 On September 9th, 2009, a fire ravaged the surgical wing of the St. Jude Hospital. Female patients on that surgical ward perished during that fire. The operations of the St. Jude Hospital were immediately relocated to the Georgia Lomb Stadium and continues to operate from that site. On November 1st, 2022, following the submission of a report by the 2021 Cabinet Appointed Review Committee, the Government of St. Lucia announces intention to complete the original structures of the St. Jude Hospital and return medical services to the OJ site at the soonest. Over the last 15 months, the team at the Department of Economic Development along with the supervision team at Caribbean Consulting Engineers and the management of the St. Jude Hospital have been working very hard to ensure that this project is completed. During the Prime Minister's New Year's address in 2024, he stated that four buildings will be completed by June 2024 and that work on the remaining structures would commence shortly. In August last year, the Government of St. Lucia signed a loan agreement with the Saudi Fund for Development for some 201 million Eastern Caribbean dollars. The greater part of these monies would go towards the completion and equipping of the St. Jude Hospital and the remainder would go towards the rehabilitation of the George Orlum Stadium to ensure that it is returned to its originally intended use. In October of last year, the Development Control Authority granted full approval for the remaining eight buildings which will form together with four buildings which had already previously received approval for what will be the entires in Jude Hospital complex. Today, on issues and answers, we want to discuss the progress made on the reconstruction efforts but also very importantly, to look at the hospital when it becomes operational and the quality and range of services that are going to be offered. I am Silas Wilson, Project Liaison Officer with the Department of Economic Development and my guests are today, Miss Lydia Atkins, CEO of the St. Jude Hospital and Mr. Barry Jonas, Project Manager of Caribbean Consulting Engineers Limited. Welcome, lady and gentlemen. Thank you. Thank you. Firstly, Miss Atkins, the completed hospital would comprise a minimum of 80 census meds and 16 nonsense meds, a total of 96 meds. In addition, a number of outpatient services will be offered at this facility. What would you say to our listeners and viewers are census and non-census meds? And tell us how does this design differ from what you currently operate at the stadium? So your census meds, good afternoon, Silas. Sorry, and good afternoon to the listening public. Census meds, Silas, typically refers to the meds that are counted for admissions and what you have as designated meds for admissions for patients. And your non-census would be those meds not designated to admissions, for example, what you have in your ER, that would allow for maybe 24-hour observations and allow for procedures or recovery from surgery, for example. You'd have mentioned that we are moving to a facility that has 80 census meds and 16 non-census meds, a total of 96 meds. Currently at the George Audlem stadium, we have a facility with 50 census meds and now 26 non-census meds. Prior to COVID-19, we would have had 10 census meds and having had a need to increase it by an additional 16 to respond to increased admissions that we were seeing and that our census meds of 50 did not allow for us to have adequate capacity for admissions. After COVID-19, we've inherited a population that is increasingly ill, increasingly morbid and as a result, you have higher admissions at the facility. And so this increased in bed capacity will definitely allow us to be more responsive to the needs of the people in the South as it relates to hospital admissions. We also would have had, as part of that new facility, two new operating rooms that are significantly larger than what it is that we have at the George Audlem stadium, as well as a designated space for endoscopic procedures. You would have mentioned 12 main buildings compared to four at the George Audlem stadium. We also would have improved laundry services that is able to support effective infection prevention and control measures. And that I think is something that we are all aware of or terminology that submissions are quite we've given COVID-19 and our requirements to be able to adhere to international requirements for infection prevention and control. Additionally, we have the two additional buildings for physiotherapy as well as dialysis, increasing our capacity for dialysis from what is currently eight dialysis chairs to what is anticipated to be 15 dialysis chairs at the... So an increase of almost 100%. Yes, correct. And we would know or there is increasing prevalence of end stage renal disease, requiring individual to have dialysis as a treatment. Important as well is that with the completion of the new St. Jude and the new physiotherapy space, St. Jude Hospital would then become the first facility and only facility on Island that is able to provide hydrotherapy. Why is that important? With increased numbers of persons with diabetes and hypertension, we have high numbers of stroke and cardiovascular incidents. And as a result, these individuals would be able to benefit from that kind of therapy to allow for us to be able to support rehabilitation, to support them in getting greater mobility post-stroke. It would be remiss of me to not indicate as well that something that is very synonymous to St. Jude, which is St. Jude's volunteer program, which we've had to struggle with at the George Audlum stadium, that the new buildings or the buildings at the new site would also include the volunteer quarters. That is important because it is something that is unique to the organization and we would want to be able to continue along those lines. And then we also have capacity then with a gym-on facility to be able to support staff wellness as part of an employee wellness program. All right, your team has played a very important role along with the remainder of the team at the Department of Economic Development and Caribbean Consulting Engineers in helping us review components of the facility that we need to make changes to. Give us a synopsis of how that dialogue has gone and what has come out of it. So we've had a number of engagements with the engineering team. We've also had a number of engagements with the project team and as a result we've been able to do a review of the laundry department, laundry and maintenance. We've also been able to do a review of cafeteria to ensure that both of those spaces meet international standards as well as provide meet the standards for prevention of infection and disease control at the facility. We've also done a review of the emergency room looking at the requirements, especially looking at the requirements for new ER and ensuring that it meets best practice in November. We would have had a team from accreditation Canada conducting a site visit with our labs and that is the lab at the new site to ensure that in its review it can give recommendations for adherence to international guidelines as it relates to workflow for that space and for the design. In February, February 5th to the 9th, St. Jude would also be hosting the accreditation Canada team as part of its Cumentum International Program for a site visit of the rest of the building to give guidance in terms of what are the requirements for us and these are very important in terms of ensuring that the building is going to be fit for purpose as well as meets the international requirements to support the proper workflow. All right, and tell us quickly as well. We will now take a commercial break and we will be back with you in just a few moments. Welcome back to Issues and Answers. Today we are discussing the St. Jude Hospital Reconstruction project, what has happened over the last 15 months. My guests are Miss Lydia Adkins, CEO of the St. Jude Hospital and Mr. Barry Jonas, project manager with Caribbean Consulting Engineers. Mr. Barry Jonas, projects of that nature require a supervision team. What is your role on this project? All right, afternoon, Mr. Silas and the rest of the viewers. I made some notes so I'm going to quickly read from it to answer your question. So our firm is the engineering consultant engaged by the client to perform the design review, design modification services and to obtain the necessary statutory approvals for the St. Jude Hospital Reconstruction Project. So what this essentially means is that we have reviewed the layouts of the existing buildings on site, the previous designs that were done by previous consultants for the buildings and the hospital services that they're providing, as well as the existing site conditions where we would have made design modifications accordingly to produce a comprehensive design package which would allow for the St. Jude Hospital to be operational, all right? So it is important to note the St. Jude Hospital Reconstruction Project does not involve the construction of a new facility, but rather the utilization of existing partially completed buildings to provide for its hospital functions. So for the design review and modification process, careful planning and consideration was ensured to comply with the specific needs of the various hospital services, including its support services and also to comply to all statutory and international standards and requirements. Now design review and consideration from the hospital management team and the client play also significant roles ensuring that the facility has improved functionality and better needed needs of the end users, right? Some examples of design consideration was its general layout accommodate the flow of patients and staffs for the various hospital functions, all patients services, surgical services, emergency services, and not only emergency services within the hospital, but throughout the site and the other needs for like laundry and food preparation. We also talk about support services for kitchen and food, medical grade fittings and finishes were considered, air quality, air pressure, the hospital management team as previously mentioned is seeking accreditation for blood, blood the blood lab and the facilities so we are working with them and the accreditation body to see what modifications we can do to accomplish this, right? Also there's electrical needs, power needs, environmental friendly, to save power, energy saving, measures, these kinds of things were considered in this design. Now, CCE has a dynamic team of experts which would have worked on the previous hospital, especially the ICU hospital, bringing a wealth of knowledge and experience from lessons learned there and implementing it in this project. We have an architect, a biomedical engineer, electrical engineer, mechanical engineer, structural engineer and Tira designer and a hospital planning expert. So with this, CCE is ensuring that the construction works is also completed in accordance to designs and specifications. We also have to provide supervision services so to ensure we're getting quality, the project is delivered on time and it's according to all the specifications and designs that we worked so hard on. In October of last year, the Development Control Authority gave approval for us to continue with the remaining eight structures on that facility. What does this mean for the project moving forward then? For the Development Control Authority, they would have conducted a thorough review of our designs submitted, including conduction of some side visits to ensure the design concerns were addressed to allow for the proper function of the hospital services. Now with the advent of their approval, it's a conditional approval, it means that the construction works can commence and we need to pay particular attention to these conditions, ensuring that we comply or implement these conditions. They would have looked like at the flow of the facilities, the entrances and exits, make sure we have enough landscaping, parking, handicap, accessibility, so these are the sum of the conditions and this is what it means for going forward. The works can finally start given those approvals. On January 5th, 2024, the Department of Economic Development published 10 notices for the remainder of construction activities. What does that mean? At what stage of the project are we now entering then? Well, that means that contracting firms are now able to bid on the project. This part of the process is where they are invited to submit their technical and financial proposals for the works based on the request for proposals provided. According to the Prime Minister, works aren't going on four buildings and are expected to be completed by June of this year. And these four buildings are namely the physiotherapy, dialysis, the West Wing which houses the kitchen and administrative offices, as well as the maintenance and laundry building that your team has been working providing supervision over site for. What has been achieved so far and at what stage, what is left to be completed as we move to complete those four buildings? The four buildings mentioned, the majority of the civil works has been completed. Mechanical, electrical and plumbing works are in its early stages, where ducting and cabling and plumbing works are ongoing. A major aspect of the works are the procurement of the various items for the works, electrical cabinets, pipes, plumbing fixtures, electrical fixtures, electrical switchboard, air condition, HVAC system, medical gas line systems. So all of these are in procurement processes to allow the facility and the majority of the installation and outfitting works still has to be completed. With that, we are aiming to finish the buildings as June as the Prime Minister is requesting. Okay, thank you very much, Mr. Jonas. Let me just switch over to Ms. Atkins once again. I want to speak for a brief moment about equipment at St. Jude. As part of the Saudi tender, we had to include all the medical equipment and furniture required for operationalizing the new hospital. Your department was intricately, intimately involved in this process. Tell us what went into it and what you think is going to be the advantages of the new equipment that has been selected by your team. So thank you again, Titus, for that question. So in November of this year, last year, sorry, as you would have indicated, we would have received from the project a list of equipment for review by the hospital. It provided us an opportunity to get the key experts, so the physicians, the nurses, the end user of the equipment to come in and to give a detailed review to ensure that the pieces of equipment that were being identified, one currently allowed for the services that are now being offered at a George Audlan stadium for us to continue to be able to provide those, as well as looking at new pieces of equipment for new services that would be added. So for example, new diagnostic services like CT and mammograms, we would have had an opportunity in 2021 to have reviewed a list of equipment that had already been procured, which is a major diagnostic equipment which included a floor mounted X-ray or CT scan, as well as the mammogram machines and ultrasound, cardiac ultrasound, an opportunity to review the list that was currently with Global Medical, where the government had already pre-purchased these pieces of equipment and to review it in 2021 to bring it up to the current, to most updated specs to ensure that we're moving forward if a facility that has the newest pieces of equipment on market, especially for the major diagnostic areas. Thank you very much, Ms. Adkins. We need to go for a break now, but when we return, I shall continue with you and I want us to spend some time speaking about commissioning. I think this is a concept that has been grossly misunderstood by a lot of people. It may seem very simple, but it is not. And so when we return, we shall delve into what is required to commission a hospital and where your team is at currently, where that is concerned. We shall be back in a minute. Suicidal thoughts like other mental health challenges can affect anyone. It can be you, your colleague, family member, or neighbor. Everyone has a role to play in preventing suicide. Know the warning signs. If you or someone you know is in crisis or emotional distress, call the suicide hotline at 203. Remember, help is available. This is a message from the Employee Assistance Program, Department of the Public Service. Contact us at 468-2269 or 468-2260. Welcome back to the final segment of Issues and Answers. Today we discuss the St Jude Hospital Reconstruction Project and to help me do so are Ms. Lydia Adkins, CEO of the St Jude Hospital and Mr. Barry Jonas, Project Manager, employed with Caribbean consulting engineers. Commissioning of a hospital is a grossly misunderstood concept. A hospital is not the same as your ordinary dwelling house that one can move into with minimal effort. To many persons, it may seem that commissioning only has to do with moving people, moving equipment, and the next day operations can resume. But it's actually a lot more than that. I know your team has been actively involved in commissioning and for people who have been employed, you have an entire commissioning team that is on board. So tell us what the concept of commissioning entails and what it is that you have done so far. Thanks, Tyler. Thank you for asking that question. It allows me to delve into what for me is the most exciting part of the hospital operations at St Jude and that is the efforts that are being made to ready the institution to move. Commissioning really is a quality focus process for enhancing the delivery of any project. And as you would have rightly said, a hospital is not like any ordinary dwelling. It's not like any other commercial building. There can't be a disruption or assist in services because you are to continue services even as you transition and you move to the new site and you need to be able to do so without causing harm to the individuals that we provide the service to. So it allows for building systems and equipment to ensure that building systems and equipment perform their intended functions and that the organization is right staffed. And by right staff, I mean the right numbers, the right talent in the space and that the facilities also completed to predefined standards. Commissioning also allows for us to look at future proofing the design of the hospital to ensure that we're not responding to the government after so many millions of dollars of investment in the infrastructure is not building a hospital for today. They're building a hospital for today in terms of being able to meet your current needs but they're also building a hospital for tomorrow. And that is ensuring in future proofing the hospital as part of the commissioning process, we're ensuring that the hospital is able to respond to the future health needs of the people of Zindusha. The equipment review had a very huge part to do with that to ensure that we had the right pieces of equipment but we also looked at what are the types of services that we now need to be able to introduce to respond to what we see as the mobility or the health burden for Zindusha. It looks at given the rapid pace at which the project is moving and quite rapid and we're very happy to see that because the prime minister as you would have indicated in his New Year's address would have indicated that four of those buildings would be ready as of June 2024 and for the works to start on the remaining buildings at the soonest. It meant that we could not wait for the completion of the hospital to begin the commissioning process and as a result the hospital would have had to start at its onboarding process of some of the key members of its commissioning team to ensure that the works required for commissioning that we're able to do so. Change management is a huge component of commissioning. It means that we need to ensure that change management is embedded in the ways of working not in terms of the new ways that will be required to work and function at the space. We have to ensure that when we look at commissioning we look at both components of commissioning in terms of building commissioning which focuses on the equipment, medical gases, mechanical, electrical and plumbing, civil works, safety, but we also have the operational side of commissioning and that is looking at our reviewing our processes. We're moving into a new space, new design, vastly different from the layout of the George Audlum stadium but when we move into that space there can't be an interruption in service. It means that the staff have to be one adequately trained for the new pieces of equipment that we would have received as well as they are very familiar with the new ways of working, the new workflows, new process flows and so there will be quite a bit of table, top simulations and exercises happening at the George Audlum stadium as we prepare the staff to move and to function in the new space. One typical example, if we look at laundry. Laundry now introduces a concept of barrier washers which is an important component of infection prevention and control ensuring that you have designated clean and dirty spaces. We don't have that at the George Audlum stadium but when the staff go into, when we move to the new facility we can't be learning these processes then. It means that we have to be doing, we have to be mapping these new processes, learn those new processes, understand how it is that we're going to be able to function in the space so that when we move into that space we're able to function in the new design with the new ways of working and that would be currently embedded in the staff. With the commissioning of the laundry department at Millennium Heights, the hospital wishes to thank the team and management at Millennium Heights for allowing St. Jude to participate in their commissioning training for their new laundry, allowing us to get at least two training trainers so that we can begin to understand and the new functions, the new functionalities that are being introduced in the space and that they become very familiar with the new equipment to ensure and to give assurance to the St. Louisian public that when we move there will be no disruption in service and most importantly that we would be familiar with the new ways, the required ways of working to continue to give the assurance of safety to patients. I'm very happy that you have actually spent some time speaking about commissioning and the seamless transition that is required in order for us to move because I think that is one very important component of ensuring that when one moves from one facility to the other that there will be very little disruption in service. Actually, and that's important because you're talking about people's lives. You certainly don't want staff to be not familiar with new equipment, et cetera. So I'm very happy that the work has started so early. But there's one more issue I want us to discuss very briefly this afternoon as well. We see a lot of new trends emerging in our everyday lives. There are new diseases that keep coming out, new trends in terms of healthcare. How will your team be able to respond to those new emerging trends in healthcare? And how will this new facility be able to help provide the kind of quality care that you need to provide for those emerging trends? The new facility really allows us to adhere to what is one of the new strategic priorities for us at St. Jude, which is to curate the best in care practices at the organization. The ability for us to introduce through that new facility, minimally invasive surgeries, minimally invasive procedures, which one allows for us to have shorter hospital stays, reduce the risk to patients, especially for acquired hospital infections, speed up and shorten the time for recovery. And so you can have a surgery, gallbladder removal, for example, using the minimally invasive procedure and allow for you to be able to recover much quicker than in a very short space of time compared to if you were to have open surgery. You're also looking at the introduction of new services, the introduction of robotics, for example, in surgery, and the introduction of new services, for example, oncology services, to respond to the increasing number of cancer cases that we're seeing. Our 2020 data would indicate that one in five persons die from cancer insomnia. And so being able to develop as part of the commissioning efforts that are also tied to the new ways of working and new services that can be offered to begin to develop very clear clinical pathways for the management of what we see as priority diseases for us at St. Jude Hospital and tying that back to the new space that now allows us to be able to do so. Improvement in the type of services that we can offer in terms of physiotherapy. I would have spoken earlier to hydraulic therapy being introduced as a key component. And so really it provides a hospital to not only look at what we're doing at St. Jude, but how we can augment what we're offering at St. Jude to the St. Jude public, but not only the St. Jude public because the St. Jude facility, especially with the government intentions around the South Wing, that we can look at an introduction of medical tourism that not only meets our needs here, but also closes the gap for the wider region. Being able to introduce and to respond to a need for radiotherapy, which we do not have many countries in the region, in the OECS or even wider chirocon that are able to provide those services outside of possibly Guyana, Trinidad, Jamaica, and being able to introduce that here in the OECS region to allow as we continue as OECS member states to speak of free movement of people that that free movement of people also provides benefits for our OECS member states in terms of health and healthcare. Thank you very much. We need to be wrapping up now. So, Mr. Bayre Jonas, your final words here this afternoon. Well, we are looking forward to working with the team and the hospital management and the client and the contractors to be, to have a fruitful endeavor in delivering the hospital to full functionality, including accreditation. We look forward to getting the hospital running at its full capacity and we are happy to be a part of it. Thank you. Ms. Adkins, certainly your staff, I am sure are very anxious about moving. They have endured, what can only be described as difficult working conditions for the last 14 years. What would you say to them and the rest of St. Moshe as we inch closer to entering a new facility? Coming into this role, Silas, I gave my commitment to the staff of St. Jude to ensure that in this iteration of the hospital reconstruction project that the hospital is able to move. And I continue to give that assurance to them that I will continue to work with the government of St. Moshe to work with the project team and to work with the staff members at St. Jude Hospital to ensure that we are able to commission a facility that is fit for purpose and to bring some much needed relief to them because they've had to operate for the last 14 years at a facility that had never been designed and intended to have functioned, sorry, as a healthcare facility. I want to give the assurance to the St. Lucian public that as part of our commissioning efforts by signing onto the Cumentum program, it's not for accreditation of the services as at George Audlum Stadium, but rather to ensure that as we commission that we do so with a very quality, focused approach that at the end of our commissioning that we can move into a facility that meets the requirements for accreditation. Thank you very much, Ms. Atkins. Thank you also, Mr. Barry Jonas. Today we have been discussing efforts by the Department of Economic Development at completing the reconstruction efforts at St. Jude Hospital. Thank you very much.