Neurological and neurosurgical referrals overseas from the Queen Elizabeth Hospital, Barbados, 1987-1996

This paper reports on neurological and neurosurgical referrals overseas from the Queen Elizabeth Hospital (QEH) for the period November 1987 to November 1996, and is a follow up to an earlier report for the period January 1984 to November 1987. It outlines the pattern of referral, diagnoses, referral centres and costs based on examination of the files of all QEH patients transferred overseas under a government aided scheme. There were 203 transfers of 191 patients (69 males, 122 females) including 10 patients who were transferred twice and one patient who was transferred three times. Patients ages ranged from 1 to 80 years (mean 37 years). Twenty overseas centres were used during the period but most patients were transferred to Brooklyn Hospital, New York in 1988, Mount Sinai Medical Center, New York, between 1989 and 1994, and Hospital de Clinicas Caracas, Venezuela (1992 to 1996). 65 percent of the referrals were for neurosurgery and 25 percent were for magnetic resonance imaging scans for diagnosis. The largest diagnostic categories were central nervous system tumors (40 percent) and subarachnoid haemorrhage (25 percent). Estimated costs reached almost BDS$11 million, but the mean actual cost was BDS$63,916 based on information from 123 patient transfers. Thus, the actual total government expenditure was probably closer to BDS$13 million. This study demonstrates the urgent need to establish a neurosurgical service at the QEH and the cost effectiveness of doing so.(AU)

Invasion: a hospital in transition following the 1983 Grenadian intervention

Stress, confusion, and a sense of loss were inevitable during the hospital relocation, especially given the large number of clients, ward communities, and staff needed to move and adjust to change. Despite the fact that the change was perceived as a positive and progressive step in psychiatric-mental health care in Grenada, there were many obstacles and much resistance to overcome. As expected, staff's and clients' fears centered around themes of impending loss and abandonment. An understanding of the transition process, along with the availability of experienced hospital staff for support and guidance, greatly aided the relocation process. Relocation still presented problems and Mt. Gay Hospital continues to struggle to carry out the lasting and beneficial changes that will best promote a therapeutic and culturally sensitive client/staff environment. Despite the fact that the hospital relocation was not entirely self-determined, but partially imposed by political circumstances, a positive resolution of the crisis occurred. The crisis brought about the change that, in this circumstance, is seen as synonymous with growth. It acted as a catalyst to bring about help from unexpected and much needed sources (U.S.A.I.D./Project Hope), which may not have otherwise been available to facilitate such a change. Richmond Hill Mental Hospital took control and advantage of a crisis situation and made it serve its immediate and pressing need for a new psychiatric hospital. (AU)

The Caribbean and New York: the heart connection - abstract

An association between North Shore University Hospital, New York and the Caribbean region started in 1982, whereby Caribbean children needing cardiac surgery were operated on at North Shore at no, or nominal, cost to the patient. During the last 6 years, 239 patients were referred for cardiac surgery 107 from Trinidad, 69 from Barbados, 19 from Jamaica, 18 from Saint Vincent, 17 from Saint Lucia, 4 from Dominica, 2 from Antigua and one each from Anguilla, Grenada and Nevis. Fifty of the patients were catheterised in Barbados between 1982 and 1985, and 55 were catheterised at Brookdale Hospital, New York, in 1986 - 1987. The other patients were catheterise at North Shore. Two hundred and sixteen (216) patients have had surgery - 180 open and 36 closed heart. Four had pacemaker implantations, 3 balloon valvuloplasties and 2 balloon atrial septostomies. There were 7 operative deaths (3.2 percent mortality) and 4 late deaths. An analysis of the programme points overwhelmingly to its high degree of success. Over the last 2 years, the programme has expanded to include 4 other major hospitals in New York. The programme is critically dependent on a system of co-operation and co-ordination between the referring and accepting physicians. Well-developed links have also been developed wihtin the wider New York based West Indian community. These links provide crucial logistic support to both patients and their families, thus increasing the economic viability of the programme while decreasing the trauma associated with the physical dislocation of extra-regional surgery. While the success of the programme is noted, it should in no way detract from the need to accelerate plans aimed at the development of an active open-heart surgical programme in the region (AU)

Neurological/neurosurgical referrals from Queen Elizabeth Hospital, Barbados - abstract

Neurological/neurosurgical cases (NNC) requiring overseas investigation and treatment have become an increasingly difficult problem for Barbados in recent years. All overseas referrals from Queen Elizabeth Hospital (QEH) between January 1, 1984 and November 1, 1987 have been reviewed. Ninety one NNCs were referred; there were 48 males and 43 females, aged 32ñ7 years (meanñSD, range 4 months to 69 years). Only five were older than 60 years. Eleven centres were used. In 1984 referrals to the University Hospital of the West Indies (UHWI), Jamaica, ceased; for the next two years, most NNCs were sent to Port-of-Spain, Trinidad. Several factors, chiefly bureaucratic delays in approval for transfer, forced new lines of referral, outside of the Caribbean. In 1986 and 1987, 63 percent of new cases were referred to North America, chiefly to Mount Sinai Hospital New York. This was made possible by a Government aid scheme. During 1984 - 1986, there were non-surgical than surgical cases. In January 1987, a CAT Scan was installed at QEH and there was a marked fall (by over 60 percent) in referrals in 1987. Each of the 13 NNCs referred in this year was correctly diagnosed as needing surgery. This represents a huge savings in non-surgical referrals for investigation. Lack of neurological/neurosurgical facilities for investigation and treatment has placed an inordinate burden on finances, social services and internists, as well as severely compromising the outcome of NNCs (AU)

Paediatric medical services in Tobago (1980-1986) - abstract

This study examined the pattern of admissions to and deaths and transfers from the children's ward of the County Hospital, Tobago, between 1980 and 1986. Data on admissions, births and premature births, deaths and newborn deaths were obtained from the Hospital's annual reports. The medcial records of children who died and of those who were transferred to the Port-of-Spain General Hospital were reviewed. Each year there were from 900 to 1075 births with 12 to 31 (mean 19) newborn deaths. There were from 843 to 1060 children admitted with 3 to 14 (mean 7) deaths. Six deaths were due to "surgical" causes and 34 were 'medical'. One third of total ward deaths were from lower respiratory tract infection. This is high when compared with national (13.8 percent) and Port-of-Spain General Hospital (23.2 percent) rates. Four of five children with acute gastroenteritis and dehydration died more than twenty-four hours after admission. Two sicklers with fever received no antibiotics for twenty-four hours. A child with cloudy cerebrospinal fluid received 80 mg/kg/d of ampicillin for the first day of treatment. There were 64 transfers: 40 were neonates, of which 23 had severe neonatal jaundice. The rate of transfer is increasing yearly. These observations suggest that there should be a paediatrician resident in Tobago (AU)