In response to the urgent need of an emergency facility in the town of San Pedro the San Pedro Business Association has formed an ad hoc committee to conduct the preliminary research to create a proposal that will be introduced to key officials upon completion.

All interested parties are invited to send their comments to the following email address:

<sanpedroer@gmail.com>

Please attempt to make your suggestions, comments and offers of assistance concise, well thought out and laid out with all relevant data and statistics that should be considered applicable.

A small team has only a short period of time in which to have a preliminary report prepared before the next SPBA general meeting and it would be helpful to have this report be as complete as possible.

SPBA members are asked to consider volunteering for the Clinic Committee.

Emails will be sent out to those board members that have expressed an interest in assisting with the data research and writing the proposal.

Thanks to the community of San Pedro, members of this message board and other interested individuals who have brought this concern to the forefront of the many other difficult issues that San Pedro is facing.

ACCC and Lions commit to work together for the PolyClinic
Lions Melanie Paz and Baldemar Graniel, who also sit as Directors for the PolyClinic II, joined the Chamber for their regular Thursday luncheon to bring to light the issues surrounding the needs of the PolyClinic. Chief amongst the needs of the Polyclinic are proper staff, security, and more emergency care. As Lion Mel pointed out, government had agreed to work with the Lions to get the needs of the PolyClinic met based upon a contract signed between the two. As such, regular meetings are held between directors and the Lions who are committed to assisting in any which way to have all the needs met.
“What we are lacking the most of right now are Human Resources,” commented Lion Mel. As such, the biggest problem is housing. Currently, the Lions are working on securing donations which would assist in paying the $600 a month apartment for a nurse currently working at the PolyClinic. Should you want to offer any financial assistance kindly get in contact with Lion Mel.
ACCC stated to Lions that they are willing to help in any way possible. Lions explained that all decisions need to go through the Board of Directors at the PolyClinic but that Lions Mel and Baldemar would act as liaisons between ACCC and the PolyClinic. Together the two ended with a commitment to work together to see what are the best ways to move the clinic forward.
http://sanpedrosun.blogspot.com/2009/04/accc-and-lions-commit-to-work-together.html

Hooray!!

I am glad to offer any assistance I can with this effort. The involvement of the doctors is crucial and I think we are off to a good start with the much needed involvement of Dr. Blackledge, Dr. Gillis and others. I would be more precise if I could figure out from the board names who some of the people on here are. I'll write a short email to SPBA at the email address given.

I just read in the San Pedro Sun that the Polyclinic has instituted 24/7 emergency on call services. April 21- April 26 Dr. Zuniga is on call at phone number 670-8755. April 27th Dr. Otto Rodriguez is on call at phone number 604-7599.
This reminds me how important it is to do the research and work with existing systems in the development of any sustainable plan.
They ask that you keep in mind that after hour calls are for emergencies only because they are keeping their days jobs at the clinic.

This system has been in place since about October of last year - but it is not infallible. With the bad cell phone service and the fact that sometimes there is more than one emergency at a time this isn't a fail safe plan.

Need one # to call with 24/7 "in house" staffing and an ambulance cart in order to respond with the shortest possible response time.

The doctors can still be "on call" at home. The emergency responders and or nurse can then evaluate the patient and determine if in fact a true emergency exists and then activate the "on call" doctor if needed.

Having to pay the doctors to be "in house" would be too expensive and likely a waste of money. This effort should not turn out to be a "free" after hours clinic like the ERs here in the US have become. There all non-emergencies could be evaluated and told to come back during regular clinic hours for non-life threatening conditions.

I think Dr. Blackledge has it just right. There may be reason to pay the doctor a small on call fee and then a minimum fee if they are actually called out. If more than the minimum is done then the physician should be paid (either by the facility or the patient) for the amount of time and the complexity of care that is rendered.

Great care will need to be taken as pointed out above that this facility is not used as convenient after hours family practice service.

The organization itself should be responsible for billing and collecting fees for the utilization of the service (i.e. E.R. charge). We will need to work out if the doctor attending should bill for his services separately or if the facility will do so. I have seen it work well both ways. Those of you practicing will know what I am referring to.

There should also be a strict rota of referrals for follow-up in the case of patients without existing physician/patient relationship. It should be made clear that interfering with existing relationships between doctors and patients will not be tolerated.

I also believe if a doctor is not willing to serve in an on call capacity then he probably shouldn't have new patients referred to him/her for follow up care. Of course existing doctor/patient relationship must always be respected.

great effort by the SPBA and everyone to keep this moving. We are working on a brief report to share some of our thoughts in greater detail and that will be forwarded along very soon.

One comment I wanted to add is that it's important to assess and understand who can and/or wants to provide emergency care. Like where I work, some docs and nurses do wonderful work but either don't want to or have not received the training to respond to true life threatening emergencies. Paramedics have all levels of training from the most basic through very advanced. As part of the Human Resources strategy, it is important to start with the great providers already there, see what they can and want to do, and see how others can help them and the community beyond that. It is important that if a heart attack happens, and people expect care, that the access, equipment, training, and support are all truly present. If not we are not truly talking about an ER but an after hours drop in clinic or something else... let's keep the discussion going.

playing devils advocate here, and admittedly knowing nothing of the topic, i hear alot spoken about this not turning into an after hrs clinic for non emergency use "like they have turned into in the US".

knowing this thing is going to take some money to operate, and the fact that the true emergency in san pedro doesnt even happen once a day, maybe you ought to let it turn into the typical e.r. allowing for more billing to keep the doors open, and keeping the nurse or whoever is on staff from going stir crazy, lol.

in the end, this is a business, yes? it has to be operated for money if even that is only to keep the doors open and the place funded. i dont think you can be half way open, know what i mean, you either are or you arent.

just throwing it out there.

fish

We had this dilemma years ago in San Miguel de Allende. There's not a shortage of competent medical professionals who are happy to provide any level of care you require. Identifying them and providing adequate facilities are the greatest challenges. We will have to determine what we're willing to afford. Half-timers and part-timers are not usually willing to pay for services they won't be using.
These things tend to be instituted by benefactors who make homes in rural communities and are best administrated by those they originally serve. Over time, such endeavors grow to serve the masses and can spawn social medical attention where the local governments are incompetent. Eventually native persons and authorities may be trained in the administration of such institutions. It is hard to imagine that nobody has begun an endowment to date.

The doctors in practice here would never let that happen...it's competition!

darrin fisher, There is more than one medical emergency per day on the entire island and surrounding waters.

You are very right there Reaper. Strokes and heart attacks lead that emergencies that we tend to see each day - but diabetic comas and many other incidents occur daily.

Usually every night, in the wee hours of the morning more often than not, there are alcohol related injuries especially at the weekend, holidays and festivals.
Then there are babies being born, miscarriages, domestic fights,febrile convulsions,asthma attacks, etc.-----each of these is a daily occurence.

If this is true the nurse on duty will need 2 security gaurds at night.

this is by far an area i have no knowledge in, but adding my 2 cents (Bz)...

first - it looks like today is Natalie's birthday - HBD, Natalie.

second - bruce had a great point that with more & more tourists coming, it would look BAD for tourism if something tragic were to happen because of lack of care facilities. plus more and more expats are retiring on AC, and this will likely shift the median age (older) on island over time. the need for 24/7 care is bound to only increase, not decrease.

third - from the outside, it is exciting to see this important project unfold with maturity and cooperation by all involved. best of luck & godspeed, all!

Thanks Sweetjane!
Well said about the rest. Don't forget the massive amount of children here and growing daily. We have a baby born just about every day. Also, as you said, with the older generation retiring here we are going to see more strokes and heart attacks.
Inplub, yes, I'm sure security for the ER unit will be a must especially at night.

Thank you Natalie ( and Happy Birthday). You have helped me clarify something that has been disturbing me.
It seems that we are really talking about 2 levels of emergency. First is sudden heart attack or traumatic injury and need for ACERS (226-3231), crash cart, ER room, on call system, and immediate transport
The second is a growing need for crisis care, treatment, and transport including diabetic care, baby deliveries, and other medical states that may require immediate treatment. This may pose the need for intense support of the polyclinic to better meet these needs.
The question is who are the services provided for and who pays for it. Doe the energy go towards the first , the second or both.

Pam, you have asked this before. There is NO "target population" when it come to providing emergency medical care. When a person or child is experiencing a life threatening emergency then they should receive life saving treatment whether they are white, black, brown, young, old, resident, visitor, rich or poor.

That is the answer to your "who gets treated" question.

That big unanswered question who will provide the needed long term funding?

The answer to that question remains unclear but I suspect that the local government, Lions club, SPBA, BTB, local citizens and tourists will all need to contribute to some extent in order for this to be viable long term.

I pesronally favor a mandantory "Ambergris Caye entry fee" collected by the air carriers and boat ferries for each person entering the island whether they are a resident or a visitor. This fee could be as little as 50 cents per person to adequately fund a 24/7 ER.

I don't think an extra 50 cents per person will keep any visitors from coming to AC and I don't think it will overly burden any locals who can also afford to fly or boat to / from the island.

I keep asking it because it needs a realistic not idealistic answer.

Pam, answers will be forthcoming once the logistics of the plan have been analyzed.

Whatever plan ends up going into effect will not occur overnight - this project will take months to be planned and then funded.

Until then please know that your concerns have been noted.

Life saving treatment only for those who can pay?


This topic seems to keep drifting into a discussion of an "after hours clinic" topic. What this effort is all about is timely and appropriate treatment of life threatening conditions. Not treatment of clinic type illness.

Treating everyone who is experiencing a true life threatening situation in a timely and appropriate fashion is NOT idealistic. It is a very realistic and needed goal.

Expecting to cover these expenses with donations or an optional contribution system I think may be idealistic.

Also Pam,

So that you are clear on my realistic views on this topic, you should know that I am in private practice. I own my own clinic and equipment. No one pays me a salary, I get what ever is left over after all my expenses are paid.

I see patients of all ages, skin colors, religions and financial ranges. Yes, I expect payment for my services. No, not all patients are able to pay in full. Occasionally a patient will present to me or our local hospital and get admitted to me when they already owe money and likely have no intention of paying. When that occurs the patient still receives the care they need from me and the hospital. I personally will likely never see a dime in that situation. That is the reality of providing medical care here in the US.

Yes, it is unfair that some pay while others have no means to pay or worse no intention of paying for their medical care. Here in my clinic with a non-life threatening condition I have the option to refuse to continue the relationship. At the hospital I don't have that option regardless of money owed I'm obligated to provide the care needed in that more urgent setting.

My patients that have insurance and or pay their medical bills make up for the ones who don't. Is that fair? NO.

Life is not fair.

On San Pedro everyone should have access to life saving emergency medical care that is provided in a timely and organized fashion in order to achieve the best possible outcome. Everyone who receives care should pay for that care. Some will be able to pay and will pay. Some will be able to pay over time and will. Some will be able to pay but simply will choose not to pay. And some will be truely poor and unable to pay.

The success of this effort relies upon finding long term stable financing to cover the financial short falls.

This is a very realistic goal.

As Tommy is saying - we are working on an emergency trauma clinic - not an after hours clinic. If people can pay they will, if they can't they will still get care. The idea is to stabilize the patients so that they can be transferred to the mainland.

When I worked at the GOB clinic which is now the Polyclinic, there was no fee for services but a donation was welcomed. I think it is the same today.

Hi Natalie - Happy Birthday Gal.

Yes the poly clinic still runs that way. When I take the kids in for the vaccinations I am asked for a donation.

Can anyone clarify this for me:

Are the on call government doctors paid by the GOB when they are on call?

Are there currently any nurses or admins at the poly clinic?

what are the current hours of operation at the clinic?

Based on what I have read the Poly clinic is owned by the Lions is that correct?

Nurse Natalie, Happy Birthday. Are you legally able to work in the medical field here in Belize?

Is anyone on this board an Emergency or trauma doctor or whatever it is called?

Is anyone on this board a paramedic?

Thanks for the assistance but I would like a little information.

A few more questions:

is anyone qualified to do paramedic training on this board?

What is the length of time needed to do this training and become a certified paramedic (if there is such a thing)?

Is there ongoing training that needs to be done to retain the certification?

Thanks again.

travelinman1 - i am send you an email regarding your questions above.

I am sure that B N U has misunderstood my concern. I doubt that anyone who knows me here would assume that I have concerns about subsidizing care for those that can not afford it. Of course everyone should get equal care. Having said that, I work throughout Belize City and that, in fact, is not a given. And i think it is important to be really clear that everyone will get equal treatment in order to get everyone involved. So kudos for those working towards this.

TravelinMan-I have spent the last 30 years as a FF/EMT. The department I work for has two paramedics on each pumper.

Here in the US a paramedic takes a National Registry test and usaully a State and County test. Each paramedic from State to State has a completely different set of protocols(rules) to follow. There is a strict continuing education guidline and recertification process every two years in most States. Also, a paramedic can't just use any drug or do certain procedures without contacting a base station MICN for orders.

Starting a paramedic program in Belize would take a very long time. There has to be certain laws in place to protect the care giver, the patient and the agency providing service. Then there is the issue of protocols, training, funding, etc. Paramedic school is a mix of college courses in anatomy, biology etc. to the actual paramedic school covering a huge array of items. Then there is in hospital training and then 20-30 shifts in the field with a precipter. It's usually a 1-2 year process to train a paramedic.

I think a proper EMT course given to island residents so inclined, and using the existing medical pros on the island is the better start. I have discussed a paramedic program with Dr. Tina many times. I'm sure in the future a paramedic program/EMT program/ER will all be a reality. There are WAY, WAY too many great medical people, visitors and residents concerned enough to make it happen.

And you doctors weigh in if I missed something on the paramedic issues.

from the Chamber of Commerce.....

Representatives from the Lion’s Club discussed the Poly Clinic. They initiated the project and the government help fund it and the building. Visiting doctors have donated all the equipment plus some that was sent to the mainland to be better utilized.

The government provides 2 doctors, 1 dentist and 4 nurses based on the population of the island, which to their understanding is 8000 people (in actuality, the population is more like 10,000-20,000 plus Dr. Lala’s yearly guest accommodations count shows that over 700 units have been added since 2005 and there are 600 units presently under construction, not including the South Beach development.) So the need for more care and better emergency care is growing.

Monthly meetings of the Board of Directors have not been held since November of 2008. Dr Edwards at Central Health is the Chairman of the Board. This has held up progress in solving some of the problems the clinic is experiencing.

One problem stated by the government is the need for affordable housing for doctors and nurses assigned to Ambergris Caye. The government has said they would build the housing unit if property was located. The Lion’s Club has looked into the availability of nearby properties, but without knowing how much they can offer for the properties, they are not able to determine if any would be available. The upper floor of the clinic could also be converted into housing. A definite plan has not been pursued yet.

It was suggested that the Poly Clinic be set up and staffed as the Emergency Care center for the island, with all the equipment, drugs and inventory required to care for emergency cases all in one place. Part of the problem now is that the doctors can not bring all the equipment necessary to treat every emergency to every call, therefore, there are often delays in getting the proper care to patients.

The Lion’s Club agrees that this is a good idea. The doctors and all inventory at the clinic is computerized and a dedicated volunteer at the clinic keeps all the rooms stocked with supplies. Originally, the clinic was supposed to be staffed 24 hours a day but the funding is not available to do that. The staff doctor for the old Lion’s Club Clinic lived upstairs so was always available for emergencies. The current staff of just 2 doctors is inadequate for 24 hour, on call, emergency duty. They are exhausted.

An ACCC member noted that a private doctor they know would be willing to volunteer to be on call for emergencies. The Lion’s Club would be more than willing to have private doctors help in this area.

The Lion’s Club also noted that there is a need for 24 hour security at the clinic. When doctors attend an emergency cases, especially at night, often there are many family members and friends of the victim that crowd into the room making it difficult to treat the patient.

It was nice meeting everyone and very kind of Amanda to chair the meeting and do the follow up. This is a complicated issue and it won't be solved overnight. However, with patience, perseverence and common sense we might just pull this off. Thank you, Amanda!

My 2 cents.

As a tourist with 8 trips down since 2005, twice spending 30 days +, we have had to seek medical care 4 times. In each case we were fortunate that the need was not an after hours, life threatening issue. (and the care was excellant!)

That being said, as a tourist I would be happy to pay a fee as part of my transportation to the Island. To me 1,2 even 5 dollars a day would be cheap "insurance" to know that 24hr emergency care is available.

A Larger tourist fee would also help with the payment issues mentioned by Dr Blackledge and ensure that the emergency care is available to all comers.

Martin, thanks for your encouragement and continued support of the project.

Hey everyone, many of you may or may not know me. I'm the president of the Canadian Charity Bandage International that Dr Gillis who posted on this link several times is part of. I will be in San Pedro next week for a few days offering the training you may have read about. I would love to sit down with all of you or as many of you that maybe available to meet about our plans and ideas as well as putting some names to faces. I'm avail to meet Sunday (May 10th), Monday (may 11th)and tuesday May 12th after 4pm as we are teaching both days. Or i can make Wed morning work. what are your thoughts? Amanda maybe you can put something together?

Darryl

Hi Darryl

I should be signed up for the course so I will be seeing you on monday and tuesday for sure. Let me see how the week pans out and I can contact you via email if we can get together prior to monday.

Hi Darryl:

I am sorry I won't get a chance to meet you but I am off to Placencia on Thursday and then on the 10th back to Florida. I am sure that Amanda will make good use of your time.