A Foray Into Jamaica’s Healthcare System

*warning- this is not a warm and fuzzy happy day blog post. It is a somewhat graphic account of a very stressful day*

It was a clear skied, sunny Friday morning as I meticulously stared into the mirror wondering if my favorite jean slacks were going to cause me to sweat even more than usual on my walk to school where I’d be teaching soil comparison to the 7th graders and an enviracy lesson, of my own design, to the 1st graders. I packed my new black bag with my computer, lesson plans and various notebooks and filled my water bottle while answering my phone. My boyfriend on the other line, sounding winded, told me that he fell off his bicycle just beyond my gate, can I help him with his cuts? “Yes, sure, come on up,” I said, picking out the antibiotic ointment, some cotton balls and band-aids from my med kit.

6 minutes later a very bloody Evrick walked up to my back veranda, red streaks streaming down one leg. I looked up at his face, my eyes wide- this was not the kind of fall I had expected- and told him to sit down, now. A quick once over told me all I needed to know- he needed stitches in his knee. We patched up the scrapes along his arm and waist, wrapped his knee as best we could and caught a ride with my host mother to the clinic in Whitehouse as I made phone calls to the teachers explaining I wouldn’t be making it to school today.

Arriving at the clinic, a nurse met us at the gate and told us to turn around, there were no doctors in today. We turned around to see my host mothers car accelerating into the distance. Ok, next option, public transport mini-bus.

We approached the area where the busses park to wait for passengers to find that Evrick’s friend from their school days was a driver. They exchanged familiar greetings and his friend invariably asked what happened. Evrick explained and said we were on our way to hospital. We moved to the front seat for more leg room and departed very shortly after that. I was so preoccupied that it wasn’t until we had almost arrived to Sav-la-mar that I realized the bus had left Whitehouse nearly empty, and had hardly stopped for passengers. For a mini-bus driver, this is a heartfelt testament of friendship- basically: “screw the extra money I’d make waiting around man, lets get you fixed up.”

The mini-bus dropped us across the street from the hospital lane, and we walked/hobbled side-by-side along the sidewalk to the hospital gate.

Savanna-la-mar is the capitol of the Westmoreland Parish. It is made up of two main streets and various side roads, it is hot, flat, dirty and smelly with congested traffic and poorly designed open drainage systems. The hospital is a fairly large building that, from the outside, looks like it’s abandoned. It’s pale yellow paint is chipping,it has broken window vents and random wires hanging from the walls. If not for the enormous crowd inside the building, the inside would look abandoned in the same fashion. The waiting room is a huge open space with metal chairs lined up facing the pharmacy to the right of the entrance. More chairs were lined up to the left of the entrance, facing reception windows and a hallway to the rest of the hospital. Directly to the back wall was a single door with a guard standing, calling out numbers for people who needed to be registered. Almost every chair was occupied when we arrived.

We arrived at the hospital around 9:30 am and Evrick, having never been in a situation like this, and I, having never experienced Jamaican healthcare, negotiated our way through the crowded, somewhat ordered chaos that was registration. Through the door with the guard we found ourselves in a very tight hallway with curtained off examination spaces to the right. The hallway opened up into a room that made my heart race. A tiny little wooden nurses station stood amidst more curtained rooms containing dying women and sick individuals, stab victims wandering around in hospital gowns, gurneys in the middle of the room carrying a man with a broken leg, pins visible on either side, and another, much smaller waiting space. Nurses spoke to us without directing their comments at us, told us to go “over there” and then walked away themselves and (while I know they are overworked and underpaid) generally added to our discontent and confusion. Ev filled out paperwork, got his vitals taken and was sent to talk to a doctor. We sat in his office and, without even looking under the bandage, the doctor gave us a yellow piece of paper and told us to give it to the nurse, who then sent us back out into the immense waiting area and told us to wait until we are called.

By that point the adrenaline had wore off and Evrick was admitting to pain. I stood on line at the reception windows to hand in his paperwork while he found us seats, and we waited for about 2.5 hours to be called back.

Finally we were going to see a doctor! This one looked like he was of Indian decent and quite young. He looked from Evrick to me with a poorly masked, puzzled expression and began to address Evrick, asking him the typical questions a doctor must ask his patient. This doctor mumbled to the paper instead of the man in front of him while chewing gum, and every time Ev asked him to repeat himself, the doctor scoffed and shook his head while I repeated the question for him. I told the doctor he was mumbling to which he responded, “well why can you understand me then?”

The doctor sent Ev out of the room for a pain shot and proceeded to ask me questions about myself, barely masking his confusion of why I was dating this common yardie from the bush. In my mind I was screaming “a good man is a good man you well educated asshole!” but on the outside I took it like a champ, hoping he would like me enough to be nicer to my boyfriend. Wrong-o!

We followed the doctor back to the “surgical room”, a poorly organized room with missing tiles in the floor, rusting equipment and a rasta man laying on one of two beds, bleeding from a heavily bandaged foot and onto the floor. We went to the other bed and Ev lay flat while the doctor prepared the kit.

Now, most of you know that I come from a family of doctors and nurses, and that gross medical stuff doesn’t scare me. I’ve watched my gentle and personable father sew up many a human being, including a friend with a very similar slice on his knee. My father talks to his patients in a quiet, even tone while he gently and methodically works. He’ll describes his actions before he starts, what will be required and how long it will take. I am always amazed by his professionalism and empathy for the patient.

If there was ever a 100% stark contrast to my Father, this experience was it. I found myself telling Ev what to expect while the doctor prepared  the kit in silence. I told him not to watch because it would be worse, that it needed to be cleaned first, then numbed and then he wouldn’t feel a thing. With my big black bag slung over my shoulder and my left arm resting on his chest I watched the doctor clean out the wound with distilled water, letting it drip down Evrick’s leg and into his sock and, as if in slow motion, the doctor began mercilessly digging with a gloved hand into the wound, down to the bone, blood seeping up around his fingers. I immediately threw all of my weight onto Evrick’s chest as he shouted in pain and his arms convulsed around my torso. Again the doctor dug and my heart raced as I angrily mumbled “easy man!” at him, my boyfriend cursed as he felt the most concentrated and pure pain he’d ever experienced and I accepted the consequences, holding him down and letting him squeeze my hand and waist until I felt vindicated in a shared discomfort.

We were afforded a break while the doctor threaded his needle. I looked into Ev’s eyes and explained that he just had to make sure there were no rocks in the wound, he would be numb soon. The doctor then forced the novocain shot into the tender and swollen area (another tensing convulsion, for the two of us) and immediately began to force the needle directly into old scar tissue without waiting for the medication to set in. More excruciating pain, more shouting as I tried to convince Evrick not to look, practically laying on top of him, blocking his view with my body. A stitch and a half in the doctor paused, considered his “handiwork” and said “this is too deep, it goes to bone, I want him to have x-rays” and cut the stitches out.

I wanted to cry, punch, kick and throw an all round tantrum. I am small but mighty, I love and I hate equally fiercely, I protect my own at all costs. Like the hummingbird I am, I wanted to stab this mans eyes out repeatedly.

During the hour we waited for the x-ray I shook with anger, fighting back tears of rage and exhaustion. What a completely helpless moment, when someone you love is in physical and mental pain and all you want is to assume their pain for them, but all you can do is shower them in affection and somewhat contrived reassurance. “Well, at least we know for sure that you’re numb this time!”

The second attempt was easier, maybe because Evrick’s sister, an employee at the hospital, joined us in the surgical room, but definitely because he was already numb. The doctor considered his medical kit and the other doctor in the room, dealing with the bloody foot rasta, asked what was wrong. “I should use a curved needle." he said, “Then go an get one” the other replied, “well they’re all the way in the other room,” our doctor answered with a lazy expression. My jaw dropped and my eyes widened at him, obviously demanding seriously?? Why yes, he was serious, I don’t know why I was surprised.

Once again I assumed the position over Evrick’s chest, seriously pep talking him “DON’T WATCH THIS”. He flinched and tensed, but was not in pain. “one stitch down, don’t look!” “Two down, don’t look!” “One left, stop looking!” Finally, the torment was over. The doctor gave him a prescription, we glared him without a word of thanks and I pointedly held my boyfriend’s hand and stared at the doctor as we walked out of the clinic and into the waiting room where the pharmacy had just closed it’s doors for the day.

What did this experience teach me? More than anything how extremely lucky I am to have first world medical care. That my father is a truly talented caregiver. That, perhaps, we experienced projected feelings of prejudice from the doctor. That medical care in Jamaica is biased, and free medical care even more so.

I know I’m not in the medical field, I’m sure some PEPFAR volunteers could write a blog post about this blog post, but from an outsider looking in, this was one of the most trying experiences I’ve had since being in Jamaica.

Know Thyself

If you don’t know who you are before you join the Peace Corps…don’t join Peace Corps. This experience gives even the most secure individual periodic moments of identity crisis, I promise. That’s not to say I have not learned a lot about myself since beginning this experience: limits, “flaws”, and hidden strengths, but if I didn’t have the conviction to stick to myself and maintain the little quirks that make me, me, I’d have drifted off into the abyss long ago. Perhaps this is relevant to all of life, and I know it’s relevant to Peace Corps in all countries, but in Jamaica I find this the truth almost every single day. It’s something about the perception of Americans that is so internalized by some people here, and the confusion when we do not fit that mold:

No, my shoes are not always clean like new; Yes, I drink out of reused pickle jars; Batti riders will never look good on me, “sexy” is just not my look- nor are neon colors; I don’t wear brand names because I can’t afford them; Oh you like my shirt? $3 at Salvation Army yo!; No, I use a capful of olive oil not a pan full of vegetable oil- trust me on this one.

Perhaps it is simply the confusion of a reality tested, or perhaps it’s the need to demonstrate a greater knowledge to the big bag American- honestly, it’s probably both, among other things, but Jamaicans love to tell you how to do things “the right way”. If you don’t know and respect yourself, you’ll be forever unsure, and struggling with your identity is the least productive thing to do in the Peace Corps. Or, let me rephrase, maintaining your identity will become the strongest stabilizer you have.

In maintaining my identity, I found something that many volunteers my age have been finding: a reborn level of patriotism that had been worn down from years of education and scrutiny. I remember telling people before I left that I was becoming too cynical of my country, that perhaps moving to a developing country for a while would remind me of America’s unique beauty and I’d feel blessed to come home. It has.

When my community members ask me if my friend of Mexican decent is my sister, when they ask me what people believe in in Foreign, when they ask me how the weather is in Foreign, I truly appreciate the diversity and scope of my experiences just living on the gigantic land mass I call home. A place where being different is to be unique, judging others is a waste of precious time, enjoying nature is a hobby and a mosque, church and temple can all be found on the same block. Yes there is adversity and differences in opinion, but at least in New York, that guy walking down the street with purple hair and dark eyeliner is just a guy walking down the street.

So, before you leave the country, pick out all of the things you love about yourself, pack them in your suitcase and wear them proudly. Know that by wearing those wonderful things, you will invite curiosity that is unfortunately veiled in light criticism, and take those moments as teaching moments. This is Jamaica my friends, a tough shell filled with soft goodness. As a friend once said, love her and she’ll love you right back.

Quality Over Quantity

I think a lot of us lately have begun accepting our Peace Corps roles as constant assessment and reassessment as our community dynamic constantly changes, along with our understanding of our community. Upon returning from Foreign, I immediately began reassessing, and pinpointing projects that should be pruned and refined, and others that just have to go. For instance, I reassessed my role at the primary and junior high school after realizing my limitations in teaching troubled hormonal teenage boys, for try as I might, I cannot hide the fact that I’m a woman with boobs while looking professional and not 14 years old.

I have also recently interacted with some very optimistic farmers working through the Farmer to Farmer program (a USAID program that sends real farmers from the US to other countries for short stints), identified a community member who could be a catalyst for change, volunteered on a top tier high school biology field trip, took on a community recycling project in partnership with the Sandals Foundation, and dealt with the same frustrating projects I’ve been assisting with since my arrival, with slightly less frustration.

I think perhaps my time home helped to put things in perspective, or at least let me rest from Sunday morning phone calls about what I’m doing today because someone needs help opening a word document at the CDC container. I was able to remember why I joined the Peace Corps, and also what my strengths are intellectually and passionately. When I got back, The Farmer to Farmer group ignited my excitement as they spoke with a similar passion and even greater intellect on the subject, the high schoolers improved my confidence, laughing and nodding as I excitedly explained why I think wetlands are SO COOL, the community recycling project, along with the breadfruit flour production are now my babies, that small legacy every volunteer hopes to leave behind.

But with all of these exciting revelations, I am understanding that a quality every community developer needs is the ability to recognize when a project is just not going to succeed with the force it should, reassess it, and move on or adjust it so that it does work. As one fabulous TED talk described, what is the point of working for two years on a project to feed your community, when all you end up doing is feeding the hippos?

*Disclaimer: yes, this is something that was said to us during Peace Corps training over and over again, but sometimes you need to touch the flame before you realize what “hot” means.*

Riding in Taxis With Strangers

I’ve been wanting to write this post since I returned, because the humor of riding in taxis in Jamaica really hit me coming back to this ridiculously wonderful country.

This post is also directed at group 84, because I wish I truly understood what I’m about to tell you upon reaching my site.

So you all know by now that taxis in Jamaica run route: they go from point A to point B all day. You might have also picked up that there are generally two types of transportation- the typical 5 seater (sometimes a hatchback) and a coaster bus that sits about 18-20 people. Cars and coasters with red plates are legal, registered taxis, sometimes people run taxi that are not registered and they have white plates like everyone else.

Now lets talk about taxi communication. First of all, you should wait on the side of the road the car is going so no one has to cross the street (follow community members lead on this and most things). The driver usually keeps his hand out the window, if you see a white plate car and there’s a hand hanging out with bills folded between his fingers, he’s running taxi (that does NOT mean you should take the car- always opt for red plate unless you KNOW the driver). If the driver holds his hand out the window palm up or with his finger pointing where he’s going, he’s asking “need a ride?”. If you are, flag him down, if you’re not just shake your head or wave your hand and he’ll keep driving.

If you flag down a taxi that is full up (filled), the driver will hold out his hand palm down or he will flash his headlights at you.

Now, here is where I wish I’d learned more about taxi “etiquette”. A taxi man may stop and you might say to yourself “there’s not a square inch of this taxi that’s not occupied by a body.” It’s all about perception. If you truly think the taxi man is just being greedy at the cost of your comfort, and you want no part of this madness, just tell him “gwaan man, I’ll catch one nex one”. I warn you that if this becomes a habit, you’ll be waiting for hours for a taxi, especially around 8:30 or 9 am and 3-6:30pm. Being a small female, there’s always room for me, usually doubled up in the front seat. It’s common to share the front seat between two medium sized women or for the smaller woman to sit on a pillow on the console. Men, don’t sit in the front unless you know the driver- it’s a male machismo thing.

If there are not 4 people in the back seat, there is room for you.

If there are 3 adults and one child in the back, you can also fit. Smaller people, particularly children, sit on the inside, which means that you may get out to allow a child or smaller adult to sit inside of you (if you have a window seat), I also do this when I know I’m getting off before most people in the taxi, especially if it’s packed. If you get looks or people seem discontent to be so smalled up, just explain “mi soon come off”.

If you have no idea where to sit but the driver says he has room for you, wait till he tells you where- sometimes he’ll want you to get in on the opposite side to where you’re standing, and he’ll usually indicate to you by pointing or just saying so. Other times, some men will get out of the car and move to the trunk or hatchback, feel free to be amused by this, “only in Jamaica”. Some taxi men take charge of their passengers and like them neatly stacked- others don’t really care.

Now on to coaster etiquette. Coasters and taxis often run the same route, especially to and from major hubs like the parish capitol and another semi-urban locations. The difference is about JA$30 (coaster is cheaper) and sometimes as much as 30 minutes, coasters make a lot more stops and fit a lot more people, so they take longer to load at point A, and longer to get to point B (since you can catch a route taxi/coaster at any point on its route). Sometimes the cheaper ride is worth it, especially if you get on early and you can pick your own seat ( I take a car taxi when I’m in a rush or waiting on the route and take the first available ride). Normal seats in a coaster fill up first and simply due to preference- of course if you know you’re getting off soon you should sit forward and in an aisle seat. Once normal seats are full, an extra seat is added with a padded board between each aisle seat, and that fills up back to front. If you’re “lucky” enough to get that seat and someone behind you gets off, you must also get off to let them off, and take that persons seat. People accept coasters for what they are, crowded, hot and a bit of a wild ride- they will most likely load and unload to let others off without complaint, but it’s still helpful if you try to sit strategically.

There are also a lot of variables when riding in a taxi. Some drivers will take detours to let off passengers that don’t live en route. During slow time, it’s not unusual for a driver to double back about 1/3 of the way out if he wants more passengers. Once you sit you’re stuck, it’s very rude to get out of a taxi once you’ve sat down- I‘ve regretted this rule many a time as a taxi man ushers me quickly into his car and I sweat and watch two other taxis leave before we fill up enough. With this rule in mind, a taxi man can pretty much go where he wants with his passengers until they start complaining- feel free to join in with a kiss of the teeth when this happens. If people demand he “tek time”, you’ll probably feel the same as he goes around the turn on two wheels and so feel free to join in on that one too. I’ve seen passengers get out of a taxi early, complaining loudly, and there are a few drivers that I just don’t take because they are rude or drive too unsafe. It’s also worth it to note that many taxi drivers run errands for community members, and that’s not necessarily something you or anyone else should complain about.

Another thing to realize, especially in your community, is that beeping at you while you walk is a drivers way of saying “waa gwan!” or “heads up, I’m behind you”- it’s not meant to be rude or to frighten you, just greet back with a raised hand, head nod or a shout, it’ll go a long way for that night when you find yourself stuck somewhere and need a drive- nice people get more in that case.

So it goes if you want to get around here. Embrace it even if you don’t love it, it’ll set you apart as a “yardie”, and you’ll have so many more interesting experiences. Ask any previous PCJ volunteer for their best taxi story, they’ll all have one.