Caribbean Islands Table of Contents
Dominican health statistics in the 1980s suggested a number of challenges confronting medical personnel on the island. Typhoid was a concern, with 207 cases reported during the period 1979 to 1984. Deaths from malignancies increased from 55 in 1980 to 70 in 1984, and deaths from hypertensive diseases increased from 58 to 117 over the same period. At least 70 percent of all deaths occurring in women over age 45 during the early 1980s were attributed to hypertensive disease. A survey of school-age children in the early 1980s indicated that 38 percent suffered from gastroenteritis. Infant mortality rates were on the rise in the early 1980s. After steadily declining in the 1970s, the rate increased from 10.2 per 1,000 live births in 1981 to 23.9 in 1984. PAHO researchers cautioned, however, that the increase could actually be the result of an improvement in Dominica's health information system as well as a statistical aberration resulting from the small number of infant deaths. Child mortality as a whole had declined from the levels recorded in the late 1970s and was stable at 0.4 per 1,000 live births in 1984. As of 1986, there were no reported cases in Dominica of acquired immune deficiency syndrome (AIDS).
Many of the medical problems on the island could be attributed to deficiencies in environmental health. Twenty-one percent of the estimated 16,000 houses in Dominica had access to drinking water; another 43 percent had access to piped water at a distance of less than 100 meters; the remainder (approximately 36 percent or 5,760 houses) had no acceptable and convenient access to water supplies. Nineteen percent of the population had access to regular solid waste collection services. Only the two major urban centers, Roseau and Portsmouth, had central sewage systems; they lacked treatment facilities, however, and instead disposed of raw sewage in the nearby sea.
Water pollution was a serious problem in Dominica in the 1980s. Large amounts of liquid and solid wastes from an oil and soap factory, a paint factory, rum distilleries, citrus processing, bay oil distilleries, and banana packaging were being dumped untreated into rivers, streams, and the sea. Health hazards also accompanied banana cultivation, particularly through the use of agrochemicals. In 1984 the United States Agency for International Development (AID) made a US$1.7- million package of assistance available to the banana industry of Dominica. Included in this package was a supply of the herbicide paraquat, which for years had been banned by the United States Environmental Protection Agency as a carcinogenic substance. In the 1980s, this chemical was widely used throughout Dominica's banana industry without the benefit of protective clothing. It was quite common to see village children carrying fresh water to their homes in bright yellow plastic bottles labelled PARAQUAT.
In an effort to address these clinical and environmental concerns, in 1982 Dominica unveiled a five-year national health plan with an emphasis on decentralization of administration and delivery of health care. At the base of the plan was the primary health-care unit, designed to serve a minimum population of 600 within an 8-kilometer radius. The primary health-care approach included home visitation by multidisciplinary teams of nurses, extension agents, and public health workers; education sessions at the village and family levels; radio programs; use of posters; and the mobilization of community groups around public sanitation, the environment, nutrition, and health. Four or five health-care units were supported by a health center, where more comprehensive services were available. The Princess Margaret Hospital in Roseau served as the nation's secondary referral facility and offered inpatient services in medicine, general surgery, pediatrics, obstetrics, gynecology, and psychiatry. One hundred and forty beds were available for general care with another forty for psychiatry. Limited in-patient care was available in the sixteen-bed Marigot Hospital and the thirty-six-bed Portsmouth Hospital. Limited medical care and long-term nursing care were offered at the ninetybed Central Geriatric Institution.
Although a comprehensive assessment of the national health plan had not been conducted by the mid-1980s, there were some encouraging signs. In 1984, about 88 percent of pregnant women received prenatal care and approximately 42 percent were attended to by the sixteenth week of pregnancy. Child health-care services covered 100 percent of children and included immunization, nutrition, education and counseling, and growth monitoring. In 1984 immunization levels for diphtheria, pertussis, tetanus (DPT), poliomyelitis, measles, and tuberculosis were above 90 percent.
Data as of November 1987
Caribbean Islands Table of Contents