The Case for Primary Health Care

It’s 4:30AM. The sun isn’t up yet but Miss Dee is already making her way up the rocky lane to the main road of her community where she will catch the first ride going into town. In her purse she carries enough money for taxi fare both ways, two mint balls and a wrapped up piece of plastic with her tattered clinic appointment card and her last prescription. She will reach the clinic by 6AM so that she can collect one of the first numbers. When she arrives she is the third person there. They settle in to wait until 7:30 when the first security guard will open the gate.

Forty-one years ago in the city of Almaty, Kazakhstan, when Miss Dee was still a bright young girl, leaders from all over the world gathered to make a decision about keeping people healthy. The Declaration of Alma Ata, as it would come to be known, states firmly that primary health care is the key to achieving ‘Health for All’ – the universally accepted goal that promotes the health of all people.

Before we get into the nitty gritty, let’s get a few definitions out of the way. What is health, exactly? The World Health Organization defines health as “a state of complete mental, physical and social well-being, not merely the absence of disease or infirmity”. And they should know. This sounds like something everyone should have, right?

Health is a state of complete mental, physical and social well-being, not merely the absence of disease or infirmity

World Health Organization

Health for All‘ is the slogan for universal health coverage: no person or population gets left behind. Women, LGBTQ+, disabled individuals, persons living with HIV – everyone is included! Unfortunately, in some places, not everyone gets included all the time.

Now what is primary healthcare? This is a way of thinking about and organizing the different aspects of health care. Definitions of primary healthcare often make reference to essential health care and primary care (not the same thing). A primary health care system has a few key characteristics.

  • It’s based on principles that are scientifically sound, and socially acceptable
  • Primary healthcare is universal – it includes every single person
  • Primary healthcare aims to provide improved access to health services, financial risk protection and improved health outcomes

And finally primary care refers to those services that are delivered in the community (usually at a clinic or health centre) by doctors, nurses and allied health workers (also called primary care providers). These services are often someone’s first point of contact with the health care system.

So if primary health care is the key to achieving #HealthforAll, and if healthy people live better, stronger lives then investing in a strong primary health care system is the best and most cost-effective way to ensure a healthy, productive population.

Investing in a strong primary health care system is the best and most cost-effective way to ensure a healthy, productive population.

Remember Miss Dee from earlier? She’s not real, but her story is. This clinic-before-daybreak sojourn is the reality for a majority of citizens who access services at health centres (clinics) in Jamaica. People leave home early hoping that they will get through the clinic quickly. But in reality reaching clinic by 6AM doesn’t guarantee that Miss Dee will be finished before 10AM or even before noon. Depending on the type of clinic, number of patients, availability of staff or occurrence of emergencies, Miss Dee may end up waiting until 3PM or later before she’s seen by a medical doctor (her primary reason for going to clinic in the first place). And remember she only brought enough money for transportation – not for lunch – and she left home too early to have a proper breakfast.

Public health care in Jamaica is a running joke. Meaning, the kind of joke people run from. Letters to editors, prime time news stories, and overheard conversations complain about common themes like long wait times, rude staff, lack of resources, lack of space and limited accessibility. The feeling of the man on the street (who only complains to overburdened health care staff and never to his chair-cushioned and air-conditioned MP) is that average people, poor people, who need and use these services are grossly neglected. Politicians and the well-to-do get private, highly resourced health care but the woman on the street gets what the duck got.

So what actually is the situation? The Layman’s Doctor recently posted a guide for people accessing care at their local health centres, in which she specifically addressed the notoriously long wait times and cautioned patients to prepare for it. For people who don’t work in or don’t access care in these clinics, it can seem like another world.

There are large crowds on days when a doctor is present at the clinic, and often the seating provided is inadequate. As we approach the summer months, there is no air conditioning, and clinics in the country don’t always have fans installed. The patient to staff ratio is usually high, which further prolongs the wait time, and to top it off most health centres do not have a pharmacy attached. This means that after seeing the physician patients have to get their medication at another (sometimes inaccessible) location, that may or may not have all the drugs they need.

If you’re frustrated just reading this, you aren’t alone. Experts the world over have agreed that accessible and universal primary care is critical to improving health outcomes. That means that people with diabetes won’t get their legs chopped off, and people diagnosed as obese can be prevented from getting diabetes in the first place.

Primary care providers save lives

WHO, 2018

In their technical series on primary health care the WHO reviewed systematic reviews and meta-analyses from a broad sweep of countries. The results were unanimous. When it comes to people dying (all-cause and specific-cause mortality), there is strong evidence that supplying primary care providers (ie clinic staff) leads to less people dying overall. Primary care providers save lives, y’all. And strong evidence that continuity of care (meaning the same doctor, same facility or strong linkages between doctors and facilities) also leads to less people dying.

For people who care more about the bottom line, the same review also examined health system efficiency (ie best bang for the buck). They found strong evidence that a supply of primary care providers reduces the number of avoidable hospitalizations, and evidence that case management programmes (think social workers) could reduce the number of total hospitalizations as well.

And for the social justice warriors (because health care is a human right), there is evidence that primary care, as compared with other types of health care, can improve access to health services, especially for disadvantaged adults.

Full disclosure – most of these studies took place in English-speaking high income countries but the evidence can be translated universally. Read the full 28-page review here: The Economic Case for Primary Care.

So if you were Minister of Health and you had to decide how to spend the meager Health budget, how would you allocate the funds? In Jamaica there are no user fees for nationals at public facilities (this does not mean health care is free!), so all the money comes from you (and a few donor agencies). You have to keep hospitals open, keep clinics running, pay your staff, provide medication, refurbish and maintain equipment, buy resources and develop media campaigns that remind people to “love yuh body, treat yuh body right“.

What’s your number one priority?

If you guessed hospitals – then you’d be right. . . Right on the side of our current Health Ministry, which is the wrong side.

Hospitals are undeniably important to the delivery of health care. Secondary and tertiary centres (smaller and larger hospitals) are vital and necessary, but they are vital and necessary in the way that having a spare tire is necessary. They’re super important if you get a flat tire, but it’s way simpler and easier to invest your time in avoiding a flat tire in the first place.

Now I know what you’re thinking – “But I can’t control when I get a flat tire!!”. And I hear you, shit happens. You drop into a pothole on the North South highway and pow! Yuh haffi draw fi di spare. But suppose you were using your spare tire every single day? If you had to choose between keeping your tires in good condition and avoiding potholes or buying a really expensive spare tire (complete with repairing the damaged tire, and the loss of work time that it’s going to take you to get the tires sorted out) which would you choose?

I really want to know, so leave a comment with your pick. And if you’re one of those brilliant minds out there thinking that this wouldn’t have happened if the roads were properly maintained in the first place then congratulations, you’ve just hit on another pillar of primary care – multi-sectoral policy and action. Because there are a lot of other things in the world that impact a person’s health, not just access to health services.

What I’m trying to say in my long rambling way is that investing the bulk of health budgets into hospitals isn’t going to yield any long-term improvement in the health of the population. Hospitals are necessary to deal with emergencies but, as we’ve shown, having a strong primary care system means there won’t be as many emergencies. A robust primary care system can handle minor emergencies and prevent major ones, reducing the burden on the hospitals and other referral centres.

So back to Miss Dee. By pouring more time and energy and investment into making primary care stronger, better and more effective Miss Dee won’t feel compelled to leave her house in the pitch-dark pre-dawn, risking ankle and foot injury on the uneven road. She could get to clinic at 8:30 or even 9 for her appointment, do her checks and see the doctor by 10, then get her medication (for free) at the same facility and return home in time for lunch. If we invested the right way, with the needs of the patient at the heart of our activities then even if Miss Dee was a 16 year old lesbian seeking advice on safe sex, or an 80 year old blind woman in a wheelchair she would have the same access, protection and positive outcome.

Health isn’t just for the good of the individual, it’s for the good of the country. Healthy people are more productive, and more healthy working people means more GDP. It’s time for all our leaders to make good on their promise – ‘Health for All’ is a human right.

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Top 7 Things to Do in Montego Bay – for Free!

Montego Bay is more than just Jamaica’s ‘second city’ – it’s the tourist capital! But for those of us who live where you vacation, sometimes it’s hard to find fun-filled activities outside the ivory towers of all-inclusive hotels. Don’t worry – I’ve compiled a list of budget-friendly (aka FREE) things to do in and around Mobay, for locals and tourists alike.

7. Take a Stroll on the Hip Strip

Recently re-named Jimmy Cliff Boulevard (previously Gloucestershire Avenue) the Hip Strip is home to Montego Bay’s lively tourism crowd. From nightlife to food spots with amazing views of the sunset and friendly crowds on yachts – the Hip Strip has you covered. Approximately 2km in length, it’s perfect for an afternoon stroll that includes park views, historic buildings, and of course gorgeous views of the Caribbean Sea #nofilter. Bonus! – the Hip Strip is also home to three other activities on this list.

6. Have a Picnic at Old Hospital Park

Refurbished about five years ago for a whopping $10M JMD, the Old Hospital Park on the Hip Strip has become the number one family-friendly chill spot. With no entrance fee, wide open green spaces dotted with covered gazebos and elegant palm trees it’s the perfect picnic spot. The sheltered location set below the bustling roadway is idyllic, complete with pink AND yellow poui trees. Romantic couples and families with small children can often be found whiling away the hours here and enjoying the beautiful view.

5. Make a Splash at Margaritaville

It’s always 5 o’clock at Jimmy Buffet’s Margaritaville, and it’s always free. Like its counterparts in Negril and Ocho Rios, Margaritaville Montego Bay has no fee for entry. Make a splash with their 120ft water slide that dunks you right into the blissful blue waters, and then have a blast on their aqua park with trampolines, swings and more. Refreshments come at a cost, but after a day like that it’s totally worth it.

4. Enjoy a Movie in the Park

You didn’t think we were done with the Hip Strip? Last Fridays of the month are movie nights with Movies in the Park, a family-oriented event sponsored by non-profit enterprise I Love Mobay. Serving up gems like The Lion King and Alice in Wonderland (with free popcorn for the first 200 children!) it’s a modern day version of drive-in style movie theatres. Just make sure to BYOB (bring your own blanket)!

3. Hang Out at Whitter Village

Whitter Village in Ironshore is technically on the outskirts of Montego Bay, but it’s easily accessible by taking an Ironshore taxi (or driving along the A1 highway). Designed to exude a classical cottage aesthetic, Whitter Village caters to residents of the surrounding communities as well as tourists from the neighbouring hotels. Boasting a variety of restaurants (Rolly Polly!), entertainment options (bowling!) and chic fashion outlets (David and Subs!) and complete with its own gazebo and water feature Whitter Village is a great spot for a chill day hanging out.

2. Retreat to Reading at the St. James Parish Library

If you’re more of an indoors-y person, don’t worry we’ve got you covered. The St. James Parish Library is conveniently located in downtown Montego Bay, stocked with thousands of volumes for you to get lost in. There’s a children’s section for young ones, and a Restricted Section that’s a little more quiet. Like many of our historical buildings, the library’s entrance features a bust of one of our National Heroes the Rt. Excellent Marcus Mosiah Garvey. The library grounds are also a popular hangout spot for teenagers, especially on Saturdays.

1. Dip Your Toes in a Free Beach (or three!)

There’s no way to write a list of free activities in Montego Bay without including the beach! Even though most of our beaches are privatized, a few choice spots still remain for the intrepid traveller (who wears their swimsuit under their clothes). Dead End Beach located at the very end of the Hip Strip (just behind Sangster’s International Airport) is a sandy, shallow swimming area, popular with small children. Should your daytime activities pique your thirst a cold Red Strip is readily available from the Dead End Beach grill and bar just across the road.

A little bit further up the road across from Sandals Hotel is a small cove of coastline (not pictured) that’s also free of charge. Despite it’s humble size, this beach gets very deep very quickly making it a popular area with the early morning swimming crowd. It can get crowded on holidays and weekends, but there’s always enough space for one more beach towel.

credit: amandawhitephotography.com

Finally, our last free beach in Montego Bay is the One Man Beach, located just beside Old Hospital Park (across the road from the Soe Htwe Pharmacy and Medical Centre – yes there’s a medical centre on the Hip Strip). The sand here is a little more coarse, and the water a little more full of seaweed, but this beach is nestled between protective jetties that frame the horizon picture perfectly!

From beaches to books, movies to Margaritaville, I’ve shown that Montego Bay can be enjoyed without breaking the bank. There’s a wealth of beauty to be discovered here, even without swiping a card. Make sure to like and share my post if you learnt something new about Montego Bay!

Pax~

on Advocacy

In Jamaica, we have a lot of people with opinions. Having a loud mouth and strong convictions is instruction Number 3 in ‘How to be Jamaican’ (Number 2 is ‘always ask for curry goat gravy’). It’s no surprise then that we have so many organizations arguing publicly for a wide range of causes and policies.

We were practically born and raised to be advocates. Ask any frustrated community who block road and bun tire to protest bad road conditions. Look at any line of people waiting impatiently to access a service – somebody is going to start advocating for more staff and decreased waiting time (albeit in more colourful language).

Even though most Jamaicans advocate from cradle to grave, Advocacy with a capital A is often described in cultured tones, refined and pedestalized into colonial approval, consisting mainly of papers, workshops and civilized protest. Grassroots movements get lopped off at the tip: keep the pretty flower, leave the dirty roots behind.

Because most groups that Advocate are based in the Kingston and St. Andrew area, their Advocacy is limited to scavenging for policy change. But if civil society organizations incorporated grassroots strategies and engaged the wider Jamaican community, their advocacy (with a common a) would have more lasting impact.

Yes, this is another rant on decentralizing our socio-cultural landscape. Buckle up, kids.

Kingston/St. Andrew is home to only 25% of Jamaicans, but they have 100% of the headquarters for civil society organizations. Whether it’s environmental protection, social justice or human rights everyone is based in Kingston. Meetings, workshops and policy discussions happen mostly in Kingston. Organized protests happen in Kingston, letters to the editor are written to the Jamaica Gleaner (you guessed it, a Kingston-based national newspaper), and social media campaigns mainly reach urban demographics.

You might argue that these organizations are concerned with creating policy change and Kingston is where policies are created so that’s where they have to be. Yes, but policy change isn’t the only avenue for activism. And can policy change be sustainable without significant efforts at the local and individual levels?

No, no it can’t.

The problem with top down change is the same problem with trickle down economics. The benefits are rarely if ever felt by the people at the bottom of the ladder. Trickle down social justice might look pretty on paper, because we have all the right policies, but it won’t change the day to day realities of the average Jamaican because our realities are largely a consequence of our mindset.

For example, suppose Parliament actually decides to decriminalize abortion. Does that mean girls in rural communities will no longer face barriers like social stigma and cultural beliefs that encourage early and frequent child-bearing? No, those barriers will remain unless someone inside that community is advocating for a different way of doing things. I already said Jamaicans are born advocates, you just need to wind us up and point us in the right direction.

So it’s all well and good to rock the boat on a national level, but it has to be matched by an equally fervent (and I would argue stronger) campaign to effect behaviour change at the level of individuals and communities.

Too see this in action, look at our politicians. MPs excel at leveraging community advocacy into political power. They don’t campaign on policy (which they probably think flies over the head of their constituents), instead they campaign on personality. Their election hinges on whether or not the people believe in them, not their ideas. All that matters is that their voters believe they’re a man or woman of the people and then they can get into Parliament where they have the power to affect policy.

And if our politicians are out here getting elected in rural Portland because they can drop it low like Pamputtae and step into Gordon House the next day (get you a girl who does both) then our civil society organizations really have to step up their game.

Policy advocacy goes hand in hand with behaviour change advocacy. It’s not either/or. The civil society organizations that are doing the most in Kingston need to start doing the most in other parishes as well. This doesn’t mean new organizations, just a shift in the way things are done. Instead of locking up all that experience and expertise in Kingston, why not share it with the communities they advocate for?

Roll into Clarendon and Westmoreland with some of those lofty ideas. Expand your reach to St. James or St. Mary and get some fresh perspectives. Build momentum across the country with deliberate efforts, not just a symposium every couple of years because funding agencies mandate it.

Sustainable change can’t happen with an approach that’s strictly top down or bottom up. It’s top down and bottom up efforts that meet in the middle. Is it extra work? Will there be some uncomfortable conversations? Does it mean leaving behind the air-conditioned comfort of city life for that extra work and those tough conversations? Yes, yes and yes. But sustainable change is really the only change worth advocating for.

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Further reading: Jamaica Observer Letter of the Day: The Undoing of Civil Society in Jamaica

Evolving Opinions on Literature

Is a love of books innate or cultivated? Can it be nurtured given the right set of conditions? Can it be groomed, guided and trained? Can it be pruned? Should it be pruned? Can it be destroyed?

I came of age in a reading household. Romance novels everywhere. John Grisham and James Patterson were staples (confession: I found them hopelessly boring). To this day my mother will probably still swoon over a good Ken Follett novel. My aunt, despite health challenges, will still use her limited energy to stay up late reading her latest acquisition (Michelle Obama’s Becoming). Even my father had a stash of Clive Cussler books and Marvel comics, in a society where reading was frowned upon as ‘unmanly’.

Nature or nurture?

My primary school evenings were spent hunting down old newsprint children’s books on dusty classroom shelves. Stories that were ubiquitous to public schools in Jamaica, with morals like ‘shortcut draw blood’ and tales that encouraged us to respect our elders and love our neighbours.

In high school, I was forbidden to read romance novels, so naturally I hid and read them any way. I started speed reading out of necessity so I could finish a borrowed bodice-ripper before the last school bell rang at 2:20. The ones I took home stayed hidden among school things, retrieved on lengthy trips to the bathroom. My parents always wondered what on earth I could be doing for so long. I was encouraged to eat more vegetables.

My high school library was under-served, but came with unexpected classics like a collection of Isaac Asimov stories that I discovered shortly after the release of I-Robot, and which piqued my interest in science fiction.

Imagine my surprise when I discovered, ten years after leaving high school, a worn and faded copy of Toni Morrison’s Beloved. A novel which, according to the Well-Read Black Girl anthology, sparked the genius of several literary leading ladies. I can’t remember ever seeing it during my tenure, but I’m sure the tepid cover wouldn’t have caught my attention anyway, focused as I was on colour and excitement. Interpret that how you will.

Aside from romance novels, paranormal romance novels, historical fiction romance novels and comedic romance novels (are you sensing a trend here?) my appetite extended to comedies, autobiographies, science fiction, young adult and contemporary novels. All illegally downloaded because books are expensive and the esoteric ones (in Jamaica, this means anything that isn’t of the Mills & Boon variety) are hard to come by. My collection included books by Jenny Lawson, Neil Gaiman, Christine Feehan, Michael Crichton, Roxanne Gay, Cheryl Strayed and Eoin Colfer.

Why did I gravitate toward these authors? Was it some combination of genetics, escapism, and excellent taste? The answer to that is about as complicated as the answer to why some people love Nutella (spoiler alert: it’s disgusting).

My literary interests grew like weeds, unfettered and sprawling. True, there was the semblance of a pattern, but it only noticeable in the negative spaces, in what was missing. After reading A Child Called It (Dave Pelzer) in third form, I knew I never wanted to read another story of abuse ever again. And after valiantly finishing The Catcher in the Rye (J.D. Salinger) I knew for sure first person stream of consciousness and the bildungsroman were not for me. Though I did enjoy A Separate Peace in literature class (I am nothing if not inconsistent).

Still my choice of books could never be described as ‘cultivated’, more like a potpourri of covers, quotes and authors that caught my fancy.

I was perfectly happy to dabble in this hodgepodge of literary entertainment until about my 4th year of medical school, when I decided I wanted to be a writing intern for an online magazine. I showed up for the interview, excited to finally take a step into the real life world of books, and my future editor asked what kinds of books I liked to read. I shared a few samples from the list above (to my credit, neglecting to mention the hundreds of romance novels) but I was wholly unprepared for her next question.

“Do you read any literary fiction?”

I’ll spare you the painfully embarrassing details of me asking what the hell literary fiction was and then struggling to remember the last ‘serious’ book I had read (Khaled Hosseini’s The Kite Runner, if you were wondering).

Now I know there are readers who are capable of excelling in medical school full time while maintaining a steady 5-6 books per month batting average, but I am not one of them. After labouring through eight hours of mind-numbing Physiology lectures, deciphering delicate metaphors in a stream of consciousness narrative is not my idea of a fun time.

That encounter in 4th year shifted my reading trajectory entirely. Before, I would devour four or five romantic or otherwise light-hearted novels per month. After, I put myself on a strict literary diet: romance novels were the fast food of the reading world and if I wanted to cultivate a healthy literary appetite I needed to stick to the ‘serious stories’.

I refused to read anything that couldn’t be described as ‘literary’, and ironically I spent a lot of that time re-reading my Jane Austen novels. I love Austen but her books are by no means ‘literary’, just old. I spiraled all the way down to four maybe five books a year, and started to feel guilty every time I saw my blog title.

That editor wasn’t to blame for my literary anorexia, at least not entirely. But there was an unspoken cultural rule that I was slowly becoming aware of, one that dictated which books were worth reading, and segregated readers in caste-like fashion based on the types of books they enjoyed.

This rule revolved around literary awards and the strict boundaries of genre. Much like a social hierarchy, the genre of a book determined the limits of its audience and in turn its perceived quality. Books and the people who loved them were snipped and cookie-cuttered into neat little labels, easy for publishers to target, but overall stifling the sprawling love of literature to which I had grown accustomed.

We readers of fantasy and YA novels can face disparagement for not being ‘serious readers’ and this pushes us to the margins of literary circles. Truth, I felt like an outsider during university when I attended functions in the Dept of Literature, though there was no real discrimination. Teens who spend hours poring over comic books and graphic novels instead of dense volumes of glorified classics get criticized for ‘wasting time’ instead of being encouraged to keep reading.

The delicate sprouts of curious literary leaves are easily crushed by censure. If society claims to value people who read, then why does it matter what they read, as long as they’re expanding their imaginations and honing their critical thinking?

Reading maketh a full man, conference a ready man, and writing an exact man

Damn straight, Sir Francis Bacon

And I’m not drawing any lines in the sand either. All forms of writing are useful in this regard: Shakepeare, Sandra Brown, badly written Supernatural fanfiction. When people are discouraged from reading what they like, they’re just discouraged from reading. Pruning practices that ought to be prohibited is literally a quote from a Harry Potter villain.

On the flip side, if you’re concerned that your ten year old has a morbid fascination with Stephen King you may want to suggest something you’d find a little more age appropriate and save the Master of Horror until the teenage years (or, you know, never). It’s like training pets, instead of punishing the unwanted behaviour, distract and replace it with something more desirable.

At the end of the day, reading should be encouraged full stop. The ridiculous competition of ‘literary’ vs ‘genre’ fiction is best left to snobby book critics and publishers with a cranio-rectal inversion. Everyone else should just be glad your child/loved one/own damn self who reads has a way more useful hobby than policing other people’s bookshelves.

Book Clubs and Bozos

Rebel Women Lit (Jamaica-based book club) finally has a Mobay chapter and I was all over the first meeting.

There were three of us. And despite the book on the table – Marlon James’s Black Leopard Red Wolf – the meeting was delightful.

Well, except for the gatecrasher who wouldn’t stop offering unsolicited opinions on a variety of topics not related to the book at hand. Gems included:

“The Bible is a great book – you should read it”

Also,

“I really think you’d like Cowboy Bebop”

and not to be outdone,

“Don’t you think people are too sensitive about everything these days? It’s like you can’t even make a joke without someone taking offense”

I am not making these up, you guys. They’re actual quotes from an actual stranger who sat down with a group of women discussing a book and felt that was the best moment to go full Kanye West.

And if you guessed that he was a man, you’d be right.

Specifically of the cisgender heteronormative variety. (You know, those people).

When I reflect on the experience I think the universe was just trying to give us the pinnacle of feminist experiences. I mean, he was only the biggest stereotype ever to walk into a cafe. We couldn’t have planned that if we tried.

In the moment though, we were all paralyzed by politeness into exchanging glances that said “Can you believe this guy?” for TWO WHOLE HOURS.

(We could not, in fact, believe him.)

Despite the interloper, we enjoyed ourselves. I have some strong opinions on the book – we agreed it was a polarizing story – even though I didn’t make it past the first twenty pages. Some other time I’ll write about why we all need to stop reading books just because they’re popular (life is too short to read shit that doesn’t spark joy).

For now I’m glad my social calendar is evolving. And if this first meeting is any indication, I may not always be on board with the book picks but I’ll always show up for a bookish conversation.

And coffee. Coffee is non-negotiable.

Burnout and the Millennial Condition

Hi, my name is Robyn, and I’m a millennial.

Hi, Robyn.

Millennials are the generation that people love to hate. We’re lazy, immature and largely responsible for the failing state of economies all over the world, especially the cow’s milk industry. We’re liberal snowflakes and angry pussy-hatted protesters. We’re progressive, artisanal and a good number of us still live with our parents.

We’re also depressed, anxious and burnt out.

Yes, burnt out.

If you’re a millennial and you haven’t yet read the Buzzfeed article ‘How Millennials Became the Burnout Generation’ by Anne Helen Petersen, go and read it now. I’ll wait.

Done?

Did it feel like a gut punch? No? High-five for being a well-adjusted human being. But if Anne Helen was strumming your pain with her fingers and telling your life with her words, you are not alone. We are even less alone than I thought we were when I first started writing this because yesterday BBC Three ran an article featuring responses from fellow millennials about how burnout looks in their lives.

Click here for commiseration. Also here.

In case you start thinking ‘Millennial Burnout’ is just another one of those disorders that only affects rich kids from first world countries – stop. Don’t think that. What is wrong with you? I’m a not-rich adult from a developing island state and let me be the first to tell you, that shit is real. Perhaps even more real in an economy that depends heavily on unstable external support and where I’m the first person in my immediate family to pursue tertiary education.

The pressure to perform, to achieve, and to never stop never stopping can easily lead to feelings of overwhelm and underachievement. You have to be on your A-game at all times – opportunity only knocks once. In a fractured health care system where most workers only have baskets to carry water, you have to go above and beyond to help the people who need it. In a society where Facebook and Instagram are as ubiquitous as breadfruit trees you are constantly comparing yourself to everyone else.

We know it’s unhealthy. The lines between work and life have become so blurred that for most of us work doesn’t end when we leave to go home. At home we’re answering work emails, work phone calls, taking work home with us to get it done in time. We – I – sacrifice family time and rest to get a little further ahead on this project or that meeting.

And even though we realize that something’s not quite right, we keep doing it. Sleep suffers, our concentration starts to slip, fatigue starts to drift in. But how can we stop? We’ve got to keep on keeping on because there’s more work to be done, more achievements to unlock, and you’re never going to get that promotion if the boss thinks you can’t handle the job.

I only go to sleep after dragging myself away from the work I brought home. I dream about work meetings going awry. The first thing on my mind when I wake up is ideas for Powerpoint presentations. I reply to work emails at 5 in the morning, and most days I am so tired that without coffee I barely function. I can’t remember how to relax, I obsess over to-do lists and I feel guilty if I take a night off to rest because there are so many things that need doing.

And it’s not just work, it’s the whole shebang. Bills and student loans, grocery shopping and car maintenance and all the little things that add up to keeping us afloat and financially solvent. We call it ‘adulting’. Our parents would have probably called it ‘life’. But life in 2019 is very different from “the way things used to be”, as Granny likes to remind me.

In every corner there’s another concern to preoccupy our thoughts: climate change, the environment, human rights, motherfucking R. Kelly, crime and violence. I live in St. James and even though the State of Emergency supposedly expired in January, I drive past cops at checkpoints twice a day. Not exactly a low-stress work commute.

This morning I texted my best friend, all the way across the world, and asked “Do you ever just feel tired?” To her everlasting credit she immediately demanded to know what was wrong. As I spilled my guts about the mental and emotional fatigue that have plagued me since med school she listened and reassured me that I wasn’t a crazy perfectionist snowflake. And then she told me her own story of overwhelm and I felt less alone.

It’s not just us and the readers over at BBC Three. Petersen’s original article went viral because it resonated with thousands of people. While I’m sure we’d all prefer to have something less depressing in common, it’s clear that this isn’t just some excuse for lazy, entitled failed adults. Haters, step off now.

True to form, millennials have gone all out to find ways to re-pep our step: #selfcare mani-pedis, meditation apps, a smorgasbord of life-changing ‘magics’. But in her essay Anne Helen asserts that no amount of self-help books, life hacks or yoga retreats will fix us. Houston, we have a problem.

Instead she invites us to find joy and meaning by living life, instead of optimizing it. A difficult concept for a generation used to curated social media streams, helicopter parenting and efficient schedules. Can we really stop moving long enough to simply enjoy things as they are? Are we even built that way?

As we millennials move into middle age, a time of life where the dirt settles and the patterns form a picture*, will we get a grip on the subconscious motives that drive us to burn out? Can we stop the imminent crash and burn in time to avoid debilitating illness? (Fibromyalgia is a legitimate concern). Will we ever move out of of our parents’ houses??

Tune in next time for the thrilling conclusion.

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*Quote paraphrased from Yrsa Daley-Ward’s poem ‘Mental Health’. Go and read it now. Thank me later.

Women’s Bodies Make the News (again)

Lately I’ve been spending my time taking deep dives into the arena of gender analysis. Holed up in a small classroom for 3 hours a week in a recurring debate on the privileges of the penis may not sound like your idea of fun, but to me it’s absolute heaven. Feminist intellectual stimulation, stinging repartee and a whole bunch of new words to add to my vocabulary. It doesn’t get much better than this.

But the perspective comes with a shadow, cynicism. The niggling fear that the status quo (which is far more pervasive and sinister than I realized) won’t ever change because so many people are invested in keeping it the same. The concern that despite our promises as a country and despite our claims as a society, the day to day culture of Jamaica thrives on the subordination of women and other non-masculine groups.

Close to my heart, the topic of healthcare: reproductive rights and abortions. Recently in the news again thanks to MP Juliet Cuthbert-Flynn (In 2018 I learnt a bunch of useless US politician names, maybe 2019 is the year I learn Jamaican ones) who tabled a bill to decriminalize abortion.

Not a bill to let women kill their children.

Not a bill to give women an excuse to be promiscuous.

Not a bill to hasten the decay in Judeo-Christian morals and values.

(all points that were raised and shot down)

The bill was tabled to allow easier access to safe abortions – because women are literally dying.

As I read the discussions helpfully Tweeted out by groups in attendance (the revolution will not be televised because there is no revolution), the points raised by pro-lifers kept circling back to the idea that women do not own their bodies. Their bodies must be offered up for the greater good ie having babies and if they die in the process well it would have been a worthy sacrifice. The MPs who responded challenged the speakers to provide data to back up their claims (they couldn’t) and questioned the right of the Church to make decisions for a pluralist society.

I happen to follow mostly ‘woke’ people on Twitter: feminists, LGBTQ folks and advocates, pro-choice supporters. So my news feed lulls me into the false sense of feeling like maybe the progressive bunch scored a win.

But then I see pictures of the pro-choice stand/march that happened before the debate started – a handful of lovely women (and men, and I think maybe non-binary persons too) clad in black with shirts and placards bearing slogans like ‘NO WOMB FOR PATRIARCHY” and “MIND YOUR OWN UTERUS”. Catchy slogans, very clever, but not a big crowd.

And then I take note of the Members of Parliament who they Tweeteed about actively participating in the discussion. Again, lovely people, but only three maybe four names are repeated.

And then I realize something. It’s great to feel like a part of a movement. It’s great to have people who agree with your values and outlook on life. It’s nice to be included (I get such a thrill when WE-Change retweets me). But the shadow, cynicism, clouds the warm fuzzy feelings.

Culture, society, Parlimentarians in the majority aren’t ready to allow women full control over their own bodies. We might get ideas. The road to change is long and hard, and it will probably continue long after we’ve passed on the torch. This ‘gender thing’ is a huge obstacle to human rights, social development and nation building. We gotta start looking at these problems fully cognizant of the biases and privileges we bring to the table. We have to stop accepting the status quo and start challenging it.

I gotta get off woke Twitter and start changing the world around me.


Just in case anyone was wondering (I was) – the only news article that spoke about this debate was a brief piece in the Gleaner that basically recounted an emotional story from a Catholic nun about overriding women’s choices for the patriarchy. You can read it here.