The Saba Island Council had a positive meeting with Director of the Caribbean Netherlands Health Insurance Office ZVK Angel Bermudez on Bonaire last week Wednesday, May 15.
The Island Council delegation, comprising of Members Eviton Heyliger, Vito Charles, Hemmie van Xanten and Esmeralda Johnson, and Registrar Akilah Levenstone, presented a discussion document to Mr. Bermudez. The Island Council was well-received. Mr. Bermudez told the delegation that he truly appreciated the initiative of the Saba Island Council to come to Bonaire to meet with him. Mr. Bermudez promised that he would meet again with the Island Council in a month to discuss short term solutions for the issues presented in the discussion document.
One of the points that the Island Council delegation brought up during the meeting with Mr. Bermudez was the possibility of ZVK covering the costs incurred by patients having to travel to St. Maarten to see a dentist as long as there is no dentist on Saba. It was noted that there has not been a dentist or an oral hygienist on Saba for more than a year. In order to see a dentist, one has to go to St. Maarten, which means the incurring of costs.
In the discussion document that the delegation presented to the ZVK Director, the Island Council alluded to the complaints of the patients on Saba regarding medical referrals and the associated logistical and decision-making issues, and the stricter enforcement of the rules and regulations.
The document listed a number of solutions. (see list below)
While on Bonaire last week, the Island Council paid a visit to the Bonaire Housing Foundation FCB and the new social housing project that is being constructed. The delegation further visited Forsa Nobo, a foundation that works with children with behavioral problems, Jong Bonaire, an organization that facilitates after school and care activities for children, and the greenhouse of Bon Terra Bonaire.
Each issue below was presented by the Island Council and discussed with the ZVK Bonaire. (list published by Island Council Member Hemmie van Xanten.)
A majority of patients who needed to leave the island of Saba for medical reasons have experienced:
• delays in their travel by last minute changes without informing the patient
• very long travel time when travelling to or from Colombia. Average travel time reported is between 30 hours and 96 hours.
• unconfirmed hotel accommodation upon arrival in hotel
• little to no travel information available. Patients depend on other patient’s information which often creates confusion and misunderstanding
• hotel rooms booked cannot facilitate the patients’ need like wheel chair patients cannot enter because the door opening is too small for the wheel chair, same for the bath room
• receiving the daily allowance not on time or after the medical referral
• patients need to call a piket number in Bonaire when their flight has been changed/cancelled
• Patients receiving double tickets for a medical visit to SXM, with Winair and St.Maarten airways
• A charter airplane arrives on Saba on Easter Monday to collect a patient who was booked for Good Friday to fly. Plane leaves empty again. Total cost USD 2400 for nothing
• Dialyses patients have not received their monthly tickets 3 days prior to departure
Decision making issues
A number of patients have indicated the ineffectiveness of the decision making procedure by ZVK in Bonaire
• Local family doctors need to request their suggested referral of a patient to authorities in ZVK Bonaire.
• ZVK Bonaire decides based on information received from the ZVK medical professional without knowing or seeing the patient.
• Medical referrals or follow up visits advised by medical professionals need to be approved by ZVK administration and specialists, without knowing or seeing the patient. The fact that medical professionals advice and ZVK Bonaire disapproves advice, creates an insecure patient who does not understand who to believe anymore.
• Medical referrals or follow up visits advised by medical professionals are being judged by specialists visiting Saba. The patient’s understanding and expectations are being put in jeopardy and again a new advise will determine the patient’s health and future. There are too many specialists involved in the patients’ decision making.
• ZVK Bonaire decides when a patient can travel, how to travel, where to travel and how long to travel without any consultation with the patient.
• Decisions made in ZVK Bonaire have not been sent to the Government of Saba nor the general public for information or publication. Example: the limited facilities of accessible ventures from April 1st have not been communicated to the people of Saba, the appointment of a complaint person has never been made public to the people of Saba, the introduction of a new charter airline has never been explained to the people of Saba.
• Bonaire ZVK decide on appointments for patients when to visit the local office in Saba to collect their paperwork without consulting local ZVK staff
• Local staff was instructed to contact patients on certain issues. Bonaire ZVK contacts the same patients as well, creating mixed and confusing communication
• When a patient is visiting a specialist abroad, and he/she will get to advise to check out related matters, ZVK often does not award such request and have the patient rather travel back home in order to start a new process.
Equal treatment issues
The patients of Saba are in many situations not treated equally with those on Bonaire
• Our local ZVK office is not informed of patients travelling with Air St. Maarten, any logistics involved and further follow up. Saban patients have to call ZVK Bonaire office (piket number) for information on these while Bonaire patients can contact their local ZVK office
• Although dental care and hygiene is compulsory for all people on Saba till 18 years of age, Saba has not had a visit by a dentist or mouth hygiene specialist for over a year.
• When seeing a dentist, a patient from Saba has to book a flight to SXM, pay the taxies, stay overnight, eat at restaurants, and pay other things like airport tax. A total amount of USD 500 will be spent with a ‘single one night stay over’ dental visit while patients in Bonaire can visit the dentist by bicycle or own car. No extra expenses are involved here.
• Bonaire patients can visit the ZVK office and receive a direct answer/follow up. Saban patients can visit the local office, but need to wait for head office to get an answer.
• Saban patients first have to travel from Saba to St. Maarten, to Curacao, to Bonaire before departing to Colombia. Bonaire patients skip this completely since they depart directly from Bonaire to Colombia. The daily allowance received for their pre-travel to Colombia is insufficient seen the prices charged at e.g. The Marriot Hotel.
Stricter enforcement of rules and regulations
• Accessible ventures operated in the past by approvals from ZVK Bonaire. Now ZVK Bonaire is applying a stricter policy creating misunderstanding and misconception by Saban patients since it was ZVK Bonaire who approved the use of Accessible ventures in the past and it became customary. No information was given to the general public of Saba who had to find out themselves on April 1st.
• Transportation from Hospital to Pharmacy is no longer covered by ZVK Bonaire. Patients have to find their own transportation
• The elderly patients, now depend on their working family members to bring them to the hospital to see a doctor.
• Since more decisions are taken now by ZVK Bonaire, the role of the ZVK office Saba has been minimized, resulting in patient expectations are not being met anymore because local staff is not directly involved and up to date.
• When calling the ZVK Bonaire office, telephone service is poor. Calls are often not answered. If answered, response of ZVK staff is often disrespectful and not polite.
• When calling ZVK office, proper answering is done when your government position as Island Council member is made known to them.
• Our local professional staff of the ZVK office is totally undermined and leaves them without any authority. Work atmosphere has dropped to a very low level.
• Create a possibility for adults to have an additional insurance to cover dental care since this is not provided by ZVK
• Allow the local ZVK office more authority, since they know the patients and can communicate with them directly
• Allow the local ZVK office to do the daily handling and running of trips off island, including airline tickets, hotel accommodation and daily allowance
• Allow the local ZVK office more decision making since they have a proven record of being capable of doing so and providing a tailor-made trip, as it has shown in the past.
• Make use of Copa airlines to transport patients to Colombia. This will reduce travel time by 83% and is cost saving:
– A ticket price with Copa Airlines from Saba to Medellin is approx. 800 USD
– A ticket price from Saba to St. Maarten is 200USD + St. Maarten to Curacao is 400USD Curacao to Bonaire is 200USD + Bonaire to Medellin is 600USD, in total 1400USD
– Hotel in Bonaire, average is 4 nights (2+2), cost 480USD
– In total 1880USD compared with 800USD. This is a 1000USD cheaper and 83% faster.
• Use Sarpa from St. Eustatius to transport patients to Colombia. This will reduce travel time by 83%
• Allow local medical professionals to make direct decisions concerning patients instead of questioning their professionalism
• Develop a direct contact between hospital and ZVK office Saba to eliminate any interference from ZVK Bonaire
• Eliminate the discriminatory items affecting all Sabans
• Show a human and concerned attitude to patients. Their ID number is not their name.
• PR and general information coming from ZVK Bonaire needs to be more publicized, communicated to the people and needs to show a professional organization that cares about our people.
• Have a local budget available for the ZVK office Saba so that logistics can be made here and paid for here on Saba.