Sea, sand, and serious study that's medicine in Trinidad for you, says Tangunu Fosi-Mbantenkhu

The word "Caribbean" probably conjures up an alluring image of sea cruises or infinite stretches of time on snow white sandy beaches, basking in the sun. You'd think the days at medical school should be a breeze, reading Gray's Anatomy under the shade of windswept coconut trees, serenading to the rhythms of nature. Well, brace yourself for a surprise. Medical school in Trinidad is no less stressful than elsewhere. Work and reclusive studying are still the medical student's lot, a world away from exotic cocktails and the surfing sea.

 

One of the many waterfalls in Trinidad's north

Ancient traditions v modern medicine

The patients I encountered in Trinidad were varied and uniquely colourful. Some of their practices are culturally derived from the continents in the "old world," from which their ancestors came. For example, it is not unusual to observe people of east Indian descent presenting with jaundice (of any cause) only after a holy man has been unsuccessful in "extracting" the discolouration by anointing the whole body of the patient with bright yellow mustard seed oil or saffron oil, a process called "jharray." Another tradition with regard to jaundice is practised by a section of Trinidadians of African descent. It is called "mal j'eux" (a corruption of the French phrase "mal des yeux"), and the parents of infants affix tiny blue cloth bags containing balls of camphor (naphthalene) to the child's clothing with a safety pin in order to prevent jaundice. The naphthalene balls in a few cases paradoxically cause the jaundice they were supposed to be preventing in the first place. This is because a number of people of African descent have a genetic disorder glucose-6-phosphatase deficiency in which naphthalene precipitates haemolysis.¹ The jaundiced consequence of the "mal j'eux" practice aside, the camphor smell is so acrid that I wonder if it does not discomfort the babies.

Western style health problems

As in other Western countries, many patients present with lifestyle diseases. Health statistics for Trinidad and Tobago show an ageing population and increasing prevalences of obesity, hypertension, and diabetes mellitus. The main causes of death are cardiovascular disease, cerebrovascular accidents, and malignancy infectious disease is notably absent from this list, unlike in many developing countries.² In marked contrast to most tropical areas, malaria is virtually non-existent.

A modern healthcare system

The prosperity of Trinidad and Tobago stems from the islands' petroleum deposits and has throughout this century allowed the country to mount extensive, sustained public health interventions to eradicate serious infectious diseases. Social improvements such as paved road networks and accessible drinking water have given the country's inhabitants a comfortable standard of living, and cooperation with international health bodies has successfully fortified the campaign measures.

 

A floating Hindu temple on Trinidad's west coast

A multicultural environment

I am lucky to have studied in such a beautiful cosmopolitan island. Interacting with Trinidadians in their country adds a personal dimension to the experience of studying here; I have been impressed that Trinidadians of all races and cultures consider themselves friends and live harmoniously together in their country, rising above the ancient antagonisms and intercultural violence that exist in the lands from which their ancestors came. The tolerance for different cultures is ingrained in Trinidadians who walk streets lined with mosques and Hindu temples standing side by side. The people of the islands are progressive and often take part in interreligious celebrations. With an average of one public holiday festival a month in commemoration of one of the island's cultural heritages, Trinidadians have the opportunity to party. Hedonism determines the Trinidadian spirit, and wherever the melodious steelpan plays Trinidadians have an instant excuse to party publicly.

The rhythmic speech of Trinidadians in their everyday lives, known as Creole, at first creates a small challenge. The process of understanding is not helped by the rapid pace at which people speak. After asking for a few slow reruns of the conversation, I did not find it so difficult to follow a conversation the words are English, although the phrases are put together differently. The people I met in Tobago are, like the island itself, more subdued in temperament than those in Trinidad and live in closer appreciation of their island's largely unspoilt natural environment than in the more business oriented and cosmopolitan Trinidad. In Tobago the inhabitants have preserved a certain rural genteelness and customs that are reminiscent of certain parts of west Africa. The friendly Tobagonians will show you on their island those places that they swear correspond with locations in Daniel Defoe's novel Robinson Crusoe, which, they adamantly maintain, was written about Tobago or "Crusoe island."

Social problems

There were not many things I disliked about Trinidad. The treatment of elderly people in society is the main observation that left an unpleasant aftertaste for me. Trinidad and Tobago's elderly population is increasing rapidly, and as a result many elderly family members are being moved into homes or living alone. Most of these homes are not custom built care centres for elderly people but ordinary urban homes registered to provide lodging and board for the elderly persons exclusively. Open space for recreation is rare, and the cool Caribbean breeze that refreshes these islands does not reach many of the care homes' inhabitants.

 

Poor area in Port of Spain

Elderly people without family support must contend with token or non-existent social programmes for their needs. Those living alone or without money are likely to sleep hungry often. Sightings of homeless, abandoned elderly people on the urban streets of Trinidad and Tobago are no longer shocking to most citizens, which gives an indication of the scale of the problem. Glossy tourism brochures about the island would rather conceal this fallout from rapid modernisation. The tendency to individualism in Trinidad, with the attendant sacrifice of the extended family, is unlikely to be reversed. Many modern Trinidadians that I have encountered have grown up more aware of the outside world than in touch with their extended families, and they see such a family network as a restrictive bond. Trinidad must therefore make sure that there are facilities catering for the needs of elderly people, if the flaw in the social fabric that exposes vulnerable elderly people is to be patched. The island, however, seems already in the process of losing its innocence.