Premier On Call: From surgery to service
‘The Illustrated History of Medicine’ by Jean-Charles Sournia keeps company with a report of the June 2012 G-20 Mexico Summit on a large coffee table in one corner of the room.
It’s an unlikely combination, with only the sophisticated presence of a crystal vase separating the two.
For Dr. the Honourable D. Orlando Smith, Premier of the British Virgin Islands and practicing physician, the two publications peacefully coexist in the marriage of his two callings – medicine and politics.
Since taking office in November 2011, it’s been Dr. Smith’s job to keep the British dependency on a sturdy economic path, with both finance and tourism – the country’s two main bread and butter sectors – falling squarely on his shoulders.
But even with a country of 30,000 citizens to run, he is still Dr. Smith – a licenced physician albeit with greatly reduced office hours.
Daniel Orlando Smith was born on August 28, 1944. A Seventh Day Adventist youth, he developed an early interest in medicine, watching medical missionaries travel the world to offer healing to sick bodies and souls.
“The Adventists have one of the largest medical missionaries in the world of any denomination. This of course influenced me as a young child, and I think from an early age, that call had enveloped me and made me think that was what I wanted to do. To be a medical doctor and help people; to be a missionary as well but the missionary part is on hold,” Dr. Smith remembers.
He would later attend the University of the West Indies in St. Andrew, Jamaica to pursue his dream of studying medicine. In 1970, he returned home to the British Virgin Islands and began his career at the Peebles Hospital.
“It was good, it was exciting, it was busy, because in those days junior doctors worked in rotation like every other night on call and every other weekend. Nowadays, things have changed and the physicians aren’t expected to work those times, but in those days that was the case and we’re a small country so it was necessary to work long hours. But it was also rewarding because you are able to see the results of what you do, and be able to assist people with their health concerns,” he recalls.
After a year, the young doctor departed BVI to be trained as a general surgeon at the Edinburgh Royal College of Surgeons in Scotland and the Royal School of Public Health in London. Dr. Smith returned to the Peebles Hospital as a fulltime surgeon, serving as Chief Medical Officer from 1978-1995. It was a challenging time for healthcare in the British overseas territory, but led by a passion to help the people of his homeland, Smith and his colleague doctors found ingenious ways to carry out their duties despite the shortcomings.
Stories abound of Dr. Smith being called in to assist with a wounded goat, and of the day he used a jug of water to stabilize the spine of a patient who’d suffered a broken neck until the patient could safely be transported to neighbouring Puerto Rico for treatment.
“We were at a stage where many of the fundamental examination and laboratory tests we were not able to do, but we were still able to perform surgery and get good results. We’ve now grown in our capacity to be able to perform most of the necessary tests in order to give patients the best care possible,” he says.
But even while crouched over the operating table, Dr. Smith had a deep yearning to lead the decision-making process that would allow for the type of health services he envisioned.
So it came as no surprise when he stepped into the political arena and was first elected to Parliament in 1999, serving as Leader of the Opposition National Democratic Party (NDP). By 2003, the NDP had won the parliamentary elections and Dr. Smith was appointed Chief Minister. He would occupy the post a second time when the NDP swept the elections in 2007, this time to the office of Premier – the title which had replaced that of Chief Minister.
“It was a kind of natural progression, not envisioned at all but a progression. Because when I returned as a physician and as a surgeon what obtained was that I was able to assist people individually I could see one person who needed my surgical skills and be able to help that person and that was good. But then there was a wider population whom I thought I would be able to help better if I was in a different position.”
“And so I became the Chief Medical Officer and in that position was able to have more influence on the direction of health care, but then you find that there’s still somebody else making the decisions about what actually happens; how much money is allocated to health care, what kind of service we do have, and those are the factors that kind of suggested or urged me to become involved to seek service at a higher level.”
From his office, Premier Smith commands a spectacular view of the harbor and the cruise ships that form a major part of the island’s tourism and one of its biggest economic earners. And as someone with a background in medicine, he is insistent that access to quality health care is available to the residents he serves.
Hence, his government has been advocating for a National Health Insurance that would be mandatory for all employers to provide for their employees. This, the Premier feels, would ensure that everyone in the Territory has access to healthcare. However, there has been strong criticism from some who feel that such a move would create financial burden for the business sector particularly small enterprises.
“What we’re doing is we have presented to the people an option as a discussion and we are getting feedback on that option and once we get feedback from all that discussion, we can look and then say this is the way forward. For something as important as this, I think consultation with the people of the territory is important and that’s what we are doing right now,” Dr. Smith insists.
For the 68-year-old silver-crowned grandfather, he will always be a physician. He performs a delicate balancing act – giving a voice to his small country in the international community and (surprisingly) tending to patients every week!
“I don’t miss being on call every other night!” he chuckles.
“But I do have an office, I like to do a couple hours each week. I don’t do that much surgery right now but I’m still licensed and I still do regular consultations and readings to keep current with what’s going on. Surgery of course is something I enjoyed, I liked because of what it could do, how it could affects people, how it could make people better. But I’m working in another area where, hopefully, myself and my colleagues we can affect the lives and make the lives of the people in the country better, from growth in our economy to health and education.”
And the medical training has certainly come in handy for the position he now holds. With his soft voice and gentle demeanour beckoning with grandfatherly warmth, some feel it is the Premier’s ability to bring this ‘bedside manner’ into his political persona that has endeared him to this supporters.
“They tell me one of the jobs that you’re doing is the qualification for being a politician!” he joked. But he did concede that being a medical doctor had made him more sympathetic to the needs of those he serves. Plus, forty years in the medical field has taught him a lot about management.
“You know there’s various schools of management and as you go through medical school, you develop a system of management, you manage patients, manage health care services, you can transform that into the way you manage, the way you look at things, and the basic thing is you have empathy towards the people of the territory,” acknowledges Dr. Smith.
He paused to reflect on the question of how he would like to be remembered. Of all the roles in which he’s served, Dr. Smith – physician extraordinaire and charismatic leader – would like to be remembered as someone who served the citizens of British Virgin Islands and served them well.
“Basically what I’m concerned about is giving service to the country, helping people in whatever way I can, and now helping to develop the country – the BVI – so that all the residents of the Territory can have a better life.”