Jamaican Healthcare System (And More Fun)

Monday was my first day of real work. 8:30 am, wowsers! It seemed sooo early... I don't know how I even did the 7:00 am shindig for 2 years before this! But I guess 8:30am just feels much earlier when it's a bajillion degrees outside and you wake up from the strength of the sun. Just a thought. But I gotta say, ending the day at 4:30pm (versus 9-10pm) is quite mind-blowing.

Today, I attended the quarterly meeting for representatives from each parish of Jamaica who work on covering cervical cancer and spear-heading the initiative to perform pap smears on 80% of women, ages 25-49) . To backup and explain a little more geography, Jamaica is divided into 14 parishes, almost like states. Kingston is often lumped in with St. Andrew (together called KSA). See colored map below. The regions are further divided into South, South Eastern, West, and North Eastern.

Anyways, today's day-long meeting was very informative. We had presentations from the National Public Health Lab on how to read and diagnose pap smears. The man (only man in a room of 30+ women, by the way) was very animated, and used graphics to demonstrate the difference between CIN1 (low-grade HPV-related infections) and CIN2/CIN3/CIS (high-grade HPV-related infections, which can eventually lead to cancer). Merck also presented on its recent lab results showing the efficacy of the HPV vaccine Gardasil in both men and women around the world. The best part had to be that the presentation was right after lunch and of course, they used zoomed-in images to show tumors and genital warts. And obviously no one in the room even flinched, except for mature Anita.

So in the past two days, I have learned a lot about the Jamaican healthcare system as well as the Jamaican work environment. Few things that stood out to me (only some relevant for my study):

- In Jamaica, the government pays for vaccines in the public sector. Not just for kids, but also for adults. So the decision to incorporate the HPV vaccines is actually quite a large one. The vaccine is roughly US$120 per shot and you need 3 shots for it to be efficacious, so it definitely adds up. The presenters at Merck said that the company is working on providing the vaccine to governments for significantly less, which would be a huge win for developing countries.

- The biggest issue right now in cervical cancer screening in Jamaica is the turnaround time in getting back pap smear results. In the U.S., the normal wait is ~2 weeks. In El Salvador, the "delayed" response time is 1 month. In Jamaica? 6 - 9 months. No joke. And that's just for the first pap smear - if you need to get a second one because the cells are abnormal, that could take several MORE months! Jamaica is SO understaffed in terms of having cytologists who can read the pap smear samples. They are considering automated processes, using visual inspection or outsourcing, but any alternative would incur a material cost. It was heartbreaking to hear the women speak about patients at their clinics who had previously never had a pap smear and then had to wait almost 12 months, only to find out they were extremely positive for cervical cancer. Some of these patients were pregnant, putting their children at risk as well.

- (To switch from the serious) Jamaicans love Celine Dion. Ok well, to be fair, I don't have enough evidence to generalize that statement. But I can share that the man across the aisle from me at work decided to blare some Celine and, more notably, sing along (off key). Jamaican friends, is this true for all of you?

- The Ministry of Health does not have cold water! They told me they have boiling water to make sure the water is clean (even though we have been drinking tap water and been totally fine) and that they add ice cubes to make it cold. But tell me, where do the ice cubes come from? I'm going to guess the tap water. But hey, if the MOH doesn't have clean water... who would?!

- Women can get pregnant using an IUD (interuterine device, basically, a copper stick that is surgically inserted as birth control). One of the women at today's meeting shared that a woman in her clinic gave birth to a baby, who came out with an IUD in its head. The device had to be surgically removed at birth. YEP. Apparently she "forgot" that she had an IUD.

So on a completely unrelated note, two things I had to share:
1. Last night, Miss Jamaica came in second place during the Miss Universe contest! I was very excited. Even if some may call me "Jafakin' " (Fake Jamaican, get it? It took me awhile), I do have some Jamaican pride! And gotta say, Yendi Phillipps is gorgeous (see below)! But then again, all Jamaicans are!

2. Ashley learned how to use the panoramic feature in her camera! Here's a pretty good shot at our view from the patio. Apologies that its ridiculously small/blurry, I didn't know how else to upload it!
3. Ashley and I babysat last night for the 2 daughters (ages 6 and 8) of our host family. They are possibly the cutest and smartest girls ever - so fun to play with and the easiest to look after. But I had to share that we played Twister. And let me tell you, the bigger you are, the harder you fall. Best workout I've had in awhile. We both lost easily to the girls... not even kidding.