By R.D. MILLER
The Inefficiency, Complication, Implicit- Bias, and Bureaucracy.
Part I– Many impoverished and developing countries have health systems, but falling ill can quickly become bleak instantly, especially if you are poor and do not have support. This essay is not a prosecution of this lovely shore local medical system but highlights of few systematic deficiencies.
Jamaica and by expansion, the Caribbean have prominent doctors and they have been essential in the condition of lives on these coasts despite an arduous battle to get through the baffling intricacy of the country’s health system.
These personal doctors are even respected than armed police officers, local judges, pastors, or politicians. And their stamp on a note, a frame of reference, or prescription, even though some of their patients cannot explain what they signed regarding their condition, consistently respected. Being a doctor that prestige provides them substantial rights and obligations and responsibility.
While the medical profession aims to provide equal treatment for all patients, healthcare inequalities and disparities prevail. The root of these social disadvantages is a current barrier since colonialism. The World Health Organization (WHO) noted that decent and affordable health care globally remains a leading cause that pushes 100 million people into acute poverty, and several die each year.
I hope this unexpected mission will represent a voice in which others have none, or a few with a voice remain mute to preserve face. These issues discovered are associated with a higher cause of untimely deaths and continuous medical problems according to the experts.
“Saying goodbye to Johnny?”
After the funeral of Johnny and people who attended left, and despite the joy of knowing that they loved him, and dealt with one of life’s inexplicable illnesses (mental health). I organized a flight out of town immediately after giving his eulogy, leaving everything behind with my next job-related task running through my mind back home.
While the rental vehicle was waiting, I went back to say goodbye to his 81-year-old mom. No matter what I had to say to support her and give her strength, I knew that in my heart I would not return to this side of town.
Before I gave an emotional last hug, that would be it. Her drooping eyes looked at me, and her weak hands held mine like she wanted me to stay or something else to say to me. Immediately, my public safety training reminded me never to lay a civil servant, much less a member of my family to rest, with no answer..
I paused and went to a small back room, and asked what happened?… I came back and sat in a small 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 became four days, but it was worthwhile and extra money spent.
If you get sick, speak up.
I am not a medical doctor, nor do I play one on television. However, I know that the medical system, especially in low-income rural areas, could use an upgrade.
Since your economic status can get you more or less medication, it seems no one willing to answer a question about what date and type of prescription provided. A properly trained employee like a customer-friendly staff at a facility or an experienced pharmacist distributing prescription drugs is critical.
There were few symptoms reported of seizures after prescribed medication, and he was never diagnosed with Epilepsy, nor a family history to suggest that underlying genetic mutations. And with no records, my journey for the truth started.
Does the system recognize that over-prescribed drugs can cause an addiction instead of targeting the actual symptoms?
Many studies have shown this simple solution can improve the safety of drugs, and I’ve witnessed the adverse consequences of over-prescribed drugs. And if prescriptions being written that may receive payoffs from pharmaceutical companies, who are there to monitor inappropriate use.
Poor care there is nothing new and the guessing game:
Part II- Our society expects local medical practitioners to adhere to exceptional standards and hold each other accountable, as suggested by many medical experts regardless of one’s socioeconomic status. These centers differ significantly, and because of a frustrating lack of essential resources and insufficiently trained staff, it poses more challenges.
Is there a “Patient’s Bill of Rights” or even a “Nurse’s Bill of Rights?
It would be good practice for local doctors, medical examiners, local offices to agree on the precise cause of death.
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.
Now, what happened to Johnny? The doctor and the local medical center may not have known Johnny, but he knew them.
It is not what time he died prematurely on a bench waiting over eight hours of the night to see a doctor, but what was the precise cause of his terrible death?
This inexplicable death represents a typical medical “model of conjecture” that has caused severe financial, emotional, and psychological pain to families.
The bureaucratic backlog continued because a single pathologist served several parishes in a country of about three million people. A postmortem is vital because it can provide critical clinical outcomes that the family can use as a history to protect future health.
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.
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 to validate his medical records?
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 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 take the money we sent him and gave him whatever available on that day?
How do you get a copy of the medication prescribed?
Also, openly discuss key outcomes with the patient and family, which include a treatment plan offered, even if it doesn’t work, which will often bring comfort.
How do you request an investigation when a lot of families cannot even afford the basic drugs?
This conclusion is a “bad prognosis” and a rush to fill out the next death certificate to fill out another empty family burial plot or general cemetery where every time a family passes, the wound remains open.
Decision fatigue cannot adequately deal with the thousands of dollars spent on recommended tests, prescriptions, and more zero tests from this previous test, financed by savings from foreign family members or by the hard-working pension fund.
Accountability when the light goes down, and one has to advocate for themselves.
Part III- In this journey to find out the truth, the more questions asked about his treatment, the fewer answers provided. Johnny’s personal history is not unique to these local communities and not an isolated incident.
Unfortunately, most times, someone has passed away and their family could not determine the cause of death or say the latest goodbye. The only proof is that tens of thousands are left in debt, lives are not being saved, and the ethical standards of medicine are being swept away in silence.
Imagine a loved one the night before drove back across the hillsides and plains for hours with anxiety, returned the next morning worried if a loved one survives an excruciating pain overnight only to be directed to a morgue because the person died waiting on critical surgery, or no answer of what transpired because a family visiting hour ended a few hours prior. No one knows if that exhausted staff was available for that midnight shift to make patient’s bedside who may need oxygen to help breathing or medicines.
Many of you can relate: The untold administrative bureaucracy files
The attempt to research medical records presents another challenge: If you can pay in advance, you can find some local private doctors providing critical care and education on a plaza in these communities. The office is crowded and the waiting period can be extremely long, but it is not the office’s fault that they may require more doctors to serve the growing and aging population.
You finally walked in and looked around and despite few official certificates on a back wall of personal achievements. One wonders where is a “Board Certification” document? This normally is a good sign that a doctor has passed periodic exams to test knowledge in the field. Though it does not take away from one’s ability and experience, it would give more comfort. They desperately need maybe more oversight and collaboration.
The ongoing waiting for critical surgery is at the mercy of the system. Inequality to vital resources and administrative obstacles that exist seem perhaps kills more patients than the actual medical condition.
“We were waiting on a good time,” And when is a good time, that could have saved his life and many others. However, sending ill patients off with a personal doctor’s letter has often resulted in an additional financial burden that appears much easier.
Even though there are Emergency Management Services [EMS], he may have left on his own not to become another case as reported where patients died before transport arrives. Some argued that is much easier taking a community taxi not equipped to transport a suffering individual.”
These poor victims are stuck with enormous transport emergency bills because most medical services and networks are privatized as it appears. Maybe a few necessary essential medical technologies in the event of an in-office emergency may help.
Declining empathy and our implicit bias.
Part IV- 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.
What this premature death represents, access to better health care between the haves vs have-nots, lack of key training, accountability in some areas that put patients first.
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 a distrust of the medical system. “I get it.” The medical practice must implement some rules to keep reserves for others.
What would Johnny’s file have shown if they could pull his medical records, or perhaps because his family wasn’t in town, and he asked the right question? 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? I imagine how he must have felt like a soldier who departed and served his country in a war and returned only to find himself homeless on the city street.
It seems since the medical center had already admitted some seriously ill individuals, one had to die so that the bed space would become available; or perhaps because he showed by himself itself without bedding supplies as few argued, it is better to have your own.
Finding the right balance for medical pathologists.
Although diagnostic tests are prone 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.
In any medical system, public hospitals and private networks have to buy MRI equipment, and they have to pay for it to stay up to date. This imaging performs a critical role in modern medicine; X-rays, ultrasound, CT scans, and MRIs show structures inside your body in crucial detail.
This very day, we haven’t examined medical regulations that govern these institutions to get a formal answer to fundamental questions as suspicion regarding care. Families possess the right to know even if they provided blood or took it from a patient, to how they arrive at decisions for surgery.
When vital questions surrounding the conclusion met with resistance, the point in asking about the time on the job or one’s qualification, we rather move on.
Today, Johnny’s test result remains inconclusive after hours of seeking to explain recommendations with a member of the team.
The fact is physicians are human beings and have financial obligations: While many patients battle for their lives awaiting the correct answer to reinforce why several tests have been ordered, the ethical principles looking out for the patient rather than economic benefit remain a sensitive balance.
There are many stories of expatriates who died awaiting test results. These findings started from possible “cancer or are it one’s liver, or maybe water around the brain.” It seems to be speculative, which has sometimes led to undesirable surgeries and poor outcomes.
Building trust in your local system.
Establishing confidence is that if the community is key. If physicians do not specialize in some critical areas of medicine, there will be a direct and ethical referral rather than ordering more tests that equate to financial gains. This amount to nothing more than a lack of human rights, patient well-being, and social responsibility, as many academics have noted for an effective health care system.
Part V- Many rural government health-centers seem to only have limited resources for vulnerable groups. After Johnny was first treated and sent home, no one recognizes what happened.
The moral value on human lives; especially the poverty-stricken communities, many people put off seeing a local doctor and do not get the required test for early detection.
Skepticism about government-funded medicines or the valuable contribution of international health organizations to some is experimental medicine, although it helps reduce medical risks.
Who do you blame for that way of thinking by some, and in a system where no one seems to question authority?
Medical education is critical, and it starts in the school system to change many cultural beliefs and stigma on top remains 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.
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.
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 the media, rural areas receive notice, or during the national election cycle. These exciting events have driven communities into a frenzy and many often vote against their upward mobility regardless of political sides.
Many people heard promises to improve their health care during the election season, but after that, nothing changed when the political leaders submitted materials before the master plan.
Sure, people pass away in the Americas, in Canada, Cuba, and England, and these nations equally have long waiting periods and a more efficient medical system. But the risk of someone dying on a bench waiting for a local doctor for countless hours is slim.
My mother succumbed to cancer after seeing the same doctor for 35 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.
No one expects developing countries like Jamaica, Guyana, Trinidad, Haiti, Dominica, to name a few, with economic difficulties in conducting equivalent activities in key areas such as wealthy industrialized countries.
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. It starts with huge medical school debts and ends with a doctor who is often overworked and underpaid according to the experts.
Even wealthy politicians died in the United States, Canada, or England when they while in treatment. If they invested and trusted their local medical system, often promoted for votes, why would they go for treatment when they became ill?
Medical experts talked about doctors shortage is worse than most people think. However, studies have shown, particularly women, there is an increase in their entry into the medical profession.
What if those leaders invest in more family practitioners, internists, and pediatricians, or create a path to become doctors? These specialized treatments and preventive screenings save lives and reduce expensive emergency room visits and hospitalizations.
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.
Home– Far too often, a funeral band has played, food served, but once everyone has left the family, you still have to turn the page. With the lack of key advocates, and a pattern seen too often, these communities become immune to these sensitive issues. Again, 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.
Tough, but we’re moving ahead.
We may not know what the true cause of your death was, but I have learned what led to your death and in our work, I believe I have established a probable cause of negligence to go forward. But by all means, the extended-stay was not about the money or looking to submit a claim, it was regarding responsibility and closure.
Because of your influence, escorting us to the beach on our summer vacation, winter breaks, countless beef patties, block parties you hosted, 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, despite location.
I did not arrive for a tragic story, and my priority was not to write an opinion. This situation analysis is to redress that critical shortcoming beneath the surface. We will continue to speak 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 gave you the homecoming an officer deserves.