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A Moment in Mental Health

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My Q&A with Dr. Alicia Malcolm

 

  1. How many clients are you serving at this time or how many mentally challenged individuals are registered with the Department?

The Department of Mental Health and Substance Dependence sees an average of 1,100 persons in our clinics per year. This number has steadily increased as persons become more aware of the importance of taking care of their mental health.

  1. What are the top three or five leading mental health issues for TCI?

The leading cause for consultations are for Anxiety/ stress related disorders and Mood Disorders such as Depression.

  1. How many do you believe are going undiagnosed and therefore unsupported?

Based on psychological research, there does not appear to be a significant difference in the overall prevalence of mental health disorders between the genders. However, there are some noticeable differences in the types of mental illnesses that men and women struggle with.  Some more common mental disorders in men include:

  1. Do you think or do we have stats to show if mental health is a larger issue for men or women?

Antisocial personality disorders. For women, common mental disorders include: Depression, Anxiety and PTSD.

Women present more frequently in our clinics than men. However, this does not mean that mental health issues are larger in females. Typically across the globe you’ll find that men are less likely than women to seek help for a mental health condition.

  1. How many are getting treatment/care/support?

It is unclear exactly how many people across the nation have undiagnosed mental health conditions. However, our encouragement is that anyone who is experiencing any sort of mental or emotional issues that create impairment in their daily functioning contact us so that we can assess and provide the necessary intervention. On average we provide treatment and care for about 15- 20 in our treatment abroad program and as mentioned previously an average of 1,100 in country per year.

  1. What is the status of the Mental Health Facility; seems it has been stagnant for many years now?

The mental health facility project is ongoing and it is anticipated to open early next year (2022). Recruitment of staff is actively being done while remaining construction works are being completed.

  1. I notice that your budget has nearly doubled in 10 years; what does this mean for Mental Health in TCI?

The increase in the budget reflects a number of things but in essence it means that there will be additional mental health professionals available to provide care and treatment for clients. In addition, new and improved forms of medication are being utilized with patients who may have become treatment resistant.

  1. How many mental health doctors do we have country wide?  What is your team size?

The mental health team is currently comprised of  eight clinicians: 4 doctors and 4 therapists. There are 12 new positions that have been added and recruitment is being done to fill them.

  1. How many children with mental health issues; and what kind?

On average 30 – 40 children are seen in our clinics per year. The top three mental health issues are Depression, Oppositional Defiant Disorder and Trauma Related- Sexual Abuse.

  1. What step would make the biggest impact on an improved delivery of care/service to mental health in Turks and Caicos from your experience?

Some steps that will assist in the continued improvement of mental health care delivery in TCI include: building local capacity through ongoing training of general practitioners; completion of mental health facility to serve persons with acute and chronic mental health conditions; ensuring greater access to services e.g through the continued use of telehealth services and strengthening community outreach and educational programs.

 

Dr. Alicia B. Malcolm (Psy.D.) became Director of the Department of Mental Health & Substance Dependence of the Turks and Caicos Islands in 2013.

 

Bahamas News

Public Hospitals Authority Foundation Donates Dialysis Machines to Princess Margaret Hospital (PMH)

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The Bahamas, September 21, 2026 – The Public Hospitals Authority (PHA) Foundation, a philanthropic organization launched in January 2024 to support public hospitals and healthcare clinics, donated eight additional dialysis machines for the PMH Renal Services unit.

Director of Foundations, Corporate and Community Relations for the Public Hospitals Authority and Executive Director of the foundation, Alana Major, said this initiative is a part of the foundation’s “Sun, Sea and Second Chances” campaign.  PHA Foundation aims to secure 30 machines for Princess Margaret Hospital.

“As of today, with this donation, we are now up to 15 machines, so we are very excited about that,” Ms. Major said.

Other members of the foundation were present, including PHA Foundation Chairman Mr. Selvin Basden, who said the foundation is committed to doing its part in fulfilling the mandate of the Government of the Bahamas.

“One of the tenets of the Government is to ensure that access to healthcare is a human right. We are committed to ensuring that, at least from our part, we can deliver on that principle,” Mr. Basden said.

The PMH Renal Services Unit dialyzes about 150 to 170 patients annually. The unit provides care for patients who have been diagnosed with end-stage kidney disease and now need renal support. Patients who receive dialysis typically come to the unit three times a week, either on a Monday-Wednesday-Friday schedule or a Tuesday-Thursday-Saturday schedule.

Head of Department for Renal Services, Dr. Thurston Carroll, said she and the unit are excited to receive the donation, as it will replace machines that are not operating optimally.

“We are particularly excited about today’s donation because, although we have 20 stations within the dialysis unit, we have an aging fleet. These new machines and new water-treatment equipment will allow us to replace some of our aging equipment so that we can continue providing services to our patients.”

Foundation representatives noted that one or two organizations are already considering making bulk donations and if it happens, the foundation may be able to secure another 10 machines or another five machines in the very near future.

PMH Deputy Hospital Administrator Angelica Lockhart-Bastian and Hospital Administrator Mr. Tevard Bastian thanked the PHA Foundation for its donation to Princess Margaret Hospital.

Also in attendance were PHA Foundation Deputy Chairman Dr. Erecia Hepburn; Foundation guest Dr. Maria Oriakhi; Chief Biomedical Engineer Mr. Theodore Nottage; Administrative Officer Ms. Appapisa Neely; and Senior Assistant Hospital Administrator Mr. Valdez Bowe.

 

By Christina Williams 
Bahamas Information Services

BIS Photos/Mark Ford

PHOTO CAPTION:

Group Photo, from left:
– Dr. Rhea Thurston Carroll, Director, Renal Services, PMH
– Nurse Kim Harris, Dialysis Nurse, Dialysis Unit, PMH
– ⁠Sister Darnell Roker, Nurse Manager, Dialysis Unit, PMH
– Mrs. Angelica Lockhart-Bastian, Deputy Hospital Administrator PMH
– Mr. Tevard Bastian, Hospital Administrator PMH
– Mrs. Alana Major, Director, Foundations, Community and Corporate Relations, PHA
– ⁠Mr. Selvin Basden, Chairman, PHA Foundation
– ⁠Dr. Erecia Hepburn, PHA Foundation Board
– ⁠Ms. Donette Danvers, Executive Assistant, Foundations, Community and Corporate Relations, PHA

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Urgent Care vs. the ER: How To Choose Where To Go

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Choose the ER when delaying care could have serious or even life-threatening consequences

When you’re dealing with an unexpected illness or injury, it isn’t always easy to know where to go. Should you head to urgent care? Or is it safer to go straight to the emergency room (ER)?

The answer depends on what’s happening and how severe your symptoms are. But in the moment, it can be especially difficult to keep calm and figure out what’s best.

Emergency medicine physician B. Bryan Graham, DO, explains how understanding the difference can help you get the right care at the right time, especially when every minute matters.

What’s the difference between urgent care and the ER?

Urgent care centers and emergency rooms both provide medical care when you can’t wait for an appointment. But they serve very different purposes.

“Urgent care generally handles illnesses and injuries that need treatment soon but aren’t life-threatening,” Dr. Graham explains. “Emergency departments are equipped to handle serious emergencies where delaying care could have serious consequences.”

Dr. Graham breaks down more specific differences between the two and how to decide where to go for the care you or a loved one needs.

What is urgent care?

Urgent care centers fill the gap between your primary care provider’s office and the emergency room.

“They’re able to treat a wide variety of conditions that need to be seen the same day,” Dr. Graham says. “Many urgent care locations offer walk-in appointments and extended evening or weekend hours.”

Urgent care may be appropriate for:

  • Symptoms of common viral illnesses, like cold and flu
  • Wounds and cuts (including those that require stitches)
  • Ear infections
  • Superficial wounds or burns
  • Pink eye
  • Possible sprains, strains or fractures
  • Sinus infections
  • Skin rashes
  • Sore throats
  • Sprains and strains
  • Urinary tract infections (UTIs)

Some urgent care centers provide services like X-rays, splinting, stitches and simple lab tests. But availability varies by location, so it can be helpful to learn in advance — before you need care — what services the urgent care closest to you provides.

“These facilities can treat many common illnesses and injuries,” Dr. Graham reiterates, “but they aren’t designed to manage severe or life-threatening emergencies. If your symptoms suddenly worsen or seem serious, the ER is typically the better choice.”

What is the ER?

Emergency rooms (sometimes called emergency departments, or EDs) are open 24 hours a day, seven days a week. They’re equipped to treat serious medical emergencies.

“People who come to the emergency department are typically treated based on the severity of their condition,” Dr. Graham explains. “That means that someone with a life-threatening emergency will be seen before someone with less urgent symptoms.”

You should go to the ER or call 911 if you experience:

  • Breathing problems, including severe shortness of breath
  • Chest pain or symptoms of a heart attack
  • Signs of a stroke, like sudden weakness, facial drooping or difficulty speaking
  • Major injuries, such as from a car accident or other trauma
  • Mental health crises or psychiatric emergencies
  • Poisoning
  • Pregnancy-related emergencies, like heavy bleeding or signs of ectopic pregnancy
  • Seizures
  • Serious head injuries, especially those with loss of consciousness (passing out)
  • Signs of a serious infection
  • Significant dehydration
  • Severe allergic reaction (anaphylaxis)
  • Severe bleeding that won’t stop
  • Severe burns
  • Sudden, severe pain that feels intense or alarming

When needed, emergency departments can provide:

  • Advanced testing, like CT scans, ultrasounds and EKGs
  • Specialized emergency care, like in geriatrics and pediatrics
  • Emergency procedures, including defibrillation and intubation
  • Emergency surgery (and stabilization before emergency surgery that takes place in an operating room)

The ER is also the appropriate place for any situation where delaying care could lead to serious complications.

When should you go to urgent care vs. the ER?

When you’re trying to make the call between urgent care and the ER, the biggest question to ask yourself is: Could this condition be life-threatening?

If the answer is yes, go to the ER.

“If you could put the word ‘severe’ before your symptoms — whatever they are — you should likely seek emergency care,” Dr. Graham states.

If the condition is uncomfortable, painful or needs attention soon but doesn’t seem to pose an immediate threat to your health, urgent care may be the right choice.

Dr. Graham offers some specific principles to consider.

Choose urgent care if you:

  • Have symptoms that are bothersome but stable
  • Need treatment within hours, not minutes
  • May need an X-ray, stitches or basic testing
  • Can’t get a timely appointment with your primary care provider
  • Have a common illness or minor injury that’s unlikely to become life-threatening

Choose the ER if you:

  • Have sudden and severe symptoms
  • Have chest pain, trouble breathing or stroke symptoms
  • Are experiencing uncontrolled bleeding
  • Lost consciousness or had a seizure
  • Have a serious injury, severe burn or major trauma
  • Believe delaying care could put your health or safety at risk

Final thoughts

Facing a medical issue can be scary, especially when you’re dealing with a potential emergency.

If you’re not sure whether a situation is an emergency, it’s generally safest to seek care in the ER, especially when symptoms are:

  • Severe
  • Quickly getting worse
  • Affecting your ability to breathe, think clearly or function normally

But above all, remember: There’s no perfect decision-making formula. Medical symptoms don’t always fit neatly into categories.

“It’s important to listen to your instincts,” Dr. Graham encourages. “Don’t go by lists alone. If something feels seriously wrong, don’t spend precious time trying to diagnose yourself.”

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Know the Possible Warning Signs of Prostate Cancer

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September is Prostate Cancer Awareness Month – which means it is time to watch out for the warning signs. Possible signs include slow urine flow and loss of bladder control — but if this common cancer is caught before it spreads, the prognosis is good.

Your prostate is only about the size of a walnut. But this small gland can cause big problems if left unchecked.

Warning signs of prostate cancer

“Most men with prostate cancer don’t have symptoms at first,” says urologist Christopher Weight, MD. But if you notice certain warning signs, like changes in your pee routine or pain, it’s a good idea to visit a urologist.

Prostate cancer is one of the most common cancers in men. But when it’s found early, it’s also one of the most treatable. Knowing the signs and talking with a healthcare provider about screening could save your life.

So, what should you look out for?

Slow or weak urine flow

Trouble starting to pee — called urinary hesitancy — is common as men get older. You may also notice slow flow or dribbling. Or your flow may stop altogether. The most common cause is benign prostatic hyperplasia. Still, if you experience these symptoms, it’s important to get your prostate checked.

Frequent need to urinate

A frequent and sometimes urgent need to urinate, especially at night, may be a sign of nerve damage or an infection. Or it could indicate that a tumor is putting pressure on your bladder and urethra.

Painful or burning urination

Pain or burning when you pee — called dysuria — is usually linked to a urinary tract infection (UTI). But in some cases, it can signal prostate cancer. This is especially true when it’s paired with other symptoms.

Blood in your urine

Another possible warning sign of prostate cancer is hematuria, or blood in your pee. Though this can be associated with other health issues, including a UTI, it’s worth checking out.

Prostate pain

Unexplained prostate pain — especially when sitting — can be an early sign of trouble. “It might also mean an infection, but only your urologist can say for certain,” Dr. Weight says.

Loss of bladder or bowel control

Bladder or bowel incontinence can happen with age or other medical conditions. But if you’re leaking urine or can’t control bowel movements, talk to a doctor to rule out prostate cancer.

Changes in sexual function

These symptoms can stem from many causes, but they may also signal prostate cancer. Talk to a urologist if you notice:

  • Painful ejaculation
  • Decreased volume of ejaculation
  • Inability to keep an erection
  • Blood in your semen (hematospermia)

Sexual health is a vital part of your overall well-being. So, if something feels off, it’s not just OK to speak up — it’s vital.

Later-stage signs

These symptoms often only appear when prostate cancer has spread:

  • Ongoing pain in your lower back, hips or chest
  • Numbness in your legs or feet

“Of course, there are endless other reasons that your back may hurt or that you have tingling in your toes that are entirely separate from any prostate troubles. But they can also be signs of later stages of prostate cancer,” Dr. Weight clarifies.

Importance of prostate cancer screening

“Since early-stage prostate cancer doesn’t cause symptoms, many men don’t know they have it,” Dr. Weight notes. “That’s why regular screening is so important — it helps catch prostate cancer early, when treatment is most effective.”

A healthcare provider may recommend screening if you’re between the ages of 55 and 69, or earlier if you have a family history or other risk factors.

Screening might feel uncomfortable to think about, but skipping it could mean missing a chance to catch prostate cancer early, when it’s easier to treat.

“A simple blood test, often followed by a physical exam if needed, gives your doctor important information about your prostate health,” Dr Weight says.
Early detection doesn’t just improve treatment options — it can also give you peace of mind.

Lower your risk of prostate cancer

“You can’t do anything about some of the risk factors for prostate cancer, like age or family history,” Dr. Weight recognizes. “But you can make lifestyle choices that support a healthier prostate.”

These small steps may make a difference:

  • Get regular prostate screenings.
  • Maintain a healthy weight.
  • Exercise regularly.
  • Eat a nutritious diet.
  • Quit smoking.

“When prostate cancer is diagnosed before it spreads to other parts of the body, about 99% of people live at least five years after diagnosis,” he continues. “But the survival rate is much lower if the cancer has spread.”

That’s why it’s so important to stay proactive. Regular screenings, healthy habits and paying attention to changes in your body can make all the difference. Talk to a provider about the right plan for you.

CREDIT: CLEVELAND CLINIC

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