Contribution to the 2017/2018 Budget Debate
Presented to Parliament
By
Dr. The Hon. Duane E.L. Sands, M.P
Minister of Health
On
Wednesday 14th, June, 2017
INTRODUCTION
Mr. Speaker,
Today marks the first time that I rise on behalf of the great people of the constituency of Elizabeth. You know Mr. Speaker … It has been a long time coming … but I can tell you …three times is indeed a charm.
I… we… started the campaign for Elizabeth in 2009. The By-election of February 16, 2010 was a battle that ended in a nail biter and proved to me that every vote… indeed every voter counts. On the evening of February 16, after a by-election involving a group of Bahamians who have played prominent roles in our country’s legislative evolution and who have been a part of political theatre… (names like Rollins/ Moncur/ Pinder/ Stuart) the final count was 1501 to 1500. It was a near victory that I got to savor for barely a night. There were 5 protest votes cast that day in my first election attempt.
That political drama was played out at Thelma Gibson Primary school long into the night… and indeed over 48 long hours in bone-chilling draft as we counted and recounted ballots. The drama then moved to the Supreme Court where day in and day out the country was focused (politically) on one thing… Elizabeth.
As you know, we lost that case … and the election – by three votes.
Despite the loss, after what could only be called “the trial by fire”, I believed that I earned my political stripes.
I was determined to fight for The Bahamas and Elizabeth.
I had the privilege of serving in that other place.
My next attempt also didn’t go too well.
The election of 2012 was disappointing, not just for me, but for many of my colleagues. But we never lost faith, nor hope. We worked, we held the government’s feet to the fire, we campaigned, and we waited.
You see Mr. Speaker, despite the recommendations to leave the people who have become my people… my heart and my head compelled me to wait in Elizabeth. Many advised me to “go somewhere else… stay in medicine…
I admit now that there were times that I wondered why God had determined that I should walk this road.
But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint.
So Mr. Speaker, as I stand for the first time in this Honorable House to represent a community – a group of people – having walked a mighty long road – allow me just a brief moment to reflect, and to thank the almighty Lord who has brought me this far.
I have benefitted from the love and support of many.
I am the youngest of the five children of Basil and Bobbie Sands, a couple who hailed from Grant’s Town and Clarence Town Long Island. Two ordinary working class people who accomplished extraordinary things in their own right and who raised five children who were taught the values of family, education, love of God, hard work, honesty and service to country.
Mr. speaker, my brothers and sisters and I have been blessed to contribute to and benefit from our efforts on behalf of this great country in hospitality, law, medicine and accounting. I admit to being the underachiever of the lot.
We were raised in a home that was absolutely disciplined, strictly Anglican but politically mature.
My mom, who ultimately left her career at Bahamasair to become the administrator of my surgical practice until her retirement is… a supporter of the FNM. My Dad, who in most other things is a wise and prudent man – a person on whose council I still rely – but who I always joke - is politically misguided… since he has been historically a supporter of the PLP.
Looking at the results in the general election of 2017… I am not prepared to swear for him this lap.
I am blessed to have the benefit of my parents’ presence and example. There is no doubt that I have benefitted from their unconditional support.
I am fortunate to have four talented, beautiful and brilliant children. Adrienne, Brandon, Nicholas and Mila. They have sacrificed much because of my vocation as a surgeon and now as a public servant.
It is for them and other young people like them that I am in this place.
Mr. Speaker, I have an awesome campaign team who has stood with me in good times and in bad. I cannot thank them enough.
We are Elizabeth Strong!
I have spent the last 31 years of my life as a physician and surgeon. It has been my honor to serve the people of the Bahamas as a trauma, cardiovascular and chest surgeon. My career choice led me to sit and learn my craft at the feet of giants - some of whom are among the most accomplished surgeons in the world.
In Baltimore and Detroit, I came to realize that a great clinician is defined by the people he is privileged to serve. So, there was never any thought of me practicing anywhere other than in my home – The Bahamas.
Surgery for me, has never really been about the agility of my hands. It has always been more about the clarity of thought and an abiding love and concern for my patients that has defined my practice.
Wisdom and common sense in the professions (and in politics) makes you realize that you should always leave before people insist on showing you the door.
I understand the concerns of patients, colleagues, students and staff as I leave the practice of medicine. I have trained several competent surgeons to replace me. Where there is a void, we will recruit someone to fill that space until one of our own is ready to step into that spot.
To fill the void, for a brief period I will provide emergency and back-up coverage.
But let me assure you, the same drive, determination and passion that have guided my surgical career, will be the tools used to fight for the heart and soul and health of my country. My focus now will be less about fixing broken hearts, connecting blood vessels, cutting out cancers or patching bullet riddled bodies – and more about providing the tools and improving the system that both prevents them from getting broken in the first place or ensures that they will get fixed even without me. I will work to improve and modernize a system that functions better than the one in which I worked.
On that you can depend… so help me God.
I am privileged to have been asked by the Prime Minister, Dr. the Hon Hubert A. Minnis to serve as the Minister of Health with responsibility for the Ministry of Health, Department of Public Health, Public Hospitals Authority and National Health Insurance. We have set out an ambitious health agenda starting immediately. My first few weeks in office have been spent understanding the challenges of our country and the system charged with promoting and protecting the health of Bahamians.
Mr. Speaker
Recently I have had the distinct pleasure of representing The Bahamas at the 70th World Health Assembly and the Commonwealth Health Ministers’ meeting in Geneva Switzerland and discussed global security, our vulnerabilities and the regional disease burden of NCDs and the public health impact of violence.
Mr. Speaker
This year, the people of The Bahamas will entrust the sum of $307,596,885 of their tax dollars to the public health sector, with $213,843,475 million for the Public Hospitals Authority (PHA) and $53,753,410 allocated for the Ministry of Health/Department of Public Health. We have provided $40 million to fund the program known as National Health Insurance.
This total is more than any other government Ministry. Combined with out of pocket and insurance expenditure Bahamians spend approximately 9.7% of GDP (800M) annually.
The Bahamas’ total health expenditure ranks among the top five in Latin America and the Caribbean. Furthermore, the total health expenditure as a percentage of GDP has been climbing over the last two decades. With the current trends in NCD’s(DEFINE), violence and infectious diseases (HIV/AIDS) our already struggling economy will be crippled by our health challenges and costs. We have made some choices over the years that have created horrendous health challenges. They cannot be wished away and they are incredibly expensive to fix. Yes, we have the technology and the skills and the drive to fix many of the problems… but can we individually or collectively afford to do so?
The old people often say “If you like it, let it kill you… and we… most of us… are doing just that.
Unless we can make fundamental changes that modify our behaviors and allow us to prevent sickness in the first place, the amount of suffering, disability and death will explode.
Add to that (as pronounced by the CMO, Glen Beneby) our public health care system is losing up to 25% per year on waste and inefficiency. Our economy don’t have enough VAT money to pay for this.
Mr. Speaker,
The biblical truth remains – “to whom much is given, much is required.”
A new day has dawned for the business and operations of health. The Bahamian people have spoken resoundingly and resolutely that it can no longer be business as usual. They expect to see, touch and feel reform. They want value for their hard earned money.
Mr. Speaker
People have told me that they are offended at the state of public affairs. They have lost their tolerance for waste and inefficiency. Opportunities for them and their children are far less than years gone by due to things done and left undone.
They have been taxed to the breaking point. So they do not feel that government can continue to spend…spend…spend while they have to tighten their belts. Many of our people are struggling to survive.
Bahamians ‘een on that run no more. They want this problem fixed.
Our government however is committed to finding solutions. What Bahamians want now is not just a description of the problem or how we got here, rather a roadmap and clear solutions to lift us out of this mess. Furthermore, they want to know whether the person or persons in charge are competent, honest, accountable and attentive. If they are found not to be, they want them to be held accountable and to let the chips fall where they may.
Let me assure the people of The Bahamas… We hear you!
Mr. Speaker
In order to solve a problem, you must first recognize and define it. Ya gatta claim it!
The Bahamas must address these health conditions.
Let me tell you the story of our current healthcare reality.
Our population has grown from an estimated 325,200 in 2005 to 369,670 in 2015, representing a 15% increase in the past decade. Much of that growth is due to migration. Birth rates have decreased from 17.1 per 1,000 live-births in 2010 to 16.7 in 2015. The non-Bahamian population in 2010 comprised 1/6 of the total population, a 25% increase from 2000. Haitians comprised 64.4% of the non-Bahamian population. Increasing life expectancy (from 73.8 years in 2010 to 75.7 in 2016) and the decreasing birth rates have resulted in an ageing population.
While we are world leaders in tourism,finance and sports, we also lead in ways that are destructive to the fabric of our social and economic well-being.
Mr. Speaker, we are one of the leaders in penetrating trauma due to gunshots and stabbings. The probability of dying from these types of injuries far exceeds the risk of death from cancer or HIV/ AIDS in The Bahamas.
In 2012 The Bahamas had the 11th highest homicide rate worldwide. We continue to hold that unfortunate distinction.
We are one of the most violent countries in the world. We beat, stab, shoot and rape each other at an unacceptable rate. Our homicide rate was triple the rate considered by WHO as an epidemic. I have said repeatedly- it is in large part due to the professionalism of our medical personnel that our murder rate is not dramatically higher.
For the last few years, the number one cause of death of a Bahamian male has been a bullet!
Mr. Speaker, it is important for a country to base policy decisions and give public accounting based on facts. There has been a question raised about the level of violent crime in The Bahamas and the controversy has been worsened by the official comments of the previous Ministry of National Security and the Royal Bahamas Police Force. As an example, “According to the police figures, attempted murder rose 47 per cent, from 15 cases in 2013 to 22 cases in 2014.
As mentioned by the Honorable Member from Mount Moriah in his contribution, fire arms (guns of all kinds) play a significant role in our crime challenges. For example a new crime study indicates that during 2010 – 2015, 78% of murder victims died as a result of gunshot wounds. He also stated that there were 906 shooting incidents during the same period that did not result in death.
Over the last five years, we have collected statistics at the PMH in our Emergency room. These statistics were collected even when I ran the A&E at PMH.
A few years ago, the side opposite while in government, took great exception to the release of the PMH statistics in part because the numbers of shootings recorded were different to statistics reported by the Police.
I was summoned to the office of my supervisor to explain why I should not be dismissed.
I present to you the numbers of stabbings, shootings and assaults at PMH alone… They do not include numbers from Doctors Hospital or the Rand. For the period 2012 to 2016, the A&E Department at PMH managed almost 8,000 (7,935) assault cases, 1,300 (1,229) stabbing cases and 1,100 (1,078) gun shot wounds. To bring it home for the Bahamian people, in 2016 alonethere were 1,272 assaults, 246 stabbings and 216 gunshot wounds recorded…and this is just for PMH. Though the A&E statistics provided by PMH seem to suggest that things are trending downwards, the total numbers remain high and unacceptable. You see Mr. Speaker, these statistics do not represent those brought in dead to A&E.
While our staff is admittedly competent… we can only help those that are brought in alive. Could we have been suggesting to the public that of the four hundred and sixty two persons shot or stabbed (2016), that if we follow the number of attempted murders recorded historically over the last five years that only 20 or 30 of this 462 was the perpetrator of these violent crimes attempting murder?
Mr. Speaker… in the spirit of transparency – we shall make these statistics available to the press and public as a matter of course. We can then allow the public to compare these statistics to any others and come to their own conclusions.
I shall now table the 2012-2016 A&E statistics in this Honorable House.
We are not doing well Mr. Speaker.
Continuing the story, our infant mortality rates have hovered between 18 and 23% during the last four years, among the highest rates in the non-Latin Caribbean. In 2016, preliminary data shows an infant mortality rate of 19.2 deaths per 1,000 live births. By comparison, the infant mortality rate in the USA is less than 6 deaths per 1000 live births. Haiti 59. Barbados 11.6. Cuba 4.5.
Another chapter in the health narrative of great concern, and yes, we should all be concerned; Overweight and obesity are extremely high in The Bahamas and worsening. The percentage of population who was overweight reached 79.2% in 2012, up from 70.5% in 2005 with no significant difference by sex. Obesity too increased so that every other person (50%) in the Bahamas has a BMI>29.9.
Most startling is that overweight and obesity among the school aged youth have skyrocketed 436% since 1988, from 6.4% to 34.3%.
Another contributing factor to ill health is low levels of exercise, although we (Bahamians) refuse to accept that this is a problem.In an important study, ninety percent of Bahamians reported eating less than five servings of fruits and vegetables a week, as compared to 47.3% in 2005, and with no significant difference by sex.
And the problem starts right at birth… Breastfeeding rates are low and have varied between 10.9% to 29.2% from 2005 to 2011. Exclusive breastfeeding for the first 16 weeks of life is considered a good start to a lifetime of healthy nutrition and has been shown to be protective against obesity and chronic diseases.
In the almost decade interval between 2005 and 2012 our nation saw a 16% increase in sedentary lifestyles; a 13% increase in overweight; a 14% increase in obesity; a 55% increase in hypertension; and a 160% increase in diabetes.
Mr. Speaker,
The Bahamas has the highest or one of the highest incidence rates of diabetes in the world.
We have the highest incidence of a set of gene mutations called BRCA-1 and BRCA-2, which is 300% higher than the world average. This means that women with these genes are 3-5 times more likely to get breast or ovarian cancer than those without the genes passed down from their parents.
Breast cancer is a far deadlier disease in The Bahamas with our women being diagnosed two decades earlier than the rest of the world and 2 stages later.