HOSPITALS

Stewart Smith-Project Coordinator NOC

Costing an estimated US$24.1 million, the 6,600 square metre building is set to house a level of cutting edge technology and skilled staff unparalleled in the Caribbean, yet on par with that offered abroad. The vision is that this centre will not only reduce capital flight, but encourage skilled nationals who have left these shores to return and contribute to the well-being of society.

These services-radiation therapy, chemotherapy, brachytherapy (cesium source insertion) and surgery-that will be offered at the centre, are not new to the country. The Ministry of Health already provides oncology services to the people of this country through the National Radiotherapy Centre (NRC) which is located at the St James Medical complex, under the auspices of the North West Regional Health Authority (NWRHA). The new building is set to replace the existing NRC. Smith says the manner and quality in which they want to deliver these services and the level of technology which would be used is what would be different.

At the NRC we use cobalt radiation. We now want to move to LINAC (Linear Accelerator) technology. It is safer and more easily directed making it better to target tumors. We will also have better tissue sparing.

"There are also other advances in technology that can now be coupled with that linear accelerator technology that would be improved. Because we would be using a team approach to the treatment of cancer, it means that we would have a team consisting of medical oncologists, radiation oncologists, surgeons, pathologists and imaging professionals. These people would now form a team that would assess patients, determine their requirements and then put a plan in place for the management of these patients. We would have no inpatients at the centre. In-patient services would be part of the Eric Williams Medical Sciences Complex.

Proposed National Oncology Centre

According to the World Health Organisation fact sheet on cancer (Fact sheet N°297, February 2006), "cancer is a leading cause of death worldwide. From a total of 58 million deaths worldwide in 2005, cancer accounts for 7.6 million (or 13 per cent) of all deaths."

Smith lamented that we are nowhere near the levels of oncology services available outside this country and must now play "catch up". On a site located on the Eric Williams Medical Sciences Complex-between the dental hospital and veterinary hospital-construction of the cabinet-approved three storey structure is set to begin within the first quarter of 2007. Health Minister John Rahael has confirmed that the project will in fact commence next year.

Looking back at past shortcomings he admitted: "We are trying to learn from the lessons of the "Mt Hopes" and so on and not building a centre, for example an entire hospital, and not doing a staffing plan. The government has made a commitment to ensure the training of nationals to fill these positions (at the centre). The centre will eventually become a training site for preceptorship and internship. We have an arrangement with the British Columbia Institute of Technology for the training of radiation therapists. We are currently training nurses in oncology at McMaster University in Canada. We have one radiation oncologist being trained in Cape Town, South Africa. We are looking for others to send on training. There is a programme in place to begin, through COSTATT, of the training of radiation therapists in Trinidad and Tobago."

Smith is adamant that if technology and the care services are improved, this will result in improved outcomes. He even revealed that care would not be restricted to basic physical needs. "For those that we cannot save and those whose lives we cannot prolong, what we want to achieve is that people die with dignity and without pain. What we have attached to this is what we call our supportive care and palliative programme. If you are terminal we think you should die with dignity. If you need to put a will in place and business in order, that kind of support is there for you. We are offering the whole continuum." These services, for example from social workers and psychologists, would be accessed.

With an estimated construction period of 31 months, Smith hopes that a full contingent of trained staff will be in place by the time the centre opens its doors. "The mere fact that we have all of these critical shortages (of nursing staff and specialists) within our existing skills mix within the health system points to the challenges we have to address. When we open the doors to the centre we can in fact conduct business of a quality that we will be pleased and proud of."
Smith says that locals spend as much as US$120,000 on treating cancer abroad.

He said: "The very patients who are being treated at the NRC, when they come here and begin to feel better and be able to re-engage society as functional people (the facility) will sell itself. I agree that we will have to build back the confidence and trust that was lost. The value proposition is a better one than taking it abroad."

He continued: "We are taking a leadership role in terms of advancing oncology care in the Caribbean region. This would be the flagship of oncology care. The vision would be that we set the benchmark for which all else must follow. The second vision is that we set the benchmark for health care in how we establish models. If we don't get the Eric Williams Medical Sciences Complex right, we won't get the centre right. Currently we are working on a parallel project with the Eric Williams Medical Sciences Complex to upgrade a number of their services. We will be having a shared services agreement with them for laboratory services."

He further added that services to nationals of Trinidad and Tobago would be free at the point of service and that no national going in would be denied care.

"There is a plan that we will be able to access insured people. It doesn't mean that you cannot be billed for your insurance. All persons who are insured and their insurance covers any aspect of cancer; the intent is that we would recover through your insurance, but you would not have to make a co-payment. If it is that your insurance pays 80 per cent, the government absorbs the other 20 per cent."