~ Situation with youngsters also dealt with ~
CAY HILL--Patients on dialysis in St. Maarten have to find a family match for a kidney or register with Cura�ao's St. Elisabeth Hospital Sehos if they are to have hope of a new kidney to prolong and improve their quality of life. There is no option to register in St. Maarten.
The plight of dialysis patients was embodied by patient Carlos Arndell who spoke to some visiting Members of Parliament (MPs) from across the kingdom when they visited St. Maarten Medical Center on Wednesday.
Several MPs from the Netherlands, Aruba, Cura�ao and St. Maarten who toured the hospital were exposed to some of its challenges. Only St. Maarten President of Parliament Gracita Arrindell and MP Roy Marlin were part of the tour. MP Dr. Ruth Douglass was present in the hospital, but was attending to her stepmother who had fallen into a coma earlier in the morning. MP William Marlin also was away because of his wife's illness.
Arndell, who has been on dialysis for more than three years, said SMMC internist Dr. Theo Jolles had "tried endlessly" to find simpler options for patients in need of a kidney. Listing with Sehos sometimes leads to a donor and that journey often leads to the Netherlands.
Without a St. Maarten foundation to arrange a patient/donor list, local patients are left basically to fend for themselves if their health insurance does not cover the cost to list elsewhere or for the transplant if a match is found.
Hooked up to the dialysis machine as he spoke to MPs Marlin, Dean Rozier (Cura�ao) and Eric Lucassen (the Netherlands), Arndell also expressed the need for a kidney specialist at SMMC, which caters to some 35 dialysis patients regularly.
Need for specialists
SMMC Director Dr. George Scot outlined the hospital's challenges and expansion plans to the MPs when the formal session of the Inter-Parliamentary Affairs and Kingdom Relations Conference resumed at Sonesta Great Bay Beach Resort for the second day, after the tours.
Scot said the hospital was operating with some 17 specialists when its operations required at least 27, with about seven rotating ones. Despite this, when SMMC is benchmarked against similar operations in the Netherlands, he said, "We are doing pretty well."
Dutch MP Ronald van Raak asked what could be done to improve SMMC's relationship with Dutch public entities Saba and St. Eustatius and what patients could be catered to in St. Maarten instead of their going to Guadeloupe, which is farther from home and presents a language issue.
Scot said efforts had been made to include the two islands and an agreement on the joint purchasing of pharmaceuticals had been signed on September 30, but the island later "went a different route."
Responding to Dutch MP Ineke van Gent, Scot said the NAf. 30 million guilder hospital expansion was one way to assist the two islands. The hospital is in need of specialists, specialised staff and a new tariff structure, not a higher tariff structure. Operational relationships, like the one that exists with Bonaire and SMMC, require hospitals to have the same system.
MP Roy Marlin asked whether SMMC was able to finance its expansion "bit by bit" from its cash flow or help was needed such as a grant from outside. Scot said a grant would help the process. "We need an integrated hospital system in one year."
Marlin raised the issue of the dialysis patients in St. Maarten, calling them "forgotten" ? a leftover from the bad administration of the Netherlands Antilles. He called for the inequality of health care in the kingdom to be addressed. He also pointed out that government was not in a position to give a guarantee to SMMC for the expansion.
Marlin further added that it appeared the constitutional change process had been focused on "a lot of paper instead of the wellbeing of the people."
Dutch MP Andre Bosman said it was important that people not think the expansion would make health care better; that improvement would come from the operations and organisation.
Quality of care
Following the SMMC presentation, MPs went on to discuss health care in general, at the end of which they agreed to install an inter-parliamentary committee to research the differences in care and make recommendations within two months for improvements.
MP Dr. Lloyd Richardson said nationality and foreign affairs played pivotal roles in health care provision in St. Maarten due to the various nationalities living here and the extension of insurance coverage to undocumented people.
Bilateral agreements are needed with countries from which where the majority of people come, he added. "Many countries are exporting people here. ... They don't want to see them again. ... They were sent out to send money back to support the economy."
MP Patrick Illidge called for countries to work together on the purchase of pharmaceuticals, because buying as a bloc in bulk would assist in bringing down the health care cost.
Aruba MP Mervin Ras said quality of health care was important. She pointed out that Aruba, Bonaire and Cura�ao specialists had working relationships.
Exploring service level agreements to improve and increase care was suggested by Aruba MP Ren� Herd�
Cura�ao MP Amerigo Thode said some 13 per cent of his country's gross national product was spent on health care. This has led to a shift from primary care to prevention. He called for the coming together of the countries on the offering of basic care to lower health premiums.
Dutch MP Cynthia Ortega-Martijn called for Dutch Caribbean countries' governments to ensure their people are protected and have a choice when it comes to abortion and euthanasia, though this was a choice on which countries must decide individually.
Cura�ao MP Eunice Eisden said Cura�ao would move at its own pace on abortion and euthanasia. She agreed that health care was a complex issue that included cultural differences.
Children and youth
The second parliamentary committee of the day, though this time without Cura�ao's participation, was formed followed discussions on the state of children and youth in the kingdom.
Cura�ao MP Herman Wiel objected to the committee, although it stemmed from a suggestion of fellow Cura�ao MP Humphrey Davelaar. Arrindell said the committee, which she had suggested be led by Cura�ao, was open to the country should a different decision be made. Aruba leads the committee.
Wiel's objection came from his belief that every country was different and had to deal with its specific problems.
MPs generally agreed that parents need to be encouraged to take a more active role in their children's lives and ways of curbing the phenomenon of "children having children" had to be addressed.
Parents need to spend more time with their children and governments need to find ways to make this happen, said Aruba MP Marisol Lopez-Tromp.
Similarly, MP Dr. Ruth Douglass said parents had to be educated to "take back their responsibility as adults in authority."
MP Richardson said quality time was not that easy to find in St. Maarten when tourism/hospitality was its singular most important "legal" business, "outside of the drugs, which is illegal."
MP Illidge said St. Maarten was struggling with its new status, but was doing so proudly although facing a need for proper homes and better social aid. He said the help promised by the Netherlands to assist with a better foundation had not been forthcoming.
Dutch MP Wassila Hachchi called for education and training coupled with listening to the needs of the youth from the youth.
Wiel's comment about Dutch judges giving "soft sentences" to sexual abusers of, in particular, children drew a strong response from Van Raak. The Dutch MP told Wiel that Cura�ao should become independent and have its own judges if unhappy with the Dutch ones.
Lucassen added to the argument, saying the Dutch prisons had more Antilleans than the schools.
To quell the situation, Arrindell reminded MPs that they were the lawmakers and were in a position to pursue concrete actions to deal with issues facing the youngsters of the kingdom.
Marcus Bent Alexander McCall Smith Carlos Tevez New Castle United Tromso Lee Bowyer
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