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My three month sabbatical in Jamaica

Dr James Oliver set up a diabetes cllinic in Jamaica, 25 years after first visiting the island as a medical student

Dr James Oliver set up a diabetes cllinic in Jamaica, 25 years after first visiting the island as a medical student

I have just spent three months in Jamaica, helping a tiny Caribbean community in the rural village of Treasure Beach to run a diabetes clinic.

I first went to the island 25 years ago, to a town named Junction, when I was a medical student.

The original medical centre I went back to had gone but I met many people who remembered me from my student days (you don't get many white people going back to Junction).

One woman said to me: "I remember you. You saw me 20 year ago. I came in and I was ill, you said go away, take some paracetamol and have a bottle of Guinness". She told me that she has drunk a bottle of Guinness every day since.

I was on the Caribbean island as part of a sabbatical rota set up by the staff of the Meads surgery in Uckfield, East Sussex, where I am a GP.

In our practice all four partners take it in turns to take up to three months off, paying for our own locums. The idea is to keep fresh but also to enable us to bring different attitudes towards medicine and broaden our medical minds.

The way I went about arranging the trip and the clinic w as simplicity itself. I picked up the phone and spoke to a local dignitary in Jamaica who knew a retired nurse from Charing Cross Hospital in London who lives in the village. From there things just escalated. We booked a room in a village hall and got hold of an old dentist's chair and some instruments. The locals spread the word - and we were away.

I took the decision not to apply for a license to administer prescriptions while in Jamaica. I wanted to experience a complete change from my working life at home. Above all I wanted to get back to basics with a more hands on approach. Working in the old village hall described above felt great - and helped me get in touch with the locals.

From my experience you gain much more when you spend the time talking to people and relate their condition to how they see life. Then you can see the penny drop as they begin to gain a new understanding. It may seem obvious but if healthcare professionals are never taught to listen and explain, then medical knowledge is never passed on.

Health education was my paramount concern, as most of the population are illiterate. For me, the main purpose of my trip was to help people to understand their condition and to empower them to take appropriate action for themselves.

The healthcare system is in total disarray in Jamaica. The greatest challenge was in gaining commitment from the professionals and ancillary workers. Things do not work to a European schedule. One problem I found was when I arrived at my clinic to find that the centre was closed. No one had bothered to come and open up. This can be immensely frustrating, especially when you are a volunteer worker. The best you can do with this typical Jamaican attitude is to relax and let it go.

The patients I saw needed the basic levels of education. For example, a woman aged 80 years came to see me with severely diabetic feet; both infected and aschemic looking. She walked on her heels and could not feel her toes. We could only clean up the wounds and educate her in the necessity to keep her nails short and her feet clean. As with many people, she walked in bare feet, so we found some old theatre pumps to give her some comfort. The extended family is important in Jamaica, and so part of the education programme was to inform her daughters on how to care for her.

Another typical case was a man of 76 years old; he had hypertensive crises and multiple mini strokes. He was also diabetic. The family had saved up to go to see a private doctor who had made a diagnosis but had not examined him. The private doctor had prescribed a long list of medicines that the family could not afford. I examined him and explained the causes of his symptoms. I gave fundamental advice such as no sugar or salt, and as they could afford aspirin, explained the benefits of it and recommended that he take it. We also talked about local fruits that were low in cholesterol.

During my time running the clinic I hugely broadened my horizon and came to appreciate now I am back in Britain just how developed we are in the UK.

As a result I believe I am driven to help my patients over here to open their eyes to the reality of their conditions, and the opportunity they have to do something positive about them.

Jamaica helped me to realise how much many of us take for granted in healthcare, especially in terms of giving up responsibility to a doctor, rather than being proactive.

In my practice in Sussex we have decided that our healthcare will now follow the more hands-on and accessible approach we were developing in Jamaica.

We have also forged a link between the local Jamaican hospital and our hospital here in Uckfield. Clinical information has been pooled and much useful material has been sent out from Sussex to the West Indies. We still have two boxes of equipment waiting and ready to go to Jamaica.

Working in the Caribbean made me realise just how accepting we are of waste in the UK and what very high standards we have in cleanliness, hygiene and available resources.

Dr James Oliver is a GP in Uckfield, East Sussex

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