Four years ago, as I clung to my seat on a bus teetering back and forth on a one lane rocky road up the Jamaican hillside, I thought I knew what it meant to be a part of the medical community. I grew up in a family of doctors and nurses and, while none pressured me into the field, I felt drawn to it. All my life I would hear stories about sick patients and the doctors and nurses that would help them. I wanted the opportunity to do the same — to help people. I had just taken my Medical College Admission Test (MCAT) and wanted to do something hands-on to widen my clinical experience, so I embarked on a medical mission trip to Ipswich, Jamaica. This tiny mountaintop town looked forward to the arrival of this medical mission team each year. The medications and medical care provided this remote community access to things that were miles out of reach and even farther from financially available. As the bus climbed the final steep hill, I could see nearly one hundred people, young and old, singing, clapping and welcoming us to their humble home.
We quickly disembarked the bus and began unpacking medical supplies and turning the five room concrete schoolhouse into a pop-up clinic. There was no air conditioning and no fans, just a mountain breeze that would push its way through the windows and toss the papers, cotton balls and bandages into the air to rain back down like confetti. I was stationed in the registration room where people came in single-file to get vitals taken. I took on the role of managing the blood glucose monitor performing fingerstick glucose checks and explaining how it helped us diagnose diabetes to the friendly and eager to learn patients. I quickly earned the name “gentle jook” (Patois for poke) for my ability to swiftly and almost painlessly get the glucose check done. Initially, I was concerned that my limited medical knowledge would not make me a useful team member. However, armed with my glucometer, test strips and a new nickname, I began to do my part to help the people lined up outside the door.
Just before lunch, a familiar-looking woman stepped through the doorway of the small registration classroom. Her body filled the entire doorway. She was tall with thick limbs and an apron wrapped around her protuberant belly. I remembered that I had seen her when we had first gotten off the bus just behind the classroom we currently occupied. She was stirring a large cauldron that could have doubled as a kiddie pool filled with stew as we arrived. The savory scent had been taunting me through the window with each breeze. “So you are the chef that has been tormenting me all morning!” I said with a smile. She let out a hearty laugh in response. “Well someone has got to feed you all. We appreciate all you are doing here,” she replied in a thick patois accent. She smiled and revealed a few missing teeth and sat down at my table offering her calloused hand already knowing what came next. I prepped her finger with the alcohol pad as I explained the procedure and had her count down to one before the needle punched a tiny hole in her finger. “Not too bad, right?” I asked as I watched the bright red blood appear in a near-perfect dome over the puncture hole. She shrugged and let out a nervous chuckle. I allowed the test strip to draw up the sample and watched the screen flash three times before reading the result: ERROR.
A pit developed in my stomach, this was the first time this had happened to me today, and I would be lying if I said panic was not beginning to brew. I swallowed hard and quickly grabbed a different glucometer with a new test strip. “This one’s battery must be dying from working hard all morning,” I nervously joked. I followed the same procedure and anxiously awaited the number coming after the third flash. 382. “Your sugar is a little high” I managed to choke out, and the panic that started as a simmer in my stomach is now boiling over. “Do you feel okay?” “I feel fine doc,” she replied. I walked the glucometer over to the physician two tables over and explained the error followed by the high reading. The physician rattled off a list of medications for me to go grab from the suitcase full of medications we had brought, and I brought them back to her with lightning speed. I wanted to see what was going to happen to the patient, but the line of patients waiting out of the door demanded my attention.
At lunch, I noticed my aproned patient with high blood sugar was no longer standing, stirring and singing over the fire like I had seen her do this morning. Instead, she was sitting down on the floor, fanning herself and complaining of feeling dizzy. I found the physician who had taken care of her and asked what was going on. “Should she not be feeling better with the medicine? I thought we needed to bring her sugar down.” “Well when your sugar is high for that long, dropping it lower, even a little bit, can feel like hypoglycemia,” she explained. I could feel my brow furrowing in frustration. This was not like the doctor shows I saw on television or the stories I had heard growing up. We discovered the problem, did what we were supposed to and yet the patient appeared worse off than she did before. I remember seeing only a limited amount of diabetes medication in the suitcase we had brought and knew that there were other patients today that needed it and likely even more in the coming days of the trip. Even if she had felt better with the medication, we could only give her a short supply.
The fact of the matter was that the help we provided on the mission trip was a temporary fix; a bandage on a wound that desperately needed stitches. The remote location coupled with the socioeconomic status of the population we were serving was a deeper wound than our donated medications and a 3-day trip could heal. While it was better than nothing, I certainly did not feel good about leaving that day nor after our 3 days. Nonetheless, the patients sang to us, cooked for us and expressed endless gratitude. As I returned to the United States, I began to appreciate the challenges that were ahead of me in medicine not solely academically but frustration with disparities that felt inevitable and daunting. There will always be patients like the chef who got the short end of the stick. However, that will never stop me from trying to help them. I will forever be reminded of that feeling of frustration when I need to advocate for patients and remember why we work tirelessly to save people.
Image credit: blue mountains view by nicholaslaughlin is licensed under CC BY-NC-SA 2.0
Medical Student Contributing Writer
Florida International University Herbert Wertheim College of Medicine
Ashley is a first generation Jamaican-American fourth year medical student interested in the field of psychiatry. She is passionate about narrative medicine and enjoys gardening and playing with her 2-year-old german shepard mix.
