“Joining Medicine in Action on the November 2017 Medical Mission to Jamaica as the Sugar Scholar was an opportunity for me to give back to the country where I was born and where my family considers home. Learning of my selection for the scholarship I was excited to finally have the opportunity to practice medicine in a resource poor setting and to provide medical care to patients that are most in need. At the same time I was very anxious about my ability to practice medicine in Jamaica. Having never practiced medicine internationally I questioned my ability to adapt the knowledge and skills I had learned through training in the United States to effectively provide care to patients in Jamaica. Knowing that I would be working alongside seasoned volunteer physicians and nurses from Medicine in Action helped reassure me that I would have guidance to work effectively in Jamaica.
My first week was spent with the clinic team. I flew into Kingston where I met Elaine Chong (wife of the late Alton “Sugar” Chong) and the rest of the clinic team at Elaine’s home. Our clinic team was composed of a gynecologist, a family physician, two registered nurses, a clinic coordinator (affectionately referred to as “Dimples”), and me, the medical student. The clinic team was tasked with setting up different clinics across the island to see patients with general medical and gynecologic conditions or complaints and to offer basic screening services such as pap smears, breast exams, prostate exams, blood pressure checks for hypertension, and blood glucose levels for diabetes.
Our first clinic was set up at the Saint Thomas Aquinas Church in Kingston where we saw primarily poor inner-city residents, many of who lived at Mona Commons, a very poor urban slum in Kingston. Our next two clinics were located in Maggotty in the parish of Saint Elizabeth and in Seaford Town in the parish of Westomoreland where we saw primarily poor rural patients at local clinics run by catholic nuns. Every morning there was a crowd of patients waiting to see us at the clinics when we arrived. I got to see many patients with diseases common in Jamaica that I rarely get to see in the United States such as tinea corporis, chikungunya, bacterial folliculitis, and insect bites, among others. However, most of the patients that I encountered suffered from the same conditions commonly seen in the outpatient setting in the United States such as diabetes, hypertension, musculoskeletal pain, BPH, glaucoma, upper respiratory infections, and depression. These patients also suffered from the same complications of poorly controlled chronic disease as patients in the United States.
Coming from a Jamaica-American household I am familiar with Jamaican Patois, but I was still surprised by the nuances and differences in how Jamaicans described their symptoms and how they perceived questions I had asked about their symptoms. I quickly realized that stomach pain could actually mean chest pain, and that foot pain could very well mean calf pain. I learned that you have to be very specific when asking a Jamaican patient about timing or severity of symptoms because the default is usually a vague response like “from time to time” or “not too bad.” One memorable patient encounter I had was with an adolescent boy who rather articulately described to me the best he could what appeared to be paroxysmal supraventricular tachycardia. Another memorable encounter was with a woman who was suffering with depression with psychosomatic complaints; she had all the classic symptoms of depression, but it really took some understanding of the norms in Jamaica to parse out her symptoms. All of the patients were so grateful to be seen by a member of our clinic team and eager to learn more about how to better control their conditions and stay healthy. The patients in Jamaica were so appreciative of me even though I felt inadequate at times seeing them as a medical student.
The most notable difference of healthcare in Jamaica compared to the United States apparent to me during my first week was the lack of access to resources. Many patients that we saw in clinics suffer from chronic diseases that require daily medications that many of them cannot afford (either to buy the medications or to see a physician for a prescription). A lot of patients that we saw with dangerously high blood pressures or blood glucose and with disease complications like diabetic neuropathy were not taking their medications because they had run out of them. I learned that as part of Jamaica’s national health system, patients with chronic diseases such as diabetes, hypertension and glaucoma are supposed to get significantly discounted prices on certain prescription medications that they need, but there seems to be governmental issues and inefficiencies that limit access to this program, especially for poor rural individuals. Specialist care such as dermatology, cardiology, ophthalmology, and radiology are very expensive and a lot of patients don’t receive specialist services because they simply cannot afford the fees to access them.
My second week of the mission was spent with the surgical team primarily seeing pre-operative patients in clinic, assisting in surgical cases, and rounding on post-operative patients at Falmouth Hospital in the parish of Trelawny. I joined a team composed of two urogynecologists, a urogynecology fellow, and an ObGyn resident. I saw primarily patients with urogynecologic complaints who had been referred by local gynecologists for surgical evaluation. Many of the patients that I saw had severe presentations of diseases such as pelvic organ prolapse, stress urinary incontinence, and vesicovaginal fistula, among others. Many of these women had been suffering with their diseases for years and were so grateful to finally get definitive surgical treatment. I got to scrub in on several cases and experience the operating room in a Jamaican hospital. The equipment in the operating rooms was older than what I am used to from the United States, but it all worked similarly. What was most different was the great interdisciplinary culture of the operating room in Jamaica; it was much less hierarchical than the operating rooms in the United States. Roles blend and everyone was congenial both in and out of the operating room. I was surprised to see surgeons, scrub nurses, and anesthesia team members conversing and eating lunch together in the same room. The surgical wards were definitely different. Privacy is not a top priority in Jamaican hospitals; nothing more than curtains and a few feet separated patient beds on the female surgical ward, but this was clearly necessary with the limited number of nursing staff. All the charting and orders was done on paper and the nurses thanked me for my neat handwriting. Overall I had a great exposure to urogynecology and to surgical care in Jamaica. The patients that we operated on were so grateful to the surgical team and so were their families. Our patients were not shy in expressing their appreciation.
Overall I had an amazing experience with Medicine in Action. The patients in Jamaica were by far the best part of my experience. All of the patients that I saw were truly concerned about their health and were so appreciative of the medical services that we provided. I felt like a real doctor. The next best part of my experience was definitely the food. You just can’t beat authentic Jamaican food. Ackee and salt fish with fried breadfruit, jerk pork and hard dough bread, oxtail with rice and peas, brown stew fish and white rice, mmhmmm! My time with Medicine in Action has informed me that I want to make global health a part of my career as a future physician and I will definitely be returning to Jamaica to do medical work again. “