In an exclusive interview with TNN yesterday afternoon, the CEO and President of Bermuda Hospitals Board (BHB) Dr. Michael Richmond acknowledged that, since the Coronavirus arrived on Bermuda shores just over a year ago, the hospital had certainly been presented with its fair share of obstacles and challenges. He would consider it disingenuous to say otherwise.
One of the first challenges that they were confronted with was making sure that the hospital was able to increase their capacity in both the acute areas and the Intensive Care Units (ICU) at the facility. They also had to make sure they were able to protect all of their staff and provide them with the appropriate Personal Protective Equipment (PPE.)
“The acquisition of protective equipment was extremely challenging, because there suddenly was a global stampede to access this type of equipment,” Dr. Richmond said.
“I’m delighted to say that, although in the early days there were some narrow scrapes, we had managed to secure and then add to all of the protective equipment that were required. Good early planning has served us well for the last twelve months.”
Despite all of the challenges that the hospital has faced, Dr. Richmond believes that all the stress has been met through the staff coming together in an exceptional manner.
“Much has certainly been asked of people in healthcare [particularly during this time] and I believe that much has been delivered; not just on the frontline, but throughout the entire healthcare continuum,” he said.
According to him, the majority of patients with the Coronavirus who attended the hospital’s emergency department had only mild to moderate symptoms for the virus. These patients were sent back to their homes so that the hospital could treat patients with more severe cases of the virus. The hospital has followed the same algorithms and guidelines for admitting COVID patients as practically every other hospital around the world.
“Although we live on an island, we’re not an island in terms of learning what is the best practice [for handling this virus] around the globe,” he said. “We have an algorithm where patients are triaged along that algorithm and, depending on the need of the patient, determines whether they are admitted or not. I don’t believe that there are any hospitals which would admit all positive COVID patients. There is not the need or the capacity to do so . . . I believe that the patients who require hospital care are put on the appropriate pathway and receive that care.”
The peak number of COVID patients in the hospital at one time was 50, around two to three weeks ago. As a result of this peak, some of the elective surgeries had to be postponed to a later date. But, Dr. Richmond can now say with cautious optimism that the numbers in the hospital have been quickly dropping, mostly as a result of the government’s recent stay-at-home and quarantine orders.
He believes that hospital staff have responded appropriately to whatever state of alert that the island is under during any particular time. One thing that staff had to do early on was to make sure that the hospital maintained most of their services.
“We did this to make sure that where a delay in care would have had an impact to make sure we did not delay care and to try and prioritize the level of urgency,” he said. “We also made sure that our staff were being guided, supported and correctly informed through these challenging times, while recognizing and valuing at the same time what our staff have brought to not just the hospital, but to Bermuda at large.”
FINANCIAL IMPACTS OF THE PANDEMIC ON BHB AND REFINANCING HEALTHCARE
Of course, the pandemic has had its financial and economic toils on BHB. Financing for the hospital actually started to change almost two years ago, before COVID-19 was even thought of in the western world.
“Since [beginning to refinance], we have been caught up in this whirlwind. BHB is part of the Bermudian economy, and as such, it’s not unrealistic to understand that what hits Bermuda is, at some point, BHB,” he said.
They have certainly had some stresses and strains on their budget, especially in terms of the unexpected costs of PPE.
“The burn rate of some of this protective equipment was certainly not something that we would have anticipated before this pandemic,” he said. “We have ridden the first part of the storm, but this is ongoing work.”
Dr. Richmond acknowledges that, in terms of healthcare financing, Bermuda is facing some serious challenges, including a rapidly ageing population and significant coexisting of chronic disease. Over time, these all lead to extremely high healthcare costs for the average Bermudian.
In order to even begin to try and lower the cost of healthcare on the island, the issue has to be seen through a number of different avenues and looking at a sum of marginal gains.
“We can try and manage healthcare in a lower cost setting as effectively as possible. That is obviously around dealing, in a primary care setting as frequently as possible, with illnesses, diseases and patients that can be dealt with in a primary care setting and also ensuring that a patient’s hospital stay is as short as is safely possible,” Dr. Richmond said.
IMPACT OF THE CORONAVIRUS ON HOSPITAL STAFF
Despite accepting that hospitals can always do more to help their staff cope during this stressful time, Dr. Richmond is extremely grateful for the risks that some hospital staff have put themselves through while treading through this pandemic.
“When there is a fire in the building, most people are leaving the fire. In a pandemic, we have asked the healthcare workers to run towards the fire. That takes courage, professionalism and a certain level of commitment. You cannot buy those things,” he said.
As an organization, BHB has to ensure that there is not just a “vacuum” of information within the organization, but that information is effectively distributed throughout it.
“I can say without fear or contradiction that a huge amount of effort, particularly from our public relations and communication department has gone into doing that,” Dr. Richmond said.
“We are very dependent on our leadership–our managers, our middle managers and our supervisor to make sure that they are keeping a watchful eye on their own staff to make sure it’s clear that if people have problems and are under duress, they have an ear that will listen to them.”
Since Bermuda is such a small and tight-knit island, Dr. Richmond believes that the majority of hospital staff who tested positive for the Coronavirus were infected within a community setting, rather than while treating patients at the hospital.
“In the management of the [infected] staff members, it’s exactly the same as the community at large; a small number of positive infections may have needed hospital care,” he said.
Several donors, including the Green family have contributed to the BHB, in particular its vaccine program. According to Dr. Richmond, these substantial donations have really allowed the hospital to remove whatever limits were in place on how quickly and widely the vaccines can be rolled out.
“The donations have been a tremendous enabler to secure a service which is doing a great job . . . Bermuda is in a phenomenally fortunate position to pretty much have a ready supply of vaccines, not every country in the world has got this luxury,” he said.
Dr. Richmond believes that, at present, around 50 percent of the island’s eligible population has had at least one dose of the Coronavirus vaccine and around 35 percent have received both shots.
Even though Dr. Richmond fully respects people’s personal choices on whether or not to receive the vaccine, he requests that people at least keep their minds open to information that is coming out about them from around the globe.
When he was appointed as the CEO and President of BHB in July of last year, Dr. Richmond was told three major things by hospital staff: to be present, to listen to the staff and to value the
staff’s input. He promised himself that he would not let them down, and he believes that he has stuck to that promise for the most part.
“I’ve been a very fortunate man and doctor who has worked in many jurisdictions around the world. I’m absolutely proud to be the executive director of BHB,” he said. “I see huge talent, commitment and compassion on a daily basis and believe deeply that there is no limit to how good and safe hospital care can truly be and would like to deeply thank all of the staff for their efforts during the past year.”
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