Dear Editor,

  Thank you for another very read-worthy Teen Times edition. Please allow me to respond to one of the articles, in particular the one about “local inspiration Dr. Jonas Wilson”.

  Dr. Wilson returned enthusiastically to St. Maarten in August 2018 as medical doctor and biomolecular engineer, ready to serve his homeland and welcomed with open arms by family and friends and an article in The Daily Herald, but will soon leave our island a major illusion poorer and frustrated.

  How can it be that a small country continually loses inspirational young professionals because they feel stagnated by our poor Governmental “organization” at all levels (executive, legislative and implementing).

  As the new leader of the Party for Progress (PFP) Melissa Gumbs explains: “St. Maarten is faced with many issues that have not improved due to a start/stop attitude that has been present from before 10-10-10,” which (I add) has been compounded by the fact that we are a multicultural village, expected to take country responsibility with growing pains that are inflated by political egos that favor talking and (as Teen Times describes) a crab mentality over structural, long term planning and effective, pro-active action.

  Let’s face it. Any country that is financially broke and needs foreign financial assistance to pay the salaries of its civil servants, has politicized the re-building of its most important tourist gateway (the airport), approves governmental budgets 8-9 months into the year with, according to its own audit chamber, poor if non-existent accountability while having expensive governmental executive changes on a yearly basis is bound to float around as a lame duck and obviously “pray” to powers with more structural and organizational experience or, in worst case, others with criminal intentions.

  We can blame the Dutch, but more realistically we should look in our own yard that is riddled with poor structure and inconsistent implementation of regulations, if implemented at all or often colored by favoritism and nepotism. We often lack the guts and out-of-the-box thinking to create progress and stability while many are afraid to take responsibility and rather point to others to take the lead. We feel stuck to antiquated rules and keep saying, “Well … this is St. Maarten,” expressing the feeling that we can’t expect much better.

  Coming back to Dr. Wilson, who will be leaving St. Maarten soon due to his frustrations with the government apparatus and, as he states, “reverse culture shock,” archaic rules and regulations at the level of the national legislature.

  Born on the French side but raised in Cole Bay, having Dutch nationality and permanent resident status, his Saint Martin-born parents living on the Dutch side from before his birth, according to literal interpretation of our country ordinances he should be seen as a “son of the soil”. Even according to our constitution he should have all the rights to be treated equally, but he was confronted with personal interpretations of ordinances and was not accepted as ‘real’ local.

  Our governments, even in our constitution, have never formulated in detail who should be seen as a son or daughter of the soil because no one dares to take the risk to either include or alienate the many persons who have over decades contributed to the development of this country.

  Despite handing in all the required documents, it took him more than 6 months to obtain a ministerial decision (MB) to work as house officer in our hospital.

  Reading through the Teen Times article, hearing from colleagues and nurses at the hospital and from my own conversations with Dr. Wilson I have to deduce that he is not only an excellent physician, but has outstanding social and communication skills extremely important for progress in our Health Care field.

  I’m also aware that, although he had not finished a specialization in the field, his intention was to serve our community as a general practitioner. Far-reaching plans with one of the clinics were made to be trained by two family practitioners, both with 35 years of experience, both trained as Dutch general practitioners. The training was anticipated to give Dr. Wilson the best possible opportunity to familiarize himself with our local health care field and the multilingual/multicultural as well as organizational aspects that come along with it. Agreed it would not be exactly similar to a Dutch or UK training and wouldn’t give him a diploma, but it was envisioned and planned to be close to a local equivalent.

  Government has given physicians permits to work as general practitioners who have no formal training as GP but have worked at the Emergency Room for a number of years, while working at the ER obviously trains you to work in emergency care but doesn’t necessarily train you to work in family practice where the approach is much more geared towards long-term medical support, psycho-social problems, preventative health and interpersonal (family) relations.

  Our government, however, thought the planned extensive GP training for Dr. Wilson was not sufficient and will only accept an official training abroad. Mind you, a training in Holland or the UK as alternatives would train the young physician for the typical Dutch or UK health care situation but would not help this physician to adjust to the local insurance and health care practices.

  In the coming 1-5 years 11 of the 23 general practitioners will retire in St. Maarten. One would think that keeping capable and interested local physicians on-island and training them locally would make sense especially because it will be almost impossible to obtain sufficient replacements for the GPs retiring, most probably creating a shortage in General Practice the coming years.

  Several of the current GPs have already indicated that they will just close their clinics and leave patients to seek alternative care, creating a gap in continuity of especially chronic care. That at a time when preventative and cost-effective chronic care will become more important to keep health care cost controlled.

  Government seems not to have a plan how to anticipate to this looming health care gap.

  We’re losing locals and there are insufficient local doctors in training to replace those that will retire. It’s sad to see a young enthusiastic local physician leave our country frustrated, but fortunately for him with excellent prospects elsewhere, so with little inclination to come back to a poorly-organized country unless St. Maarten really makes some effective changes, cleans up its yard and makes use of its local talent.

Gerard van Osch, MD