The National Health "Service", I use the word Service with caution

The nagging worked, and here I am updating the blog. Excuses for not doing so earlier: very slow internet connection (now resolved); busy with other stuff; not much of any note to report etc etc.

Yesterday was an education. I've been seeing a doctor privately throughout my pregnancy - and whilst to British ears that sounds wildly extravagant, when you get to the end of reading this, you'll realise why it is the option of choice out here. At $85 a visit you certainly can't afford to be a hypochondriac here, but for a regular once a month check up, it is money well spent....and how many NHS doctors in the UK provide you with their personal cell phone number and an invitation to call whenever you need to?

However, whilst money can certainly buy you access to a doctor out here, when it comes to delivering a baby on the islands the playing field suddenly gets very level indeed. My doctor is going to perform the C-section, but the only place to do so is at the government clinic (immediately opposite our house). The notion of me being booked in by a separate route on account of being a 'private' patient doesn't exist, so in order to have the baby there, I had to register as a patient at the government clinic. The clinic is somewhat like a cottage hospital: it doubles as both the government provided GP service and a hospital all in one building (although emergencies are thankfully not wheeled bleeding and dying through the GP waiting room!). So, forewarned that I needed to be prepared for a long wait at the clinic, I went yesterday at 8.30 (the smart women start queuing at the door at 7am....there are no appointments, but the place works on a first come, first served basis). The short version of this story is that I left at 3.40pm, having had my blood pressure taken and spent 10 minutes with a doctor who read through the notes from my own doctor. That's right....7 hours in the same room for nothing to happen.

The long version - and trust me, the more colourful version follows.

The waiting room has 6 banks of hard plastic chairs in a square room (probably no more than about 90' square), treatment rooms are off this room. The receptionists sit behind reinforced glass on one side of the room where someone has cut parsimonious holes in the glass in all the wrong places.....so you have to shout through the hole to be heard and then quickly jam your ear against the hole to hear the reply. And then repeat the process 2 or 3 times to make sure you heard right.

I had paid the $250 to register as a patient (the fee for 'belongers' is far less than this) for the antenatal clinic the previous week. The room was filled, standing room only by the time I got there at 8.30. Needless to say, I was the only white woman in the room - which is a little unnerving at first, but by the end of 7 hours, I realised that had another white person come in the room they would have looked very out of place! For the most part, the people in there were very pregnant and there for the ante-natal clinic, or mother's with children for their shots. Nearly all were either Haitian or Dominicans (judging by the languages being spoken), I was the only Brit and spent an enjoyable day with a lovely woman from Kisumu (Kenya) who's husband works for the Government Investment bank. The woman from Kenya couldn't get over the level of inefficiency in the place....which says something either about Kenya's level of medical provision or the Turks Island ability to process patients....one or the other!

I was armed with a book (History of the World in 10 1/2 chapters by Julian Barnes) and a breakfast bar. At 11 Tim dropped in with a couple of bottles of water and more biscuits, at 11.30 a nurse called me in and took my blood pressure (which was by now up to 125/75....a long way up from my normal which is around 90/60). In the meantime Stanley paid us a visit: Stanley is one of the local nutters. He is probably around 65, wanders around Downtown, sometimes in his blue Santa hat, always armed with a file of important looking papers (most of them religious tracts) and wearing an official looking ID badge on a chain around his neck. Rather than preaching to us or singing to us (his other talents), he walked around and round the waiting room yelling at everyone to leave him alone, holding gibberish conversations with the (un)lucky few he chose at random and then left (presumably because the best way to be 'left alone' was to leave himself!). After Stanley, SPICE showed up which sent a ripple through the place. The Special Police for Immigration, Customs and Excise regularly do sweeps across the islands picking up the undocumented, but also the unfortunates without their documentation (ie legal). One of them guarded the door then the rest did a sweep of the room demanding to see work permits. The place was very crowded and very noisy and so I decided to sit tight and see what happened. I have no work permit because I don't work - so on that basis felt no need to go justify my existence to them. But, I was also without any documents because they were all in the Immigration office being regularised.

As I suspected - and I am shameful of this - they didn't even ask me for any proof because there were plenty of Haitians and Dominicans in the place they could bully and terrorise. The poor woman from Kenya was given grief because her documents were also in immigration and they wouldn't accept copies of her NI payments proof (you can't pay NI without a work permit) or her TI drivers licence (you can't get a TI drivers licence without proof of residency). I'm not sure they removed anyone from the building - maybe it was just a scare-mongering exercise - but one does wonder whether they went around the wards next, enquiring of people's status (dragging the sick from their beds etc!).

The presence of illegal aliens in the country is a huge issue at the moment. The bulk of the illegals come in from Haiti and the bulk of these are semi-literate and unskilled. They put a huge strain on tight resources (in terms of policing, but also socially in terms of bringing with them TB, HIV and petty criminals) and on such a small island it is vital that a check is kept on immigration. What makes an utter mockery of the situation, is that Immigration officials accept bribes to stamp Haitians in through the airport - our 2 illegal Haitian workers regularly fly back and forwards to Haiti and have acknowledged that they get in and out by bribing immigration officers. So the right hand is letting them in and the left hand is trying to get them out.....or maybe the right hand is just doing their best to ensure that the left hand has something to do all day to justify their salary!

Suffice to say that once SPICE had gone the room had noticeably thinned out - which was good news for those of us left. Or so we thought. At 1pm Nicky popped in to bring me some sandwiches, I spent a couple of hours playing with 2 Haitian toddlers (who thought it hilarious that I couldn't understand a word they were saying and were fascinated by my freckles), the cleaners arrived to swab the place down before the start of the afternoon session and the place was a room full of Creole banter and laughter as the cleaners (Haitian) exchanged shouts and jokes across the room with the patients.....for all the language and mannerisms and chaos around me I might as well have been in Port au Prince for about 10 minutes. By 2.30 the morning clinic was done with and the place filled up for the afternoon. There were just 4 of us hugely pregnant women left.....ominously the doctor appeared to be about to leave when Nicky arrived with a cup of tea for me. Nicky, he of the short temper and plenty of experience with Turks Island medical provision tried to find out when I might be called in. Only to discover that the nurse in charge of the pregnant women had knocked off for the day, the reception staff had no idea and the doctor was indeed about to leave until the next day. By this point there was me and a woman from Haiti who had been there since 7am.....Nicky charged into the administration office and demanded that someone do something about the utter lack of service. And lo, a woman he knew emerged and managed to get my file onto the desk of a very sweet Filipino doctor and I was finally seen at 3pm. Or rather she read through my doctor's notes, asked me all the usual questions (what was the date of your last period and then proceeded to work out how many weeks I was by hand; how much thyroid was I taking ..... all this information of course was already on file!) and confirmed that everything was fine and she would 'put in a request' for me to have the C-Section on 3 December. Note the 'put in a request'. I have to go back Monday to see the regular doctor on Monday for yet more pointless questions and to (hopefully) find out if 3 December is a definite or not. Armed with a flask of coffee, sandwiches, a book and cushion - those seats are not comfy for someone with little padding!

No-one knows why it took so long to see me, or indeed why the doctor was leaving before some of us had been dealt with....but the level of noise in the room and the quietly spoken doctors (Filipinos and Indians just cannot do 'noise' like West Indians) probably didn't help in their bid to call patients to their rooms. What was remarkable was that in the course of 7 hours there was never any fighting about who had jumped the queue and who should be seen more urgently. I've seen plenty of arguments break out in the Immigration office when mouthy large women (and that is the usual culprit) come barging in demanding to see someone in authority much to the annoyance of the hundreds that have been waiting patiently for hours.

So, there we have it. I am probably going in on the 3rd to have this baby, I'm hoping that I don't have to wait a full 7 hours on Monday just to have my blood pressure checked and have the date confirmed. But I did get to read a chunk of my book, I did meet some interesting people and I did learn that whilst my credit card can't help me avoid the Government clinic for this procedure, for all other medical problems I can buy my way into a quiet, calm, efficient doctors waiting room....unlike many of the woman in the Government Clinic who have to forego a day's wages each month for the sake of 10 minutes with a health care professional.