Mangaia is an island of over 500 souls whose only urgent medical treatment is provided by a Nurse Practitioner who is now on three months’ maternity leave.
Let’s examine the secretary’s letter for what needs to go right if emergency care is needed on any of the Pa Enua.
1. Let’s say a person presents with a life-threatening emergency and has six hours to live. The secretary says diagnosis will begin with “oversight of the surgeon in Rarotonga through med/tech/phone/Skype.” This assumes that telecommunications are fully functioning. But even a drop of rain places that in doubt especially in the outer islands; the patient now has 5 hours to live
2. Are the required drugs available to stabilise the patient? The Secretary cannot be sure: “Pharmaceutical stock continues to be one of those challenges we seem to continue to have …” Without stabilising drugs, the patient’s condition deteriorates to critical; she now has three hours to live;
3. Is a plane available to evacuate the patient? What are the bureaucratic delays likely to be expected in mobilising the aircraft, especially in the middle of the night?
How long will it take for the flight to be approved and how long will it take to reach the island and return to Rarotonga? How long to get from the airport to the hospital? By my estimation, the patient has long since run out of time.
The Constitution of the Cook Islands guarantees equality before the law.
This means there cannot be two tiers of health provision: islands with doctors and islands without doctors.
The secretary should seek to uphold the constitution rather than spend her time writing long letters defending the indefensible.
By the way where is the minister in all this? Are his constituents on Atiu happy to be doctorless, as the secretary suggests they should be, in this brave new world of nurse practitoners?
Pa Enua Lives Matter
(Name and address supplied)