Myron Rolle1,2, Deen L. Garba1, Jahzreel Thompson3
1Program in Global Surgery and Social Change, Harvard Medical School
2Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
3Department of Anesthesia, Doctors Hospital, Nassau, Bahamas
Deen L. Garba
Program in Global Surgery and Social Change
Harvard Medical School
25 Shattuck St, Boston, MA 02115, United States
Copyright: This is an open-access article under the terms of the Creative Commons Attribution License which permits use, distribution, and reproduction in any medium, provided the original work is properly cited.
©2021 The Authors. Caribbean Medical Journal published by Trinidad & Tobago Medical Association
An unhelmeted cyclist heading west on Bay Street, Nassau is clipped by a speeding motor vehicle. The cyclist falls to the ground, fractures his skull and is unconscious. Emergency medical services rush to transport him to the nearest hospital. In Accident and Emergency, the patient undergoes a nasopharyngeal swab and is found to be COVID-19 positive. The proper alarms are triggered to inform all of those involved in this patient’s care of the protective measures required to manage him. This patient needs an emergent decompression of his skull fracture and his positive COVID-19 status complicates his care. Nurses, staff, physicians, therapists, security, technicians and all other members of his care team are now exposed to COVID-19. Fortunately, there is a vaccine that could help protect these Bahamian frontline workers. But what do you do when those same healthcare professionals remain reticent about taking the vaccine? You recognise the challenge, lean in with data and firmly advocate for the safe and effective move towards a stronger health system and a stronger nation through vaccinations.
The pandemic caused by COVID-19 has impacted a vast majority of people in the world. To date, there have been 124 million COVID-19 cases and 2.74 million deaths worldwide. 1 In the Bahamas, an island nation of 400,000 people, there have been 8,839 cases and 186 deaths. 2 Understanding the limited healthcare capacity to properly treat any potential overwhelming surge of COVID-19 patients, the Bahamian government and public health officials instilled strict behaviour lifestyle modifications. There is a 10pm-5am curfew. Mask wearing is mandatory. Foreign travel is discouraged. Gatherings are limited. Virtual school options are offered. Hand sanitiser and/or recent negative rapid antigen tests are required to enter most buildings. Despite these conservative measures, there is still a population of Bahamians that remain the most vulnerable to COVID-19 and her variants – and that is the frontline healthcare worker.
Bahamian healthcare workers are the lifeblood of the health system. No operation, no illness, no triaging can be managed without them. Their responsibilities are arduous at baseline. Now add in a global pandemic and one can see lives disrupted – personally and professionally. They have been called frontline heroes, because similar to a battle in the field; they are the persons who would have faced the virus head on. Few people have seen the rapid breathing, sweating and exhaustion of patients infected with the virus. Few people have been at the bedside of a dying COVID-19 patient to comfort him in his last moments. Bahamian healthcare workers know this experience and they know this pain. For months on end, healthcare workers added extra layers of clothing, gowns, masks and face shields to protect themselves from the virus. These items, worn for hours consecutively, are far from comfortable, almost unbearable and sometimes smothering. Collectively, the Bahamian healthcare worker believed that freedom from the daily stress COVID-19 placed on their work life would come in the form of a vaccine. However, once the 20,000 AstraZeneca vaccines (a vaccine that reduced symptomatic disease by 79% and reduced severe COVID-19 hospitalisations by 100%) arrived on the island, the hesitancy by frontline healthcare workers was palpable. 3,4
It is well documented in academic literature that black people have been used as experiments for medical science. This history has created a chasm of distrust between blacks and the healthcare system. Syphilis was clandestinely tested on blacks in Tuskegee. 5 Vesicovaginal fistula repairs were performed on black slaves without informed consent. 6 Some studies used for medical education such as the Framingham Heart Study did not include black people. 7 The Bahamas, a country with a demographic of over 80% black people, is no different. The newness of the vaccine and the non-local development of the vaccine understandably creates pause by those wanting to make informed decisions. Unfortunately, that pause in vaccinations could mean life or death. That pause could mean a health system that breaks. That pause could mean an economy that suffers. That pause could mean a country that does not advance past the pandemic.
The Bahamian healthcare worker is essential and needs to be vaccinated. The Bahamas relies on their continued service and as the lifeblood of the country – nothing happens in the medical space without their involvement. Many Bahamians who have received care from frontline healthcare workers have recovered. They have survived and they are living to fight another day. A vaccinated healthcare worker adds to the workforce, adds to the service delivery and adds to the morale of the country.
The COVID-19 positive cyclist in need of emergent surgical intervention in the Bahamas will be managed by a great team. A fully vaccinated team further ensures that every team member will be safe, the capacity to manage any pathology that comes through the door will remain high and the country will move forward past the pandemic. No vaccine dose left behind.
- Johns Hopkins University Coronavirus Resource Center. COVID-19 Map. https://coronavirus.jhu.edu/map.html (Accessed 29/03/2021).
- ZNS Bahamas. Covid-19 Update 17/3/2021, published 18/03/2021. https://znsbahamas.com/covid-19-update-17-3-2021/ (Accessed 29/03/2021).
- Eye Witness News. VACCINE HESITANCY PERSISTS: PSA head says many officers “reluctant” to get vaccinated, published 19/03/2021. https://ewnews.com/vaccine-hesitancy-persists-psa-head-says-many-officers-reluctant-to-get-vaccinated (Accessed 29/03/2021).
- Eye Witness News. Dahl-Regis: Vaccine hesitancy is a “real concern”, but more pro-vaxxers than anti-vaxxers, published 15/03/2021. https://ewnews.com/dahl-regis-vaccine-hesitancy-is-a-real-concern-but-more-pro-vaxxers-than-anti-vaxxers (Accessed 29/03/2021).
- Centers for Disease Control and Prevention. The Tuskegee Timeline, published December 10, 2020. https://www.cdc.gov/tuskegee/timeline.htm (Accessed 29/03/2021).
- Wall LL. The medical ethics of Dr J Marion Sims: a fresh look at the historical record. J Med Ethics. 2006;32(6):346-350. doi:10.1136/jme.2005.012559
- Andersson C, Johnson AD, Benjamin EJ, et al. 70-year legacy of the Framingham Heart Study. Nature Reviews Cardiology. 2019;16(11):687-698. doi:10.1038/s41569-019-0202-5