary civil works [and] the structural and remedial works required to house and operate the machine have also taken longer than anticipated,” he said.

“These works are complex and involve specialised engineering and different subcontractors to ensure compliance with international safety and performance standards for radiotherapy equipment.”

Clark stressed that the delays were not due to inaction but rather a deliberate effort to ensure the facility meets global best practices.

The CEO said the QEH has continued to support cancer patients through overseas treatment arrangements in collaboration with the Ministry of Health and Wellness, “ensuring no one is left without care”.

“When operational, this linear accelerator will significantly expand our capacity to deliver high-quality cancer care right here in Barbados,” he added.

The officials reported that 99 per cent of the civil works are complete and preparations for installation are in their final stages.
Once operational, the linear accelerator will mark a major milestone in Barbados’ cancer treatment infrastructure. (SM)

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