Destination Jamaica: a medical journey

The small medical clinic off the highway in Falmouth, Jamaica
could be overlooked in a blink of an eye, yet some patients drive
six hours across the island to visit the clinic’s medical
staff.

They begin lining up on the deck of the white-washed veranda at
dawn throughout the week.

By 8:30 in the morning, when the medical staff arrives, there
can be anywhere from 80 to 100 patients waiting ““ all
smiling, all greeting the doctors, and all hoping to get some
much-sought medical relief.

The small clinic is the site of a visiting team of voluntary
physicians from the UCLA Medical Center and Kaiser Permanente,
David Geffen School of Medicine students, nurse practitioners,
acupuncturists and a videographer.

The UCLA medical group’s annual 10-day trip to Jamaica
took place in April. The trip ““ an academic exploration and
practice of international medicine ““ included being stationed
at a clinic, a health fair, an orphanage and a girl’s
shelter.

Upon entering the clinic, the UCLA medical group hurries past
the three women from the church that do a preliminary triage of the
patients. They pass the official triage room where blood pressure
and temperature are taken and go into the exam rooms located by the
pharmacy to prepare for the day.

The fans are operating at the highest setting, but the thick
mugginess of the air can’t be distilled. Already sweating,
the medical staff begins seeing the Jamaican patients, treating
them for skin infections, diabetes, hypertension, arthritis and
asthma.

Their dedication to their craft and their unrelenting energy
have the medical team seeing patients with as much gusto when night
starts to set as when the day began. They average 100 patients a
day on their last day.

“The overall feeling is one of camaraderie, and
there’s a lot of sweaty hugs and kisses from the
patients,” said Ashley Christiani, chairwoman of the UCLA
Primary Care College and an organizer of the mission.

One of the medical team’s strengths is its integration of
a multidisciplinary staff.

“Everyone bonded and got along well, working together and
learning from each other. I think it is an ideal model for a
clinic,” said Bruno Lewin, a family practice doctor and the
group leader of the mission.

Sanjeev Sriram, a fourth-year School of Medicine student, feels
the collaboration between medical students and nurse practitioners
was valuable to his future as a pediatrician.

“The culture of medicine in this country is that you get
trained separately and then you get thrown into the work
environment together, and everybody just assumes that you’ll
work together just fine,” Sriram said.

“I think one of the most eye-opening things about this
experience “¦ was just getting to know nurse practitioners and
knowing how to better coordinate our skill levels.”

This was the team’s third trip to the Salmouth Methodist
Church Clinic, organized by the UCLA Primary Care College, and most
members of the medical group paid their own fare with assistance
from Air Jamaica.

But they weren’t the only passengers ““ 20 boxes of
medicine and supplies followed the team’s arrival. The
supplies were to be placed in Ziploc bags and plastic bins in the
clinic’s pharmacy.

The minor surgeries the team performed included benign tumor
removal, lipoma fatty tissue removal and dermatological procedures.
The group also did pap smear screenings and supplied patients with
free-of-charge medication.

Jamaica has social healthcare in which there are governmentally
funded medical institutions available to the public, but it has a
private sector, as well. The patients that visit the clinic get
referred to the local health care officials after the team
leaves.

The free medication can be a relief for patients who may not be
employed, are on a pension, or can’t afford it.

“We provide other services that can be expensive, things
that may not be crucial like removing lumps and bumps that we can
do that a patient may not be able to afford outside,” Lewin
said.

While in the country, the team communicates with local
physicians in Salmouth on referrals and patient needs.

“We’ve really been focused on leaving something of
lasting value, so it’s not just coming in for 10 days, and
patching people up and then leaving until the following
year,” Christiani said.

We’ve really made an attempt to build relationships with
the local providers and to train even the non-medical staff on how
to provide better care.”

The mission was just as much a practice of international
medicine as it was a learning experience for the students. After
each day of clinic, the students discussed the cases they saw and
gave presentations on relevant issues in pediatric care, diabetes
and asthma.

“Humanitarian missions can really get people to fall in
love with community health,” Christiani said.

“(People) really get the opportunity to see what it feels
like to practice medicine where they’re relying on a lot of
their clinical skills as opposed to technology.”

The team also visited an orphanage, a girl’s shelter
called “Place of Safety” and a health fair during its
10-day mission.

Christina Han, another fourth-year medical student, recalls the
girl’s shelter most resoundingly.

“(The girls’) welcoming smiles and hugs, along with
their eager and unbashful participation in our women’s health
and sex education discussion, told so much of the similarities in
children around the world,” Han said in an e-mail.

“The high aspirations of each young woman despite her
harsh circumstance and the success stories shared by the staff
showed the Jamaican people’s resiliency and faith.”

Other members of the mission also had fond memories of their
work in Jamaica. Sriram remembers his first surgery, a lipoma. The
patient had the mass of fatty tissue collected on his lower back,
which was a pressure point whenever he sat down.

“He was one of the happiest guys just because it was
giving him so much relief, and it was good to hear,” Sriram
said.

Tatum Langford Korin, the historian and videographer of the
trip, documented the operation on film.

“The Jamaican people are so appreciative of everything
that they got from these doctors,” said Korin, who had
interviewed the patients.

“No (member of the medical team) sat for any second, no
one took a rest “¦ there was no lull in energy, and nobody was
turned away,” she said.

The medical team even provided health education advice on which
high-potassium fruits would help with blood pressure, along with
medicine or which exercises to do to alleviate arthritis-related
pain.

The group also saw a few patients who had skin infections which
both Lewin and Christiani said were common in tropical environments
such as Jamaica.

Scabies, an infection of the skin by a mite, can cause intense
itching due to allergic reactions. This skin condition, among
others, was treated.

“What I found time and time again was the utter gratitude
that people left with having felt treated “¦ There was no
urgency (on the part of the medical staff) to get out of there,
because they wanted to see as many people as they could,”
Korin said.

“The Salmouth clinic relies entirely on U.S. and Canadian
physicians to come and run the clinic,” Christiani said.
“Otherwise they would just be an empty building, so we want
to do the best we can to be there for them.”