COMMENTARY: The First Door
By Dr. Craig Stoutt, Contributor
Before anyone reaches a hospital bed, they sit in a clinic chair. Or they don’t. That is where the trouble begins.
I grew up in Long Bay. I played the organ at the nearby Carrot Bay Methodist Church as a boy. I taught at music at the then BVI High School and Althea Scatliffe Primary before I ever put on a white coat. Long before I was a doctor, I was a neighbour. And I want to begin this series where the health of a nation really begins – not in the operating room, not in the intensive care unit, but in the clinic down the road from your home.
For nearly two decades, I watched people arrive at the hospital too late. Too late for prevention. Too late for the quiet fix that would have cost a fraction of what we spent saving their life. Nearly every one of those stories traced back to the same place. The front door of our health system was closed when they needed it open or rather they were unable to hear the message that was relatable to them.
That front door is primary care.
A clinic is not a small hospital. It is something different, and in many ways something more important. It is where a nurse knows your grandmother by name. It is where a doctor notices a blood pressure creeping up in January and catches it before it becomes a stroke down the line. It is where a man who would never set foot in a hospital will quietly ask a question that saves his life.
Primary care is the slow work. The patient work. The work that does not make the news. And the work that decides, more than almost anything else, whether our people live long and well.
Right now, across our territory, the first door is harder to reach than it used to be. In Virgin Gorda, our people wait in a facility that has needed serious attention for years. In Anegada, families wonder whether the clinic will be staffed on the day they need it. In Jost Van Dyke, a serious case can still mean a boat ride to Tortola in weather nobody should be travelling in. On Tortola itself, district clinic hours have tightened, home visits for our elderly and others with chronic illnesses have thinned, and the wait for a simple appointment can stretch into weeks.
This is not the fault of the nurses and doctors inside those clinics. They are working with what they have, for the people they love. The question is whether the country is giving them what they need to do the job.
A blood pressure caught in a district clinic is a prescription and a conversation. A blood pressure caught in the emergency room is an ambulance and a hospital stay. Early is cheap and kind. Late is expensive and cruel. A country that wants to take care of its people designs its health system around that truth.
A strong primary care system in the Virgin Islands is not a mystery. Clinics in every community with hours that fit how our people actually live. Home visits for our elderly that happen on a schedule, not on a promise. Screening for the conditions hurting us most, done as part of ordinary care.
These are not miracles. They are choices. Other small nations have made them. We can too.
Our health begins at the front door. If we want a healthier country, we have to keep that door open, staffed, and close enough to home that our people can find it in time. We are a people who have always taken care of each other. Our turn is to build the system that matches who we already are.
Dr. Craig Stoutt is a Consultant Anaesthesiologist and Intensivist with more than twenty years of service in the Virgin Islands health system. On Our Health is a five-part series on the state of our health and the country we can still build together.
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Good and to the point. No fluff. No skirting the issues. Written like a true educator.
Thank you for your service Dr. Stoutt.
This could be a very interesting series, provided it does not devolve into the familiar exercise of surface-level blame assignment directed at one individual during an increasingly heated political season. What is needed is not a convenient villain, but a serious examination of root causes and, more importantly, workable remedies.
The real questions are straightforward: What are the actual issues? Who is responsible for the day-to-day operation of healthcare? Who sets policy? Who is responsible for ensuring that policy is executed? And when those policies are not carried out, what corrective mechanisms exist to address failure and restore accountability?
Healthcare is far too important to be reduced to a convenient political instrument or an arena for partisan point-scoring. Anyone who chooses to use it that way deserves to have their genuine concern for the welfare of the people of this Territory called into question. Serious problems require serious analysis, not campaign-season theatrics
Cure to any sickness is by fasting or eating less , and praying. Body is driven by H2O meaning water , drink more water with alkaline base, we also vibrate on different frequency, meaning what we think we will attract at some point.,,Ome example is the company you keep, you eventually over time start to think and act like them over time, like people who gossip, where adultery and fornication is a norm, and objects , house phone that replaces God as an Idol, so to sum it up , wage of sin is death, and way of the Lord is life in Jesus name.Amen lol ;
Right on point.
Hope the message reach the deaf ears that control the purse strings of the country.
Great read. Thanks for speaking up Dr. Stoutt.
I like where you went with the proactive prespective of clinics and the cost. I hope that in further commentary you explore the role that the individual plays in diet and preventative care , which is a part of the proactive piece.
…note that those choices start early to engrain healthy habits. Our schools therefore play an essential role in shaping our diet and our lifestyle. Everything is connected! I just watched a documentary on Japanese schools where from kindergarten they have a Nutritionist in schools and kids are taught healthy eating habits and are provided with healthy meals while at school.
Early childhood nutrition is one of the clearest examples of how politics can get in the way of common sense. When Barack Obama was president, Michelle Obama pushed for healthier school meals through her healthy kids initiative. Instead of focusing on the goal—making sure children had better nutrition—many Republicans pushed back by arguing that it interfered with parents’ rights and freedom of choice over what their children should eat.
Fast forward to Donald Trump returning to office, and we see many of the same ideas being presented again, only with different branding and stronger messaging around school choice and “Make America Healthy Again.” The policy may look different on the surface, but the basic goal—healthier children—is largely the same.
The conversation shifted away from helping children and toward scoring partisan victories. That is way we must not play politics with this essential social service of Health.
A great read, Classmate. I look forward to reading the other articles in the series.
I remember growing up in the 1st District and having 2 clinics that were open, staffed and serving the community. Today, those clinics are a far cry from what they were in the 80s. What happened to set us back in this way? Not to introduce politics here but the party in power’s slogan is Forward Ever, Backward Never but if we are honest with ourselves in this country, we have regressed significantly in so many areas. Did this Government meet problems? Yes, they did. Did we vote for them on the promise that they would address them, Yes we did. Have we seen those meaningful changes we voted for? NO! In fact, things have gotten significantly worse. May we vote wisely at the polls for the upcoming election. We owe it to our children and theirs.
Remember this comment. This is one of the candidates he is smartly coming forward, introduction to the public. It’s not a bad entrance just revealing the intention of the introduction is all