~ Long hours, little support added to his decision to leave ~

By Sanny Ensing

Dr. Tjon Kon Fat, one of two obstetricians working out of the St. Maarten Medical Center, is leaving the hospital on March 11, and explains that being on call 24/7 is the main reason for his departure. "If you are on call every night, you get tired, and you make mistakes."

He continues: "We do our own deliveries. I have no midwife who checks the patient for me. There is only one midwife here who works for herself. We definitely need more midwives, as she cannot take on all the patients alone."

With Dr. Tjon leaving and Dr. Petit only working another year without being on call, the medical center needs to get people in. "A change is needed because other gynaecologists will not want to come and work in St. Maarten Medical Center without the extra support of midwives, but flying gynaecologists and midwives in costs money," says Dr. Tjon.

"I saw an advertisement in the Netherlands by St. Maarten Medical Center," Tjon tells, "looking for gynaecologists in Holland. The ad stated that there are soon to be two more midwives on the island as a support to the gynaecologist. It was advertised as short term; three to six months. Then the person can extend her stay. But who can go and work somewhere for 3 to 6 months only, and under what conditions?"

The medical center needs new doctors and specialists. When Dr. Tjon leaves, Dr. Friday will be the only gynaecologist left on call. Tjon: "If you have to work alone and be on call alone all the time, you are going to make mistakes. Right now, we each handle our own patients, so we are on call 24/7 and that means you are tired. In the Netherlands, you are not allowed to work all the time. You have to go home and rest when you are on call. Here you cannot. Some people tell me to close my office, but you cannot do that; if people need you, you have to be there."

"A year ago, when Dr. Friday did not work yet, I decided to tell the medical center I would leave, because I knew I would be on call all the time and I needed to protect myself. And I knew I could make mistakes because of being tired. I have decided to go back to Suriname. Suriname has big hospitals. The level of care is comparable to St. Maarten, but it is easier for us. Midwives do many deliveries, there is a lot of personnel available and I won't have to be on call continuously. The nights will be easier. It was a difficult decision to make. My children grew up here and I have worked here for many years, but now I have made up my mind. I am looking forward to going back. If nights were not a major problem working here I might have stayed. I am not the type that likes to move a lot. In the 17 years that I lived and worked here, I have had a great time, and especially my working relationship with Dr. Petit has been good."

So is the care on St. Maarten up to par? Dr. Tjon replies: "Many patients on St. Maarten look at Miami, and the States in general, to compare hospital care. They expect a lot and want a lot. I think that the care here, for a small island, is reasonable."

Compared to the French side of the island, however, you do see a big difference. They have seven gynaecologists, four working out of the hospital and three privately, and about nine midwives. According to Dr. Tjon, "On the French side they are quick to send patients with minor problems to Guadeloupe or Martinique; we usually deal with minor problems ourselves. We do not cooperate with the French side;" he says, "they are part of the European Union and we are not."

Another point is the C-section rate. According to Dr. Tjon, St. Maarten's caesarean rate is higher than in the Netherlands which is 12%. Exactly how much higher Dr. Tjon could not say, but according to Dr. Petit, "a rough estimate" would be 20 to 25%. Even so, that is still lower than in the States, where the 2007 rate was reported to be 38%.

Dr. Tjon: "In the Netherlands there are enough trained persons to take care of the patient. Here you have to anticipate, in case something can go wrong, you want to do a C-section already. At night the operation room workers need to come from home, and it takes a minimum of 30 minutes to have the patient on the table." He did point out that the peri-natal mortality rate in the Netherlands is higher than in other European countries and that they want more 24-hour service in hospitals in the Netherlands. "Maybe it is because they have a lot of home births," Dr. Tjon said. "The fact is that I do not take any risks."