Montserrat Health Situation a detailed study

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Montserrat Health Situation a detailed study
 

– Reported, March 13, 2012

 

Montserrat is a tiny island of approximately 102 km², situated in the volcanic island chain that stretches from Saint Kitts in the north to Grenada in the south. In 1989, Hurricane Hugo had virtually destroyed Montserrat and the island was still recovering from its effects, when after lying dormant for nearly 400 years, the Soufriere Hills volcano erupted in July 1995 and devastated Montserrat , altering the lives of its residents forever. Most of the population fled the island as soon as the volcano erupted. The southern two-third of the island was declared unsafe and the population moved to the north, a sparsely populated and poorly developed part of the island. Much work had to be done in the north for this area to support life and allow the population to survive. Over a relatively short period of time, two-thirds of the population left Montserrat and settled either in the U.K. , the U.S.A, or other neighboring Eastern Caribbean islands. Montserrat is a British dependency that has its own system of Government, with a Chief Minister and three other Ministers duly elected by the people, as well as a Governor who represents the British Government. The volcano totally destroyed the former capital, Plymouth, and a new center in the north, at Brades, has since been developed and functions as the Government headquarters. Elections were held in 1996 but no party won a clear majority and a coalition government was formed.

SPECIFIC HEALTH PROBLEMS
Analysis by population group
Children: There were no infant deaths during 1997-2000. There were 251 cases of acute respiratory infections among children under 5 years in 1998, 300 in 1999, and 240 in 2000. There were 27 cases of gastroenteritis in this age group in 1998, 8 in 1999, and 16 in 2000. There were 56 cases of gastroenteritis among children age 5-9 in 1998, 28 in 1999, and 33 in 2000. During 1997-2000, there were 60 pediatric hospitalizations-15 were for respiratory diseases and 15 were for surgery.

Adolescents: Mental health is an area of concern among adolescents, especially violent behavior and the use of illegal substances, mainly marijuana. There was one birth in the 10-14 years age group in 1998, and none in this age group in 1999 or 2000. There were 17 births among 15-19 years old from 1998 to 2000.

Adults: There were 109 births among 20-59-year-olds from 1998-2000. All births 1997-2000 took place in the hospital and were attended by nurse-midwives, except for one in 2000 that was delivered at home. In 2000, a total of 77 admissions and 49 deliveries were recorded in the obstetrics ward of Glendon Hospital. There was one maternal death in 2000 and one stillbirth. Persons in the age group 25-44 years make up a high percentage of those seeking attention at the Casualty Department of the Glendon Hospital. In 1999 and 2000, diseases of the respiratory system, injuries, abnormal clinical findings, and diseases of the musculoskeletal system were the main reasons for attendance.

Elderly: The natural disaster especially affected the elderly, many of whom had previously lived independently. Left homeless and dislocated from their families who had migrated, they were affected financially, socially and emotionally. This situation has left them completely dependent and has had a serious negative impact on their mental health. The 60 years and over age group accounted for 21 % of the total population in 1999, with a male-female ratio of 1.1:1. Most people in this age group do not receive a pension and those who qualify receive a monthly allowance around US$ 150 from the Government. Three homes provide 140 beds for long-term geriatric care; two of these are run by the Government and one by an NGO with a subsidy from the Government.

Family health: After the volcano erupted, 74% of all households were relocated. A social survey in 1997 noted an average of 1.9 persons per household of 1,762 families identified. 37% were single-person households, with the occupant under 60 years of age; 25% were childless; and 14% had occupants that were exclusively 60 years and over.

Disabled: There are no special services for the physically disabled. Wheelchairs and other devices to assist the physically disabled are generally provided by the Montserrat Red Cross. More complex devices (e.g., an artificial limb) have to obtained abroad. There are no formal health care facilities for people with learning disabilities. A number of families with dependent disabled relatives have gone overseas where facilities are better.

Analysis by type of health problem
Vector-borne diseases: Though the vector Aedes aegypti is present on the island, there were no cases of dengue between 1994 and 2000. In 2000, two cases were confirmed. There were no cases of malaria, yellow fever, Chagas’ disease, schistosomiasis, or plague during 1997-2000.

Diseases preventable by immunization: Immunizations continue with high coverage for all antigens administered to children under 1 year old since 1996. An adult MMR campaign was completed in 1999. No cases of tetanus, mumps, measles, whooping cough, polio, or diphtheria were recorded. There were 14 cases of hepatitis B from 1998-2000.

Intestinal infectious diseases: There have been no cases of cholera recorded for many years. There were 83 cases of gastroenteritis in children under 10 years of age in 1998, 36 cases in 1999, and 49 cases in 2000. There were 93 cases of food poisoning from 1998 to 2000, though none were identified as salmonella or shigella.

Chronic communicable diseases: Tuberculosis is rare in Montserrat with only three cases reported 1997-2000. No cases of leprosy have been recorded in recent times.

Acute respiratory infections: During 1999, 828 persons attended the Glendon Hospital emergency department with acute respiratory infections; in 2000, 770 persons attended for that reason.

Zoonoses: There were no cases of rabies reported 1997-2000.

HIV/SIDA: The cumulative total of HIV-positive cases in Montserrat is 7, there are 2 cases of AIDS. No routine testing of pregnant women for HIV is done. There were 34 cases of syphilis in 1998, 47 in 1999, and 5 in 2000.

Nutritional and metabolic diseases: There were 10 deaths due to diabetes from 1998 to 2000. In 1999, 187 persons attended the emergency department for diabetes; 289 people attended in 2000.

Diseases of the circulatory system: Cardiovascular disease accounted for 30% of deaths in 1999 and 35% in 2000. There were 9 deaths due to cerebrovascular disease in 1999 and 2 in 2000.

Malignant neoplasms: The number of deaths due to malignant neoplasms was relatively stable, with 8 in 1998 and 7 each in 1999 and 2000. In 1998, all deaths were among males over 60 years of age, with 50% due to prostate cancer. In 2000, 5 deaths were among females over 65 years of age.

Communicable diseases: An outbreak of acute viral conjunctivitis occurred in 1998, with 188 cases. There were 17 cases in 1999 and 11 in 2000.

Oral health: The Community Dental Service, run by a dental auxiliary, offers basic diagnostic and emergency treatment for children, pregnant women, the elderly, and special benefit patients. The sole dentist on the island provides service through the private sector.

Mental health: At the end of 1999, there were 93 persons registered at the Mental Health Clinic: 48 suffered from schizophrenia, 23 from alcoholism, 10 from organic psychoses, 6 from neuroses, and 6 from other conditions. The mental health services have suffered from the effects of depleted human resources. There is no specialized facility for the care of acute mentally ill patients. Two psychologists were appointed in 2000 and are providing counseling and support.

RESPONSE OF THE HEALTH SYSTEM
National Health Policies and Plans: Given the devastation caused by the volcano, the Government formulated a plan for the recovery and rebuilding of the country. A strategic plan was prepared with input from the community, the private sector, NGOs, government officials, and regional organizations. The health sector developed a health action plan with 10 main objectives: 1) To develop appropriate health strategies and plans to deliver a high standard of care to the population. 2) To review regulations and policies governing the operation of the health sector. 3) To develop adequate health care facilities in the safe zone. 4) To strengthen the institutional management of the Health Department, including performance standards and overall planning framework. 5) To ensure adequate provision of basic and more advanced medical and nursing training. 6) To improve disaster preparedness planning within the health sector. 7) To develop HIV/AIDS prevention policies. 8) To strengthen health promotion programs. 9) To review and improve the care of the mentally ill. 10) To improve clinical standards within the context of a primary and secondary health care program.

Institutional Organization of the Health System: The Ministry of Education, Health, and Community Services is responsible for providing accessible, adequate, and affordable health services to the population. It is also responsible for overseeing and regulating the health system and services, including water supply and waste disposal. The Chief Medical Officer coordinates the health services, particularly primary care services. The Secondary Care Manager is responsible for the functioning of the hospital. The Principal Environment Health Officer reports to the Permanent Secretary on environmental matters. Health promotion services are provided by a community health nurse. Additional water service was needed in the north and approximately 1 million pounds sterling was spent to improve the water system. Water quality is constantly monitored by the Environmental Health Department. Sewerage in most households drains directly into septic tanks. Domestic solid waste was initially a problem when the influx of persons came to the north of the island. Garbage is compacted and covered on a regular basis, but disposal of industrial waste, oils, and abandoned cars is problematic. Garbage is collected by two government-paid contractors. The Environmental Health Department is responsible for the protection and control of food supplies and is continuing a limited inspection program. Health services are divided into Community Services and Institutional Services. The primary health care services include maternal and child health, immunization, school health, dental health, mental health, health promotion, and environmental health; all are categorized as community services. All the services provided at community level are free to the public. The Institutional Services provide inpatient facilities, outpatient facilities, long-term geriatric services, and laboratory, X-ray, and pharmacy services. Users are expected to pay a fee when they access services at the hospital, though pregnant women, people over the age of 65, and certain indigent persons are exempt. Long-term geriatric care is free. The Glendon hospital laboratory conducts hematological and biochemical testing as well as blood banking. Only basic microbiological investigations can be performed. There is no sale of blood or blood products and the blood bank depends on voluntary donors. There are no specialist vision or hearing testing services on the island other than the basic tests carried out in the clinics. Eye specialists have recently begun to visit Montserrat to examine and treat patients in a private capacity. No drugs, reagents, or biologicals are produced locally for use in the health sector. All items are imported through the Organization of Eastern Caribbean States/Pharmaceutical Procurement Service, which performs annual audits. The challenge of retaining staff is one that Montserrat has been facing since 1995. Nursing services both at the hospital and in the primary health care clinics rely heavily on trained nurses. In-service training is carried out for several categories of staff as the need arises, depending on the availability of tutors to conduct the training. Montserrat had a nursing school which has been closed since the volcanic eruption. Thus, all training is conducted off island. Arrangements have been made with Antigua and Dominica to assist in this training .

 

 

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