Dr. C.V. Alert, MB BS, DM, FCCFP.
Family Physician.
In a breaking news story today two men died after they were attacked by a group of masked assailants in a drive by shooting in a quiet neighborhood last night. They were rushed to the hospital where some overworked doctors battled courageously, but unsuccessfully, to keep them alive.
The neighbors all voiced opinions. These were good men, they were very friendly in the neighborhood. They talked to everybody. We need to stop the guns coming into this country, and we need regular police patrols in this area. The ‘drug situation’ is really out of hand. On the call-in programs, there was almost universal agreement that ‘this little rock’ had become too violent. The police offered to step up patrols in the area. Security and tourism officials, in particular, pledged enhanced security for visitors and locals alike. Everyone agreed that ‘something’ needed to be done urgently.
At the same time, and in the same hospital, the NCDs (non-communicable diseases) like heart attacks, strokes, kidney disease and even some cancers took a few lives. But apart for immediate family members and perhaps a few co- workers, there were no outward signs of anguish. There was no news flash. People did not phone in to the call-in programs, and the mass media did not send out their reporters to interview family and friends. People were dying so frequently from the complications of the NCDs that extending ‘thoughts and prayers’ meant little more than saying “Good morning. A nice day”.
While this author lives in Barbados, this story is not unique to Barbados. A 2024 United Nations report spoke of an “intensification of organized crime and … lethal violence” across the Caribbean region. It said surging drug production in South America, which often passes through the Caribbean on its way to the US and Europe, and the high availability of firearms, had “contributed to soaring homicide rates”. It named Jamaica, St Lucia and Trinidad as particular areas for concern. Instead it said “most gangs in the Caribbean” were “typically parochial, and focused instead on protecting their territory”. It added that the gangs were more often involved in local drug dealing, prostitution, scams, extortion, disrupting elections and securing government contracts.
Returning to the NCDs, it is no surprise that these are all called ‘silent killers’. Conditions like obesity, diabetes and hypertension, and their complications, are our major killers, in most of the islands, are all considered as preventable in medical circles, but attract little active efforts to prevent them. Statistical analysis over the years point to a growing obesity problem, with obesity serving as a platform around which many of the NCDs develop. The number of overweight
and obese persons keep getting bigger, and the numbers of persons who develop diabetes and hypertension keep rising. We keep enlarging the Emergency Department at the Hospital, and establishing more private Emergency clinics, but the suffering and deaths keep rising. We are producing more doctors every year, at the same time it takes longer and longer to see a doctor. And the national health expenditure keeps rising and rising, even as the local population is falling.
When a tap is leaking and the floor is getting wet, one can either respond by trying to stop the leak, or buying a bigger mop to keep the floor dry. Building more Emergency clinics is like investing in bigger and bigger mops.
When a citizen dies violently at the hands of masked gunmen, there is a major outcry for officials to ‘do something’. Our National Security apparatus must be mobilized. Communities are encouraged to come together. Our border patrols must be tightened. Politicians of various parties do not hesitate to comment on their party’s commitment to tackling ‘crime and violence’.
When a citizen dies from an NCD, there is ‘the sound of silence’. There is no call for the Ministry of Health and Wellness to resuscitate any ‘health promotion and disease prevention’ initiatives. The NCDs will continue to be called ‘the silent killers’. And if this is our response, or lack of a response, to the NCD epidemic, we will face an even greater challenge facing the twin epidemics: the NCDs and the Climate Change.