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A little hospital doing big thingsBY HG HELPS Editor-at-Large helpsh@jamaicaobserver.com
Sunday, January 17, 2010
DR Nadine Bourg perhaps summed it up best: "It is a humble little hospital, in a small community, doing great things." Head anaesthesiologist Dr Bourg was referring to her medical institution of employment, the Annotto Bay Hospital, located in South East St Mary, a 45-minute drive heading east from Constant Spring in upper St Andrew.
The hospital, founded in 1867 by Dr John Pringle as a medical post for workers, has grown at a rapid pace to emerge as one of the leading institutions of patient care islandwide.
The new hospital, opened in 1950 at its present location along the eastern coastline on the edge of the town heading toward Portland -- with a picturesque view of the Caribbean Sea in tow -- has outstripped all expectations and those involved in its growth believe that the best is yet to come.
The entrance to the Annotto Bay Hospital.
MORGAN... I have been here since 1968 and it has been a wonderful experience
Dr Locksley Wolfe (left) and Dr Ray Fraser doing a laparoscopic surgery last week.
BOURG... it is a humble little hospital, in a small community, doing great things
The entrance to the Annotto Bay Hospital. 
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Up to 15 years ago, the hospital had only one doctor, who attended to all the medical cases, including running wards and doing surgeries.
Now, the facility built to house 120 beds has a complement of 38 doctors, 40 registered nurses and 18 enrolled nurses, supported by a group of enthusiastic and energetic technical, administrative and ancillary staff who are all committed to improving patient care.
The hospital was recently upgraded from Type C to Type B in the Government's rating scale, a notch below the Kingston Public Hospital (KPH), the University Hospital and the Cornwall Regional Hospital, all Type A public institutions, in terms of services offered.
If you talk to most employees, they will mention a name that seems to be synonymous with progress and improvement of the facility's physical and technological advancement. That name is Dr Ray Fraser, a Manchester-born justice of the peace and consultant surgeon who moved to the Jamaican capital to attend Kingston College, then on to the University of the West Indies where he sat a Natural Science degree. After that he went to Cuba where he completed studies in medicine, before going on to do post-graduate studies in surgery in Edinburgh, Scotland.
"I came here in 1994 from the KPH. I came at the height of controversy over whether or not the hospital should be closed," Dr Fraser told the Sunday Observer.
"There was only one other doctor here and there was no laboratory, no telephone system, the Outpatients Department was only a small room and the operating theatre needed refurbishing," he said. "The tuberculosis ward, which is now where the lab is located, had no roof."
Dr Fraser said that after making a list of priorities for improvement of the institution, companies like Jamaica Producers (JP), Jamaica National Building Society, Haffizulla's, through its owner, the late Alfred Haffizulla, and National Commercial Bank assisted, topped by a $1.5-million contribution from JP subsidiary, St Mary Banana Estates, which went toward building a lab, conference room and office for the senior medical officer.
While much of the hospital's backing comes from central government -- particularly in terms of recurrent and capital support from the North East Regional Health Authority, and structural contributions by the CHASE Foundation and the National Health Fund -- non-government organisations in Jamaica and outside offer much support.
Deaconess Hospital of Indiana in the United States is one of the main contributors.
"In 1995, I went to Indiana and Deaconess accepted our plea for assistance," Dr Fraser said. "We didn't buy anything for the operating theatre for 10 years and the amount of assistance that they have given us over the period is over $150 million."
One of the practices that allows the hospital to stand out is laparoscopic, or minimal invasive surgery, which can be an emergency or non-emergency elective procedure in which fibre-optic devices are inserted in the patient's abdominal wall and allows surgeons to remove affected body parts by viewing television-like monitors.
The recovery period is short, post-operative complication and scars are minimal, unlike the usual operation. It is also more cost-effective, as patients spend less time in hospitals during the period of recovery.
Such surgeries may last a minimum 30 minutes, or for hours depending on the case.
A medical crew of a surgeon, assistant surgeon, nurse, theatre technician and the key person, a cameraman, make up the team, after anaesthesiologists prepare the patient.
Annotto Bay Hospital is regarded as the number one location, publicly or privately, for laparoscopy surgeries and outdoes all of the major institutions in this procedure.
The Sunday Observer was privy to one such surgery last week, a successful procedure that removed a woman's gall bladder.
The idea of doing such surgeries was born out of discussions between representatives of the Jamaica Awareness Association in California, which has supplied equipment and expertise worth over US$100,000 each year for the past five years, and hospital personnel.
"Dr Weekes of California came here with a team of nurses, doctors and started in-service training at Annotto Bay," said Dr Fraser. "They would come in June to teach, leave and return in November to assess. They did that for four years.
"We now do laparoscopic gynaecology surgeries, one of the few hospitals in Jamaica doing them. Patients come from Kingston and other parishes for surgery, and with all these developments we were moved from Type C to B," he added.
"We also have a major laparoscopy conference in St Mary each year which over 150 doctors attend and when the conference ends, we usually have a week of laparoscopic surgeries at the hospital," Dr Fraser said.
The hospital has departments of medicine, surgery, obstetrics and gynaecology, paediatrics, anaesthetics, outpatients, psychiatry, pharmacy & diagnostic (X-Ray and laboratory) and child guidance. It takes referrals from other hospitals, including nearby Buff Bay, Port Maria and Port Antonio.
Head of obstetrics and gynaecology, Dr Glenton Strachan, spoke confidently of improvements in his department.
"We are challenged, but we have to cope," he said. "We do between 1,000 and 1,100 deliveries per year, and while the national infant mortality rate is 30 per 1,000, ours is 14 per 1,000."
Ward Assistant Eileen Dawn Allen, who has been at the institution since 1990, said that the economic crunch has put a damper on activities.
"The staff is more comfortable, but the Government is making it rough for us. They have cut down on work and overtime and a lot of people are not comfortable with that," she said.
"Apart from that, we have seen a hundred per cent change over the years. Visitors come from all over to do surgeries, some from even overseas. They say they get better service here. Me naw leave here to go nowhere else," she said.
Allen's commitment seems to have rubbed off on the hospital's longest serving employee, operating theatre technician Mona Morgan.
"I have been here since 1968 and it has been a wonderful experience," she told the Sunday Observer while preparing to assist with a surgery.
Retired since 2007, but retained to do sessions about four days a week, Morgan has seen the upward movement in the hospital's progress and has witnessed thousands of surgeries during the time.
"Things are much better now, there have been a lot of big changes, like for example we didn't have laparoscopic surgeries and now we are the top hospital for that kind of surgery. We are doing more and better things now," said Morgan.
Worker morale -- despite challenges for some with what they describe as low salaries -- remains relatively high, due in part to the effective management-worker relationship that exists.
Veteran worker Hyacinth Williams, who will leave her post as laundry room supervisor later this year, is anxious to see what retirement has in store for her, but is already slowly missing the place she calls home away from home.
"I will retire in June, but I have spent a wonderful time here," said the resident of the sleepy fishing village of Robin's Bay, three miles west of the place from which she has earned a salary since February 1981. "When I came here at first you don't want a day off and when you are at work, you don't even want to leave. At that time we had only one doctor on duty. Several things have changed, but we have come a long way."
Another long-serving worker of 17 years, porter, or male attendant Errington 'Ibor' Roberts, a former top line footballer for several teams in the area, including former Premier League outfit Spartan, wants to see more done for people in his category.
Roberts' main wish is for the porter's lodge to be repaired, a project that the hospital's administration said is still in its plans, but needs to be supported by funding that is not immediately available.
"I really want them to fix it, other than that I still love the work and saving lives," said Roberts. "There are some dedicated workers here, but some who seem to just come and make a dollar, instead of focusing more on what they are there to do. The hospital is in my community and I will do anything to make it stand, without a murmur."
Those who feel their hands regularly say without nurses at a hospital, patient care would slide to unthinkable levels.
Matron Jean Rowe has been head of the institution's batch of nurses since 2001 and she has seen it all.
"It has been a challenge, when you look back at the equipment, supplies and staff available, especially when we have full wards," she said.
The long-serving professional cites motor vehicle collisions or crowd anger as two of her main concerns.
"Motor vehicle accidents can stretch us, but even more serious is when someone gets chopped and the crowd comes in to kill or kill again," Matron Rowe said.
"We do not have a perimeter fence, so people come in at various times to obstruct patient care," said Matron Rowe, who also served the Port Maria Hospital and the Bustamante Hospital for Children.
Her deputy, Claudia McLennon -- who has been at Annotto Bay since 1987, left a year later and returned to stay in 1991 -- has seen and has grown with all the changes of the last two decades.
"We thrive on quality and we don't expect anyone to go home displeased," McLennon boasted. "It's been good and I can't really complain too much. Most of the staff here are from outside St Mary, as far away as Westmoreland and Manchester, but they stay. The nurses have been great and we have two to three per ward, depending on the patient load."
Acting Sister in charge of the operating theatre, Lucretia Watson, agreed.
"Sometimes it is challenging, but I have got used to the blood," said Watson, a western Jamaica native, who made the bold move to go east nine years ago after completing studies at Cornwall Regional Hospital's nursing school.
"Sometimes the length of the cases can be a turnoff, but I have fallen in love with the place and I enjoy my job," she said.
Two other specialists who figure prominently in surgeries -- Burmese/Jamaican doctor Tun Tun Oo, a naturalised citizen who can now follow the Jamaican dialect sharper than a razor, and former Campion College student Andrew Wray -- both sounded upbeat about the hospital's future.
"Yeah man," Dr Oo said, underlining his grasp of the local chat.
"That was a problem when I came here more than 10 years ago, but not anymore. When I came here there were three doctors, now there are 38. I am not leaving here," said Dr Oo, who hopes that his daughter, a third-year medical sciences student at the University Hospital of the West Indies, will work in Annotto Bay when she completes her studies.
Dr Wray, who has been at the hospital for two years and two months, said: "When you have good teachers and good people working with, you will always do good things.
"Since I've been here I have participated in over 1,200 surgeries, so I am always kept busy. Rarely do we find any of our patients getting infections," said Dr Wray, who intends to pursue post-graduate studies in surgery at the UWI, the institution at which he read for his first medical degree.
Dr Bourg, a pleasant, beautiful face who has the miraculous reputation, her peers say, of getting some patients better once they merely get a glance at her, continues to heap praise on her senior colleague, whom she credits with the turnaround of the institution.
"Dr Fraser treats the hospital like he treats his own child and it filters down to the rest of the staff," said Dr Bourg. "It is a very progressive hospital and Dr Fraser has been an excellent SMO. He has brought the hospital a far way."
Better days seem to be ahead for the hospital, which now boasts a 24-hour laboratory that tests blood and body fluids, a soon-to-be-reopened X-Ray Department, refurbished and with new equipment.
The laboratory, with its longest serving employee of 16 years, Karleen Anglin, is regarded by doctors as one of the most efficient in Jamaica, as it delivers results swiftly.
In close proximity to the areas where health care is administered is a small tuck shop, profits from which go back into helping with structural improvements.
Those in the mix continue to hope that overseas and local charities will continue to back up support from the South East Regional Health Authority; and that proceeds from More Fire, an annual stage show put on by home boy deejay Capleton, will continue to warm the hearts of others like fellow artiste Beres Hammond and the local business community, with additional support.
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