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Monday, March 30, 2009

Physician Heel Thyself


Dr. Lester CN Simon

To arrive at the correct diagnosis, all doctors are taught to start by obtaining a proper medical history of the patient’s ailment. This should then be followed by a thorough physical examination and appropriate investigations. Let’s carry out this exercise to see if we can diagnose what is affecting the Antiguan and Barbudan doctors who were trained in Cuba and who are still unregistered and unemployed.

The first historical point we have to register is that as far back as 1988, the Cabinet of Antigua and Barbuda agreed that local doctors trained in Cuba will be eligible for registration on satisfactory completion of a one year of internship in Antigua and Barbuda. It should be noted that the local Medical Board was in agreement with that position. It should also be noted that this requirement for a local internship for one year was identical to what obtained in other English-speaking West Indian islands. Moreover, this requirement of a local one-year internship was adopted in many islands after consultation with the Dean of Medicine of the University of the West Indies.

The question you are dying to ask is why this requirement for registration was not communicated to all medical students going off to Cuba in 1988 and thereafter. I will answer that question by telling you that in 2007, almost twenty years after the Cabinet decision, I tried to find out how many of our medical students were in Cuba. I went to the Ministry of Education. No one knew the answer. It was suggested that I go to the Board of Education since that was the agency that gave scholarships. They asked me to give them a few hours to get the information. I gave them more hours than they wanted, and yet I was turned over to the Cuban charge d’affaire.

One crucial point we have to examine is what is meant by an internship. Let the definition from the online dictionary, Wikipedia, suffice: “A medical intern is a term used in the United States for a physician in training who has completed medical school. An intern has a medical degree, but does not have a full license to practice medicine unsupervised. In other countries medical education generally ends with a period of practical training similar to internship, but the way the overall program of academic and practical medical training is structured differs in each case, as does the terminology used.”

One key point to appreciate is that whilst academic medical training can be universalized, practical medical training is largely dependent on the way the local medical system is organized and the prevalence and morbidity of different types of diseases doctors are commonly exposed to.

Call it what you want because the name does not matter. Investigations by competent authorities including regional medical councils show that while the internship done in Cuba is perfect for Cuba, that same internship is grossly imperfect for Antigua and Barbuda and the rest of the English-speaking West Indian islands. This is the basis of the 1988 Cabinet decision. The fact that this perfect-for Cuba but imperfect-for-us internship in Cuba, is largely a reflection of the relatively good state of healthcare and the medical system in Cuba compared to the healthcare system in Antigua and Barbuda and the other islands, should not escape your attention. Cuba boasts an excellent, highly integrated medi9cal network system that is the envy of countries in the Caribbean, Latin America and the rest of the world.

The other key to hold on to is that the doctor doing an internship (the intern) does not have a full license to practice medicine unsupervised. Prior to the recent Medical Practitioners Act 2009, the laws of Antigua and Barbuda catered only for complete registration. This meant that any newly registered local doctor trained in Cuba, could practice initially unsupervised in a system for which he or she is not adequately prepared practically. And “practically” is the operative word. This is untenable. Ironically, after Cuba has done so much for us, we are being asked to do relatively next to nothing.

Those who suggest that older, local registered doctors are against local, Cuban-trained doctors are misguided. The medical pie is much larger than you think. The center of healthcare in the OECS in the future will be in the country that sees this Cuban-trained local doctor issue as an opportunity instead of a problem. This country should be Antigua and Barbuda.

Until such time when we can “cubanize” our healthcare delivery system, there is only one solution for all local doctors trained in Cuba, as noted as far back as 1988. Call it what you like: internship, externship, or whatever. My demonstrating colleagues must undergo the type of supervised practical training with the related registration in the proper place that is appropriate for the country in which they want to practice. And which country is that, my dear good doctor? Antigua and Barbuda, I presume.

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