Speeches in the National Assembly

APPOINTMENT OF A COMMISSION OF INQUIRY TO INVESTIGATE THE INCIDENCE OF ILLNESS AND DEATHS IN THE BARIMA-WAINI REGION OF GUYANA
Dr. Ramsammy: Thank you, Mr. Speaker and all Colleagues. I would rather that we did not have to have a motion like this in this House. I would have rather that the circumstances that have caused such a motion had not occurred. The truth is that this Government and any government in this country and all of us, have committed to, and we should try to ensure that no baby dies of preventable causes. That is our national aspiration, our national strategy, and that is the global strategy.
We have not been able to achieve that aspiration in any country in the world. Nonetheless, it is an aspiration that we must continue to strive for. Indeed, in our own national policies, we have said that by the year 2025 we would have hoped that there would be no baby dying of preventable causes. Indeed, we have worked in Guyana, in the region and around the world to ensure that diseases like acute diarrhoeal diseases do not cause any death. That is something we have worked for.
It is true that most of us, Guyana included in the Caribbean and indeed all of the CARICOM countries, including Haiti, have, over the last two decades, reduced under-five deaths dramatically. In Guyana, it is very dramatic. Under-five deaths, in 1990, were over 2,600 and now it is just over 200. Just over 200 are too many; we should know that, but there is the story of a dramatic reduction.
Indeed, the vast majority of them, if we look at five year periods between 1980-1985, 1985-1990, 1990-1995, you would see that approximately 2,600 deaths annually have been reduced over a period. By now, we are just over 200. Most of those under-five deaths in Guyana and around the world, the number one cause, if we take it country by country, including in African countries where AIDS cause a number of deaths among under-five children, by country, region and globally, is acute diarrhoeal diseases. More than 33% of under-five deaths are caused by acute diarrhoeal diseases. Do you know what the tragedy is? Firstly, we know how to prevent it. Secondly, we know how to treat it when it occurs. The fact that we are still dealing with this as the number one cause of death demonstrates that in spite of our knowledge and in spite of the tools we have, we have not been able to totally prevent acute diarrhoeal diseases and to totally prevent deaths by acute diarrhoeal diseases.
The truth of the matter tonight is that there were three children who died. All of us in this country should feel a sense of loss and should feel diminished by that fact. So, this evening, as we debate this motion, I would hope that all of us in this House and around this country are not only sympathetic to those families, and are not only concerned, but would want to ensure that it does not happen again.
Let me just say this to the Hon. Member Brigadier (Ret’d) Granger and to all of our Colleagues that I believe all of us in this House support that first Resolved Clause that we express sympathy. I know for a fact that the Minister of Health, on several occasions during that period, did express sympathy. I heard him say that. I know that the media asked me about this and I expressed sympathy to those families. Tonight, I think we have an opportunity, all of us, in solidarity and in unity in this House to express our sympathy to the families.
I am not going to try to figure out the motivation for bringing this motion. It does not matter to me what the motivation was. What is important is that the motion seeks for us to answer these questions: What were the causes? What could we have done to stop it? What must we do now so that it does not happen again? This is where I believe, Colleagues, that the motion calling for a commission of inquiry is a little bit premature. We need to first exhaust those mechanisms that are in place.
Hon. Member George Norton knows very well that this House passed a Bill that is now an Act called the Ministry of Health Act. The Ministry of Health Act has a regulation that establishes an expert panel that is automatic. It is automatic. First of all, within 24 hours of the death of a child, an expert panel must be convened. I do know that that expert panel was convened. I would want to think that this House would want to examine that report.   [Mr. Greenidge: So, where is it?] Well the report is there and we can ask. Maybe the shortcoming of the regulation, Mr. Speaker, is that we did not require that report to come to the House, but there is nothing to stop any Member of this House to ask for that report. We do have a social sector Committee, a standing Committee, that could enquire into this.
I am just simply saying that I would have rather explore and utilise those mechanisms in place so that we could not only examine that report, but that we could, through our standing Committee of Parliament, decide whether the report did not go far enough and ask for further inquiries. I think that this House should utilise all the mechanisms at our disposal before we go outside of this House to find answers. If that were the case, I would support it. I would support going further if we are not satisfied after utilising all those. I think that any time a child dies, we should want to have all of the mechanisms we have in place utilised and examine those reports.
Mr. Speaker, the truth is that there is a mechanism in place, one to prevent these things from happening and, two, to respond when, in spite of our best efforts, we still have illnesses and so on. One important step is establishing the epidemiological surveillance system which is in place. We would recall and I believe the dates would be in 1992, because the Hon. Member, Ms. Gail Teixeira, became Minister, I believe some time in October 1992 and inherited a situation where a cholera outbreak across Central America and South America actually entered Guyana. It entered through the Venezuelan border into Region 1. In fact, the young doctor then, who was the Regional Health Officer (RHO), I believe, at the Mabaruma Hospital, is now the Chief Medical Officer in Guyana, Dr. Shamdeo Persaud.
A surveillance system evolved from a weak system which we had. Since then it has been built up more and more. Layer upon layer have been built. I know that when I was at the Ministry of Health, and I know still, there is a surveillance system that has daily, weekly, monthly and quarterly reports. There are certain diseases that have daily reports. One of them is the acute diarrhoeal diseases. We have daily reports on this for every health centre and for every hospital. So, for every community we have a baseline. There is diarrhoea in developed countries, in developing countries and so on. It is not like you can ever totally prevent it from happening. There is a baseline. Given the various conditions that exist, there is a baseline. An outbreak is when you deviate from that baseline upwards. Even an addition of one is a deviation. When that happens, there is a heightened alert that causes us sometimes to do more than one check per day. So, we keep checking by the hour. That is a system that is in place that allows us to detect what is happening. The Minister has explained and I am not going into those details. The reports would have gone into those details to show whether in fact those early recognitions of an outbreak did occur.
These are systems that are in place. Indeed, it is not only that; we have identified over the years from experience, for various communities, what kind of infectious conditions exist during rainy seasons and during dry seasons. During the time that this outbreak occurred, it was a dry period when the river water was actually low. There was concentration of certain viruses. Indeed, whilst there were tests that demonstrated a presence of Escherichia coli (E. coli), there was, in fact, a high level of rotavirus. We all know that one of the major causes of acute diarrhoeal diseases in Guyana is not E. coli, though E. coli also contributes; it is rotavirus. Rotavirus accounts for approximately 30% to 40% of all acute diarrhoeal cases in children.
In Port Kaituma, in fact, because I read the report, the cause of the disease in that outbreak was rotavirus. The newspaper reports that gave you that impression did report E. coli. The official testing demonstrated rotavirus. Mr. Speaker, I do not want to go down to that detail. The truth is that whether we are dealing with Nigeria, Rwanda, South Africa, Grenada or Guyana, rotavirus is a major cause of diarrhoeal diseases.
Whether it is E. Coli, clostridium difficile or rotavirus, there is one important treatment which is what our Colleague, Hon. Member Basil Williams, kept talking about - salt-sugar solution. We all know that one of the critical elements of protecting our children is to have ready supply of ORS. Indeed, these supplies are available at all of our health centres and hospitals. They are not always utilised by the personnel. It is a struggle that we still continue to make sure that the health personnel are effectively utilising ORS.
Indeed, in instances of outbreak, we make sure that every family has ORS in their homes. We provide that supply. One would recall, Mr. Speaker, in 2005 during the massive flooding which was the perfect condition for acute diarrhoeal diseases, the United States Centers for Disease Control and Prevention (CDC) came here and projected that there will approximately 750 deaths of children under five years old. Indeed, we had one. We had one, and not the 750. There are many Members in this House who helped us out. We distributed ORS into every family’s home around Region 4.
Mr. Speaker, we have, as a country, been building these systems, ensuring commodity supplies. The Hon. Member spoke of the water tablet and said that it only works with clear water. The Hon. Member is not aware, I think, that what we utilise is not the traditional water tablet. It is a product called ‘Pure’. Pure, in fact, is a product that Guyana worked very hard with companies abroad to develop, because it is meant to be used with exactly the kind of water you are talking about. It was meant to work as a flocculant. It removes all those ingredients and purifies the water. Those are the kinds of tablets that we use in those areas.
Clearly though, with all the mechanisms in place, on this occasion, we did have deaths and illnesses. We need, therefore, to recognise that as much as we are building the system, it still has areas that we need to strengthen. I think we should all accept that we need to strengthen it and find out how we are doing this.    [Mr. Nagamootoo: How many more deaths do you need to have that done?]
The truth is, as I said, that we have made progress in addressing child mortality. We have gone from a child mortality of 120 per 1,000 to now under 20 per 1,000. I think the figure is 16 per 1,000. That is progress, but, for me and for all of us, 16 should not be acceptable. That answers the question that the Hon. Member Mr. Nagamootoo is asking. We should be trying to bring that number down to fewer than 10. The truth is that no Caribbean country has reached under 10 per 1,000, excepting Cuba. That is because we are struggling still around the world to reach this target.
By 2010, three new vaccines became commercially available. Two of the three had relationship to the deaths of children from preventable diseases. One was pneumococcus PV 13 vaccine, which prevents infection by pneumococcus and, therefore, prevents certain kinds of influenza. That is acute respiratory infection...represent the second largest cause of death in our country and other countries around the world.
I am happy to say that Guyana is one of the few developing countries which have PV13 as part of our immunisation programme – one of the few countries. We may not yet reach 100% since it is a new vaccine.
The second vaccine of the three is rotavirus vaccine and I am glad that Guyana is one of the few developing countries which now provide routine rotavirus vaccine. This, more than the improvement of the health system, more doctors, more nurses and so on, help us to achieve this dramatic reduction in child mortality.
We are trying our best to ensure that we continue to improve the health of our children and, indeed, by 1990, the total number of deaths in our country was approximately 14,000 per year, total deaths of children and adults. The average number of deaths annually now is about 7,000. Part of the reduction comes from the fact that deaths of more than 2,400 children, who died in our country, are now being prevented because of all the things we do.
In spite of all of that, I think that the death of any child from preventable causes should be enquired into and that is why when we passed the Ministry of Health Bill, we put the regulation for an automatic investigation. It is not somebody who decided it must happen automatically. That is what happened in this case.
For those reasons, I believe that whilst we are supportive of this House expressing sympathy, I think that we should, therefore, utilise the mechanisms that we have at our disposal to enquire further into those deaths that we want to. I certainly do not have any objection to us doing that.
We can go into all kinds of other things. Dr. Norton talked about the pit latrines. We should endeavour, in this country, to sooner rather than later not have to utilise pit latrines. The other day I visited a community, Dr. Norton, that still has pit latrines but the community was not in Guyana; it was in the United States of America.   [An Hon. Member: Where?]    It was in Mississippi.
I am saying that we have to continue to strive because I would hope that I am still alive and active in trying to improve lives in our country when this country could say that using pit latrines is part of our history; it no longer exists. I think we are all on the same path. How we get there is something we can debate but we need to ensure that we are working together on this. I would hope that any maternal death or child death, all of which elicit an automatic investigation, one day we will have no more, no more investigation because there would be no death of children and no maternal death. That should be our aspiration.
I, therefore, urge that we utilise the mechanism at hand. I know that the Hon. Member and all of us can see the merit of utilising the mechanisms that we have, not only to look into the reports already available but have the sector Committee do what it is mandated to do and enquire further into the Ministry what has been done since in order to prevent another outbreak that causes death. I am sure there will be outbreaks but they should be short and should cause no death.
I urge Members for us to take a different route that would engage us first before we seek to have more extensive mechanisms in place.
Thank you, Mr. Speaker. [Applause]