By R.D. MILLER
Part I– The Inefficiency, Complication, Implicit- Bias, and Bureaucracy.
The World Health Organization (WHO) and other medical experts noted that access to decent and affordable health care globally remains a contributing cause of death and millions more are pushed into acute poverty each year and the numbers are growing.
The expert also noted that, globally, more than a third of the world’s population – around 2.4 billion people – currently have no access to a basic health facility.
Our family tragedy is not a indictment of this delightful island medical practice or system, but a highlight of systematic deficiencies.
Despite some stunning coast lines, beaches, breathtaking sunsets, and welcoming smiles, becoming sick can turn bleak swiftly, especially if you are impoverished and do not have reasonable access to the medical system.
Jamaica and by expansion, the Caribbean consist of excellent doctors. They have been essential to an excellent standard of living on these shores. But with these successes, there is an arduous battle to follow through the baffling intricacy of the country’s health care system, especially if you are impoverished and or not well-connected.
Being a doctor that power allows them considerable rights, trust, responsibility, and accountability. They are more respected than many armed police officers, local judges, pastors, or politicians.
Plus their signature on notice, a sketch of recommendation or prescription, even though some of their patients cannot read what they wrote concerning, their medical condition, constantly honored.
While the medical profession aims to provide equal treatment for all patients, healthcare inequalities and disparities prevail.
Some of these disparities and barriers from social disadvantages go back to colonial rule along these Caribbean shores.
“Saying goodbye to Johnny?”
Shortly after Johnny’s funeral ended and people who attended were leaving and despite the joy of knowing they loved him; life dealt him an unexplainable illness (mental health). I had arranged a flight out of town after delivering his eulogy, leaving everything behind with my next job-related task running through my mind back home.
While the rented vehicle waited, I went back saying goodbye to his 81-year-old mom. No matter what I had to say to support her and offer her added strength after her son was buried, I knew that in my heart I would not return to this side of town.
Before I gave an emotional last hug, her drooping eyes filled with sadness looked at me, and her weak hands held mine like she wanted me to stay or something else to reveal to me. My general safety training prompted me never to lay a civil servant, much less a member of my family to rest, without an answer or an attempt for closure.
I hesitated and continued to a small back room, and asked what transpired? I came back and sat in a narrow hallway as the crowd walked in and out. After further reflection as a teenager from my summer and winter vacations the way he took care of us, one hour turned into five days, but it was rewarding for the extra not budgeted money spent.
Part-II “If you get sick, speak up, ask questions and demand an answer.“
I am not a medical doctor, nor do I play one on television. I consistently respect and admire their work, but I recognize that the preventive practice and the medical system, largely in low-income rural counties, could use an upgrade, more accountability, and easier access for especially the poor.
There were few symptoms reported of seizures after they had prescribed him medication. However, they did not diagnose him with Epilepsy, nor a family history to indicate those underlying hereditary mutations. And with no documentation, my journey for the truth provoked more questions at each stage of a few medical stops.
It seemed no one was willing to answer any question about what date and specific type of prescription were provided. A trained employee like a patient or customer-friendly intake staff at a local hospital or an experienced pharmacist distributing prescription drugs can be critical to saving lives.
Does the system recognize an over-prescribed combination of prescriptions can lead to addiction instead of targeting the actual symptoms?
Research consistently noted that prescribing a regulated substance to patients when there are concerns, and failure to offer counsel can cause a risk of overdose and death. I’ve witnessed the unfortunate effects of over-prescribed medicines in my line of work.
This does not differ from forcing an ill patient off with a personal doctor’s letter that has frequently resulted in added financial burden and no solution.
If prescriptions are being written, no monitoring, and if there are payoffs from pharmaceutical companies, who are there to monitor inappropriate use.
But let’s get back to the quest for the truth.
Part III- Now, what happened to Johnny?
The first line of contact for a sick person is critical, and one should put the patient first because their decision could represent the difference between life and death. It seemed they had assigned a value to these patients’ lives woven by classism. Sadly, that a person’s social or economic place in society determines their value in that society.
Johnny complained about his stomach every time he saw the doctor, and that was about five times in two years,” the family said.
“Did he vomit before arriving?” Question asked.
There were no follow-up visits or calls to see if the most recent prescription helped.
Why would you request more?
Since he suffered from mental health illness, who did you notify to ensure that it was administered correctly?
The doctor and the local medical center may not have known Johnny, but he knew them.
It is not what time he died on a bench waiting over eight hours through the night to see a doctor, but what was the precise cause of his terrible death?
Although our society cannot attribute all losses to substandard practice, this ‘inexplicable death embodies a familiar model of suspicion” that has led to financial, emotional, and psychological anguish for many families..
The guessing game!
This very day, the exact cause of death remains unknown, but the family must accept what they record on the death certificate. And the audacity to contact the family after his death to ask questions about symptoms, perhaps to justify what to record on the certificate is nauseating.
If he was not treated for cancer, what led him to this conclusion?
Where is his doctor to ask follow-up questions and validate his medical records? If he is out of the country on vacation, who assumes his or her place at this medical facility.
When he was admitted for a few days, and given fluids, and thank you for your care, what were the reasons?
We are still waiting for that answer.
Provided they released him alone to the street where are the documents of his treatment plan or what has led to the discharge if he was back at the center in a few days for the same medical issue.
Has he prescribed the right pain killers, or was it based on the ability to pay, or did they confiscate the money we sent him and issued him whatever was available on that day?
How do you get a copy of the medication prescribed?
How do you request an investigation when a lot of families cannot even afford the basic prescribed drugs?
Openly discuss the treatment plan and offer the potential medical outcomes with the patient and family, even if it doesn’t work, will provide trust, comfort, and equity in the system.
It would be good practice for local doctors, medical examiners, and the coroner’s local offices to agree on the precise cause of death.
An autopsy is crucial because it can provide critical clinical results that the family can benefit from as a record to safeguard future health.
The bureaucratic backlog continued because only a single pathologist served several parishes in a country of about three and a half million people. And I believe that delayed burial for weeks as the family had to wait before being informed to get ready for his burial is linked to that backlog.
Johnny’s conclusion is a “bad prognosis” and a rush to complete the next death certificate to fill another empty family burial plot or general cemetery where every time a family passes, the wound remains open.
Where there is doubt as to the cause of death, it is acceptable to write “unknown,” undetermined, or “awaiting further investigation or written as “probable”. It doesn’t diminish one’s professional title. While it does NOT offer closure to family and friends, it says more about the ethical standard that poor people must accept.
Decision fatigue cannot adequately deal with the thousands of dollars spent on recommended tests, prescriptions, and more tests from this previous test, to test that test result financed by savings from family members abroad hard-working pension fund.
What this premature death represents, access to better health care between the haves vs have-nots, lack of key accountability in some areas that put patients first.
Part IV – Declining empathy, implicit bias
What would Johnny’s file have shown if they could pull his medical records?
Did they only see his mental illness often tagged [insane- or mad man] and used that to dictate the level of attention?
Did anyone know he was once a public servant, an excellent dedicated police officer?
Johnny could not receive blood until someone from the family or anyone else gave in advance. One argues people seldom give blood as a volunteer or become organ donors while a few regard it as a taboo rooted in a distrust of the medical system.
The system needs reserves and has to be balanced for others and I comprehended this concept. Though logical, it represents an eye for an eye concept, and you are out of luck if no one stand-in for your social well-being. However, the medical practice must implement some rules to keep reserves for others.
Simply seeking answers regarding his medical care regardless of one’s life lived in the community should not result in silence, which is deafening.
I imagine how he must have felt like a veteran who departed and served his country in a war and came back alone to find himself homeless on the city street. They turned him away several times prior, and it seemed as if the medical center had already admitted patients who arrived earlier and they reached bed space capacity, please wait on God.
Given his status, it seemed one had to die for bed space to become available; or perhaps because he showed by himself without bedding supplies as few argued, it is more helpful to have your own.
You are on your own without a family member or an advocate
The community expects local medical practitioners must comply with good standards and hold each other accountable, as advocated by many medical experts regardless of one’s socioeconomic status.
These centers vary considerably, and because of a disheartening lack of essential resources and inadequately qualified personnel, it presents further challenges.
Is there a “Patient’s Bill of Rights” or even a “Nurse’s Bill of Rights?
Economic inequality and administrative obstacles perhaps kill more patients than their actual medical condition. The ongoing waiting for critical surgery seems to be at the mercy of the system, and when they call you depend especially if you can’t afford to pay upfront..
The established fact is every minute someone passes somewhere, whether generally, for medical reasons, from an accident or violence, etc. However, the society hopes that if they are under the care of a doctor or a nurse, they perform the steps and deal with the case in an appropriate and humane matter.
Too many problematic articles show a few local emergency rooms serve as a place where one goes to die in some of these districts..
Part V- The reality: Johnny’s case is not unique to these local communities and not an isolated incident. The more questions asked about his treatment, the fewer answers provided.
Often, the only proof is thousands of dollars in debt from medical bills, and lives are being unsaved while the ethical standards of medicine are being swept away in silence like the ocean.
Sadly, many people died and their families could not resolve the matter of death as many headlines have published, and “It is under investigation” perhaps anticipating that with time the victim’s family pain will go away.
Imagine a loved one on a lengthy trip, drove across the hillsides and beautiful plains for hours with anxiety, returned the later at dawn feared if a loved one sustains an agonizing pain overnight only to be directed to a morgue.
There are reported instances where an individual passed waiting for vital surgery. The surgeon was not available, turned away, or had no answer of what transpired because the family visiting hours ended and they must vacate the medical center.
No one knows if that exhausted staff was available for that midnight shift had time for one who may call for oxygen, clear a vomit to help to breathe or offer pain medicine.
Part VI- The administrative bureaucracy files
The undertaking to research medical records raises another challenge: If you can pay in advance, you can locate a few local private doctors providing critical care in these communities.
Many patients have stuck around for a lengthy time in a crowded space. This is not the office’s fault in keeping up with the increasing and aging population where it shows that the medical system can no longer maintain without significant resources to overhaul
Despite few official certificates on a back wall of personal achievements. One wonders where is the “Board Certification” document?… This commonly is helpful proof that a physician has passed periodic exams to confirm proficiency in the field.
Even though it does not take away from one’s competence and experience, it would provide further comfort. This medical system needs maybe more oversight, verification, and collaboration.
Johnny and many others may have left some of these offices on their own not to become another case as reported where patients died before transport Emergency Management Services [EMS] arrives.
A delicate balance for the medical pathologists.
The fact is doctors are human beings and have financial obligations: In any medical system, public hospitals and private networks have to purchase MRI equipment, and they have to pay for it to remain up to date. The imaging system performs an integral aspect in modern medicine; X-rays, ultrasound, CT scans for crucial details.
Although diagnostic tests are susceptible to false positives, a pathologist’s role is critical as a member of the team that helps other healthcare providers reach diagnoses. The basic expectation is that these analyses advise a patent for comfort, reasonable or bad news.
Today, Johnny’s test result remains inconclusive after hours of pursuing to explain recommendations. Families possess the right to know the medical system provided blood or took it from a patient, and how they decide for surgery.
Is it cancer of the liver, stomach, kidney, water on the brain, wheezing, shortness of breath, excess mucus, and chest tightness, or diabetes that has later led to surgeries and in some cases fatal outcomes?
Missed or delayed diagnosis, avoidable delay in treatment, inadequate follow-up after treatment, inadequate monitoring after a procedure as medical experts only create more errors.
While many patients battle for their lives awaiting the correct answer to reinforce why several tests were ordered, the ethical line it seems between public health responsibility, private financial burden and benefit remain a sensitive balance as most medical services and networks are privatized.
This very day, there still is a gray area regarding what medical regulations adequately protect a family who seeks satisfactory answers to fundamental questions of accountability. However, we rather move to make sense of these gaps.
Part V- Building trust to reduce barriers in the local system.
Many rural government health centers merely have resources for vulnerable groups. When Johnny was first treated and sent home, no one recognizes what happened or guidance from the medical center.
Establishing community confidence is key. Especially in poverty-stricken communities, where a few will put off consulting a local doctor, and do not receive the required test for early detection because of distrust, and poor outcomes of families and friends.
If physicians do not specialize in some critical areas of medicine, they make the referral rather than ordering more tests that equate to financial gains and that is problematic.
This amounts to nothing more than a lack of human rights, patient well-being, and social responsibility, according to medical experts.
With no medical insurance, a certain status in life, and if society deemed one as a mental health problem-(mad -man), that can create additional barriers.
Barriers frequently create skepticism and even government-funded medicines, or valuable contribution of international health organizations, to some is an experimental drug, though it may prevent diseases, reduce medical risks and increase life expectancy.
Medical education saves lives, and it starts in the school system to change some cultural beliefs and stigma that remains a social issue for some. An erectile dysfunction, chronic chest pain, or an unusual lump on one’s body need the attention of a trained doctor and not only with a homemade drink or alternative medicine.
Who do you blame for that way of thinking by some, and in a system where no one seems to question authority or leaders, and constant minimization to deflect?
Failure to meet basic needs in these communities:
“Where are the political officials and the minister responsible for health,” I asked?…. When a moral crisis strikes or during the national election cycle, these events have driven communities into a frenzy and many often vote against their upward mobility regardless of political sides.
Simple, looking in, it seems political leaders submitted materials before the blueprint, and it has worked until your family needs critical medical help. Many people heard promises to improve their health care during election cycles but after that, nothing has changed.
Many developed nations like the U.S. Canada, Germany, and the U.K. have extended waiting for periods for care, sometimes low staff with a more efficient and well-financed medical system. But the elevated risk of someone dying on a grassy bench waiting eagerly for a local doctor for countless hours is slim.
My mother died from cancer after seeing the same doctor for 40 years with excellent medical insurance, and though we do not doubt the cause of her death, each family will inquire what more they could have done.
There is no expectation that Jamaica, Guyana, Trinidad, Haiti, Dominica, and a few nations in Africa and Asia with economic difficulties deliver medical equivalents in key areas like wealthy industrialized countries.
If the health care system does not modernize. Many of those who studied locally or abroad will continue the “Brain Drain” effect, including experienced nurses fulfilling critical role of these extremely skilled professionals.
It starts with logical economic plans to reduce huge medical school debts, attracting more qualified doctors, and maybe better salaries.
What if those leaders invest in more family practitioners, internists, and pediatricians, or establish a path to become doctors? These specialized treatments and preventive screenings save lives and reduce expensive emergency room visits and hospitalizations.
If they invested and trusted their local medical system, often promoted for votes, why would they seek their special treatment in countries like the United States, Canada, or England for surgery when they have medical issues and where some wealthy ones have died?
Regardless of socio-economic background, mental health issues, or pre-existing conditions, all should receive the same medical attention, such as a local social, sporting event. The first-class image with an embryonic operation in many areas of the medical system including emergencies in a widening gap of economic inequality is problematic.
Accept it, because the way it is, it’s just despair.
Over and over again, a funeral band has played, food served, but once everyone has left the family, the pain does not cease when the music stops. With the lack of key advocates and a pattern seen too frequently, these communities become immune to these sensitive issues.
Once more, there’s another night of music, food, and dance, the funeral, and these malpractices go on unaccountable.
This beautiful land, always bound by heritage, culture, or authentic love, but no one would jeopardize everything given the poor medical infrastructure that has outpaced its effectiveness in the face of a growing aging population.
Sure, they have good care, but the ongoing pain where some are avoidable paints a different story of the healthcare system that needs modernization to keep up with the excellent doctors there.
Finally, tough, but we’ve moved ahead.
I hope Johnny’s unexpected mission will represent a voice in which others have none, or a few with a voice remain mute to preserve face.
We may not know what the genuine cause of your death was, but I have studied what led to your death and in our duty, I have established a reasonable cause of negligence to go forward. But by all measures, the extended-stay was not about the money or seeking to submit a claim, it was seeking responsibility and closure.
Yes, despite a system that you have sworn to defend, neglected you, many of us are better civil servants today, from what we have learned from you and your high expectation as a law enforcement officer, despite location.
Your influence, joy, love for humanity; escorting us to the beach on our summer vacation, winter breaks, countless beef patties, block parties you hosted, and your integrity, respect for the rule law lives on.
I did not arrive for a tragic story, and my priority was not to draft an opinion. This situation analysis is to redress that critical shortcoming often beneath the surface and a good smile.
We will continue speaking up, so this does not happen again to anyone regardless of their race, sex, color, or socioeconomic status. It was an honor to be part of this effort that allowed you the homecoming an officer deserves.