Medical Community Question

this answer comes from a recent former primary health care provider on stx...
a. too specialized by far - not enough demand
b. the hospital does not provide an appropriate environment for such a complex surgery.
he would certainly have travelled off island - even if the best spinal surgeon in the world was on stx.

Let me clarify my question without getting into really technical terms - he is an advocate for minimally invasive procedures such as laparoscopic techniques....not the "gut you open and go from there". These are primarily day surgeries in an outpatient surgical facility, and I have absolutely no idea if STX or STT even has such a facility....I can only be the funnel through which information is dispersed and I'm flying blind. There is an ortho surgeon on STX who is a fellow with the American Association of Orthopaedics, so he must be doing something other seeing 5 year olds with than snotty noses 🙂 Back surgery patients frequently are unable to travel long distances for quite some time, so does that just leave them stranded on the mainland until they are fully healed?

You say:

"he would certainly have travelled off island - even if the best spinal surgeon in the world was on stx."

Meaning.....what? He would have gone somewhere else due to lack of business, lack of facilities, or just the ability to make more money? That the medical community will continue to refer to the mainland or PR regardless of WHO is here? Or the fact that the islands aren't ready to move into the 20th century? Please understand there is no negativity in this post, just asking for honest answers from those who have "been there, done that".

It's not a complicated question but the answer really can get very complicated. But let me relate a little story which MIGHT throw some light on the subject (or further muddle it.)

An acquaintance of mine who was born here successfully practised dentistry in NYC until retiring a couple of years ago. He has an abundance of family and friends on STT and it was always his plan to retire here which is his home. Although officially retired, he felt that he could keep his hand in while giving back to the community and approached the hospital about working part-time in one of the clinics. It was more an altruistic gesture on his part than anything else.

To cut a long story short, after many months of being given a total runaround by the powers that be, he finally got fed up with all the nonsense, scotched the plan and is now REALLY retired here and very much enjoying himself. The hospitals are government entities and the government here can tie itself up in massive knots with the flimsiest gossamer threads.

If your friend is really interested, the best thing he could do would be to make a PMV and present himself in person at the hospital(s) here. Unless the hospitals are actively recruiting someone in a particular field, their response (or lack of) will be exactly as your friend has already experienced. Hope this helps.

Becky: My 2 cents...

There are maybe 150,000 people in all of the VI. At least a third live without insurance and under the federal poverty guidelines. There are no outpatient surgical facilities. In fact, if your friend mentioned them, that might be your problem. The hospital administartion on St Thomas is currently fighting to prevent a group of surgeons (including an orthopod) from opening one. I am sure there is some specialized equipment for his work, and if he was willing to pay for it, the hospital would probably let him practice.;)

I think that the orthopedic surgeons see a lot of gun shot wounds.

To STT Resident: The hospital is a semi-autonomous government agency, totally separate from the health clinics, which are under the jurisdiction of the Dept of Health. Maybe that is why your friend got the brush-off??

Becky: I forgot to say that he would probably do better contacting Frank Odlum, Chief of Surgery directly. No telling where the fax to the hospital went. And one of the unfortunate parts about "the way things are" is that people do not respond appropriately to calls, faxes and the like.

Thank you all for your responses....being 'not retirement' age yet, with 1 in college and 2 more to go, it may not be realistic for him. I know the man well....buying the equipment and/or joining forces with those attempting to open a day surgery center probably isn't his "thing". I guess we were hoping with the advent of the new improved hospital on STX (whenever that really happens) that more specialized services would be available. I've explained the population demographics, etc., to him, and a new patient can't very well ride the ferry home after a surgery like that 🙂

As I told him, the islands are incredibly handicapped un-friendly...the winds of change, they do blow slowly in some areas, huh?

Thanks again for the input....he's somewhat of a bulldog and does not go down quietly, but he may have met his match with the local medical facilities. However, he DOES have to eat while living here, and I don't think a job at McDonald's will quite cut it.

EE, thanks for a contact name - I have the feeling his curriculum vitae is sitting on the corner of someone's desk, waiting on the time capsule to be opened.... Odlum is on STT?

Becky - he still should do a PMV to determine whether life here would suit him. As you may have gathered from researching this forum, people come with all good intentions and then leave. This is not the "real world" as some know it but neither is it a "Third World" as some disgruntled transients describe it.

Dear East Ender - yes, I know the hospitals are "semi-autonomous government agencies" but whatever description one applies to those bearing that fancified description they still suffer from the neglect of the overseer in many cases. WAPA for instance? In my response to Becky I just lumped everything in rather than subject her question to a discussion about semi-autonomy versus direct government involvement.

The only semi-autonomous government agency I know of which has remained incredibly successful and continues to grow is The West Indian Company Limited.

I understand from the aquaintance I mentioned that he went through all channels - but when I next see him I'll ask for more details. The point that I was making is that he's a "bahn here" with big family ties and friends here...

no I meant that my husband - a primary care provider - would not have elective surgery personally on st croix no matter how good the surgeon was. IN his fairly well respected opinion, the hospital and attendant services are not up to par.
My husband would have elected to go off island for any surgery and that has nothing to do with the quality of the surgeon.

He also meant that there are not enough suitable cases per year to justify a spinal surgeon moving to st croix.

Jane - Thank you/your husband for your personal experience..it says volumes once I go back and re-read the thread.

Not to beat a dead horse, but is this why many people have the air transport service? If it's not an elective surgery, it's emergency, which opens another can of worms...but if the islands can't handle a day surgery, what do they do with emergency cases? Patch 'em up as best they can and shuffle them out?

I think we are back to re-grouping and starting over....the PMV was more of a vacation/look in the phone book...the island suits him just fine, but as others have pointed out on many occasions, being able to make a living in one's chosen profession can become more difficult here. I guess it can never be stressed enough...look at YOUR PERSONAL situation prior to making a decision and ask a LOT of questions...just because you, or the entire population if that's the case, think there is a "need" for a service doesn't necessarily mean it's going to happen.

Thank you STT Resident and EE, for your respectful and well thought out answers as well.

Before I kill this thread, can anyone tell me about services on Puerto Rico?

We recently had a friend deliver a baby in the hospital in STX and had a wonderful experience both during delivery and her post-partum care. After planning to deliver "normally", she required a c-section and was very pleased with the results.

Most people who have used the facilities that I know feel it does what it does well, much like any small town or rural hospital. But there are lots it doesn't do. I had my knee replacement back in the states for two reasons -- that surgery is not done on STX and my in-group surgeons were in KY.

My 2 cents.

Thanks, Linda...with the presence of CIGNA (I think that's the right provider) on island for gov't employees, which comprise a huge part of the overall population, and whatever provider Hovensa uses, my naive brain assumed about everything was done, it was just a matter of if there was anyone to do it.

Strange that they want to build a state-of-the-art hospital without the specialties and sub-specialties that this would entail...so basically we're getting a big walk-in clinic? I'll do some i-net research - due to my own personal medical history and my husband's previous bout with Guillian-Barre, which almost killed him, I'd be interested to see just how this is intended to work. Hmmmm....yet another mystery to be pondered and solved!

Becky: I have to say that both hospitals are improving. Both are JCAHO accredited. However, there are deep-seated problems in the health care system from the primary care system through long term care.

People have air evacuation insurance because there are emergency services that are not available. For example, there is no full-time neurosurgeon on St Thomas, and I think it is the same for St Croix. So, you fall and hit your head... If you are unable to pay for air ambulance sometimes a general surgeon will do an emergency craniotomy, sometimes people will be sent to Puerto Rico at government expense.

I do not have any first hand knowledge about health care in Puerto Rico. I do know people who said that while their physician spoke English, the staff did not. Kinda makes it hard to communicate.

Also, you do have to check the fine print in the air ambulance brochure. Most pay to take you to the nearest facility that the service is available. So if you broke your leg on St Thomas, you would not be evacuated because that service is available. Unfortunately, most services are available on Puerto Rico. You can pay extra for a policy that flies you to the hospital you choose.

EE, STT Res, Jane and Linda-

Please forgive what may seem to be an argumentative statement - I do not mean it in that manner at all!...but "things are improving" and the hospitals are now JCAHO accredited...and yet you could have a general surgeon doing a craniotomy? Yikes! (No offense to any general surgeons intended, just a personal moment of enlightenment). Is there any anticipation of bringing specialty emergency services to the islands, or is this a pipe dream?

Yes, we pay the big bucks to the air charter to get us out of here in a hurry to where we need to be because of our medical histories....however, as we grow older, we are naturally concerned about what constitutes an emergency and appropriate stabilization and triage care while everyone gets lined up to get us somewhere else.

The population of STX/STT/STJ is roughly the population of the city where my physician friend currently practices, which is flooded with specialties and subspecialties. I've been here long enough to know this ain't the "Real World" or the "Third World", but I do believe this is an important topic with the number of baby boomers retiring to the islands. It makes those of us with less than perfect health take a deep breath and say the Novena to the Angels...

Becky - the Chief of Surgery at the hospital on St. Croix is Josh Morowitz. He moved here from Connecticut 1-1/2 years ago. If you need his direct contact info for your friend, shoot me an email and I'll give you his home and cell numbers.

The hospital has been bringing in quite a few new doctors and specialists in the past couple of years, but it does take time to fully upgrade the hospital's equipment and populate it with a full staff such as might be expected in a large city elsewhere. We do have a more complete list of specialists than most other rural small towns of around 50K residents. The problem with increasing the number of specialists is that so many of them are TOO specialized to make a living in a rural hospital setting. There just aren't enough of their specific kinds of cases to warrant having them here full-time.

If a doctor is flexible in what he is willing to do in his pratice and will branch out into a broader aspect of his specialty field then he is much likelier to be of interest to the hospital and clinics. It's kind of like if Russell was ONLY willing to dispense one category of medicine... only pain killers or only antibiotics or only anti-depressants, etc. At large mail-order pharmacies, they probably have employees who only dispense one particular type of medication all shift. That wouldn't work here.

Thanks, Alexandra -

I've relayed all of this info, but the coconut telegraph reaches farther than I can...probably a no-go at this time based on what he has heard, but not because of lack of cases...from what I can tell from brief emails, there's plenty to go around...other factors play in as well. I've veered off my original topic anyway. Thanks for the info on the chief surgeon, though. And your point is well taken on time for growth for any industry, even hospitals.

I'm just surprised, I suppose, to find that many services are not offered in the islands, i.e., knee surgeries, neurosurgery, specialized pediatrics (from another post)...these are things I never really thought about thoroughly prior to moving here. Things others need to think about, seniors and those with special needs children, etc. I'm not entirely sure newbies like myself consider all of these things carefully. I remember a wonderful man who had an autistic son who finally had to give up and go back to the mainland to get services for his child....he "assumed" he could get what he needed here. Now there is someone here on STX who is immensely qualified to work with autistic kids, but arrived just a wee bit too late for one child. However, only through the networking like we see on this board can we find out some of the things our "island education" is lacking, and my thanks to those who have answered honestly and to the best of their ability.

Word to the wise - if you have a particular set of circumstances in your life, health or otherwise, move that to the top of your priority list for your PMV...it might be the cutting edge difference.

Hi Becky,

One difference I see is isolation. You mentioned that a city with 150,000 residents usually has a "state of the art" hospital and it does. But doesn't that hospital also draw from the surrounding counties, farmland etc? Here there is nothing to draw from. It's hard to be a trauma center, for example, when there is nothing to be the center of. Clear as mud??

How was the graduation!!!

Becky: You can get knee replacement surgery on St Thomas. There are people who choose to go to the states for many services they could get here.

My statement about improvement is meant for a couple of reasons. People who have lived here a long while can tell horror stories about the hospital. At one time, family was expected to bring linens for their loved ones, for example. And Virgin Islanders don't much believe that things can change in any meaningful way. That the hospitals meet JCAHO accreditation standards is a huge leap from what once was. Health care is not up to stateside standards-yet- but they are working toward it.

A craniotomy by a general surgeon is better than central herniation, right? There is/was a part-time neurosurgeon. Have not seen or heard of him in many months. But if your neurosurgery emergency occured when he was not there...

Now special education services, that is a whole other ball of wax!

STT Resident: The only reason that these changes have come about is that the hospitals have been granted semi-autonomous status. The West Indian Company has been semi-autonomous for many years, the hospitals only 6 or 7. It is going to take time. I also meant that the Health Department clinics suffer from still being under the thumb of the "central government."

I guess I just need to shed that old Southern-states state of mind, huh???? This has just brought up some interesting things I really hadn't given a lot of consideration to (although I should have, so that's my own fault!) Since my husband is a pharmacist, I have become more aware of the high incidence of diabetes and hypertension in the islands and the need for those services...but I guess I was letting my stateside brain think for a while...my bad! And I tend to think of the islands as being closer together than they actually are...hence my very incorrect figures. I had it right on total, but I forget we are spread out and travel is a wee bit more difficult than hopping in the car or on a train or bus. Also, I guess I have to chuckle at a doctor who can't get a job....now THAT'S funny! We ain't in Kansas anymore....

Linda J, thanks for asking about the graduation - I am now the very proud mom of an attorney (pending the bar exam) and another son who was to have been an assistant caddy for Tiger Woods a week ago (I think that means you ride in the second golf cart behind and look at the back of his head, but hey....everyone started somewhere!)