Why Hanover

From time to time I get quizzical looks when I tell people that I work in primary care (aka clinic) in Hanover, one of Jamaica’s most rural parishes. The eyebrows climb even higher when I further explain that no, I don’t have a private office somewhere.

Fellow doctors wonder how I survive on the salary (and compared to my hospital colleagues it is meagre). Patients who connect with me are disappointed that I only work in hot, overcrowded government facilities and not some low-traffic office with an air-conditioned waiting room. Would-be mentors are perhaps bemused by my preference for this rural space that offers little in the way of career advancement.

But I continue to choose Hanover year after year, even though my feet itch with wanderlust and three years is the longest time I’ve stayed in one place since high school.

But why?

Well, the parish is beautiful. Lucea overlooks a picturesque bay of rolling blue sea. Cascade overlooks lush green hills of swaying bamboo. For almost the entire length of the highway that passes through Hanover the sea is a few scant feet away from the road, replete with stunning sunsets and the cool calm breeze of true island living. But that isn’t it.

I stay in Hanover because I believe there is so much good I can do here.

Whether it’s running the parish’s first treatment clinic for persons living with HIV, or saying yes to every single patient that turns up at clinic in the hills no matter how full we already are, or spending the extra time to listen to an old man reminisce about his favourite son – there is so much good I have done, and so much that I can still do.

Clinics have a bad rap among patients. Somehow people developed the idea that hospital doctors are better (this is laughable because Hanover is so tiny that the same clinic doctors often also work at the hospital) and that clinics are not worth their time. But in the time that I’ve been working in Hanover (did I mention it’s been three years?) I’ve been so lucky to work alongside doctors and nurses who care passionately about the overall well-being of their patients, not only about their blood pressure or HbA1c.

The magic of primary care is really how one doctor or one nurse or one community health aide can make a dramatic difference in the outcome of a person’s health. The beauty and the privilege of my job is watching people not just improve their condition, but thrive with care and support.

The fulfillment that I get from my daily work reminds me why people look at medicine as a calling and not just a job. And while I won’t always work at the level of individual patient care, the purpose of my duties will always remain the same: to bring quality healthcare to the people who truly need it. They say you never forget your first love; and wherever I work in the world whether elsewhere in Jamaica or further abroad it is and always will be Hanover that has my heart.

Type Sea Hospital 

Noel Holmes Hospital sits almost on the edge of a cliff. Strong sea winds whip around tree branches, hairstyles, the odd piece of gravel. As you approach the edge the gust steals your voice, dulls your hearing. 

The hospital is a little thing, boutique in size if not style. There is nothing cute or trendy about it. Type C is the first hospital grade, a step up from the Type 5 health centre. There is a general ward, a maternity ward and a space for overnight observation. Staff is limited and patients are relatively few; cases are simple. The days are short, the workers friendly. Time passes in the island way. 

Historically, Fort Charlotte (where the building rests) defended Hanover from seafaring enemies. This bastion now turns inward, defends against a sinister more pervasive threat. Primary caregivers work hard to prevent the spread of illness, and control chronic disease. 
Our success or failure depends on the whim of patients and the dictates of a disinterested administration. Noel Holmes is a boat adrift, but does the tide drag it toward or away from the safer shore?