Where is Johnny’s doctor? The medical uncertainties for being poor and sick in Jamaica: R.D. Miller

A balancing act
Poor medical care is ubiquitous as studies have shown that it is often routed disparities along racial and ethnic lines. Becoming ill can get extremely dark quickly on these shores.

Poverty remains the main cause in most Caribbean islands, but one’s status woven in ongoing social stratification since colonialism remain a barrier. This is not an indictment on the local medical system, but a light on a dark issue where others do not have a voice.

Jamaica and by extension of the Caribbean have excellent doctors. They have been pivotal in the quality of lives despite an up-hill battle to overcome the challenges in public health.
These doctors are cherished even sometimes more than police officers, local judges, pastors, or politicians. And their signature such as a referral even if their patients cannot read what have been written concerning their health, is accepted
Being a doctor gives them significant rights and responsibility. And with this enormous power, and influence, one must ensure accountability that put patients first.
After Johnny’s funeral, I looked into his mother eyes, and began to ask a few questions.

What happened to him?
I am not a medical doctor, nor do I play one on television, but critical analysis is needed for improvement especially in poor rural areas.
It is their responsibility to not only have an up-to date office with the technology to better diagnose symptoms, also a well-trained staff such as an educated pharmacist as studies have shown will improve the safety of medication.

Furthermore, discuss findings with patient and family that includes treatment plan even if it may not work. They are significant dissimilarities in these medical centers from the lack of resources, and categorically inadequate skilled staff.
And this creates more challenges concerning practice and ethical standard in medicine.

It would be a good practice that physicians, medical examiners, corners offices are all in agreement as to the real cause of one’s death.
Doctors must hold one another to high standards as best practice suggested in the medical profession.
Equally important, adapting to the cultural shift and embracing younger doctors especially females as studies have shown an increase in the number of women entering the medical field.

Now what happen to Johnny?
It is simply not what time he died on a bench waiting for over 8 hours to see a doctor, but what was the actual cause of his death?

This in-explainable death represents a common medical “guessing pattern” that have caused severe financial, emotional, and physical pains for families.

With little-known surrounding this death, the funeral had to be placed on hold because the doctor was away and the body could not be released to be prepared for burial.
The delay continued because only one pathologist serving several parishes in a country with about three million people.
An autopsy can provide critical-clinical finding that the family may use as a history to protect future health.
“Was he vomiting before he arrived?” a question asked.
“Johnny complained about his stomach each time he visited the doctor, and this was about the third time in two years”, the family replied.

There were no follow-up visits, or call to see if the last prescribed medication helped.
Today, the real cause of death still unknown, but the family had to accept what was recorded on the death certificate.
He died from “stomach cancer.”
“If he was not treated for cancer, what led to this conclusion?
Where is his doctor to ask follow-up questions, and to validate his medical records?
How do you asked for an investigation when you cannot even afford the basic prescriptions?
These final conclusions are simply “poor prognosis”

Decision fatigue cannot answer thousands of dollars spent on recommended tests, prescriptions, and more test-to-test to the result of that previous test, funded by family members abroad.
Johnny’s story is not unique, because there are other families who return to check up onloves admitted for treatment, and only to be sent to a morgue after they have been searching for hours.

Accountability
More pathologists are needed and even second opinion would have built confidence and credibility.
There are local doctors providing critical education and healthcare tucked away in a plaza, but more collaboration and oversights is needed. Even sending patients off with a letter often led to unwanted additional financial burden.

If some community doctors do not specialize in certain area of medicine, there needs to be referrals rather than ordering more test that amount to financial gains.
These failures are simply a lack of humans’ rights, patient welfare, and social responsibility as many scholars have noted for a good medical system.
What would Johnny’s file have shown: Did they only saw his mental illness and used that to dictate the level of attention.
Did anyone know that he was once a public servant, a police officer.

Was he prescribed the right pain killers, or was it based on the ability to pay?

And if prescriptions being written may have kickbacks to pharmaceutical companies, who is there to monitor inappropriate use. Often prescribed painkillers as studies have shown has led to addiction and not cure for the actual symptoms.

Many government health-centres seems to only have limited resources for vulnerable groups. After Johnny was first treated and sent home no one really knows what happen.

Without any medical insurance, certain status in life, and if society deemed one as a (mad -man) someone with a mental illness, that can create additional barriers.The value some place on human lives; especially the poor people many sick individuals put off seeing a doctor, and do not get required test

Failure to engender community trust
Johnny could not receive blood, until someone from the family or anyone else gave in advance. This concept is like an eye for an eye, and you are out of luck if no one stand in for your well-being.

One argues that people seldom give blood as a volunteer, or become an organ donor and only for a price while others see it as a taboo routed in distrust of the medical system. I get it! that the medical practice must implement some rules to have reserves for others.

Cultural belief and stigma also remain an issue for some; where an erectile dysfunction, chronic chest pain, or an unusual lump on one’s body can be cured from homemade drink, or alternative medicine.
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There is still skepticism of government funded medication or contribution from international health organizations. To some it is an experimental drug even as it helps to minimize medical risks.

Medical education is critical and its starts in the school system
Where are the political leaders, and minister of health?
Many have seen promises of better overall health care during an election season, but after it appears nothing has changed.
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Yes, people die in America, Canada, Cuba, and England as some argues that they have long waiting period and a better medical system.

However, the chance of a person dying on a bench waiting on a doctor for 8 hours is thin. No one also expect countries such as; Jamaica, Guyana, Trinidad, Bahamas, Dominica Republic to name a few with economic struggles to operate on the same level in some key areas.
But what this death represent is access to better health care between the haves and the have nots.

Doctors and nurses are still making a difference and over worked and maybe underpaid.
Many of whom studied abroad and returned, but the “Brain Drain” effect ‘including nurses continues to play a major role in the emigration of these highly-skilled professionals.

Even well-off politicians who have died in the U.S. Canada or England while seeking treatment.
If they invested and trusted their own local medical system often promoted for votes, why would they leave for care when they become sick?

​Empathy: Regardless of one’s socio-economic background, mental issues, or pre-existing conditions, all should be given the same medical attention such as a local popular sporting event.
A first-class image with embryonic operation to address medical emergencies in an ever-widen economic inequality gap is problematic.
Far too often a funeral band played, food served, but after everyone leaves, families still wants closure.
It seems many communities are becoming immune to these issues.