Perspective

Bahamians in denial

More than half of all confirmed COVID-19 deaths in The Bahamas – 31 in total – occurred in the month of August alone, making last month the country’s deadliest on record for the novel coronavirus outbreak.

COVID-19 claimed the lives of 17 women and 14 men last month – 10 of them being in their 50s, three in their 40s and two in their 30s, with the youngest case fatality being a 20-year-old woman.

New Providence recorded 22 of the deaths; Grand Bahama recorded four; and Bimini, the Berry Islands, Abaco, Eluethera and Long Island each recorded a death in August.

Those who have died from COVID-19 in The Bahamas are mothers, fathers, sons and daughters, siblings, relatives and friends.

Others who are fighting for survival or have recovered from the disease, tell of painful symptoms and sickness unlike any they previously experienced, and the burden of COVID-19 on the healthcare system is negatively impacting the timely delivery of care for all other medical conditions.

Yet, there are still many Bahamians who refuse to accept that COVID-19 is a real illness, or that it can be dangerous for people of all ages who have conditions including high blood pressure, diabetes, serious heart conditions, asthma, cancer and obesity.

To put in perspective how many of us suffer from these conditions, Ministry of Health statistics state that almost half of adults in The Bahamas are obese, more than a third are diabetic or pre-diabetic and close to 40 percent have high blood pressure.

Close to half of those who died from COVID-19 in The Bahamas (46 percent) had either high blood pressure or heart disease, 31 percent had diabetes and 11 percent had asthma.

Being in denial about COVID-19 is resulting in exposures to the virus that are avoidable, according to President of the Consultant Physicians Staff Association (CPSA) Dr. Sabriquet Pinder-Butler, who told Perspective that physicians are grappling daily with the effects of patients who refuse to accept the reality of the virus, or the risk it can pose to many in the society.

She acknowledged that culturally, Bahamians have a difficult time accepting the seriousness of disease, and believe that either prayer or home remedies are sufficient responses in the absence of lifestyle changes and compliance with prescription regimens.

“They would prefer to pray it away,” Pinder-Butler said, “or use some sort of bush medicine and bush medicine has its role, but we have to be wise with the other things that we need to do, and that is what is not happening.”

The state of denial, she pointed out, is not unique to the current pandemic.

She offered, “We have a hard time convincing patients that they are diabetic even after they have lost a limb, even after they have dialysis and five people in the family have had these things, they still say, ‘I only have a touch of sugar’ or ‘I’m not claiming this.’”

“Claiming” is a term used in charismatic Christian circles referring to one’s outward acceptance of a circumstance or situation.

The CPSA president, who practices family medicine, pointed out that some patients who test positive for COVID-19 refuse to accept the validity of the test result, while many others refuse to accept that COVID-19 exists, or is more than just a common cold or flu.

“We are having a serious challenge,” she stressed. “I have had Bahamians who live abroad call me because their parents are home ailing and they know that they have COVID-19, and they refuse to get help.

“No matter what is going on, shortness of breath, cannot move, can’t eat, loss of taste, [they say] ‘this is not COVID-19’.”

Notwithstanding monitoring that those who test positive for COVID-19 ought to be undergoing, Pinder-Butler revealed that physicians are continuing to encounter and be advised of patients who are not abiding by isolation guidelines.

She added that she fields calls daily, pleading with individuals to abide by quarantine instructions.

“We still have patients who come and attempt to come to healthcare system knowing they have been exposed or have tested positive for COVID-19, and they are still at the food stores, pharmacies, gas stations, everywhere,” she indicated.

Healthcare workers have died or have been placed in quarantine or isolation due to COVID-19 infection or exposure over the past six months, and a recent occurrence described by Pinder-Butler could explain how some healthcare exposures are happening despite existing protocols.

She advised that a COVID-19-positive patient who was discharged from Doctors Hospital just over a week ago, subsequently presented to one of the island’s clinics.

“We have a screening,” she expounded, “and I’m thinking what is happening is most of them know what the questions are on the screening, so when you ask [the questions] they will tell you no, and then when they get with the doctor – which means they have passed all of the frontline to come in – you find out that this person either has COVID-19 or has symptoms.”

Ministry of Health data points to the home and the workplace as the two leading sources of cluster transmission and exposure for COVID-19 in the second wave.

According to Pinder-Butler, some Bahamians, who are known contacts of a COVID-19-positive case, are refusing to protect their coworkers by staying at home, disclosing a recent phone call she received from a workplace seeking advice about a staffer who refused to remain at home even though a member of the worker’s household was COVID-19-positive.

“Of course some of the other persons who worked there were upset because the person knew, and they came to work,” she said.

“We are understanding that some people who become ill or who die, we can trace where they might have contracted [COVID-19] and they were home, but someone else took it to work, passed it on to someone who lives in the house, and this is what is happening.”

Cultural attitudes about sickness and disease and about COVID-19, have been discussed at the association level, the CPSA president advised, noting that physicians understand the need to take the lead in helping the public understand that COVID-19 is real, and is not a hoax or a myth.

“If we are going to save ourselves, that has to be the biggest thing, that we get our persons to comprehend that it takes us to stop this,” she affirmed.

Healthcare system overwhelmed

Various public health models point to the increasingly detrimental impact of COVID-19 on healthcare systems and the delivery of care for chronic illnesses as waves of outbreaks and the responses that accompany them, persist.

The CPSA president said that while physicians have tried as best as possible to administer telemedicine to those with chronic illnesses during lockdown periods, the volume of people requiring emergent care coupled with manpower losses and diversions due to COVID-19 have impacted the timeliness of patient care.

Pinder-Butler acknowledged, “That had an impact on persons who were in wait of care or wait of appointments that are now starting to pile up, and we are still trying to get them to see physicians so that they don’t end up in the emergency room, so we are having a challenge with that.”

In recent days, reports have surfaced on social media of patients complaining of inadequate care or inordinate wait times for responses from doctors and nurses.

Among them was a Freeport man who claimed his wife died back in August as a result of the impact of COVID-19 on the delivery of healthcare on Grand Bahama.

With respect to current healthcare difficulties, which are an exacerbation of longstanding challenges in the system due to COVID-19, Pinder-Butler stressed that impacts on the timeliness of patient care were not unexpected under the anticipated circumstances.

She conceded, “Unfortunately, it was to be expected because we have not had any new physician staff nor nursing staff to any significant extent in one instance, and in the other instance as best as possible the healthcare institution tried to work with resources in terms of manpower and spacing, trying to protect essential workers and patients who are immunocompromised.

“Unfortunately, we knew that there were instances where there were so many people in need of emergency care, so the timeliness may not have been ideal, but it would have been what was best allowed, given our circumstances with so many persons requiring emergent care.”

Regarding manpower shortages, the CPSA made several recommendations to the government, according to Pinder-Butler, including the retention of junior physicians.

“But we are still waiting for them to start work,” she pointed out, “even though they said they have hired them. We take too long to make these things happen, and this is an emergency situation. What is the hold up?”

The CPSA also requested additional nursing and support staff due to the extra needs associated with COVID-19 patient care, and recommended that government seek the assistance of medical teams that provided aid to the country in the aftermath of Hurricane Dorian.

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