Medical Association of Jamaica Presidential Address September 2011 By Aggrey Benjamin Irons MB. BS. DPM. DM There is no doubt that the title of this organization defines its purpose. The MAJ or MEDICAL ASSOCIATION OF JAMAICA says what it is and what it does but for too many of us it only says what it means or intends or what it WAS. We DOCTORS, like all current professionals face squarely the question of whether we are here to serve the public or is the public here to serve us? In the months leading to this moment I have been forced to answer this question with a paraphrase of the great statesman John Fitzgerald Kennedy who exhorted us to ask what we can do for our country and not what our country can do for us! In fact, a real analysis of our dilemma will show that the more we are inclined to do for our country, the more our country is inclined to do for us! It is inclined to give us the traditional job security and prestige that has always been the reward of the conscientious medical practitioner only if we continue to invest the sacrifice, patience, humility and wisdom that our training and practice have taught us. Despite our traditional confidence and competence there is no doubt that ourselves , our profession, our association and by extension our country, have been infected by an acute on chronic VIRUS of SELF DOUBT which symptomatically causes us to repeat the question: WHAT IS THE RELEVANCE of the MAJ to me and my life? (and WHY SHOULD I give life to the MAJ?) It is this question of self doubt and this question of RELEVANCE which I am prepared to answer unequivocally over the ensuing six months and onward into the next two years. Please join me today as we explore the phenomenon of RELEVANCE together: I will literally spell it out for you: R- REVOLUTION This word has always been emotive, loaded and sometimes quite frightening. To some it means the capacity for turning around, while to the more cynical it may simply mean going around in circles. The spirit of revolution however implies a positive cycle of change. It implies that energy be directed conscientiously; and consistently be applied, to achieve change (s) that all of us can believe in. Some of these changes have to be immediate or short term while others will be gradual, long term and take more time. It is only through an astute application of OUR TIME and OUR ENERGY that the work of the MAJ – MEDICAL ASSOCIATION OF JAMAICA – will redound to the success of ourselves, the health of our patients, the progress of our profession, and the well being of our country JAMAICA. We will need REALIZATION & REDISTRIBUTION OF RESOURCES ON THE ROAD TO RAPID RECOVERY AND REALISTIC REHABILITATION. The acquisition and application of these individual R categories are admirably outlined as part of our five year FIVE point program. IN our first six months we will: RATIONALIZE AND REALIGN CURRENT HEALTH SPENDING (together with the NATIONAL HEALTH FUND) REDUCE THE INCIDENCE OF VIOLENCE ON OUR ROADS AND IN OUR HOUSEHOLDS RE DISTRIBUTE PERSONNEL ISLANDWIDE TO MAKE PRIMARY CARE A REAL PRIORITY REVERSE NEGATIVE TRENDS REGARDING THE IMAGE OF HEALTH CARE PROFESSIONALS. REPAIR INTERNAL DIFFERENCES AND EXTERNAL RELATIONSHIPS WITH FELLOW PROFESSIONALS (including the MINSTRY OF HEALTH) RESTORE THE ETHICAL PRINCIPLES & DIGNITY OF OUR PROFESSION REVITALIZE OUR RURAL GROUPS & CHAPTERS REGULARIZE THE STANDARDS OF MEDICAL PRACTICE IN CONJUNCTION WITH THE MEDICAL COUNCIL OF JAMAICA RESPECT THE RIGHTS AND DIGNITY OF OUR PATIENTS BY IMPROVED PUNCTUALITY & FUNCTIONALITY AT OUR OFFICES, CLINICS AND HEALTH INSTITUTIONS REPLACE, REPAIR AND REFURBISH AILING INSTITUTIONS RESEARCH NEW & EFFICIENT METHODS OF HEALTH CARE DELIVERY RESTORE REALISTIC USER FEES ( Voluntary, compulsory incidental & insurance) REALIGN COSTS OF HEALTH CARE WITH OUTCOMES REDUCE INCIDENCE OF MALP0RACTICE AND LITIGATION (along with MAJIF) REALIZE SIGNIGICANT SAVINGS BY WASTE REDUCTION AND TECHNOLOGICAL IMPROVEMENT RAISE/ LOWER APPLICABLE RELEVANT HEALTH INDICES TO IMPROVE JAMAICA’S INTERNATIONAL REPUTATION RELAX AND RESTORE OUR ENERGIES BY INCREASING OPORTUNITIES FOR RECOVERY & REHABILITATION (of Physicians etc.) E- EDUCATION: Every DOCTOR is AN EDUCATOR and must recognize that education is the principal tool of change. There can be NO REVOLUTION without EDUCATION. We must be mentally and physically prepared not only for the journey of change but also to sustain our goals (changes) once we have achieved them so that we can lock into that age- old Jamaican Adage – ‘ Good, better, best, – never let it rest…………………… It is EDUCATION that has given us the right and privilege of/to practice. It is education (continuing) that makes us able to renew and refresh our profession and it is EDUCATION that will improve the length and quality of the lives of our patients and by extension OUR SELVES. In order to educate the wider public, we must first educate our own selves and each other. This objective can only be attained through appropriate information gathering and information sharing. In the ensuing six months the following strategies will be executed in order to Establish Education as a true priority of the M.A.J.: ESTABLISH along with MAJIF (Medical Association of Jamaica Insurance Fund) the most MODERN and EFFECTIVE WEBSITE for the EXPOSURE of the principles and practices of our members and member organizations together with opportunities for Ethical advertisement and professional cross linkages EXPLAIN to our patients and nation the ESSENTIAL relationships between PRIMARY, SECONDARY and TERTIARY CARE and the Real savings to be gained by genuine HEALTH CREATION AND MAINTENANCE. ELUCIDATE along with the MINISTRY OF HEALTH the appropriate POLICIES and PROTOCOLS for EPIDEMIOLOGY so that the DISTRIBUTION & DETERMINANTS of disease will form the real basis for interventions and treatments of a truly ENLIGHTENED POPULATION EMANCIPATE ourselves from mental slavery – often self induced – that doctors can only manage disease in complex organisms but somehow cannot appreciate and apply the knowledge required to manage large complex organizations like Hospitals, Regions and Ministries of Health. ENJOIN our junior colleagues in the pursuit of intellectual advancement that will result in additional qualifications in the areas of Public Health, Business Administration, Law and Politics. EXPAND the availability of scholarships for our worthy medical students by encouraging each year’s graduating class (regardless of University) over the past fifty years to establish one (more) sustainable annual scholarship with matching funds from the private and public sectors. EXERCISE caution and due diligence in the accurate, recording, researching and notification of disease processes in order to EXPAND the knowledge base of our profession and facilitate appropriate sharing of that information with our colleagues worldwide so that we EVENTUALLY move towards EQUALIZATION of the standards of care without prejudice to any class, race or creed. ERADICATE stigma and prejudice associated with conditions like Mental illness and Communicable diseases (including HIV and other STDS) by EXPLODING myths, EXPOSING ignorance and EXEMPLIFYING fair treatment and ESTABLISHING EARLY detection, ENLIGHTENED prevention and EASE of availability of treatment. ENUNCIATE categorically and ;unequivocally the internal academic/responsibility relations within and between the various levels of MEDICAL DOCTORS in the health team. Similarly, ENUNCIATE categorically academic/responsibility relationships between doctors and other professional members of the health team to facilitate the ease of crossover and career changes for suitably qualified health professionals. (so that any hierarchical ratings can be based on the appropriate principles and not on sentiment or myth). ELEVATE POST GRADUATE, IN SERVICE, and ONGOING education to a level of fair and transparent CERTIFICATION so that general and specialist qualifications will continue to have real meaning while ensuring that NO DOCTOR loses the basic tenets and practices or fails to sustain a level of basic medical education that is not exceeded by a consistently improving level of education of the most recent graduates of our medical schools. This is one sure way of preventing any possible lowering or erosion of our beloved and blessed MEDICAL STANDARDS. L – LEADERSHIP: Every medical practitioner is a potential leader and will at some time in his/her life be required to lead others, lead teams, lead processes, lead organizations, lead revolutions and even lead nations. There will always be various levels of leadership and all leaders must at some time be prepared not only to lead but also to be lead by others. The really insightful leader knows that his role can never be permanent and must always help to prepare the next leader thru proper succession planning. It is with this in mind that the MAJ will institute the following short and long term strategies. LIVE by the edict that EXAMPLE is better than precept. i.e. immediately become aware of the need to be role models for the hundreds/thousands of bright and committed young people of our various communities who want to be like us (STORY OF DR. HANS STAMM) LEARN THE LESSONS of the great LEADERS of our time – i.e. humility, integrity, discipline, unselfishness and recognize that these are not incompatible with personal success. LOVE your profession, LOVE your community, LOVE your family, LOVE your patients and recognize that LOVE is at once a verb and a noun which is synonymous with charity (giving) e.g. the ROTARY – 4 WAY TEST. e.g. LUKE Chapter 6 :27 “Love your enemies, do good to them which hate you” e.g. Matthew Chapter 5: 44 “But I tell you: Love your enemies and pray for those who persecute you’ 4. LIST and REVISE your priorities on a regular basis. Always have a List of things to do daily, over time and before you die (i.e. a bucket list). LITERALLY tick your list as you achieve those goals and never be afraid of the impossible dream. LIFT your standards daily (not only thru education) by realizing that We are living proof that PRACTICE makes PERFECT! LIBERATE your entrepreneurial spirit by taking advantage of the new financial partnerships which the MAJ will establish with banks, credit union formation, expansion of MAJIF and rejuvenation of the MAJ Trust. LABOUR together (i.e. collaborate) to achieve strength in numbers and take advantage of the “multiplier effect” in an economy that forces many of our patients to downgrade healthcare priorities. Lean on each other for emotional, social and even financial support in time of need by lowering the damage done to or done by the ailing physicians and their ailing relatives. LOUDLY LAMENT the LIES that regularly VICTIMISE DOCTORS in our society by joining your voices with that of the MAJ in pursuing just causes (e.g. the proper use of disposables) and condemning injustice like the improper use of public facilities and resources by anyone, and the strident targeting of DOCTORS as reluctant TAXPAYERS when DOCTORS are collectively and individually among the highest taxpayers in the economy! LOBBY,LOBBY, LOBBY the government and private sector on behalf of our patients and ourselves to search for and implement lifestyle adjustments and cost effective methods of re-energizing the health care dollar. LOWER the cost of health care by reducing the costs of OBVIOUS WASTE and WASTERS! E.g. the employment of more lawyers to handle litigation and less doctors to give proper health care. E – ENERGY As scientists, we are forced to embrace the truth that energy can neither be created nor destroyed. However, it is equally true that it (ENERGY) can be changed in form i.e. it can be renewed or replaced. It is with this in mind that we will seek to RE-ENERGIZE ourselves through the following fuels: ENCOURAGE labour through reward and recognition. We will not fail to recognize the contributions of our membership – past and present – by continuing our system of internal recognitions and awards and supplement this by more active recommendation of our Doctors for appropriate NATIONAL HONOURS not only for service to the profession but also for service to their communities and nation. Our non partisan Doctors have been woefully under- represented in our national honours lists over the last fifty years especially when we reflect that Heads of Department in our colonial University College (s) were almost all assured of a KNIGHTHOOD BY THE REIGNING MONARCH. E.g. Sir George Alleyne, Sir Kenneth Standard, Sir Harry Annamuthodo. EMPOWER our ‘junior ‘ colleages by increasing national and international training opportunities in concert with local and international organizations and our increasingly influential colleagues in the DIASPORA. We will be relying more on our younger colleagues to turn their insurmountable energies into growth and development of their professional organization as they play a more significant role in governance and decision making which will lead to the next energy level which is to: ERADICATE the term JUNIOR DOCTOR and replace it with the term MEDICAL DOCTOR (Physician or Surgeon) while maintaining and improving the STATUS OF THE CONSULTANT (Physician or Surgeon. Etc.) and REVALUING (not DEVALUING) the title of Professor! (explain) EMBRACE our medical colleagues in representational politics and encourage them to become ACTIVIST members of the MAJ to increase our representational, professional energy and remind them that they are DOCTORS before being POLITICIANS and that their colleagues need their energy as much as their constituents. ELEVATE (re) the status of the CMO as the chief “Professional” officer of the Ministry of Health while, halting the current sliding devaluation of the post to a point where we no longer hear the voice of the CMO as the principal health spokesperson in the country. This will hopefully re- energize the other medical officers of the Ministry whose opinions and work functions (and self esteem) are being eroded by internal and external functionaries.. EMPATHIZE with our fellow health professionals in the “Professions Aligned To Medicine” and recognize their need to practice and upgrade their own professionalism without us feeling threatened that their upliftment will dilute our status. This will demand a re-energized confidence on our own part that the medical profession is the standard by which other professions are judged. In this way, we can use our collective energies to upgrade the health care of our nation without falling prey to the DIVIDE & RULE strategy that has been keeping our standards and salaries at the lowest levels of all health professionals in the Caribbean ( e.g. Bahamas & Cayman). EXPAND HEALTH TOURISM to levels EXEMPLIFIED by developing models like KOREA and SINGAPORE to a level where Jamaican Health Care will share and sustain the magical reputation of being the best in the world. This will facilitate health care becoming a net foreign exchange earner which will underwrite the provision of proper health care for the ‘poor’ and help to stem the brain drain. The MAJ is already in partnership with JAMPRO to facilitate this end. We have the manpower and need to supplement this with the TAX INCENTIVES found in other forms of TOURISM. ENGAGE our CARIBBEAN and INTERNATIONAL colleagues in new partnerships while strengthening the old and traditional ones. We have already established strong ties with our Trinidad/Tobago colleagues and with the help of our Fellow, Past President Ambassador Beaubrun we are seeking to strengthen our Caricom linkages in order that our voices will be heard clearly by the Health Ministers and other policy makers of the region. Our Immediate Past President has just returned from participating in the AGM of the BMA where new alliances have been formed. A forthcoming trip to Washington DC will continue our alliance with our USA colleagues while a November visit to our Canadian colleagues is anticipated. This will serve to energize our five year five point program and facilitate reciprocal participation in our annual conference/symposium. V – VOLUNTEERISM The value of VOLUNTEERISM has always been established as the cornerstone of really worthwhile SOCIAL activity and even more as the foundation of NATION BUILDING. The unique combination of time and energy, given at no price, contributes so much to real change as to make that contribution invaluable. Giving freely of one’s time and energy must never be confused with freeness, as time and energy are among the most expensive commodities in the economy. We will continue to recognize and participate in the value of VOLUNTEERISM VIA the following strategies: VALUE the time and contribution of our colleagues by having shorter and more effective meetings to facilitate more informal interaction and mentoring activities. VIST our rural colleagues with greater frequency to savour their hospitality, maintain their connectedness and fulfill their needs (for security and modern amenities). VENTILATE the problems of our member organization through more structured Council activities in order to: VERBALIZE the variety of concerns which the medical fraternity has at this time – DO SO WITH ONE STRONG VOICE VERIFY & VALIDATE the enormous contribution that our members give to their organization through volunteerism and daily vocation by regenerating our ‘best practice awards’ and other incentives VENERATE our ‘forerunners’ by celebrating Founders Day annually (November 21) encouraging our ‘Fellows” to be active spokesmen for our organization and requiring them to write the history of our association. VARY the current approaches to health care to include greater emphasis on proper record keeping and sharing of outcomes through appropriate referrals and report writing. VIRE – (explain) funds on an annual basis with the assistance of the Ministry of Health to re distribute financial resources to under-served areas and create well needed NEW POSTS. A – ACTION Actions definitely speak louder than words. Although the preceding list may be considered exhaustive, here are some Additional Activites that will underline our relevance in the coming months. ASSOCIATE – Our primary purpose is to join, meet and build. Too many doctors literally do not know and cannot recognize each other. We will facilitate more formal and informal meetings especially between the older and younger practitioners and ensure that recent graduates are incorporated into our organization by accessing free observer status during their internship. ATTEND and encourage attendance at all relevant HEALTH CARE ACTIVITIES not only to bring greetings but also to be an essential part of the implementation of all worthwhile health care policies. This will involve all our executive officers as properly prepared spokesmen for our association. This will further involve our entire membership as visible, active partners in our national health care! APPRECIATE significant milestones including births, deaths, anniversaries, promotions etc through proper record keeping and timely ‘mailings’ to our membership and their families. ADOVOCATE – We shall relentlessly speak to and for the needs of our profession at the level of both our service and academic providers in a manner that reflects ADVICE rather than ANTAGONISM. Our APPROACH will always be NON-CONFRONTATIONAL as we seek to WIN FRIENDS AND INFLUENCE PEOPLE on your behalf (see- NEGOTIATION) ACCELERATE OPPORUNITIES for the professional growth and development of our colleagues and profession ADVERTIZE (ethically) our joint successes and maintain AWARENESS within our profession of all the modern trends and practices AVAILABLE and ACCESSIBLE to them ABILIFY (explain) our treasury and treasurer and (EN) ABLE him to produce timely AUDITED ACCOUNTS for inclusion in an ANNUAL REPORT of which we can all be proud. ALLEVIATE any suffering – acute or chronic- including our own as soon as possible (see previous reference to leaders N – NEGOTIATION The complex yet simple ART of convincing others that what you need is also good for them has always been one of the CORE functions of this association. Negotiation has taken place within the organization and needs to be a successful precursor to any attempts at successful negotiation extra – organizationally (i.e. we must put our own house in order before we seek to engage in negotiation with others – in unity there is strength). With this in mind we shall continue to: NOMINATE the appropriate representatives to advocate for us at the appropriate levels and to assemble a ‘dream team’ that will enhance our ability to produce ‘WIN –WIN’ situations wherever possible. Our Past President (WIGUT) and our President Elect (JMDA) have already spearheaded some key advocacy steps which I intend to expand and finalize both nationally and internationally. NEUTRALIZE & NORMALIZE brewing and longstanding intramural conflicts in the following areas for example: (i) ‘JUNIOR DOCTORS & CONSULTANTS’ – to facilitate rebuilding of the FIRM! (ii) CARDIOLIGISTS, CARDIOLOGISTS & CARDIAC SURGEONS (iii) RADIOLOGISTS & RADIOGRAPHERS (iv) PHARMACISTS, PHARMACOLOGISTS & DOCTORS IN GENERAL (v) NEUROLOGISTS & NEUROSURGEONS (vi) ANAESTHESIOLOGISTS & ANAESTHETISTS (vii) DOCTORS & NURSES (PRACTITIONERS) (viii) DOCTORS & DOCTORS ( at all levels) etc. (ix) PSYCHOLOGISTS & PSYCHIATRISTS NATIONALIZE our struggles wherever NECESSARY so that our patients and fellow professionals acknowledge and support the fact that we act for the common good and NOT IN SUPPORT OF NARROW SELF INTEREST. NURTURE the new and old relationships and partnerships that we have established with for example: a) BANK OF NOVA SCOTIA b) NATIONAL HEALTH FUND c) NATIONAL MEDICAL ASSOCIATIONS d) CHASE FUND e) TRADE UNION ORGANIZATIONS and most importantly with each other. C – COPE This is at once a goal, a synonym and an acronym for all the managerial activities of the MAJ. As doctors, patients come to us because of an inability or disability to COPE. We MANAGE them, we HELP them, we HEAL them, we TEACH them to cope. As doctors we ourselves must manage our lives and our professions so that we too may COPE with the changes generated by ourselves and others. As an association of DOCTORS we must COMMUNICATE (coordinate, cooperate etc.) ORGANIZE , PLAN and EVALUATE etc. constantly to MANAGE our own affairs. We will manifest our coping skills and managerial personality by the following behaviours: (1) COMMUNICATE: with our membership by every means possible. (2) COLLABORATE: through a series of well defined projects under our five year five point plan. (3) COOPERATE: genuinely, nationally and internationally with all our partners. (4) CONTROL: management process through a reorganized and revitalized headquarters. (5) CONSTRUCT: and refurbish new head office facilities (6) COORDINATE: social and professional activities with a focus on healthy lifestyles and image building. (7) COMPILE: a modern, shared database compatible with our our vision and mission while maintaining our yearly planner as the ultimate reminder of our activities. (8) CONFER: equally and imaginatively so that all views will be considered. (9) CREATE: a professional environment that facilitates excellence in every area of endeavour. (10) CONGRATULATE: each other for a job well done. E – EXCELLENCE EVERY EXAMPLE EXPRESSED thus far has been geared toward the pursuit, the journey and the goal of excellence. In striving for excellence we have constructed a virtual cake of varied, mixed ingredients. In order to put the icing on this proverbial CAKE we shall combine the following final ingredients. (1) ENCOURAGE research and publication as the ultimate provider of information and facilitator of progress by awarding a specific MAJ prize (s) and publication of the proceedings of our annual symposium as a supplement of the West Indies Medical Journal. (2) ELEVATE our annual conference/symposium and its attendant activities in order to become the best of its kind in the region and a ‘must attend’ reunion for all our colleagues all over the world. (3) ERADICATE ‘third world communicable diseases” with a concentrated effort at 100% immunization. (4) EXPAND MEMBERSHIP in MAJ and MAJIF BY 100% in the ensuing two years. (5) ELABORATE & EXPLAIN the FIVE YEAR FIVE POINT PLAN TO OUR MEMBERSHIP, OUR PATIENTS and OUR NATION TO FACILITATE ENLIGHTENED OWNERSHIP! excellent (healthy) maj! excellent (HealthY) profession ( MEDICINE)! excellent ( healthy) doctors! excellent ( Healthy) patients! excellent (Healthy) nation!