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Volume No. 2 Issue No. 61 - Monday December 8, 2008
WHO Assistant Director on Dominica Health Care
By Sean Douglas

dr carissa etienne
Dr Carissa Etienne WHO Assistant Director General.
Dominican Dr. Carissa Etienne who has risen to great heights on the international stage, first with the Pan-American Health Organisation (PAHO) and now the World Health Organisation (WHO) as its Assistant Director-General, has highlighted the major global challenges facing the health sector in developing countries like Dominica.

Dr. Etienne, one of the pioneers of the primary health care programme in Dominica in the 1980s, delivered a lecture on Health in 21st Century Dominica at the Fort Young Hotel in Roseau last week. It was the fourth lecture in a series of lectures under the auspices of the National Reunion Committee.

According to Dr. Etienne, the major factors that are impacting health in developing countries like Dominica are: the current world financial crisis; the food crisis; climate change; epidemiological transition; population changes; globalisation and health delivery issues.

In her delivery, Dr. Etienne referred to a World Bank report which forecasts that as a result of the present financial crisis, up to 200 million jobs worldwide could be lost. The crisis is already having a negative impact on government spending in the social sectors, namely, health and education. The financial crisis could also see aid levels drop, significantly affecting developing countries. The tourism sector, the lifeblood of many Caribbean economies will according to the Eastern Caribbean Central Bank suffer as a result of the world economic downturn.

The WHO Assistant Director-General also pointed to the impact of the food crisis on developing countries like Dominica.

�As a result of this food crisis, there is decreasing availability of food but also increasing prices. In Dominica we are relying more and more on imported foods. Because of this food crisis, there is a risk that we are going to see under nutrition to children, that indeed as food becomes more expensive and less available, the food that people can afford becomes high fat and high sugar foods. Therefore obesity which is already becoming a problem and which now has emerged as a sign of poverty, we are going to see increasing levels of obesity,� Dr. Etienne said.

Dr. Etienne also spoke of the impact of globalisation on health and the opportunities that are now available. �There is significant technological advancement. There are implications for tele-medicine, for e-health. This is an opportunity that we can use.

There is also the widespread use of mobile phones not only in Dominica, but globally and we can see how this technology can be used to improve education, health education to be utilised to enhance connectivity and how that relates to health.

Very important as well with globalisation is that we have entered the information age. Therefore our health care workers who were once very isolated now have greater access to information. And we can begin demanding of our health care workers that whatever health care that they deliver, it must be evidenced-based and it really must be on the cutting edge because they have access to that information.

But very importantly the patients and clients that we serve also have access to that information and this is important because increasingly persons in our society will begin demanding better health care and quality health care ,� the WHO Assistant Director-General stated.

Dr Etienne also spoke of the impact of climate change on health care and spoke of a number of island states in the Pacific and elsewhere which are losing land due to rising sea levels and the impact of climate change generally. There will be more tremors and extreme weather events as a result of climate change.

The direct impact of climate change on health especially in Dominica will be more mosquitoes and higher incidence of malaria and dengue fever. There will also be a negative impact food production and severe water shortages.

There will also be a higher incidence of respiratory illnesses particularly asthma and a higher incidence of diarrhea and potential increases in food borne infections, Dr Etienne said.

The WHO official lamented that globally, all over the world there is increased dissatisfaction with health care services that �are just not meeting people�s needs and expectations�. Mention was made of growing health inequities within countries and between countries.

Dr. Etienne stated that there is a total lack of social health protection in many countries and added very often �in Dominica we don�t know how fortunate we are, that we are significantly better off than most people, especially when one looks at the situation in Sub-Saharan Africa�.

On the impact of changes in population, Dr Etienne stated: �Changes in population will also have an impact on developing countries like Dominica. � The developing world is witnessing ageing and it is occurring at a much faster rate than happened in the developed countries.

Therefore increasingly we are going to see a growing number of elderly people. We have less time to prepare for those numbers of people so this bulge will come upon us and it will have implications for the disease profile that we will begin to see, implications for social and health needs.�

The senior WHO official lamented the double burden of disease now afflicting developing countries. �In fact what is happening in developing or low income and middle income countries is that we are seeing a double burden of disease, so while the chronic diseases are becoming more prevalent at the same time we are dealing with communicable diseases.

We are dealing with emerging diseases like HIV/AIDS and re-emerging diseases like TB but also other conditions like respiratory illnesses and diarrhoeas. So this epidemiological transition which is also occurring much faster than in the developed world is quite an issue for low income countries and also an issue for Dominica .�

Dr. Etienne also spoke of the problem of the shortage of health care workers not just in developing countries but in developed countries as well. She lamented the loss of qualified health care workers from developing countries to developed countries and said that to cope with this crisis, developing countries have called for a code of ethics.

Dr Etienne said however that while there is a problem with retention and production in developing countries � it is clear that we are not producing the appropriate skills mix. Many of our workers are not trained in dealing with communities and their health and also addressing some of those lifestyle issues that are so much a feature of our disease burden�.

At the end of the lecture which attracted an audience of over three hundred persons, Dr. Carissa Etienne was presented with an award by the Executive Chairman of the National Reunion Committee, Mr. Hubert Charles. The gathering included two of the persons who moulded Dr Etienne in her early years in the medical profession, namely, Professor Gerald Grell and Dr. D.O.N McIntyre.

Minister for Health and the Environment, Hon. John Fabien, new Minister for Education, Senator Sonia Williams and Dominica�s Ambassador to CARICOM and the OECS, His Excellency, Charles Maynard also attended the lecture. E-mail to a friend

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