What is the PNM's plan for the economy?

[Habit7]

Again, allyuh is the greatest...except in comprehension.



I never said scale up a dhf, I said scale up the new buildings to be hospitals.



De Beatup great story on Couva DHF, I fail to see how it's relevant though.

Like you read a different, PNM version of that report? Where exactly are the "commendations"? I see that there are some acknowledgements, and a lot of things that are needed, but I don't see any "commendations"
Reports of this type tend to be dry, analytical summaries, they are not to be tainted, or at least they shouldn't be, by any emotion or feelings. They tend to leave that for the politicos and guys like Habit7 and them.

I know you won't see that because it would have required you to first read the (PNM) report.

Directors concurred that a strong medium-term fiscal plan is needed to re-establish a sustainable fiscal path and ensure debt sustainability. They commended the authorities for the important steps taken thus far and encouraged them to put in place a comprehensive fiscal framework to guide their multi-year adjustment efforts.

You all have good night, tomorrow I will quote from your Republic Readers, maybe there was at least one comprehension exercise that you did already so you won't have to continually be wrong.

[Habit7]

[
Oh yeah I totally forgot about that housing scandal!
http://www.newsday.co.tt/news/0,168757.html

In an interview at the offices of the Opposition Leader at Charles Street, Port-of-Spain, days before the convention, Rowley maintained the issue raised by the removal of materials from the public hospital site to his family’s private housing development at Mason Hall, had absolutely nothing to do with him or his wife. His wife hired a contractor, Warner (Construction and Sanitation) Limited, and that contractor sub-contracted another contractor, NHIC, who, independently, shifted materials.

Seems Rowley and Jack go way back! No wonder a certain individual have not been extradited as yet.

This is PM of T&T ladies and gentlemen.

Warner (Construction and Sanitation) is owned by Allan Warner, a Tobagoian businessman, not Jack Warner. The very Allan Warner sold land to Ashworth Jack for him to acquire his pumpkin house.

I knew De Beatup wanted a distraction away from the hospital discussion so he threw out Landate. I didn't expect you to think every Warner is Jack.

[De Dragon]

Again, allyuh is the greatest...except in comprehension.



I never said scale up a dhf, I said scale up the new buildings to be hospitals.



De Beatup great story on Couva DHF, I fail to see how it's relevant though.

Like you read a different, PNM version of that report? Where exactly are the "commendations"? I see that there are some acknowledgements, and a lot of things that are needed, but I don't see any "commendations"
Reports of this type tend to be dry, analytical summaries, they are not to be tainted, or at least they shouldn't be, by any emotion or feelings. They tend to leave that for the politicos and guys like Habit7 and them.

I know you won't see that because it would have required you to first read the (PNM) report.

Directors concurred that a strong medium-term fiscal plan is needed to re-establish a sustainable fiscal path and ensure debt sustainability. They commended the authorities for the important steps taken thus far and encouraged them to put in place a comprehensive fiscal framework to guide their multi-year adjustment efforts.

You all have good night, tomorrow I will quote from your Republic Readers, maybe there was at least one comprehension exercise that you did already so you won't have to continually be wrong.

What utter sheit you really talking? Aren't the new buildings already hospitals? Are you saying build a hospital, and then try to make it a hospital? I swear, sometimes in your overarching desire to appear erudite and knowing, you talk like a pre-schooler, fack, even your insults are Montessorian
I did read the IMF report and thus made the comments that I did. You read it and put your red and ready spin on it. The line that you conveniently took out does not amount to glowing praise no matter how much you'd like it to, it merely acknowledges what has been done, and what still needs doing.

[drchaos]

My bad Jack Warner does own a sanitation company as well thought it was the same ...

Beat up? You went silent on the health care issue which is the lack of a beat up and normally means yuh eh know what you talking bout.

So I say lemme throw out some more bait ...

[De Dragon]

My bad Jack Warner does own a sanitation company as well thought it was the same ...

Beat up? You went silent on the health care issue which is the lack of a beat up and normally means yuh eh know what you talking bout.

So I say lemme throw out some more bait ...

Now he will come with his "made you eat your words" sheit, even though you have acknowledged your mistaken Warner identity. This guys' arse talks more than his mouth. Imagine spending upwards of 3 billion dollars, then looking to "scale up" to then make them hospitals? I heard of "build it and they will come" but I didn't realize that it applied to hospitals!
What is needed(since these fools who these other fools elected always need someone to suggest an idea or tell them what is needed), is to start an extensive training for medical personnel with a view of staffing these as-yet unbuilt hospitals. Raise the salary levels especially for nursing and ancillary staff so we don't continually haemorrhage them to other countries' health care systems. Ensure that doctors rostered for the hospital remain there, doing what they will now be well paid to do. Ensure that drugs are available, and that the pharmacy is staffed throughout. Have a properly constituted Medical Board and eliminate this "good old boys" sheit when doctors run afoul of their oath. This is by no means an exhaustive list, but just a few suggestions that in my limited experience could go a long way to making these new facilities world class.

[eliteauto]

it sad when someone deliberately dumbs down themselves to serve their partisan interests, are you guys really gonna harp on simple English to try some kind of oneupmanship? It seems to me it's pretty clear what Habit is saying is there are existing health institutions at Arima and Point and the Gov't will be upgrading those to hospitals with the construction of same, to have a to and fro that nitpicks the language used is stupid, I'm sure the discussion on both sides can move on from that level of pettiness to salient points for and against. Coma nah man guys

[drchaos]

Elite its not about simple english ... Its a concept that he put forward about staffing a hospital from a DHF which just won't work.

He is trying to justify that we can have all three new hospitals up and running just cause PNM ministers said so. It does not work like that and it never has.

Oh and I don't serve partisan interests, Habit does. I refuse to choose between one of these two parasitic organisations that run this country. Would have voted for an independent if there was one on the ballot sheet but sadly there was none.

[eliteauto]

I've seen you put forward points that show you have some knowledge of how the health system works locally, both from staffing and function perspectives, I think that's where we need to keep the focus in terms of the (im)practicality of constructing the new facilities, I just felt the exchange on Habit's lack of clarity was being drawn out maybe Dragon was correct with "in your overarching desire to appear erudite and knowing," but dat between he and Habit

[De Dragon]

I've seen you put forward points that show you have some knowledge of how the health system works locally, both from staffing and function perspectives, I think that's where we need to keep the focus in terms of the (im)practicality of constructing the new facilities, I just felt the exchange on Habit's lack of clarity was being drawn out maybe Dragon was correct with "in your overarching desire to appear erudite and knowing," but dat between he and Habit

What Habit7 proposes is not only financially irresponsible, but logistically impossible. If you were to transfer the entire staff to a new hospital, you will still be sorely lacking in personnel. Even if you take a core of doctors and nurses, you will still need hundreds of additional staff to properly operate a hospital. Habit7's use of phrases like " all that is needed is to transfer of staff and operations to the new buildings and eventually scale it up to match its potential as additional staff and operations are funded." shows either an obvious lack of knowledge of health care management, or acceptance of spending of billions of dollars carelessly. We have the time to get the staffing right BEFORE the additional hospitals are built, but if we have no plan, then we have no staff, and therefore these hospitals should be put on hold. Note that contrary to what Habit7 and others say, I have never been against adding extra health care capacity.

[Redman]

We have the time to get the staffing right BEFORE the additional hospitals are built,

The construction and training should be synchronized.
The commissioning of these buildings happens on a phased basis ....and the training should be able to deliver the required staff to meet the commission.

Training and construction should be happening at the same time.

[drchaos]

I've seen you put forward points that show you have some knowledge of how the health system works locally, both from staffing and function perspectives, I think that's where we need to keep the focus in terms of the (im)practicality of constructing the new facilities, I just felt the exchange on Habit's lack of clarity was being drawn out maybe Dragon was correct with "in your overarching desire to appear erudite and knowing," but dat between he and Habit

Habit is a cool fellar, is good banter with him. Seems to have a broad base of knowledge and knows how to find information that he doesn't know. Problem is he will twist that knowledge to favor a certain political party line, reminds me alot of Uncle Patos. Wait ... maybe he is Mr. Manning ....

Junior staff are not a hard thing to come by for these facilities (may not be the best quality but you can get them locally and from worse off third world countries). But the senior staff with expertise is what they will have the problem with. I thought Deyalsingh was a better fit for the Health Minister as he is not a doctor and may not be involved with the medical cartel that Fuad was part of. This cartel ensures that even when senior doctors are employed they spend very little time in the hospital and more time in their private practices. All these corrupt systems need to be dismantled before you attempt to staff additional hospitals. Thats why I was trying to say that system should be fixed before adding new buildings to the mess of the health care system and they can be fixed very quickly just needs a minister and a PM with some big cajones.

[Habit7]

What Habit7 proposes is not only financially irresponsible, but logistically impossible. If you were to transfer the entire staff to a new hospital, you will still be sorely lacking in personnel. Even if you take a core of doctors and nurses, you will still need hundreds of additional staff to properly operate a hospital. Habit7's use of phrases like " all that is needed is to transfer of staff and operations to the new buildings and eventually scale it up to match its potential as additional staff and operations are funded." shows either an obvious lack of knowledge of health care management, or acceptance of spending of billions of dollars carelessly. We have the time to get the staffing right BEFORE the additional hospitals are built, but if we have no plan, then we have no staff, and therefore these hospitals should be put on hold. Note that contrary to what Habit7 and others say, I have never been against adding extra health care capacity.

At this point I wonder if De Beatup are just arguing for argument sake

2,500 staff for Children’s Hospital
By Richardson Dhalai Wednesday, August 12 2015

On the eve of the formal commissioning of the Couva Children’s Hospital and with construction of the Point Fortin and Arima hospitals having already begun, Health Minister Dr Fuad Khan yesterday disclosed staff would be drawn from throughout the Regional Health Authorities (RHAs).

Speaking to reporters following yesterday’s formal handover ceremony of keys to Level 2 and 3 of the San Fernando Teaching Hospital Chancery Lane, San Fernando, Khan, said approximately 2,500 staff members would be required to manage the children’s hospital.

“I’m working on that (staffing arrangements), I had a meeting with all the chairmen (of the RHAs) and I indicated to them that any of the staff that we need to deploy to the Children’s Hospital, we will deploy them,” Khan said.

“But we are starting off with radiology, starting out with outpatient clinics, and one of the ideas from the chairmen was we should move the whole paediatric unit from Mt Hope into the Children’s Hospital as fast as we can, and then utilise the other hospitals as satellite paediatric institutions, which is not a bad idea so you just move the staff, all, lock stock and barrel,” he said.

Asked to clarify that staff would be relocated from the other RHAs, Khan said, “yes, because once we move departments, we move staff, because the Couva accident and emergency, they will be moved to start up in the Couva Children’s Hospital.” The Children’s Hospital is expected to be officially commissioned on Friday.

http://www.newsday.co.tt/news/0,215490.html

[drchaos]

Habit you should know better than to quote that numb skull Fraud Khan

So you proposing to move the entire pediatric department from Mt hope to Couva?
So what you are proposing is to leave Mt Hope with any pediatric services?

Mt hope is a well established Pediatric unit so you gonna waste all those buildings and equipment? A&E, ICU and wards?

So you are not expanding pediatric services ... you moving from them from point A to B how does that help?


Yes that will end well ....

Fuad had no idea how he was going staff that hospital because they started fishing for solutions a few months before opening. They were throwing out tones of dumb ideas.

[De Dragon]

What Habit7 proposes is not only financially irresponsible, but logistically impossible. If you were to transfer the entire staff to a new hospital, you will still be sorely lacking in personnel. Even if you take a core of doctors and nurses, you will still need hundreds of additional staff to properly operate a hospital. Habit7's use of phrases like " all that is needed is to transfer of staff and operations to the new buildings and eventually scale it up to match its potential as additional staff and operations are funded." shows either an obvious lack of knowledge of health care management, or acceptance of spending of billions of dollars carelessly. We have the time to get the staffing right BEFORE the additional hospitals are built, but if we have no plan, then we have no staff, and therefore these hospitals should be put on hold. Note that contrary to what Habit7 and others say, I have never been against adding extra health care capacity.

At this point I wonder if De Beatup are just arguing for argument sake

2,500 staff for Children’s Hospital
By Richardson Dhalai Wednesday, August 12 2015

On the eve of the formal commissioning of the Couva Children’s Hospital and with construction of the Point Fortin and Arima hospitals having already begun, Health Minister Dr Fuad Khan yesterday disclosed staff would be drawn from throughout the Regional Health Authorities (RHAs).

Speaking to reporters following yesterday’s formal handover ceremony of keys to Level 2 and 3 of the San Fernando Teaching Hospital Chancery Lane, San Fernando, Khan, said approximately 2,500 staff members would be required to manage the children’s hospital.

“I’m working on that (staffing arrangements), I had a meeting with all the chairmen (of the RHAs) and I indicated to them that any of the staff that we need to deploy to the Children’s Hospital, we will deploy them,” Khan said.

“But we are starting off with radiology, starting out with outpatient clinics, and one of the ideas from the chairmen was we should move the whole paediatric unit from Mt Hope into the Children’s Hospital as fast as we can, and then utilise the other hospitals as satellite paediatric institutions, which is not a bad idea so you just move the staff, all, lock stock and barrel,” he said.

Asked to clarify that staff would be relocated from the other RHAs, Khan said, “yes, because once we move departments, we move staff, because the Couva accident and emergency, they will be moved to start up in the Couva Children’s Hospital.” The Children’s Hospital is expected to be officially commissioned on Friday.

http://www.newsday.co.tt/news/0,215490.html

A SUGGESTION from a chairman is what you're basing you're lame-o idea on? It is known that a new facility cannot be staffed ENTIRELY from scratch. As I said, if you empty a DHF, you cannot run a hospital. If you move an entire hospital staff, you still have to replace that staff from the donating facility. Centralizing a particular specialty, like Paediatrics, still only requires the staff for that department, and still leaves the other facilities to staff the satellite departments if you were to transfer every employee. At the end of the day nimrod, you still have a staffing void to fill. Yet you want to talk comprehension? Learn to admit when you don't have a clue about every single thing, and you'll come across as less of a whiny child who cannot have it his way.

[Habit7]

Well as I say, allyuh is the greatest.

For those keeping score:
IMF release a PNM report that commends but not really commends the govt.
And Fuad Khan and a RHA chairman is just as inept, if not more, as me in knowing how to staff a hospital.



I await what more you have to say just in an effort to be disagreeable.

[drchaos]

Habit, proving someone's idea is inept and asking hard questions that you can't answer about the health system makes you look like you don't know what you talking about.

Further claiming people's ideas are good just because they are in positions of authority (like Fraud and an RHA chairman) now just makes you look dumb ....

[Habit7]

Habit, proving someone's idea is inept and asking hard questions that you can't answer about the health system makes you look like you don't know what you talking about.

Further claiming people's ideas are good just because they are in positions of authority (like Fraud and an RHA chairman) now just makes you look dumb ....

What proof has been offered that proves anything inept?
What hard questions that were asked that weren't answered?

Love him or hate him Dr Fuad Khan is an accomplished urologist with a MBA, had a controlling interest in a successful private hospital and was elected by a majority of citizens. De Dragon said my idea shows that I don't anything, my idea is similar to Dr. Khan's. I am just citing an authority health care administration, in addition to citing case studies as with what occurred with gradual scaling up of the EWMSC in the 1980’s. All you all offering so far is your personal opinion.

Are your credentials exceeding Dr. Khan's?
Are your ideas of either raising health surcharge 1400% for everyone or having the middle and upper class bear the majority of the expense for the running of one hospital, accountable to the public as Dr. Khan's suggestion?



This is just becoming who can be more belligerent about something that not even realised yet lead by De Beatup and Dr. Chaos Warner.

[Habit7]

Habit, proving someone's idea is inept and asking hard questions that you can't answer about the health system makes you look like you don't know what you talking about.

Further claiming people's ideas are good just because they are in positions of authority (like Fraud and an RHA chairman) now just makes you look dumb ....

What proof has been offered that proves anything inept?
What hard questions that were asked that weren't answered?

Love him or hate him Dr Fuad Khan is an accomplished urologist with a MBA, had a controlling interest in a successful private hospital and was elected by a majority of citizens. De Dragon said my idea shows that I don't anything, my idea is similar to Dr. Khan's. I am just citing an authority health care administration, in addition to citing case studies as with what occurred with gradual scaling up of the EWMSC in the 1980’s. All you all offering so far is your personal opinion.

Are your credentials exceeding Dr. Khan's?
Are your ideas of either raising health surcharge 1400% for everyone or having the middle and upper class bear the majority of the expense for the running of one hospital, accountable to the public as Dr. Khan's suggestion?



This is just becoming who can be more belligerent about something that not even realised yet lead by De Beatup and Dr. Chaos Warner.

[drchaos]

We have asked you time and time again and you could not answer simple questions on how do you intend "scale up" was the word you used a DHF to a Hospital.
You have put forward the concept but never explained details on how it would work. We have pointed out why it won't work.
That you won't have staff to run wards or other services for 1 new hospital let alone 3.

Now you praising Fraud Khan ... When he became minister of health your hero Fuad admitted that there was a problem with consultants not doing their contracted hours in the hospitals and spending that time in private practice. He responded with a directive to move Junior doctors to acting senior positions instead of forcing his friends to actually do the work they are paid to do. Juniors without specialist training are now acting as Registrars and consultants and working on patients without the qualifications to do so. This guy acts in the interests of his cartel and colleges not yours or mines.

He was Health Minister when he was not included in a committee to decide the direction of health care for the country by his fellow MP's after many of his blunders became apparent.

Continuing to praise Fuad lol it helps my point.

[zoom rader]

Men have Habit7, Redman and Eliteauto all of which are pro PNM looking small in here

[drchaos]

[b]Are your credentials exceeding Dr. Khan's?[/b from Habit


So what you saying Habit is if a man with credentials tell you that the earth flat you go believe him?

[rspann]

So Dr chaos, you saying the man acts in his own interest and that of his colleagues? Hmmm interesting.So hypothetically this person should not be health minister because it is in his interest for the health system not to work properly? and that he would always put his private business above the interests of the country?

[Redman]

[b]Are your credentials exceeding Dr. Khan's?[/b from Habit


So what you saying Habit is if a man with credentials tell you that the earth flat you go believe him?

yet you/Dragon expect every one here to agree believe you.

[Habit7]

[b]Are your credentials exceeding Dr. Khan's?[/b from Habit
So what you saying Habit is if a man with credentials tell you that the earth flat you go believe him?

No I am saying that if accomplished health administrators are saying staff and wards can be transferred to a new hospital and over time more staff can be added until it reach it full potential, I am in good company. While De Beatup, who cant read "commend", and yourself, who thinks every company with Warner in the title is owned by Jack, both think that a DHF can never become a hospital, never.

With a simple google search I found several examples otherwise:
http://www.jica.go.jp/zambia/english/of ... 40711.html
http://www.newvision.co.ug/new_vision/n ... d-hospital
http://maldivesindependent.com/politics ... tal-116454
http://www.tiozambia.com/chilibula-clin ... -hospital/

It could start with the idea you seem to be distancing yourself from now, which is moving the A&E unit to the hospital and start wards for observation, then acquiring specialists in surgery, radiology department with radiographers and at least one radiologist, acquire biomedical technicians offer to CT & MRI, all while increasing nursing staff. Specialists can start offering clinics and having nurses assigned to them all while having support from increasing administrative staff, auxiliary staff, maintenance staff and all else that is logical.

It would seem that whether it is funding a hospital to staffing a hospital to running a hospital, you have some opinion why it is impossible, everybody is an idiot, it has never been done before and somehow Jack Warner is involved. I await to see what else you claim to be impossible I would have to show you an example of.

[drchaos]

Habit learn to read nah boy ... I never said never.
What I did say is they will be out of office before the Couva hospital is fully functional. Because you and your party want to build hospital without planning how you going to staff or fund it and then scramble for failed solutions after the damn building ready to be inhabited. The same mistakes of the PP are being repeated by the PNM and both being praised by you.

Numbskull .... you have quoted articles about Zambia as an example? ...How large is Zambia? How many medical schools does Zambia have? How many speciality training programs do these universities have?
They have 3 large medical schools and their capacity for training specialists far outpaces our own
They also have the ability to pull doctors and specialists from the African subcontinent who have similar board exams and registration systems.

Same goes for the Maldives who has 1 medical school and pulls the rest from a large pool of specialists and doctors from the Indian subcontinent.

Now compare that to Trinidad the entry requirements to get registered with the medical board in sweet T&T are the same as UK and US hospitals, Indian and African doctors come here to save money for a year or two and move to the states or UK2 ..... Habit you does read any of these articles you post or you does just slap them on for effect.

What is this primal lust you have with Jack? ... I already give yuh right with that ... but you keep harping on simple mistake to distract from your big blunder about turning a DHF into hospital.

[drchaos]

So Dr chaos, you saying the man acts in his own interest and that of his colleagues? Hmmm interesting.So hypothetically this person should not be health minister because it is in his interest for the health system not to work properly? and that he would always put his private business above the interests of the country?

Tell me what miracles Fuad Khan has done for the Healthcare system and then we go talk ...

[Allergic2BunnyEars]

Why you looking for miracles though?

[Habit7]

Habit learn to read nah boy ... I never said never.

Elite its not about simple english ... Its a concept that he put forward about staffing a hospital from a DHF which just won't work.

For the umpteenth time the hospitals were not started by the PNM, the are being financed and are under contract. A change in govt cannot just stop them, there has to be a contractual reason. Unless you know the contract reason for it to stop, stop whining and take the public hospitals the majority of citizens across the political divide want.

With one voice you are saying Zambia too big for comparison, but Maldives (a third of our population) pulls from the subcontinent. Don't we pull specialists from India too? So what if they go to the US, our local doctors doing USMLE too and not coming back too. As far as I know the medical board accepts doctors from US and accredited commonwealth schools primarily . Dr. Khan tried to bring 300 Ugandans doctors but when their govt found out they blocked them from coming In addition there are Cubans and Chinese doctors including a group of Chinese specialists who just finish their stint and I personally know would love to stay because they love Trinidad.

One of the reasons frustrated specialists leave is because the infrastructure is crumbling and their is little sign of improvement. Yes there are other issues but nothing is wrong with dealing with them simultaneously.

[drchaos]

Habit learn to read nah boy ... I never said never.

Elite its not about simple english ... Its a concept that he put forward about staffing a hospital from a DHF which just won't work.

For the umpteenth time the hospitals were not started by the PNM, the are being financed and are under contract. A change in govt cannot just stop them, there has to be a contractual reason. Unless you know the contract reason for it to stop, stop whining and take the public hospitals the majority of citizens across the political divide want.

With one voice you are saying Zambia too big for comparison, but Maldives (a third of our population) pulls from the subcontinent. Don't we pull specialists from India too? So what if they go to the US, our local doctors doing USMLE too and not coming back too. As far as I know the medical board accepts doctors from US and accredited commonwealth schools primarily . Dr. Khan tried to bring 300 Ugandans doctors but when their govt found out they blocked them from coming In addition there are Cubans and Chinese doctors including a group of Chinese specialists who just finish their stint and I personally know would love to stay because they love Trinidad.

One of the reasons frustrated specialists leave is because the infrastructure is crumbling and their is little sign of improvement. Yes there are other issues but nothing is wrong with dealing with them simultaneously.

Our medical board will only accept specialist qualifications from outside once the US or UK will accept also accept them.
So If an Indian doctor with specialist training wants to come to Trinidad to work he needs qualifications that the US or the UK will accept. If he already has that why the heck would he come to Trinidad?
The only Indian doctors that come here come as junior doctors most move on after a year or two. No where near the number we need so they do nothing to fix the shortage we have.

Cuban's make up a very small number of doctors in the system, they come for short term contracts, two year or less. Cuban nurses come in larger numbers and are harder working than alot of our own nurses but still not near the numbers you need. There is also a language barrier, they can speak ok English at best. There have even been instances of the wrong medications given to patients because of a break down in communication and it is covered up.

The Chinese sent two neuro surgeons and a Pulmonary specialist to SWRHA, whom I have met. They have commented on many occasions that the working conditions are much better at their respective centers back at home. They have never commented on any plans to stay here.

So no Habit you cannot compare Zambia or even the Maldives to T&T's health system.

[drchaos]

"One of the reasons frustrated specialists leave is because the infrastructure is crumbling and their is little sign of improvement. Yes there are other issues but nothing is wrong with dealing with them simultaneously."

Wrong! the main reason is finances, the second reason is our backward healthcare system.
A medical specialist in T&T can make around 480K TT a year in the public sector. In the UK Consultants make around 80K to 100K GBP a year and live better lives, in the US they can make around 130K+ USD per year.

There are alot of Trini foreign trained doctors that do return from the UK and US but they end up working in the private industry. When you are making over 100K TT a week why go hustle for a 40K a month in the public sector?

The Healthcare system system, not infrastructure frustrates specialist who have been trained abroad, ancillary staff do not do their jobs, the culture is one of laziness without repercussions and corruption without penalty.