One of the best things about healthcare delivery in Guyana is that it is nationalized. Care is free and available to every citizen. It is financed and managed through the Ministry of Health working together with regional and local government. There is an independent private sector. However, despite a national health system, there are several gaps in the delivery of health care in Guyana.
Chronic diseases, such are hypertension, diabetes and heart disease, are becoming more prevalent in Guyana and currently there is not an infrastructure in place to help manage this growing problem. Patients are presenting to the emergency department at advanced stages at which time there may not be great treatment options available. Unfortunately the regional health center, which would ideally be the place for primary care, is not very equipped. There is usually just one physician available to staff a large local population and he/she may not be well trained to manage chronic disease. The availability of equipment such as blood pressure cuffs, glucometers, monofilaments, debridement tools for diabetic ulcers are often in limited supply. Lab testing and monitoring are usually not available. The idea of routine screening and preventative medicine is nonexistent. Ancillary staff, if available, is also not well trained.
While most patients living along the coast have access to some sort of health care, whether through regional health centers or the local emergency department, those who live in the interior have little to no access. This is largely because of the sparse population and difficult terrain. The population comprises mostly of indigenous people and miners - in emergency situations, they travel for days to the capital to receive care.
In Guyana, there is very little support for persons with mental health disorders or substance abuse. During my short time in Guyana, there were more than a handful of persons presenting with suicide attempt, often with paraquat, a freely available but deadly herbicide. At a public health level, there needs to be better regulation of who has access to these poisons as this is an easily preventable cause of morbidity and mortality. There is poor education about mental illness among the population as well as among providers. If a patient survives a suicide attempt, he/she is discharged from the hospital without any resources or treatment to address with underlying mental illness. Substance abuse, specifically alcohol, is never addressed. Training providers as well as the development of a psychiatric unit or treatment center will be a small step to help address this growing problem.
One of the largest challenges to health care delivery in Guyana is the lack of an integrated health information system. Medical records are completely on paper and patients’ charts do not go with them throughout their contact with the medical field. The medical record is not used to support decision making. For example, if a patient presents to the ED with hypertensive emergency, a new chart is made up for the admission. Even though the same patient presented a week prior with the same issue, the record is not automatically included and there is no way to use information about their previous treatment to guide treatment decisions now. In addition, the contents that make up the medical record are sometimes sporadic and often incomplete.
There are many areas that need to be built up for the health care system in Guyana to become what it needs to be. There needs to be programs in place for advance training of physicians and compensation and work plans that keep these well trained physicians interested in staying in Guyana. Local health centers need to become the first line for screening and management of chronic diseases. Also, within the public health sector education programs need to be developed that teaches local population about disease, mental illness and a healthy lifestyle.
In Guyana, there appears to be a commitment by the government to improve the overall healthcare delivery system. With the monetary support and partnership with many foreign agencies, Guyana is slowly on its way to delivering the care its people need.