on the question of choice

Time and again we debate our debating of the A word in Jamaica. In Parliament. On the streets. In churches. In the bedroom. In doctor’s offices. In back alleys. With hangers, with pills, with blood.

The ‘A’ word. Abortion.

The idea is castigated by our ‘Christian-minded’ nationalism and people get very upset whenever it’s brought up. Words like ‘murder’ and ‘human life’ get thrown around. Women are accused of being careless and cruel.

I think too often we get caught up in Christian morals to the detriment of our fellow citizens. As if we forget that slavery too was sanctioned by ‘God’. And I’m not saying that people shouldn’t read Bible, praise Jesus and pray to their Lord but the same way I stay out of Christian people churches is the same way the Church-State should stay out of women’s bodies.

Much like the buggery law it’s simply embarrassing that abortion continues to be a debate in government in 2018. Not even a debate, an issue so taboo we don’t even talk about it. Like sex education. Come to think of it, maybe abortion would be less of an issue if there was more sex ed. I digress.

It’s high time we doctors stopped pussy-footing around while women suffer. And it’s high time Parliament stopped ignoring the issue just because it makes the Church uncomfortable. If you not going to clamp down seriously on rape, stop bawl out when the victims are forced deal with the consequences.

Give women the choice, and get your damn hands off our wombs.

Another month older, another month wiser

I had about five paragraphs talking about how I planned to cut my hair and how hair is such a big deal for black women and why is it even such a big deal in the first place but it fizzled out when I cut my hair and realized how big a deal it wasn’t. So now my hair is four inches shorter and I am out of a blog post.

In lieu of some introspective self-reflection, I decided to share a snapshot into my life for the last month. So in no particular order. . .

1. In early October I learnt that a family celebration does not, in fact, have to break the bank, and birthdays can actually be commemorated with low-key gatherings and cake. Definitely cake. My purse and heart are grateful.

2. In mid-October Montego Bay hosted its very first Pride march which was also my very first Pride march. I helped carry the rainbow flag and it maxed out my feeble upper body strength. And though the actual marching was pretty short (can’t complain, the sun was brutal) the feeling was pretty incredible.

Pride was definitely an experience – a lot more head top and dash out than I would have expected, along with uncensored dancehall songs on the people dem good good Sunday morning. But overall I had a sense of bittersweet, well, pride. I was proud of the LGBT movement in Montego Bay for coming out and enjoying themselves, even as a good number of them opted to cover their faces. I’m already looking forward to Pride 2019.

3. In late October I recognized a full year of settling into my leadership role at work. It was a good chance to reflect on how much I’ve grown, how many leadership books I added to my shelves (a lot) and how many I’d read (very little) and where I plan to go next in my journey to becoming a girl boss.

4. I’m participating in my high school’s mentorship program for the second year in a row, and I’m excited to see what new adventures and experiences are in store us for in the upcoming school year. Last year was a blast of learning and growth for both me and my mentee, and I expect this year to be no different.

What have y’all been up to?

Your ideas suck. Now what?

Since my last super-optimistic post on the importance of having a vision, I have been taken down several pegs and come to a few realizations.

  1. It is not enough to simply have a vision. You have to successfully communicate that vision and get buy in from the right people.
  2. Unlike your friends, the right people may not be overwhelmingly interested in hearing your vision. In fact, they may leave the meeting at lunch time, when you’ve wasted the whole morning discussing reports, before you get to talk about your vision at all.
  3. Colleagues and work buddies will not always be as enthusiastic about this whole vision thing as you’d like them to be. Sure you’re fired up and ready to go but for everyone else it’s the same old boring meeting agenda that they always check out of. And don’t even think about asking questions in that setting. Not even the crickets will respond.

It’s exciting to have an idea that you think is great and will push the team in new, progressive directions. So it can be tough when your boss effectively says your brilliant new progressive idea is barking up the wrong tree. Ouch.

Hurt feelings aside (scrape it off and move on, this is business) it’s a great real life example of leaders being able to say we’re hacking away at the wrong forest. One silver lining in that cloud of ‘ooh, bummer’ is learning what kind of forest to look for when you’re at the top of that ladder swiveling your binoculars around. The uncomfortable experience of sharing an idea and having it critiqued is a powerful lesson in zoning in on the key issues.

For some people, I know, criticism makes them shut down immediately and not offer up any more ideas. But for me, I’m so eager to learn I don’t shy away from being wrong. In classroom settings I always attempt an answer, even if I’m not sure about it. Especially when I’m not sure about it. In the professional world I’ve been a lot more cautious about voicing my ideas. But I’m coming to realize that just like in class, getting things wrong can be a great way to learn how to get them right.

Visions (but not like, the high kind)

Lately I’ve been feeling really stressed out at work. Proper stress: headaches, stomach aches, feeling like I was about to explode from internal pressure. I was freaking out about my work responsibilities which seemed to loom ever larger in my paranoid imagination, but in reality were only so intimidating because I was setting the bar so very high for myself.

I started listening to this podcast a few months ago. And while it’s a kick-ass repository of career advice and entertaining conversations on how to be awesome at your job, it was also setting me up for failure. Every new technique I learnt, I wanted to start doing immediately. I judged my own growth against concepts and ideas from more experienced professionals and found myself painfully lacking. I threw myself into a fit, trying to ‘catch up’ and ‘do it all’. My control freak tendencies came out full force.

And week after week, my job resisted all attempts at micromanaging. Shockingly, people are impossible to control. I know this is breaking news to you guys, so maybe take a second to get used to this epiphany. Patients do whatever the hell they want, responsibilities and priorities shift all the time, colleagues do not share your work ethic, etc etc.

Mercifully, the culmination of all this stress was a breakthrough and not a breakdown. Driving home on the verge of tears for the fifth Monday in a row I let my thoughts swirl around the car interior like angry wasps. Then among the wasps, wisps of remembered conversations and podcasts snippets coalesced to remind me of a word I had forgotten in my desperate scramble to control.

Vision.

I didn’t have any. Or I had too much. I didn’t know, because in the middle of all this over-thinking and I had never actually stopped to think about what I wanted to make happen. I was furiously building a boat on dry land without ever having dreamed of the sea.

So I started dreaming, and I started writing things down. I wrote quickly, more concerned with getting the ideas out of my head before they exploded my head. I edited after, because I have standards.

And incredibly I felt lighter. The stress had shifted from an angry hornet’s nest to a more manageable ball of barbed wire. I knew what I was aiming for now, what the end result should look like, and I had something I could show to other people and ask for help so I’d feel less alone. It was incredible.

In his seminal work, Stephen Covey talks about how important it is for a leader to have vision. He makes the analogy of a group of people in a forest working to clear a path, with managers directing the machete-wielders to chop down the right set of trees. But the leader is the one who climbs up, looks around and yells, ‘Wrong forest!’

And honestly, I understood that when I was reading it. Yes, obviously vision is important. 2+2=4. Duh. But I didn’t really get it until I had finished mapping my own visions and realized, with great humility, that this was the most important part of the job all along.

Di stress / Distress / De-stress

Please enjoy this post I wrote 2 years ago while struggling to survive my intern year. The level of optimism is truly remarkable considering I was on my Paediatric rotation at the time.

The shift from medical school to internship is the shift from dipping one’s toes in the swimming pool to diving in the deep end. When you’re a medical student, duty ends at 10pm. If you can’t get an intravenous access, you call the intern. 12 o’clock is always lunchtime.

Suddenly, it’s July 1 and the minutes don’t roll over. Free paper has been burnt. You have passed the dreaded MBBS and received, in return for your labours, more hard work. Harder work, in fact. Your duties extend for 24 and 48 and 56 hours. Sleep becomes a concept. Lunchtime, a luxury. You become the person the medical student calls when they’ve destroyed all the veins in their quest for an IV access.

Why am I here again?

If you haven’t asked yourself that question at least once in the last six months, consider yourself lucky. You might actually want to try your hand at the Lotto.

If there was a buzzword for internship, disillusionment would be it. When asked what lessons have been gleaned from the “Internship Experience”, one intern from a hospital which shall remain nameless (we’ll call it the Really Tall One) responded with an outburst,

“Old doctors want our experience to be as frustrating as theirs to ‘build character’.”

You know it’s time for a paradigm shift when you point out workplace inadequacies and your boss responds with,

“You merely adopted high patient loads and low resources. I was born in it, molded by it. I didn’t have the luxury of readily available investigations until I was already a SR and by then it was an insult to my clinical acumen.”

It’s admirable to want your interns to be the best they can be but there are practices in medicine that in any other profession would spark the ire of an entire HR department. But I digress. This isn’t meant to be a call to arms.

Sometimes the answer to that ever-present question is positive. Real life patient care (as opposed to the dabbling that’s done in medical school) can be and has been rewarding and invigorating. The General Surgery rotation is particularly satisfying in this regard: patients enter the hospital bleeding, broken, dying and with the flick of a scalpel, the swish of a stitch (and some strong pain meds) they survive to maim themselves (or someone else) another day.

Lest this turn into a clichéd trope about the satisfaction of a job well done, I do have some misgivings about the surgical field. Once a patient expressed their profuse gratitude for having their infected digit amputated. You’re . . . welcome?

As uplifting as those moments are, they seem to be outweighed by the downsides of working in the public system. Like McGyver and Miss Lou, you has to tun yuh hand mek fashion. Whether it’s performing an entire sepsis screen (including lumbar puncture) on a neonate without assistance or manoeuvring a 250lb patient with bilateral skeletal traction off their stretcher and onto the CT machine, provided the CT machine is working. One disadvantage faced by every public hospital is inadequate funding, but necessity is the mother of invention. If you haven’t made an IV drip stand out of a curtain hook or a chest tube out of a Foley catheter, you haven’t really lived.

There is a certain satisfaction to seeing patients managed conscientiously despite low resource settings, but can medicine be equally reward and punishment? Ours is the lot of sleepless nights, thankless hours and the constant threat of occupational exposure (latent TB, anyone?). Is the smile of a mother when you tell her yes her baby can go home really worth the stress of q4hrly bilirubins?

As the most junior member of the medical team that stress of ‘getting it done’ rests squarely on the intern’s shoulders. It often feels like we’ve been left in the deep end of the pool to sink or swim, complete with Yoda-like figure declaring “do or do not, there is no try”. Coping mechanisms become currency as we try to stay afloat despite the setbacks. Periodic nervous breakdowns, the impenetrable veneer of cynicism and a strong tendency toward smoking and alcohol are only a few of the methods employed.

If you are stranded amidst the sea of disillusionment, clinging to the battered lifeboat of responsibility it helps, I think, to remember the reason you started out on this journey in the first place. Sankofa, my friends. It is okay to look back for that which you have forgotten. Whether it was the personal fulfilment you get from helping other people or the determination to be consultant someday, internship is decidedly BYOM. Bring Your Own Motivation.

At six months in we’ve already committed to this gestation period, for better or for worse. And when we are delivered in another six months, freshly registered and happy to be out of the frying pan of internship, we’ll look back from the fires of Senior House Officer year with the same clouded nostalgia as the consultants who believe that their internship experience was the only one worthwhile.

The more things change, the more they remain the same.

 

a word on checkpoints and the assailing of women’s bodies

The State of Emergency is now in its tenth month. Violent crime levels appear unabated. Every issue of the Western Mirror carries a front page headline on some gruesome murder or gunfight.

Twice daily checkpoints are my new normal, since I live and work in two separate parishes. I drive through, waving to the unlucky soldiers assigned to stand in the middle of the road in the grueling summer heat, and smile.

At first I would approach each checkpoint with a sense of trepidation. Would they stop me to search my car? And then annoyance. Would they stop me to try and get my number? My experience was getting harassed by soldiers and police officers alike who appeared to have no other reason to stop me than to chat me up like a man in a bar. It was unprofessional and frustrating.

I used to slow and stop so that the officer or soldier could peer into the car, but these days I slow down just enough to give a brisk wave unless I’m told otherwise. This is just another way one learns to navigate social conventions as a person of the feminine gender.

After a while, when my frustration had faded to good-natured acceptance, I started to notice female soldiers now deployed to man the line. One day while cruising through at my snail pace, I overheard a bus driver call out a raunchy greeting to the lady soldier standing in the road. I cringed, and questioned.

Beyond the sexism that exists among one’s professional colleagues, a sexism that can potentially be challenged and eroded by professional success, is there a deeper and more pervasive sexism in society at large that undermines the execution of professional ‘gender roles’?

Is there a certain level of respect accorded to soldiers and police officers? Do we accord that same respect when the soldier or police officer is a woman? And does the change in tone when addressing a female member of the armed forces imply a lack of respect, or is it simply a neutral cultural phenomenon?

I’m pretty sure that woman was used to getting catcalls in her line of duty, and many women are. Some find it annoying, some find it flattering, and for some it’s just a part of life, neither good nor bad. In my culture there are many things that my liberal ideology struggles to accept, and this is one of them.

Is it inappropriate and unacceptable for a man to calls out ‘Psst, babes‘ when a woman walks by? Is it only inappropriate when he does it to certain Women, or in certain Spaces? Does the acceptability depend on the man’s intention: to objectify and assault, or to compliment and affirm? If the action is allowed, is there an expected response? Is it rude to ignore them? It certainly seems that way.

And is it really such a big deal?

In some spaces it can be. As a general rule I ignore the leaking air and the catcalls, but on certain streets I make damn sure to respond with a polite greeting. At issue here is the concept of danger. On main roads I feel safe enough to ignore the calls; on side streets I am too aware of my vulnerability to invite an uncertain threat. I fear, so I conform. But does this make me complicit in a social norm I desperately wish would change?

I don’t have the answers, but I think it’s important that we start talking somewhere. A catcall on a lonely avenue isn’t the same as being sexually assaulted, but the threads of gender-based violence run deep. Until we can pick up the ends, wherever they are scattered, we will never begin to untangle that knot.

Inventing Language

I have two entirely different and diverging spiels to divulge about this topic. The first, which I’ll probably (forget to) talk about later, is inspired by Dr. Eric Levi’s post about changing the culture of medicine by changing the words we use when we talk to each other.

The second, which I’ll talk about now, has to do with the way we produce and consume Jamaican literature. I say Jamaican specifically, because I think the Caribbean on a whole is doing much better with producing stories that are told in the language of the people. But I can’t shake the feeling that as Jamaicans we aren’t quite there yet.

Prolific writers like Erna Brodber and Kei Miller (among many, many others) must be commended for following the ample footsteps of Miss Lou and putting our dialect on an international stage. But when I read The Last Warner Woman (Miller) or Nothing’s Mat (a recent release by Brodber) I don’t feel like I’m hearing the voice of the man or woman on the street. The dialogue and narration tend to feel like a weirdly off-brand version of Jamaican dialect, the distinction growing when they employ the use of Patois. It’s not that they use Patois wrong (because it’s a language with its own rules and I’m very adamant about that but I should probably leave that argument for another time) it’s just that it doesn’t feel right.

Of course I might be judging their writing too harshly. It’s much easier for me to say that Tamika Gibson captures the essence of the Trini accent perfectly in her YA novel Dreams Beyond the Shore because I don’t live in Trinidad and have no reference for the nuances of their everyday conversations. But I know what I expect Jamaicans to sound like, and the bar I set might be too high to realistically reach on the page.

Another reason for my discomfort with our language in print might be that the sounds and phrases I hear in Montego Bay are noticeably (albeit only slightly) different from the turns of phrase used in Kingston or other parts of the island. So maybe Miller and Brodber are staying true to their own ears, while alienating mine.

In either case the point remains that I have yet to read a Jamaican novel that rings true with authenticity*. It either feels like I’m watching Jamaica through the eyes of a foreigner or like I am the foreigner with strange and altered expectations for the writing. It doesn’t help that most Jamaican writers live abroad, and I have often wondered if it is easier to write home from the Diaspora or if the distance does something to the translation. As if in their habit of making our language and culture more palatable for the foreign audience it loses the vivre that makes it appeal to the local one.

Where does all of this thinking leave me? Tamika Gibson mentioned in an interview that she wrote the award-winning manuscript because she wanted Trinidadian youngsters to have a book that was in their language. Growing up all the stories she read were about foreign places and foreign people and she didn’t want that to continue.

Neither do I. But as I grapple with the idea of writing an authentically Jamaican story I recognize that my struggle is in the physical act of putting one word after the other. Having read so many novel and stories and poems generated by a largely cosmopolitan author base certain phrases and descriptions spring readily to mind. Certain combinations of words naturally trip out of my fingers, but none of these fit our local setting.

There’s no set or pre-defined way to describe Montego Bay because it just hasn’t been described often enough. So the task that rests with the writer who talks about home is really to build the language brick by brick in a slow meticulous operation. Because it’s never really been done before so you have to pay attention to get it right.

It’s the difference between moving into a densely populated neighbourhood where all the houses have been around for centuries and moving into a neighbourhood where all your neighbours are still building the houses from scratch. It’s grunt work, fantastic work, and it will take elbow grease, grit and determination. Luckily, we’ve got those in spades.

on the Legitimacy of ‘Free’ Health Care

Disclaimer: Opinions reflected here are my own, and not representative of any other person or entity. This post isn’t even about a specific country. It’s entirely hypothetical. Any resemblance to actual places or policies is completely coincidental and should be ignored.

No person in need should be refused health care because they are unable to afford it.

If someone is sick they should get be able to access the treatment and investigations they need without going bankrupt. This is what the World Health Organization considers ‘Health for All‘.

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But health systems need to be sustainable. Governments shouldn’t promise health care gratis and then serve up a substandard product. Free service with unacceptable wait times, drug shortages and costly basic interventions is impractical and unfair to the population receiving it. It’s free health care in name only, a political tactic, and frankly demeaning to the patients who must navigate these inaccessible territories.

Being able to get medical help without having to pay through the nose is great! I see a doctor at my local clinic for free, get a prescription which I fill at the nearest government pharmacy for free. If I need blood work, an x-ray or ultrasound, those are all free too. If I need to be hospitalised, I don’t need to worry about a bill, and I can rest assured that the hospital has all the resources required to treat me according to international standards.

But what if there are not enough doctors in the clinic, or not enough space in the hospital? What if there isn’t enough medicine in the pharmacy, what if the machines for blood testing or x-ray or ultrasound aren’t working? What if the hospital is overwhelmed by demand and its resources are inadequate for a population this size?  What happens then?

I don’t have the answers but I’m sure the solution is more complicated than just throwing more money at the problem. Sustainability and capacity building are nuanced and necessary concepts that demand to be addressed. Failing to take them into consideration results in a quagmire of dissatisfaction and deteriorating quality.

If high quality, patient-centered health for all is the goal, then the steps to get there must reflect this realignment of values. Any health system that decides to serve users at no charge must remember that it exists to serve, and not to inconvenience or ignore its customers.

Plastics and the Environment

The government of Jamaica plans to ban plastic bags smaller than 24″x24″ in January 2019.

This is widely regarded as a Good Move, however I cannot dilute my skepticism. I believe plastics are evil and harmful, I believe climate change is a dangerous and disturbing reality but I’m not convinced this is the smartest solution.

The biggest users of plastic bags (lada bags, scandal bags) are the lower class. Middle class and upper class Jamaica jumped on the environmentally conscious bandwagon years ago, carrying their artisanal tote bags to the supermarket and recycling their plastics when possible. But for the average Jamaican downtown who visits Mr. Chin shop to buy a few pounds of rice and flour lada bags are the most economical option. When plastics are banned, will the increased business costs be passed on to this consumer?

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Image from JIS website

The government refers to these plastics as single use, but the majority of Jamaicans who get these bags in the supermarket use them in all sorts of ways: to carry goods, food, medications, papers. Many people re-use them as garbage bags. And even though I switched to biodegradable garbage bags, I still use lada bags to collect my cats’ poop when I clean their litter boxes. It’s just the most practical option at this moment.

If the government wants to address our serious problem with plastic pollution, I think a better use of their time and energy would be to invest in more recycling plants. There’s only one on the western end of the island, near the border with Trelawny, and no recycling receptacles anywhere in Montego Bay at all.

It would also be worthwhile to invest more time in public education on the environmentally friendly substitutes in their day to day lives. Market baskets, boxes instead of bags at the supermarket, paper boxes for food instead of styrofoam. If these options are upfront, public and popular, if they are easy to choose then people will begin to adjust accordingly.

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Banning plastic bags is more stick than carrot, and punishment is not the best long term solution to behaviour change. Because what it really comes down to is a question of convenience. It is more convenient to get a plastic bag from the supermarket than to walk with one of your own. It is more convenient to throw garbage out the window of a moving car than it is to find a bin. That’s what we need to change.

This is basic system design, GOJ. Make the right thing easy to do.

Early Mornings (are a health hazard)

I’m hoping this becomes a trend.

Waking up early, I mean. Not suffering from smoke inhalation. It’s day six (?) of the Retirement Dump fire in Montego Bayor as we who live close by call it, “too damn long”. It’s really uncomfortable to wake up and go to sleep in the smell of smoke. Even more uncomfortable to do yoga in it. Not to mention the laundry. My bed sheets are soaking up the smog as we speak, and I don’t even want to think about my hair.

 

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DEATH FOG

One of my favourite things about our house-in-progress is that we finally have work desks right in front of the windows. But peering out my windows to contemplate the flowers in the garden is now a health hazard because I have to contend with emissions of carbon and god only knows what else in the air.

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Please ignore the cables and focus on the haze of death fog.

So on top of the probably indefinite State of Emergency, St. James is now slowly choking to death or at least serious illness. If bad things come in threes, I can’t wait to see what else is going to kick us when we’re down. That’s not true, I can totally wait. At least until I can breathe again.

 

 

 

Hopefully we come out of this with no serious ill effects. You know, other than migraines, chronic cough, upper respiratory infections,  exacerbated asthma. . . I could go on, but run on sentences are harder to do when the air is full of noxious fumes.

Til next time.