USC Project Jamaica: Day II

Friday, December 18, 2009

Today was an exciting day. Our Project Jamaica team got the opportunity to visit Cornwall Regional Hospital, the 2nd best hospital in Jamaica, and the premier medical center in Montego Bay. We met with Dr. Brown, an obstretrican/gynecologist. Dr. Brown had worked with Cornwall for years, but now led his own private practice in a clinic nearby. He gave us a tour of the hospital and introduced us to doctors and nurses he knew if they crossed our paths. The pharmacy students wanted to check out the hospital’s pharmacy, so we dropped by and got to speak with the Director of the Pharmacy. We also got to speak with pharmacy students interning there and other staff from this department. A few of the pharmacy students compared USC’s pharmacy program with the curriculum offered in Jamaica. It was interesting to learn that only one school in Jamaica, the University of Technology, houses a Pharmacy program. (In fact, there are only five universities on the island.) Learning this made me so thankful for all of the opportunities and schools we have in the United States. Another interesting point is that the University of Technology has a bachelor’s pharmacy program, where students can enter after two years of community college and high scores on their A Levels (a standardized exam that students submit when they apply to universities). In the US, however, all pharmacists must hold a Doctorate in Pharmacy, generally after completing an undergraduate program. Consequently, the role of a pharmacist varies greatly in Jamaica. In the US, the role of a pharmacist is rather broad: they are capable of administering vaccines, conducting screenings for diabetes or hypertension, participate in health fairs and present public health lessons on topics from AIDS to poison prevention, in addition to their clinical roles of administering medication. However, in Jamaica, the role of a pharmacist is confined to the pharmacy.

After checking out the pharmacy, we got a chance to meet Dr. Fray, the Senior Medical Officer of the hospital. It was an honor. And in retrospect, it was definitely the pinnacle of my experience in Jamaica. Over the past month, Dr. Fray and I had been corresponding to confirm our tour of the hospital and our volunteering assignment with the Pediatric Ward, so it was nice to finally meet him. We then spent the next thirty minutes discussing healthcare in Jamaica. We asked Dr. Fray, “What would you focus on, if you could invest money in one thing regarding Jamaican healthcare?” He responded, “public health education,” such as pamphlets, seminars, and tv programs informing the population about ways to stay healthy and prevent illness.

Dr. Fray then identified leading causes of hospitalization in Jamaica. He explained, “We have the best food in Jamaica,” but noted that this wasn’t an excuse for the increasing diabetes and cardiovascular-related illnesses Jamaica witnessed. In addition, Dr. Fray noted that car accidents were a frequent cause of hospitalization. He labeled car accidents as the unnecessary trauma, since injuries could be prevented with seatbelts, driving at safe speeds, and pedestrians crossing at designated points.

I asked about the partnerships between the government, policy-makers, engineers and doctors in the hopes of implementing traffic lights, cross walks and so on. Dr. Fray felt that even with those policies, people would still jaywalk. I stated that we could introduce education policy programs, more thorough requirements for obtaining a license, driver’s training courses, and crosswalk education in school curriculums. Dr. Fray said that with time, Jamaica’s traffic laws would adopt more Western-like policies. He projected that things would improve over the next ten years. But in the meantime, he acknowledged, you could get anything you wanted in Jamaica if the price was right, including a driver’s license.

Dr. Fray continued that Cornwall was often inundated with patients. Because of the unnecessary trauma of car accidents and other preventable illnesses, Cornwall splits its resources between cases that require grave treatment and cases that can be easily prevented. In fact, Cornwall holds 400 hospital beds, but accommodates 500 patients at any one time. This is because Cornwall is a public facility. Upon the inception of Jamaica’s new administration 2 years ago, healthcare and education became universal services funded by the government. While eliminating barriers to healthcare, this shift in policy overwhelmed public institutions, such as Cornwall, which cannot turn anyone away. Interestingly, Jamaica’s healthcare reform also called for free drugs at public hospitals. But Dr. Fray noted that these freedoms have come at a cost: the patient’s time. In fact, it could take all day for patients to get their prescriptions filled. And he attributed the wait to the shortage of pharmacists in the hospitals. As Cornwall is a public hospital, the pharmacists here get paid 1/3 of the pharmacist salaries from the private sector. Talking with Dr. Fray was both insightful and humbling. Dr. Fray’s position gives him quite a bit of influence, so I felt honored that he gave up some of his precious time to meet with us.

Later that afternoon, we returned for our Poison Control Presentation in the Pediatric Ward, wearing our Santa hats and USC Project Jamaica shirts. We got to meet the pediatric patients and walk them to the multi-purpose room, while a few people helped set up for the presentation. As we walked down the halls of the Pediatric floor, I noted the vibrant colors and welcoming paintings of familiar cartoons, such as Spongebob, Winnie the Pooh, and Mickey Mouse. However, beds that the patients stayed in were old, the floors dirty, the overall atmosphere unkempt. Most patients didn’t have shoes, and I noticed sores on their hands and feet as they scurried to the playroom. While shoes aren’t the gravest necessity, they do protect feet from wounds and exposure to pathogens.

We then started the poison control lesson. We started with the game “Pick the Poison,” where the audience has to choose between two similar looking objects and select which one is a pill and which one is candy. The purpose of this activity was to illustrate that candy and medications look so similar, that oftentimes one can’t differentiate between the two. I was really thankful that all of the patients were energetic and engaged in this activity. From there, we explained why they should be careful when putting items in their mouth. We emphasized that they should always ask an adult before eating anything they can find around the home or the hospital. And we discussed different types of poison one can find around the house, such as oil in the garage or perfume in the bathroom.

After our presentation, we rewarded the children for their efforts and gave them each a toy for Christmas. All in all, I thought it was successful first lesson in Jamaica.