Malta rightly claims to have one of the best health services in the world – a reality that has been achieved through the hard work of several governments over the years.
We have one of the oldest – and best – medical schools in Europe and we were, of course, fortunate to have had the Knights Hospitaller of St John the Baptist for 200 years who not only had very high standards of medical practice in hospitals for those times, but also enacted several public health laws based on the medical expertise of the day.
For example, selling fish in carts kept in the full sun was strictly illegal at the time of the Knights, to prevent food poisoning. This initial trip into the science and art of medicine was augmented by the arrival of the British in our country at a time when British medical practice was making big strides forward in Europe and increasingly benefitting from the new scientific discoveries of the 19th century such as the existence of microbes and general anaesthesia.
This level of health service needs to be maintained and improved consistently for the good of the Maltese people at a not inconsiderable expense. Improvements and discoveries occur in piecemeal fashion practically every day. However, every silver lining has its cloud and I am not referring simply to the ever-increasing cost but also to the efficiency of the service itself and the bureaucracy which inevitably creeps in with such a large organisational structure. It is important that we are all on our toes to weed out practices and systems that slow down the service or render it insufficient.
Before the last general election, the PL had a field day picking on the defects in the health service and promising heaven on earth the day after elected. Promising to remove queues, deficiencies in the supply of drugs and sorting out a number of other problems. About three months before the election, I warned on a television programme that things would not be so easy because of the several interconnecting and structural problems that existed. Well, Labour has now been elected but the problems still remain. Let me share with your readers some experiences I endured during the whole of one week. One evening, I was called to see a 91-year-old patient in Birkirkara who, upon examination, was found to have developed a cardiac arrhythmia. On phoning for the ambulance service, where I made clear it was an arrhythmia, 50 minutes had to elapse before the ambulance actually arrived – and I had to phone twice before it showed up. The patient died shortly after arriving at the admitting department, notwithstanding the efforts of the medical and nursing staff!
The casualty doctor on duty phoned to ask me if I would mind issuing the death certificate myself, as they did not issue these when the patient died shortly after arriving at hospital. The problem was that the Ministry/Department of Health website, from which these and other certificates are downloaded frequently, was itself down and out and the family had to go on a wild goose chase to obtain the required certificate, which was duly procured the next morning!
A number of medications provided free of charge under the Pharmacy of your Choice scheme are also out of stock. Unfortunately these include certain doses of Phenytoin (Epanutin) which is used to control epilepsy. A pharmacist in my area told me of a woman who was regularly on Phenytoin ceased to take the drug because of its unavailability, with the dire consequence that she had a very serious epileptic attack and ended up in hospital. There are also many privately bought medicines usually available on the market that are currently also out of stock and are not even available at hospital – and investigations should be carried out to ascertain why this is happening. One such drug is Xanax (alprazolam) which has suddenly disappeared from our shelves for some inexplicable reason. This has led to many patients having to switch to different medication with the unpleasant consequences and problems that often accompany this procedure.
The reason I am writing this is not to cause alarm but to show how the PL’s election campaign did not in any way really handle realities but was only built on false pretences. As I warned then, the problems that exist – such as the procurement of medication, staffing, financial issues and waiting lists – cannot be resolved by political rhetoric alone. It really is necessary to look at such problems from outside the box. No government will be able to resolve many of these problems on its own and therefore a national effort will be necessary to target these issues even, if necessary, by changing tendering legislation for drug procurement, for example.
A real effort to avoid the repetition of these events would be to appoint national committees – even with representatives from different political parties – that can then cooperate in seeking and finding real solutions to reduce these conundrums even by legislation, if necessary.
I hope that, in the future, a more consistent and effective approach will be adopted that will really lead to seeking real solutions to the myriad problems in our health services as opposed to a simple whitewash. The less rhetoric we use and the more concrete national cooperation and seeking of real outcomes there is, the better for us all! The quicker the government realises that many issues cannot be handled by it alone, the better the chance of actually getting anywhere at all. The less partisan political interference there is in health (just as in education), the better for us all. Remember – we will all be patients one day!
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