COVID-19: Vaccine, Politics, Socio-Economics and are some Caribbean islands pricing themselves out of a return visit?

The Hidden Engine:

The Caribbean tourist industry has been its economic engine. It is the most tourist-dependent in the world according to the World Travel and Tourism Council (WTTC), and the UN World Tourism Organization (UNWTO). For some islands experts also noted that tourism accounts for upwards of 40 percent of the Gross Domestic Product (GDP).

Photo by Asad Photo Maldives

Since COVID-19, travel spending has suffered an unprecedented 42% annual decline (roughly $500 billion) from 2019.  International travel and business travel had the sharpest declines, and experts have noted spending fell 76% and business travel spending fell about 70 percent.

Several decades ago, manufacturing areas like sugar, banana, coffee, poultry, and bauxite; played a key role in sustaining the economy. These jobs were the balance between the service economy that provided what established the middle class.

Sadly, many were sold to foreign investments; and jobs moved elsewhere because of globalization and the development of technology. These investments also followed cheap labor and better tax incentives like tax breaks, grants, reduced costs of opening or expanding a business facility, and free job training.

The companies that remained for about a decade were no longer competitively priced or folded due to massive imports, poor management, and reduced production.

These factory closures have affected communities from local stores, restaurants, bars, and street vendors who depended on these operations. It has increased unemployment, and widen the gap between the have’s vs haves-nots; especially for the dominant Caribbean islands like Trinidad and Tobago, Guyana, Haiti, Dominica, Jamaica, the Bahamas, and other parts of Latin America who were already looking for an economic booster shot.

It has created an extremely a social divide, that made it worse for generation by generation where poverty and inequality have been on the rise regardless of the political side in power. It seems today, more charity organizations asking for aids rather than a platform to develop innovation for the next generation who will be key to the sustainability of these shores.

Taking from Peter to Pay Paul:

Globally, there is an increase in commodities; prices of home building materials even for preparation for school since the pandemic. Additionally, supply chains contributed to increased volatility in import, export, and producer price many leading economic data have shown.

Photo by Karolina Grabowska



COVID-19 has caused an economic shock three times worse than the 2008 financial crisis, economists notes. But nations who were unprepared suffered the more. Though many blame their ongoing financial problems on lockdown, it is not the sole issue.

Since the COVID-19 pandemic, there are reports of enormous fare hikes from taking a local taxi from an airport to a hotel lodging. Sadly, it seems to represent an opportunity for prior lost revenue and will discourage future trips, especially for budget-stricken travelers.

A simple COVID-19 test few argued as required or visiting and departing typically run between 20-35 US dollars. I have spoken to recent travelers who visited Jamaica that it can cost about US$80.00, and that varies depends on the location to get back on a flight.

Photo by Polina Tankilevitch

Another traveler complained that while at airport checkout custom fined her for items because she may have forgotten to take off a sale tag. For several natives going on vacation, it is not unusual to purchase a new set of clothing.

These connected visitors often purchased items also to be given away or returned if not worn. Even a few extra boxes of protected masks to support aunt Jane is being seen as a business trip. In addition, reports items missing after inspection of luggage to clear check out.

Reports have shown excursion trips almost double in cost. Some of these businesses were already struggling financially before the pandemic. It is like you are simply paying for others who are hesitant to travel.

Despite the pandemic risk, some will continue to travel due to heritage, cultural connections, while others just need a mental break.

These deep-roots vacationers’ trips to an authentic small restaurant tucked away on a lovely rural hillside or a small beach shop away from the populated areas with an aunt, grandparents, uncle, or siblings play a pivotal role in the off-the-grid economy disposable income.

Vacation is also beyond the beach and now into urban centers, taking in historic sites and cultural events.  Travel reports have shown there was a growing influx of travelers in places like Europe and North America, and part of ASIA before COVID-19.

Photo by riciardus

Visiting and spending out of protected tourist zones is like direct remittance, where countries like Haiti, Dominican Republic, Guyana, and Jamaica alone accounted for almost ($10 Billion USD) annually according to IOM UN Migration.

A delicate balance:

The pandemic has divided many communities where local government officials struggle on what businesses should remain open or close temporarily. Health ministers also argued many visitors to the region were not adhering to the safety protocol, and I believe they should.

Managing the number of incoming visitors some of whom may not have been vaccinated and the local economic impact is a delicate topic. This pandemic has put leadership decisions between a rock and a hard place. It is a balancing act closing the local economy because others will die from the lack of an economic vaccine.

R.D.

Even though many locals have complied from social distancing, wear masks, and are vaccinated, frustration continues. Some argued that locals are being locked down, while visitors are allowed to move freely and party.

The lack of consistency in local guidelines, from what business will be closed, or street will be blocked to enforce curfews to the type of transportation allowed to operate only add to the frustration.

Many argue it seems leaders are utilizing these times of fear, anxiety, and economic uncertainty to gently push in a direction to gain despotic political power through restrictions. Though it may not be a push to reduce democracy; freedom only comes through knowledge, and reasonableness is only possible if talk achieves consensus. 

COVID-19 survival is like an underground business operation. It is a balancing act navigating the pandemic risk for their economic viability. So, many people march to their drumbeat.

Those who are well-connected, wealthy, politicians and who can afford to self-quarantine, healthcare access, and more than likely already vaccinated; often seem to be the ones who are jabbing fingers and scorned at those who break curves rules, or demonstrating crying for help.

Overcrowding at a local hospital

Some locals are concerned that the healthcare systems had already been struggling in keeping up with critical needs. Additionally, while this surge pushing hospitals to the brink with the worst still likely ahead, the pandemic has exposed its inefficiency, from limited bed space to overcrowding to mitigate this pandemic and other key issues before the outbreak.

Despite the blame game, and people who still traveling, I believe anyone who tested positive for COVID-19 or has other medical issues and is aware of potential medical hurdles would not risk their lives to navigate a few islands’ healthcare systems.

Another shot not in the arm.

Sadly, many politicians in these impoverished and developing counties are like dealers in a casino; they always come out ahead; including other well-connected people. They are salaried employees on the people’s taxes and the impact of this pandemic is less severe.

On top of a fragile economy; local communities coughing up an economic virus that had already been dormant just waiting on a strain to be reactivated. The pandemic has put the region’s governance under the microscope and exposed the fragile labor force and the poor.

Photo by Julia Volk

For decades, it looks like leaders have been playing poker economics where no one knows the outcome of the hand dealt, expecting and promising a more reliable hand each election cycle since independence from once colonial rule.

Today, many educated students are waiting to join a list of call centers with high student loans and limited job opportunities. The idea of purchasing a small house off the grid from a modest job is becoming more challenging.

Some reports show three out of four youths are unemployed. Many students are not achieving the critical academic requisite from the lack of resources, even heading back to the classrooms that were already overcrowded.

Yes, with high unemployment and undervalued currency, dwindling middle class, and increased poverty is breeding added violence from robberies, murders, and criminal assaults.

Generally, any increase in price on basic goods and services such as; bus fare, taxes, groceries, fuel, or government services, and if wages remain stagnant and have not budged in decades, families must cut back somewhere.

Often especially for basic food supplies, prices can vary from an adjacent store a few steps away, with little enforcement only adds to the economic struggles.

Several reports have shown nearly nine in ten voters say they are concerned about inflation, the rising cost of living, and limited job prospects and financial uncertainties have created more economic fever and financial strokes.

What next?

The United Nations World Tourism Organization (UNWTO) has been meeting to discuss a global coordinated partnership on the impact of the Coronavirus on world travel and tourism, according to reports, but who is at the table for the impoverished nations?

Photo by August de Richelieu

With the cost of living increasing globally, the pandemic remains unpredictable, more young people are becoming infected in the region and dying.

Many communities are not even close to a first dosage, where access to the poor, frequently seen through the eyes of politics can be difficult, while others are on the second, or even getting close to a third.

There are reports of people still refusing to be vaccinated. However, I believe that there are no more valid excuses for not being vaccinated other than health reasons.

Many impoverished people who were already left out of the economy instantly feeling the brunt of an outsider; especially the ones who refuse to be vaccinated. It seems they are the ones should be rounded up like slaves when they voiced their concerns.

Often reaching out with a small support group with a conversation about the vaccine may help some hesitancy due to people’s conflict with religious ideology, distrust of their leaders, or ignorance.

Nurses, doctors, and scientists are key in public health awareness and dispelling myths communicating with and educating patients and caregivers about the benefits of vaccination and vaccine safety.

One hope is that access to this vaccine, does not become for sale or used as a political platform for future election votes across some of these shores, and elsewhere


The sun will rise again on these shores, and if people follow the science and recommendations, it may lead to less need for targeted price hikes.

Photo by Jonathan Petersson

There must be a balance where everyone can navigate this recent significant change; support each other regardless of your political views, locals, incoming and departing visitors working collectively where no one felt left out or pressured to have a sense of normalcy.

See you again soon!

R.D.

Is it time for a Rastafarian prime minister for Jamaica, or the region?

The unintentional award.

“First, they ignore you, then they laugh at you, then they fight you, then you win,” Mahatma Gandhi.

Monday, April 5, 2021, the Jamaica Observer noted that “Minister of Security Dr. Horace Chang claims if more individuals replicate the respect that “true” Rastafarian men show to females, it would reduce recent reported heinous acts of violence against women

The acknowledgment stopped shy of advocating that any Rastafarians (Rasta) seize on a more active community or an appointed role on a task force to focus on violence.

Having been publicly recognized for peace; safety, self-dependence, and humanity. Is it time for a Rasta to seek Jamaica’s highest office; including other parts of the Caribbean, maybe CARICOM, and offer a pure path for socio-economic improvement and to reduce crime?

Should these islands hope soon to say, “Welcome First Lady Queen, someone like “Ifrica” to the Nyabinghi Mansion that serves all communities?

Photo by Lucxama Sylvain

Many locals argued that the government ran out of ideas to address an uptick in crime in this delightful and vibrant nation. Others suggested it was about time their lifestyle be recognized as a model.

Though this public declaration is viewed through the political lens; any domestic violence awareness or public safety is positive news regardless of the messenger. However, recognizing Rastafarianism cannot be captured in a tweet, plug, or sound bites.

It is a fact that despite Rastafarian’s popularity, many individuals who wear natural hair on these shores beyond Jamaica still face discrimination.

Photo by Anna Shvets

The fine print:

Violence only can be pursued if reported, so it does not mean that domestic violence appears not to occur in a certain culture, but you must give credit when it is applicable 

The Rastafarian community has a wide range of skills and qualifications, dispositions, and competencies. Their skills could play even more of a broader role in mentoring the next politician, doctor, police officer, teacher, counselor, or investment banker should the government invest more in this community.

Another way to give credit is simply to analyze the amount of Rastafarians with criminal records or incarcerated compared to their population. Reports have also shown that even when some Rastas are incarcerated, they have a lower recidivism rate. 

For over a decade, reports have shown that Jamaica ranked in the top 10 countries of most violent places with an average of over 30 deaths per 100, 000 thousand citizens, but this opinion is not about the murder rate or lack of resources.

Photo by Kat Wilcox

Though violence is ubiquitous, and the region is no stranger, which is a public health issue. Addressing crime and other social-economic problems on these shores is often woven in complexity surrounding politics, law, culture, and economic status.

Many Rastafarians’ skills can collaborate their approach to life by promoting peace and love and have a broader impact on these communities riddled with socio-economic anguish, political dogma, and violence.

The resistance and struggle with an ongoing foot on their necks.

I am not a philosopher, nor is this opinion an undertaking to explain its origin, but pick up your R**s) hand out of my hairstyle, and foot off the man’s neck. 

British royal insignia 

Since the mid-1930s, shortly after the inauguration of Ras Tafari as the Negus of Ethiopia, meaning “King of Kings. Jamaica’s Rastafarian began promoting the teachings’ authority of Selassie over King George V (Jamaica was formerly a colony of England, but it has faced enormous resistance, according to scholars. 

Rasta made the anguish of many black people a pedestal of their consciousness to free themselves from slavery and neocolonialist chains and return to Africa research has shown. 

From 1940 and 50s, many branches opened, led by Leonard Howell, a former member of Garvey’s Universal Negro Improvement Association who was incarcerated for preaching its culture.

During this period, reports have shown that the Jamaican Government considered Rastafarian’s ideology dangerous and subversive and a menace to social norms.

Sadly, many were marginalized rather than being accepted as determined, valuable citizens linked to the same slave ship. This resulted in greater isolation from education, employment, land, and housing.

Photo by Maria Orlova

Rastafarians were made to be seen as deviant and should be rounded up like slaves from an alien world. The cultural isolation created an oppressive mentality that created tension mistrust in authority until now.

It was like from the 1880s into the 1960s, many American states enforced segregation through “Jim Crow” laws and other places still operate like a depiction of George Orwell’s best-known novels–1984- Animal Farm: “All are equal, but some are more.”

Fortunately, despite being discriminated against, they did not resort to disturbances or violence like Paul Bogle; one of the nation’s heroes fought with law enforcement under a colonial government in the Morant Bay Uprising on October 11, 1865.

Paul Bogle (1820 – 24 October 1865

Total independence need more than published paper, but also a mental shift:

John Robert Lewis is one of my heroes, and an American statesman and civil rights activist who served in the United States House of Representatives for Georgia’s 5th congressional district from 1987 until he died in 2020. He was a proponent of good trouble, and maybe this 1865 uprising, was ahead of its time.

Despite an apology in 2019, when the government of Antigua apologized for the nation’s treatment of Rastafarians at a meeting of the Organization of America States (OAS), it will not change overnight from these delicate quiet decades of social distancing.

The splinters of history have given the colonial state of Jamaica and others in its system along these shores, and elsewhere globally, a free ride on how they have been ridiculed and treated.

Unfortunately, the architectural class system requires a psychological shift going back to the classroom for absolute acceptance. Today, some even maintain there is rationale to sustain them as an outcast.

In July 2020, the Supreme Court of Jamaica said a student could not attend classes if she did not cut her dreadlocks according to reports. This rule further erodes the distrust in government, and I believe to maintain a class system.

Dale and Sherine Virgo with their two children, including 7-year-old ZV. Photo Credit: WP

According to several reports, the minister of education, Karl Samuda, declined to comment on the ruling, which came on the eve of Emancipation Day, celebrated in Jamaica and elsewhere to mark the end of slavery in the British Empire.

Stepping back and feeling the Rasta vibes:

Rastafarians have been the cornerstone even it was an idea of social equality, peace, brotherhood, environmental preservation, liberty, resistance, independence, and universal love. They have been a critical voice of poor, black, oppressed people of Jamaica and beyond.

Though local cultural struggles persist, it is apparent that Rastafarianism is not a clearly defined area, but many people can identify with their passionate vibes that have gravitated to their values and peaceful lifestyle across all races.

Rastafarianism has come a long way since the 18th century when Ethiopians emphasized an idealized Africa. It gained international attention, and thanks to the music of devoted Rastafarian Bob Marley and others.

Bob Marley

The Jamaican government or any other place does not require a crisis to recognize that where the Rasta lives, make ends meet, there will consistently be peace (one love).

As (Jah Crew) a reggae superstar said in one of his songs, “Rasta is passing through.”

Though some of us invested in razors, or at the barbershops, do not wear the dreads living in a world where some rules are defined for us, we accepted with a signature for our economic stability, but quietly we are Rastas in our approach to life where internally, peace, love, humility remains

The reggae band, Morgan Heritage said in one of his songs, “you don’t hiffi dread to be Rasta”.

Once you arrive in the Rasta’s place, he or she greets you. No need to look around because it is quite a level of respect, hospitality, and calm that comes over you. There are countless stories of the comfortable place they often offer for an extended or temporary stay on these shores.

Regrettably, it took violent headlines to recognize them despite their plight; they remain a delightfully peaceful culture.

Far too often, it seems, Rasta must speak to show he is intelligent and frequently seen by their dread-locks before exploring their brains.

Rastafarian movement culture and its context run deeper than grow your political dreads or smoking marijuana. Today, their peace-making practices may be the best thing to calm these rough oceans.

The Honorable Prime Minister (Ras)

What would Rasta’s first 100 days in the office look like?

The debris from colonialism, poverty, social disadvantage, and oppression, I do not believe The Honorable Prime Minister (Ras) will solve it immediately, but how would you know if you do not give them a chance.

Photo Credit: Fenkel Production

Today, predominantly capitalistic means and foreign investments have created jobs, but self-reliance has diminished. It has created a wide gap between the haves vs. the have-nots.

The Rasta administration may have an answer from a bottom-up approach, promoting local production and getting back to more self-reliance.

The balance eliminates bias; corruption, promotes diversity, and national security will be key and a diverse board that will represent everyone at the table; and a chief priority that matches their message, to change course on many fronts.

Sure, they may debates on lighting marijuana in the house of parliament. I doubt there will be a black image of God or Haile Selassie’s divinity in the local churches to replace some of what is there now, but more sociopolitical consciousness.

While the “Reparation” debate continues through the monetary lens by many leaders. Prime Minister Ras’s approach maybe not be the size of an account, but a mental shift from hopelessness, crime, abuse of women and upward mobility for the nest generation.

This will promote economic growth even if you do not have dreads, where peace and prosperity, honesty, stability, and calm for all.

Yes, the movements are more than of August 20, 2012, when Rapper Snoop Dog has transformed his name to Snoop Lion, following his interest in Rastafarianism.  

Child abuse is Beyond April’s Awareness, and an Everyday Occurrence

By R.D. Miller

More than April

During April, several communities, schools, health departments, including domestic violence centers will wear the color blue to show solidarity in honor of National Child Abuse and Awareness. April brings not only a new season but a more radiant spirit, fresh flowers, and birds, and a break from the cold winter for many.

Photo by Max Vakhtbovych

I have always enjoyed the changing of the seasons, especially from winter to spring. It reminders me that there are a few things around the home that need to be fixed. It can be absolutely ruined from the previous season that may be ignored because it looks excellent on the surface.

This hastily formed mentality often parallels how child abuse gets overlooked until it becomes a major repair, got pushed aside hoping it can last another season.

Many of us have questioned behaviors we encountered and never bother to inquire for whatever reason. Sometimes, it is too personal, revisited old wound, it is an over there issue or we are simply helpless because of resources, or too busy.

I however remember a videotape of an uncle trying to sell his young niece for sex to generate a few dollars. This story is just one and I am sure many of you are aware of an incident and it is not on tape, but does that mean it never happens?

So, what do you do?

Awareness is speaking up, and if you are a victim, seek specialized help. Make sure you trust the person who will hear your story and have a backup plan if you do feel uncomfortable and not to be re-victimized.

Understanding and identifying even the presence of psychopathology of sexual deviancy by some perpetrators or risk factor of becoming abused takes collaborative efforts by a unified community and it is everyone’s responsibility for prevention beyond April.



Child welfare professionals can play a critical role in helping identify possible substance use disorders (SUDs) and supporting families in overcoming safety barriers.

Your teacher, a family member, pastor, friend, political leader, and others in aware authority fail to discuss or prevent perpetrators of this crime against humanity share the same responsibility.

“It takes a village to raise a child,” a famous argument made by many. However, reducing these incidents and promoting awareness in April, despite its intention, can be difficult where a village often does not exist.

Sadly, especially in many impoverished and developing countries where they are struggling due to socio-economic and high criminal elements issues, polarization, inequalities coupled with ignorance, cultural traits, and taboo and barbaric ideology, a victim’s story easily gets lost.

Furthermore, negative portrayals of a victim simply by shaming, and minimization promote tolerance for the negative behavior. It can hinder even an investigation to hold perpetrators accountable, or treatment to reduce the child abuse cycle.

Beyond April’s Numbers:

According to the National Sexual Violence Resource Center, nearly one in two women and one in five men have experienced some type of sexual violence and victimization.

The International Labor Organization also reported that about 21 million people are victims of human trafficking, for sexual exploitation, especially women and children. This affects all communities, especially minorities.

Child abuse is defined as the non-accidental physical or emotional injury caused by an act.

• Educational neglect

• Neglect of basic needs

• Medical neglect

• Psychological neglect

• Child sexual abuse

There are also different types of child abuse violence from incest to trafficking, and in statutory rape relationships where adults engaging in sexual contact with minors.

Key victim assessment is a typology of an intake process, documentation, interview, or evaluation in assigning the challenges, confidentiality of the victim to ensure correct support beyond an interview.

One of the most effective strategies is supporting families before they reach a crisis.

Global Action also noted despite billions invested, to combat this issue, many people nonetheless believe this is not their problem. This type of thing only happens over there. As society’s disconnect grows, we are more connected far more than the devices inform us, and whatever happens over there often will have an impact over here or the other way.

As I have argued in the past, Boko Haram is not just a Nigerian issue, and this terrorist group might have taken 250 young women at one time, but in many other regions even where many vacations and experience the beautiful beaches and sunset, a young child goes missing daily due to child abuse, and that number is still rising.

These communities need to undertake a more comprehensive step to address as reports have shown an uptick in child abuse even death, and not only photo-ups just to send out an image of selected empathy or saying what is politically correct.

If leaders want to establish a lasting legacy, these issues must be at the forefront of the community agenda.  Child abuse topics should be part of all political debates for a candidate who seeks higher office.

Society cannot continue allowing an at-risk child’s story to be silent because everyone identifies the perpetrator especially due to one’s financial status, position held in the community, or family support one provides.

Analyzing next April:

On March 6, 2016, Johns Hopkins and American University researchers published what they called “sweeping bias in non-black teachers’ expectation of black students.”

Photo by Nesrin Danan

What does this have to do with child abuse you might ask?

Everyone is entitled to their own belief, and not everything should be perceived through the lens of black and white. However, the interpretation of information among influential people with decision-making power that can have a lasting effect has to be free of biases.

I believe the low expectation of non-white students as the sty shown by some white teachers is as dangerous as some who target a youthful person because he sees no hope.

Social neglect tends to cause more victims in the long run.

If a child’s development fails due to bias, it is no different from an academic system that allows criminals to pass through and become teachers, volunteers in schools, or churches that prey on innocent children.

As many studies have shown, such as a sexual offender who holds a distorted belief of their victims, if one has low expectations regardless of race or socio-economic status or culture; if a student person happens to be missing or becomes a victim of psychopathic abusers, it is less likely to put in the to find and protect this child.


Often, and sadly, when one addresses child abuse, the visible scar tends to be the only focus. However, when these children become victims, it is not solely due to diminished expectations, but the combination of the lack of resources, xenophobia, poor parenting, and many other community issues that failed to invest in child development. And therefore lessen the chance of succeeding.


Photo by Luis Dalvan

Today some of these neglected and abused children presently find comfort under a bridge from a passing business person who exploits them even more.

Many in wealthy home also being disguise on an electronic platform because the emotion is between the victims and the abuser on the screen.

Some designate it as bullying, but it frequently led to physical and sexual abuse by a perpetrator who uses vulnerability to their advantage.

Rebuilding April’s Awareness:

Sexual exploitation education are areas of society that will forever link with young people such as with media, politics. As a result, when society searches for answers to forge a better union, most events will provoke debates, resources and awareness.

Sometimes the experience one brings is simple from his or her social mobilization process. Therefore, it can be challenging to separate one from the environment that has been created, and this is why listening is key to the victim’s story to develop trust and prevent abuse.

Photo by RODNAE Productions

It also stretches to the offender, to develop an analysis of why one may believe it is normal behavior.

Poverty and inequality make it a daunting task, but April’s awareness cannot disappear when the season changes. 

Sadly, up the road, down the hill, at the local shops, child abuse up until now can be a muted subject.

It is not always due to low expectations, but where more victims are caused due to classism and other economic stratification.

Managing these crimes of opportunity is simply becoming more reactive, and when these lovely days or months approach it has to be beyond a spring cleaning until another color emerges.

What next? Domestic violence and so on.

This crime against humanity;  coupled with the collapse of society’s moral compass, whether in an urban city, rural area, or along the shores, child abuse is uncomfortable to discuss. However, how society corrects itself and builds for brighter surroundings, security and prosperity will make beyond April worth noting.

OH-DEAR`

We~ Are~ All~ in ~It ~Together~ Podcast`

Sadly, too many in our community are being deprived of their rights to a fruitful, peaceful life, and the pursuit of happiness.

Calling Grandma 25 years ago

Do you feel me, do you hear me, do you understand me? Podcast

A brief look at leadership abilities, the aptitude to recognize emotions; needs, and pain in moving a community forward

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Have you seen Johnny’s Doctor? The medical uncertainties of being poor and sick in Jamaica`

By R.D. MILLER

Part IThe 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.

R.D

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.

Photo by EVG Culture

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.

Photo by RODNAE Productions

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.

Photo by Klaus Nielsen

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.

Moving forward.

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.

REST IN PEACE (RIP)