Caribbean SCI Congress 2018

1. Caribbean SCI Congress 2018 Policy andprovisionforinclusion. C.H.S. (Joe) Alcala, MD. Ministry of Health, Environment and Nature. September 28th 2018. “Accessibility in BroaderPerspective’’

2. Content of presentation: • Global view; • Definition SCI; • Impact and cause; • Data(?); • Policy and Provisions; • Where to start; • Recommendation for action; • Inclusion; • Looking forward.

4. Feels like PARADISE!

5. Trouble in Paradise??

6. Structure of Care. HNO open in 2019 or 2020? Sint Elisabeth Hospitaal founded 1855.

7. Spinal Cord Injury (SCI). Definition: “all lesions to the spinal cord, conusmedullaris and caudaequina” International perspectives on Spinal Cord Injuries, WHO, 2013.

9. Consequences in three areas of functioning. Impairment: Problems of body function or alterations to body structure (paralysis or loss of bladder and bowel control). Activity limitations: Difficulties in executing activities (walking or eating). Participation restrictions: Problems with involvement an any area of life (employment or transportation).

10. Classification. • International Classification of Functioning, Disability and Health (ICF): • - Health condition (disorder or disease); • - Body functions and structures; • Participation; • Activities; • - Environmental factors; • - Personal factors; • Contextual factors.

11. Type of SCI. • Traumatic: • Traffic accidents; • Violence related (gunshot wounds); • Work related (working on heights and mines); • Falls; • Sport (fighting, gymnastics, Rugby, American football). • Non traumatic: • Communicable diseases (Tuberculosis and HIV); • Non communicable conditions (Cancer, degenerative diseases, cardiovascular disease); • Nutritional deficiencies (neural tube defects, Vitamin B12 deficiency); • Complications of medical care.

12. Local Data?

13. Number of road accidents.

14. Registered vehicles.

15. Legislature? • Road safety (P.B. 2013 no. 41 GT Wegenverkeersverordening). • Article 22. Use of alcohol and other substances. • Excessive alcohol use is defined as: • - More than 220 microgram alcohol per 1 liter expelled breath; • More than 0.5 milligram per milliliter blood. • Articles 45 – 48. Speedlimits. • Article 78. Restaints (seatbelts, child passenger restraints). • Article 79. Helmet use.

16. Policy and provision. Policy: A plan or course of action, as of a government, political party, or business, intended to influence and determine decisions, actions, and other matters. Provision: Usually entails an act to ensure the realization of a policy. Financial (regulation of tariffs, subsidies, funding), ensuring capacity or formulation of laws.

17. Local policy on SCI.

18. How To?

19. Where to start?

20. Recommended areas of action. Primary prevention programs. Strengthening the health system. Raise awareness. Define priorities for research on prevention of SCI. Involve all relevant sectors and stakeholders. Encourage collaboration. International perspectives on Spinal Cord Injuries, WHO, 2013.

21. Primary prevention programs in health care.(1) Communicable diseases: Screening for HIV in at risk groups and treatment with HAART. Non communicable diseases: Prevention of neural tube defect by folic acid supplementation in pregnancy. Aggressive screening for and treatment of cardiovascular disease.

22. Primary prevention programs in health care.(2) • Core Government business. • - Ministry of Health, Environment and Nature understaffed and disorganized; • - No Public Health law; • Health finances go to care, not prevention; • No intersectoral approach. Result: - Health professionals and institutions are on their own; - Activities and funding goes to private organizations; - No coherent and sustainable approach; - Little to no data available to assess impact.

23. Strengthening the health system.(1) • Health coverage. • BVZ (since 2013): • More than 90% of population is covered (148.360 as per end 2017). • Includes primary care, laboratory and radio diagnostic tests, hospitalization, revalidation care, dialysis, assisted transportation, palliative care and referral for specialized care abroad. • - Total costs in 2017 of Naf 506.9 Million (Hospitals 149.185 Million, Rehabilitation 3.939 Million, Home Care 10.501 Million and GP’s 29.907 Million). • “Jaarverslag SVB, 2017.”

24. Strengthening the health system.(2) • Health coverage. • AVBZ (since 1997): • -Special fund for the costs of chronic care; • For physical, mental and psychiatric disabilities; • Applications are evaluated by an advisory commission. Evaluation? Supervision?

25. Strengthening the health system.(3) • Actual care: • - Should be timely and appropriate (post crash assistance, trained professionals, prompt intervention and accessible rehabilitation); • Coordination essential for enhancing effectiveness and reduction of costs; • Guarantee supply of appropriate assistive technology and health products.

26. Raise awareness. • Ministry of Health, Environment and Nature: • - Has no formal department or campaigns at this time; • Two communication officers; • No information strategy or priorities defined; • No (SCI) materials developed; • No separate funding available. New “Wellness foundation”?!

27. Define priorities for research on prevention of SCI. Epidemiology department: - four members of which two Epidemiologists (1 Medical Epidemiologist); - since 2010 unclear positioning within the Ministry; - salaries are paid but no budget available for activities or research; - still important monitoring of communicable (“syndromic surveillance primary care” and “HIV monitoring”) and non communicable disease (“Curaçao stroke questionnaire”) ongoing; - collection of mortality data ongoing. Roleand positioning VIC (Volksgezondheids Instituut Curaçao)??

28. Involve all relevant sectors and stakeholders. • Multisectorial approach: • Health; • Ministry of Health (GMN), Institutions of care, healthworkers, NGO’sandpatientorganizations, insurance companies etc. • Infrasctructure; • Ministry of Plannificationand Urban Development (VVRP), Labour Inspection (SOAW), constructionand development companies etc. • Industry; • IndustryandBussinessassociation, labourorganizations. • Sport andEducation. • Ministry of Sport andEducation(OWCS), Sport federationsandorganizations, Schools andafter school care.

29. Encourage collaboration. Benefits: - Create platforms in whichall relevant stakeholders canparticipate, ta assurecontinuing information gathering of prevention and action programmes\plans. - Avoidunnesesarywastage of limited human, infrastructuraland financial resources. Whowill lead?

30. Policy andprovisionforinclusion. Inclusion: the action or state of including or of being included within a group or structure. Op 10 mei 2017 tekenden de partijen PAR, MAN en PIN het regeerakkoord: 'Ontplooien van Curaçao’s potentieel’, een regeerakkoord met speciale aandacht voor onderwijs, vorming en armoedebestrijding. “Het regeerprogramma is de uitgangspositie van deze regering en is richtinggevend om een inclusieve samenleving met een goed ontwikkelde bevolking te creëren, waar actief burgerschap en duurzame ontwikkeling vanzelfsprekend zijn.”

31. So what are we waiting for? Waitingisn’tpunishment. It’s preparation!

32. “There are those who look at things the way they are, and ask, why? I dream of things that never were, and ask, why not?” Robert Kennedy “To accomplish great things, we must not only act, but also dream; not only plan, but also believe.” Anatole France

34. “Vision without action is merely a dream. Action without visionjust passes the time. Visionwith action can change theworld!” Joel A. Barker Thankyouand have a succesfullcongress!