Carly Schwartz

Medicine In Action Sugar Scholars

Reflections on trip to Jamaica

I would like to thank Medicine in Action for inviting me to come on their November 2011 trip to Jamaica. The experience was enriching and unforgettable. I have known for a long time that I want to practice international medicine in my future career, but this trip was my first opportunity to participate in the delivery of health care in an underserved country. As I flew into the airport in Kingston, I did not really know what to expect. Would the health care delivery services be so different from our own in the US that I would be confused and unhelpful? Would I be familiar with any of the afflictions the patients had? Would I be able to communicate successfully with people of a different culture?

When I met the rest of the MIA team on that first evening, I learned that our plans for the coming week were vast. More than thirty women were scheduled for surgery, and a separate clinic would be set up in different locations around the country almost every day. There was a lot of work to be done. As I suspected, I saw some illnesses that are common in Jamaica that I had never witnessed before: ringworm, scabies, etc. I unfortunately learned that many of our surgical patients had ailments that had gone untreated for years and fibroids and masses that had grown to very large proportions. I learned about the universal health care system that is in place, which allows free health care for all citizens but is rife with issues of poor access, inadequate supplies, and medication shortages.
But I was more surprised by the sundry similarities. The most common ailments of the general medicine patients were hypertension and diabetes. Just like in the US, patients with diabetes find it difficult to control their glucose levels and suffer complications. Patients with hypertension run out of medication and present with dangerously high blood pressures. Young women are nervous about getting their first Pap smear, but bravely agree after being told that it serves to protect them from cervical cancer. They promise to tell their friends afterwards that it is not actually painful. Many patients used lingo that was often unfamiliar to me, but the clinic nurses spoke the international language of medicine. The operating room was not as well-supplied and the equipment not as shiny and new as in the ORs I have rotated through in the US, but I still managed to contaminate my sterile gown during “scrubbing” and had to start the process over again (just like at home).

Two days of the trip stand out in my mind as particularly salient. We travelled to a rural area a few hours away from the capitol city of Kingston, and saw patients at a clinic set up by a local convent and run by nuns. This area of the country is so remote that there is no ambulance service that will travel there, and the nearest hospital is more than one hour away. The need was tremendous. Patients would arrive to the clinic hours ahead of its opening, prepared to write their names down and then wait all day to be seen and examined. But these patients were not impatient or surprised at the long waiting times, they were used to it. And rather than compete and argue with one another in an attempt to be seen more quickly, they helped each other: if I called out a patient’s name and that person did not answer, the name would echo throughout the waiting room. The other patients would begin repeating the name, searching for the summoned person until he/she was found and informed that it was his/her turn. Many of the elderly patients were brought in by younger neighbors: people who were not related but often explained their presence by telling me, “Ms. So-and-So used to take care of my own mother, so now I help to take care of her”. The patients in the greatest need seemed most willing to come together and help each other, and find their own ways to keep their friends and family healthy in the face of insufficient health care.

The trip was largely successful, in that all of the thirty-ish surgeries were performed effectively and hundreds of patients were seen and treated in our clinics. But for me, the trip was life-changing. The experience reaffirmed my desire to work abroad in an underserved country, and it also got me thinking about the problems of deficient access and availability that plague so many rural regions: both in foreign nations, and even in our own rural areas here in the US. I hope to find creative ways to address these problems in the future. I am so grateful that MIA gave me this opportunity to explore my interests, and I will not soon forget this wonderful group of people and their virtuous mission.