Air quality and the political toxicity
Words are singularly the most powerful force available to humanity. We can choose to use this force constructively, with words of encouragement, or destructively using words of despair. Words have energy and power with the ability to help, to heal, to hinder, to hurt, to harm, to humiliate, and to humble. — Yehuda Berg
Last week there were lots of words crossing the political divide about the ‘patient’ who has been terminally ill for many years? In fact, things got so bad that a doctor called a press conference to appraise the media and the public about his concerns about how the patient had been treated. To my surprise, the chief physician overseeing the treatment of the sick patient showed up to hear what his Opposition colleague had to say. He was disappointed and shocked when he heard that the treatment of the patient was far from ideal.
The chief was upset when his colleague insinuated the death of two individuals was as a result of the condition of the sick patient. Referring to the sick patient, the doctor told the gathering at the press briefing that medical personnel at the facility have lots of fears and trepidation, prompting them to stay away from work. They were concerned that their colleagues may have died because of the sick patient, so some of them suddenly fell sick and had to stay off the job.
To give some clarity to what was said, the chief then called a press conference and told his gathering that it was irresponsible for the other doctor man to brief the press about people dying because of the sick patient, though not said explicitly. The chief chided his colleague for implicitly suggesting that the dead bodies were linked to air quality.
A sick situation
I have been monitoring the developments at Cornwall Regional Hospital (CRH) for some time, and I am sick and tired of the noxious political fumes that have have been spewed into the atmosphere causing serious political intoxication. There is blame left, right and centre (well, maybe not centre, because there is only a left and a right in this instance). But since then things have worsened. The Nurses Association of Jamaica has reported that more than 100 of its members stationed at the CRH have been adversely affected by the toxic fumes; some complaining about skin rashes, frequent headaches, weakness in the joints, chronic hypertension, and chronic heart conditions. If this is not a crisis, then I don’t know what is.
I suppose we haven’t learned the lessons from the ‘dead babies scandal’ that befuddled the then Minister of Health Fenton Ferguson. What is clear to me is that the Ministry of Health has not learned that when in crisis it is not the time to withhold vital information, because communication is king. It should not have taken a leaked document prepared by former Chief Medical Officer Dr Winston De La Haye to evacuate within 10 days for the public to know that CRH is faced with a clear and present danger. Dr Tufton has since publicly acknowledged that this is a crisis. This is what he had to say in response to the Opposition spokesman on health about the issues at CRH: “…I don’t think it’s a perfect scenario. I think what we confronted has been almost a perfect storm in that a series of events have come together to create what I would consider to be a crisis.”
At the heart of IAQ
I am not a medical professional, but I was curious to find out if there was any possibility that there is any relationship with air pollution/noxious fumes and heart attack and this is what I found.
The concept of indoor air quality (IAQ) is especially important about the environments within hospitals and other health care facilities. IAQ is also a component of sustainable concepts that are incorporated into the design of such facilities. Improved IAQ is a viable goal for overall improvements in building occupant satisfaction at hospitals and other health care facilities (Stipe, 2015). Therefore, the patients within the facility and the staff caring for those patients are all directly impacted by the quality of air in the building.
“Toxicological and epidemiological studies suggest several possible pathways by which inhaled noxious particles could induce out-of-hospital coronary death, a fatal condition due to ventricular tachyarrhythmia, which can be triggered by several mechanisms, including ischemia. First, particle mass (PM) may increase the risk of sudden death by affecting autonomic control of the heart. Oxidative stress could alter the sympathetic and parasympathetic tone that affects heart rate and heart rate variability. Decreased heart rate variability has been associated with sudden cardiac death. Epidemiological studies have associated air pollution with increased heart rate and decreased heart rate variability both risk factors for severe arrhythmia and mortality. In a recent study by Park and co-workers, fine PM was associated with decreased heart rate variability, especially in patients with ischemic heart disease and hypertension.” (Forastiere, et al 2005)
Communicating in crisis
Strengthening crisis communication and management capacities in health systems has become a major concern for governments around the world, especially taking into account the following recent global trends:
• an increasing number of health crises and disasters;
• growing social and economic losses and long-term consequences for vulnerable societies;
• during the past 20 years, disasters have killed at least three million people and adversely affected 800 million more; and
• health is a significant concern and a priority in crisis management.
During the Ebola crisis Texas Health Presbyterian Hospital made some mistakes in handling the first diagnosed case of Ebola in the United States. However, executives and clinicians from the hospital have admitted to their errors of judgement and have since learned a valuable lesson. I believe that the Ministry of Health, through the health minister, should apologise to the patients and staff at CRH for the mistakes it has made in dealing with the decades-old problem. If it is not already in place, the Ministry of Health needs to put in place (or revamp) its Crisis Communication Policy (strategy) given all that it knows and the lessons learned from the dead babies’ scandal.
Establishing effective communication channels among all the actors (including the Opposition) involved in an emergency has been proved to be an essential instrument to allow a quick and efficient response to the crisis. Guaranteeing a continued exchange of information among health authorities, population and media, using different communication channels (social networks, blogs, online magazines, and other Web portals, etc) is essential to manage an emergency most efficiently.
The diagnosis, prognosis, and solutions at CRH might not be conclusive; however, if the Ministry of Health gets the communication right, now and in the future, then we wouldn’t have to hear the political pontifications about dead bodies. The situation at CRH is a serious crisis. It has the potential to have a negative impact on the health of both patients and staff (medical and non-medical) for many years to come.
Ministry of Health and Well-Being
It is time for us to start the conversation of re-branding the Ministry of Health to become the Ministry of Health and Well-Being. The Mission of the Ministry of Health is: “To ensure the provision of quality health services and to promote healthy lifestyles and environmental practices. The ministry, together with its regional health authorities, agencies and related organisations make up the public health system and are responsible for health care delivery across the island.”
In addition to offering quality health services, the new Ministry of Health and Well-Being would ensure that the social, emotional, spiritual, and psychological well-being of both patients and workers at all levels be integral in its mission and vision. The staff is as important as patients to the viability of CRH. The staff includes the doctors, nurses, housekeeping, maintenance, administration, etc. It should never be lost on us that the indoor environment impacts the productivity, morale, health, and welfare of workers — and ultimately retention of a facility’s workforce.
It is time to conduct an IAQ audit at all health facilities across the island to ensure that grandma can be admitted to hospital knowing that the air is clean and Aunt Jackie can go to work and return home happy and healthy with her full complexion. However, while the audit is conducted the new Ministry of Health and Well-Being must commission a time series study to analyse the effects of noxious fumes on a sample population of former and current staff and patients at the CRH. Time series analysis over time accounts for the fact that data points taken over time may have an internal structure that should be accounted for. It is only then we can definitively and conclusively make direct correlations between illnesses, dead bodies, and noxious fumes. Stay healthy!
Henry J Lewis is a lecturer at the University of Technology, Jamaica, School of Humanities and Social Sciences. Send comments to the Observer or hjlewis@utech.edu.jm.