Patricia K. Foo

Medicine In Action Sugar Scholars

Reflection Essay - February 2010 Jamaica Trip

The name Jamaica comes from the Arawakan name, Xaymaca, meaning the “Land of Wood and Water.” Flying into Jamaica from the north, the lush green hills and cerulean blue waters bring this indigenous name to life. Every year more than three million tourists visit this verdant landscape.

Like many popular vacation destinations, the quotidian life for Jamaicans is often unseen by tourists. Based on 2002 per capita gross domestic product (GDP), a measure of the country’s economic health, Jamaica ranks 94th in the world, falling between Guatemala, 93rd, and Egypt, 95th (neighboring Haiti ranked 125th). In terms of actual levels of GDP, this is equivalent to almost a ten-fold difference in per capita GDP between the U.S. and Jamaica.

What accounts for the difference in economic output between these neighboring countries? Should and can anything be done to close the income gap? These are complex questions. In my view, we can roughly divide the approaches to answering these questions into two broad categories. For lack of better terminology, I will call these the ground level and aerial approaches. The ground-level approach is largely promoted by programmatic, hands-on individuals and tends to be focused on specific issues. Results are often local and measurable: fix 10 cleft palates, educate 100 girls, or prevent 1,000 cases of malaria. In contrast, the aerial approach is championed by organizations like state governments, the World Bank, and the International Monetary Fund. These groups seek answers in large population datasets and search for solutions that often involve wide-ranging systems and government policies.

Both approaches provide important insights, yet it can be difficult to move between the two approaches and to translate lessons from one to the other. From the ground approach, one often gains an appreciation for the issues that matter to people, the strategies that will work if implemented, and importantly, how hard the work is. From the aerial approach, one can see the unanticipated good and bad ripple effects of interventions and possibly see strategies for large-scale change that would be unattainable by individual community programs.

When I chose to pursue a dual degree in medicine and economics, I was motivated by a desire to retain both the ground level and the aerial perspectives in my career. My trip with Medicine in Action was my first foray into seeing the ground-level perspective of health and healthcare in developing countries. During three days in the operating room and two days in community-based clinics, I saw a snapshot of local healthcare issues. To my surprise, treating patients in Jamaica was very similar to treating patients in the U.S. Although the anesthesiology machines were older and not a computer was in sight on the floor, hysterectomies proceeded as usual. Our fourteen patients recovered in the same amount of time as patients in the U.S., and they went home, grateful and hopeful for relief of their multi-year symptoms. In clinic, we saw women for the same suite of routine gynecological issues as we would see in a U.S. clinic. One woman’s anxiety before her first Pap smear was the same as any woman’s first-time anxiety in the U.S. These parallels and similarities seen in our clinical work also appeared in issues of poverty. Poverty among our Kingston patients was a magnified but analogous version of urban U.S. poverty. Instead of a few overcrowded homeless shelters, entire squatter towns existed. Housing conditions were distinguished not by the presence or absence of rodents but by the quality of the housing material—iron or aluminum.

The main lesson that I took away from my trip to Jamaica is that we are more similar than we are different. My ability to relate to the people who patiently waited for hours outside our clinic was no different from my ability to relate to patients in the U.S. Our patients confronted similar hardships in poverty as impoverished individuals in the U.S. but often to a greater extreme. Their communities were strengthened by the same values of mutual support and strong leaders on which our own communities are built. Despite our differences—perhaps fewer in Jamaica because of a shared language—we are remarkably similar as individuals in sickness and as communities of both unique strength and significant need. While we must respect cultural differences and the imposition of entering as an outsider, I believe that we must remember that the problems faced by others, even those an ocean away, are problems that we can understand and address in solidarity.

With this important lesson in mind, I return to my educational training to determine how I can apply what I have learned from this ground-level work to guide my aerial-perspective research into answers and solutions that matter to people. I look forward to coming up with answers to this question.