Dear Editor, due to the numerous letters that I have written to your letter column on health issues, people often meet me with their own medical horror stories, recently I met a young lady who told me her heartbreaking story which she suffered at the hands of one of Guyana’s better know medical practitioners. Some five years ago she became his patient, after doing various tests; he diagnosed that she would need to have a hysterectomy and carried out the operation removing her entire uterus. After the operation, this young lady learnt that there was no need for such an operation because there was nothing really wrong with her that entailed such drastic steps. She told me that she has tried seeking justice from the Medical Council of Guyana but to no avail. The chairman of the then medical council Dr. Walter Ramsahoye never found the time to conduct the investigation and now there is hardly a chance that the matter will ever be heard since it concerns one of its present members. The trail of blotched medical operations in Guyana is a long and winding one and to those who suffered the way this young lady has, brings much anger to me. Unlike the present chairman of the medical council who would quickly brush such incidents under the “third world” carpet, I’m not as inclined to accept such a ridiculous excuse for incompetence and greed. Many of the doctors operating in Guyana hardly bother to properly research their cases and rush to judgment and in the process leaving shattered lives behind. When a doctor makes a mistake, it usually means that someone else will have to live with the result of his error and it is people like my friend who are forced to pick the pieces up and try to move on. Truthfully I was on the verge of giving up this medical struggle that I have been single handedly waging for some time now but after hearing this young lady’s extremely sad story and seeing the anger and hurt in her eyes, I have been given new strength to keep the pressure on our medical practitioners in the hope of improving our medical system so that some other unsuspecting soul will not have to suffer the way this young lady continues to do. I am asking other persons who have suffered at the hands of our medical practitioners to get in contact with me on telephone number 621-4018 so that we can take this fight to a higher level. I am in the process of registering a foundation which will assist and educate persons about medical matters, we have already started our website > www.gmrsc.com and we are adding medical information to it on a daily basis. Join the medical fight now and make the difference for better health care for all.

Yours faithfully, Bryan Mackintosh. Health Advocate

Save our women from unnecessary hysterectomy surgery

Dear Editor, On Friday November 19, Kaieteur News reprinted an excellent article written by columnist Freddie Kissoon. Freddie in his usual no-nonsense style brought to light the frightening occurrence of women undergoing hysterectomy operations.

Mr. Kissoon rightfully asks the question whether these hysterectomy operations were necessary or if it was the case that a small group of doctors was carrying out these operations simply for profit. This is a frightening revelation and one that demands a thorough investigation by the Ministry of Health.

The amazing thing about this story is that it was first published in August of 2003 in Kaieteur News and yet none of the so-called women's organisations ever commented on it. Surely, something that can impact so heavily on the lives of women, in which they lose their childbearing capabilities because of an unnecessary operation, should have caught the attention of some members of these groups, but not a word from any of them, strange to say the least.

I guess that the response from the Medical Council of Guyana on this scary issue would be that we live in a third world country and that as patients, we should learn to understand our third world place by keeping quiet regardless of the pain and hardship that we are forced to bear due to the incompetence of some doctors. I have never been burdened by the third world curse, simply because my fore parents came from Scotland and Portugal and I do not for a single moment consider myself to be less of a human being than someone born in the USA or any other developed country.

As such, because of my inherited first world attitude, I intend to continue asking the question that our medical practitioners do not like to hear.

Prime News on November 24, 2004 carried the story of Marcel Yhip, who was told that she needed to have a hysterectomy to remove the fibroids that tests had indicated were on her uterus. Unfortunately, after the operation the pathological examination revealed that no such fibroids were found even though her entire uterus was taken out. Surely, the doctor who carried out this operation should have made sure that the prognosis was 100% accurate before undertaking such a severe operation. Surely the experience that he must have acquired over the years, after undertaking numerous such operations should have indicated that he was about to make a mistake.

Can he truly say that he cannot differentiate between a uterus infected with fibroids and one that is fibroid free? The young lady that Freddie Kissoon wrote about in his article is not Marcel Yhip, so it means that we have at least two cases on record of women being unnecessarily operated on. Just imagine how many more unfortunate women are out there who are suffering silently because of someone else's fault or greed. It is only when victims such as Marcel Yhip decide to speak out on the injustices that they have suffered, that we will see changes in our medical system. Since my last letter on this issue, I have had numerous calls from women who have had hysterectomies and the names of just a couple of doctors are being called time after time.

Let us have an intense inquiry so that we can get to the bottom of this frightening issue and I'm hoping that the various women's groups will come out in support of this call.

Bryan Mackintosh - Health Advocate

 The following are the different arguments over the issue of nurses being allowed to  administer to anesthetic to patients   

This letter was published in part by stabroek News

Dear Editor, the Minister of Health was quoted recently in your newspaper saying that the Ministry of Health and the Georgetown Public Hospital will shortly start training nurses to administer anesthetic on patients going there for surgery, surely the Minister cannot be serious. The administration of anesthetic is no simple task; surely the Minister cannot have such disregard for the lives of Guyanese to even have conceived this thought. In any other part of the world, Anesthesiologists are highly trained medical practitioners who had to undergo rigorous training before they are allowed to perform anesthetic on any patient. In the real world, an Anesthetists must know about the human body and how it functions, the effects of anesthetics and other drugs on the body, and how to treat allergic reactions, how to revive and resuscitate patients in the event of complications during the surgery. The following are some of the tasks and duties of an Anesthetists: assess the patients' medical status and how that might affect the anesthetic, assess patients' pain management requirements before surgical operations, decide on the anesthetic drugs and techniques to be used before, during and after an operation, the Anesthesiologist must be able to discuss the anesthetic process with patients, must be able to give both local and general anesthetics to patients, provide pain relief for women in labour, must be involved in the resuscitation of critically ill people such as trauma victims, the Anesthetist must observe and care for patients before, during and after operations, must be able to record details of drugs given. Come on Mister Minister does this sound like a job for some nurse who hardly knows the difference between a bedpan and a doorknob? I’m not quite done yet; Anesthetists need to have medical, surgical and technical skills. They must have good communication and people skills in order to relate well to patients. They must also have crisis management skills, skills in analysing and interpreting information, and the ability to make decisions. Look Mister Minister, why don’t we really take the medical world by storm, in the future whenever anesthetic is required, why don’t we just get a piece of two by four greenheart and give the patient a good whack on the head and if the patient wakes up before the surgery is completed, then a second blow to the head will surely send them back off to sleep, this method will not only be very effective, but can actually end up saving the hospital millions of dollars and even the porters and cleaners can be taught this new anesthetic technique. Bryan Mackintosh, Health advocate

 This was a back up letter sent to Stabroek News.

Dear Editor, What a perfect excuse for incompetence, Guyana is a third world country, and as such we have no right to proper medical care. The unfortunate side effect to such a statement is that we the people of Guyana will continue to suffer and there seems to be no desire on the part of this present Medical Council of Guyana to even put measures in place to stop the decay taking place in our medical system. If we were talking about car parts or even the poor work that contractors are getting away with on a daily basis, maybe I could have looked the other way, unfortunately we are talking about the health of our country and its people and that ironically includes innocent children.
In any other part of the world, the head of the medical council would have been called upon to resign for such a horrendous statement. We as a people seem quite satisfied to condone incompetence and those who benefit from it. I wish to go on record in calling for the removal of the present Chairman of the Medical Council of Guyana; simply because we as a nation cannot afford to have someone who does not seem to understand the functions and the importance of the office that he has been placed in charge of. The medical council is not there to condone or make excuses for doctors who operate outside of their qualifications; the medical council is the policing body that is supposed to monitor all medical practitioners to ensure that they keep within the confines of their qualifications. In order for the medical council to be effective, the least we should do is to ensure that those who we place on its board are beyond reproach by his or her peers, as it is, five out of the seven doctors on the present medical council have complaints lodged against them with the very medical council that they are part of, can those persons ever get justice for their causes seeing that the very people who must give them justice are the very people who have aggrieved them? Guyana is at the crossroad of self destruction, we can either start to fight back or we can sit quietly and allow yet another institution to go astray. Yours faithfully Bryan Mackintosh, Health Advocate

 This letter was published in Stabroek news, Sat , 4th Sept 2004  
Dear Editor, Permit me to respond to the concerns of the public at the idea of nurses being trained to provide anaesthesia. First, the public, as well as public officials must know that there are two categories of nurses who administer anaesthesia in Guyana.

1. Anaesthetic Nurse - a registered nurse who receives on the job training in anaesthesia. Over a period of time the anaesthetic nurse acquires clinical skills and knowledge to be able to perform anaesthetic duties at a satisfactory standard.

2. Nurse Anaesthetist - a registered nurse, who has successfully completed two years specialised training in anaesthesia at a school of nursing, followed by six months internship at the Georgetown Public Hospital Corporation, under the supervision of an experience and qualified Anaesthetist and Anaesthe-siologist. This category is certified and registered as nurse anaesthetist by the General Nursing Council of Guyana after success at the council's qualifying examinations.

It takes a minimum of five and a half years for a nurse to be qualified as a registered nurse anaesthetist; three years training as a registered nurse and two and a half years specialized training in anaesthesia.

Prior to January 1995, there was no structured programme for Nurse Anaesthe-tists in Guyana; hence what existed was the anaesthetic nurse. Even though anaesthetic nurses for decades have been providing anaesthesia successfully, it is not the ideal situation and they should be encouraged to pursue the Nurse Anaesthetist Education Pro-gramme.

It should be noted that only two batches of nurses benefited from the nurses anaesthetist training programme in Guyana. They included nurses from Georgetown Public Hospital, St. Joseph's Mercy Hospital, Woodlands Hospital, New Amsterdam Hospital, Linden Hospital and one self-sponsored nurse.

In January 1995, Nurse Anaesthesia Overseas, a division of Health Volunteers Overseas, established an educational programme for nurse anaesthetists in Guyana, in collaboration with the St. Joseph's Mercy Hospital and the Ministry of Health. Thirteen registered nurses and registered nurse/midwives were admitted to this initial programme at the St. Joseph's Mercy Hospital School of Nursing. In January 1998, a second batch of six nurses was admitted to the programme, which was held at the Georgetown School of Nursing.

Approximately ninety-seven percent of the lecturers were from North America and they spent varying periods with the schools, teaching and clinically supervising in their areas of expertise eg obstetric anaesthesia, paediatric anaesthesia, spinal anaesthesia. Specialist anaesthetists from the hospitals in Georgetown also made significant contributions to the student nurse anaesthetists training, particularly in the area of clinical practice.

It is not practical for me to itemise the entire syllabus of the Nurses anaesthetist educational programme in this letter, however I will state that it includes Human Biology, pharmacology, patient assessment, prevention and management of complications, pain management and cardiopulmonary resuscitation.

Nurses are trained as Nurses anaesthetists in many countries including the United States of America, India, Jamaica and St. Lucia. In fact there is an International Federation of Nurses Anaesthetists. In 1997, three representatives from Guyana's first batch of Nurses Anaesthetists attended the 50th Annual International Convention in California USA.

It is the Nurses Anaesthetists training programme that the Ministry of Health is planning to re-establish. However, the present salary for nurse anaesthetists needs urgent attention if the remaining three registered nurse anaesthetists of the original eight trained and employed by the government, are to continue their service to this country.

I hope that by this letter I have been able to alleviate some of the apprehensions of the public. Yours faithfully, Donal Sylvain RN, RM, RNA

Editor's note, I wonder if Mr. Donald Sylvain would like to lie on an operating table knowing that the person who is going to administer anesthetic to him is just a nurse and not the highly trained doctor who is really supposed to be there. In Guyana 99% of the nurses are nothing more than bedpan changers, I have seen many of them in action and I definitely would not want them to administer anesthetic to me of any kind, Bryan Mackintosh.

Letter to the Editor of www.kaieteurnewsgy.com : Unusual number of maternal deaths

Dear Editor, there have been five deaths of women during childbirth (maternal deaths) so far this year at the Georgetown Hospital . These are: Sandra Persaud - died 18/1/05 , Prammsttie Deodat - died 17/3/05, Sonya Padmore - died 17/3/05, Tracy Schapmy , Allison Wharton - died 10/04/05

This is already equal to the total number of maternal deaths for the year 2004. Has any of these deaths been investigated to see if there was negligence on the part of the doctors, nurses or hospital management? Any death of women who died in labour should be thoroughly investigated – as these are usually healthy women in the prime of life.

I am not privy to the internal management of the Georgetown Hospital , but from the above, it leaves a lot to be desired and is an indication of the quality of medical care at the institution.

What is the point of importing many foreign doctors, giving them more favourable terms of employment than local doctors, and the quality of hospital care cannot improve? Many patients referred to the specialist clinics have to wait two to three months or more to see a specialist.

Is it because these doctors spend most of their time doing private practice in private hospitals rather then seeing patients in Georgetown Hospital up to 4.00 p.m., as their terms of employment dictate?

M. Y. Bacchus Obstetrician& Gynaecologist