Victoria Hospital — St. Lucia’s Hospital “Jail”
The recent spike in COVID-19 cases in St. Lucia is certainly of grave concern to the island’s health and overall economy. Prior to this upsurge, there were multiple comments in the media both local and international that described St. Lucia “success” in limiting the impact of COVID-19 in St. Lucia. This included multiple congratulatory remarks that celebrated the apparent success (“This is even more validation of our country’s success in the management of COVID-19,” said PM Allen Chastanet in late August[1]). This feeling of apparent success and subsequent ad-hoc response hindered St. Lucia’s capacity to handle the COVID-19 crisis and contributed to this significant number of cases and death. 825% in the number of cases from October 1st to November 24th, an 8-week period).
Clearly, as this recent increase shows clearly there are numerous gaps and deficiencies regarding COVID-19 management in St. Lucia which cannot be solved by arrogantly lecturing the population of St. Lucia or creating a police state with COVID-19 wardens. Furthermore, there have been significant adverse medical outcomes including deaths of patients detained to Victoria Hospital as a result of the policies of the current administration. This has resulted in significant mistrust of the Ministry of Health by the general public and hinders the ability of the Ministry of Health as they lost significant public goodwill to engage the public during this continued health crisis.
The recent press release[2] about the recent viral video about the conditions at Victoria Hospital and subsequent public statements[3][4][5] results in following observations:
1) There was no regular meal service previously when there was no kitchen at VH resulting in significant gaps in meal coverage and major consequences for patients that may need to take critical medication at predetermined times.
2) There is insufficient ventilation at the hospital and does not meet the WHO guidelines on Severe Acute Respiratory Infections Treatment Centre. The importance of adequate ventilation particularly in wards with Moderate or Severe patients where Natural ventilation and Hybrid ventilation with Dilution and HEPA filter exhaust air treatment is recommended does not appear to exist at Victoria Hospital.
3) There is significant mold at VH which is of grave concern given that it is a respiratory hospital and likely patients with respiratory issues are going to have their conditions exacerbated if detained at Victoria Hospital. (WHO reference) While it is true that there is mold in multiple buildings in St. Lucia, this has also resulted in multiple institutions like SALCC having entire buildings out of commission for much healthier students and faculty.
4) There was no telecommunications capability as per “The construction and renovation works compromised our network and telecommunication infrastructure. This severely affected our fixed line service. We are working with the telecommunication service provider to rectify the problem.” A patient detained at VH isolation was truly isolated if they lost power to their cellphone as there is no way for them to contact their families.
5) There was no ability for family members to provide any critical items such as food and water to patients detained at isolation given that this is a new service “Drop Off Service: This is a new service offered by the hospital to facilitate the submission of supplies to patients by their loved ones.”
There has been no public commitment by the Chief Medical Officer or the Ministry of Health regarding any policies and procedures while patients are mandated to isolation at Victoria Hospital at the complete discretion of the CMO. Numerous requests have been directed to the Ministry of Health requesting a copy of these policies which the MOH claim to exist but these policies and procedures have never been provided to the public. These documents should be clear on all the steps relating to the management of COVID-19 and accessible at the COVID19 dashboard. An example of the protocols that some countries have is the following from the New Zealand Ministry of Health.
It should outline all protocols and guarantees that the Ministry of Health will follow when a patient is detained to isolation as per the powers granted by the COVID-19 Prevention and Control Bill. With great responsibility comes great accountability and this seems severely lacking in the current COVID-19 management. The general population is mandated to follow COVID-19 protocols in public but then in turn has no idea what protocols and processes are followed when a patient is detained at Victoria Hospital as this location is out of bounds to the public. The public is asked to blindly trust the authorities while the authorities do not provide any commitment and guarantees to the public. These policies and procedures should be science and evidence based and reviewed and analyzed by independent third parties. The Ministry Of Health has mandated protocols for all sectors but hypocritically has no equivalent commitment of the protocols that they will follow themselves and hence cannot be held accountable for any failures. They have not committed to any minimum service level guarantee and completely absolved as per Clause 61 of the COVID-19 Prevention and Control Act but the public is expected to blindly trust.
It is also important to note that since isolation removes the patient’s family from providing any assistance to the patient, the patient is then completely dependent on the hospital staff for everything. This may explain the higher mortality rate at Victoria Hospital from patients mandated to isolation as there are numerous cases of mistreatment resulting in adverse health outcomes and eventual death.
The removal of family support and mandate of hundreds of people to isolation at Victoria Hospital over the past six months has likely resulted in an increase in the mortality rate of these patients. The patients mandated to Victoria Hospital isolation depend solely on the medical professionals who do not have the requisite skills, time or resources resulting in adverse outcomes. The majority of patients subjected to the COVID-19 isolation rules during the earlier phases of the COVID-19 pandemic have not a COVID-19 positive test. Even the SLMDA has advocated for COVID-19 positive patients such as their members be allowed to stay home.
Some questions that would be important to explore.
· Has there been any analysis of the health outcomes of the patients that have been mandated to Victoria Hospital under isolation conditions to determine their eventual outcome?
· What percentage of persons mandated to VH Isolation ended up testing positive for COVID-19 between March 2020 to September 2020?
· What percentage of persons mandated to VH Isolation suffered adverse medical outcomes as a result of their Victoria Hospital Isolation?
When will the government of St. Lucia provide details to the St. Lucian public on the processes and procedures that will be adhered to when mandated to Victoria Hospital isolation. In the COVID-19 Isolation Protocols and Processes document there should be information as below. Some of these guarantees are basic and obvious but may not necessarily be adhered to if they are not formally written and committed too. Or should the patient’s expectation should be that there is no commitment to any minimum standard of care while detained at Victoria Hospital.
- How many meals is a patient in isolation provided? Will dietary requirements required by their medical conditions be provided? How often are they provided with water?
- How often are vital signs taken of the patients? Will they always be recorded on the patient’s chart?
- Is there any protocol for patients that have already existing medication they need to take? How should they get any necessary medication while at Isolation?
- How often does the VH staff communicate with the patient’s family? What modes of communication are used?
- Will the VH staff be able to communicate with the patient in English? Will the VH staff indicate any major medical event to the family such as a significantly elevated temperature or reduced oxygen concentration?
- Are there power outlets in the room? Will the patient be able to charge their phone to allow them to communicate with others while in isolation?
- What temperature will the room be kept? Is there air-conditioning and adequate ventilation?
- Are there individual bathrooms in each room or will they need to have a shared bathroom with others while in Isolation?
- What are the criteria for discharge from VH isolation? Is a negative COVID-19 test sufficient? How long after the negative test or tests will the patient be discharged from Victoria Hospital?
- Are there any circumstances in which a family member can visit or stay with a patient in Isolation? The Law makes provision for minors but no mention is made of adults that might need help from family members?
[1] https://today.caricom.org/2020/08/26/cdc-reduces-saint-lucias-covid-19-rating-to-level-1/
[2] http://www.govt.lc/news/conditions-at-the-respiratory-hospital
[3] https://www.facebook.com/MinistryOfHealthSaintLucia/videos/press-statement-conditions-at-the-respiratory-hospital/2704568543125776/
[4] http://www.loopslu.com/content/issac-explains-why-mold-respiratory-hospital-not-serious-issue
[5] https://www.facebook.com/allenmchastanet/posts/2742475812674244
