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Whose responsibility is it? #21

Our Jamaican language is replete with words that are used in a different way to Standard English and can mean the opposite; for example “soon come” has no definitive time constraint. Also having “a few friends over” could be a party with 300 people in attendance.

As an extension to the above there are words used in both languages that have no meaning in the other. I choose not to write some of my Jamaican words in this medium, but suffice it to say that in a fit of anger, my range of expressions far surpasses the British, American, and Canadian repertoire by a long way.

My word of the “misunderstood in translation” is Maintenance. It has no meaning in Jamaican that resembles a noun, or an action word. It is used without any intention leading to action or intervention in our country, and is not even a subject of interrogation for the common complaint “it nah wuk, it bruk down”. This misunderstanding goes from the very small to the very large issues.

If we accept that a motor car and a house are major personal investments then in the case of the former, why would we choose to insure a J$ 10 million investment as a third party risk knowing full well that there is an illegal taxi waiting around the corner to crash into you, and you do not have the 10 million to replace you vehicle? In addition, with our notoriously bad roads we fail to check tire pressure, engine oil, coolants, and front end alignment as we fall into craters every 100 meters.

Most home-owners are blissfully unaware of the electrical wiring in their own homes. Copper wires meet aluminum wires and conduct and vibrate at different frequencies causing joints to become loose and sparks are generated that cause fires (in the panel box and at the pot head). They have no idea of the paste to retard the chemical breakdown or that lugs in the panel box need to be tightened at least twice per annum.

Therefore at the individual level our two largest personal investments in capital are at risk because “mi neva know” is not a valid response to required regular servicing and maintenance. The relationship between electricity and flammable material does not require a PhD in physics or chemistry.

This exact condition is to be found in commercial buildings whether owned, leased, or rented, and in Jamaica few businesses include the cost of preventative maintenance in their annual budgets. In fact the line item Repairs and Maintenance only means repairs. It is like budgeting for legal fees that will only occur if we get in trouble with the law.

These are simply numbers that go into the budget so that if they are avoided our performance will be rewarded by a bonus. We face no consequences if the building burns down as that will be, from our myopic perspective, “an Act of God” and we will be totally absolved. I call it “creative accounting”.

In the recent crisis the Cornwall Regional Hospital is under the microscope. It may be the most publicized example of a “sick building” when that investigation is concluded and the cost of rehabilitation or rebuilding becomes a budget reality. As it is a hospital designed to “heal the sick not make them sick” it has great media attention at this time.

If the diagnosis of fiberglass dust in the air-conditioning system is the correct source of the fumes, then we have a complication in the steps towards rehabilitation. Firstly, if the action previously taken in cleaning caused the shedding, then perhaps the entire system is compromised. Secondly, if the entire system is compromised, is it sufficiently discreet so as to allow replacement without compromising other sections, and what are those sections? Thirdly, if the system design is no longer appropriate for a modern infection control of airborne infections, should it be repaired or abandoned?

If I were to hazard a guess I would suggest that a closure of the hospital for major overhaul would be a likely action that would address a number of issues. The staff and patient safety cannot be compromised under any circumstance. The closure could allow a really complete overhaul and ensure that Cornwall Regional returns as a really first class facility that could increase their surgical capability, train Consultants, increase ICU capabilities, and increase their Accident and Emergency potential. If accomplished this could truly become an international standard hospital allowing for treatment of local and foreign patients due to the close access to and from the airport.

However a close inspection of many Government-owned offices and private commercial offices will reveal a high percentage of hazardous construction resulting in mold in air-conditioning and walls, sewage defects, and the use of asbestos or fiberglass. The slavish use of rectangular ducting often means that modern cleaning robots cannot be used, and there is no other method that allows for minimizing regular cleaning cost and time. Clean air and low or no contamination is essential for a modern hospital.

In nearly every case there is a design flaw, and a careful back-tracking of the process will reveal that safety logic has been over-ruled by “creative accounting control” to contain estimated construction costs within the approved budget. In many cases this is merely an attempt for the financial gurus to try to establish themselves as a higher order species than scientific and technical experts in the pecking order. The financial decision makers therefore hope that there is sufficient time to enjoy their rewards and bonuses, and then they either retire or die before their poor decisions are discovered.

Going back to Cornwall Regional, I would be willing to bet that the design of the airflow processes had not been done in accordance with modern requirements such as segregated air directions that minimize air-borne infection, fresh air changes per hour in operating theatres, and completely segregated systems for isolation units may not have been part of the final approved design.

Secondly the frequent inspection of the facilities that would entail measurements of air quality and other sources of contamination would not have met the rigorous and costly public health requirements due to lack of money, personnel and the non- enforcement of standards.

However there is the golden opportunity for the Minister and Ministry of Health to forget the blame game, and to take a careful look at all the health facilities so as to identify other faults. The sheer enormity of the problems may be beyond the immediate ability of the Government to resolve in one year. However it will provide an accurate estimate of remedial capital expenditure that can be prioritized and funded in future budgets. At least the public could understand the situation in a fully transparent manner and support the efforts required to save their own lives and those of their loved ones.

The two major Political Parties must agree, in this context, to share the culpabilities of neglect; to avoid useless political finger-pointing; and agree to become technological watchdogs and avoid awarding future contracts to incompetent persons. This is an essential function of a Parliament.

It is important that we all explain technical issues in a simple way, and be truthful about what can be accomplished in the short term, as in this approach we will gather support rather than anger. This is the hand of friendship based on truth, which we all must extend to the staff and patients of Cornwall Regional Hospital, with the hope that in like circumstances they would do the same.

We have been saying for a number of years (probably greater than a decade) that we intend to implement an Occupational Safety and Health Act (OSHA) in Jamaica. This is admirable when attempting to achieve or maintain international standards of operations. Some industries will soon find that access to international markets will be conditional on meeting and maintaining those standards, just as they now have to do with HAACP (Hazard Analysis and Critical Control Points).

Many Jamaican businesses and Government operated companies have found that the cost and discipline of attaining HACCP or ISO certification has been an onerous undertaking, but one that we cannot ignore in the global markets.

Hotels, airlines, shipping lines, and the food exporting industries have had to bite the bullet and take the plunge and for them these are the rules of the game. So they have adapted and now budget for the real cost of certification.

OSHA will be more difficult as it is not solely externally mandated, and therefore we have the conditions of our own local workforce to attend to, in addition to the international demands. This introduces the ability of our local Trade Unions, Staff Associations, and individuals to take legal action against non-compliance.

This is an entirely unknown topic for the nation as a whole and has cost implications for  both  inspection  and  compliance  that  will  impact  budgets.  If these are misunderstood then disputes will contribute extreme pressure on an already over- burdened court system.

Whose responsibility is it to introduce transparency as a way of governance and public understanding?


Executive Insights
James Moss- Solomon
Executive in Residence
Mona School of Business and Management
February 27, 2017
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