Several customers chatted idly last Thursday at Faith Hospital’s pharmacy while waiting for their prescriptions. Down the hallway, nurses checked charts for the five people receiving care at the inpatient unit, and a sole person received treatment at the dialysis unit.

With only a little more than 2,000 people to serve on Cayman Brac, on many days the hospital’s activity matches the island’s tranquil atmosphere.

But it does not take much for that to change, according to Dr. Srirangan Velusamy, the director of the Cayman Islands Health Services Authority’s Sister Islands Health Services. To handle incidents ranging from car crashes to diving accidents to medical complications from a disproportionally large elderly population, Faith Hospital workers have to be ready for anything, said Dr. Velusamy.

Faith Hospital lab technician Jay-R Lim Aquino checks the bloodwork of a patient. Faith Hospital’s medical laboratory was accredited by the U.S.-based Joint Commission International earlier this year.

Last Wednesday was a prototypical example of just how quickly Faith Hospital can turn into a bustling hive of activity. That day, practitioners responded to four emergency calls all around the same time. For an 18-bed facility with only five doctors and a handful of nurses, “that was kind of a mass-casualty situation for us,” said Dr. Velusamy.

With the percentage of the elderly population on the Sister Islands more than double that on Grand Cayman, those situations could become more commonplace.”

To meet that challenge, Faith Hospital’s bare-bones staff needs a Swiss Army knife’s worth of skills.

Dr. Velusamy exemplifies this, serving as the hospital’s director and its only surgeon. On busy days such as last Wednesday, his specialist gynecologist and anesthetist help in the emergency room. Nurses, too, go from working in delivery rooms, emergency rooms, the inpatient unit, and in any other area that may need assistance.

“It’s a challenge for us to play multiple roles, and not many people are willing to do that,” Dr. Velusamy said.

Recruiting people that have both a diverse skill set and a desire to live on a tiny island is one of Faith Hospital’s primary challenges, he said.

“Recruitment to Cayman Brac is much harder. We don’t have much over Grand [Cayman] besides clean air and safety – no cinema, KFC, etcetera,” he said.

The lack of amenities on the Brac rules out most young nurses and doctors from working there, though Dr. Velusamy said that may be for the best, considering the high-pressured situations his staff can be put in. A doctor on call is basically “the captain of the ship,” and can’t rely on someone with more experience when the going gets rough, he explained.

When the idea of a hospital for Cayman Brac was first mooted, there were no government funds available to build it, so Brackers built it themselves, completing the hospital in 1972. Hence, the building still carries the legend ‘Faith Hospital, by the People, for the People.’

While some healthcare professionals may be reluctant to live and work on the Brac, the ones who do often end up staying their entire lives, Dr. Velusamy added. This gives the hospital an advantage over others when it comes to providing care with a personal touch, as the island’s doctors and nurses are attending to their neighbors and close acquaintances.

Cayman Brac resident Yvette Dilbert is one of those who has spent a career at Faith Hospital.

“I started here in 1973 before it was officially open. I was in high school and came here as a volunteer. I worked as a practical nurse, RN, midwife, public health nurse, and in 2000 became hospital administrator,” she said. “Most people who aren’t going to stay here are gone within four years. But the ones that stay make this their home. We have a hard time deciding who’s the real Caymanian and who’s the ex-pat who’s become a part of the community.”

Being a lifelong Brac resident, Ms. Dilbert said she remembers when the island’s entire healthcare facility comprised of a small government clinic in the Stake Bay area and a pharmacist that provided a variety of services.

She said the need for the hospital came about in the midst of an economic boom on the island in the 1970s, when Cayman Brac was a major destination for tankers to make ship-to-ship transfers of oil en route to the United States. With no help from government, the seamen were instrumental in funding the hospital’s construction, along with help from churches and the donation of land from the late Captain Charles Kirkconnell – hence the hospital’s slogan, “By the people, for the people,” she said.

After several years, government took over the hospital, and in the 1980s the one-building facility was expanded, and in 1993 its new inpatient unit was built.

“In my time here, I’ve just watched the changes. We’ve gone from the days where a patient will just walk in and say, ‘I’d like to see a doctor,’ and we’d take them, to where now they call and make appointments and we have a health information system we use to book patients and access records,” said Ms. Dilbert.

Airlift has been one of the hospital’s most recent improvements. Cayman Airways has traditionally been used for evacuations for heart attacks and other emergencies that cannot be treated on Cayman Brac, but that could take hours if planes are busy or there are other complications.

A helipad installed behind Faith Hospital in 2016 now allows the Royal Cayman Islands Police Service helicopter to take patients from there straight to Health City – shaving hours off of evacuation times, and potentially saving many lives, said Dr. Velusamy.

Another one of Faith Hospital’s recent achievements was when its laboratory received the “gold seal of approval” for international quality standards for patient care and service delivery by the U.S.-based Joint Commission International in April.

Now, Dr. Velusamy said, he is concentrating on the Sister Islands’ preventative healthcare services by developing a weight-management clinic and a “brain clinic” for patients at risk of dementia and Alzheimer’s.

The Sister Islands Health Services director also said he’s lobbying the Health Services Authority for more nurses – “my nurses are overworking,” he said – and another building that would serve as a storeroom.

“Space is the problem,” he said. “We have to find room for the speech therapist … We want to take some of the non-clinical areas in the hospital to a separate building. Our storeroom for medical supplies would be used for clinical areas.”