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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  categories are admirably  outlined as part of our five year FIVE  point program.  IN our first six months we will:

  1. RATIONALIZE AND  REALIGN  CURRENT  HEALTH    SPENDING

(together with the NATIONAL HEALTH FUND)

  1.  REDUCE  THE  INCIDENCE  OF  VIOLENCE  ON  OUR  ROADS AND  IN OUR  HOUSEHOLDS
  2.  RE  DISTRIBUTE  PERSONNEL  ISLANDWIDE  TO  MAKE PRIMARY CARE  A  REAL  PRIORITY
  3. REVERSE   NEGATIVE   TRENDS   REGARDING   THE  IMAGE  OF HEALTH CARE  PROFESSIONALS.
  4.  REPAIR  INTERNAL  DIFFERENCES  AND  EXTERNAL RELATIONSHIPS  WITH  FELLOW  PROFESSIONALS (including the MINSTRY OF HEALTH)
  5. RESTORE  THE  ETHICAL  PRINCIPLES &  DIGNITY  OF  OUR PROFESSION
  6. REVITALIZE OUR RURAL GROUPS & CHAPTERS
  7. REGULARIZE  THE  STANDARDS  OF  MEDICAL  PRACTICE IN CONJUNCTION  WITH  THE  MEDICAL  COUNCIL OF JAMAICA
  8. RESPECT  THE  RIGHTS  AND  DIGNITY  OF  OUR  PATIENTS  BY  IMPROVED  PUNCTUALITY &  FUNCTIONALITY  AT  OUR OFFICES,  CLINICS  AND  HEALTH  INSTITUTIONS
  9.  REPLACE,  REPAIR  AND  REFURBISH AILING INSTITUTIONS
  10. RESEARCH  NEW & EFFICIENT  METHODS OF HEALTH CARE  DELIVERY
  11. RESTORE  REALISTIC  USER  FEES ( Voluntary, compulsory  incidental & insurance)
  12.   REALIGN  COSTS  OF  HEALTH CARE  WITH  OUTCOMES
  13.  REDUCE  INCIDENCE  OF  MALP0RACTICE  AND  LITIGATION (along with MAJIF)
  14.   REALIZE  SIGNIGICANT  SAVINGS  BY  WASTE REDUCTION  AND  TECHNOLOGICAL   IMPROVEMENT
  15.   RAISE/ LOWER   APPLICABLE  RELEVANT  HEALTH INDICES TO  IMPROVE  JAMAICA’S INTERNATIONAL REPUTATION
  16.    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.:

  1. 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
  2. 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.
  3. 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
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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).
  10. 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.

  1.  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)
  2. 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.
  3. 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.

  1.    LIFT your standards daily (not only thru education) by realizing that

We are living proof that PRACTICE makes PERFECT!

  1.   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.
  2. 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.
  3. 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!
  4. 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.
  5. 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:

  1.   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.
  2.  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:
  3. 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)
  4. 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.
  5. 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..
  6. 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).
  7. 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.
  8. 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:

  1. VALUE the time and contribution of our colleagues by having shorter and more effective meetings to facilitate more informal interaction and mentoring activities.
  2. VIST our rural colleagues with greater frequency to  savour  their hospitality, maintain their connectedness and fulfill their needs (for security and modern amenities).
  3. VENTILATE the problems of our member organization through more structured Council activities in order to:
  4. VERBALIZE the variety of concerns which the medical fraternity has at  this time – DO SO WITH ONE STRONG VOICE
  5. 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
  6. 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.
  7. 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.
  8. 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.

  1. 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.
  2. 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!
  3. APPRECIATE  significant  milestones  including births, deaths, anniversaries, promotions etc through proper record keeping and timely ‘mailings’ to our membership and their families.
  4. 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)
  5. ACCELERATE OPPORUNITIES for the professional growth and development of our colleagues and profession
  6.  ADVERTIZE (ethically) our  joint successes and maintain  AWARENESS  within our profession of all the modern trends and practices AVAILABLE   and  ACCESSIBLE  to them
  7. 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.
  8. 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:

  1.  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.
  2. 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

  1.  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.
  2. 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!

  1.   excellent   (healthy)  maj!
  2.   excellent  (HealthY)  profession ( MEDICINE)!
  3.   excellent  ( healthy)  doctors!
  4.   excellent ( Healthy)  patients!
  5.   excellent   (Healthy)  nation!