Flies

Fly infestation at the Corito garbage dump site. You are not safe walking even upwind from the garbage dump at Corito. It is unimaginably worse if you live downwind of it. The cause is an infestation of flies. There are flies everywhere. The swarming has been going on for two weeks now.

I spoke to Cuthwin Webster to find out if he knew about the problem. Knew about the problem? The man is so steamed up I could hardly make sense of what he was saying. He is mad as hell.

The problem results from a failure to deal with the garbage correctly. The rules for taking garbage to the dump are simple. For the purpose of this problem, they cannot be simpler. Domestic waste, stuff from the kitchen, goes to the left when you enter the dump. This area is covered daily with a layer of earth, to prevent smell and reduce flies. Construction waste goes to the right, where it is left exposed. It is clean and does not assault the nostrils if left uncovered.

The trucks which have the contracts to collect the construction waste know the rules. At the Corito main gate they announce to the gate keeper that they are bringing construction waste. They are directed to the right. It is only when they dumpster upends the cargo that the mass of rotting kitchen waste hidden in the bottom of the dumpster is revealed. Now, it lies on top of the construction waste, and is covered with maggots and flies. Little Harbour and George Hill lie just downwind.

The culprit is one of our biggest hotel developments. They do not make sure their staff put the kitchen waste in bags in the correct garbage bins as they are supposed to do. Their housekeeping staff stand accused of mixing the kitchen waste in with the construction waste. That is what is causing the problem.

Why, you ask, does not the dump just cover up the construction waste? The answer is that it is an expensive process digging up the marl, trucking it to the top of the waste, and spreading it around with backhoes. Cuthwin says he is paid by government to cover up the area for domestic waste. If he is to cover up the construction waste area as well as the domestic waste area, it will cost twice as much. Government is not prepared to pay for that.

I agree with Cuthwin. It would be a big help if the Environmental Health Unit could find a way to make the construction people obey the rules. It is a matter of the public health. We could have an epidemic of some sort on our hands if this continues.

Not to mention the inconvenience of spitting out flies every time you take a breath!

I know. I went walking from Corito to Tanglewood this morning.

Medical School

St James School of Medicine. My attention was caught by a throw-away line in Victor’s recent speech, published a few days ago on this blog as “Golf Course”. Right at the end of the speech he said, “and, the long awaited Medical School is scheduled to open in August/September and will create opportunities for the apartment rental sector and other businesses.” That was it. No further explanation.

I went off to do a little research on the internet.

The Caribbean Accreditation Authority for Education in Medicine and Other Health Professionals would be the agency responsible for authorizing such a school. This Authority is the officially recognized institution for accrediting medical schools in the West Indies. It has existed since the year 2004 when the British General Medical Council abandoned us and went off to be fully integrated into Europe. The Authority has a website. I went to visit it. There are eight medical schools listed as having applied to the Authority for accreditation. Some of the schools have achieved full accreditation, while others are only provisionally accredited. I had a look at the details for each of them. I learned that these appear to range from No 1, the University of the West Indies to No 8, the University of the West Indies School of Veterinary Medicine. No 4 is the St James School of Medicine.

So, I went to the “details” page to learn what it had to say about the assessment of the Anguilla project. I found the following from the year 2007:

I note that Sir Graeme Catto and Professor ER Waldrond are the two persons who carried out the Anguilla assessment. Professor Sir Graeme Catto is well-known as the President of the General Medical Council of the UK. He is a Scottish doctor, Professor of Medicine at the University of Aberdeen, Vice-Principal of King’s College and St Thomas’ Hospital Medical and Dental School. Professor ER “Mickey” Waldrond is a distinguished professor of medicine at UWI. This is a very serious team. Their recommendation that the school be given provisional accreditation must be given weight. The St James School was obviously not considered by them to be a fly-by-night operation.

But, I note that this 2007 assessment is only provisional. The assessment team was to have visited in six months time to see how the school was progressing in setting up the facilities for the admission of the first class of students. Did they ever pay this second visit? I cannot find any report of their later assessment, if it ever took place.

I do a little more exploring. I learn that the St James School of Medicine already has a West Indian operation. It has functioned in the island of Bonaire since 2001. YouTube even has a video about it. I find a few grouches posting negative things on various blogs. I find some doubt that the qualifications they give are acceptable in various States of the USA. Then, I go to their website.

I find something odd about the banner at the top of their home page. I say to myself, “Hold on, is that not a view of Road Bay in Anguilla taken from South Hill?”

It may be a minor thing, but I wonder to myself why would they want to illustrate a web page about a school in Bonaire with a picture of a bay in Anguilla.

I ask myself, is the plan to close down the Bonaire medical school and transfer all courses to Anguilla. What would cause them to take such a step?

Is Victor right that this school is about to start up in Anguilla in September?

If so, where is it going to be?

How come I have not heard of any activity on the island relating to the school since provisional approval was given in 2007?

It is all a complete mystery to me.

Swine flu

Only healthy travellers pass through Blowing Point. Most sensible people recognised that this whole H1N1 Influenza A pandemic panic was a media-driven frenzy from the start. Mexico had the worst of it. A few hundred people were infected. A total of 26 died. Deaths elsewhere from infection have been minimal. As of Tuesday, total worldwide deaths stood at 53. The math shows there is a 1 in 250 or 0.4% chance of dying. A normal annual winter flu outbreak would cause more fatalities than this one has. The H5N1 avian flu episode last year produced more fatalities. The Spanish flu pandemic of 1918 killed an estimated 30 million. The 1957 pandemic killed two million. Even the 1968 pandemic killed a million. If people die from flu in the Southern hemisphere this coming winter, and many thousands will die, the betting is it will be from the common flu, not swine flu.

Just as the epidemic everywhere in the Northern hemisphere is in decline, we in Anguilla have to show our solidarity with stupidness and join in the frenzy.

Have you seen the new form they give you to fill out when you land in Anguilla? I understand this form is part of a regional initiative, and was not invented in Anguilla. It looks like this:

As you hustle with 40-odd other passengers for a place in the queue at Blowing Point, an Immigration Officer appears. She tells you that you must fill out this swine flu questionnaire. You have to do it before you get to Immigration. So, you fill it out while standing and being jostled in line. You take it to Immigration. The officer looks at it. She gives it back to you. She tells you to hand it in to Customs. Customs looks at it, and tosses it aside.

Or, you are among the hundreds of visitors from St Martin for the Regatta last weekend. You are arriving at an “upscale tourist destination”. So, you have arrived on your mega yacht at Crocus Bay. Immigration makes everyone get off the boat. You take the dinghy to the beach. You find a taxi to take you to Sandy Ground. There, Immigration makes everybody fill out the form. By now, God alone knows how many people you have infected. Yes, I know you are not supposed to land at Crocus Bay, but they do.

Didn’t the designer of this form realise I am supposed to read it before I fill it in? Did he really intend to put that final notification at the end of the form for my information? It says clearly that if I answer “Yes” to any part of the questionnaire, I am to be isolated. “Isolated” means I am to be separated from my family that I am travelling with. I will be taken away, by force, if necessary. I will then be put through various Hospital procedures. It may take days, if not weeks, before I am allowed to go about my business or enjoy my holiday. In those circumstances, which fool would answer yes to any one of the questions? Which one of us is going to admit to ever having visited Mexico? I would suppress my cough even if I had to choke. Who would be so stupid as to admit to having sneezed in the past year.

Faced with the information at the bottom of this form, I would deny I had a fever anytime in the last ten years. Breathing would never have been easier than it is now. I would not admit to having had a sore throat since I was a child.

Whatever they intend to do with the hapless traveller who answers “Yes” to anything on this form, I think they should keep that last bit of information confidential. Let the officer spring it on him in ambush if he has answered “Yes”.

Next thing, we will be banning imports of pork meat.

Just because this is a government form does not mean that it is backed by law. It is not an Immigration form. Nor is it a Customs form. It is a hastily made up medical form. Has anybody even checked if it has the force of law behind it? Do I commit any offence if I fill it in falsely?

I seriously doubt it.

Ambulances

Does Anguilla have an effective ambulance service? Recently, National Bank of Anguilla and Caribbean Commercial Bank donated EC$80,000.00 to the Health Authority of Anguilla for the purchase of a new ambulance. This new ambulance was intended to replace the two old ones that frequently failed to start, or broke down during an emergency.

The need was obvious. As Dr Bonnie Richardson-Lake, PS Health Department, said at the cheque presenting ceremony,

“Everyone in Anguilla needs to feel that they have access to good quality care, and that in case of an emergency they would be well looked after, thus making them feel more secure.”

The cheque presenting ceremony

More recently, Cap Juluca Hotel handed over an even newer ambulance to the Health Authority. It cost US$85,000.00.

As CEO of the Health Authority, Darlene Baptiste, said at the handing over ceremony, she was grateful for the partnership between the hotel and the Authority,

“which provided an opportunity to provide optimum health-care services to the people of Anguilla.”

According to the newspaper report, Chairman of the HAA, Dr Franklin Lloyd, said,

“the provision of the ambulance was another demonstration of the Authority’s determination to continue to improve the quality and timeliness of health care. He called on the Emergency Medical Technicians to function at all times as dedicated professionals with efficiency, commitment and compassion, noting that although the ambulance was well equipped, it was for them to operate it at a high level to ensure quality service.”

The handing over ceremony

At the same handing over ceremony for the new Cap Juluca ambulance, the Director of Medical Services, the Rt Hon Dr Sir Kennedy Simmonds spoke. He said that,

“the state-of-the-art ambulance, coupled with the ongoing updating training of the Emergency Medical Technicians, would help the HAA to deliver more effective and efficient first emergency response service to the people of Anguilla.”

Cap Juluca's new ambulance

You would think, with all that new equipment, not to mention the high hopes and promises expressed at the two handing over ceremonies, Anguilla’s ambulance and emergency service would be one of the best in the West Indies.

Listen to Darren Augustus’ story. In the calypso world he is known as The Mighty Tornado. About two weeks ago, on 24 April, he ate lobster. It was meant to be his birthday celebration. It turns out he had developed an allergy to lobster. By the following day he had become violently ill. His limbs had swelled up. He could not walk. He was vomiting, and suffering from diarrhea. His head was spinning.

He did what you or I would have done. He telephoned the hospital for an ambulance to come and rush him to the hospital.

The response? “Sorry, we have no gasoline for any of the ambulances.”

Fortunately, his girlfriend could drive. She got him to the hospital, no thanks to any of the three ambulances then in the service of the HAA.

Read it, and weep for us. Clearly, Anguilla at present has no effective ambulance service. Regardless of the amounts of money donated and invested.

My recommendation is that whoever is in charge of that department ought to be fired, for cause, forthwith.

I only waiting to hear the calypso!

Dengue

Is Anguilla at risk of a dengue Epidemic? Dengue is a mosquito-borne infection that causes severe flu-like illness. Sometimes it causes a lethal complication called dengue haemorrhagic fever. That‘s the worst form of dengue. All dengue is very painful and dangerous. It is also known as ‘break-bone fever’, for good reason. There is no known treatment for the virus itself. That's not to say that dengue is untreatable. They treat the symptoms. They can reduce the pain with analgesics, etc. Appropriate medical care can save the life of a patient. But, you have to know that the possibility of dengue exists in the community to begin to take precautions.

As The Anguillian Newspaper warned us last year:

Persons suspected of having dengue fever must see a doctor at once. As Dengue Haemorrhagic Fever is a deadly disease, early diagnosis and treatment can save lives. Unless proper treatment is given promptly, the patient may go into shock and die.

The characteristics of Dengue Fever/Dengue Haemorrhagic Fever are
• Abrupt onset of high fever.
• Severe frontal headaches.
• Pain behind the eyes which worsens with eye movement.
• Muscle and joint pains.
• Loss of sense of taste and appetite.
• Measles-like rash over chest and upper limbs.
• Nausea and vomiting.
• Severe and continuous stomach pains.
• Bleeding from nose, mouth, gums and skin bruising.

The virus is widespread, if not epidemic in the islands around us. It is in the BVI. It has long been a health problem this year in nearby St Maarten/St Martin.

Now, I read in the Anguillian Newspaper that the Anguillian public health authorities are spraying for mosquitoes. They warn us to shut our windows against the fogging. But, they don’t indicate why they are fogging, or what exactly the target is.

There are no known requirements for reporting the statistics on the incidence of dengue. No person in authority will admit to the prevalence of dengue in Anguilla.

Dengue is now in Anguilla? Shusssh! That is a national secret. We are not supposed to know about it. We are certainly not allowed to talk about it. It might damage the tourist industry. Anyone who even discusses dengue in Anguilla is betraying our tourist industry. And, the tourist industry is the real and only Anguilla, isn’t it? So, any discussion amounts to betraying Anguilla.

How widespread in Anguilla will dengue have to become before it becomes a dengue epidemic? Should we even be told that dengue is a problem that already exists in Anguilla?

Health

Free specialist medical treatment in the UK? I always thought it was a bit cheeky of us. A year ago, at a meeting of Chief Ministers and FCO officials in London, our Chief Minister delivered a paper, “Access to UK Health Care”. We have previously been granted the privilege of sending up to five persons unable to obtain specialist medical treatment in Anguilla to England to get it free of cost. That means at the cost of the English taxpayer. It appears that we were not satisfied with that number. The Chief Minister was calling on the FCO to pay for that number of patients to be substantially increased for Anguilla. If you do not remember, you can read all about it in the Anguillian Newspaper.

There are many Anguillian patients who need specialist medical treatment that is not available in Anguilla. Such treatment is almost certainly available in nearby Barbados or Puerto Rico. England seemed a bit far to go. And, why were we asking the British taxpayer to fund our medical bills? I could not understand. Surely, it would have been more appropriate for our taxpayers to fund deserving cases? And, why not send our medical patients that we are paying for to Puerto Rico or Barbados for treatment? The convenience of the shorter travel distance, and the probability of the cost being no greater, seemed to me to be the clinchers in the argument.

Anyway, I heard nothing more about the issue. The Chief Minister came back from London and reported that the British Minister of Health was looking into it. Well, it seems we got our answer in the House of Commons yesterday. As Dawn Primarolo, Minister of Health, explained, there is no limit to the amount of Anguillians allowed to travel to the UK for health care. But, they must stand in line and pay for it like any other overseas visitor. Nor are there any plans on the part of the UK government to review the quota of patients that Anguilla can refer to the UK. Quite right too! Any Minister who answered otherwise should be fired immediately. Any political party that authorised her to answer otherwise should be dismissed from government at the next elections. It seemed pellucidly clear to me.

If it were to be otherwise, I have a proposal for ensuring reciprocity and saving our pride. We in the wealthier Overseas Territories such as Anguilla ought to invite impoverished English medical patients to spend time in our sunshine to help them to recover their health faster. After all, it is free for us. It does not cost us anything to share it. We might as well throw in the airfare and board and lodging for the duration of their stay. All paid for by the Anguillian taxpayer, of course. And, let us see how that suggestion would fly with the Anguillian taxpayer.

Reverse Osmosis

Water Corporation of Anguilla. I want to go back to a topic that concerns me. I wrote about it two weeks ago. The comments that were posted in response did not answer any of the issues.

We have no regulations controlling the disposal of waste in Anguilla. Waste is dumped all over the island. There is no limit on the type of waste that we can dump, or where we can dump it. Every kind of poisonous material is dumped all over the island, not only at the public landfill at Corito.

Much of our solid waste contains poisons that will eventually do us damage. Particularly vulnerable are foetuses and growing children. As this waste rusts and breaks down, the heavy metals in it leach into the ground and filter down to the water table. There, it accumulates until we suck it up in a well and sell it to the people.

The danger of drinking Anguilla's ground water was one of the main reasons we were told why the reverse osmosis plant at Crocus Bay was obliged to bring sea water from far out to sea. They treat sea water and used it to supply the island with safe, drinkable water. They are not allowed to treat the ground water, though this would be much cheaper than sea water.

The main pollutants that we should be concerned about are the heavy metals. Excessive levels of aluminium, arsenic, beryllium, cadmium, chromium, copper, iron, magnesium, nickel, phosphorous, thallium, and zinc, in our water supply, will eventually poison us. There are 23 heavy metals in all. These metals leach into the water from ordinary household waste that we dump.

Reverse osmosis does not remove these poisons from the ground water. Highly specialised machinery is required to remove these poisons from our ground water. We have no plan to purchase and run such equipment.

Reverse osmosis is a process that removes sodium chloride from water. That means it filters out the salt. It does not “clean up” anything else that may be in the ground water. Adding chlorine to water does not assist, except to kill the e-coli bacteria that seep into the water table from our septic tanks.

If you want to learn more for yourself about this problem, Google “heavy metal poisoning” or “cleaning heavy metals”.

Why in the world would we want to go back to trying to “treat” Anguilla's ground water? Because it is cheaper!! Cheaper for whom? And, for how long until the medical bills start piling up?

Any new reverse osmosis plant in Anguilla should be obliged to use sea water for the health and safety of children not yet born.

PAC

Proposed New Public Accounts Committee for the Falkland Islands. We all know by now that we do not have a functioning PAC in Anguilla. There is no one in Anguilla exposing maladministration in the use of public funds. There is no one even looking at the way that the different government departments are spending public funds. Except the internal audit department and the external auditor. The internal auditors are professional civil servants just doing a job. No offence intended, I have no idea who they are and even less what they do. They do not report to us, so how can we know? The external auditor is no doubt very professional, but he would be mainly concerned to ensure that the government spenders look good. He would make suggestions for improvements. His concerns would not include exposing mis-spending when he finds it. Nobody wants to rock the boat!

So, it was with great interest that I read how the Falkland Islanders are planning to set up their PAC in their proposed new Constitution. Their discussions include some of the features that various Anguillians said they wanted to see in any new Anguilla Constitution. In particular, they plan to appoint three members of the public to sit on the committee, with two members of the Assembly, making a PAC of five persons. A majority will be from the public! Additionally, they plan to bring in experts to give advice in their own particular area of skill. They are considering giving this new PAC authority to scrutinize companies with government-sanctioned monopolies.

That would include in Anguilla such entities as ANGLEC, the new Water Authority when it comes on stream, and the Health Authority of Anguilla. These are all desperately in need of supervision of how they spend public monies. We already know we do not have a functioning health service in Anguilla. And, now the rumour is that we are about to lose the initiative to develop a Health Fund. The whole kit and caboodle of the Anguilla health sector appears to be collapsing. A lot of exposing needs to go on. No one in Anguilla is willing to take on the job.

The Falkland Islanders say they are going to look to see how the PAC functions in other overseas territories.

I only hope they do not take their lead from Anguilla.

Health Authority

Is there something seriously wrong with the Health Authority of Anguilla?

First, we heard that the Board of the Authority was pressured by the Minister into resigning en masse.

Then, last month we learned that the surgeon at the Hospital had been told to go home.

Now, last night we heard on the radio that the Health Authority CEO has been given three months’ salary in lieu of notice, and told that his services are no longer needed.

Will somebody please enlighten us?

Why all this blood letting in the Hospital?

Quarantine

Oriental Fish Imports. A correspondent sent me a Belize article from Caribbean Net News. I read it with interest. I was amazed. I had no idea that any public health authority in the West Indies was so aware of the environmental issue. It was staggering, for someone residing in Anguilla to read about such principled determination.

Their Quarantine and Inspection Service has recently confiscated and destroyed 4,492 pounds of fish originating from Asia. The reason? The fish were inspected! It was noticed that they were not from the USA as stated on the permits presented for importation, but from Asian countries such as China, India and Vietnam. The problem? The fish represented a high risk for the introduction of diseases to the aquaculture sector. These countries are not transparent in their reporting of fish diseases.

It gets better. I learned that the Belize Agricultural Health Authority in 2006 issued 6,257 animal health and food safety permits. All application are screened by a Veterinary and/or Food Safety Officer. A risk analysis is performed for those commodities that represent a high risk due to Belize’s natural conditions. In 2006, six international site visits were conducted to verify inspection, approval and certification procedures. Four documented risk analyses were performed for those commodities that represent a high risk. These included milk powder, duck meat, packaged bees, and pork.

In the same year, 2006, the Quarantine and Inspection Services confiscated over 106,500 pounds of high-risk commodities. They refused entry into Belize of a total of 90,000 pounds of commodities due to high pest infestation.

Can any of us in Anguilla imagine anything like that happening in our Public Health or Fisheries Authorities? I doubt it. If I am wrong, please let me know. And, what was much more extraordinary, the information was published! It was information that the press and public could access. It was not kept from the public. That is quite extraordinary for us in Anguilla. As my correspondent writes,

How mucha high risk or pest-infested commodities were confiscated in Anguilla in 2006? If anything has ever been confiscated here in living memory, it's a State Secret. But we have the Cuban tree frog, the killer tick, the pink mealy bug and a zillion African snails.

Of course, Belize has marine parks. She has fish farms. She has one of the greatest barrier reefs outside of Australia to protect. Her officials have more reason to be interested in the marine environment than our officials. We in Anguilla have nothing worth protecting. Or, so it would seem!!

Health Check

Health Authority of Anguilla. On Thursday night Ras B interviewed Minister of Health Evans Macneil Rogers. I did not hear the interview myself. One of my correspondents did. This is what she wrote about it.

Last night the Minister of Health held an interview with Ras B on Heart Beat Radio. Interestingly, he did it on the condition that no calls be accepted from listeners. What is disturbing is that the Minister went on to make statements regarding the outgoing Health Authority Board and the Health Authority that demonstrate either a shameful ignorance of the purpose, structure and operations of the Authority, or another deliberate attempt by a politician to mislead the people.

The Health Authority legislation was carefully constructed as a model for future legislation regarding statutory bodies. Gordon Carnegie had many sleepless nights. He made sure that Anguilla would not make the mistakes that others had made.

The Board is required to have 7 members – one representing medical, one nursing, one business, one finance, one human resources, and two representing the public interest. The Board also has four supporting committees to advise it.

Each Committee has two members of the board as chair and deputy chair, and includes executive managers of the Authority and other private and public sector persons with the particular expertise. All of those 4 committees meet every month and report to the board on a monthly basis. The four committees are: The Patient Care and Quality Services Committee – headed by the medical member of the board included doctors from the private sector (like Dr. Paige) and doctors and senior nursing personnel from within the authority. This committee looks at the medical and patient care issues, including complaints from the public. It also worked on the diagnostics – (the public should not be deceived by the Minister's attempt to indicate that this was being ignored.) This committee provided guidance for the board on all medical matters and was headed for the first 3 years of operation by Dr. Brett Hodge, with Nurse Yvonne Rey as co-chair until the end of their term in December. It was on the recommendations of this committee that the Board implemented the diagnostic changes in the Authority.

Nurse Rey was also chairperson of the Nursing committee which advised the board on all nursing matters. When Dr. Hodge and Nurse Rey ended their term, the Minister for six months failed to appoint their replacements. In essence, he "starved" the Board of this vital expertise. For six months a board which should have 7 members was forced to operate with only 4.

The other committees were the Finance and Audit and Human Resources committees, which were set up similarly to the other committees. The board also created a Dispute and Grievance Resolution committee to assist staff who may have issues that could not be solved within the system.

The Human Resources committee assisted the human resources department with policies, recruitment and training decisions. I am appalled that the Minister told the public on radio last night displayed that the human resources department needed restructuring. This is an insult to Mrs. Meridith Gumbs, the human resources manager who literally worked day and night to ensure that the department was one of the most professionally organized in the public and private sector. The minister seems to be judging or damning the authority based on the need for customer service training, but if the truth were to be told Meridith Gumbs had several training sessions for the staff. Coincidentally, the same person that Meridith had looking after the training needs of the Authority, was the person that the minister took to study the "customer service" needs of the authority.

The Health Authority was set up to allow for input from inside and outside the Authority. The Board does not arbitrarily or high handedly make decisions. All this is public knowledge as the Authority published all this information very early in its operations. All sectors of the authority had to give quarterly accounts - The minister, the ministry and public were kept informed.

The people should know, in fact someone should tell the Minister that there is a difference between governance and operations. The board governs, the CEO and the managers carry out the established policy. The CEO does not have to go to the Board to buy a light bulb for the Operating Theatre. The empowerment of the lower levels is to cut out bureaucracy and make sure that the service is efficient. This is why Mr. Eric Reid OBE worked so hard to establish a Health Authority.

People are tired of hearing the Minister claim to be such a health professional. As a minister of government he should be looking at governance and regulation of the authority – his experience as a med tech does not give him the knowledge or experience to run the health authority or override the national health plan which was developed by health experts, health professionals and the people of Anguilla. Please tell the Minister, it is not about him, there is no room in health for pretense and self-importance.

The government needs to pay serious attention to the social development. The recent events point to that. The government should be concerned that one of the most qualified health professionals in the region, Mr Foster Rogers, is working in the Chief Minister's office and not in health – the minister did not want him – Why did Orris Proctor resign? – the minister frustrated him. Why was it such a fight to get the well-qualified Dr. Bonnie Lake to be appointed as PS Health? Why is she now sidelined by the Minister? Why are there so many proposals or plans from the Health authority and other social development departments lying unattended on the Minister's desk for a year or more? The ministry of health needs a serious check up.

Well, what do you make of this situation?