The Interview: January - March 2019

THE

Story on Page 5

INSIDE THE ISSUE •

Turks and Caicos Islands Hospital introduce Cardiology to services profile

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US teleradiology company is contracted to provide specialist radiologist services

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Native doctor appointed as the country's first dedicated Nephrologist

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IHC provides an update on diagnostic imaging post Sept 2017 hurricanes

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Health care staff undergo ACL Risk Management Training

US BOARD CERTIFIED SURGEONS

LIVE ABOVE THE LINES. 1

Call +1 649 941 2800

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TECHNOLOGY

Innovative health care solutions.

InterHealth Canada - Turks and Caicos Islands Hospital has recently introduced an offshore teleradiology service that is expected to further improve patient care by allowing radiologists to provide services from a remote location other than the health care facility.

SERVICE DEVELOPMENT

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THE INTERVIEW

Teleradiology involves the secure transmission of

Teleradiology is particularly important when a sub-

radiological patient images, such as radiographs (X-

specialist such as an MRI radiologist, neuroradiologist,

rays), CTs, and MRIs to a remote location where

pediatric radiologist, or musculoskeletal radiologist is

interpretations are rendered and then returned to the

needed. These professionals are generally only located in

requesting care provider. TCI Hospital’s technology is

large metropolitan areas working during daytime hours.

Health Insurance Portability and Accountability Act (HIPAA) compliant. The processes and technical

The offshore teleradiology service at TCI Hospital is

infrastructure guarantee secure and confidential data

intended to deliver on call coverage Monday through

management.

Friday 10pm to 8am and emergency remote coverage for any unexpected absence of the radiologist such as sudden

The Turks and Caicos Islands Hospital performs in excess

illness or incapacitation. This provides the in-house

of 16,000 diagnostic imaging tests per year. There has

radiologist with on-call relief and strengthens the

been an increase in diagnostic activity consistent with the

hospital’s current operational contingency plan to ensure

overall increase in patient activity. The on call volumes

continuity of services and mitigation of any disruption on

also indicate an increase in utilization over the years. In

patient care. The single radiologist covers the entire

accordance with the staffing strategy outlined in the

Turks and Caicos Islands as there are no consultant

Project Agreement between InterHealth Canada and the

radiologists within the local private health care sector.

Turks and Caicos Islands Government, there is a sole

TCI Hospital is already reliant on a locum radiologist to

consultant radiologist working for Turks and Caicos

conduct over-reads, peer review and cover planned leave

Islands Hospital. The consultant radiologist provides

periods.

reports for all diagnostic imaging data and covers on-call requests for both medical centres 24/7 except for annual

Teleradiology utilizes standard network technologies

leave.

such as the internet, telephone lines, wide area network(WAN), local area network (LAN) and the latest

InterHealth Canada has contracted a Joint Commission

high tech computer clouds. Specialized software is used to

Accredited Teleradiology company based in the United

securely transmit the images from one facility to another

States with a wide variety of specialist radiologists

and enable the radiologist to effectively analyze the

available 24/7. The volume of radiological procedures has

images. Technologies such as advanced graphics

globally outstripped the radiologist population creating a

processing, voice recognition, and image compression are

growing demand for teleradiology services.

also often used in teleradiology.

M&T department members with other trainees and trainers.

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Cardiologist Himanshu Shukla, M.D. (Second Right) with IHC, TCIG and NHIP representatives

Based on statistics, Cardiology and Ophthalmology are the two most frequently required medical services under the Treatment Abroad Program (TAP). Hence, the introduction of on-shore Cardiology services will provide high quality and comprehensive care to patients, which reduces government expenditure and the need for patients to travel abroad.

InterHealth Canada - Turks and Caicos Islands Hospital officially announced the commencement of Cardiology services under the Visiting Consultant Program during a press conference on Friday 8th March 2019. The new development will provide incountry access to Cardiology medical care that was previously only available under the Treatment Abroad Program (TAP).

Under the Visiting Consultant Program, medical expertise from all-over the world in various specialties visit the island on a periodic basis to deliver services in outpatient clinics and operative procedures, which are not permanently available in-country.

Patients who require Cardiology services will be identified by TCI Hospital’s Internal Medicine Physician to ensure the referral is clinically necessary and to promote best use of resources. The service will be delivered on a quarterly basis with clinics ranging from 7-10 days based on patient volumes.

Visiting Consultant Cardiologist, Himanshu Shukla, M.D. will deliver adult cardiology non-invasive programs, specifically, echocardiography rhythm monitoring and consultations at a tertiary care level.

An innovative technology has been introduced under the program as an alternative to the a traditional Holter monitor that measures and records a patient’s heart activity (ECG).

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The stick-on Zio patch empowers patients to maintain a clean, uninterrupted signal with minimal effort or disruption to their lifestyle. The miniature device also gives the assurance of reliable data with a clear and comprehensive look into a patient’s heart rhythm over longer periods for more appropriate diagnosis.

There are also no wires to manage, batteries to charge or leads to reconnect. Cindy Durham, a cardiology patient and nurse at the hospital was used to demonstrate the technology.

Visiting Consultant Cardiologist Himanshu Shukla, M.D.

The inaugural visiting consultant cardiology clinic was held last week with overwhelming positive feedback from patients. Dr. Shukla stressed that the technology is also more customized to the patient population, suitable for local climatic conditions, more cost- effective and has minimal hardware. A portal ultrasound has also been used during the consultant visits, which is another innovative expansion to the hospital’s current capacity.

During the press conference, Dr Shukla also stated that building a cardiology program is advantageous to the country. Based on population demographics and steady growth, persons may experience a cardiology issue at some point. It is an unfortunate, but a realistic statistic. An increase in diabetes and renal healthrelated conditions across the community can precipitate heart related issues for persons. Therefore, appropriate screening, management and counselling for patients early in the process is invaluable. Dr Shukla also believes the transition and growth of the program will be successful in the long-term since the infrastructure and platform has already been provided.

Chief Executive Officer of InterHealth Canada – TCI Hospital, Daniel Carriere stated: “It is great that we can bring this type of talent to the Turks and Caicos Islands. Dr. Shukla’s credentials, experience and qualifications are impeccable and we are very fortunate to have a person of this caliber providing services. This is another example of bringing services close to home, which is always great for the patient and their families. We are always open and willing to work with Ministry of Health - TCI Government in exploring avenues that will ease the burden on government budgets. We recognize that health care is expensive by nature, and anything that the organization can do to lessen the cost and continue to improve services for our patients is something we are interested in doing.”

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Portal Ultrasound Machine and Zio Patch

Chief of Medical Services of InterHealth Canada – TCI Hospital, Dr. Denise Braithwaite-Tennant stated: “Cardiovascular disease is prevalent in the Turks and Caicos Islands. It is very important for us to support primary health care in preventive measures to reduce the impact on secondary and tertiary care interventions. The Zio technology is new to the country, and Dr. Shukla has also graciously funded 10 Zio patches for local patients at the onset. We are very appreciative of health care providers who view their expertise as a means of delivering a philanthropic service, as opposed to strictly focusing on the bottom line. The introduction of pediatric patients to the cardiology program requires the creation of a business case, which is currently under creation. Our next iteration is to include pediatric patients.

Dr. Shukla’s first clinic visit was held on Providenciales due to patient numbers, but this does not eliminate the prospects for future visits to Grand Turk.”

Minister of Health, Agriculture, Sports and Human Services, Honorable Edwin Astwood stated: “The launch of the program is very pleasing to all of us. We have heard that Cardiac and Heart Disease are the number one complaint in the Turks and Caicos Islands. To be able to better monitor and control these diseases can go a far way in dealing with the local population… It was also fitting to see the process that is taking place, whereby we are moving one step closer to the ideal situation that we envisioned this facility to be. The introduction of the program is very commendable as we are moving in the right direction. We are extremely happy to see this state-of-the-art technology being introduced in the Turks and Caicos Islands...”

TCI Government (TCIG) Acting Contract Performance Manager, Florinda Talbot delivered remarks on behalf of the Government’s Contract Management Unit, which oversees the partnership agreement between TCIG and InterHealth Canada. Talbot stated that the introduction of cardiology services supports both standards and service development of the hospital.

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THE INTERVIEW

Interim Chief Executive Officer of the National Health Insurance Board, Dr Terese Maitland stated:” To date the majority of patients who require cardiology tests and procedures, ranging from non-urgent to life-threatening emergencies, are treated outside of the TCI under the auspices of the Treatment Abroad Program, which is managed by the National Health Insurance Plan. Indeed, cardiology-related referrals, rank second in the total number and accounts for approximately 12% of treatment abroad referrals and a substantially larger percentage in terms of cost. Today officially marks the on-boarding of some of these services. This is expected to provide TCI residents with in country access to a broader range of cardiology related medical procedures…NHIP is excited about this endeavor, which is anticipated to be more accessible to a broader cross-section of our valuable clients and beneficiaries, facilitate prevention and early detection whilst simultaneously being cost effective and allowing us to stretch our health care dollars...”

NEWS

TCI HOSPITAL PURSUES ACCREDITATION TO OFFER MEDICAL INTERNSHIPS The internship program seeks to cover four of the major disciplines.

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...creating a pipeline of talent The hospital has acquired three successive Diamond rankings

by Accreditation Canada International in 2012, 2015 and 2018. The findings of the recent internship on-site assessment will be reviewed in the next UWI Accreditation Committee meeting in April or March 2019 and later released.

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NATIVE DOCTOR APPOINTED AS COUNTRY'S FIRST DEDICATED NEPHROLOGIST CKD is defined as abnormalities of kidney structure or function, present for more than 3 months with health implications. Over 90% of kidney failure in the Turks and Caicos Islands is caused by diabetes or hypertension. Most diabetes and hypertension can be prevented through healthy lifestyles. CKD is irreversible and tends to be progressive.

InterHealth Canada – Turks and Caicos Islands Hospital is pleased to announce the appointment of Grand Turk Native, Doctor Vancelee Forbes as the country’s first full-time Nephrologist.

Dr Forbes is specialized in renal and general internal medicine and has served across both medical disciplines at the health care facility since 2014. In recent years, she adopted a part-time Nephrology Consultant role. The introduction of a dedicated Nephrologist is a strategic initiative facilitated by InterHealth Canada in partnership with TCI Government, to strengthen the prevention and management of Chronic Kidney Disease (CKD).

The last stage of CKD is kidney failure. Once a person develops kidney failure, he/she will require renal replacement therapy in order to survive. Three renal replacement therapies are currently available. These are renal transplantation, haemodialysis and peritoneal dialysis.

The number of patients diagnosed with the condition has increased over the years. In order to further enhance the quality of care and mitigate these trends, the private health care management company submitted a multifaceted, evidence-based proposal to TCI Government requesting support to develop the renal service.

A stakeholder meeting was held on Wednesday, February 13th 2019 with dialysis patients and other health care stakeholders.

The meeting was well-received and patients expressed optimism about the future strategic advancement of renal services and transplantation opportunities. Dr. Forbes outlined the process and challenges encountered with the current renal transplantation program and potential solutions, which require a multisectoral approach.

Dr Forbes also announced the development of a Peritoneal Dialysis program, which is a homebased form of renal replacement treatment for interested and eligible patients. The treatment option will be covered under the National Health Insurance Plan. Nearly 50 patients are currently required to visit the country’s Outpatient haemodialysis Centres at TCI Hospital as frequent as three-times per week to undergo lifesaving treatment for kidney disease.

Dr. Vancelee Forbes 12

The first haemodialysis unit was opened in Grand Turk to accommodate six patients in 1995 followed by a second unit on Providenciales in 2006.

InterHealth Canada assumed the management of the country’s renal services in 2010 with two modern outpatient haemodialysis units across both islands.Â

There were 25 patients undergoing dialysis treatment upon the commencement of services in 2010, and the number of patients has since doubled.

Dr Forbes is the daughter of Mr Darius Forbes and Retired Chief Nursing Officer, Pastor Mary Forbes who pioneered the development of the renal services within the Turks and Caicos Islands over two decades ago.

Cheshire Hall Medical Centre

THE INTERVIEW

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Overview of Diagnostic Imaging Services Post 2017 Hurricanes

All of these conditions, when combined have led to premature component failure, significant increase in downtime and potentially shortened the expected lifecycle of the diagnostic imaging equipment.”

INTERIM CORRECTIVE MEASURES

Similar to other major service providers across the country, InterHealth Canada - Turks and Caicos Islands Hospital received significant damages during the hurricanes in September 2017. These included latent damages to the electrical circuitry of medical equipment that only became apparent over time. The total cost of repairing the damages to the hospital’s physical infrastructure and medical equipment is estimated to be USD$16 million.

Biomedical Engineers employed at the facility assisted by overseas specialists worked assiduously to resolve any emerging technical issues. To date, all diagnostic imaging machines are fully operational. The intermittent downtime experienced in previous months with CT and Mammography machines were minimal. The MRI machine was operational, but with limitations on the type of radiological scans that could be performed at the time.

The majority of the equipment in the hospital is highly sophisticated and extremely sensitive. The environment of CT, MRI and Mammography machines require tight control over temperature and humidity. An independent review of the Diagnostic Imaging infrastructure at Cheshire Hall Medical Centre was conducted by XRCT Limited, a physics consulting company based in Ontario.

“Despite the high temperatures and lack of humidity control present in the facility, the records show the hospital continued to make every effort to operate the equipment under these extreme conditions in the interest of providing vital and medically necessary patient care,” stated XRCT Consultants in an official report.

These efforts sought to ensure the continuity of high-quality care and to minimize the number of patients who require treatment abroad. Patients were categorized based on clinical priority and the equipment up-times were maximized by increasing the volume of radiological scans performed per day.

The report stated: “In the wake of the storms, the lack of air conditioning lead to ambient air temperature and humidity conditions within the facility that were outside of the manufacturer requirements. This created a severely hazardous environment for electronic components. In addition, the restoration of power to the island created multiple daily power outages, surges and brownouts.

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THE COMMUNICATION PROCESS

THE MAINTENANCE PROCESS CT, MRI and Mammography machines generate significant heat while in use and at rest. Therefore, operating temperatures within these areas are closely monitored, checked and reviewed regularly to ensure temperature and humidity is within the guidelines established by the manufacturer.

Any changes in these precise specifications can create the risk of overheating and damage to internal components. Monitoring the relative humidity of MRI rooms is also crucial to avoid the risk of moisture damage to very delicate electronic components such as electronic expansion boards, cables, and connectors.

XRCT Limited also performed an extensive review of the service records for the Diagnostic Imaging department and stated: “Over the months/years preceding the storms in 2017, the service history for all the equipment was excellent. In fact, with the exception of a few random downtime events and planned maintenance, the uptime of all clinical systems was quite good, in excess of 99%.” Based on these expert findings, the technical issues experienced over previous months were evidently not attributed to inefficiencies in the maintenance or management processes established by InterHealth Canada, but were connected to acts of nature, beyond human control.

InterHealth Canada has continued to abide by the terms of the Project Agreement and meet the extensive reporting and service standards detailed in the contract. As partners in health care, InterHealth Canada is contractually mandated to submit monthly reports to the Turks and Caicos Islands Government (TCIG) related to over 48 clinical key performance indicators, including Diagnostic Imaging services. These key performance indicators seek to demonstrate how effectively the management company is achieving pre-established targets. InterHealth Canada fully supports and complies with these accountability mechanisms.

The TCI Government via the Contract Management Unit has been kept informed, at all times, where services have required expansion or, where challenges such as the 2017 hurricanes have caused damage to equipment, resulting in some delays to services. Representatives of TCI Government’s Contract Management Unit and Fortis TCI also conducted a physical inspection of the UPS and surge protectors in the Diagnostic Imaging Department.

THE LIFE CYCLE PROGRAM Managing the lifecycle of medical equipment from planning to purchase, installation, operation all the way through decommissioning and disposal helps medical institutions improve operational efficiency, enhance quality and reduce service-related cost.

The purchase of capital equipment is covered under a life-cycle program, which is a reserve fund established under the contract between TCI Government and InterHealth Canada for equipment replacement. The decision to purchase equipment involves several key considerations. These include: Equipment Specifications and Suitability, Procurement and Logistics, Available Financial Resources, Prospects for Maintenance, Repair and Life expectancy InterHealth Canada has filed a short term and long-term recovery plan with TCI Government and are actively considering replacement possibilities for key modalities in diagnostic imaging. Negotiations are also underway with the insurance companies relative to the damages ensued..

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NATIVE RADIOGRAPHERS APPOINTED TO TCI HOSPITAL

Recently employed Radiographers, Latavia Ingham (L) and Andresha Gardiner (R)

duo of trainee radiographers who conducted observerships at InterHealth Canada - Turks and Caicos Islands Hospital over recent years have returned to fulltime employment with the institution.

Latavia Ingham and Andresha Gardiner are the latest TCI citizens to be added to a specialist area of health care and have simultaneously filled a longstanding skills gap in the domestic labor market.

Both radiographers graduated from the University of the West Indies, Mona Campus in Jamaica with a Bachelor of Science in Diagnostic Imaging with Radiography in 2018.

Ingham also holds a Bachelor of Science in Diagnostic Ultrasound Technology from Barry University.

The duo conducted integrated clinical rotations across various hospitals in Jamaica to acquire the required practical experience of diagnostic imaging equipment, system and processes.

Diagnostic Imaging Manager at TCI Hospital, Sandy Burgess expressed excitement about their return and the opportunity to utilize their competency, energy and enthusiasm to enhance radiological services in the local community alongside the existing team.

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Commenting on the appointment, Chief of Allied Services, Eleanor Hall said: “It is such a pleasure to welcome both radiographers who were mentored by us during their training, and are therefore very familiar with the work processes and personnel in the department.”

She continued: “As they begin their professional life in this organization, the opportunities ahead for further training and experience can only enhance and increase their skills in the various modalities available within the department.”

RISK MANAGEMENT

Health Care Practitioners undergo ACL Risk Management Training The sessions were also designed to equip participants with practical techniques, skills and strategies for effective use of risk management tools, developing a risk management plan to respond to identified risks, evaluating the effectiveness of the risk management plans, and integrating risk management plans with other organizational plans and frameworks.

A two-day interactive workshop facilitated by Accreditation Canada representatives was held on February 19th, 2019 at Turks and Caicos Islands Hospital, which targeted health care professionals in leadership and management roles who are responsible for identifying and mitigating risk in the organisation. The training also covered peoplecentred care and improving safety in facilities management.

Health care teams practiced and applied the presented techniques, skills and strategies by analysing case studies and examples. The agenda topics included:

The audience included senior and middle management, quality improvement team leaders and clinicians in both formal and informal leadership roles in the organisation. The training provided participants with guidance on evaluating risks for health care organisations and its link to the HSO standards, defining different types of risk, creating an accurate map of risks, and preparing risk response strategies. HSO stands for Health Standards Organisation.

- Risk in Complex Health Care Organisations - Conducting Root Cause Analysis - Incident Reporting System - Prospective Analysis - Sector Specific and Functional Risks - ERM Infrastructure - When Things Go Wrong 17

NEWS

THE INTERVIEW

REFRESH

Level 2 and 3 Certification in Food Hygiene and Safety Catering

Employees of Refresh, the catering division of the hospital have acquired a Level 2 and 3 Certification in Food Hygiene and Safety based on UK and EU standards. InterHealth Canada - Turks and Caicos Islands Hospital has a responsibility to provide the highest level of care possible for their patients and this, without question, includes the quality and nutritional value of the food that is provided. InterHealth Canada Construction and Services division are ultimately responsible for ensuring that patients have a positive experience during their stay, which includes their dietary and nutritional requirements.

Congratulations!

All Catering staff receive regular training to ensure they have the skills, qualifications and competencies required to achieve the highest standards in Food Hygiene and Food Safety which include the control of food safety hazards, temperatures, safe storage of goods, food preparation, personal hygiene and premises cleaning. Staff are also fully compliant with the current Food Hygiene Legislation. The picture shows the Catering team based at Cheshire Hall Medical Centre with certificates for their successful completion of Level 2 and Level 3 Basic Food Hygiene.

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Building

building healthy communities

HEALTH BOOTHS

"Right time...Right patient...

Right drug...Right Dose...Right Route."

InterHealth Canada doctors and other clinicians held an information booth on February 23rd 2019 outside an actively traversed grocery store on Grand Turk to offer on-the-spot advice and raise awareness of medication reconciliation.

Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician’s admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital.

Persons within the local community were encouraged to keep the most accurate list possible of all medications, especially during transfers across different health care settings. This information helps to improve various important aspects of care transitions and patient safety.

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TAKE CARE OF YOUR BODY. IT’S THE ONLY PLACE YOU HAVE TO LIVE.

"PERFECT FOR PARTIES AND CELEBRATIONS"

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ECPS Career's Day

Building

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Health care professionals from various departments at TCI Hospital participated in the Enid Capron Primary School Career's Day on Thursday 7th February 2019.  The educational booth featured an array of real surgical instruments, point of care devices, on-the-spot blood group testing with teachers, nutrition and dietetics. 21

These demonstrations provided students with a captivating visual of some of the tasks associated with the various medical professions.

BECOMING JOB READY The Human Resources Department at TCI Hospital participated in the H. J. Robinson High School annual Exit Readiness Exercise for 5th form students under the theme, “Laying a Strong Foundation for my future” on Wednesday February 20th.

Science Projects on Display

IHC Deputy Human Resources Manager, Tavardo Reasias and Human Resources Officer, Vernessa Forbes engaged in a series of activities to prepare students for the world of work and offered guidance on their career pursuits in health care. The session featured mock interview sessions with students to evaluate their performance and provide feedback on areas for improvement so they can better prepare themselves for future interviews.

IHC Representatives with students

Representatives of InterHealth Canada - TCI Hospital attended the Holy Family Academy Roman Catholic School to serve as judges and support a team of eleventh grade students in the school's science fair. The project focused on Antimicrobial Resistance: A Cause for Global Concern.

The science projects on display reflected the creativity and critical thinking of students in the sciences, and proposed practical interventions. Our Education Manager, Quality Risk and Patient Safety Manger and Senior Infection Prevention and Control Nurse were in attendance.

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THE • INTERVIEW

Students from Providenciales Middle School conducted a tour of the laboratory at Cheshire Hall Medical Centre in February.

Medical Technologists at the hospital were excited to provide the curious minds with a behind-the-scenes look at the department's critical role in the patient treatment process. The year 7 students wanted to apply their biology lessons to a real-life-scenario. Here is an excerpt from their blog: "We were treated to an exceptional all-access visit to the histopathology and micro-biology labs at the hospital on Provo. Children learned how doctors receive tissue samples from all patients who undergo any surgical procedures in order to confirm diagnoses or test the outcomes of previous care.

Everything from human organs to skin and other tissue is tested and prepared for study under the microscope in the histopathology labs. The work done in this lab not only helps to save lives, by identifying the cause of illnesses on a cellular level, but could also be used to explain how or why a person may have died."

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Care packages were delivered to Cheshire Hall Medical Centre to observe International Women's Day 2019.

International Women's Day (IWD) is celebrated on March 8th every year and the recognition of women continued on March 9th. The Soroptimist International Club of Providenciales visited the Cheshire Hall Medical Centre to donate surprise infant care items to expectant and new mothers on the maternity unit.Â

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General Practitioner, Dr Dionne Lightbourne (Top Left) conducted an interview with PTV News on the signs, symptoms, treatment and prevention of Dengue Fever.

Oncology Nurse Specialist, Gemma Watson (Bottom Left) participated in a radio show on RTC 89.1 FM Health Matters, along with National Cancer Society President, Rosemary Jolly to discuss the topic of cancer on World Cancer Day. Dr Vancelee Forbes (Bottom Right) participated in an interview with PTV News inside the Healing Garden to raise awareness of kidney disease and discuss her recent appointment as the country's first full-time Nephrologist.

InterHealth Canada physicians participate in various health promotion activities every quarter to educate the community on various ailments.

Reg Warren and his wife Debbie visited the Turks and Caicos Islands Hospital during their recent vacation to express gratitude to the medical team for the care received during a previous encounter.

Reg was rushed to the emergency department on February 1st 2018 after a freak kiteboarding accident on Long Bay Beach, which caused a fracture and massive laceration across his face.

The injury required surgical intervention and several dozen stitches due to the size. Reg and his wife were grateful for the level of care received at Cheshire Hall Medical Centre, which provided a good foundation for multiple subsequent and successful overseas facial plastic surgeries. The couple delivered a surprise donation of $1000 towards a care package initiative for inpatients at the facility.

Reg and Debbie (centre) with hospital managers

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Sassy

Promotions

New Lead Nurses

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It's a girl!

The Interview

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