~ More than 5 hours of waiting for 4 stitches and a bill of US $877.50 (EUR 830.00)! ~
On March 14, 2023, we reported to the Emergency Department of the Sint Maarten Medical Center (SMMC) at 10:00am, because my wife had suffered a flesh wound in her leg, which needed to be stitched up.
Soon she was seen by a triage doctor who determined that the wound needed to be sutured. No fracture was detected. Whether we were insured was the question. Yes, at Menzis and we showed the Menzis health insurance card . No, you are not insured, because you do not have local insurance, we were told. Despite the fact that Sint Maarten belongs to the Kingdom of the Netherlands, a Dutch health insurance card is however not accepted. And which tourist has local insurance? No one, right? At a later stage – after filing a complaint – we were told that the SMMC did not conclude a care contract with Menzis and therefore we were not insured. This explanation is acceptable. In practice, uninsured meant that the SMMC could charge what they want, more about that later.
After the triage doctor, we were referred to the waiting room. Only after 5 hours (!) of waiting we were helped further. We could not entirely avoid the impression that the local population was favoured, but of course that cannot be substantiated. The doctor who applied the stitches was friendly and knowledgeable. Now quickly checkout and away. No, first an X-Ray had to be made to rule out that the bone had not been hit. The attending physician didn’t know why either, but the chief physician had determined that. Of course, the X-Ray should have been made before the stitches were applied. If they had found something – which fortunately wasn’t the case – should the stitches have been removed?
During the complaints procedure, the SMMC stated that we had agreed with the X-ray. This was a bit more nuanced. We indicated at two doctors that we did not see the point of an X-ray after applying the stitches, but the head of the department insisted that an X-ray be made, to rule out that the bone had not been hit. There was only a flesh wound, which was also determined by the Dutch triage doctor. He also did not understand why an X-ray had to be made, but because he had only been working in the SMMC for 2 days, he was overruled by the Head of Department. There was no point in protesting further and we only agreed because we wanted to leave as soon as possible.
Given that we were not insured according to the hospital, we had to pay the bill ourselves. That amounted to a whopping US $877.50. For 4 sutures plus a tetanus injection and an X-ray. Because you only want to leave after almost 6 hours in the hospital, you pay and do not enter into the discussion about the height at that moment.
The next day I filed a complaint with Mrs. Bonnie Dekker, a board member of the SMMC. I indicated to her that in the past I was Managing Director of the Amersfoortse Antilles (now Ennia), at the time the largest health insurer in the Antilles and that the staff of the SMMC was insured with me at that time. And that I knew something about rates. The bill of US $877.50 was excessive in my eyes (not to mention the long waiting time).
Her response was as follows: “As far as the amounts are concerned, I understand that there is no insurance. The cost of treatment including care for a wound may be higher if this was done in an emergency room, because an amount must already be paid for the consultation itself. Of course, I don’t know what the care situation was and why the doctor decided to take an X-ray. I have asked our complaints officer to send me a digital form. Once I have that, I’ll send it via WhatsApp”
We completed the complaint form and sent it with the request to provide a breakdown of the costs. Despite multiple requests to do so, still nothing received. We received a copy of the bill we already got when we left the hospital. The specification on the bill read:
1. ER Treatment Group 3 : NAf. 1,270.00
2. Lower leg right: NAf. 309.50
Total: NAf. 1,579.50 (= US $877.50)
I made it very clear that I wanted to receive a full breakdown of the costs: use of the Emergency Unit, costs of the triage doctor, costs of the attending physician who placed the stitches, costs of the head doctor, costs of tetanus injection, etc. Only on the basis of this, it can be assessed whether excessive charges have been made. Again, US $877.50 (EUR 830.00) for 4 stitches seems to be on the high side, to put it euphemistically. You also might think that the SMMC is trying to cover the costs of the new hospital in this way. But as said, the hospital refuses to give a full insight of their costs. As a result, they can charge what they want.
Sint Maarten is and remains a beautiful tourist destination. But, try – as far as possible – to avoid the SMMC. Go to a local doctor or to the hospital on the French part.
Finally, another point of attention for tourists. When renting a car, please note the following: In accordance with the LAM (National Ordinance on Motor Vehicle Liability Insurance), the coverage for civil liability is limited to NAf. 90,000 (approximately EUR 50,000). This means that in the event of an accident, for which you are liable, you only have a cover of EUR 50,000 and you personally pay for the excess. Especially if the other party has an injury, this can involve considerable amounts. Fortunately, most car rental companies nowadays offer a standard coverage of 1 million, but it is still wise to check this carefully (NB: the same applies to Curaçao, Aruba and Bonaire).
Peter van der Pligt
Dear Editor,
Present-day medical/city/provincial/state authorities devised programs where by addicts are given clean opioid-drugs, as an alternative to the addicts’ struggle to acquire their drug of choice no matter the source. Drugs that do not have toxic pharmaceuticals in them seems a good choice. So it seemed. Problem: Addicts often take these meds from the authorities and sell them on the black market as a source of income and to feed their habits.
1. Medical professionals have tried to string out their patients with lower doses of the drug over time.
2. Injection sites, with clean drug paraphernalia provided free, as to a place to shoot up with medical supervision.
3. Dry out cells provided to those willing, but most return to their addiction.
4. Legalizing weed, vaping and possession of small amounts of illegal drugs.
When will we be able to be honest with ourselves, and admit there really is only one way to end this drug pandemic? Do our elected officials not realize they are looking more and more like the cartels of Latin America? Drug dealers and drug pushers. None of these officials have seen people shoot up, with lines on their arms and between their toes. They have not witnessed horrid crimes committed by addicts to pay for the addicts’ needs.
A bunch of pampered people, feeling sorry for others, but without the belly to make the appropriate choices to save many lives.
What can be done. Nay, what needs to be done: Certain civil liberties need to be suspended at particular times when needed. A determination needs to be made declaring addiction as a form of mental illness that can lead to suicide and death. Make addiction not just an illness, but to continue as an addict is also a crime punishable by forced treatment.
Addicts usually will not help themselves, but rather will do everything possible to feed their habit. Addiction is a severe mental illness that can be seen as a precursor to suicide/self destruction. I know, harsh words especially to those who love and care for the addict, but there really is no other way. Either the police have to have the authority and ability to pick up and detain these people, or those that love them should be able to have them institutionalized within facilities whose whole job it is to treat these individuals over a set period of time up to 6 months. Breaking an addiction and assisting the addicted will take time and effort to meet their varied needs.
Decision: Treating addiction should be either the government’s job or a private affair. One or the other.
After all people die all the time. Perhaps we need to decide simply how they are to die and whether we as a society should have the ability to legally save a life through force, or live and let them die. A gambler will continue gambling until they are forced to stop. So too the addict. Look at Hastings in Vancouver! City blocks full of homeless and addicts forever growing in numbers.
Force addicts to be saved, a life returned to an accepting society. This drug pandemic will continue and grow just as casino commercials shower our youth with potential wealth opportunities, developing their addictions. End casino advertisements on TV and radio, and respect the potential and existing addicts among us. Legalized weed and vaping is creating new and long-lasting problems within our communities. The spread of opioids is the problem, not just those contaminated with toxins. Many drugs are poison to the body. The only thing you should be inhaling is the air around us. I cannot believe I am saying this, but Nancy Reagan was right when she said, “Just say no to drugs.”
Steven Kaszab
Dear Editor,
I’m appealing to all elected representatives and the general public on both parts of the island not to abandon the 1648 historical Concordia treaty and replace it with a new one. Moreover, the Treaty of Concordia is historical and significant. It is one of the oldest treaties in the Western World, and is a leading example of small countries’ vision across the world. It was established in 1648 and preserved for centuries on pillars with letters carved out on stones. Please don’t let outside forces destroy it.
Legal implication of a treaty: A treaty doesn’t have to be between nations. It could be between people and their representative(s) also, as is the case of the treaty of Concordia. A treaty can be stay-open or initialled, e.g., FR and NL. Amendments can be made to a treaty.
History: The treaty was established for 375 years now, from 1648 onwards. Its particular purpose: Close co-operation between governments and businesses on both parts; free movement of goods and services between borders; maintaining an open border policy; easing the travelling restrictions from one part to the other.
In summary, the Treaty of Concordia is an internal document established in 1648 between the people and their representatives. As I mentioned before, a treaty can be left open, or initialled. Don’t remove it or replace it with a new one. Putting an end to the 1648 treaty will be a serious error for the island and its people. This Custom document rests in the hands of the people. It can’t be eradicated for just border control purposes, but it can also be amended.
Thank you for reading this article.
Joseph Harvey
All rights reserved
Dear Editor
To begin with, this article defines money, and provides a general understanding of currency stability, along with important policies regarding trade between countries. Economists define money as a medium of exchange for goods and services. This means it could be used to pay for goods and services. Money is also income. In accounting, your cash in hand or at the bank is money. Money also consists of notes and coins; Treasury bills; promissory notes; checks; bank account; plastic money such as credit cards; now making its way into the digital world is cryptocurrency such as Bitcoin and other digital currencies.
There are many important functions of money: it must be generally acceptable in businesses and the community; it must be portable and durable, easy to carry around and long-lasting; a store of value. It can be saved in a bank or in cash for future payments; a unit of value. It must be able to divide into large and small quantities or units. Whatever money is today, it must have public trust and confidence that it can be exchanged for goods and services. We are living in the fiduciary system, where the value of currency must have public confidence that goods and services can be exchanged for money.
After the Second World War (1939-1945), the Breton Woods System was used to measure the value of currencies against the gold standard for countries around the world. The system was based on a fixed dollar in terms of gold. The dollar provides a fixed point, and other currencies’ values were measured in terms of the dollar. If an American dollar is worth 25 grains of gold and countries of the European Union euros worth 50 grains of gold, it would mean one euro will equal to two American dollars.
Under the Brent Woods System exchange rates were pegged to one another country’s currency, and were stable. Up until 1971 the fixed and floating exchange rates were in operation. A country in the fixed exchange gold standard must maintain its monetary currency in terms of a certain amount of gold, and must also allow gold to be imported and exported. The floating exchange rate allows the balance of payments of countries to adjust automatically, if imports rise faster than exports. In this case the supply of currency will increase, and there will be an exchange rate depreciation. Imports for the country will become more expensive, and its exports will be cheaper.
The floating exchange rates are managed by the market forces. If a country’s balance of payments showed a deficit or a surplus, devaluation or revaluation could be negotiated in the IMF system. In 1944 an adjustable peg system of exchange rates came into existence called the Breton Woods Systems. IMF was created from this organization as a monetary system to manage the debt problems of developing countries; manage the balance of payments deficits of countries; manage the fixed and floating rates of countries; it also lends foreign currency to countries to correct their balance of payments problems.
After the world depression of the 1930s and the Second World War 1939-1945, countries of the world had to finance war equipment from banks and other lending institutions; from then onward inflation in the money market and the cost of goods and services started to rise, and the cost of living become more expensive as a result. Today many countries are also affected by the COVID-19 pandemic crisis, natural disasters, high unemployment, healthcare and severe environmental problems. In 1999 inflation in the Caribbean was down to single digit figures. Most countries in the region are now reducing their balance of payments deficits. In St. Maarten the current account deficit in the balance of payments is of concern.
History. According to the quarterly bulletin of the Bank of the Netherlands Antilles 2000 stated that consumer prices were on the rise in the last quarter of 2000. Inflation jumped from 0.3% to 0.5% in that same year. In Curaçao and Bonaire inflation rose 5.7% and 4.5% respectively. St. Maarten experienced 0.8% in 2000. As one can see St. Maarten’s performance was excellent and did not depend on the rest of the Antilles to survive. In 2000 on St. Maarten healthcare was down, unemployment down, cost of living was also down. The island can still stand on its own taking the above factors into consideration.
Summary and Conclusion: The introduction of a new Caribbean Guilder currency is fast approaching by the ending of 2024. A series of questions are forthcoming about this new currency. Will it be pegged to the United States dollar like the Antillean guilder? What will be the exchange value? How will this affect the balance of payments deficit in the current account for the country? Why St. Maarten must join with Curaçao for the new currency, and St. Maarten has already dollarized? In 2003 Ecuador national currency, the Sucre was pegged to the US dollar at US $1 = S. 25000. The country is now using the US dollar as its main currency. How does this compare to St. Maarten’s situation?
It is important to learn about regional and trade and agreements to trade, and how countries can benefit from their policies and strategies. Most of the institutions and organizations listed below could help developed and developing countries diversify Their economies: CAIG, CDB, EECM, EU, IMF, IBRD, ACP-LOME, NAFTA, OECS, OPEC, WTO, World Bank. For your convenience.
Thank you for reading this article.
Joseph Harvey
All rights reserved
Dear Editor,
I continue smiling when I hear the people who I am close to, say to me, "I blow you yesterday but you didn't notice it was me", or "I say you need glasses because I blow you, you look and you didn't react". One day I asked one of them, "How is it that you noticed me, and I did not notice that it was you?" Her answer to me was, "When you going to stop being a police?" I wanted to answer her when the retired architects stop looking at buildings or the masons stop looking at how a building is plastered, but I told her, "When you go back into the book that you learned from, to get your driver's licence. She answered "But everybody does it".
I cannot tell you what she meant because it was not clearly established what was the reason for my first reaction, nor can I say what she meant, because it was not clearly stated" She said something to me. She got an answer and responded implying that I had accused her of wrongdoing. The old people used to say, "That is your guilty conscience”. Which brings me to the question? Why would someone who is doing something which is not allowed, expect for others to respect and accept what they are doing?
There is an idea/concept in the law "gedoogd beleid", which is, even though it is not permitted by law, we will let it ride. My reaction to that is, it is not fair for the person who makes an extra effort to abide by the law to see others getting away with "as it were murder" A lady asked me what to do about a seatbelt ticket that she got from an officer who she knows got black tint on his car. I told her if she does not want to fight it in court she should fight in the court of public opinion. My opinion with the law is, it is either black or white. There should not be any grey area. The grey area belongs to the discretion of the judge.
By now we have an idea what is the duty of the "Ombudsman", but I do not think we know what the duties of the Public Prosecutor are. Which brings me back to the lack of civics education in schools. Is not the term "Lawless community" looming somewhere in our future? Even though there is talk about separation of church and state, the government is constantly involved in matters of the church. So then why not adhere to Proverbs 22:6?
Do we really expect better from those young people on motorcycles? Where is the example? So, I ask myself "Wah really goin on?"
Russell A. Simmons
