If It’s Monday this must be Lucea

You might be wondering where I’ve been and what the hell I’ve been up to. I’ve been wondering that myself. My absence from this space hasn’t so much been a lack of things to talk about as feelings of uncertainty “am I allowed to talk about that?”. I will say that the confidential nature of my job isn’t exactly conducive to a personal blog, especially when most of the things I want to talk about are not always ‘fitting’ for ‘doctors’ to talk about, and I feel like my insignificant opinions carry more weight now. Self-censorship is hard to get over.

But I’m back. Because I feel as if I will burst if I do not write or yell something into the void. More catharsis than infomercial, this writing for me is therapeutic and I ask that you allow me the space to untangle my wrapped-up tied-up experiences.

My life these days is a delicate balance of work and school and relationships. Adulthood has a lot to do with balance, and I tend to measure my success as an adult by how well or how poorly I keep all these balls in the air. (Spoiler alert: I do not juggle well).

Moving up the career ladder from Senior House Officer to Medical Officer came with a new batch of responsibilities. This might seem logical to you, but I was wholly unprepared for later working hours, deadlines, reports and programme coordination; getting a new clinic off the ground, meetings with international stakeholders and the subsuming world of regional politics. It’s more than a mouthful, but it’s work that I’m excited about: making an impact on patients’ lives, experiencing infrastructural issues firsthand, being in a position to effect change, however minimal. I feel like I’m laying the foundations for the rest of my career so even though the building blocks might be heavy this groundwork will pave the way for something glorious. I hope.

In the same breath, I have been lucky enough to get a scholarship for an online Diploma programme taught by UWI St. Augustine. It’s a year long programme in the Clinical Management of HIV (an area I have grown very attached to) and I am in month two. I am discovering never before seen time management skills. They’re still new, like a foal on wobbly legs, but I haven’t missed a deadline yet which means progress. Yay, personal growth.

But like any of those ‘pick two’ triangles, one side just can’t seem to fit in with the rest.

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My grandmother likes to complain about, among other things, the way I seem to be too busy to spend time with her. To my credit as a granddaughter I only screen about 10% of her calls and I see her almost weekly but I’ve noticed that parents and grandparents get more sentimental as they get older. I also missed my best friend’s birthday because I forgot to account for time zone differences and I haven’t seen my other close friend in months because of our crazy schedules (she’s a new mom and I work in a different parish). The point is that balance gets harder as you get older, and if like me you didn’t have much practice before it will take a lot of stretching to get it right.

I’m not including moving house and furnishing a new apartment, keeping my cat happy, maintaining a healthy relationship with my partner, trying not to kill the houseplants or my second and third jobs in the hospital and elsewhere because that’s another mouthful. It gets stressful and frustrating and I’m constantly questioning whether I’m making the right choices. Sometimes it’s hard to tell, especially with all the background noise of the rest of the country and the wider world. Violence, bullying and bigotry seem to be run of the mill these days but I still have to follow through on the paths I choose to tread.

Of course there are times when I drop the ball, when I miss the mark for perfect daughter/partner/colleague, times when I have to say no for my sanity instead of saying yes for a million other reasons and the negative self-talk threatens to drown me in tears. But I am learning that adulthood, at least for me, means walking on these wobbly legs until I’m strong enough to gallop in the direction of my dreams.

 

“Senior” House Officer: Doc, where’s my steth?

Firmly in the category of Things No One Asked For (wedged between merchandising coffee mugs and your annual pelvic exam) this one is all about how I spent my Senior House Officer year. If anyone is still reading this to get some idea about medical life in Jamaica, you’re in luck. Everyone else, bear with me.

For my SHO year (the second year of relative supervision, coming after internship and before postgraduate study), I spent four months at the hospital in Internal Medicine and eight months in primary care bouncing around the clinics of St. James and Hanover. I had wanted an even six month split but the powers-that-be changed the schedule from two six-month rotations to three rotations of four months each, likely as an incentive for doctors to spend at least some of their time in primary care (which is woefully understaffed).

While I enjoy solving the diagnostic mysteries of Internal Medicine and relish the mental challenges of our limited resource setting, I did not particularly like my time at the hospital. One of the reasons is the aforementioned limited resources, which made it exponentially harder to get the job done (the job being getting the patient better and out of the hospital) but another more important reason was the unhealthy and sometimes toxic working atmosphere.

Doctors in hospitals across the world have to battle against so many barriers to effective patient care. Sure there are administrative and technical hurdles, but one of the most damaging and pervasive problems doctors face is other doctors. We can be unkind and unsympathetic toward our colleagues, we can be harsh and critical where kindness and compassion are needed. We can be overly competitive, deliberately misleading, and frankly aggressive. Specialties often argue instead of cooperating, departmental heads are sometimes overbearing and the support staff is at times less than supportive.

I frequently left work feeling like I spent the last 8-36 hours running a hamster wheel, exhausting myself and getting nowhere. For all my efforts I was yet to see any noticeable improvement in the quality of care being offered, and in fact quality of care was on the decline as Cornwall Regional was on the brink of a crisis by the time I had moved to my next rotation.

Unlike its older brother, primary care has no pretensions about the level of care it is able to offer. Clinics don’t promise CAT scans and then tell you the machine isn’t working; or promise urgent lab results that take hours to be processed. Primary care understands that its role is to prevent and screen, to catch the life-threatening emergencies before they become life-threatening. And that pace is so far suiting me just fine.

Hanover is the smallest parish in Jamaica, splitting its geography between enchanting sea vistas and rolling hills of green green bamboo. I spent my four months here really sharpening my clinical skills and patient interactions. I honed my management of chronic illnesses and developed some much-needed confidence (from all the time spent in clinic by myself because there weren’t enough senior doctors available). Hanover’s narrow, winding roads are where I learnt to drive and the country clinics reinforced all the stories I hear about the generosity of rural folk. I was sad to leave it behind.

(Spoiler alert: I’m stationed back in Hanover for the foreseeable future)

The camaraderie and team spirit were like a breath of fresh air after Cornwall’s sometimes hostile overtones. I felt more comfortable offering care at a less urgent pace (even though we had our fair share of emergencies!) and I appreciated the opportunity to effect behaviour change before it got to the stage where tertiary or secondary care was needed.

Despite challenges with patients’ educational level and access to care I still believe that primary care is where our efforts need to be concentrated if we are ever going to make our country truly healthy.

But enough about me. SHO year is all about testing the waters and seeing where your passion lies. It’s about picking up skills you think are important and spending time with physicians or surgeons or anesthetists who you think can teach you a thing or two. Internship is merely meant to be survived; SHO is where you thrive. Attack the smorgasbord of hospital specialties like an all-you-can-eat buffet, or settle down to dine at one specialty for the whole time – it’s up to you. Just remember that along the way you’re molding yourself into the medical officer or resident who will be the ‘senior’ by the start of the next year.

What kind of senior do you want to be?

Should you go to Med School? Probably not.

Medicine has long enjoyed its reputation as a distinguished and well-respected profession with an assortment of perks. Not just in Jamaica but worldwide, doctors rank up there with lawyers and politicians in the hierarchy of  ‘jobs you want your kids to have’. Children with even a mediocre aptitude for science get pushed into medicine and often for the wrong reasons. If you want to be a doctor because you “like helping people” or just so you can put that “Dr” in front of your name you probably shouldn’t go to medical school.

If you like helping people that’s awesome, but you have to be realistic about what exactly you’re working toward and what that work involves. (If you just want the fancy title, get out now). I’m not trying to discourage anyone from becoming a doctor but I do think it needs to be said that being a doctor isn’t for everyone. Similarly, being a garbage collector or plumber isn’t for everyone. And yet someone has to do it. You can appreciate this comparison once you understand that the way we ascribe meaning to jobs is totally arbitrary and ultimately pointless.

People who create immense joy and inspiration like musicians or writers are not revered or compensated equivalent to the value of the work they produce. Conversely our government leaders who exist to serve the tax-payers who elected them are revered and compensated entirely out of proportion to the work they don’t produce.

The bottom line is this: If you could be guaranteed the same amount of wealth and respect by working as a grass cutter (or any other underpaid job), would you still want to be a doctor?

If you said yes, be prepared for a lifetime of hard fucking work. Getting accepted to medical school is only the first hurdle, and it’s a pretty big one. You need the right grades and a decent collection of co-curricular activities. In today’s society it helps if you know the right people. The sheer number of applicants to medical schools annually is staggering; competition is fierce and it will be like this for most of your career.

Aside: If you don’t get into medical school it isn’t the end of the world. If after reading this article and doing your research you decide that you 110% want to do medicine there are ways and means. And you’re young, you have so much time. If after the soul-searching and the research you decide it isn’t for you then congratulations! Go do something that makes your heart sing.

Let’s say you get accepted to medical school here at the University of the West Indies. If your parents can’t afford to, you now have to figure out how to finance all five years of your education. A part-time job is out of the question because you won’t have the time, scholarships are hard to come by and student loans are expensive to repay. Where do you turn then?

Let’s say you decide to take out a student loan. Now you have to hit the ground running with your studies. Medical school is essentially a brain dump of information, most of which has to be memorized until you can understand it enough to apply it. There is constant competition among your peers in tutorials and exams and a stifling atmosphere of one-upmanship. The pressure to continuously outperform your colleagues rarely lets up. Starting here and continuing for a good half of your career, sleep will become a hypothetical concept.

Once you graduate, you’re staring down the barrel of what will probably be the worst year of your life. Internship is a grueling marathon of stamina and skill with the added weight of being responsible for people’s lives. And halfway through the year, if you took out loans, the Student Loan Bureau will come knocking.

If you decide to pursue postgraduate studies, you’re looking at another 3-5 years of school, loans and now trying to balance your family life (probably) with your career and education. If you don’t pursue postgraduate studies, your marketability plummets and your pay grade stagnates. Either way you will probably go prematurely gray from the stress of it all.

If you’re still not re-considering, you’re likely thinking one of the following thoughts:

But doctors are rich!

Unless they inherited wealth (which admittedly, a good many doctors do) doctors aren’t rich. For an average Joe from a lower to middle income family, it takes several hours of overtime to maintain the lifestyle the public usually associates with doctors, especially in the early years of a career. In the grand scheme of income rates, Jamaican doctors get paid very poorly compared to our international counterparts (even South African doctors get more money than we do). But there a lot of different factors influencing how much money you make, most importantly post-graduate study.

But doctors are well-liked/respected!

This is true to some extent. Certainly doctors have special privileges: people smile at you more (people smile at puppies a lot too), you can stand as a character reference (so can ministers of religion) and banks tend to want to lend you money (it’s a trap, Jim). But like Uncle Ben said, with great power comes great responsibility. And if you slip up even once it’s a long way down.

But doctors are _______!

It doesn’t make sense to generalize. The experience of the doctors you have so far been in contact with will not be your experience. The field of medicine is constantly changing and rapidly evolving. It isn’t now what it was fifty or even ten years ago. Technology makes things easier and harder, popularity and accessibility make competition a hundred times fiercer, and regulatory bodies have turned medicine into a business, always looking at the bottom line.

The volatile landscape of the medical profession demands a special kind of adventurous spirit who does their research beforehand. Map your territory. Talk to a medical student, talk to a young doctor, talk to an older doctor, shadow them at work, flip through a medical journal, visit a hospital. Get a feel for the shoes you’ll be walking in.

And after you’ve done all that, talk to yourself. If you have a keen interest in helping people, if you love challenges and relish hard work (and care very little for sleep), if you’re naturally competitive and have a good head for business with a passable understanding of the human body then medicine might be the career for you. Otherwise, set your sights elsewhere. Preferably something in line with your natural inclinations.

Might I suggest Banking and Finance?

Dear Patients: Please Stop Asking Me for Sick Leave

Dear Patients,

Please stop asking me to write you sick leave and then getting disgruntled when I say no. If I don’t think you’re sick enough to stay home then that is the medical opinion you have paid/waited in line for. If you don’t like it you can go and pay/wait in line somewhere else. Please stop asking us (doctors) to compromise our ethical standards (and potentially risk losing our license to practice) for your benefit. It’s considered fraud. I wouldn’t show up to your place of work asking you to break the rules; I only want you to extend the same courtesy to us.

Sincerely,

‘Doc’

P.S.

While we’re at it, please stop asking me to write your prescription in someone else’s name. It’s not just that your boyfriend clearly has no medical use for the vaginal inserts I’ve prescribed for you, it’s also insurance fraud. Thank you.

 

Doctors and Mental Health

The lives of medical professionals (at least the part of our lives that we choose to share with the public) are a lot like Instagram posts: lots of happy, successful moments to build the image of being competent and caring. But just like Instagram, real life is never as perfect as that carefully curated snapshot.

If you remember my last post about the things we don’t talk about, there was one really important topic I left off that list:  mental health. Just like physical health, our psychological well-being is integral to the way we function. But while we won’t hesitate to get ourselves checked at the first sign of illness, we balk at the idea of talking about our feelings or worse, spending time in therapy.

Sometimes we don’t talk about it because we feel our patients need to believe that their doctor is operating at peak performance. Discussing our mental health issues openly, or even acknowledging them can have a detrimental impact on the physician-patient relationship. Patients tend to think of doctors as superhuman, somehow immune to the struggles that plague the average person. In reality, doctors have the same problems as everyone else. But we don’t like to be reminded of that. We buy into the con, believing that we are somehow capable of feats no one else can do.

Sometimes that’s allowed, even expected – not everyone can perform brain surgery or resuscitate newborn babies – but other times we overreach. Doctors frequently pull stunts like trying to function normally after 36-48 hours with no sleep. We sweep treatable issues like depression under the rug because of course we can handle it, self-medicating with substance use or else ignoring the problem entirely until it can no longer be contained.

The medical profession carries one of the highest rates of suicide (1.4-2.3 times the rate of the general population). But discussing an issue that can call into question your fitness to practice is absolutely off-limits. In the most ideal and ethical situation, doctors would put the patient’s interest ahead of their own security, but we are human first, driven by the same fears and needs as everyone else. And there is a very real fear that any perceived disability will end or permanently blight our careers.

On top of this is the associated stigma of mental illness that is so very rampant in Jamaica and the Caribbean. No patient wants to see the “mad” doctor who “tried to kill himself”. But if any progress is to be made in erasing this stigma we physicians have to be the pioneers. And since this stigma persists even among doctors, we are the first hurdle we have to clear. After that, education and sensitization of the wider society.

Even though no one seems ready to talk about it* (Megz over at Barefoot Medz is one of the few, doing a really great job) mental health is a discussion we need to have. In such an emotionally draining and psychologically demanding profession it isn’t fair to anyone to have doctors fumbling to look after their mental health alone.

We need to catch mental health issues among physicians from early, as early as medical school even. Mandatory psychological screening for depression, anxiety and PTSD among others should be instituted for all the high risk professions: doctors, police officers, firefighters. We shouldn’t have to wait until a doctor commits suicide or a policeman kills his spouse before doing something. Prevention or at least early detection is paramount.

There’s a lot of work to be done. Efforts have started but they’re halfhearted at best and the government offers little in the way of support. We must be our own advocates and work with other key players to remind the public that there is no good health without good mental health.

*

Further reading: a pediatrician’s experience with psychosis, and a GP’s experience with depression.

*After writing this post, I discovered Dr. Eric Levi an ENT surgeon who is also making strides in the discussion on mental health in doctors. 

Nepotism, hamster wheels and career-sized roadblocks

This career we call medicine has so many taboos, so many topics everyone seems to avoid talking about.

Like how much we’re really making. Or how to move up the career ladder. Like private practice, emphasis on the private. Or pension schemes and permanent appointments. Like opportunities for postgraduate study. Or the nepotism this country wears like a second skin.

When we get together as a group we’re always talking about wacky patients, the dire lack of resources, horrible bosses or survival stories. Advice is limited to clinical discussions, and a lot of the mid-career medical professionals seem too busy trying to further their careers to steer a junior down the right path.

In the ‘glory days’, medicine was an apprenticeship. Younger doctors worked closely with their older counterparts, learning everything they had to teach about the human condition (medical and social). At the same time, medicine was a lot more paternalistic with physicians adopting an almost godlike role in society. So some change is for the better. But now most doctors play their cards close to the vest, for some reason reluctant to share their hard-earned wisdom.

It’s true that the world of medicine is significantly more competitive now than it was fifty years ago. You can’t throw a stone in Montego Bay without hitting a doctor’s office (some charging a measly $1000 (USD$7) for visits). While medical schools continue to graduate hundreds of hungry indebted interns every year. In Jamaica where everybody haffi eat a food the stiff competition breeds contempt and secrecy, jealousy and sabotage.

But to what end?

The crab in a barrel mentality of stepping on a brother just so you can move up a scant centimetre on the socioeconomic scale is not going to work in the long run. Resources and opportunities shouldn’t be so scarce that we have to fight to the death for them. Information ought to be shared equally, not bottled up and parceled out to a privileged few. Younger doctors should not be forced to reinvent the wheel when there is a wealth of experience available for tapping in to.

We’re told, work hard and you will be rewarded. We’re told, if you want good yu nose haffi run. We’re told, I went through the struggle now it’s your turn. No support, very little encouragement, and everyone more tight-lipped about career advice than a gang of Sicilian mobsters.

Maybe I’m too young, too idealistic, too millennial to simply fit right in as another cog in the nepotistic hamster wheel of capitalism that Jamaica seems stuck on. Either I’ll find a way to make the system work for me, or get flung violently off the ride like the broken ill-fitting piece of machinery I really am.

Only time will tell.

Big Pharma in Little Jamrock

a Third World Perspective on the Ethical Dilemma of Drug Company Gifts

Who doesn’t love presents? Santa Clause, your mom, your boy/girlfriend – doesn’t matter who it’s coming from, as along as the tag has your name on it (and you don’t have to pay). Can you imagine if you could get presents, not only from people who care about you, but from people you associate with in the professional sphere?

What, presents from work colleagues? Not quite. Gifts and privileges from medical representatives trying to push their products. What’s the harm, you might ask. I’ll take their stuff, but my prescriptions don’t have to change. Besides, so what if I prescribe Brand X instead of Brand Y. The patient still gets the same drug.

But there’s plenty of harm.

Multi-million dollar pharmaceutical companies, affectionately called Big Pharma, spend tidy sums of money each year keeping physicians loyal to their brands. This comes across as fancy dinners, paid vacations, or even just catered meetings. The medical representative proffers the olive branch of food (usually) in return for the chance to remind physicians why we need to prescribe their pills.

This, of course, can have disastrous repercussions for patient care, particularly when the ethical practices of physicians are called into question. For this reason the relationship between doctors and drug companies is heavily regulated in the United States and other countries. But in Jamaica physicians are left up to their own devices when handling drug company influences.

For the most part the attitude of Jamaican doctors appears to be politely non-partisan. We’re appreciative of the benefits meted out by medical representatives, but brand loyalty isn’t a widely supported concept*.

In medical school our lecturers went to great lengths to teach generic names instead of brands for common drugs. It’s a habit that sticks until you start working with doctors who almost exclusively use trade/brand names and then all our lecturers’ hard work is undone. And strictly prescribing generics becomes impractical when you start to consider affordability, brand vs. generic efficacy (and there is a difference) and of course patient preference. Most of our choices as doctors will be based on one or more of these factors, not just which company gave us better stuff.

Another aspect of third world presents that differs from our first world counterparts is the quality and scale of the benefits. I hear stories (from the U.S.) of travel expenses being covered and expensive electronics being gifted to conference attendees. Big Pharma has even literally paid doctors cash to recommend their products.

Now I am a still a small fry in this medical business, but I just don’t see Lil Pharma here in the Caribbean shelling out that kind of money. We get catered lunch meetings and one or two free conferences for medical education purposes, but the average ‘kickback‘ here is most often a pen or some hand sanitizer. Really, it’s like they’re not even trying (by comparison).

But this doesn’t necessarily mean we aren’t being swayed. Especially when you add in other local factors like how Jamaica is so small that chances are you’re actually friends with one or two medical representatives (and so feel compelled to prescribe their drugs). Or how Jamaica has so much corruption that even if physicians practiced unethical brand loyalty people would probably still turn a blind eye. On the other hand, Jamaica is so poor that most patients aren’t able to afford fancy brands anyway so it’s not much use pushing those medications on our market.

This is where public and private practice diverge widely. Patients in the public system are treated based on availability of medication because for the most part they cannot afford to pay full price for their medications. Pharmaceutical companies sometimes bid for spots on the National Health Fund subsidy so that their drug can reach a wider base. Yay, right? Not necessarily. These are the cheaper drugs, often generic formulations and usually older than what the rest of the world is using. Standard of care takes a back seat to any kind of care we can manage at this point.

By contrast in private practice, patients are generally seen as wealthier and more actively involved in their health. These patients usually don’t mind paying more for a brand name medicine if they feel it works better than the generic, and this is where the industry can get a toe in the door. This is where the ethical dilemma of industry gifts begins to take root. And if we are going to start any kind of regulatory or even supervisory process this is where we must investigate first.

But for now people are comfortable. Patients get their medications, physicians get their food, and Big Pharma gets their profits. It’s a win-win-win, until someone (likely the patient) loses.


*Not statistical. Based on my own (limited) observations.

St. James: warm, welcoming, dangerous, defensive

This parish is a bundle of contradictions. While we smile and wave at tourists on the Hip Strip, lotto scammers fleece hundreds of thousands of dollars from unsuspecting (and greedy) foreigners. Upscale communities like Mango Walk and Ironshore are book-ended by their less refined counterparts Paradise and Flankers. In and around Montego Bay we are a thriving urban cesspool but you don’t have to drive too far out of town to find coconut groves, yam grounds and the occasional babbling brook.

When I went to Flamstead for a health fair Obie told me to make sure I got some coconuts (apparently Flamstead has good coconuts?). I ended up coming home with more than just coconuts, thanks to the generosity of rural folk and the fertile farmland that the community is nestled in.

In fact the good experiences I had at the health fair were entirely due to a brand of kindness that too many Jamaicans are growing up without these days. The church members who hosted us were more than accommodating, and the clients we interacted with were so polite! A far cry from the average short-tempered clinic patient. Jamaicans generally have a problem with patience (meaning we have very little) but aside from some minor hiccups the day was very productive.

As a thank-you gift (and because we asked, shamelessly) the church pastor sent us off with yam, sugar cane and other goodies. Even though I didn’t get home until after 6 I would gladly trade any sweltering unfriendly clinic shift with another day in the field like that one.

By strong and glaring contrast my home visits in the community of Flanker were filled with sharp zinc fences, sketchy looking dirt tracks and suspicious neighbours. Going to someone’s home is totally different from going to their community; home visits are a lot more intimate, and the experience was an eye-opener.

The contradictory nature of St. James came out full force again. Though it is a stone’s throw away from the planned upscale development of Ironshore, Flanker has a lot of captured land* and it is well known for having a violent streak. But while the stereotypical cruffs* congregated at every corner shop, behind the high gated walls you can find middle aged career types, retired couples and aging invalids. Yes, there were the common twenty-something girls with artificially lightened skin and lengthened hair, but in the same place a dirt road might actually lead to a house with floor-to-ceiling windows overlooking the beautiful bay.

I left Flamstead with gratitude. I left Flanker with grounding.

In my dispassionate survey of these alternate living situations, I recognized that there is no one way to be Jamaican, to be uptown or even to be ‘ghetto’.  Neighbourhood lines and bank accounts don’t always gel, and poverty cannot be measured solely on the basis of ones weekly income. I recognized that the struggle was so much realer that I could have imagined, because it was many struggles rolled in to one. How old you are impacts how much money you make impacts where you can afford to live impacts your access to health care. The intersections of the biological, psychological and social spheres of health were made suddenly and painfully alive.

But despite my personal revelations St. James will continue to woo visitors with visions of sandy beaches and gorgeous sunsets, while hiding their less savoury vistas behind highway rails and zinc fences. When will we improve the pathetic social infrastructure that is dragging our economy down? When will we realize that a nation’s people are its best investment?

 

**
Cruff – unemployed male, usually in his twenties, who spends his days smoking weed, drinking rum and Boom and catcalling any girls unfortunate enough to pass by

Capture(d) land – land that isn’t legally owned (yet) by the person living on it

If It Ain’t Broke? CRH is Definitely Broke

Local news headlines are reporting that the regional hospital on the western end of the island is having difficulties with the decades old ventilation system, forcing most of its services to be badly curtailed. As the only Type A hospital outside of the KSAC its services are integral to regional health stability. Not just the most critical patients but also the day to day management of stable patients depend on this hospital’s functions.

Which is perhaps why in an effort to avoid national panic, the Government (through the media) has downplayed the potentially longstanding and severe effects of the situation. Ventilation issues are the problem, they quip, and point to engineers assessing the situation, the plans in place to fix it. Never mind that every day brings the shut down or relocation of some critical department. Never mind that daily staff and patients are exposed to unknown airborne chemicals with unforeseeable effects to their physical health.

The problem as Dr. Christopher Tufton rightly pointed out is primarily one of neglect. For decades the ventilation at CRH has not been working and none of our successive governments has bothered to fix it. So when a simple problem of airborne irritants occurs there was no ventilation  system in place to redirect the fumes. And when they did turn the system on the problem only worsened. (This is a classic example of sick building syndrome).

Internationally speaking, workplace hazards are problems ripe for litigation. It is the responsibility of the employer to ensure that the employee is not placed at unnecessary risk in carrying out his or her duties (the so-called ‘due diligence‘). Where unavoidable this risk should be carefully calculated.

Human lives are at stake.

Healthcare workers are put at risk in so many other ways: needle-stick injuries, violent patients, contamination with blood or other bodily fluids, the constant exposure to illness. We mitigate these risks as best as we can, accepting them as part and parcel of our call to service. But the continued pressure to work in an environment with unidentified and potentially catastrophic risk is, I think, too much to ask. What the media (and therefore the public) have yet to fully realize is that human lives are at stake: patients, medical and non-medical staff, siblings, spouses, parents, children.

I don’t envy the Health Minister’s seat right now, backed into a corner with IMF restraints and the demands of an ailing health sector. And just as you said, Dr. Tufton, there is no quick fix. But the people working and convalescing in this contaminated institution cannot be left to languish while the situation is slowly rectified. Decisive action is needed if lives are to be saved. Come Dr. Tufton, do sumn before sumn do wi.

Reframing Misconceptions

I make a habit of naivety.

Not always on purpose, but often enough that even my super-oblivious brain has recognized the trend. In his more romantic moments, my current partner says that my optimism is the perfect antithesis to his cynicism. In less romantic moments, he expresses great concern about my intelligence.

Running headlong and heedless from hospital medicine into primary care with the half-baked hopes of “fixing Jamaica’s healthcare problem at the source” will not rank highly in my self estimation. And it was silly of me to think for a second that the only thing broken was the almost universal lack of health education among Jamaican patients.

I will probably never know how wrong I was, because I will probably never fully comprehend the multiplicity of the flaws afflicting the delivery and reception of our healthcare. From patient contact to policy making, I think there are a myriad of ways for either the system or the client to fail each other.

This is where my optimism wanes. I doubt myself. It’s one thing to be exasperated by a  health illiterate patient in the emergency department, mentally berating primary care doctors for not taking the time to have proper dialogue with their clients. It is quite another thing to be confronted by climbing physician:patient ratios, dwindling consultation times, and perhaps the most frustrating of all: repeat offenders. The patients who, despite adequate counselling and interventions, persist in their unhealthy behaviours.

Cynicism rolls in like a dark cloud, closely followed by the lightning storm of burnout. The horizon of my imagined clinical nirvana (where patients and physicians work together to help patients live longer, better lives) all but disappears.

And yet.

The dream of an effective and efficient health care system isn’t inherently stupid. Yes, I was foolish to think I could effect change just by wishing for it hard enough, but the bottom line is that change needs to be effected. And the nugget of reality at the core of my fantasy is the desire to be a part of that process.

If I just re-frame my ideas of how exactly health care reform will happen (a lot more meetings and red tape, and a lot less glitter and fairy dust), the cloud of cynicism drifts out of sight. It will be longer, more tedious and may not turn out quite the way I expect (like most adult dreams) but that is okay. I don’t have to throw away the dream, I only have to take it down from that lofty shelf and actually work at it.

It would be easier to be cynical.