AmbergrisCaye.com Home Forums The Cayes Ambergris Caye The care and emergency treatment of Mr. Fred Somes

from the Chamber of Commerce....

The following email was received to better clarify the events that occurred in the care and emergency treatment of Mr. Fred Somes. The Chamber apologizes for any inaccuracies it may have reported:

Ambergris Caye Emergency Rescue

The minutes of the Chamber meeting on April 2 might have given a slightly incorrect evaluation of what happen on the morning of March 27th.

ACER had a First responder on the scene fifteen minutes after we received the call about Fred Somes. We had another 4 responders on scene with oxygen and IV supplies five minutes later. I knew who was supposed to be on call that morning, had his number and personally tried to call the Polyclinic Doctor. He did not answer after repeated calls. I then called another Doctor and after repeated calls he answered and came to the scene. I also called the other Polyclinic Doctor that wasn't on duty and he came to the scene.

The team knew we needed cardiac drugs and a monitor on the scene. There was a delay in getting what we needed even though we asked for them when we made the call to the Doctors.

Collectively we got Fred stable enough to transport him to Belize City. I personally arranged the flight with Tropic and he was moved in a little less than two hours after we got the call. There was no delay due to not having proper phone numbers. I have personally maintained a phone list of Emergency Phone Numbers for three years. It is available to anyone by email (scubawalk@aol.com) and I have personally delivered it to most of the Doctors around town. It would be helpful if the Doctors of San Pedro would enter these important numbers in their cell phones and carry them to calls outside their office.

This is not intended to be an indictment of any Doctor. They work long hours and don't get the credit they are due.

We do need a better plan if San Pedro is to grow and prosper in tough economic times. If we can't provide adequate Medical treatment on this island, tourists will travel elsewhere and local citizens will suffer needlessly.

Random thoughts about medical issues of San Pedro

1. Hold a quarterly government sponsored meeting of all Doctors on Ambergris Caye to discuss the ongoing growth of medical needs on the island.

2. First meeting to focus on Hurricane readiness

3. Create a plan to handle emergencies

a. Who can be treated on the island and who needs to be evacuated

b. What is the best way to evacuate based on type of injury

c. Available resources to provide transportation

i. Tropic/Maya

ii. Island Ferry

iii. Wings of Hope

iv. BATSUB

v. BDF

vi. Astrum

d. Doctors need to know the costs to evacuate - locals vs tourists - so the patient can make an informed decision as to how to handle their medical needs

i. Which Doctors know how to evacuate tourists back to their home country?

e. Should the Belizean Government set up a pre-arrangement with a Medical Evacuation service to provide coverage for tourists?

i. Provide consistent service at a fixed cost to tourists

ii. Evacuation insurance

f. Most Doctors on the island and the Polyclinic have been supplied with an excel spread sheet of all the emergency numbers. It would be a good idea for them to save the important ones in their cell phones so they will be available if they need them in an emergency.

g. Doctors who know how to use cardiac drugs and Nitro should have a supply in their homes so they respond directly to the emergency without having to go by their offices to pick them up.

h. AED's and monitors should be checked on a regular basis to make sure they work and the batteries are charged.

i. Oxygen tanks should be refilled and checked after each emergency

Dr. Wil Lala, who agreed to follow up on this topic last week, was in agreement with the above recommendations. He also found that a doctor who has been here for 8 years but was trained in Germany is finally approved to get her license to practice in Belize. She is an Emergency Care specialist and Dr. Lala is going to draft a letter to the Minister of Health to have her assigned to San Pedro to assess the emergency care needs of the town and the Poly Clinic as well as providing Emergency Care services.

The Poly Clinic was discussed because it has the facilities to be an emergency care center but it has not been set up that way. The Lion's Club funded the Clinic initially. It was suggested that the Chamber and the Lion's Club meet to discuss what can be done to make the Poly Clinic the Emergency Care Center.

And to think no one wants Belize-N-Us to move to San Pedro and help out...

Every community should have such a plan. Get er done.!

"It was suggested that the Chamber and the Lion's Club meet to discuss what can be done to make the Poly Clinic the Emergency Care Center."


Does this sound familiar?

Above recomendations are a good start. I would just like to add that expecting any of the doctors to be adequately supplied and bring their own supplies to the scene in a timely fasion is not reasonable.

The town should purchase a cart or van (personally I think ALL vans should be removed from the island) and transform this vehicle into an ambulance equiped with the basics to evaluate, stabilize and transport patients with medical emergencies.

In addition emergency responders would need to be trained and available 24/7 to bring this vehicle to the scene and properly utilize it in a timely manor.

The cost of the vehicle and needed basic equipment would not be very high. The largest expense would be the need to pay emergency responders to be on stand-by 24/7.

I personally will help any way possible with this effort.

I posted images of some medical cart examples in the photos section.

I am not an ATLS (Adult Trauma Life Support) instructor but I am ATLS certified as well as PALS (Pediatric Advanced Life Support) certified and could teach much of these coarses to the emergency responders if needed.

I certainly concur that a crash cart should be purchased, maintained and dispatched with the first responders. I also believe that an ATV such as a Polaris should be availalbe at all times for those first responders and at a minimum should carry one of the Phillips portable defibrillators and a full scale First Aid Kit along with mechanical devices for freeing a victim that is caught in a vehicle or structure. It would also be helpful if the ATV could be fitted with a stretcher that someone could be strapped down to so as facilitate transport for more definitive treatment. I have had a lot of experience in this area and would be more than willing to try and help establish some kind of system that would more effectively respond to emergencies.

What happened to the ambulance that Dr, Jeff had donated to the Island 5 or 6 years ago? Does anybody know if it is still here, does it need much in the way for repairs?

Haven't seen it for years...it was loaded with equipment and supplies that were purchased with funds raised by community fund-raising...and then parked and abandoned behind the school.

The ACER team has been doing a fantastic job as first responders, they are well trained and efficient.They are volunteers.
The problem is not so much as to HOW to get them there as to WHERE to take them.

Nurse Natalie has hit the nail on the head. The first responders have boats, trucks, atv's etc at their disposal via a network of volunteers - but the poly clinic isn't open 24 hours per day, the private clinics are open only during regular hours too. So if there is an emergency in the middle of the night a doctor must be located and willing to open up his clinic.

Again this boils down to money. When the private doctors open up their clinics to emergencies there is no guarantee that there will be a form of payment/reimbursement for the supplies utilized during the emergency. And yes this might sound very materialistic - but if the doctors can't pay their bills they are forced to close up shop.

The poly clinic is simply a clinic - not a hospital and as such is not fully equipped or manned to handle emergencies 24/7.

We need to work as a community to lobby the government and secure private funding etc to get the clinic converted into a hospital. This should be a high priority for the town.

And this may not seem "fair" but I believe that all of the doctors on the island should offer a few hours each week to be not simply available on call, but actually stationed at the poly clinic - and of course they should be paid for those hours of duty. Yet another doctor should be available on call in case of multiple injuries or illnesses.

In a town of 20,000 residents there should always be at least one doctor available to assist in emergencies or respond to illnesses.

We have plenty of wonderful folks that are willing to volunteer their time, vehicles etc. but these volunteers are not all certified and licensed physicians. Those that are qualified really do need to band together and figure out a workable system to support the town.

If we co-ordinate all efforts, monies and equipment etc into one central location we will attain the goal much quicker than if we continue with small, private, semi-equipped clinics with doctors that are often absent over weekends and holidays.

This is truly a dire situation that the towns people should be up in arms over.

Of course, there are a few other critical amenities that need to be addressed and it seems that slowly but surely each situation is beginning to receive the attention they deserve.

I personally know very little of what happened in the past but I think Nurse Natalie and Amanda (as well as others) are getting at the real issues here.

It might help if we get a partner somewhere in the US that could help us set up a true emergency response organization that we could then raise funds for. I think in this case we would also need a local doctor to take responsibility for managing the physician component of this undertaking.

I think the way to go is private funding for this as the government has enough fiscal burdens already and given the current economic climate the government is unlikely to be able to provide much in the way of funds.

I also believe that we could come up with a model that would provide ongoing funds for the emergency response organization through perhaps a voluntary contribution from our tourists. This would take a real committment from the hospitality community and would of course be ripe for abuse if we are not very careful but I think most tourists would be happy to donate $1.00 Belize a day per person to fund this.

For myself I would be happy to try and get a hospital or physican organziation here in South Florida to support us in this endeavor. I am also to provide some limited funds and my time to help move this along.

I have been talking to some folks up north of the cut about my concerns about medical treatment especially in the event of severe weather when water transportation would likely not be available.

I am newcomer to this board and I am not trying to insert myself into this situation for any reason other than trying to be helpful. I am only on the island about 1/3rd of the time but stand ready to help in any way I can.

Anyone feel free to contact me by email to discuss.

I doubt that "privately donated" funding will be steady enough or long term enough to adequately maintain a E.R. type facility on the island.

It's likely that many of us could find ways to equip the poly clinic with "private" or donated funds / equipment but like I stated previously, the biggest expense is having trained personel on site 24/7.

Without the Belize government's long term financial involvement this will be a difficult task to accomplish for sure.

Here in the US E.R.s are big money losers. They are expensive to operate and have very low collection rates (lots of free care). The reason our hospitals have them is 1) to provide true emergent care to our community 2) the E.R. is the source of as much as 75% of a hospital's admission rate.

Critical care is expensive. The costs will be less there than here in the US but long term, stable funding will be needed.

This goal can and should be accomplished. The island's full / part time residents and tourists numbers are certainly significantly high enough to justify this extra expense to the GOB.

A single central location with a medical transport cart and 24/7 "in house" emergency responders will significantly improve response time and improve survival rates. Local doctors could then rotate being "on call" and present to this location after hours when needed instead of having to open their own doors or present to the scene. One phone # and one phone call could then result in a faster response from the responders. The responders would then assess the patient and consult with the doctor by phone or simply ask the doctor to present to the central location (E.R.). And unlike here, if the "emergency" turns out not to be a "true emergency" then the responders would not be obligated to transport the patient or possibly not even involve the local doctor at that time.

If my help is needed I can be reached at the office M-F 8-5 US central time. I will volunteer my time to teach ACLS (Advanced Cardiac Life Support), ATLS (Adult Trauma Life Support), PALS (Pediatric Advanced Life Support) and NALS (Neonatal Advanced Life Support)if needed. I am not an instructor in these coarses but have been certified in all of them.

I may be able to locate some equipment and bring it to AC but I'm confident the equipment would be much cheaper if purchased in Mexico instead of here in the US.

Please call if my assistance is desired.

www.medicalcenterforyou.com
001-601-849-1918
tommy@tecinfo.com

Martin and Tommy thanks for your concern in this area. I have some friends that are on the new board of the poly clinic and I will pass your info along to them.

The government of Belize does have to provide certain basis necessities to its tax payers and medical care is one of these items. As is basic primary school education. We are sadly lacking in these areas and the public is having to meet the short falls - unfortunately when it comes to critical care lives are at stake. When it comes to schooling entire generations livelihoods are at stake.

Most likely the funding for an emergency room will need to be a joint effort from a number of departments of government. The ministry of health of course, but our big extra push will hopefully be from the ministry of tourism. Without basic health facilities we will be left behind in the tourism industry compared to other nearby nations.

Dr. John Gillis here in Halifax, Canada, emergency room doctor and medical director of Bandage International, the charity group of doctors and paramedics which has come for the last four years to teach emergency skills in Belize, including on AC/San Pedro.

I am sorry to hear that a bad event may have happened and hope that this renewed interest helps brings things together in a more coordinated fashion. We have been a partner in this endeavor by raising our own money and co ming to Belize to help a country and an island we love.

We have to date made 6 trips to San Pedro to teach the very skills referred to in this thread, having trained over 150 San Pedranos in first aid and CPR (with certification from our partner the Belize Red Cross), and in basic and advanced rescue. On our last trip, we trained 25 senior students at the high school to try and set a tone for the future. We have also worked to train the rescue team, and have brought equipment including defibs (one left with dr. dan and dr. tina), backboards,and more. We have looked into transport options (the ambulance rotted away a long time ago in front of the medical school) and are happy to fill a medical cart with supplies we have already on hand. We have had positive meetings with Mayor Paz and Minister Heredia regarding how to provide better and more coordinated emergency care on AC. We have even offered to look into having volunteer Advanced Care Paramedics and/or Canadian trained emergency room physicians be stationed on a rotating basis on the island.

My point is that this is not the first time these issues have been raised and there is definitely a willingness both on AC and among friends abroad to help improve this situation which is so important not just for the well being of Island residents but for the security of tourists who visit and thus the health of the tourism industry.

The issue seems to gain steam....held together by the great work of people like Dr. Dan and Dr. Tina, Nurse Nathalie, the crew at Island ferry, and many others... but then lose a bit of steam. Time to gain momentum and keep it moving. Time to get all the players in the room and find a way to make a system work... the San Pedro way.

We will be back in the fall, with whatever is needed... but the more people that can work together on this project, the better off all people in San Pedro... locals and visitors alike... will be.

drop me a line at johnmgillis@hotmail.com or check out www.bandageinternational.org

Cheers and see you soon,

John M Gillis,
MD, CCFP(EM)
MBA (Master of Belikin Acquisition)

I think it should be simple to put a plan together since this is nothing new and it has been done and continues to be done all over the world. The problem is funding.

You can always ask for donations but the problem is everyone asks for donations and that can fall out of favor.

You can ask the government.

You can ask the BTB, which is what should happen

Or you can find a way to have the funds generated through tax ($1.00 tax for every person that comes to Ambergris Caye paid via water taxis and the airlines should generate about $250K or more BZ per year. That should fund everything we need.

We need full time emergency responders. They should be setup like in the US in a place where they sit around and clean their vehicles and check equipment and train! That is all nothing else. They should not be diving they should not be construction workers they should be trained professionals.

without at least 4 or 5 full time employees and a vehicle as well as a station it is not possible to provide proper emergency service for a population of this size.

Of course this service would not be able to respond to emergencies 4 miles north or more in a reasonable amount of time so it is essential that a group of strategically located volunteers be trained and on call all over the island to assist and prepare for the pros.

The first step is to come up with a plan and then figure out what it will cost and then figure out where to get the money.

Maybe the GOB should tack on a 'Medical' tax to land tax for foreigners (the people that can afford it)? A land tax of $100 or $200/year is a steal for US, Canadian or European land owners. For those who own a $300-$500US condo/house what's a another $100-$200/year?? Maybe a little bit more to help educate the kids would be in order too.

I am completely with you until you get to the part about "what's another $100-$200/year??". I am not on board with this approach. If you want to approach it this way then let's just tax every non-Belizean say $10,000.00 a year or make that a month or a day. From my, admittedly limited, perspective the whole point would be to build a sustainable voluntary organization that can meet the needs of the citizens at the lowest cost possible. Also, since it has been mentioned that those 4 or more miles north would have to rely on volunteers I see no point in taxing them if they are to receive no services. I like the per person approach but I am against new taxes and if this could be accomplished via donations that would be preferable in my view.

I also don't believe that you need to duplicate the hideously expensive "sitting around the firehouse all day" approach. Plenty of rural communities that have much larger service areas are adequately served by vountary organizations. Perhaps a case could be made for a dedicated buidling such as a fire house etc. which could be used for training and to house the equipment (and of course serve a social function as well).

I had no idea that the island was the beneficiary of folks like Dr. Gillis. Here is a physician and organization that are, eminently qualified, already involved and apparently willing to continue helping in this situation. There is a level of committment and experience that we should not let get away. I am not sure but perhaps we could somehow combine Dr. Gillis and his organizations help with an educational aspect that would benefit everyone by training and certifying in some way people that work in direct contact with our visitors.

I can tell you this from long experience (and it was long ago as well) that any emergency organization depends upon three things. Planning, training and communication. Without these elements any emergency system will fail.

Let me know if I can help somehow other than rambling along here on this board.

only part i want ot make a small comment about is why do the tourists (me) have to pick up the extra $1, and not have the $1-2 be added into condo dues of owners? as tourists, we are already paying the 9% tax and a departure tax, and now one more tax?

it would personally irk me that i save my pennies for months to be able to get there, and then have to help support services for those who can afford $100K+ vacation homes (not to mention the 500K ones)in foreign countries when i never will be able to in my lifetime.

i've kept mum for years, and call me a socialist, but often it sickens me to see the amount of cumulative wealth on that island when people are poor and animals are sick and dying, the occasional tragedy occurs cuz no proper services are available, you cant drink tap water [i drink the water at some places i stay, but NO WAY would others - and i have NEVER heard a travel specialist tell a potential tourist coming for the first time that it is okay to drink the tap water] students can't afford a notebook and trash is strewn all over the place.

Not sure what the best way to do it is but I really think that some sort of fee for people who come to the island is worthwhile. There use to be a chamber fee of $.50 per tank. I am not proposing the fee for only tourists it wold be for anyone coming to the island local or otherwise. I go back and forth from this island more than any tourist and it would really not bother me. we are talking about $1 to help ensure that should there be a medical emergency you and anyone else on this island regardless of the color of their skin or economic situation will have a better chance of survival.

The overall problem is not the lack of people wanting to get involved or the lack of ideas or the lack of training. If you want to have professionals on standby with the equipment that will save your life you need to pay them. If you pay them properly they might actually stay for a while too. It is easy and all it will take is money.

OK sweetjane - you are a socialist but you can drink the tap water. At least I haven't had any problem with it so far. If you have to save pennies then that is your problem and not mine. I'll bet you have never lived the poverty and deprivation I have but I don't whine about it. I am not trying to pick a fight as it would be much better if we could get on with trying to find a solution but please keep the class warfare out of this (by the way how is it that animals are poor? Never heard that one before or rich animals for that matter).

TravelinMan1 has it right. Just put on a small charge (I would prefer voluntary) if that is the way to go. Just remember the reason there are not more people visiting Belize is because of the huge tax already levied against visitors using the international airport. The charge could be one that is autommatically added but with the stipulation that it is voluntary and it can be removed at the payor's request (sweetjane).

What I had in mind is not a "fire station" with trained personel on the clock just washing a golf cart during their down time.

I'm referring to an actual E.R. as the "central location". The need for the 24/7 staffing is because many of the emergencies will be brought to this location by: family, friends and volunteers who would rather rush the patient to this location rather than call and wait on the ambulance cart.

Yes, 24/7 staffing is expensive and at times is wasteful. But it is the best way to decrease response time therefore increase survival rates.

This E.R. should not be allowed to be abused and used as an after hours or "free" clinic for non-emergencies like here in the US. There a non-emergent case could be told to present themselves to one of the local doctors during regular clinic hours.

Volunteers would still play a major role but should not be exclusively responsible for the emergency medical care for a population of this size.

I don't think that tourists and condo owners should be the only ones "taxed" to pay for this service.

Martin - would you kindly share your emergency-organization qualifications with the readers of this board - methinks they would be impressed.

Yes you can drink the water, and the kids are poor in part because the taxes are already too high.

The second homes of our local politicians in foreign lands are much more troubling to me than the second homes of rich foreign persons on Ambergris Caye.

Saga is doing a great job with the poor animals and every dollar you donate goes directly to projects (IMHO).

Every time you levy a dollar in tax money you spend a significant portion of that dollar to collect, enforce and administer the tax.

I am surprised that some people here think the locals should be taxed even more! Those condo owners from the US and Canada are paying substantial taxes at home for the services they have, why not in Belize? I think most of the locals are just making it as it is and another tax would be unfair. Those of us who can afford to vacation in Belize, own condos or houses or have a profitable business there sould be able to come up with a little extra cash for the betterment of Belize. An emergency service will not run without cash.
The last time I used Goldson (March)the tax was $35.00US (or maybe $37)and that is on par with other airport taxes in the Caribbean islands I have been to.

It is the local's duty to ensure that the medical care is available - and it should be at the local's cost. The government should fund this via our tax dollars. Many of us make our income from tourists and we should protect them and keep them healthy and alive.

I think in most cases tourists and workers come to AC because of the added advantages of some basic services and amenities. There are certainly more places in Belize that actually offer a more realistic look at Belize then AC.

The cost of living here on Ambergris Caye is higher then any other place in Belize and there is a reason for that.

A $1 tax used for emergency services here on Ambergris Caye might do some of the following depending on the amount of cash it would generate (easy to determine by simply looking at the numbers).

- Implement an emergency medial service 24/7/365
- Implement an island security or policing service

Both of the above are needed and would make AC a better place for locals and visitors alike.

In regards to current tax levels they are very low at this time and if we want to have services they must be paid for. You can't expect people to work for nothing.

In regards to what should be done I will leave that up to more qualified people (doctors) but I would think that a combination of ER at the polyclinic and paramedic services working out of the same location would provide the assistance needed.

Volunteers are important but you cannot discount the value of full time employees who know:

- Where they are going
- What equipment to bring
- Have the transportation to get there
- Can respond in a timely fashion

Emergency medical services are just that. They must be rendered in a timely and effective manner. If you respond to a heart attack with a band aid you are not helping anyone. Training and equipment can be donated but paying someone every week requires an income stream.

If the price of your tropic ticket goes up by $1 and the price of your water taxi ticket goes up by the same amount I don't think anyone would notice.

By the way maybe the number is not $1 maybe it is .50 cents. I think someone could easily figure this out.

I have spoken with Minister Heredia and Mayor Paz about this issue numerous times. We have discussed many ways to improve the local fire service and medical care.

To organize a proper medical team/ER type situation one thing must be done. A local doctor needs to be in control and manage it. Medical facility, supplies, protocols, continuing education and other issues will constantly need attention.

Now let's bring in real world Belize issues. If a "tax" was raised to fund this, who collects, accounts and distribute the dollars?

So let's say a full time paramedic program was started, now what? Who writes their protocols, who is the base station contact, what legal issues are there?

I think an "EMS Summit" in San Pedro would be a good idea. Get the folks with the expertise to come down and meet with the local responders and put our heads together to find a workable solution. Is that a tax write off trip to SP????

And SJ, I get your points, like I have said before, sometimes the folks here on AC.com care more than the residents about certain issues.

A common theme on this board is that proposed condo and hotel developments are going to ruin AC. The aging population, who have the capital resources to buy their dream place in the sun, are the ones who place the highest demand on emergency health care. Most municipal governments charge development fees to developers to provide for the increased infrastructure required as a result of their developments. Of course, the developers include these extra costs in determining selling prices. While these tourist developments will not likely place an increased demand on the school system, they will certainly place an increased demand on medical, police and fire services. It only makes sense that the developers should foot the bill to provide adequate facilities. I believe that the South Beach proposal includes medical facilities. Ongoing operational expenses can be covered by tax revenue and/or user fees. I see no problem in the government attempting to pass part of the operating costs off on tourism if tourism is using the service. It's a delicate balance. Charge too much, and tourists go elsewhere. Don't provide adequate emergency response service, tourists go elsewhere.

Nice to see this topic continuing... a couple points:

1)"Just paying emergency personnel:: let's assume that the money can be found with taxation or donation (which is a big if...),

a)there are no paramedics in San Pedro that are trained to the standards those posting here would expect. The paramedics in Belize City are trained at a basic EMT level and there are very few. Having these people in San Pedro would mean training them somewhere else (very costly) or bringing them in an paying them North American Wages... expensive and politically difficult re: paying foreigners big bucks

b)paying physicians- there has long been a hesitancy to licensing foreign physicians for fear of them taking over and interfering with the ability of Belizean physicians to earn a living and maintain influence on what is rightly their system. This may explain why it took Dr. Tina 8 years to get a license if in fact she finally has one. This sentiment I can very much understand and has to be treated sensitively. We can't just pop in 10 North American ER docs and let them run and clinic where they bill whatever they want to fund the clinic... not gonna happen politically.

2)Taxation- big issue that I'm not gonna tackle fully but very tough battle to fight and also to make sure that $ collected for health make it to health. Money has a way of going into a central pool for general use and other purposes. I'll leave this one alone.

3)Having an ER- this is a laudable goal and one I would like to see happen but we are a many steps away from this, finances a side. A good start would be having someone on call, whether a local doc, a volunteer from away or whatever works. The staff simply do not exist to have an ER at this time. We came to Belize thinking just that but have spent most of our time training lay people in basic skills because that's who is around and looking to be trained and that's the level of training in the community. The model is that each time these people gain more skills and can do more. As we extend this, and more people come into help and work together, an ER may be viable but is not at this time.

Again, let's work together to make sure that progress continues on this issue.

And to Reaper... I would come down anytime and with our charity's president, Advanced care Paramedic darryl Chickness help to organize an Emergency Health Services Summit. Something we've thought about and a great suggestion by you!

Last time I checked on this issue Dr. Tina still did not have a license for private practice in Belize. This is posted NOT to be a negative comment about her but to simply point out the difficulty in getting outside doctors licensed for private practice in Belize.

I didn't take it as negative...u are correct.

I had proposed the island take over the fire service from the national brigade. I am able to bring FF's from San Pedro and put them through a 16 week training academy which includes EMT certification. They could also do "ride along" training for three or four months while being hosted by our local FF families.
It would be a start.

The only way to ensure that the funds are used properly is to keep them out of the hands of government. They should or would need to be privately managed by a commitee of some sort which should be accountable for every dollar (full disclosure).

There are a numbere of people on this island whom I would trust to make good decisions with those funds.

Have the meetings, determine the needs, make a plan, determine the cost, then figureout how to get the money!

what I don't want to see is a tax levied without the first steps completed. We need to know what it will cost before we speculate on what the tax might be. Maybe the BTB would simply cut a check. BTB gets funds from Tourists, locals and retirees. Most of the industry stakeholders have asked that more of the funds generated here on AC be spent here on AC.

What reaper just said is a perfect example of just how easy it would be to train these folks. This would also give a career to people who might not have one, whith the ability to earn a good living.

first, apologies for having my back up this morning. it's grey, rainy and 46* here, it was 7 am, and i am a woman - i ask for a l'il slack.

i saw mr. smith's very respectable creds before i posted.

i fixed my poor grammar.

i said condo [and HOA] fee, never increase tax to locals.

as a tourist, i would gladly donate 1 dollar (and prob more), as long as i felt there was a balanced fairness to it.

if u knew me, you would not be surprised that this year alone i have already donated to holy cross school, rc school, acccsd, and saga (twice), and decked a friend's son out in futball gear. i am not opposed to giving a fair share in any way.

so please do not think i'm some a-hole trying to start a class war, i'm just an [socialist] a-hole wanting basic services available for all.

Again, training and supplies are not the main obsticles.

Ability to pay for "in house" 24/7 responders is the issue. "Private" funds to fund this effort will be very difficult at best. An "optional" fee will also likely fail long term. Unfortunately I think that some form of mandantory contribution source is the only realistic long term funding answer.

I am involved on a very limited basis with SACNW which is a VERY worthy and successful effort to reduce crime and aid with medical emergencies in that area. The cost of this effort is going to be an on going long term problem. Initially everyone gives what they can but over time everyone's "donations" fade.

I don't see any other viable options outside of mandantory contributions to the E.R. effort. Who, when, how, how much and management are the initial answers we need to get this ball rolling.

Sounds like we have plenty of qualified volunteers willing to pitch in for training and supplies. Long term stable finance is the monkey on the back to be dealt with first.

I will help anyway I am able.

Although Amanda and Natalie are correct in their assessment of the emergency medical problems here, the solution is not quite so simplistic. Quick response is, of course, vital to good emergency care but so is proper medical equipment and the training of the doctor involved.
Emergency trauma care is an area of specialization and we should not expect the same results from a doctor who specializes in dermatology. I doubt anyone would retain a Corporate Tax Attorney to defend them in a Capital Murder case. The same goes for medicine. There are many disiplines of medicine but until we have all the necessary resources on the island to deal with traumatic emergency cases, I'm afraid this controversey will continue.
The Polyclinic was intended to be the panacea of emergency care here, but After a lot of money and equipment was donated by foreigners, we find ourselves with the same needs. Until the Polyclinic functions as intended and the "Docton On Call" is "On Call" and not on the mainland, we will suffer from the same margins of care.
Some of the doctors in private pratice here already donate many hours and their own supplies for emergency care without the expectation of compensation or even a simple "Thank You"!
The solution will not be easy but the core element is in place. The Polyclinic should have a doctor trained in trauma care, the necessary equipment, a patient bed, and a gate to the airstrip to facilitate the quick evacuation of a patient if needed. Someone should solicit donations of portable defibulators and supply every doctor on the island with such. All airliners that fly here have them aboard. Most hotels, schools, government and office buildings in the U.S. and Canada have them readily available. So should we!

P.S. Sweetjane, I've seen those claws out before ;-)

Maybe you'll also cut me a little slack when I get a liitle fired up here and won't let it go when I should.

I respectfully and completely whole heartedly dissagree with this "we need a trauma specialist to have a good E.R." statement. I bet you a coke or beer that most if not all of the local doctors would do a good job handling emergencies of all forms. Any additional training needed could be brought in by E.R. doctors (drdisaster) already on the board who I'm sure are instructors in these coarses for other doctors and have already stated their willingness to train these docotrs if any addition training is needed.

We are not trying to create a level III trauma center on AC. We just want a functioning 24/7 E.R. for starters.

again, i'm a peri-menopausal woman...what's your excuse?!

at any rate, this discussion is bringing out some very good ideas on all sides.

I don't make excuses, I just buy myself one of Pedro1's tee-shirts.

It might be good to take a look at what sorts of events constitute the bulk of SP's emergencies and to be sure an emphasis is placed on treating those things.

oh yea, and maybe stock up on Midol in local pharmacies

As is visible in my posts I agree that a long term sustainable income stream is needed and certainly running an operation of this magnatude (at least for Belize) will require it. I don't think it would be as dificult as you may think.

In the end the project for SACNW is a good example of what can be accomplished when a clear plan is set in place and responsible accountable people are in charge. I also agree that going forward our biggest challenge will be to continue to raise funds the way we have. It never ends and the more you have the more you want to accomplish.

Thanks for the support by the way.

Dr. Tom.. I would be happy to work with any of the local docs as friends and colleagues to help the ER system...to date we have enjoyed out work with Drs tina and dan. Because of the economics of medicine on the island, there is currently very little incentive for the docs, all of whom as far as I can tell are very competent, to work together and cover each others patients. This is an issue which in this system needs to be sorted out. Is there an available incentive to help these docs who are often run off their feet or can volunteers help them at night with no impact on their patient practice? It's a challenge that can be worked out... So what about the Emergency Health Summit?

When was the last time you visited the US and had free or minimal charge medical care? The US doesn't even offer that to it's own citizens! They provide emergency care and you get the bill after. That is all Belize has to do but to get to that point, as in the US, someone has to pay upfront... In Belize from what I saw the locals can't afford the extra it would take but those who come in from the US, Canada and Europe and buy condos/homes/set up business and make a profit OR enjoy the riches and beauty of Belize can afford to pitch in. They have paid at home, a place that has allowed them to make the cash so that they can enjoy Belize so why should Belize be any different? Would these people agree to exploiting their home country? If not then why agree to exploit Belize????

Who's exploiting Belize????

I would say the people who own a $300,000.00US condo or home and pay $100.00/year land tax. They see that there is no hospital or emergency care unit and that the education system is seriously lacking because of inadequate funding. What would they pay in tax at home???
If these people have a serious problem they get flown back to the States/Canada for care... what happens to a local? I may be wrong but to me it looks like they are forcing Belize back into a form of colonialism. They take what Belize can give and give back very little...

"Dr. Wil Lala, who agreed to follow up on this topic last week, was in agreement with the above recommendations. He also found that a doctor who has been here for 8 years but was trained in Germany is finally approved to get her license to practice in Belize. She is an Emergency Care specialist and Dr. Lala is going to draft a letter to the Minister of Health to have her assigned to San Pedro to assess the emergency care needs of the town and the Poly Clinic as well as providing Emergency Care services."

The Minister of Health is mentioned in the first post of this thread and never again. If a physician who finally got licensed has to ask the Minister of Health for an assignment to San Pedro, it seems the Minster of Health (is there also a Ministry of Health?) would be an excellent starting point for assistance in this endeavor. Yes? No? Why is that option not being discussed in lieu of bringing in US assistance?

I agree with Amanda. This is the government's job. Time to demand action on the government's part. Budget problems? Sorry, health care of the citizens jumps right to the top of the budget if the citizens demand it. Accept out-of-the-country assistance but don't let the government of Belize off the hook here.

Aren't there any government officials located in the SP area?

[/quote]
When was the last time you visited the US and had free or minimal charge medical care? The US doesn't even offer that to it's own citizens! They provide emergency care and you get the bill after. That is all Belize has to do but to get to that point, as in the US, someone has to pay upfront... In Belize from what I saw the locals can't afford the extra it would take but those who come in from the US, Canada and Europe and buy condos/homes/set up business and make a profit OR enjoy the riches and beauty of Belize can afford to pitch in. They have paid at home, a place that has allowed them to make the cash so that they can enjoy Belize so why should Belize be any different? Would these people agree to exploiting their home country? If not then why agree to exploit Belize???? [/quote]

In Europe - at least in the UK and France, free or very low cost medicine is available to everyone. Both my USA grandmother and stepfather have benefited from this and been amazed at both the quality of care and the price. My grandmother was visiting France and became ill on the plane arriving into the country. An ambulance arrived, she was treated on site by excellent paramedics and then transported to hospital and kept overnight. The total charge for her care was about $80USD. She was shocked and delighted at the quality and speed of the treatment she received. Even more so now that she is being used to milk the system by doctors in the USA. My stepfather, also visiting France, was injured seriously after falling through a plate glass window (my French grandmother had a habit of polishing her staircase just a bit too much). He spent a week in hospital enjoying the care of very cute (in his words) French nurses. That cost him about $120USD.

There are some very good health schemes in Europe, many of which provide free or subsidised health care to a high standard.

I would feel much better about this discussion if Fred was not in the Topic.
Is that to much too much to ask before this thing gets totally hijacked?

I don't have a lot of time but the tax issue with Goldson is not the departure fee that you pay when you leave the country but the tax levied as part of the airfare you pay when you purchase a ticket to Belize. Ever wonder why you can fly to Cancun from South Florida for under $150 round trip and the cheapest fare to and from BZE is at least three times that amount. The fact that you don't know about the tax doesn't mean you are not paying it.

This thread isn't being hijacked at all. I think Fred would want something positive to come out of his unfortunate death.

Now on to "locals". I assume by that term most here are thinking of poor folks living in shacks. What about the wealthy "locals"? There are many of them. What is their responsibility to improve the emergency healthcare on the island? If I owned a major business or hotel/condo development I think it would be my responsibility to help out. After all it is my life, or my family, friends or employees and guests that are at risk.

When a tourist in my town (and we get WAY more visitors than San Pedro) uses the local EMS they get free paramedic care from the FD and pay for the ambulance ride. We don't tax all of them upon arrival. My taxes pay for that service.

I think a great way to solve this problem is to meet with the local folks that are involved in the North and South Neighborhood Watch Comittees to see what their ideas and what is needed are. Then put the collective heads together of the folks here with EMS and medical training along with the island medical pros. Take inventory of what is available equipment and personnel wise. Address those items needed and training required. After a good idea is formulated present it to the GOB and the local business community for funding ideas.

A tourist ( I should say most) won't have a problem paying a nominal fee for EMS service provided. A proper system would be able to bill an insurance carrier directly. A "locals" payment could be worked out also.

Billing an insurance carrier is a lot more complicated than most people think. Most (but not all) group health plans will reimburse the insured for emergent care but generally won't actually pay the provider. Those with the foresight to purchase travel insurance should generally be covered (though some Canadian travel insurers are very stingy). The US "medicare" system won't pay for any care rendered outsite the US. We might be able to persuade some of the larger assistance companies to help us fund a level 3 or 4 center if it can prevent patients being evacuated (this would be on a cost benefit basis).

Oh, and I forgot to mention that the Canadian provincical systems are all over the place on paying for care outside Canada. They generally try to avoid paying anything but if they do pay it will generally be at a much lower level than you would expect.

Quote: In Europe - at least in the UK and France, free or very low cost medicine is available to everyone. Both my USA grandmother and stepfather have benefited from this and been amazed at both the quality of care and the price. My grandmother was visiting France and became ill on the plane arriving into the country. An ambulance arrived, she was treated on site by excellent paramedics and then transported to hospital and kept overnight. The total charge for her care was about $80USD. She was shocked and delighted at the quality and speed of the treatment she received. Even more so now that she is being used to milk the system by doctors in the USA. My stepfather, also visiting France, was injured seriously after falling through a plate glass window (my French grandmother had a habit of polishing her staircase just a bit too much). He spent a week in hospital enjoying the care of very cute (in his words) French nurses. That cost him about $120USD.

There are some very good health schemes in Europe, many of which provide free or subsidised health care to a high standard. Unquote

Take my word for it there is no such thing as free. It is just paid for differently in the countries you mention and other than on an emergency basis it is rationed. I assure you that you don't want to be of a certain age and need a certain treatment using the NHS of the UK. France is somewhat better in this regard but not much. Even Canada with it's system is a complete shambles with patients on gurneys in hallways for days at a time.

This is not to say that these systems don't have their good qualities but please don't imply that the US system is expensive and the others are free.

just a side note: here in my part of PA, i don't think EMS is nearly completely covered by our taxes (very high, in our county). every year we get a donation card for ambulance service. it is voluntary to donate.

every time that card comes, i think to myself: if it was my husband or mom that needed that ambulance, i sure hope they have the $$ to get here and help.

so, every year we give. end of story.

Yes Sir, I'm in for this "summit".

I will not be able to come until July this year. It would also need to be prior to the start of our American football season with our first game usually the first weekend of Sept. I have 2 sons who both play and I am not willing to intentionally miss any of their games. So if you guys would consider scheduling it between the first part of July and the end of August then I would like to be there and be involved in this effort.

Thanks

I'm not sure this is accurate information. On Feb. 14, 2009 @ 21:30 Dr. Danny told me directly that Dr. Tina was still unlicensed for private practice in Belize. I have also been told by Dr. Danny that she was trained in anesthesia.

Obviously she may have been approved since Feb 14, 2009 but this information needs confirmation directly from her or Dr. Danny.

This project is very much needed, but it will never see furition or be sustainable unless the Government of Belize takes an active role in implementing it. There have certainly been many generous offers of assistance from groups and individuals on this thread. Hopefully that expertise could be utilized by the Government, but the Government would expect to have control,and righfully so. This is a problem for all of Belize.
I am dismayed by the comments that expats who come here are in some way exploiting the system. If you look back at the many thread on this board, I think you will see that there are many people giving time and resources to libraries, schools, clinic, neighborhood watch groups etc. Please let's not make this a "them and us" thing. If we want to see this accomplished, lets keep that out of it.

I think the point I was trying to make (badly) was that it is possible to have a good health care system and emergency service provision that is affordable to all, even tourists and foreign residents.

From the positive words coming from people like TravelinMan, Reaper and others, I believe that a seed has been sown and their suggestions are sounding very positive and realistic.

I'm sorry Collyk, my post wasn't directed to your thoughtful post. I agree we can and should have an affordable service provision for all and some of the suggestions have truely been very realistic and worthy of consideration. I guess I would like to see the discussion remain postive, as that is the only way it can be accomplished.

I am happy to help in any way I can. I have done everything from running the US Air Force's Tactical Aeromedical Evacuation System (worldwide) to managing most of the emergency rooms in SW Ohio to running a business that dealt with all aspects of travelers healthcare including 24/7 operations center. I am on the island from tomorrow until 10th of May but probably won't be back until July sometime. If we can agree on a date I will do my best to adjust my schedule to be there.

July may be a good time to schedule the "summit".

It will need to be between July 8th and August 15th in order for me to be able to attend. Not that my attendance is critical to achieving this goal but I would like to attend and contribute to this effort.

"This project is very much needed, but it will never see furition or be sustainable unless the Government of Belize takes an active role in implementing it. There have certainly been many generous offers of assistance from groups and individuals on this thread. Hopefully that expertise could be utilized by the Government, but the Government would expect to have control,and righfully so. This is a problem for all of Belize."

Health issues know no season or vacation schedule. They are never scheduled for availability of volunteers. The only constant is the Government of Belize. It's not only their job, but they are always here. None of volunteers so eagerly posting mention a word about petitioning the government as well as coming to a "summit". Why is that?

It is assumed by me that IF a "summit" is scheduled that the local government officials WOULD attend and hopefully the national level health officials as well.

I don't think any of the "eagerly posting volunteers" expect to succeed without the local and national government agencies not only being involved but actually being in charge of this effort.

My personal interest is just to aid in getting this ball rolling and hopefully off the ground. Long term sustainability will require the GOB to be financially committed to this effort in my opinion. Whether it's the Town of San Pedro or whether it's the national GOB or a combination of both it the unanswered question.

In my opinion, there are only two ways an 24 hour ER and paramedic service will stay in business.
1. Operate it like a business and present a bill after every service. This will very likely not happen.
2. Get a group of community leaders and doctors around Belize and start petitioning the GOB for better health services. Along with private donations the GOB can keep things running they just need to get the ball rolling. I'm sure the GOB can scrape together enough cash if they needed to.

Its nice to see there are doctors and organizations around North America that would like to contribute, but without the GOB, its not going to happen.

Belize cannot adopt the French system and tax the Belizean people to death. 65% tax for small business owners is crazy! We cannot afford the US system either. A special product made just for Belize is needed. What that is? I have no idea.

1) organize a group of people to come together with some local and national government officials.
2) make a plan that will solve the issues on AC not nationwide.
3) get the plan approved and come up with a budget to make it happen.
4) figure out how to fund it.

We are not looking for a health care system simply and ER with paramedics.

As Joanne and others have mentioned we cannot reinvent the health care system here. I think we need to focus on the ER and paramedics for the island. Nothing more.

If anyone thinks that a tax on condo owners is going to make it happen they are going to be disappointed. There must be a relatively constant revenue stream and in the end it is feasible that the operation will fund itself. I don't think anyone will have a problem paying a couple of hundred dollars to receive the services and if people can't afford it we can just leave them on the side of the road! Just joking. the system will take care of it. The services are for everyone so they must be paid for by everyone.
Somebody make the 1) happen and I will be there.

I think the Town of San Pedro should be the government agency in charge of this effort.

I very much like the idea of an "entry fee" where every person arriving to AC pays a small fee which entirely goes into the E.R. financing. It could turn out to be as little as 50 cents per person to adequately fund a 24/7 E.R.

I don't think an extra 50 cent expense will deter anyone from coming to AC.

I agree 100%

I will help organize this meeting.

First question, can both travelman and dr disaster attend in July?

Will Thurston of lovey&thurston be on the island in July?

Will most or all of the local doctors be there in July?

Next questions:

Will the mayor, Mr. Heredia (sp?), chief of police, members of the town board mostly all be on the island in July?

Will the heads of the local neighborhood watch programs be local in July?

Please sound off to these questions when able.

I will start compliling a list of the people able to attend and try to establish a set date.

Yes for me and I suspect that with enough advance notice we can make sure that the government officials and the police OC and Neighborhood watch people also be available.

I left out Reaper, can you come in July Rich?

I will be on a couple of other adventures in July. I have full trust in everyone's abilities and will assist any way I can.
I think having Drs. Dan and Tina involved will also be a must. Also bringing the SPBA and the local airlines/Astrum/BDF Air Wing and BATSUB on board is a good idea.

Tom, Thurston will be in classes in July.

I think July or early August is a good goal.... Darryl and I will speak to our contacts locally and with the Belize Red Cross to see how we can help. Bandage International is quite pleased to help coordinate a summit and will bring some ideas as well as personnel that would fit the project... paramedics and physicians. I agree that this must be locally driven and that government and local docs are very important. As mentioned we meet each time we are around with Mayor Paz and with Minister Heredia when his schedule permits and their involvement is critical. A concrete plan to give them is even more important as noted by others.

Dr. Tom, let's get all the info before we move too fast but let's make sure we move. Maybe I'll give you a call tomorrow.. or call me 902 488 5445.

Cheers...

"that government and local docs are very important"

Actually, THE most important. The docs perform the actual patient care services. The governments officials provide the cash. Without the cash, their participation in meetings does not qualify as assistance.

They have go to Belmopan and request some monies now in lieu of a future bill appropriating monies on an ongoing basis from the GOB. That's their role.

They do that, then you got something.

not here to split words with ya skippy... "the most important" is accurate. The fact is that for whatever reason, these things haven't gotten done... those posting on this board including myself are simply looking for team work to help get an important project moving for everyone's benefit.

Point taken. I think you can tell that I'm trying to raise the bar on the definition of government assistance in this endeavor. You can throw mountains of voluteer effort at this but without even a molehill of government financial support, it won't last, IMO. Ongoing financial support from the GOB is the key. I mean, after all, how much revenue does SP and AC generate for the GOB?

There has to be a way for the financing to stay in place when the ruling GOB party changes. Politics is going to take a big role in this endeavour...

Many of you folks posting on here have a lot more experience in and of Belize, it's people, the government and the needs. In my humble opinion government involvement is often very problematic. Of course we would need at least the tacit approval of the local and perhaps national government but we should guard against this system becoming part of the spoils system.

It seems to me that whatever is done needs to be driven by the actual medical needs of the people on the island. It should include the folks in the North as well the South in addtion to San Pedro.

I think a useful model would be to analyse the medical needs and compare that to the actual capabilities we have and go from there. We should pay particular attention to existing referral and transportation practices. It is critically important to involve the physicians that practice on the island right from the beginning and they should be given every assurance that we will be endeavoring to help each and everyone of them succeed as professionals and economically. This needs to kept in mind at every stage of this project and in the design of the system that we hope will ultimately emerge.

In designing any system of medical care transporation is always a key issue as is communication but given our geography it is likely of paramount concern.

How the referrals are handled will be another major point of contention if not thought out and agreed to by all the physicians.

Someone needs to take the lead here and organize this first meeting. I think this is better done by someone that lives on the island, that knows the local political ropes and has a relationship with at least some of the local physicians.

Let me know as far in advance as you can and I'll do my best to be there and contribute to the best of my ability.

Good point Martin... I have sent a note to some of the ACER folks and some of the business folks who have been involved in growing emergency care on the island... and I know others are doing the same... the project def. needs an anchor. Good enthusiasm so far though!

GoB can do something - see news item below from Channel 7 / last night's news:


Healthcare in the Toledo District is about access, particularly for those thousands of residents living in far flung villages, across miles of unpaved roads. And that's what this clinic, the Isabel Palma Polylcinic in San Antonio Village promises to provide for those residents. The clinic has forty five rooms, complete with an Emergency treatment, Maternity and Nursing stations, nebulizing bays and consultation rooms. It is also outfitted with X-Ray and Lab services as well as a pharmacy.
It is part of the Health Sector Reform Project and is named after career nurse Isabel Palma, whose daughter Kamela Palma is now Belize's High Commissioner to the United Kingdom.

Tenitive dates for this meeting are sometime between July 19 and July 29.

If these dates are in conflict with with another important meeting or if anyone knows of a conflict that would prevent the local political leaders from being able to attend then please post the conflicting date.

Thanks

Copy of my note to one of the town officials.


Ersel,

Martin Smith (former head of the US Airforce medical emergency response world wide), Dr. John Gillis (ER doctor and medical director of Bandage International) and I are trying to organize a meeting with the local government heads of San Pedro in an attempt to establish a 24/7 ER facility on AC.

Tenitive dates are sometime between July 19 - 29.

Could you please forward this message to your mayor, Mr. Heredia, as well as any other government official and ask if they would be able to have a meeting about the need for 24/7 emergency medical care on the island?

Thanks
Thomas R. Blackledge, MD
601-849-1918
tommy@tecinfo.com
www.medicalcenterforyou.com

Dr Tommy, I will write your letter in a formal manner and then deliver the request.

Then I will follow up a week later.

Start getting pen to paper. Get some of the local doctors on board, talk to the Lion's and the poly clinic committee etc.

I know travelinman and I are willing to assist in co-ordinating down here.

Just remember - be realistic.

well said amanda...

I've requested this subject be on the agenda of SPBA's next meeting.
It's been raised at SPBA before - maybe the time has come for this to move to the forefront of that organization's agenda.
It's important to us all.

kudos to you all.

Diane, the big issue is long term financing.

Training, supplies and equipment are small obsticles.

Please approach SPBA with "how do we get this effort financed long term?" question.

Also a local leader needs to "spearhead" this effort.

Long term financing for public health care facilities is GoB's job.
If GoB can build a 45 bed clinic in Toledo it can staff a polyclinic here.
They have money!! It's how they spend it that the public needs to have a voice in.
When we allow GoB to sidestep it's job on AC we perpetuate an inequality that has been in place far too long.
AC is the rain-maker for this country. Gotta take care of it for the country to move forward.
IMHO SPBA and other groups should not try to take on jobs for which they are not qualified and for which they have no time - but exerting pressure on the right gov't bodies, informing public, and doing once-off projects where results are clear and measurable - that is something do-able.

Does anyone have information of how many people over a year needed this kind of treatment?

We got excuses 18 months ago of no money when we asked for more police protection on AC ...... but when a viable suggestion (BDF patrols) was made directly to the PM, it was met with an "Ok - yea we can do that". And GoB came through - it took a lot of private sector support and co-ordination (Rebecca, Tim, Cal and Amanda, Legacy, Captain Morgan's, and others deserve standing ovations for their contributions)
--- BUT the base/oversight of the operation was/is from GoB
BEcause of that, this program is now part of our infrastructure.
The brainstorming may yield some ideas about how to work with what we have - including existing budgets and personnel. If you keep that in mind something is more likely to happen.

I think there needs to be absolute clarity on who the potential patients are. Are you providing equal care regardless of ability to pay for ER care and transport, or are you looking to serve only those people that can pay for the best? I don't see a value judgment on either choice but it needs to be clear.

FYI - the much referenced Master Plan deals with land allocation for appropriate infrastructure - including health care.
I'll try to scan the page on infrastructure and maybe Marty can post it.

Pam's point is important - and so is information on the value and availability of decent insurance that will cover these things.

If we can replace the "have-a-bake-sale when there is an emergency" plan with a "get a group policy" plan, we would have part of the answer on funding.

SPBA can provide a model - we're business people and have workers and this could start a trend or at the very least solve a few problems for people we care about.

I'll work on details on that and make them available.

Pam, no doctor that I have ever worked with has ever performed a wallet biopsy prior to providing emergency medical care.

Emergency medical care is intended to be available to any person with a true medical emergency regardless of social status, religion, ethnicity, sex, age or any other categorization the patient may fit into.

The GOB is required to provide basic emergency medical care to critical patients regardless of whether or not the person has money.

Most certainly insurance and the ability to pay for care will need to be a factor that will be addressed at the appropriate stage of planning.

Most tourists tent to have travel insurance and would be able to pay for care that way.

Many people have insurance to pay for their care and should be expected to pay when possible.

The Belize social security system pays for health care.

At the moment we are discussing an emergency room - not a place to go after hours because you have the sniffles. I would imagine that if you have the sniffles you would be attended to, and you would have to pay for that attention.

The SPBA has been talking about tackling some of these issues but a few more business people need to join the board! Help!!

"Vernon and Francis Wilson immediately stepped forward and provided their personal credit card and were charged 8500.00 U.S.D. by the hospital."

Do you think a San Pedro Doctor could afford this?

You lost me here. Please clarify the point of this post.

I believe that is the amount they wanted for Fred treatment

In a private hospital they require money - at KHMH (Gov't hospital) they don't.