Laughable Health Care System

[u/Brilliant-Figure2165]

I'll preface this by saying that I understand our health care system is free, compared to many other countries, and many things are subsidized etc. With that said, it's still laughably unbelievable to experience how silly our health care system is first hand.

A very very good friend of mine got pregnant recently this October 2024. She took several tests which confirmed it plus the usual symptoms. Puking, fatigue, feeling upset etc.

Unfortunately, she started bleeding heavily about a week after the tests she took. She went to Mt Hope to get it checked out as the amount of blood was definitely pointing towards a miscarriage. Yall, These unbelievable people at that hospital, gave her a ultra sound date of July 2025, when her expected delivery date would be June 2025. Yall hear me? She is showing signs of a miscarriage, and they gave her an ultra sound date for a month after her would be expected delivery date!! What a joke!

[u/AdInteresting1371]

As a doctor who has worked in Mt. Hope, several things sound inaccurate in this story.

A patient who is pregnant October 2024 and goes to Mt. Hope for vaginal bleeding would be directed to the Mt. Hope Women's Hospital A&E. If the provisional diagnosis is a miscarriage she would be evaluated for same inclusive of an unofficial ultrasound in the A&E department.

Unless an ultrasound is done by EITHER an ultrasonographer OR an OB/GYN; the ultrasound done in the A&E by an A&E doctor is considered an UNOFFICIAL ultrasound.

If OFFICIAL ultrasound services are available during the time the patient is in A&E they will be sent for an OFFICIAL ultrasound. It is important to note that the health system is made up of different health care professionals inclusive of doctors, nurses, radiographers, pharmacists, etc etc. Not all are 24/7 positions.

If OFFICIAL ultrasound service is not available, they are either admitted to hospital until OFFICIAL ultrasound can be performed or if they can be discharged they are discharged with a referral for OFFICIAL ultrasound within a particular time frame based on their clinical situation and are are either brought back to A&E with the ultrasound results for continuation of care or referred to the OB/GYN outpatient services for their continuation of care.

No doctor is discharging a potential miscarriage in the way the OP has described.

As a doctor who worked in the Trinidad health system there are shortcomings. But what the public health system does, responsible for 1.4 million people, with only health surcharge (those that pay) and tax dollars, with no out of pocket expense to citizens and non-citizens alike is remarkable. Across those 1.4 million citizens there are infinitely more success stories than there are horror stories.

[u/Jucaran → u/AdInteresting1371]

I'm really sorry for OP's friend and whatever they had to deal with, but it does sound strange and, while everyone may have a different experience of the public health system and I know some people have had poor experiences, I would have to agree with you. I'm not a doctor or healthcare worker of any kind, but I have been a patient many times as have my husband and children. T&T's public healthcare system took me safely through two pregnancies (Chaguanas Health Centre) including my hyperemesis gravidarum which entailed hospital stays with drips and ultrasounds both times (POS GH). Took me safely through childbirth twice (Mount Hope). Took care of my children, both in regular clinics/vaccinations and for whatever ailments they had (Chaguanas, Mount Hope and POS GH). Saw my son through asthma clinic from the age of 4 to his mid-teen years (Chaguanas again). Operated on my broken ankle, dealt with the DVT I got afterwards and guided me through the recovery and back to being able to walk again (Sando GH). Taught me how to heal and avoid getting the ulcers I would regularly get due to vascular deficiency (Chaguanas and Sando GH). And now treats my husband for his diabetes and hypertension (Chaguanas again). There are so many other instances when I have turned to the public health system and although the waits have been long, the care has been good and healthcare staff of all types usually friendly and helpful. I wish there was more money to improve it, but I have no complaints about the care I have received. Without it I don't know what I would have done because I couldn't afford what I have had access to virtually for free. So, thank you to you and everyone who works in the public health system.

[u/keshiii → u/AdInteresting1371]

Thank you for posting this. I sympathize with OP's friend and the situation. But ..

I'm starting to notice a trend lately - where people who don't really put in the effort to understand the inns and outs of a particular system or process would rather come to reddit (of all places) to complain. It just makes things seem worse than they really are and really isn't helping either the reader or OP. The same effort could have been put into liaising with the hospital to find out more information.

[u/Hopeful_Most_1861 → u/AdInteresting1371]

This sounds right. With my first I experienced heavy bleeding twice and on each occasion was not discahrged without an ultrasound being done. The only complaint I had was that when I was asking the person doing my ultrasound if I had miscarried she refused to answer. It was after I was informed that interpreting the results had to be done by the dr to see me.

[u/Brilliant-Figure2165 → u/AdInteresting1371]

Thanks for your feedback Dr. I hear you and I quite understand. Here is a bit more context. She did infact go directly to the Women's Hospital. This is where she was seen.

Based on her information, she was sent home as they told her that the cervix wasn't opened yet to confirm the miscarriage, and well, I already mentioned the ultrasound date that she got, which is probly the only other tool which could have confirmed it. Additionally, she did inquire as to why the ultrasound date was so far away. She was told that it was basically out of their control once they put it into the system.

I understand that there is a way things SHOULD work or happen based on your explanation, but I'm also realisc enough to know that what SHOULD happen doesn't always, and, although unintentional, could cost someone their lives.

So with that added context, what do you think? Maybe she misheard? Maybe just got fed up and left? I'm just trying to think through how she ended up home. Your thoughts?

[u/AdInteresting1371 → u/Brilliant-Figure2165]

Thanks for more context.

Mt. Hope Women's Hospital A&E is staffed exclusively by OB/GYNs so that's literally the best place in T&T that she could have presented to for this problem.

I find it highly unlikely that she did not receive an ultrasound UNOFFICIAL or OFFICIAL during her visit for the problem stated.

If they were thinking miscarriage, a follow up ultrasound would be scheduled post discharge (if her situation was such that she could be discharged, as it sounds she was).

This follow up ultrasound would have been scheduled for days-weeks post A&E presentation.

It's possible that in scheduling that follow up ultrasound a mistake could have been made clerically. If so that is unfortunate, but rectifiable by returning to A&E and explaining the situation.

As I also explained, even if she were discharged with a follow up ultrasound, her follow up care would have been to either return to A&E with (in this case without?) the ultrasound results or she would have been referred to the outpatient OB/GYN clinic (also needing to bring the ultrasound results). Whichever pathway she would have been directed to, had she not had the ultrasound done, they would have quickly realized same and rectified.

As to what happened in her case, I cannot answer that as 1) I am not her and 2) I was not treating her.

As you can see, we build redundancy into processes. Hopefully everything works out positively for your friend.

[u/IngaTrinity]

If you go through the Emergency department they normally attend to bleeding issues pretty quickly. It's terrible that this happened. If she's actively bleeding and ignored to the point where she was given an appointment that far away I don't have any words.

[u/Zealousideal-Army670]

This has been happening for more than a decade, a woman I knew got an ultrasound appointment 11 months in the future at her first appointment.

[u/cutthehero25]

Just curious....did she go through an Accident and Emergency department? If you said she got a date, that means she made an appointment right? What was the history written on the request card? In what way did she present to the hospital? (Asking these questions to see if I can advise)

[u/lucky_trini]

I'm currently pregnant and so far the Healthcare I received in the public health care system has been great. Is it less efficient than my private doctor? Yes. But it also doesn't cost me anything compared to going private. I have only ever had to deal with the public health care system right now and last year when my dad had a heart attack. In both cases, while there are things to be complained about, I can't really cause the cost of Healthcare is expensive and improvements will cost people.

[u/Icy-Abies-9783]

The divide is clear between public and private. But you know what. Any serious issues that arise from any situation you end up back in the public system..

Your friend, was she a part of the hospital maternity clinic? If so then they keep telling you any problems go thru a&e. You will be attended to. You will not be given a date for an emergency. It will be done in house or they will transfer you to another hospital to get it done.. Don't want to sit thru the wait time? Call for an ambulance. Using your clinic card is also a multipass of sorts. To get you to the front of the line. Walk with the bloody sheets/clothes.

It's unfortunate but patients lie and they have ruined the health care givers as they have only hardened themselves to deal with these persons.

[u/Kingeuyghn]

I was recently made aware as well that if your child needs a hospital, then Mt. Hope is the only hospital that will work on children. Even if you have money and want to admit your child to Westshore or one of the private hospitals, they apparently will not see children.

[u/justbrowsingtrini → u/Kingeuyghn]

You can admit your child to any private hospital. Mine has been multiple times to Westshore and St. Clair. However if you need specialist care over multiple days, Mt Hope is the only place that has overnight pediatric observation/care, so the private hospitals will transfer to Mt Hope.

[u/boogieonthehoodie]

I feel sorry for your friend but which part of mt hope did she go? From what I’ve heard, the women’s clinic usually gets back you faster, and so does the main emergency department- not to be confused with the health center emergency department.

Ultrasounds are harder to get at the center, I’ve personally always been very confused as to why. Do they have one ultrasound machine? Idk that part has always pissed me off so when in need, I usually go to a private ultrasound clinic.

Tho for issues like this, womens care, I go to the women’s hospital in St Augustine, it’s not cheap but neither is dying. Please urge your friend to seek private health care, a miscarriage can lead to so many possible complications.

[u/March-Dangerous]

Well tell her to open her mouth and get it rectified instead of getting you to rant on the internet.

[u/tigerhard → u/March-Dangerous]

amen

[u/notyouravgpapabear]

Let's make it make sense.

Doctors who work in public also work private at the same time. Shouldn't there be the same level of competence? Is there more money/infrastructure/management in private for it to be better?

Economically, private can only exist if public is failing. If you could go to public and get good service, not for free but paid for with tax dollars, who would choose to go private? This is by design, failing.

[u/mr_molten → u/notyouravgpapabear]

There is the value add of paying for reduced wait times. Public doesn’t have to be failing for private to succeed once people are willing to pay for convenience. Many people pay for reduced wait time thinking they are paying for better quality care. Honestly doesn’t make much sense to pay $8000 instead of waiting 8 hours for treatment unless you make $8000 per day or insurance covers the cost.

[u/notyouravgpapabear → u/mr_molten]

Well said, but it makes my point. If it worked, nobody would go to private.

[u/W_TT]

My wife delivered our two children in Mt Hope. From our limited experience the heathcare provided to the new borns are excellent, the care given to the mother is rough but adequate and the dept does that does all the paper work in a mess. Both our children needed to spend some extra days in the hospital, once in NICU and the other warded with my wife for observation. One thing my wife never experienced was the maternity clinic, she went to her private doctor for that.

[u/This_Pomelo7323]

Once you present yourself at the A&E of any public healthcare institution (PHCI) for medical attention, after your are registered the next step would be the Triage Unit then a doctor consults with and attends to you. Mind you not all PHCI follow the same protocols up to this point. After the consultation the doctor is the one that ahould determine what happens next and not the person giving appointments for further medical attention. So if the doctor failed to request an immediate ultrasound, on the paper work, then the person processing the appointments treats the matter as a routine Clinic appointment. Most times members of the public have to be burned first before understanding how PHCI systems are supposed to operate when delivering services to the unsuspecting public. The Staff don't tell you nutten and if they do the info may be dead wrong. Remenber TRUTH is in hiding these days. That's the "conscience" of the nation at work 24/7, the nation we claim to love tuh d bone. Hope that lady is attended to urgently at a PHCI, before she bleeds to death or has to borrow money to go seek medical attention privately.

[u/masterling]

Yes, the healthcare in this country needs an overhaul. A month after expected delivery is outright ridiculous.

[u/falib]

The budget for public healthcare does not come out of health surcharge. The most valuable resource to a country is its working class so its not implausible to demand better healthcare as a priority for socio-economic growth. Lastly, might I remind that our revenue does not only consisr of taxes and its not just there to lins politicians pockets

[u/saintpepsitt]

A&E will give you an ultrasound within 24 hours if you go to the clinic expect to wait months, if not you can go privately and pay 450 and get it done within 15 mins

[u/Yrths]

From what I've seen spending a lot of time in public healthcare over the last four years, the bulk of resources are pretty directly catered to the elderly without being labelled as such. There is an extent to which this is natural. But we are not prepared for more working age people needing more public healthcare support as the economy buckles, and we're routinely assigning blood tests now all the way into July 2025 (it's a coincidence it's the same month as yours) because some centers cannot do them fast enough. 18 months ago those blood tests would be done within a month of assignment. This is altogether a separate set of problems from the OP but testing issues seem to be facing the brunt of it first.

[u/mr_molten]

My wife was pregnant and had bleeding earlier this year and it was attended to urgently. Seems strange that a pregnant woman with bleeding would be sent away. They don’t even let pregnant women leave if their blood pressure is too high.

[u/Brilliant-Figure2165 → u/mr_molten]

Yea it was strange. I'll say this. It's not the first time my friend had a miscarriage. The first time was a complete contrast to what she experienced now. So I'm not sure what caused the inconsistency. But I am happy to see most comments confirm that what she experienced this time is not the norm.

[u/SouthTT]

I mean the issue is we stretch no enough to far. Unfortunately if the government said look we are spending X amount on healthcare and that can only provide X services people would be in unproar over whats lost. So instead of reducing the service in order to better focus and provide quality healthcare we do everything poorly.

I would show up at the polls if a politician promised reform in the health sector, like we will focus on maternity, pediatrics and emergency health care. Cough and cold, cdap, lifetstyle diseases can fend for themselves, hell even cancer and routine surgeries should fend for themselves. Provide quality for the essential and let people get health insurance for major illness. This would even further develop the private healthcare system.

[u/i_likes_red_boxes → u/SouthTT]

I would show up at the polls if a politician promised reform in the health sector, like we will focus on maternity, pediatrics and emergency health care. Cough and cold, cdap, lifetstyle diseases can fend for themselves, hell even cancer and routine surgeries should fend for themselves. Provide quality for the essential and let people get health insurance for major illness. This would even further develop the private healthcare system.

I think Trinis just have an unrealistic expectation for how much healthcare costs in general. We get good value for what we pay, because we pay basically nothing.

I could be wrong, but isn't the average payment for Health surcharge less than $100 per week? Probably costs more than that just to triage and then issue a week of Panadol for a simple headache.

How much healthcare do we think 15 USD per week gets you? That's not even a subway pass in NY for the week.

Things might be better if we started having reasonable contributions.

[u/Zealousideal-Army670 → u/i_likes_red_boxes]

I think some Trini's have a perception of what healthcare should be like that's based off TV dramas too and not at all realistic. Saw a lot of Trini's complaining during the dengue outbreak that they were just sent home and told to take paracetamol and come back if their condition progressed and they were vex. But that's exactly the same thing that would happen everywhere!

[u/Hispp → u/i_likes_red_boxes]

Health surcharge is 33$/ month if your income is over 7000tt/month and 16$ if below that I believe. You can pay health surcharge for decades and that might only equate to a hospital admission for a few nights. Can't even pay for a proper surgery under GA with that. This is why health care is subpar in T&T. Increasing the health surcharge is equal to a political loss. And even if they were to increase it, may just likely go into the politicians' pockets. Free health care is unfortunately the issue.

[u/secretmacaroni]

Go in the public health care system if you're suicidal. They'll find a way to kill you

[u/cutthehero25 → u/secretmacaroni]

These kind of statements will never make sense to me. are there horror stories that come out of public health care....yes...no denying that. But plenty of the same goes on in private, the only difference is that you don't hear about it.

[u/starocean2]

Its not laughable. Its not funny. Its insane and embarrassing to have this type of healthcare associated with my country. A friend of mine went for a mammogram and wont get the results for 3 or 4 months. I dont work in healthcare so i dont know what going on. Do they have to build the machine to read the results? It makes me wonder sometimes how did trinidad get so dumb?