In her column on the site Dossier Koninkrijksrelaties, Jessica Besselink shares her observations from the medical care on Saba:

If you live on Saba, you know the drill: the “school trip” to Sint Maarten. Not for beaches or shopping, but for a “medical”—the island’s shorthand for a doctor’s appointment. For more serious cases, patients are flown to Bonaire, Curaçao, Aruba, or even Colombia. One acquaintance recently spent an entire day folded in half aboard the ZVK plane—a no-frills, no-toilet medical shuttle between the BES islands—only to reach Aruba for a ten-minute consult with a specialist. A tropical tour of suffering, with layovers but no relief.

On Sint Maarten, the routine is familiar. A van picks you up, drops you at the St. Maarten Medical Centre (SMMC), and then the waiting begins. You’re handed a number, but privacy isn’t part of the package. The waiting room manager announces your origin like a flight attendant calling departures: “Statia? Saba?”—followed by your medical specialty, broadcast to the entire room. Doors are labeled in bold letters, and unsolicited advice comes free with your ticket. When a toddler in the waiting room erupted into coughs, the manager barked, “Take the child out of the stroller and pat its back!” Medical expertise? Maybe. Humiliation? Definitely.

By day’s end, you reunite with fellow islanders in the airport line, laden with groceries and exhaustion. Shopping is a necessity—Saba’s shelves don’t carry everything—but what about the mother who spent all day hauling her baby in a carrier for a ten-minute appointment? Where does she change a diaper? Where does she pee? The airport bathroom, grimy and cramped, is the only option.

Healthcare here isn’t a straight path; it’s a fragile web. A gust of wind, a specialist’s flu, and your appointment vanishes—rescheduled for weeks later. One diagnosis took us over two years on Saba. Not for lack of effort, but because the MHC psychologist’s plane couldn’t land in bad weather, and then she quit. Months passed before a replacement arrived and untangled the case. By then, the prescribed medication had to be routed through Sint Maarten.

Treatment isn’t just care—it’s a logistical odyssey. Five weeks after our first specialist visit, we returned to the same doctor, only to learn that the ordered ultrasound had never taken place. Radiology refused, indifferent to the fact we’d flown in. The specialist shook his head: “This is bad care.” Not due to negligence, but because the system crumbles when a single link fails. Bad care—when a patient spends days traveling for a procedure that should’ve taken minutes. No one’s to blame, yet everyone suffers.

Employers on Saba adapt to this reality. Staff disappear for days, even weeks, for their own appointments or to accompany family. As a school leader, I’ve watched children miss weeks of class because their mothers were stranded on Sint Maarten awaiting births. Back in the Netherlands, I’d hesitate to ask for an hour off for a checkup; here, I schedule colleagues’ entire days for a single consultation.

And then there’s Saba itself. The clinic’s doctors and nurses pour their hearts into their work. They smile, they worry, they comfort. But their eyes betray the strain—they are the system’s backbone, holding it together as it groans under the weight. When SabaCares’ management was abruptly sidelined without explanation, patients were told to direct questions to the facility manager or board. The staff soldiers on, but trust in this lopsided system feels like leaning on a wall that could collapse any second.

Good intentions aren’t enough. Even the most dedicated care fails when the gears don’t mesh. Until healthcare stops feeling like a chaotic school trip, we’re left hoping we stay healthy. The Kingdom promises good care and quality of life for all. On Saba, that promise gets lost in referrals, waiting rooms, and the endless shuffle between islands.

 Jessica Besselink, Dossier Koninkrijksrelaties