Description of the food safety system in hotels and how it compares with HACCP standards.

BACKGROUND: Tourism is an important earner of foreign exchange in Jamaica; hence, the protection of the visitors' health is very important. A study of travelers to Jamaica in 1996 to 1997 found that travelers' diarrhea (TD) affected almost 25% of visitors. The Ministry of Health (Jamaica) initiated a program for the prevention and control of TD aimed at reducing attack rates from 25.0% to 12.0% over a 5-year period through environmental health and food safety standards of hotels. This article examines the food safety systems in Jamaican hotels located in a popular resort area to find out how comparable they are with the Hazard Analysis Critical Control Point (HACCP) strategy. METHODS: A cross-sectional study was done of hotels in St. Mary and St. Ann. Quantitative data were obtained from food and beverage/sanitation staff and qualitative data through in-depth interviews with hotel managers. Observation of the food safety operations was also done. RESULTS: The majority (75%) of larger hotels used a combination of HACCP and Ministry of Health food safety strategies (p = 0.02) and offered all-inclusive services (r =-0.705, p = 0.001). Larger hotels were more likely to have a better quality team approach, HACCP plan, and monitoring of critical control points (CCPs) and more likely to receive higher scores (p < 0.05). More than two thirds of hotel staff were knowledgeable of HACCP. Significantly smaller hotels (87.5%) received less than 70% in overall score (r = 0.75, p = 0.01). Identification of CCPs and monitoring of CCPs explained 96.6% of the change in the overall HACCP scores (p = 0.001). Hotel managers felt that some hotels' systems were comparable with HACCP and that larger properties were ready for mandatory implementation. Conclusions. While some components of the HACCP system were observed in larger hotels, there were serious shortcomings in its comparison. Mandatory implementation of HACCP would require that sector-specific policies be developed for smaller hotels and implemented on a phased basis.

Curriculum development in Community Health: drift or shift?

The curriculum in community health is best described as eclectic and dynamic. Its relevance is maintained by its response to the macro-environment; this response, whether innovative or otherwise, may be incremental on the one hand or feature wholesale change consequent on radical rethinking on the other. This paper reviews the content of the emerging curriculum in community health and the University of the West Indies, Jamaica, and attempts to discern the process of change and the factors which have informed these developements.(AU)

Sensitizing Caribbean medical students to management issues

In the health sector, deficiency in management skills is a feature within all services - though less so in the public health sector. Over the last ten years, the University of the West Indies has developed and conducted a health management course for medical undergraduates aimed at sensitizing them to management as it relates to medicine and health care. The course is delivered during the penultimate year of the curriculum and thus far has a potential target audience of approximately 600 students. Didactic lectures have accounted for 83 percent of contact time with the remaining time utilized for debates, video presentations and student presentations. Five short case studies have been developed which have allowed a reduction in the "didactic diet" within more recent times. Students' reactions to the course were rated overall as "fair to good" for presentation, content and relevance; the response to case studies was "interesting, realistic and helpful in their understanding of subject matter". Some students felt that it was important and interesting course but that the time scheduled for lectures sometimes made attendance difficult; in any event their focus at this time was on clinical aspects of their training and they could not spare much time for this course. This experience in teaching management to medical students must be built on and strengthened so as to enhance the cognitive and attitudinal outcomes. Departments, like individual faculty members, sometimes have tubular vision which is to be admired in the pursuit of individual sciences(s), but in an undergraduate programme of medical education, parochial goals must give way to the objectives of the institution as a whole.(AU)

Student learning experiences with Jamaican practitioners

Due to the destruction of teaching facilities in primary care by a recent hurricane, first clinical year medical students were placed with general practitioners, in order to fulfil the requirements of a community medicine clerkship. Student feedback indicated a very high level of interest, with a varity of learning experiences - the attitudinal attributes of general practitioners ranking highest. This experience has provided a useful opportunity to enhance the training of medical students and to develop collaborative links with non - university physicians. This paper summarizes the experiences of the first 39 students involved in the clerkship. (AU)

The prevalence of health insurance in a Jamaica suburb and its correlations with service utilisation

The prevalence of health insurance in a low-income Jamaican community was determined from a systematic sample of 103 households. A household prevalence for health insurance of 32 per cent was found. Differentials in health service utilisation were more striking for private practitioner services where the highest correlation with coverage was found (r=0.346,p<0.001). A negative correlation with local health centre utilisation was obtained. The level of health insurance coverage in the community and its impact on service utilisation would suggest the possibility of harsh economies in health sector, forcing consumers in low-income groups to seek a buffer for the expenses incurred from needs unmet by the the public services. Part of this favourable prevalence of health insurance may also be due to job-related coverage (AU)

Learning health management by doing it

The course leading to a diploma in health management which was introduced at the University of the West Indies in 1984 contains a large practical element. This article explains how the students tackled their field assignments and draws attention to the benefits gained and the difficulties encountered (AU)

Ciguatera fish poisoning in a Jamaican family

Five people who ate fish at an evening meal became ill 6-8 hours later. Early symptoms included diarrhoea, vomiting, leg weakness and parasthesia. Emergency management for three patients took place in a Casualty Department and they were discharged within 8 hours. However, while the patients were recovering, a variety of other symptoms developed but they were able to return to school and work within 1-2 weeks, though symptoms persisted for some weeks thereafter. This small outbreak of ciguatera fish poisoning highlights the need for more information about this disease among the general public and the medical profession (AU)

Management of the transport fleet of the Ministry of Health

Focuses on the transport fleet of the Ministry of Health in order to formulate proposals for upgrading its management. Lists the number of vehicles assigned to the Ministry of Health, the specific persons to which these are assigned and the major activities which make up the daily routine of the fleet. Presents the guidelines as set out by the Procedures Manual within which the transport fleet operates. Contends that the procedures were meant to ensure: inventory control, operating cost control, utilization control, control of servicing and preventive maintenance ans cost benefit analysis via the vehicle history summary. Discusses the five major management processes - planning, organizing, co-ordinating, directing, and control evaluation. Contends that, from discussions and interviews held with persons involved in the management of the fleet, the problems identified originate in the planning exercise which was prior to the development of the procedure manual. Comments on the weakness in the present filing system, the inability of the transport officer to undertake all the prescribed duties of his office because he has to undertake clerical duties, was largely through under-utilization of vehicles and on the misuse and abuse of vehicles. Presents a summary of proposals for upgrading the transport fleet(AU)

Dysfunctional uterine bleeding (DUB)

Dysfunctional uterine bleeding is not one disease but a category of diseases. The dysfunction underlying the abnormal bleeding is unknown though it is widely believed to be due to a defect in ovulation and oestrogen and progesterone secretion. Diagnosis is by exclusion and curettage to eliminate organic gynaecological disease, anaemia and any obvious cause must be treated. Treatment is by observation to await spontaneous cure, hormone or anti-fibrinolytic therapy, hysterectomy or radiotherapy and is ultra-conservative in the young, becoming more radical as the menopause is approached (AU)