Where is Johnny’s doctor? The medical uncertainties for being poor and sick in Jamaica

By R.D. Miller

A balancing act:

Medical care is universal as studies have shown, but are often rooted in inequalities along racial and ethnic lines. The most daunting obstacle for people experiencing poverty around the world is accessing quality health care. Becoming ill can get extremely dark quickly on these beautiful shores. Poverty continues to be the prime cause of death in most Caribbean islands woven in ongoing social stratification since colonialism.

This is not an indictment on the local medical system, but a light on a dark issue where others do not have a voice or few with a voice will remain silent. Jamaica and by extension of the Caribbean have excellent doctors. They have been pivotal in the quality of lives, despite an uphill battle to overcome the daunting challenges in public health.

These personal doctors are cherished even sometimes more than armed police officers, local judges, pastors, or politicians. And their signature on a referral even if their patients cannot read what has 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.

“What happened to Johnny?”

After Johnny’s funeral and the people who attended left, and despite the joy knowing he was loved having dealt with one of life’s unexplainable illnesses (Mental Health). I had a flight arranged to get out of town immediately after delivering his eulogy abandoning it all behind. But my training prompts me that you never lay down a fallen public servant much less a family member to rest without an answer.


While the hired vehicle waited, I went back saying goodbye to his 81-year-old mother. In spite of my appearance I knew I would not be back on that side of town. Before I gave her an emotional hug and in my mind, this would be it. Her grave eyes stared back at me, and her weak hands grabbed mines as if she wanted me to stay, or something else to tell me.

I paused and went to a small back room and inquired, what in fact happened?… I returned and sat in a small hallway while the crowd walked in and out. After another reflection as a teenager from the summer and winter breaks reflecting how he took care of us. As a result, an hour became four extra days, but it was worth it.

Critical analysis:

The doctor and the local medical center may not have known Johnny, but he knew them.

I am not a medical doctor, nor do I play one on television, and I am aware that health care expenses and access globally are so high that they push 100 million people into extreme poverty, and several die each year according to the World Health Organization (WHO). But critical analysis is needed for improvement especially in poverty-stricken rural areas.

Who is responsible to have an up-to-date office with the technology to better diagnose symptoms? Furthermore, well-trained staff like an educated pharmacist to distribute prescription drugs to individuals or answer a question on a prescription. Many studies have shown, this simple will improve the safety of medication.

They are significant dissimilarities in these medical centers from the frustrating lack of critical resources and inadequate skilled staff. And this constitutes more challenges concerning practice and ethical standards in medicine.

Furthermore, candidly discuss key findings with the patient and family that includes a treatment plan even if it may not work. It would be a good practice that local physicians, medical examiners, corner offices are all in agreement as to the real cause of one’s death.

Local doctors must hold one another to high standards as best practices suggested in the medical profession. Equally important, adapting to the cultural shift and embracing younger doctors especially females as studies have revealed an increase in the number of women entering the medical field.

Now what really happen to Johnny?

It is simply not what time he died prematurely on a bench waiting for over 8 overnight hours to see a doctor, but what was the precise cause of his terrible death?

With little-known surrounding this death, the funeral had to be placed on hold because the personal doctor was away and the body could not be released to be prepared for burial. Finally, that explained the five weeks we waited after his death before we were told to get ready.

This unexplainable death represents a habitual medical “guessing pattern” that has caused severe financial, emotional, and psychological pains for families.


The bureaucracy delay continued because only one pathologist serving several parishes in a country with about three million people. An autopsy is vital because it can provide critical-clinical finding that the family may use as a history to safeguard future health.

“Johnny complained about his stomach each time he visited the doctor, and this was about the fifth time in two years,” the family replied.

“Was he vomiting before he arrived?” a question asked.

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 obtain a copy of the medication prescribed?

How do you asked for an investigation when many families cannot even afford the basic prescriptions?

This final conclusion is simply “poor prognosis” and a rush to fill out the next death certificate to fill another empty family burial plot or a general cemetery where each time a family walks by, that wound remains open

Decision fatigue cannot correctly answer thousands of dollars spent on recommended tests, prescriptions, and more test-to-test to the null result of that previous test, funded by family members abroad. It seemed the more questions asked regarding his treatment, fewer answers.

Johnny’s personal story is not unique to these local communities; there were other reported stories of anxious relatives who have returned to check on family admitted for treatment. After eagerly searching for an hour only to be sent to a holding morgue. Additionally, misdiagnosed or waiting for critical surgery for months based on inequality and vital resources continue to exist through an administrative hurdle.


More pathologists are needed and even a second opinion would have built confidence and credibility or what medical regulation properly governs these facilities to obtain an official answer to resolve basic questions.

Also, tracing medical records is another challenge: If you have the ability to pay- upfront, one can find a few local private doctors providing critical education and healthcare tucked away in a plaza. However, the waiting period can be extremely long and despite few official certificates on a back wall of personal accomplishments, more collaboration and rigorous oversights are desperately needed. Even sending ill patients off with a personal doctor’s letter often led to unwanted and added financial burden.

If community doctors do not specialize in certain critical areas of medicine, there need to be an immediate and honest referrals rather than ordering more tests that amount to financial gains. These failures solely represent a lack of humans rights, patient welfare, and social responsibility as many scholars have noted for an effective medical system.

What would Johnny’s file have shown if they could locate it or maybe because his brother was not from town, and asked the rights question. Did they only saw his mental illness often label [Mad-Man] and used that to dictate the level of attention. It seemed since the ward already admitted some seriously ill individuals, one must die for bed space to become available; or may be because he showed up without his own bedding supplies as few argued, they had to bring their own.

Did anyone know that he was once a public servant, an excellent dedicated police officer?

Was he prescribed the right pain killers, or was it based on the ability to pay or did they took his money we sent him, and gave him whatever available on that day?

And if prescriptions being written that may receive payoffs from pharmaceutical companies, who are there to monitor inappropriate use. Frequently prescribed painkillers as studies have shown, have caused addiction and don’t cure the actual symptoms.

Many rural government health-centers seem to only have limited resources for vulnerable groups. After Johnny was first treated and sent home no one absolutely recognizes what happened.

Without any medical insurance, a certain status in life, and if society deemed one as a mental health problem-(mad -man), that can create additional barriers. The moral value some place on human lives; especially the poverty-stricken communities, numerous people put off seeing a local doctor and do not get the required test for early detection.

Failure to engender community trust

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

One argues that people seldom give blood as a volunteer or become an organ donor and only for a price while others saw it as a taboo rooted in distrust of the medical system. “I get it.” The medical practice must implement some rules to retain reserves for others.

Medical education is critical and its starts in the school system to change many cultural beliefs and stigma on top remain a social issue for some; where erectile dysfunction, chronic chest pain, or an unusual lump on one’s body can be cured of homemade drink or alternative medicine. Skepticism of government-funded medication or valuable contribution from international health organizations, to some, it is an experimental drug even as it helps to minimize medical risks.

Basic expectation:

Where are the political leaders and responsible minister of health,” I asked? It seems only when a moral crisis hit the media, rural areas receive notice, or during the national  election cycle. These events filled with promises whipped communities into a frenzy and many often vote against their own upward mobility regardless of political sides.

Numerous have seen promises of better overall health care during an election season, but after it appears nothing has changed where political leaders introduces materials before the blueprint

Absolutely, people die in America, Canada, Cuba, and England as some argue that they have an extended waiting period and a more effective medical system. My own mother died here from cancer, and we still have questions. However, the chance of a person dying on a bench waiting on a local doctor for countless hours is thin.

No one also expects developing countries such as; Jamaica, Guyana, Trinidad, the Haiti, Dominica Republic to name a few with economic struggles to operate on the equivalent level in some key areas as wealthy industrialized nations.

Though there are several personal doctors and nurses still making a big difference, overworked and may be underpaid. What this premature death represents, access to better health care between the haves and the have-nots, lack of key training in some area that put patients first.

If the system does not create overall modernized health care for all, many of whom studied locally or abroad will continue the “Brain Drain” effect, including experienced nurses fulfilling a critical role of these extremely 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 ill?


Regardless of one’s socio-economic background, mental health issues, or pre-existing conditions, all should be given the same medical attention such as a local social sporting event.

The first-class image with an embryonic operation to adequately 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 needs closure. It seems many communities are becoming immune to these sensitive issues until there is another night of music, and this continues without accountability.

Because of your personal influence, escorting us to the beach on our summer vacation, winter breaks, countless beef patties, but your integrity, respect for the rule law, and yes, despite a system that you have sworn to uphold, neglected you, many of us are better public servants today, from what we have learned from you and your high expectation as a police officer, in spite of location.

We may not know what was the actual cause of your death, but I have learned what led to your demise and in our line work, I believe that I have established negligence probable cause to proceed. But by all means, the extended stay was not about the money or looking to submit a claim, it was regarding responsibility and closure.

I did not land to encounter a tragic story, and my priority was not because I can write an Opinion. This situation analysis is to redress that critical shortcoming. We will continue speaking up, so this does not happen again to anyone regardless of their socio-economic status. I was honored to be part of this effort that gave you the home coming one deserves.


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