Prison Ablaze: A Symptom, not the Disease

Yesterday the Tower Street Adult Correctional Facility caught on fire.

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Photo from the Jamaica Gleaner

Predictably, the government is scrambling to conduct an ‘urgent upgrade‘. The article is peppered with buzzwords like ‘relevant stakeholders’ and ‘infrastructural development’. Interestingly there is no mention of whether any of the inmates were injured, just that they have been relocated.

It’s also worth pointing out that the fire affected the part of the prison that houses the mentally ill inmates. What is the level of supervision for these inmates, and what are their living conditions like? Were these facilities particularly susceptible to fire hazards? Was the fire an accident of poor maintenance, or the intentional act of unsupervised inmates, or something else entirely?

The article is keen to remind us that ‘high-profile’ criminals like Vybz Kartel are also housed at this prison. Is this supposed to garner public sympathy, or expedite government intervention? I’m not sure why the popularity of certain inmates is relevant to the reporting.

But it all goes to highlight the reactive way we deal with crises in this country. Institutions and resources struggle along for years carrying water with baskets until something catastrophic happens. Whereupon every Jack man jumps up to point fingers and fling on a hasty fix, only to have the system break down again because nothing long-term was put in place. For all the government’s talk about cutting costs (and it is mainly talk), you would think they would learn that prevention better than cure.

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.

Clouds and their Silver Linings

The recent deluge haranguing Montego Bay has put a damper on so many things. Parties are in danger of being rained out, employees have yet another excuse for being late, and most frustratingly I can’t get the sunshine time my laundry needs to dry.

While I’m stuck in this limbo land of weather, I am realizing with greater certainty how important it is to be patient, with the world and myself. All good things take time; seeds and stories and life plans must germinate before they can flourish. Though Montego Bay is utterly miserable in a downpour, the rain brings much needed refreshment to a parched and grimy landscape.

In an effort to remind myself about this need to be patient I started a ‘Future journal’. In it I have been writing down all the things I think I need to have a good life. It seems materialistic, but by writing down these worldly wants I find that I can filter out most of my day-to-day whims (which are never necessities but still somehow make me feel like I’m missing something vital) and focus on the true essentials.

In the middle of this cold front I also managed to get sick again, which has reminded me to pace myself and listen more keenly to what my body is saying. Right now it’s saying that I need a health dose of Vitamin C and more blankets. But I hope the lessons in patience and listening will stick around even after my sneezing fits are over.

 

Apologetics: My Strange Fixation with White Women

Alternative title: Navigating my Reader Identity

When I was a little girl and just starting to flex my writing muscles the first story I ever wrote was called Cottage on the Hill. It was about two young white girls from London who went to spend summer vacation with their grandparents in rural England. Of course, I had never seen a cottage or spent a summer with my grandparents or been to rural England but as so often happens with young black writers the stories we write are the stories we have read about.

It never occurred to me at that age to consider Jamaican characters or settings. I had never read about home outside of those little chapbooks from primary school (you know the ones with the newsprint and sketches) that tried to impart Serious Moral Lessons through Anansi stories and others. But that wasn’t what I wanted to write – I wanted to write proper short stories. And proper short stories were about people from outside of the Caribbean.

I grew up, of course, and developed a thirst for Caribbean literature despite the disinterested way it gets tacked on to high school syllabuses. I actively seek out Jamaican writers and as many women writers as I can. Colonialism may have dictated my preferences but I can change that if I try hard enough. And sometimes the trying is hard. What I want to read isn’t always available, but often what is available ends up being what I want to read.

Transition with me from books to the online world of blogs; most of the ones I’m familiar with (and like) are written by upper middle class white suburban housewives. What the hell is this demographic? I have no idea. Okay, maybe I have a little idea. But as I grapple with this proclivity and the desire to see myself represented in internet writings, guilt often bubbles up. It feels like consuming all this content from a foreign culture only pushes me further away from my own.

Another issue is that I have more in common with these women than I do with people I actually live and work with. Cue identity crisis! Cue questioning my life choices*! This is why I read those blogs, this is why I feel distanced from my own culture: camaraderie and the quest for acceptance. But what is the solution, lock myself away from the world and read only content produced by Jamaicans for Jamaicans?

No, xenophobia isn’t the answer here. It isn’t automatically bad to be intrigued by alternate ways of life. On the contrary, globalization is accepted and encouraged. Where it crosses the line into acculturation is a little blurry, but we’re working on that.

These days I berate myself less and less for my tastes, but unlearning decades of stigma for being ‘the weird one’ is hard. I will probably never stop liking The Bloggess or Neil Gaiman, but I am gradually unwinding myself from the notion that these interests make me less Jamaican. In reality I will always be Jamaican, just a Jamaican who is open-minded, liberal and a little more day-dreamy than expected.


*Life choices like watching Doctor Who, listening to The Chainsmokers, and reading yet another Jenny Lawson/Elizabeth Gilbert mental health guidebook cleverly disguised as a novel.

 

fangirling | C’bean Writers and New-ish Novels

This may come as a surprise but in between the bonfires, spring fairs and medical conferences that have marked my weekends for the last few months I have actually found the time to read a book or two (or five).

I was recently tapped to write a set of book reviews for Susumba.com, an opportunity I leaped at (perhaps too hastily) which is partly why I come bearing book recommendations. In no particular order, here are three books you should definitely add to your collection for this summer and beyond.

Here Comes the Sun by Nicole Dennis-Benn

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Nicole Dennis-Benn is an expat Jamaican living in Brooklyn. Her wedding ceremony at a private resort made local headlines some years ago for the triviality of their being a lesbian couple. Only in Jamaica. Awkward home country reception aside, Dennis-Benn’s first novel is a keeper. Here Comes the Sun is a multi-generational narrative that exposes and shames the tourism industry in Jamaica for its exploitation of the working class and poor at the same time as it deeply considers the damaging standards of beauty to which we subject our girls.

Excerpt from my review:

Emboldened by the objectivity of distance, Dennis-Benn unflinchingly chronicles the troubling reality of the Jamaican feminine experience. She furthers this discussion by giving glimpses of the taboo – Margot’s love affair with the out lesbian Verdene Moore. Dennis-Benn’s handling of their relationship is understandably delicate, dancing nimbly around author surrogacy and Jamaica’s homophobic climate. The result is an intimate and acutely human portrayal of an oft-ignored struggle, woven beautifully into the tapestry of the wider work.

Delores, Margot and Thandi are moulded by the tragedies of their youth in a seemingly never-ending cycle that will be unsettlingly familiar to a Jamaican audience. In light of recent events regarding the abuse of girls and women, the timing of this novel is especially crucial. Often the story of sexual abuse victims is narrow and oppressive. In her novel, Dennis-Benn attempts to expand their narrative.

Children of the Spider by Imam Baksh

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Full disclaimer, this is a YA novel. But don’t let the genre fool you – Baksh’s debut novel (which won the Burt Award for Caribbean Literature) is a fast-paced adventure that will keep you hooked until the last page, no matter what your age. Imam Baksh is a master of pace and plot and the eerie, menacing characters practically crawl off the page.

The novel centres around Mayali, a fugitive from the sulphur-and-brimstone world of Zolpash where her people are subjugated under the rule of Spiders and their Brethren. She escapes to our world (Guyana, to be precise) and enlists the reluctant help of Joseph, an Amerindian Deaf-Mute techie, to warn the Guyanese president that the evil Spiders are trying to take over the world.

I loved this story. It was so exciting to see Caribbean tropes (the bumbling policeman, the cranky taxi driver) be represented in fiction, and Baksh weaves mythology into contemporary Caribbean life the way Gaiman did with Norse mythology in American Gods (who else is excited for that premiere?!). Children of the Spider is almost definitely the adventure book of 2016.

In the Morning Yah by Sheldon Shepherd

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Known more popularly as the lead singer of the roots-reggae-dub collective No-Maddz, Sheldon Shepherd published his first collection of poetry in 2016. Including some original pieces by his father Keith Shepherd, the anthology also features the works of five visual artists who contributed pieces to complement the poems.

Shepherd’s poems are mostly observations on daily life and the hustle of making ends meet interspersed with reflections on sociopolitical issues and the occasional whimsical meditation on love. Reading dub poetry presents a Shakespearean challenge however because while Shepherd’s work is delightful and entertaining on stage the poems on page lack the energizing metre that brings them to life. Still, the book is an excellent repository for performance poems with a distinctly original voice.

Did you read any of these books? Know/love the writers? Have recommendations of your own? Feel free to share your comments below. :)


Here Comes the Sun is published by Liveright, and available at Bookophilia in Kingston as well as online.
Children of the Spider is published by Blouse and Skirt Books, available on Amazon and very likely Bookophilia.
In the Morning Yah is published by Pelican Publishers and available wherever Nomaddz is performing, I think. Also probably Amazon.

Bonfires and Other Gateway Drugs

One thing leads to another and suddenly I’m on a beach under the full moon at 9 on a weeknight, swaying around a bonfire to the sounds of Rasta youths spitting troots and the soulful melodies of Kali Grn and DReblz.

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Glowing embers and DReblz in action

I think I’ve started taking deliberate steps down a path of cultural appreciation – specifically an appreciation of Rastafarianism and its associations. Rastafari is one of those aspects of our culture that we don’t really notice until we stop and look at it. But it’s all around us, like water to a fish, and it impacts so much of our daily life – from curse words to our reaction to authority to our taste in music. Rasta gave us reggae and weed and locs. In return we gave them Bad Friday and a persistent (though waning) stigma surrounding their lifestyle.

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Hol’ a vibes

I’m not sure when this journey started, maybe the day Obie and I visited the Rastafari Exhibit at the Montego Bay Cultural Centre. But it was definitely after Lyrical Eloquence Reloaded when we discovered (Columbus-style) Kali Grn that we fell down the rabbit hole. First it was the Spring Equinox Festival then a beach bonfire under the full moon then the Bad Friday commemoration at the Civic/Cultural Centre on Good Friday.

The experiences that lie along this path have been, so far, incredible. I used to think – and perhaps it used to be true – that MoBay had little to offer in the way of cultural events. Compared to Kingston where there are reggae concerts practically on a weekly basis, and a variety literary/musical/artistic gatherings we are taking our first tiny steps. But they are definitely steps in the right direction.

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

Spring Equinox at the Rasta Village

Barefoot, bamboo pipe and box food – this was the scene at the Indigenous Rasta Village on the outskirts of Montego Bay last Sunday. It was a space for communion, reasoning and celebration.

The Rasta Village is accessible by one of two routes – you can drive through Porto Bello to the Montego River Gardens then cross a river to get to the venue. Or you can drive through Fairfield, down a narrow winding dirt track until you reach the last house at the end of the lane. Behind the house is the village.

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Welcoming is the first word that comes to mind when you step into the circular space that housed the festival. Everyone nods and smiles openly when they greet you, with an enthusiastic clasping of hands in what feels like a physical manifestation of namaste.

The full programme included yoga, drumming sessions and an open mic segment. There were performances by Mentor, Nomaddz and Rasta Village Live. Around the central camp were stalls displaying natural oils and soaps. Two huge jars of cannabis stems rested atop a table under the main gazebo. The smell of cook food and ganja perfumed the air.

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As I sat cross-legged on a borrowed bamboo mat I drank my sip and looked around at the motley collection that had gathered. There were a lot of Rastas, certainly, but also several bald heads (I know, you don’ haffi dread fi be Rasta), more than a few mature upper middle class people, and quite a lot of people my age or a little older.

The vibe of the gathering had put me in a mood for reflection (or maybe it was the contact high) and I was intrigued by the thought that all these people from different backgrounds had come here with the same purpose: to revive, renew, replenish and reaffirm. That everyone would be affected by the experience in different ways, and would take away different things from the event that touched them uniquely, if it touched them at all.

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Nomaddz and Rasta Village Live

I leaned into the Rastafarian faith a little more that day. A lot appealed to me: the ideas of personal divinity, the belief in livity, the impressive respect for life in all its forms and yes, the ital food did taste good too.

But I also couldn’t stop my usual anxious over-thinking. I was convinced that there was a right way and a wrong way to be Jamaican and I was definitely doing it the wrong way. every “Blessings” or “Blessed love” I received in greeting I returned a nervous “Good afternoon”. I couldn’t help it – when I’m anxious my Patois stalls. I felt like a fake, because I have locs but I know very little about Rasta culture beyond what I read in school. Only the warm smiles from everyone (and I mean literally everyone) kept me from running away with my head bowed in shame.

How Agent Sasco song go, “no fashion dread nuffi come a talk bout Selassie”?

But over and over my mind kept returning to the deep seated contentment that shone from the faces of the Rastas I interacted with. They had invited us into their sanctum santorum and were so willing to share their music and ideas and food with us – a little bit of their culture free of charge. Maybe it was the weed or maybe it was the kind of peace that springs from a deep personal connection with faith, but however they achieved it I wanted some of that contentment for myself.

I left the Village feeling inspired and uplifted, on a healthier mental and physical plane. The sip and ital food had warmed my belly and the conscious lyrics of Mentor and Nomaddz had warmed my heart.

Then I promptly went and had KFC for dinner. It’s a work in progress.