Hello I’m Dr Ingrid Buffonge I am a Montserratian. I am an emergency physician. I’ve been a medical doctor for 22 years with a lot of that time spent on Montserrat.
This message is in support of the Helping hands of Glendon whose projects are intended to create funds for Glendon hospital Montserrat.
Montserrat’s position as a British colony allows us constant access to funding through DFID and this allows us stability in rough times such as at present when the economies of other small islands states heavily dependent on tourism are experiencing quite a greater struggle. However, colony status also means that we are not in full control of the money we receive. Our small population size is often given as a reason why our funding agents feel that Montserrat does not qualify for certain items or a certain level of development.
Yet development requires population growth and financial sector development these are dependent on improved investor confidence and on persons inside and outside of Montserrat including our diaspora having the assurance they require.
It is therefore essential that we pursue other avenues of funding for the progress we desire to be achieved. I am truly delighted and very impressed that the members of the Helping Hands of Glendon team have assigned themselves to this task.
So those of us in healthcare feel that Montserrat should be as good as the so-called developed countries of the world in terms of the emergency medical care we provide and this includes access to urgent care off island when necessary. We don’t expect to have everything on island but it is essential that we have what it is needed to ensure the rapid diagnosis of conditions that cause death or permanent disability, AND it is essential that we have protocols in place that ensure fast, safe and effective off island transfer of priority patients to pre-established destinations. For example, a heart attack protocol ensures rapid diagnosis and transfer to Guadeloupe for example where intervention in a tertiary centre can reperfuse coronary arteries and preventing death and disability.
If I could talk about one item needed in this moment it would be on island CT scanning. CT scanning has not been available on Montserrat but it needs to be.
CT diagnosis allows the clinician to answer 3 questions:
- What intervention does the patient need?
- Does the patient need to leave the island?
- An if so where does the patient need to go?
As you can imagine not being able to answer any of these questions with a test available on island results in delays in optimal care and often unnecessary medical evacuation as before they can be answered the patient must travel off island for CT.
Patients requiring emergency CT scanning on Montserrat generally go to Antigua by medical evacuation which is costly, inconvenient, labour intensive and risky for patients who are potentially unstable. Scan results sometimes indicate that the patient can be looked after on Montserrat – they need not have left the island if they could have been scanned locally. On other occasions patients scan results indicate that they need to be sent somewhere else and not Antigua- Neurosurgery for example is not available in Antigua so an abnormal head CT after trauma requiring neurosurgical intervention if scanned in Antigua has wasted often 24 hours of critical time before transfer to the right place can occur. In most emergencies time is everything.
The government of Montserrat has recently committed to a local critical care service and this is fantastic. However, without CT scanning locally many patients who could benefit from this service still require medical evacuation to Antigua before the healthcare professional managing them can have a diagnosis which allows them to know what they are treating.
CT scanning is necessary for the following emergency conditions:
- Strokes- this is a common diagnosis on island because of the high prevalence of risk factors such as diabetes, hypertension, high cholesterol and obesity. Strokes can be due to blood clots requiring blood thinning medication and in some cases removal of the clot. Rapid diagnosis and very early treatment is necessary to achieve a good outcome – early and appropriate intervention prevents death and disability. Some strokes are bleeds in which case starting blood thinning medication without a CT diagnosis would kill the patient. International stroke guidelines recommend CT scanning with the first hour of care – this is impossible if patients must travel to Antigua first.
- Early CT scanning within one hour is also strongly recommended when trauma CT scans of the head and neck are required and these patients should not have this delay and risk -of having to go to Antigua for a scan, or worse, not having scan.
- Pulmonary embolism which has taken the lives of persons on Montserrat requires CT diagnosis.
- Some surgical emergencies require urgent CT scanning before the surgeon can make decisions on care. Delays to CT or lack of access to CT when patients are in critical condition and too unstable to travel are also really important factors to consider.
- There are also less immediately life threatening conditions for example for the diagnosis of some cancers that would be able to be diagnosed early and more conveniently with local scanning.
- Well a good CT scanner in 2020 is will cost about a million Us dollars – 800,000 pounds.
- I am confident that the helping hands of Glendon is a safe and transparent charity for individuals to make donations to. I am hoping that the charity will be able to reach out to businesses, large companies and philanthropists who may want to donate. I know there are other groups out there who are fund raising for Montserrat – I am hoping that these groups can work in unison with the helping hands of Glendon in raising the money that Montserrat needs to realise the progress that we all desire.