Desolate, yet all undaunted

There are days when I feel like a balm in Gilead and then there are days when I feel like a band-aid on a diabetic foot. On days like those, when my best intentions butt up against the machinery of social injustice like a very small recalcitrant cog in a very large and impersonal wheel, on those days I dream a little dream about the kind of system I want to work in, and the kind of care I want my patients to receive.

In my dream, healthcare is widely acknowledged as a fundamental right. Instead of flexing their defense budgets, countries flex their high life expectancy and superb quality of life. Within governments across the world, health and wellness ministries get the lion’s share of resources because without them people would literally die. This includes ministries responsible for food, housing, water and electricity so that people can eat with clean hands in safe dwellings and store food in healthy ways.

In my dream, we preach and practice the bio-psycho-social model of health by recruiting and training a large cadre of mental health and social health professionals, alongside nurses, doctors and pharmacists. Mental health isn’t stigmatized, it’s a routine part of formal education (along with gender and cultural studies) from the kindergarten level onward.

In my dream, no one struggles to pay for healthcare because there’s no such thing as ‘payment’ for a service that is essential to human well-being. Healthcare providers are treated with dignity and respect by their employers, who understand the traumatizing nature of the work they do and encourage them to take care of their own health. This way they do not fantasize about migrating with their expertise to work in more lucrative environments. We retain enough healthcare providers of various disciplines so there are no long waits for non-urgent care. We have enough equipment and people to maintain the equipment because management no longer believes in quick fixes and ignoring a problem until someone else has to deal with it.

Patients can wake up at a sensible hour and easily travel to their nearest health facility, because it is always less than an hour away. They can visit their provider, do their investigations and fill their prescriptions on the same day. Language interpreters are available, bathrooms are gender-inclusive and all facilities are accessible for persons with disabilities.

Because providers take the time to explain complex treatment regimens with patience and empathy, patients take an active role in their healthcare and don’t only worry about their health when they get sick. Because there is close communication between primary and secondary healthcare providers, treatment interventions are oriented around the patient, their family and community, instead of a rigid hierarchy. We change our model of medical education to prioritize prevention, primary care and public health instead of obscure diagnoses and competitive sub-specializations, recognizing that these are necessary things but the vast majority of medical graduates will not become pediatric neuro-oncologists.

I dream a dream where even in the tiniest clinic in the furthest district beyond the last streetlight a midwife or a health inspector or a community aide has the power to change a system that perpetuates the very conditions we try so hard to treat. Instead of feeling like a useless band-aid, doomed to watch the wound fester and never heal, I hope we can reach for the idea that there is a better way.

When we feel like things can change,
we might actually

And then, who knows what might happen? This is the part where I always wake up, shake the sleep from my eyes and get back in the arena to fight. Another day of being balm and band-aid, the believer and the battle cry. Another day to dream and press on, to make the dream come true.


Featured Photo credit: Luis Villasmil on Unsplash

Early Mornings (are a health hazard)

I’m hoping this becomes a trend.

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



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

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

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




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

Til next time.

Things I want to shout about: everything I learn on Community Health

The Riverton City dump is a hot mess. Literally. It’s a hot mess that has outlived its life a thousand times over, like the ancient has-been who refuses to retire. Riverton started out at the same height as the rest of Kingston and St. Andrew and it now overlooks the sprawling plains of Jamaica’s capital. Layers of garbage are thrown down year after year, getting pressed into the earth by giant rollers. But now all the rollers are broken and the garbage, still being thrown down, has begun to pile up.

Lined with waterproof materials such as clay or plastic Natural clay liner of approximately 1.5m thick
Leachate management system NONE
Onsite operations – disposal, storage, formal sorting Onsite operations – disposal, storage, informal sorting
Daily covering of waste Covering of waste does not occur daily
Use of landfill equipment: compactors, tractors, bulldozers, tyre balers Use of [poorly maintained] landfill equipment: compactors, tractors, bulldozers, tyre balers
Clear separation of waste at tipping faces Separation of waste to some extent
Environmental monitoring – leachate and gas monitoring wells Monitoring wells for leachate only
Controlled access and egress Access and egress under limited control
Safety and directional signs Safety and directional signs
Ample security Limited security

This table borrowed without permission from Norbert Campbell of UWI, Mona. [My edits].

Let me give you a hint: it is NOT a day at the zoo.

In the midst of the sprawling one man’s trash landscape is Tyre City. Bales of tyres piled higher than a man’s shoulders sit grinning, a fire hazard to the whole facility and breeding ground for the infamous Portmore mosquitoes. The tyres are sometimes sent to individuals or companies who landscape, or to people fixing roads, but these tyres have been sitting here so long they have sunken into the landscape.

And then the tyre baler broke down.

Much like the infamous informal sorters who emerge unseen from the piles of rubbish carted in daily by dumptrucks. They dress like people from the Sahara, but theirs is a desert of plastic, cardboard and metal bits. They scale the mountains of garbage, picking their treasures from Kingston’s trash. But you wouldn’t dare call them scavengers. Proud and persistent, these workers make a pretty penny from their odd occupation and manage to live quite comfortably.

And they don’t like pictures.

But perhaps no one is more comfortable than the Riverton pigs. Huge, loud, dirty animals that roam the mud pits and shanty towns of Riverton City, they are kept in pens with access to the stream that runs through the dump. Take a second to ponder the environmental ramifications of that sentence. These pigs are not only native to Riverton. The next time you buy a piece of roadside jerk pork for an amazingly low price, think about where the vendor could have gotten the meat so cheap. It probably wasn’t your local meat shop.

Oink. Oink.

Perhaps the worst-off group at the Riverton City dump is the staff at the facility. They are subject to subpar working conditions: non-sterilized biological waste, the constant risk of radioactive waste slipping past the sensors (which happens more often than not), the rundown equipment and almost complete lack of proper maintenance. Not to mention government pay. And this list doesn’t even begin to cover aesthetic issues like the overwhelming heat and inescapable atrocious stench. The risk of vector-borne illnesses is impossibly high, what with numerous stray animals on site: goats and dogs, as well as smaller pests like rats and roaches.

The Riverton City dump is a hazard to the health of its workers and the community surrounding it.  Everyone is getting shortchanged, even the people whose trash is being collected and thrown there. They don’t know it yet, but they are steadily clogging a toilet that will someday overflow. And when it does, this public health disturbance will become a public health disaster.

I think the entire facility ought to be chucked into a giant autoclave. Or at least invested in so they can fill the damn thing properly every day.