During a trip to the Caribbean this month I had insights into the remarkable similarities between the health challenges of the UK and the tiny nation of Montserrat, as well as the unique difficulties of providing comprehensive care to a population of just 6,000.

Montserrat, a British territory 30 miles from Antigua, is defined by the Soufrière Hills volcano. Long dormant, it awoke in 1995 to devastating effect, eventually destroying the Georgian capital of Plymouth, its new hospital, the airport and surrounding villages. More than half the island is now uninhabitable. Thousands fled abroad, many to the UK.

In the aftermath a second hospital was built, supported by four local clinics.

Three major issues for Montserrat are just the same as the UK - improving management of long term conditions, getting patients to attend local clinics rather than the hospital emergency department - and the prospect of British government spending cuts.

A senior nurse explained that a series of amputations a few years ago focused attention on long term diseases. Amputees in the spacious and well tended sheltered housing bring the point home.

But other challenges are unique to a small population. Crucially, there is only one surgeon in the country. Obstetrics is a service where health managers want to provide more on-island support, to reduce the trauma, cost and risk of medivac-ing women to Antigua.

Mental health services are slowly being expanded. Although the eruptions only claimed 19 lives, many families lost their home and all their possessions, while emigration of relatives and friends has caused further trauma. Add to this the stigma of mental health and the difficulties of confidentiality in such a small community, and the complexities of providing mental health services become apparent.

The Montserrat government’s permanent secretary for health and community services is Beverley Mendes, an experienced health manager. Beverley is interested in an exchange with a senior UK health manager to share ideas and secure new perspectives on meeting the island’s health needs. If you are interested please contact Beverley at mendesb@gov.ms. If you would like a perspective on the island please contact me at richard.vize@emap.com.

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