Speeches in the National Assembly

Minister of Health [Dr. Ramsaran]: Wellness Warrior T-shirts.
Mr. Speaker: Thank you very much.
Dr. Ramsaran: Mr. Speaker, thank you for this opportunity to address us on this significant issue of the health sector and concerns that might have been raised by the Opposition benches.
First of all allow me to congratulate the Minister of Finance for a well presented Budget, well crafted. At the same time allow me to congratulate his hardworking team. I know many nights I was summoned by his staff to go to that building at upper High Street to help them craft the budget or liquidate queries they might have had while they tried to create a document that would have reflected accountability and continuity. This budget - and a budget is a costed plan - comes in the wake of last year’s Budget which did certain things, for example, laying the foundation for us to bring around radical change or continuation of changes already started in the health sector. In other words, we are thanking the Minister for a budget which dove-tailed or synchronised with our previous efforts.
I do note in the social sector that the Ministry of Education now has a little adage over us. In the past years, the Ministry of health and the Ministry of Education were running neck to neck. So I congratulate too the Minister of Finance for recognising the good role that another social sector is playing. I am not unhappy or jealous I am happy that he education sector is so endowed because health is not only run by the Ministry of Health. We have been benefitting remarkably Mr. Speaker and Mdm. Minister from the input of a better and better cadre out of the education sector into our training programmes. So I am quite happy that although we are not significantly increased we are adequately increased from the $17-plus billion we had to the early $20 in the billions. That will allow us some room to address certain new issues and challenges while at the same time looking on gleefully as our sister ministry, the Ministry of Education, continues to produce cadres that we need for our training programmes. The point that I am making here is that this is a budget, a plan, and it must not be looked at in isolation.
Similarly, before I get into the health sector directly I would like to look at other things which we should not look at in isolation. For example, our pensioners will be better able to perform because they have a little ‘toupse’ in the addition to their pensions. At the same time pursuing the theme we must not look at things in isolation, we must look at their subsidies in electricity. At the same time we must look at the moneys their grand children would be getting to go to those better run schools by the Minister of Education. In other words, I want us to look at this Budget as an integrated whole. I would like, for example, to note that the Ministry of Health also benefits significantly from another Government of Guyana body or national agency, the University of Guyana (UG).
The University of Guyana over the past few years quietly, unsung and sometimes unrecognised, has been adding significantly to the cadre of qualified health workforce. I note in the Budget on page 40, paragraph 4.76 that significant sums are added to help that sister body, the University of Guyana, grow and improve. I welcome this because we too, in health will benefit. Later, if time permits, we will see how it integrates into my contribution because I will be wanting to speak to you about the post graduate programmes the Ministry of Health, the University of Guyana, and the Government of Guyana are crafting so we can ensure, not only professional progression of our graduate doctors in Guyana, but at the same time better, more specialised services, from those upgraded doctors to the patients.
Let me continue to congratulate the Minister for this well crafted document and now turn to some things more specific to health.
The Ministry of Health relies on the input of several other partners. I think it was my colleague Mr. Hamilton who referred to the term the social determinants of health. The Health Ministry for example will depend on the integration and support of the Ministry of Local Government, the Ministry of Amerindian Affairs and I mentioned the Ministry of Education. For example there is the misguided impression that suicide is the purview, the remit of the Ministry of Health. Suicide is a very complex issue and the Ministry of Health is happy to play its part – I should say unhappy to play its part in this event - because usually we come in contact with the suicide victim or attempted victim at the end of a chain of events.
So that is the theme I am pursuing, that we need to look at health as a more complex manner. That is why, am I am picking out this subtheme on suicide so as to illustrate this point, the integration of the budget and how it helps many other sectors to help the health sector. We see depression, for example, as one of the underlying causes but there are other social factors that lead to suicide. As a result, the Ministry of Health recognised in the past few years that mental health needs to come more closer to the front burner and get on the front burner, as for example some other areas of health we have some concerns of – rehabilitative medicine. I would like the media and the audience in the gallery to note that this was very much publicised. The Ministry of Health conducted early in this year what it had said with the continuing education campaign, whereby some 150 operatives not only from the Ministry of Health but from the Prison service, the Police service, the Municipality, the Regional Government, the Private Sector, the Women Affairs Bureau, Women and Gender Equality Commission and other such bodies attended a session for those people who deal with the wider society on depression, because the Ministry of Health is  convinced this is a multi-tasked, a multi-disciplined approach and effort needed.
Here again I am bringing out to the goodly gentleman, Dr. Norton - and I am certain he knows better, but he was making some political points, pinching at the Ministry – suicide is not only the business of the Ministry of Health; it is the business all of us. Your Ministry of Health is on the move. Only recently, I told you 150 people – and it was advertised, people were invited, many agencies took part and the nursing school demanded that we make it not only a module of higher education but that we integrate it more often or more frequently as a module of their education. So things are happening. What surprises me – and this is where I probably reflect on what Dr. Persaud said – “what is wrong with you people”, do you not see what your Ministry is doing? It is there; it is visible. There were 150 people trained. Those are some of the initiatives we are taking.
However, we do not do our business in the media. Probably we need to look at that, how we blow our own trumpet. I would like to recognise the concerns of my goodly colleague across the way about suicide but ask him to join in the efforts too. For example, when such training sessions do come around there are organisations he might belong to that can take advantage of it. That particular training – and I do not want to spend more time on this – was done by an overseas-based Guyanese who is a trained nurse and at the same time a trained mental health nurse and has many other letters behind his name. We are seeking the right persons to come and do the training. A smaller session was also held at the New Amsterdam Hospital for some of the staff and other persons there. Those are some of the things we are doing to address the issues and to assure the audience, the House and wider public that we have identified the right issues.
I am happy that Dr. Norton is in an advisory mode today, he is being very poetic too, but I will advise him that it is not to be poetic; we need to be practical and realistic and look at the wider canvas against which we are delivering health in Guyana. For example, we speak about delivery of health services at the primary healthcare level. This country has made bounds and I do not like to go back five or ten years much less twenty or twenty-five years. Let us look at the audience some might not know this, at one stage in this country the only ambulance that was functioning was a little rackety one that the St. Johns Ambulance Brigade had. Why are you laughing Mister? This is serious. I think persons like Mdm. Teixeira might recall that – the only working ambulance in this country was the St. Johns Ambulance, a little white, square vehicle. What a shame that was twenty or thirty years ago. What is happening now? The change is there.
Your Minister of Finance has allocated this year again multimillion dollars to buy, to strengthen, the national fleet of ambulances. What is laughable? What is wrong with you people? Last year there were seven ambulances. And what I want you to know Mr. Speaker, you will see around the corridors young men and women dressed in black uniforms. Those are not ordinary doctors, they have been given further training and that is what you have to look at, creating an ambulance authority – and I would not stay long on this point – is not simply buying the ambulances. The infrastructure has to be set up; the training has to be set up. I want to congratulate those young people who have for several weekends, several evenings, stayed back at the training courses which incidentally Mr. Speaker has been piloted, guided, encouraged and nurtured by international centres of excellence. [Interruption] I hear a voice in the wilderness shouting Vanderbilt.
These guys actually know something; they actually do read something. [Interruption] Somebody is complaining about their salaries but look at the young people, gleefully coming here to do their job and loving it. Why? Because, as I will tell you, we do not only have salaried incentives but non-salaried incentives such as training, such as giving you a mark in live, such as making you  an emergency medicine specialist. That is what we have been doing and I would like to tell you and coming only from the humble ambulance. I made certain there are two ambulances because at a certain time in this country you would have had to push the ambulance of the St. John’s Ambulance Brigade to get it here. Now two good ambulances are outside, but I want you to look at the crew; those are good people who are going places.
3.25 p.m.
The Ministry of Health is a learning organisation and by definition a learning organisation trains, retrains, continues to train and realigns. To do this the Ministry of Health cannot do it alone, so we have been able to extend our hands for help to what we call Centres of Excellence. My goodly Colleagues across the way, Mr. Moses Nagamootoo, mentioned one, but there are so many. Recently, we have been able to construct relations with other Centres of Excellence, for example, the Libyan Institute of Calgary University. That has been going on quietly for the past two years, whereby ... [Interruption]. So, we were speaking about the non-salaried incentive besides the pay. We are giving them training and they are staying. As a matter of fact, we have persons who want to know when the next tranche of training is coming, but I was distracted a little bit.
We are crafting our relationship with Centres of Excellence, so two things will happen: our graduate pool of doctors - and congratulate the Administration. They do not like this terminology, “The Jagdeo Scholars”. That is get them in a tizzy because he had trained, he crafted training 500 of them, and they are now going to become the specialist under the programmes of the PPP/C Administration, utilising the strength and power of some of the Centres of Excellence I spoke to you about. What we are doing? We are creating the future generation of specialists in Guyana.
Currently, we have almost 300 students who just came back and they are moving on, not only to be specialists in emergency medicine, but in Paediatrics, we had a recent batch which graduated; in general surgery; in Altru Pediatrics; more interestingly, we have made a certain good move, supported by our partners overseas. Some of the surgeries we were doing overseas only at the beginning of this year, for example, almost totally pro bono I was able, or the Ministry of Health was able to send overseas, 10 little babies, some of them not so young, 11 years old, with serious cardiac issues and they were treated and are back Hon. Member – shortly - because of our expanding reach and cooperation with those Centres of Excellence. Right now, a few days ago a team came to help us further. We in the near future, hopefully shortly after the mid-year mark, will be able to do those surgeries here. No expense, no social dislocation; and what else? Our youngsters will be getting to rub shoulders to shoulders with those top level specialists and get exposed. That is the way to go, a progressive organisation... [Interruption] I am hearing another voice in the wilderness. Let us go back, not to 300, but to 500...   [Mr. B. Williams: Why are they not going into the hinterland?]     Why now are they attacking my doctors?
I want to say that in this country we have approximately...
Mr. Speaker: Do you have a cure for bad lighting?
Dr. Ramsaran: That was Mr. B. Williams’ interrupting.
Mr. Speaker: I see.
Dr. Ramsaran: Mr. Speaker, that is one aspect I am trying to address. I am trying to say that we have been able to invest heavily over the past period of this Administration and weigh in the past two into Human Resource Development and Management. In other words, not only did we think to create the chador of graduate doctor, but even before they graduated, we were crafting post-graduate programmes. Congratulate us for that. At the same time that is why I spoke to the University of Guyana. It is not help but yet it is health. It is an integrated approach to managing health. They are going to make or help me produce those persons. Guyana is a large country. We are as large as the United Kingdom, but we have a population that could barely fit into the street in London and we are scattered all around the country. This Administration is forced to delivered quality services with a small population based all around.
What have we been doing? We have been indulging and this budget supports it further, as you would see from the speeches, the relevant paragraphs of the Minister’s speech and we will discuss this further next week, line by line. More moneys are being given for training. Nursing was mentioned and certain figures were given. I thought I should look at that. Yes, we have increased the number of nurses that we are training, but what is not being said so nosily this year, is that we also have evening classes.
I remember when I introduced evening classes it was scoffed at-the night school. Well what we are doing is not only expanding the East Street Nursing School backwards right into the alleyway and it is not a huge building, although one sees only a small facade, but we have been able to split the sessions in such a way and we were criticised, right by these benches here: “What are you doing in the night? Why are you training nurses in the night? The night classes right now are getting better results than the day classes.... [Interruption] Where are you living?
Be careful with the interpretation of data. I look about in the audience and I see people who I think can crunch figures. They are six different papers that the nurses have to write. The failure rate, as being touted by the goodly doctor, indicates that some might have fail, not all. There is a small portion that might have passed all; there might be a larger portion that might have passed not all, but what they are not telling you is that, the system allows three re-sits and those who might have gotten four papers can re-sit again. That is the system. We can address it. Do we give them one re-sit or do we give them two re-sits? What I want to tell the goodly people in the gallery is that even while they are re-sitting...
Mr. Speaker: One second, Dr. Ramsaran. I meant to bring to your attention that you seem to be spending a lot of time with the ... You are to address your comments within the House and to the Chair. You are not speaking to any public gallery today. Thank you.
Dr. Ramsaran: I take your guidance. [Interruption] Mr. Speaker, I never meant to slight you. Anyhow Mr. Speaker, the cameras are this way. But let me get this over more for the wider consumption. The nurses are allowed three re-sits. One of the reviews that we are doing is that should we say that this is too much. Is this one of the reasons that they do not push their best? Those are things we need to look at because do you know what, Mr. Speaker? When we are having them re-sit, the still get their stipends, though small it is.
I want to address this issue of stipend and pension. The stipend is small because it is not intended to be a salary. In some cases we provide limited spaces in our dormitories. This is to facilitate persons who might have come from the hinterland or are in difficulty circumstances.
Mr. Speaker, I want to underline to your audience, both in the gallery, both on the cameras and both behind their shoulders that we are so compassionate, probably too much so compassionate that we give them three times over. I see some of us who are pedagogues in the audience and in the benches are somewhat apprehensive. Why do I give them three chances? I see the goodly headmaster, Mr. Whittaker, his brows are furrowed now. “Why are you giving them so many chances? At the Caribbean Examinations Council (CXC) they would have been out.”
We are looking at the details and I want to caution that we should not be misled by the first brush - everyone fails. Many failed some of the papers. A very significant minority of high flyers passed everything. What I want to say is this; we have a private school in this country too and when we compare the results with the students from the private schools and the nursing schools, they were equal. What I am saying is we have to look at this deeper.
One point that is not being brought to your attention and which Dr. Norton must know of is the fact that we had introduced a new curriculum and we were discussing if besides the other points I mentioned if could have been an issue. I want you to leave with this; the Saint Joseph Hospital Nursing School had similar percentages of passes and failures. That has led us to decide or come to the conclusion that it might not necessarily be the students, but the process and we have discovered certain other issues.
We have already written on the very day that we got the results. Fortunately for us, for the third consecutive year, the regional nursing body was having its convention in Guyana – luckily for us. We officially invited them to have a look at the curriculum and the process. Do you know why? Because it was that regional body, through one of its consultants sponsored by Pan- American Health Organisation (PAHO), which created our new curriculum of which we are proud. We need to see now what went wrong. I am anxiously awaiting the second sitting results to see how things went.
I have some issues here, for example, you might find at the Georgetown School of Nursing Functional Nursing Paper I and Practical Examination, those two have a high level of persons are passing, but in between the Functional Paper II, a lower percentage; and then Clinical Nursing Paper I, a lower percentage. Obviously, there is something amiss and it is not that our kids are not bright. It is the process that we need to look at. We are doing that. I want to assure the Speaker and Members of the House that, not only have we written to the chairperson of the Regional Nursing Body, and they promised to get back to us within a few weeks, which was when we had the results, but we have intentions to do our in-house analysis. We have done some. Are we, for example, missing absenteeism among two-thirds? We had had a little glimmer of this from the students themselves, telling us things. We are looking at that.
I believe my Permanent Secretary, who is a man trained in human resource and somebody who is gung-ho on discipline, has taken certain measures. The beggar report, when the investigation would have been had, will be looked at. I do know that in the past, not necessarily addressing this issue, I had discovered in the nursing schools, we have several, where some persons have put themselves on fulltime university training courses, while they were paid to be tutors. We will look at this.
Again, I am closing on this point, crunching the data, you have to recognise there were six papers and some people passed some and some failed some and a very small number failed all. We need not to bash them, but to find out what the problem is.
We are now very happy to note that in the speech by the Minister of Finance, he distinctly brought to the front burner nursing training and indicated that his ministry will be helping us with funding to review the process. That is what we must do; continuous review of our processes.
I noted some other points that were made by speakers from across the aisle. Mrs. Lawrence made some remarks regarding the delivery of services, particularly as it regards cancer, our women and young ladies. Up to that point, I used to put Mrs. Lawrence’s contributions in the category of the Late Mrs. Backer, but when I heard that contribution, I was a bit disappointed yesterday.
The impression the Hon. Member gave was that practically nothing is being done for female health, especially health, as it regards cancers in women. This is far from the truth. This is way from the truth... [Interruption]  That is in the Hansard. The Ministry of Health has, over the past few years, especially from around 2006, launched massive campaigns in fighting certain diseases: cancer, tuberculosis, but let us come to cancer.
We discovered, and there was a study done by another patriotic woman of the country here, Ms. Irving. Yvette Irving did a study a few years back and she tended to show that cervical cancer occurred more frequently in women of indigenous origins. That prompted certain realisations. However, the John Hopkins University was later recruited through the person of another goodly gentleman, not a Guyanese, but he should be made an honorary Guyanese, Dr. John Valara. He came here and helped us to set up the Visual Inspection Using Acetic Acid (VIA) Clinics. It is somewhat disappointing that leaders among our women are not recognising the value and not promoting it. Not saying, “Yes!” out there, I stand from my spot here in Parliament and say, “Ladies go do it!” instead of throwing a wet blanket on it.
Since that programme over 30,000 women, and that would be women in the suspect age, more susceptible to cancer, have been examined. I have the list here of where that service is offered.
I want to recognise some humble people who pushed this programme: Medex Ramsundar, Nurse Patricia Singh also known as Ann Rodrigues and a few others. A few others who I would like to note, for example, Ms. Nurse Luke, Patient Care Assistant (PCA) Amanda Damon, people who not only delivered services in their clinics, but fetch their equipment all around the country quietly. They must be recognised.
I want to say ... [Interruption] [Inaudible] that is a good point Mr. Speaker, probably these humble workers need to be recognised with national awards sometime.
Mr. Speaker:  On that note, can I ask that you be given a 15 minutes please.
Prime Minister and Minister of Parliamentary Affairs [Mr. Hinds]: Yes, Mr. Speaker. I rise to propose that the Hon. Minister be given 15 minutes to continue his presentation.
Question put and agreed to
Dr. Ramsaran: Thank you Mr. Speaker for allowing the continuation. Women’s health and female child health is on the front burner because if you were to check recently, only last year late, we released our strategy and that would be for the next five years period. Certain groups have been recognised as being vulnerable. First of all the Ministry of Health has recognised, as the international community has, that there are four categories of chronic diseases, which are threatening mankind, due to change in demographics, eating habits and so on and so forth. That is, hypertension, which can lead to cardiac conditions and heart attack and so on, diabetes which leads to certain things, cancers and pulmonary conditions.
Let us just invite you, Mr. Speaker you would have gotten your copy I hope. You will get my copy, Mr. Speaker and let the Members of the Assembly probably collect their copies in e-form and see what the Ministry is doing to address these chronic diseases. If one checks the statistics, our young able-bodied workforce suffers from these, where a young man, 42 years, collapsed. He could have been saved if certain things were done and if he did certain things.
Let us look at one category, the cancers. This Ministry of Health, over the past few years have been putting that one category of chronic diseases on the front burner, especially cervical cancer, breast cancer and let me tell you this, Mr. Speaker, I see I have got your attention, prostate cancer is the number one cancer killer in Guyana, but because...
Mr. Speaker: Are you trying to scare me or something?
Dr. Ramsaran: And everyone. What I mean, Mr. Speaker, is this because cervical cancer and breast cancer is more spoken of we miss that vulnerable category. We men need to start being protected and taking care too.
The Ministry two years ago introduced the Human papillomavirus (HPV) vaccine; this was a revolutionary and forward looking move. It was added to 15 or 16 other vaccines that are being given by your Ministry of Health. Do you know what a vaccination programme means? It means that you are preventing childhood diseases – vaccine preventable childhood diseases. Every mother here should want to sing praises to the Ministry of Health, even on those benches. I know they want to do so, but I am not Dr. Westford so I cannot lead the choir. She did a good job yesterday. But let me tell you, with the vaccine programme, onward, upward will we ever go. Guyana has as much as 98% coverage. Larger countries, more powerful economies have lower levels. The HPV vaccines and I would like to call this particularly to the attention of the Hon. Member Mrs. Lawrence, it aimed particularly at protecting our young ladies. It is given at a certain age, so that it can fight cervical cancer, which would arise when they are 39 or 50 years old.
It has taken off in this country, the Guyanese people are enlightened. But there is a small fringe element, you are saying that ...    [Dr. Anthony: But they said that last year.]     Yes, I checked the Hansard. Some Members of the Opposition benches were actually opposing that vaccine; opposing something to protect our young ladies. However, it did not get traction. As a matter of fact, it has become so in demand that older women are also asking for it, but because it is in short supply even internationally, even internationally there is now a shortage. Guyana got in first.
Regardless of any sarcasm from the Opposition benches, those things must be recognised as protecting our young women and our women folk.
Women’s health is intricately linked with reproductive health. It is also linked with the health of their young children, especially up to the age of five years. There are two indicators that the Ministry of Health is proud to speak of. We would like you to bear with us as we look at the under five mortality rate in Guyana. I would like to report to you - and it is reflected in the budget, down at the back, in the relevant sections - that Guyana is not doing a bad job and that we are on the crust of achieving that particular goal. Unfortunately, we have notice certain trends that threaten us. I think I should warn or forewarn the House and the Nation from this level.
We note that while we are able to control vaccine preventable diseases; while we have been able to overcome the infectious diseases of childhood, diarrhoea and dysentery and so on, we are losing our children to accidents, violence and fires. Recently, in the past year or two, our figures, our statistics have been skewed in our disfavour because of losses of the under five to accidents. For example, last year, I think five died in accidents and three died in fires. In small numbers, when the crunch is done these things can make one look bad.
Although the Ministry of Health has no control over the accidents directly; has no control over the fires directly; we still bear the brunt and pain of losing these eight kids last year. Eight of 191 make a significant statistical shift. But if we were to work together in a multi-agency fashion, we need to address the accidents. For example, a kid should not be walking on a road, even if it is a country road, even if it is a side road without supervision – issues like that.
As the strategy pointed out, we are providing services across the life cycle and my goodly colleague from the Ministry of Health, Parliamentary Secretary, Mr. Joseph Hamilton mentioned this. The elderly too are taken care of; the elderly too concern us. What we have been doing quietly. Where are these doctors? They are not only in the city, we are sending them out. I will show you how. But we have done another thing quietly, we have started to send these doctors to places where there are the indigent and weak, for example, the Dharam Shala, every month they have doctor... for example, to the eye institute. We are taking care of more and more populations and of course, in other areas.
I hear some bubbling up, but these programmes will take time to grow. Remember we brought these doctors back within the past few years. They have to pass through a prescribe period of attachments at certain levels and hopefully we will then grow the programme. But the point I want to make is that within our limited resources, we are trying to juggle the deployment and use of that valuable human resource. One can go on a particular day- and do you know what we are doing? We are planning it.
The people with impaired vision come at a particular time to the institute to collect their pension books or whatever. We piggy back on that and send our team to look at them so that we do not have to go all over looking for them. They come and we help them at I think it is called Saint Phillip’s Green, there is a place there. Those are some of the things we are doing.
I see that in this Budget, the Minister of Finance has given us more moneys. He has given us this year, following our complaints that we could not do adequate outreaches because we had so many doctors, they were so enthusiastic to get out there that he has given us $50 million to do exactly that. I want to congratulate him because it was a cake walk when we approached the Ministry of Finance; no opposition. Either the Ministry of Health has good talkers or I think better, the Minister of Finance is very enlightened. He will be getting more and more healthy people back in his workforce. He will be getting less people spending less time in his hospitals. In other words, he will be having a productive workforce. I want to underline that $50 million have been given and this will be used to push health literacy and to reach to those corners where sometimes it is difficult to reach.
This is another point I want to tell you, Mr. Speaker, the dynamics are changing. Many persons are going places where they have not gone before. The hinterland is opening up. There are women getting into advance stages of pregnancies in places where they would not have gone with their men before and that present challenges to the Ministry of Health. Therefore, I want to thank you Mr. Minister of Finance, the Hon. Dr. Ashni Kumar Singh, for that additional $50 million to do that type of work.
Communicable diseases have also been address. For example, let us look at vector-borne diseases. The Malaria programme is doing well, but at the same time due to the same dynamics I have just mentioned, there are challenges. More Guyanese are going more places in the hinterland. They are after the wealth that gold mining could generate. They sometimes are not as cautious with their health as they should be; this presents challenges for you Ministry. That is why I would like to recognised what I saw recently in the newspapers, only a short while back, where five Region No. 8 villages got vehicles and I saw the ATVs. I know that these villages, from time to time, use them to help the health sector too. I will be remiss of me if I did not touch on another thing, the attitude of my health workers.
3.55 p.m.
Some of the workers are angels; they do well; they treat my patients and relatives of patients well. I would call your attention to a Kaieteur News article on Sunday, March 2, 2014, “High risk patient testifies of life saving care at the Georgetown Public Hospital Corporation”. Here it is that a woman testified - it was quite visible, she and her bouncing bundle of joy - that she went to that institution and in one instance...   [Mr. B. Williams: What are you reading there?]    I can give you it. It is Sunday, March 2, page 35, Kaieteur News, of this year. She said, if I can precise it,  that she almost did not  want to accept  the services because of the attitude of one worker, but that negative impression was immediately reversed to a more positive impression because of the attitude, the positive attitude, the caring and compassionate attitude, of another worker at the said institution in the same department. Those are some of the challenges we face, managing the human resource.
I see the Public Buildings is well recognised, doctors at the ready during the budget debates.
Mr. Speaker: Yes. It is because you have adorned it with ambulances that it does not need.
Dr. Ramsaran: I would like to point out to that these young people are going more places now and the Ministry of Health has put itself in the position to deliver, as I said last year, more services to more people at more time with more specialised persons.
I would like to point out too that there is another area that we should not miss. Shortages have been capturing the attention of the Ministry of Health periodically, the issues of expiring drugs and the annual report of the Auditor General. What we do note is that my Permanent Secretary, and his team, has always been able to give explanations. I have the impression that there was an agreement that those answers are also supposed to be published in subsequent reports. I will check to see if that is so.
Indeed, there are too a large number of gift items coming in with short shelf life. These sometimes are brought in by good well meaning organisations, which are our friends who bring good stuffs, but, at the same time, they would have brought stuffs with short shelf life. What I would like to point out to Dr. George Norton is - he made some very good queries, incisive queries - that many of those items, which were accumulated over years, are also, in a similar fashion, as how sometimes we have discarded equipment which we find difficulty in getting off the inventory.
I would like to come back to the Agricola fiasco. No drugs were dumped - none. Those drugs were expired and were withdrawn from our Quamina Street property whereby our workforce could have used that as the Mash Camp. I will tell the Members that it was painful for a certain nod of my good workers, such as Dr. Monique Odwin. She did this. She wrote pre-emptively, and there is a letter, to the Food and Drug Department telling it that she has the stuff and she needed to clear the property. What is very disappointing is that I spoke to Kaieteur News before it published..., when we knew it was taking pictures. What we did have was an empty room, an empty space, at the Agricola Health Centre. The medications were being correctly managed by my director. There are two rules the Hon. Member Dr. Norton failed to tell the Assembly. What was she doing? She was separating expired drugs from current drugs. That is the law.    [Dr. Norton: In the yard?]    Correct. She did well.  She was putting them to be stored to be destroyed by the agency he referred to and she notified that agency.
In many cases we are in a dilemma. These agencies move very slowly and we have an accumulation. One might very well find that the Ministry is hoping to destroy drugs in 2014 that have been accumulated for five to six years. Small portions gathered up. At the same time we will address the issue expiring drugs.
Mr. Speaker: Hon. Member, you have five minutes to conclude.
Dr. Ramsaran: I will conclude, Mr. Speaker. Thanks for your indulgence. The specialty hospital is now, again, on the... More visibility is seen. Piles are being driven and as I told the media recently, almost 300 piles have been driven. There are another 200 or 300 on site for inspection and in total some 1,300 piles needed to be driven. Things are happening there; moneys are being expended. The report will show that hundreds of millions are being expended.
Mr. Speaker, I want also to bring to your attention another article which shows that even in the city piles are having to be driven. Here it is, “There are blatant building violations in the city”.
Do you remember last year, Mr. Speaker, when I indicated, in particularly, to Hon. Member Ms. Ferguson that a building cannot be seen   going up until the geotechnical survey is done. There is a gentleman called ‘Trini’ from the Engineer’s Department who is actually demanding that even for smaller buildings geotechnical surveys should be done. The Ministry of Health was right.  Last year when I told you we spent $446 million to do certain things – land preparation and geotechnical survey – it was correct. The officials at City Hall are enforcing what the Ministry of Health...
Mr. Speaker: It is just by way of correction Mr. Boyce is a councillor with no engineering expertise.
Dr. Ramsaran: The point is that he is bringing to the attention a very good point which resonates with what I said. When you are seeing these pictures here, Mr. Speaker, I want you to know that it will take some time for you to see the hump.
Further, I would like to recognise another of our long-standing strategic partners. Even as we speak, there is a scientific conference going on, including the Cuban brigade in Guyana and the Cuban trained Guyanese doctors. It is for the first time that the Cuban trained Guyanese doctors are dominating in numbers. Do you see the plan? We are growing them.  Previously, the Cubans would have been in the majority. This conference is now being held at the Umana Yana. I want to recognise that and I want to tell you that our young doctors have opened up the vista to present research items. The Guyanese research agenda in health is poor and this is an opening. At the same time, I would like to call to your attention, Mr. Speaker, that that scientific conference is resonating well with the speech made with our Minister of Foreign Affairs last year when she spoke to a friendship that goes back more than 40 years, when she recognised the anniversary with our relationship with Cuba.    [Mr. B. Williams: It started under the PNC.]     It started under Jagan.
I would like to tell you, Mr. Speaker, this, that the scientific conference, which we must recognise, is being held in honour or dedicated to the five brothers who are now still detained as if they were spies on United States of America ground. I would like to bring this to your attention. I would like us, probably in closing, to recognise, again, as the Minister of Foreign Affairs Mrs. Carolyn Rodrigues-Birkett did last year, that Cuba is a strong partner, that we not only intend to recognise the anniversary, but to build on it, and at the same time to keep in mind the five brothers and make suasive effort to have their release and have them rejoin their compatriots in their homeland.
Mr. Speaker, I would like to thank you for allowing me to bring to you some of the concerns of the Ministry of Health while recognising the powerful foundation that the Minister of Finance  has created for us over the past few years in health and the enlightened budget that he has presented, in such a way, that we can continue growing from strength to strength, that the Ministry of Health will be able to perform a subsidiary function to support other Ministries and the administration as it rolls out its social policy. We will keep the nation healthy while the other Ministries in the country take us forward collectively.
Before I sit I must encourage everyone, including my colleague Members on the other side, to endorse this budget. It is an enlightened budget. [Applause]