Setting up health care services in Paradise is akin to sowing the seed. Picking the place, people and process to yield a rich harvest is the challenge. I came looking for an adventure, and got what I was looking for. In spades.
The first day at work, no one in the clinic had expected me to show up. Lesson One: Don’t start work without orientation. I went for orientation, only to find the clinic director was off island. Lesson Two: Make the time to orient yourself to the ways things work-island style.
Ferry and seaplane schedules dictate the time available for providing specialty services. All patients arrive at the start of the day, and sign-in for service. No name, no service. Specific subsets of patients register along with routine visits, creating bottlenecks at the start of the process. No surprise that waiting for hours is the norm. The waiting room is always busy and bustling, creating an illusion of high demand.
Social constraints abound at all levels. Literacy and language (Patois, French, Spanish, Creole) barriers limit communications at every step. Social and cultural norms often run counter to Western medicine standards. For instance, bush tea and herbals have been traditionally used to treat seizures. Preventive health is not a high priority without resources to meet basic needs. Parents have to be educated, reminded about visits and occasionally escorted to the clinics. Schools are understaffed and underfunded to meet special health needs, leaving families to fend for themselves.
Financial and political factors create additional challenges. A Medicaid cap severely limits the amount of federal funding for the territory. Poverty level is defined at annual incomes below $9500 for a family of four (in contrast to $28000 on the mainland). Combine that with wages at half the mainland rate and a cost-of-living 30% higher than Washington D.C., and you have a large uninsured sector. The territorial delegate does not have voting rights at the federal level. State senators are elected every two years, leaving little time for long-term planning. In less than a year’s time, Paradise is on its third commissioner of health. On the neighboring British Virgin Islands, the government dissolved earlier this year.
Lesson Three? In Paradise, every challenge is an opportunity. The adventure has just begun. Come along on the expedition in future Casebook postings.
The first day at work, no one in the clinic had expected me to show up. Lesson One: Don’t start work without orientation. I went for orientation, only to find the clinic director was off island. Lesson Two: Make the time to orient yourself to the ways things work-island style.
Ferry and seaplane schedules dictate the time available for providing specialty services. All patients arrive at the start of the day, and sign-in for service. No name, no service. Specific subsets of patients register along with routine visits, creating bottlenecks at the start of the process. No surprise that waiting for hours is the norm. The waiting room is always busy and bustling, creating an illusion of high demand.
Social constraints abound at all levels. Literacy and language (Patois, French, Spanish, Creole) barriers limit communications at every step. Social and cultural norms often run counter to Western medicine standards. For instance, bush tea and herbals have been traditionally used to treat seizures. Preventive health is not a high priority without resources to meet basic needs. Parents have to be educated, reminded about visits and occasionally escorted to the clinics. Schools are understaffed and underfunded to meet special health needs, leaving families to fend for themselves.
Financial and political factors create additional challenges. A Medicaid cap severely limits the amount of federal funding for the territory. Poverty level is defined at annual incomes below $9500 for a family of four (in contrast to $28000 on the mainland). Combine that with wages at half the mainland rate and a cost-of-living 30% higher than Washington D.C., and you have a large uninsured sector. The territorial delegate does not have voting rights at the federal level. State senators are elected every two years, leaving little time for long-term planning. In less than a year’s time, Paradise is on its third commissioner of health. On the neighboring British Virgin Islands, the government dissolved earlier this year.
Lesson Three? In Paradise, every challenge is an opportunity. The adventure has just begun. Come along on the expedition in future Casebook postings.
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