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Presentation at ECCB’s 7th Annual Growth and Resilience Dialogue

Published 26 April 2023


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Eastern Caribbean Central Bank
7th Annual Growth and Resilience Dialogue: April 25 to 26, 2023
Presentation by Hon. Dr. Terrance Drew, Prime Minister (Transcribed)

Let me start by saying, it is indeed a privilege for me to be here. I think that fora like these are the types of fora that we need to really advance our country and to advance our people. Interestingly enough, as I look at what this year’s theme is, I think I used to practice some months ago in this area, so maybe, apart from being the Prime Minister and Minister of Health, I think I have some professional credence to speak to this topic. And so, I want to really congratulate the Eastern Caribbean Central Bank for its initiative and being the leader that it is, not only here in Saint Kitts and Nevis, but in the region, really to help us to set ablaze the paths that are necessary to ensure that we continue our growth and development.

In Saint Kitts & Nevis and the rest of the Eastern Caribbean, the COVID-19 pandemic had an unprecedented impact on our health systems, our economies, and the lives and livelihoods of our people. COVID-19 influenced supply chain chokeholds and really affected us in multiple ways that we have not resolved as yet.

It revealed gaps in the health systems which must be plugged to ensure resilience, preparedness, and readiness to respond to the next public health threat, which could be occurring now, next week, or next month.

Currently, the public health threats to the ECCU include (1) Norovirus gastroenteritis which has been traced to outbreaks in our source markets; (2) Influenza with new and emerging strains which have the potential to cause future outbreaks. Influenza, as you know is seasonal flu; (3) Vector-borne diseases (meaning it is transmitted by the bite of a mosquito) like dengue, chikungunya, and zika; (4) Cholera which is impacting Haiti; (5) Antimicrobial resistance (AMR); and  (6) Natural disasters – flooding, hurricanes, earthquakes, and volcanic eruptions. The ECCU is challenged by many public health incidents and emergencies.

The theme and focus of this year’s Growth & Resilience Dialogue is appropriate and timely. I am particularly looking forward to the outcomes from the 1st plenary session whereby I anticipate hearing policy recommendations for two priority areas: (1) preparedness and response to health emergencies; and (2) Enhancement of the cohesion between doctors, dentists, veterinarians, and environmental health practitioners to adopt the ‘one health’ initiative to effectively combat the anti-microbial resistance (AMR) challenge and to ensure stewardship of antibiotic usage.  

The 2nd plenary session hopes to highlight the value of traditional, folk, or complementary medicine in today’s world. A sizable proportion of our patients use traditional medicines and some form of traditional knowledge in health as a form of self–care or more specifically as a personal primary healthcare strategy. We know this, we drink horse rub dung, and the cattle tongue bush, and this came from hundreds of years of observation, and this should not be taken lightly. That is why I am happy that this is actually a part of it.

Our healthcare providers tend to be more oriented toward modern medicine and should also be sensitized to the role of traditional medicine because the typical patient often has a different worldview from that of nurses and doctors. How many times are we told as doctors, “Well I stopped taking the blood pressure pill, I am taking the bush”? It is a common thing in Saint Kitts and Nevis.

I support the call for more research in this area to inform how traditional medicine can effectively interface with modern medicine. During the pandemic we witnessed firsthand the benefits of the collaboration of both forms of medicinal practices, modern and traditional, to combat the symptoms of COVID-19, for example, the blend of turmeric, ginger, and lemon juice for its anti-inflammatory effect and to help boost the immune system. We also used sunlight and a plethora of other types of herbs, which of course would have contained a lot of vitamins to help to combat the infection that many of us suffered from.

Research has underscored the therapeutic benefits of cannabinoids (cannabinoids is the fancy name for cannabis, marijuana, and ganja, as we call it in the subregion) and we therefore welcome the third (3rd) plenary session. We anticipate regional data on the uses of cannabis along with hearing about the best practices in establishing a medicinal cannabis industry. I can say that Saint Vincent in the OECS has already shipped medicinal cannabis to Germany and that Saint Vincent already has a lab that is already approved by the European Union (EU) system, where once their cannabis is tested to be safe in Saint Vincent it is allowed to be shipped into the EU. In Saint Kitts & Nevis, we intend to develop such an industry and hope to partner with our colleagues in this regard.

As we strengthen our health systems in preparation for future public health threats, we must embrace innovative technologies to ensure efficiency and efficacy in healthcare delivery. Digitization of the operations of the Ministry of Health is a priority of this Government and so we look forward to the exposition scheduled for Day #2.

Digital technology could help make unsustainable healthcare systems more efficient, improve the interaction between patients and medical staff, and offer more affordable, quicker, and more effective treatments for diseases.

A few examples of technologies that enhance medical facilities and healthcare delivery are artificial intelligence (AI), very interesting. A study was done with Google, and if you are not a medical practitioner, don’t do it; if you were to introduce signs and symptoms into Google search, the diagnosis normally pops up in the five options that Google gives you. Quite interesting. AI, we know is already being used in medical schools as we look at flow charts, that medical students and doctors can use to reach a diagnosis that is more dependable. So, AI is fundamental in medical practice today. Machine learning is also important, as is virtual care or telemedicine.

Why is this important? Because our region is small. I don’t think we have a million people in the OECS member countries. Yet, our demand for quality healthcare is extremely high and our expectations as members of these subregions; these expectations are also high. And so, telemedicine or virtual care can offer access to high-quality healthcare without leaving the region. Just to put things in perspective, we are already going to partner with the University Medical Center Hamburg, in Germany, to assist us in virtual medicine or telemedicine, with respect to reading our MRIs, x-rays, ultrasounds, and delivering other types of knowledge transfer opportunities. This is very powerful.

AI technology can be used to diagnose illnesses and provide specialized remedies. Internationally, the pharmaceutical industry is using machine learning to find novel medication candidates, instead of the time-consuming and expensive traditional way of searching through chemical libraries. Virtual care became an important practice during the COVID-19 pandemic, as it allowed medical professionals to interact remotely with their patients.

This is very interesting, in terms of using the technology to develop vaccines. There’s a virus that normally affects children called the rotavirus and AI was actually used to develop a vaccine to deal with the rotavirus. And so, studies that used to take sometimes decades can be narrowed down by one-tenth of the time. And so, they used this system to really develop a vaccine for this type of virus and the vaccine proved to be effective. AI is impacting medicine significantly in positive ways and that is why it has to be a part of the tool, that we would use to deal with improving our healthcare delivery.

These are critical future healthcare considerations for our region as we work towards fortifying our healthcare systems and transforming our nations into sustainable island states. And if you look at the words here, it says, resilience, that’s one word, but sustainable, which is quite important as well. And that I think we need to not only apply to other industries, but it needs to be applied also to the healthcare sector. Very critical. So, our current goal is to address our anxieties about the future head-on, approach technologies with an open mind, and gain as much knowledge as we can to position ourselves for the changing world.

As Prime Minister and Minister of Health, I, with my team, have prioritized investment in healthcare. Investment in essential infrastructural and equipment upgrades, most vital being the Construction of a New Smart Hospital. Why is this critical? With climate change, we are expecting stronger hurricanes. As it stands most of the infrastructure was not built to withstand the stronger hurricanes that we might expect, and we cannot afford to have a hospital that is not resilient, understanding what we have been told so much about, especially over the last decade.

We’re also looking at the purchase of critical equipment like MRI machines, EEG machines to test the brain, modern ultrasounds, and so forth; and the advancement in general of Health Sector Institutional Enhancement Projects, are foremost on our agenda…a part of which includes the digitization of our healthcare systems.

Digitalization is important because it helps with efficiency. Why is it important to do it? How many times do people go to the doctor and the doctor says, “So what medication are you taking?”, “Well, doc I am taking a small white tablet”. How does that help the doctor? People really don’t know the names of their medications. That can lead to medical errors. Now only medical errors, but can also lead to excessive spending, and incur significant costs. Why? If you were to show up to a doctor and you said, “Well I got some white tablet last week from the hospital”, the doctor does not know what you had, you don’t know, and the doctor has no way of accessing your health record from the hospital to know. And so, the doctor prescribes the next set of medication for you that you go and buy. And so, you are doubling up and it seems like one patient, but when you multiply that across, you quickly come to recognize that that is an expense that you could have avoided. Another area that you have wastage: “Well I went to the doctor the other day and I had an ultrasound done.”, “What is the result of the ultrasound?” “Well doc I can’t remember. They said they see something over here on this side and something over there”. That is a new doctor who wants that information, so what does the doctor do? “Well, let’s get a new ultrasound”. Again, excessive spending. Had the doctor had access to an electronic health record, that doctor could have gone into the system and could see your medical health record and be informed and make the appropriate decision.  Therefore, it is important.

Just to announce today, the CABLE, has won the bid to connect all of the health institutions of Saint Kitts and Nevis with fiber optic cables. By the end of the year, we should have our electronic health record system in place. And so, we are going to use the technology right here in Saint Kitts and Nevis to create what we call a resilient system, and apart from that, a sustainable, affordable health system as well, using the technology.

Since assuming office, we have already purchased an MRI machine, new surgical equipment for the ophthalmology laboratory, new theatre equipment, and have sourced new dialysis machines, and we have also sought to bring in new specialists as well.

We are currently in the midst of an extensive consultative process and moving swiftly towards the operationalization of a National Health Insurance Scheme which will offer tremendous financial benefits to our people. That again is part of building a resilient and sustainable system. A lot of people across our subregion do not have health insurance and as a result of that, you know what the outcome is; earlier death, lack of treatment that they could have had otherwise. Those things not only affect the health of individuals and communities, but they affect our economies as well, because of lost years of productivity. Economists know better than me that that would have a tremendous negative impact on the growth of any economy.

COVID-19 has taught us that enough well-trained human resources for health are required to respond to any public health threat. However, we need to grasp the latest technologies to enhance its offering to attract younger adults to the profession.

I want to end by introducing something new to the discussion as I will not be here but permit me to add this dimension. Presently in the ECCU, there is a lack of medical centres of excellence. There is hardly any country or island that has centres of excellence. When many of our people must access specialized care, on many occasions, they have to travel abroad, where care is extremely expensive. Those who lack financial resources or don’t have appropriate health insurance go without care or substandard care. I have seen patients who might have had a chance to live, but they die because of lack of access. We can therefore, consider, and I hope that this gets to the other Heads, I intend to bring this also at the CAROCOM level as the Chief Spokesperson for Health; we can consider establishing a center of excellence on each island or territory that each of can have access to. Break it down into simple terms: Saint Kitts and Nevis can have a centre of excellence for cardiac diseases, heart diseases. Saint Vincent might be able to have one for gastrointestinal issues. Antigua might be able to have one for neurological diseases. What I am simply saying here is that it calls for collaboration and a shared vision, that we need to provide for our people in the subregion top-class healthcare. But we are too small for each of us to carry that burden and if we share the burden then there are greater possibilities that within the subregion, we can have centres of excellence where we can serve all of our people. Barring that it is going to be extremely difficult for each island to provide quality health care in a significant number of areas for our citizens.

I, as the Minister of Health, have quickly recognized that our budgets do not allow us to carry that burden, and our population sizes do not allow us to implement these centres of excellence all on the same island or in the same territory. And so just like how we have a common currency, and we would have taught the world how to do it, I think we have an opportunity to expand that depth of collaboration, an understanding of the importance of sharing our burdens, to ensure that at the end of the day our people would have access to good, quality healthcare.

Let me wrap up by saying, of course, I feel privileged to have been given this opportunity. And once again I want to congratulate ECCB for being the leaders that they are, in ensuring that today’s activity and that of tomorrow would be had so that in the end it will lead us down a path to create healthcare systems that are resilient and sustainable, so our people can have the privilege of excellent healthcare.

Thank you very much.

The event can be viewed here, https://www.facebook.com/ECCBConnects/videos/3426385787631070
Prime Minister and Minister of Health, Hon. Dr. Terrance Drew’s presentation begins at 17:20 in the recording listed above.

(L_R) Host of ECCB 7th Annual Growth and Resilience Dialogue, Dr. Marisa Grant-Tate; and Prime Minister and Minister of Health the Honourable Dr. Terrance M. Drew

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