An Aside on Jamaican Culture (potentially upsetting imagery)

When I was on my Junior Surgery rotation, we had a 94 year old lady who presented with Stage IV breast cancer after having had a mastectomy for cancer in the other breast.

The tumour this time was a rock solid, fungating mass that had already changed colour, and I had to wonder as I often did and will how a patient waits at home for their situation to deteriorate this badly before coming to the hospital. Breast cancer is a terrible thing – any illness is. But patients keep presenting at such late stages, all hope is almost lost.

Just like the countless diabetic patients who present with severely infected feet days or weeks after the initial problem. Sometimes they show up so late, the only option is to amputate the limb.

We have this pervasive culture of “I going to watch it likkle first” whenever we see something going wrong. Then we sit and watch and watch until it becomes so much bigger than anything we thought we could handle. Like another patient who had to piece together brassieres to fit her growing tumour until she finally presented with one breast twice the size of the other.

I don’t know if it stems from the general antipathy toward doctors that we have as a nation (especially Jamaican men!) or if it is just that we underestimate the problems we are faced with. Jamaicans do have a tendency to put troublesome things out of their minds until we can bear it no longer.

Whatever the reason, we need to stop it. The business of healthcare is prevention, not intervention. Doctors don’t want to have to cut the foot off. Or remove the breast. We want you whole and healthy and happy.

But your health is your responsibility.

kingston public hospital

kph shall admit from the the wretched sea
that washes patients to its shores
here mothers cry for their young,
swallowed up by the sea
kph is nothing new
at kph, you do not speak of time
time is unlimited
time, undefined
kph shall call diagnoses
patients with:
polytrauma
stab wounds
gluteal abscess
diabetic foot
gsw
appendicitis
metastatic malignancy
kph is vexed about short staff, scant resources, broken CT machine,
loud patients, no beds, and where the hell is the 0.9% normal saline
kph is revolting against first world second world third world
division
standard of care should not have to be a decision
kph is nothing like the rest
kph will not be counted among air-conditioned private hospitals
will not be praised by the chief medical officer; doctors will not want to work here
kph is knives, bombs, guns, blood, fire
blazing for treatment
yes
kph is a lab
purple top, grey, top, blue top, red top test tubes
serial CBCs, U+E’s, LFTs
PT/PTT, Trop-I 
q6hrly vital signs
kph will not change things
kph need to be changed
vjh is the birth of a people
and kingston hospitals are
arising, awakening, understanding
kph treat, is treating, have treated
kph shall continue even after interns have stopped working
kph shall survive you, me
it shall linger in downtown kingston, on the corner, down the road in time forever
kph is health, only health will tell
kph is still not perfect
kph has no doctors, nurses
kph is just a part of the story
his-story her-story our-story
the story still untold
kph is now calling, yelling, begging, irritating
making you want to default from clinic
but you will not default from this clinic
kph is big
cannot be small
kph cannot be shamed, cannot be blamed
the story is still not told about kph
kph has copies of the bible, your dockets
lab reports, your x-rays, your consent forms, your nurses’ notes
the treatment plan, the diet guide
kph is no secret
kph shall be called boring, stupid, senseless
kph is watching you trying to make sense of kph
kph med students are messing up your veins
making you want to sign yourself out of kph
but you shall not sign yourself out of kph
kph shall frustrate you
because
its medical care is to be continued in the clinic
in the clinic in the clinic in the clinic

.

Based on Dis Poem by Mutabaruka, which is a very deeply moving spoken word piece that I happen to be dancing to at the aforementioned unnamed dance show this week. Yay.