By R.D.
The Eternal Struggle of Inefficiency, Politics, Complication, Implicit Bias, and Bureaucracy.

Access to adequate and affordable health care continues to be a significant factor in global mortality rates, as highlighted by the World Health Organization (WHO) and other medical experts.
While the medical profession strives to treat all patients equally, healthcare inequalities and disparities persist. Some of these disparities and social disadvantages can be traced back to colonial rule along these Caribbean shores.
According to the expert, a significant portion of the global population, approximately 2.4 billion people, currently lack access to basic healthcare facilities.
Whose responsibility is it to ensure the well-being of individuals: elected officials or the private sectors that dominate this industry, particularly in impoverished and developing countries?

In countries where the healthcare system is managed by the government, there can still be a significant wait to receive the necessary treatment. According to experts, this problem has resulted in numerous deaths each year, particularly among those who are economically disadvantaged.
Witnessing the medical tragedy firsthand.
Our family’s tragedy serves as a poignant reminder of the systemic flaws within this lovely island’s medical practice or system.
While the coastlines, beaches, sunsets, and friendly smiles are undeniably enchanting, falling ill can be a challenging ordeal, particularly for those who are impoverished and lack necessary medical care or support.
There are highly skilled doctors available in Jamaica and throughout the Caribbean. Their contribution has played a crucial role in upholding the standard of life on these islands.
Being a doctor, or a leader in the medical field comes with significant authority, trust, responsibility, and accountability. They are highly respected, even more so than armed police officers, local judges, pastors, or politicians.
Moreover, even though some of their patients are unable to read what they wrote regarding their medical condition, their signature of recommendation or prescription is always respected.
Even with all their knowledge, achievements, and immense power, understanding the complex workings of the nation’s healthcare system can still be a challenging task, especially for those who are less fortunate or lack connections.
Again, this is not an indictment of the entire system, but it does have some serious problems that need to be addressed.
Bidding farewell to Johnny, his story, and the medical failure

After delivering his eulogy, I had a flight booked to head back home, already thinking about my next job-related task the following day. He had to endure a difficult mental health condition that life handed him for decades, just like countless others around the world.
You may encounter them while walking down the streets, under a bridge, an abandoned home, or within these communities. They are often overlooked, forgotten, and left to fend for themselves. But they are someone’s dad, brother, cousin, or uncle.
Despite his mental health issues, he was able to care for himself, function properly, and pose no threat to the community.
It was heartwarming to see the love and affection they had for him during his funeral, knowing how deeply they loved for him while he was alive. As everyone gathered at the repast, the moment had come for my final farewell.
I came back to bid farewell to his 81-year-old mother while the hired vehicle patiently waited. Deep down, I was aware that no matter what I said, the chances of me making the journey to this part of town to support her and provide her with extra strength in person after her son’s funeral were slim.
There was a profound sadness in her eyes as she gazed at me, and her hands clung to mine with a firm grasp, as if she had a final message to share or a reason for me to stay.
I waited an extra minute before entering a small back room, approaching another family member, and questioning as to what caused Johnny’s horrible demise.
I returned and sat in a little hallway, watching folks pass in and out with a lot of unanswered questions. Should this be another funeral and we go on? I wondered.
During our summer and winter breaks, I couldn’t help but admire how he looked after us. He had a way of showing love, care, and instilling important values in everyone he met.
Unfortunately, his mental health struggles eventually overshadowed who he was.
How could someone just toss aside those valuable life lessons? “What on earth would he have done?” I asked.
I have been trained in a field which emphasize the importance of providing an explanation or seeking closure before burying a civil servant or a family member.
My brief trip unexpectedly transformed into a five-day journey, but it was undeniably worthwhile as I unraveled the complexities of the medical system and sought the truth or evidence.
Now, what happened to Johnny?
According to others who saw him on a regular basis, including his family, Johnny visited the doctor frequently, complaining about his stomach on each time. This happened around five times over the course of 15-20 months, and each time he used money provided by family members abroad to pay for his visits.

At first, what were the documented concerns?
“Did he vomit before arriving?” Question asked.
How did he arrive at the facility, and can we have a breakdown of the thousands of dollars spent?
May I inquire if there were any records or follow-up care provided when he was admitted for the first time and subsequently discharged?
Were there any follow-up visits or calls to verify if the most recent medication was effective?
The prescription and issuance of medication at the medical center should ideally be accompanied by a receipt indicating the amount paid and type of medication.
Who attended to him? Or was it because of his mental illness that no one bothered to notify or call to ensure that it was administered correctly?
How can you obtain a copy of the prescription medication? This became like a strange language.
Johnny was familiar with the doctor and the local medical center, despite not being known by them.
The initial interaction with an intake or evaluation staff at these community medical health centers is of utmost importance. The decision made by these intake units could have life-saving consequences.
Many patients’ lives are greatly affected by classism, poverty, and inequality, which diminishes their value to mere monetary worth.
Unfortunately, like many other places, it seems a person’s social or economic status dictates their value in today’s society.
Despite perhaps unclean appearance and potential need for hygiene, it is important to consider the urgency of someone seeking help before dismissing them based on surface-level judgments.
The game of guessing!
Decision fatigue cannot appropriately deal with the thousands of dollars spent on recommended tests, medicines, and additional tests from the previous test, to test the outcome of the prior test, all funded by funds from hard-working family members abroad, some of whom are on fixed income.
This is one of the reasons why many families have fallen into financial catastrophe and yet have no solution.
When you obtain the results, please notify the family?

The time he passed away on a bench while waiting for a doctor for over eight hours in the middle of the night is not the main concern, but rather the exact cause of his tragic demise.
Although our society cannot blame all losses on poor care, this “inexplicable death” embodies a familiar model of suspicion” that has caused financial, emotional, and psychological anguish for many families.
Where is his doctor when to ask follow-up questions and verify his medical records? Who takes his or her place at this medical facility if he or she is out of the country on vacation?
The exact cause of Johnny’s death remains a mystery; however, the family must either embrace or reconcile the information provided in the official death certificate.
It is truly appalling that the family was contacted after his passing to inquire about symptoms, possibly in an attempt to justify the information that should be recorded on the death certificate.
The Office of the Medical Examiner is responsible for identifying the cause and manner of death. How could they have come to this decision if he hadn’t been treated for cancer and had no prior diagnosis, despite years of evaluation by medical professionals?
What were the reasons he was admitted for several days, given fluids, paid for testing, and thanked you for his care?
Do you happen to have a copy of the cancer medication that your team has kept? Additionally, were any recommendations given regarding a treatment plan.
We are still waiting for a response.
If they released him alone on the street, where are the documents of his treatment plan, or what caused his discharge if he returned to the center in a few days for the same medical issue?
Was he prescribed appropriate pain relievers, or is it based on his ability to pay, or did they confiscate the money we sent him and give him whatever was available that day?
“Speak up, ask questions, and demand an answer if you become ill.”
There were several reports of seizures after he was given medication. They did not, however, diagnose him with epilepsy, and there was no family history to suggest any underlying hereditary mutations in genes.

Despite the lack of documentation, our relentless quest for the truth left us with even more questions after each visits to different medical facilities he visited.
I am not a doctor and do not play one on television. I continue to respect and admire their work, but I am aware that preventive medicine and the medical system, particularly in low-income rural counties, could benefit from an update, improved accountability, and increased access for the poor.
It was quite frustrating to find that no one was willing to provide any information regarding the date and specific type of prescription given.
An effectively qualified employee, such as a caring intake staff member at a local hospital or a knowledgeable pharmacist distributing prescription drugs, can help save lives.
Does the system acknowledge the potential for addiction when multiple prescriptions are over-prescribed, instead of addressing the root causes of the symptoms?

Research indicates that administering a controlled chemical to patients despite concerns, and neglecting to provide counseling, can significantly elevate the likelihood of overdose and mortality.
Through my professional experience, I have witnessed the detrimental consequences that can arise from the overuse and misuse of medication in the absence of assistance or awareness.
As I delve deeper into the inquiry into his cause of death, I questioned the lack of monitoring for prescribed medications. It makes me wonder if pharmaceutical companies influence the use of their drugs through financial incentives, and if there are any safeguards in place to prevent misuse.
From my conversations with a few patients, it seems like providing a sick patient with a personal doctor’s letter often leads to additional financial strain without effectively addressing the patient’s needs.
Let’s return to the probe into Johnny’s death.
The delicate balance between integrity, moral responsibility, and ethical concerns
Due to the limited number of pathologists available to serve multiple parishes in a country with a population of approximately three and a half million people, the bureaucratic backlog continued to persist.
It seems that the delay in burial may be connected to the backlog, as the family had to wait for quite some time before being notified to make arrangements for the burial.
Johnny’s conclusion is a “bad prognosis” and a haste to finish the next death certificate in order to fill another empty family burial plot or general cemetery. For many families, the wound remains fresh while driving past or visiting a burial ground.

Given that many families cannot afford even the most basic medicines or burial costs, how can one seek an answer when a loved one dies and there are issues about the death or how the reports or cause of death are being handled?
Discussing the treatment plan and potential medical outcomes with the patient and family can foster trust, comfort, and fairness in the system, even if the desired results are not achieved.
It is crucial for local doctors, medical examiners, and the coroner’s local offices to reach a consensus on the exact cause of death. Their primary focus should be providing families with independent answers, rather than being preoccupied with fees.
An autopsy is crucial as it may reveal vital clinical findings that can help safeguard the family’s future well-being.
If there is uncertainty surrounding the cause of death, it is considered acceptable to use terms such as “unknown,” “undetermined,” “awaiting further examination,” or “probable.” It does not affect one’s professional reputation.
Although it may not offer solace to loved ones, it does shed light on the moral expectations placed upon individuals in disadvantaged circumstances.
This premature death reflects a gap in access to better health care between the haves and have-nots, as well as a lack of critical accountability in some sectors where patients should come first.
Growing implicit bias toward poor patients and lack of empathy.
Johnny would be unable to obtain blood unless a member of his family or someone else contributed in advance. Some believe that people rarely volunteer to donate blood or organs, while others see it as a taboo stemming from distrust of the medical system.

Indeed, donating blood is crucial. I fully grasped the importance of maintaining a balanced reserve for the benefit of others. While the argument is sound, it promotes a tit-for-tat mentality, leaving those without a support system at a disadvantage when it comes to their social welfare.
Nevertheless, it is crucial to establish certain regulations in the medical field to ensure resources are available for others especially the poor.
What would Johnny’s file have revealed if they had access to his medical records?
Did they only see his mental illness, which was frequently labeled [insane- or mad man], and use that to determine the level of attention?
Did anyone know he used to be a public servant, a dedicated police officer?
Individuals, regardless of location, community, or status, must be able to get the information and support they need for their medical care. Absolutely no one should be greeted with silence when they seek assistance.
Given his status, it appeared that one had to die for a bed to become accessible; or perhaps because he arrived alone when the pain was unbearable without bedding supplies, as many argued, it is more useful to have your own and keep it under close supervision.
What happened to the bedding and additional items he brought to the facility when he was admitted?
They had previously turned him away several times, and it appeared as if the medical center had already admitted patients who had arrived earlier and had reached bed space capacity, so please wait on God.
I imagine he must have felt like a veteran who left to serve his country in a war and returned alone to find himself homeless on a city street.
Without a family member or an advocate, you are on your own.
Is there such a thing as a “Patient’s Bill of Rights” or even a “Nurse’s Bill of Rights?”
The community expects local medical practitioners to adhere to high standards and hold one another accountable, as many medical experts advocate, regardless of socioeconomic status.
These centers vary greatly, and they face additional challenges due to a depressing lack of essential resources and inadequately qualified personnel.
Economic disparities and administrative stumbling barriers may have kill more individuals than their medical conditions. The continued wait for crucial surgery looks to be at the mercy of the system.

For those who cannot afford to pay in advance, death may be the only option to alleviate their suffering.
It is a harsh reality that every minute, lives are lost all around the world due to various causes such as medical conditions, accidents, violence, and other unforeseen circumstances.
Nevertheless, it is expected that individuals receiving medical care will be guided by healthcare professionals to effectively and compassionately manage their situation.
It’s absolutely mind-boggling how some of these local emergency rooms and medical centers seem to have turned into death traps.
Seriously, it’s like they’re competing for the highest mortality rate!
Once again, we find ourselves in a situation where resources are scarce and the system seems to have a knack for making the downtrodden settle for whatever little care is available, even in emergencies. It’s almost as if their lives are worth absolutely nothing!
The reality on these medical systems:
Johnny’s situation is not unique to these communities, nor is it an isolated incident. The more questions about his treatment that were asked, the fewer answers that were given.
The absence of ethical standards in medicine is causing the loss of lives, while the silence surrounding the issue allows thousands of dollars in medical debt to serve as the only evidence of care.
Many lives have been lost on these shores, as well as in other impoverished and developing regions, leaving their families unable to find closure.
Some individuals are still clinging to the phrase “It is under investigation,” seemingly hoping that the anguish of the victim’s family will diminish over time.

Imagine accompanying a loved one on a long journey, traveling through the hillsides and lovely plains for hours with anxiety or returning at dawn frightened that a loved one may experience severe pain overnight to be led to a morgue and no answer.
The extra misery, the hospital clock buzzed, the end of family visiting hours, and they unwillingly bid their farewells, unable to provide any overnight support; knowing that resources are limited, who knows what care will be provided overnight.
Nobody knows if an overworked staff on duty for that midnight shift had time for someone who might need oxygen, clear their vomit to help them breathe, or administer pain medication..
Heartbreaking news has emerged of people sadly dying while awaiting critical surgery, which is not new.
Medical pathologists must strike a delicate balance.
Doctors, just like anyone else, have their fair share of financial obligations. It’s no surprise that in any medical system, both public hospitals and private networks have to invest in purchasing MRI equipment and ensuring it stays up to date.
The imaging system is a crucial element in modern medicine, providing X-rays, ultrasound, and CT scans to capture important details.
While diagnostic tests can sometimes give false positives, the role of a pathologist as a team member in helping other healthcare providers make diagnoses is absolutely vital.

When does honesty and integrity balance in ensuring additional requests for tests are not based solely on the dollar amount, but rather on the hope of saving lives?
Johnny’s test result, like the others, remains inconclusive despite multiple tests, and even retesting the previous one yields no clear explanations or recommendations.
Is it liver, stomach, or kidney, cancer, water on the brain, wheezing, shortness of breath, excess mucus, and chest tightness, or diabetes, heath issues that has resulted in surgeries and, in some cases, fatal outcomes?
While many patients struggle to find answers and undergo various tests and surgeries, the ethical dilemma arises from the intersection of public health responsibility, private financial burden, and potential benefits, considering the hidden privatization linked to the public medical services and networks.
Furthermore, because of their power in these communities and minimal post-procedure monitoring, if no one is held accountable for negligence, as medical professionals have warned, it would only lead to further errors.
This just harms other fine doctors and nurses who are attempting to do the right thing despite inadequate resources.
Even today, it is unclear what medical standards effectively safeguard a family seeking appropriate answers to core questions of accountability.
The files of administrative bureaucracy
There’s still hope in the system! If you’re willing to pay upfront, you might just stumble upon some exceptional local private doctors who offer top-notch critical care in these communities.
The office is clearly struggling to keep up with the increasing and aging population, which highlights the urgent need for substantial resources to revamp the medical system.
Many patients have remained in a crowded area for an extended period of time.
Where it become problamatic, getting medical records has suddenly become a lot more interesting.
How can Johnny and others determine if a physician lacks expertise in crucial medical areas and is ordering unnecessary tests for potential financial gain if his file is now missing?

Despite the fact that there are few official certificates on the back wall of personal achievements. One has to wonder where the “Board Certification” document is. …
This is frequently used to demonstrate that a physician has passed periodic exams to confirm proficiency in the field.
According to medical experts, this amounts to a violation of human rights, patient well-being, and social responsibility.
Johnny and many others may have left some of these offices on their own in order to avoid becoming another case where patients died before Emergency Management Services [EMS] arrived.
Building trust to reduce barriers in the local system.
Building trust within the community is absolutely essential. In impoverished communities, it’s unfortunate that some people delay seeing a local doctor and miss out on important tests for early detection.
This is often due to a lack of trust and negative experiences among their families and friends.
However, these interventions may have the potential to prevent diseases, lower medical risks, and extend life expectancy, but who get access and are they free to the poor?
Barriers often give rise to doubt, and even medications funded by the government or important contributions from international health organizations are seen as experimental drugs by some people.
With no medical insurance, a certain status in life, and if society deems one to be a mental health problem-(mad -man), additional barriers can arise.

Medical education, such as access, saves lives, and it begins in schools by changing some cultural ideas and stigma, which remain a social concern for some.
For example: Erectile dysfunction, chronic chest discomfort, or a peculiar mass on one’s body might necessitate the care of a trained doctor, not a homemade drink or alternative medication.
Who do you blame for some people’s way of thinking, especially in a system where no one seems to question authority or leaders, and where there is constant minimization to deflect?
The politics of the medical system, and it will get better after this election, and the next?
Unpacking Johnny’s route through the system and looking from the outside, it appears that political leaders submitted items before the blueprint of total care, which served as talking points and picture opportunities until your family needed emergency medical attention.
“Where are the political officials and the minister in charge of health?” I inquired. …. When a moral crisis strikes or during the national election cycle, these events have thrown communities into a frenzy, and many people, regardless of political affiliation, vote against their upward mobility.

Many individuals heard promises to enhance their health care during election campaigns, but nothing has changed since; especially for the underpriveliage.
What if some of those leaders invested in more local family practitioners, internists, and pediatricians, or established a path to becoming a physician?
These specialized treatments and preventive screenings save lives and reduce the need for expensive emergency room visits and hospitalizations.
Why would they seek special treatment abroad in countries such as the United States, Canada, or England for surgery when they have health problems locally, and where some wealthy individuals have died if they trusted their local medical system?
Many wealthy countries, including the United States, Canada, Germany, and the United Kingdom, experience high wait times for care, similar to these less efficient and well-funded medical systems. However, the chances of someone dying on a bench for over 8 hours while waiting for a local doctor is slim.
We have another family member who died of cancer after seeing the same doctor for 40 years and having excellent medical insurance, and while we do not question the cause of death, each family will wonder what else they could have done, but the lack of knowledge about the cause of death, as well as neglect, would have been concerning.
What comes next and how to proceed.
If the healthcare system fails to modernize in certain crucial areas. Analysts anticipate that the movement of knowledgeable nurses and proficient doctors from these communities will persist in, adding to the phenomenon known as the “Brain Drain” effect.

A number of these medical students have undergone training both domestically and internationally. This will lead to a significant decline in essential services for the nation, and place a burden on the overall economy to address these pressing needs.
One nurse I spoke with mentioned the lackluster management and the less-than-ideal pay of the job.
It all starts with logical economic strategies to address the challenge of medical school debts, attract highly skilled doctors, and potentially improve compensation, as well as necessary upgrades, accountability, and even patient bills of rights.
Ensuring equal access to medical care for all, regardless of background or health, is just as crucial as it is for local social or sporting events.
Even though certain upgrades have been implemented, the idea of a highly efficient medical system can differ significantly from the real situation, posing substantial challenges in an era of rising economic disparity.
Accept it, eat, drink, get and dance because the alternative is unknown.
Should families like Johnny’s just accept that it is what it is? Once again, the funeral band has played and the food has been served countless times, but the pain lingers long after everyone has departed from the grieving family.

It seems like these communities have developed a certain resilience to these sensitive issues, likely because they lack the necessary resources, hope, advocates, or support. Unfortunately, this pattern has become all too familiar.
This beautiful land, always bound by heritage, culture, or genuine love, but no one would jeopardize it all because of the poor medical infrastructure, which has outpaced its effectiveness in the face of an aging population.
The Bittersweet Goodbye: It was tough, but we had to keep pushing ahead.
I’m hoping Johnny’s unexpected mission will serve as a voice for those who do not have one, as well as those who do but keep it quiet to save face.
We may never know what caused your death, but I have looked into the circumstances surrounding it and, as part of our obligation, have established a plausible cause of negligence to proceed.
Nonetheless, the extended stay and extra cash spent were motivated by a need for knowledge, accountability, and closure, rather than a desire to submit a claim based on the information gathered.
Regrettably, despite your pledge to uphold a system that has failed you, many of us have become more equipped public servants as a result of the vital lessons we’ve learned from your steadfast standards as a law enforcement officer, no matter where we work.

Your influence, motivation, compassion, and affection for humanity continue to resonate.
You took us to the beach during our summer vacations, winter holidays, and memorable block parties, street vendor meals, but most importantly, your strong principles and commitment to the law left a lasting impact.
We did not come seeking a terrible story or to express an opinion. This situation analysis aims to remedy a major flaw that is commonly hidden behind the surface and a pleasant smile often in this medical system.
We will continue to speak up for the voiceless, so that this does not happen again to anyone, regardless of race, gender, color, or socioeconomic background.
It was an honor to be a part of the effort that resulted in you receiving the homecoming that every officer deserves for putting their lives on the line each day.

Rest in Peace (RIP)..






























































Leave a comment