The use of telemedicine promises the provision of quality care to all Bahamians and visitors across its islands, often reducing the distances that have to be travelled to the key health centres, writes Noelle Nicolls
When it comes to infrastructure, not all parts of the Bahamas are equal, and nowhere is this more striking than in the health sector. There are 29 inhabited islands scattered between some 700 isles and 2,500 cays that stretch across nearly 260,000 square kilometres of ocean bed. The demands of each populated area stretch government resources to the maximum, particularly on those remote settlements, far removed from the seats of power in Nassau, the capital, situated on New Providence island.
But when it comes to medical technology, the Bahamas goes the extra mile. The government is aggressively promoting a public-private partnership to connect the archipelago with a ‘health bridge’. In January, it launched a virtual skin clinic in Abaco, a chain of islands 170 km north-east of Nassau. A dermatologist stationed on New Providence runs a surgery in Abaco using advanced digital communication technology – video-conferencing for patient consultations backed up by high-quality digital photographs or video taken by nursing assistants in the remote clinic. He sees his local patients from 9am to noon, and those in Abaco from 2pm onwards.
In the first month of the programme the clinic treated 42 patients who would have otherwise have had to incur significant costs to travel to Nassau for treatment. Of that cohort, three patients needed further testing in the capital, and one patient tested positive for cancer. The government is almost ready to roll out the programme in Andros and Long Island, two other major population centres. And plans are already in place to replicate the skin clinic model with paediatric clinics.
There are currently two full-scale public hospitals in the Bahamas: the largest, Princess Margaret Hospital (PMH), is in Nassau, while the Rand Memorial Hospital (The Rand) is in Freeport, Grand Bahama. Other public facilities include the Sandilands Rehabilitation Centre, which is the only hospital dedicated to the treatment of mental disorders and geriatric care, and a network of 55 main health centres and 59 satellite clinics.
“We have X-ray facilities in many of the family islands that have been there in excess of eight years, sometimes up to ten years, and they have never been used. They are still in the box. That is because the Xrays we purchased were using analogue technology, and they required a technician and radiologist. We are converting those analogue machines to digital, so you only need a technician on the island,” said Hubert Minnis, Minister of Health.
The reality is, there will never be a sufficient number of dermatologists, radiologists, paediatricians or other medical specialists to staff each and every island of the Bahamas. The scale of the archipelago is simply too vast. The public health system is, however, sufficiently staffed to support a structure that requires technician-level workers in outlying clinics with radiologists stationed in the main hospitals.
The use of telemedicine is, therefore, an important strategy for providing quality health care for all Bahamians and visitors across the islands. There is a tele-radiology pilot project running in two communitybased clinics, South Beach Clinic in New Providence and Eight-Mile Rock Clinic in Grand Bahama. Radiologists at PMH or the Rand consult regularly with technicians and patients at the two clinics. They utilise a Picture Archiving and Communication System (PACS) to store, share and archive imaging data. The idea is to link the entire Bahamas into the PACS system. International partners can also be plugged in, so a doctor in Nassau would be able to consult with a radiologist at the University of Miami, for example, if the need arose. The programme has been successful to date, and the government is looking to use the technology to provide long-distance services to pre-natal ultrasounds.
With the government fully committed to the health technology revolution, it is set to launch a major initiative to promote entrepreneurial opportunities in the sector. Once enacted, the Medical Care Improvement Act will remove the 45 percent import duty on building materials and medical equipment for investors developing or refurbishing public health-care facilities. The cost of health-related infrastructure has created great disparities between public and private sector facilities, so the government will also extend the customs duty exemption to the Public Health Authority and the National Insurance Board for similar programmes.
When he announced the new measure, Prime Minister Hubert Ingraham said: “There is no question that the prosperity of a nation is vitally dependent on the health of its citizens. To that end, it is equally important that a country’s medical-care facilities and equipment are at the highest standard that is reasonably attainable. The availability of health care at high quality is critical.”
The government’s telemedicine vision extends well beyond the nation’s boundaries. Leaders in the heath sector see the country becoming a nerve centre for the Caribbean. The goal is to use the success in connecting the Bahamian family of islands as the launch pad for a regional breakthrough. Throughout the Caribbean, health professionals would then be able to link up with resident consultants in the Bahamas using the latest technology.
