COMMENTARY: The Forgotten
By Dr. Craig Stoutt, Contributor
In Article 1, I wrote about the front door of our health system. The clinic. The first place a Virgin Islander goes when something does not feel right. Today I want to write about what happens when a person cannot reach that door.
There is a category of Virgin Islander our health system has been quietly losing for years. The bed-bound grandmother whose family has run out of options. The elderly man who lives alone and has not seen a clinician in eight months. The mother caring for a son with special needs, who cannot get to the clinic because there is no one to watch him. The neighbour with diabetes who needs a wound dressed and is not strong enough for the bus. These are the forgotten. They are the people for whom the clinic is too far, the wait is too long, and the system has stopped showing up.
A strong health system does not wait for these patients to arrive. It goes to them.
That is what community health services are for. A nurse who knows the bed-bound patients in her district and visits them on a schedule. A clinician who runs a pop-up at the church or community centre. A team that handles dressings, medications, blood pressure checks, and mental health visits in a person’s own home. This is not luxury care. This is the basic spine of public health, and we used to do it better than we do now.
The reason this kind of care matters is not only compassion. It is mathematics. The patient who is seen at home, on a regular schedule, is the patient who does not arrive at the emergency room in crisis. The wound dressed at week one is not the amputation at month six. The blood pressure checked monthly is not the stroke that takes a grandmother away from her grandchildren. Community health is the cheapest, kindest medicine our health system has ever had access to. And we are letting it slip.
I have watched this happen for twenty years. Not because anyone decided to abandon the forgotten. But because the resources got pulled, the staffing got thin, and the home visits became a thing the system used to do rather than a thing the system still does. That is how good care quietly disappears – not by decision, but by drift.
It does not have to keep slipping.
A serious community health programme in the Virgin Islands looks like this. Public health nurses assigned to every district, with caseloads they actually know by name. A scheduled rotation of home visits for our bed-bound, our elderly, our patients with special needs. Standing partnerships with the churches and community centres where our people already gather. A clear referral pathway from the home to the clinic to the hospital and back. And the simple, radical idea that no Virgin Islander should be forgotten because they cannot get to a building.
I have spent my career inside the rooms where the forgotten eventually arrive – the emergency room, the intensive care unit, the operating theatre. I can tell you with certainty that almost every one of them could have been seen earlier, in their own home, by a nurse who knew them. We failed those patients before they ever reached me.
We do not have to keep failing them.
A nation is judged by how it treats the people who cannot speak loudest for themselves. Our forgotten patients do not march. They do not protest. They do not write letters to the editor. But they are watching. So are their families. So are the rest of us, who will all one day be old, or sick, or unable to reach the clinic on our own.
We can do better. We have done better. And we will.
In the next article, I want to write about a disease this country has also begun to forget – and what is happening because we did.
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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We used to say “an ounce of prevention is worth a pound of cure”. Short term savings often lead to long term costs. Well done Dr Stoutt, a voice for the forgotten.
When someone is unable to access that door, what happens?
For centuries, people have commonly regarded clinics, hospitals, waiting rooms, and offices as the hubs of healthcare systems. However, disease might deplete a person’s strength, mobility, freedom, wealth, or ability to travel to such locations. For many elderly and fragile individuals, just getting to an appointment can be a medical crisis in and of itself.
A woman with severe arthritis may require the assistance of three people just to leave her home. A retired diabetic may have to choose between paying for transportation and purchasing groceries. A bedridden patient may not see a nurse for months because no one is available to offer care at home.
And then what happens?
Behind closed doors, things quietly deteriorate. Blood pressure rises uncontrollably. Wounds get infected. Loneliness worsens depression. Families, already fatigued, are struggling to fill the gaps created by an overworked healthcare system. Many patients arrive at a hospital with manageable ailments that have developed into life-threatening situations.
The sadness is that many of these emergencies could have been avoided with a home visit, community nursing, low-cost medication, or reliable transportation.
What happens when the legs that previously carried a family through years of hardship become frail with age? What happens when proud, independent people become bedridden and rely on others for even the most basic tasks? What happens when the expense of treatment, medicine, or travel exceeds what a pension can cover?
Too often, the response is nothing but silence.
Appointments are missed. Illnesses worsen quietly in the house. Family carers feel overwhelmed and unsupported. Small medical issues become crises when help arrives too late.
Yet these are the same people who once carried society forward: our parents, grandparents, neighbours, retired teachers, labourers, civil servants, and caregivers. They spent decades contributing to their communities before finding themselves unable to access the care they now need most.
So, what happens when the door to healthcare becomes unreachable?
A compassionate healthcare system does not wait comfortably behind clinic walls. It reaches outward. It sends nurses into communities. It brings care into homes. It makes healthcare affordable, accessible, and humane.
Healthcare is accessible only if the elderly, disabled, and vulnerable can physically and financially reach it.
One day, any one of us could stand on the other side of that door.
And when that day comes, the answer we provide today will define the kind of society we choose to be.
If patients cannot reach healthcare, then healthcare must find a way to reach them.
Dr. Stoutt, Thank you for remembering the forgotten. Home visits need to be reintroduced into the health care system. Thank you for reintroducing this vital aspect of awareness. I hope it does not fall on deaf ears.
Another well written piece classmate. I know from experience that the schedule you referenced is not in place. They come today and then not for another 3 weeks because they “do not have a ride”! How? We are boasting strong revenues and cruise numbers. Where is the money going? #All13MG!!!!
Firstly, too little, too late.
Secondly, the management of the Public healthcare system from persons like yourself is atrocious.
YOU are intimately aware of the shortcomings and rank incompetence of the management of the Public healthcare system of the Virgin Islands.
Address the failings of the management then speak specifically to why we cannot recruit competent staff to provide these specific services. This, good sir isn’t a drift, this is intentional and there are physicians and nurses that have left the public system that can attest to this as fact!
I’ve Known Dr. Craig Stoutt for more than 25 years. He’s actually the best doctor I know!
Well said – thank you for caring