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Setting new healthy standards

Interview - March 30, 2012
Minister of Public Health and Sports Dr. Richard Visser shares with United World Aruba’s new path in healthcare – from drug addiction treatments to obesity-related diseases to the use of new communications technologies in medicine
Please tell us about Aruba’s drug problem.

In talking about addiction and homeless addicts, we have basically given all the power, the money and the resources to all the NGOs (non-governmental organizations). We have empowered the NGOs. They have a heart for it that the Government does not really have. The Government has stayed with the main direction of where we want to go – coordination, administration and technology. We have introduced electronic client files, an EZRA computer system. It comes from Holland and is part of the very well known organization DeHoop, which is an addiction rehab organization. They have developed a software program where you can follow your addicts once they are in the program. You can find out if a client has a Sexually Transmitted Disease, where they have been treated, if they have psychiatric problems etc. I have bought the system and this is distributed to all the 16 points around the island, so whenever an addict is admitted, they will know what he/she has and what treatment to continue with. For the first time, we do treatment from A to Z. It takes three years to go through our programs basically. From the detox facility to treatment facilities to halfway homes to reintegration
For the first time, we have a new curriculum that we are introducing into the schools – to train the trainer. These trainers go into our schools with this prevention program for addiction, alcohol and drugs.

Is this being implemented because there is a high level of addiction in Aruba?

Well, we are a small island and we depend to a great extent on tourism, so having addicts in our streets can really have an impact on our economy. The past government basically put a house up where they could take a shower and leave, and that’s about it. They were not given any treatment, so the problem got worse and we could not handle it, and it got into the city center, which is where all the tourists are. So we have now taken the issue out of the justice system, and we have put it under healthcare, which then means that you treat it as a disease and not as a crime. So you have a whole different approach. We work with Santo Domingo and DeHoop in Holland and a psychiatric organization called Parnasia Bavo Holland for addicts with psychiatric problems. We are also talking to a private high-end rehab institution.

I have traveled to Colombia and seen what they have done and I have talked to them. Because of this, we are implementing a 24-hour hotline, which started in mid-March for any family members, addicts etc. so they can reach someone dialing #190, 24 hours a day and get guidance and an immediate response. We also have a different branch. We determine whether an addict is aggressive or disturbing the community and we can take him against his will and put him in treatment. We have worked together with the ministries, the police and the judges here to design this program. The judge makes a decision and we can then pick the dangerous addict up and put them under mandatory treatment for one to two years. We have a capacity of about 150 for people who voluntarily go for treatment and a capacity of around 62 for aggressive patients. At that point, we should be able to handle our situation pretty well.

We are also re-educating people who work with addicts. We have a university program for people who are working in the field to upgrade them to be able to handle this new challenge and system. It is actually a long-term treatment system. We also have homes that we are building as permanent residences for people who cannot ever live on their own. A small group falls under that category and they will be in assisted living homes as ex-addicts or addicts.

How do you work with NGOs here?

We have a national drug agency (Hunto de Consehos) that basically advises me. In that, there is one representative from each NGO plus a president and a vice president. This is where we get our information. It is all coordinated under the EZRA system. Each NGO has a direction – they do not just do whatever they want. They are financed by us and they really have to adhere to what we as a group decide. Our social system has also changed so that we pay for treatment. The Government is paying for most of the treatment right now, and that is a huge switch and change in terms of how we deal with addiction. We have given power to people who can really use it. We have seen that the Government is not effective when it comes to this – it is messy and it is not fun. Government is just too slow to react to this, whereas NGOs do things even without help from government.

As you know, we are building a new hospital. I wanted it to be efficient and I wanted the quality of care to be much better. If you build the right environment, in itself your quality of care will increase. Aruba has the great fortune to have a high standard of care, with this new project infrastructure catches up to case.

In a lot of the hospitals that were built 20 to 25 years ago, no one ever thought about simple things like putting all your plugs at waist height, so that no one has to bend. The technology that we have now was never put into the buildings. So you also have a lot of contaminations and infections because of the bacteria that end up in hospitals. So this architecture group has completely separated the traffic of people, meaning that workers have their own elevators and other areas which never cross the public coming in. Patients will also have their own lines of traffic, meaning that a patient who comes from the operating room will never see people coming in to visit, because then you have cross-contamination. These things improve the quality of care instantly.

Then we have the design and efficiency. In the past, you would have very long rectangular buildings with a nurses station and the nurses would have to walk all the way to the end of the hall to see room number 1, room number 2 etc. The new designs actually have a racetrack so that the nurses’ station is central in the building and the equipment and the supplies are central, and all the rooms are built around it, so that in just a few footsteps, the nurse can be in any room on that floor. The supplies and medicines are also centralized. We are set up to be totally compatible with e-care, e-medicine etc. I can have a hospital in Miami looking at the patient. We are looking to have an exemplary hospital and upgrading what is there, you massively improve the quality, services and how people feel when they come into the hospital. We are creating a bigger room so families can come in. We know that the healing process is much better when families can come in and be around their loved ones. Right now that is impossible. Because we are an island and we have one main hospital, when you have a room for four, there is actually room for four. So we can double our occupancy in a couple of hours. We have been planning ahead. The hospital will be ready in two years’ time. We signed yesterday and in November we will be breaking ground. It is exciting.
But I have even bigger plans.

Let’s hear about them.

We are doing three huge things. 1- PACO (Pan American Center for Obesity), 2- Baptist Health South Florida, 3- Drimpy E-medicine and Health Bus. We have created a childhood obesity platform in Aruba. You can go to, and we have worked very closely with the World Health Organization. I was able to make an impact. Just like you said, I am a minister but I am also a scientist and I do research, so I am able to influence the countries and get votes and move them in new directions, which is to get obesity out of chronic diseases, and create a platform so that we can get the stakeholders and partners that need to come to the table. With chronic diseases, everyone thinks that you need to be a doctor to talk. That has been one of the problems. But with the obesity crisis, we have realized that changing the environment is the greatest impact we can have. We have done nutrition and movement for 50 years, but it has not made a difference – it has only made it worse.

So now the scientific community is moving towards creating a different environment around individuals and vulnerable groups, especially in Latin America and the U.S. But Aruba has a higher rate of obesity in the U.S. – in adults it is 77% and 36% in children. We are looking at poor and rich countries in the Caribbean and Latin America that are moving towards obesity. It is a real danger. Healthcare systems cannot pay for these chronic diseases. Chronic diseases are now considered to be a developmental problem. It is not even a medical problem. That is why the UN has addressed it in the new millennium goals, which were passed in September in New York. This will have a huge impact on a country’s economy and productivity and everything – education, what these kids will make in life. We have realized this.

We have brought the top scientists of the continent here together twice – once in January and then for the actual congress here in June to create a platform and a paper (the Aruba Call to Action). This paper was passed and included in the UN millennium goals for chronic diseases. That led to me representing the Dutch Kingdom as the first minister in history not from Holland to represent the Kingdom at the UN. This was the catalyst for that. It was basically the first time that so many different people from different sectors got together and started talking the same language. That was here. Globally, it was a first step. All the global players were here.

This year we will hold the second conference and we will focus on getting people to move as well. We are looking at best practices. We have researched all the best practices. A very critical part is preconception – we need to get parents ready before they think about becoming parents. Then the first year to the first two years of life are so critical, that they determine almost 50% of how your child will be in the future. Here is where a lot goes wrong – if a child is born underweight, they will have the same propensity to become obese as a child who is born overweight. In Haiti, their average kilokal intake is half of what it should be, yet they have 50% of women are overweight and obese. How do you explain that? The choices have much more to do with the environment than they have to do with food and movement. It is not like we think. In Peru, we have phenomenon called stunting because people were underfed for so many years, so they were short. They are born with fewer growth hormones, but this also means that their organs are smaller so they can handle less. They have more problems producing insulin so they get diabetes faster when they gain weight. We have to manage that in a different way.
This is where the scientific community comes together and tries to handle it. The actual changing of the environment comes from everyone outside of the healthcare field. The healthcare field sets the direction, but the work really happens outside, like Brazil banning children’s adverts. It is the only country in the world to ever dare to do that. It is Colombia looking at the ciclo vias and the healthy movement that they have for the whole country. It is Mexico banning soft drinks and fast foods in schools.

We are also the first island or country that a very reputable hospital chain in Florida (Baptist Health) has signed with. We are doing a pilot program here for a hospital. We are reusing a hospital and turning it into a green building and we are co-branding with Baptist Health South Florida. We are going to do urgent care, which will be a buffer for our emergency care. Urgent care is a step below where you basically pre-screen people and you handle 80% of all cases so that your hospital can really focus on the real extreme stuff. We are going to do diabetes – the eye care, foot care, dialysis and the whole protocol on these islands. Diabetes is a major problem here. Obesity causes everything from heart disease to diabetes, to cancers. Breast cancer is closer linked to being overweight and obese than smoking is to lung cancer. These are things that most people do not know, and that is why our rates are so high in breast cancer.

We are also going to do oncology – we are going to have a bunker built and we are going to do radiotherapy, chemotherapy, nuclear medicine and we are going to continue developing it to become a complete cancer hospital. It is their first move into this area. Everyone here is insured and they can get treatment and care for free. Aruba has a very unique U.S. airlift – we are two hours away from Florida and we have U.S. immigration. We are really set for this. We are going to be digitalized, meaning that a doctor here can work on a patient while a doctor in Miami does as well. All the vitals and the scans will be digitalized. We are going to create a whole new sense of how we can optimize care in countries that do not have super-specialists. With e-medicine, you can have the super-specialists looking at the same patient twice.

We are also looking at m-health. Devices that we have now can monitor you wherever you are. We want to develop that – this is the future of medicine. We can use these things. We want to be a center of excellence. Baptist Health sees 12,000 patients from our region here in Miami. They could see a lot more if you did not need a visa for Miami. This is going to be a new era of real medical tourism for us. So you really need a niche market, and with a name like Baptist Health, you can create that. 70% of tourists coming to Aruba are east coast Americans and they all know Baptist Health South Florida. They are going to decide to come to this island compared to others. People say that the newlyweds and older people come to Aruba. The older crowd often times deal with chronic diseases, so they are all looking to be in a place where if something happens, they will be able to connect with the U.S. If we have an oncology center that is run with Baptist, that is going to change what happens here.

I am bringing Drimpy here, which is a web-based e-medicine i-cloud. Eventually every citizen here will use it. It is basically Facebook for healthcare, called Drimpy. It works the same as Facebook, but in pink you have all your public health instances, your hospital, insurance and certain specialists and doctors who will answer your questions directly. Self-care becomes a strong point. It is a huge part that we need to do. You can have access to your family members’ files and you can access that information remotely. You will be able to go to the NGOs and talk about your health problems. It will also be used as a system where physicians and groups can ask questions once a week (just say you have diabetes) about whether you are taking your medication, if you are eating right etc. If you answer “no” too often, then you will get a house visit.

You can send an SMS and that alone will create such a movement in self-care and education. We are also going to have a health bus, which is a 40-foot container that is an air-conditioned clinic. There is a scanner on board that measures your BMI (Body Mass Index) and a lab where you can get all the basic lab results immediately, and we do health promotion. Aruba is one of the first places in the world where we are doing electronic medical dossiers, countrywide. All our primary healthcare practitioners here now have their dossiers online. That means that you can transfer files to a specialist and if he leaves and a new doctor comes in no matter where, they will get the file. Then patients can start building up their file themselves. It is the future – patients need to be in control of their health. At the same time, you can get research out of it. This bus will do screening on obesity and non-transmittable chronic diseases. At the same time, the information coming out of the bus will be used for research. It is kind of a rolling research vehicle.

And in terms of education and well being…

We have a pilot project for some schools and all the kindergartens will be healthy in terms of food in the cafeterias, sports, etc. This Drimpy will help us move faster into people’s homes. A program is being developed where a physician can prescribe exercise as a medicine. The kind of prescription depends on what condition that person is in. You get it like you do a prescription in a pharmacy. As a physician or patient, you need to be able to know what your exercises are and have examples to do them in your house, and all of this is possible. It is connecting the dots, and you need a system that is in the cloud, which connects everyone and everything. We are developing this here and we will be the first island or country to have it. We are going to focus specifically on creating a healthy environment here. We set up a new institute for just this: IBISA Institute for Healthy and Active Living, which is focusing on implementing our entire national prevention plan.

I think that the three things that I’ve just presented are really unique aspects that nobody else is doing. Aruba also has a very unique aspect to it – we are uniquely set up to hold big conferences (geographically, the air lift and our facilities), and we have not made use of that. People want to come to the Caribbean, and we have the facilities, but we are just not promoting this enough. These are areas that we are developing here and we will become known internationally. We have to look at the niche areas and who to partner with to create that name. Baptist Health Florida is instant name recognition. These are the things that will really move us into a new direction.

Other interesting developments going on include a three-year, 13 million euro project with Soper Strategies Netherlands to turn Aruba into the first dengue-free island beginning in June 2012. Also there is a project with the hotel industry for IBISA to create healthy vacations. Marked with our healthy lifestyle guide, tourists can follow these for a healthy vacation. From that they choose to act, to what activities they participate in local “Cyclovias”, bike, swim, run races, healthy walks, etc.
Come to Aruba, have fun, be happy, and look great too, and leave even more gorgeous.