DOMINICA - Life Unscripted on the Nature Island

Editor’s note:This article was published in the Editorial section of the Chronicle Newspaper on July 24,2009.

The Ministry of Health and other relevant authorities should move quickly to upgrade the systems, facilities and personnel available to deal with medical emergencies in rural communities and remote areas.

This month, a young cadet was pronounced dead at the Princess Margaret Hospital after being unable to get emergency medical treatment for several hours when he became seriously ill at a camp in the Castle Bruce area. Persons trying to assist him were reportedly unable to reach key medical personnel at the district health centre and there was no ambulance to transport the stricken cadet to hospital.

This is not an isolated case. A few weeks ago, The Chronicle reported an incident in the same area in which a desperately ill woman nearly died when there was no ambulance to rush her for treatment when a medical emergency arose. In that case also, it was not possible to get appropriate medical treatment for the ailing woman in her rural community or its immediate environs.

These incidents and others make it quite clear that many persons who suddenly get ill or injured in the far-flung regions of Dominica could find themselves in a most dire predicament. Indeed, life-threatening medical emergencies may arise in places where medical help is several hours away and there is no ambulance. In such situations, a multitude of risks and negative consequences inevitably arise.

As a developing nation with a vulnerable economy, Dominica does not have the capacity to put ideal systems, facilities and personnel in place for medical emergencies in remote places. But health officials in Dominica can definitely examine existing medical facilities to see if they are functioning as expected and take steps to upgrade these in the interest of providing the best service possible.

Since Dominica is the nature isle of the Caribbean, its eco-tourism sites are powerful magnets for adventurers from all parts of the world. However, these visitors may arrive here with underlying medical complaints that predispose them to health risks in Dominica’s rugged hinterland. Therefore, how the nation deals with medical emergencies involving sickness or injuries in remote areas with challenging terrain is an important consideration in the development of the island’s tourism product.

Dominica is a mountainous, volcanic island that is vulnerable to landslides and flash floods, especially in rural and remote areas. If the island intends to accommodate an ever-increasing number of visitors to eco-tourism sites found in remote areas without easy access by road or waterway, then build the capacity to meet their health, safety and medical emergency needs.

In any case, local residents of rural and remote areas deserve the best medical systems and facilities that the nation can provide with the resources at its disposal. Unfortunately, it seems that the island is not doing as well as it should in this area, even if current economic constraints are taken into account.

The time is ripe for forward-thinking health authorities to move urgently to examine and upgrade Dominica’s capacity to deal with medical emergencies in country communities and interior locations.

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You’re young as you feel…Forever 16

How appropriate it is for me to be writing this post on the same Dominica is recognizing the elderly people around the island.

FAQ: Why is it that people in Dominica seem to grow old more gracefully and live longer than people elsewhere?

This is one of more frequently asked questions by Doctors and critics all around the world, and who are yet to understand what makes Dominicans to live so many years. Dominica boasts a remarkable concentration of very old people in good health and they’ve begun to arouse the interest of medical science.

Over the weekend I visited my Grandmother, who on June 12, 2008 turned 90 years, but looks like 70 – as you can see from the picture above. As always we had our usual conversation – but during this visit my keen interest was to find out more about my grandmother growing as a young lady. After a conservation spanning more than two hours with the strongest lady I know, and to cut a long story short – it all boils down to diet and lifestyle are clearly all-important but are there other factors at work here too: quality of life perhaps, the support of families, something in the genes even?

In recent years it’s become a common celebration where: birthday parties, often organized by a vast extended family, for yet another of the country’s citizens reaching the age of 100.

Below is an excerpt from an interview by BBC correspondent John Pickford with centenarian Violet Wilfreda, in his attempts in understanding longevity in Dominica.

A century and still batting

Violet Wilfreda Joseph had her 100th birthday party a few years ago. She was born in the last year of the 19th century when British colonial rule in Dominica had another 79 years to run. So how does it feel to wake up in the morning knowing you’re 108 years old? “Glad to see the day“, she told me, without a moment’s hesitation. Her mobility is restricted but she has good eyesight and hearing, an astonishingly unwrinkled face and still lives in her own modest wooden home in the centre of Roseau. Could she give me any clues as to how she’s lived so long?

For years she’s started the day with a glass of coconut water, a drop of gin and a banana, though since her 100th birthday her family has persuaded her to drop the gin. Fish is her favourite form of protein, especially fish heads (”I like sucking the bones“, she told me) and she’s always enjoyed Dominica’s rich diversity of tropical fruit and vegetables. And another important clue perhaps, she shares her home with three generations of her extended family, including several children. They always give her a kiss before they go to school. “They keep me young“, she said.

According to the Dominica Council on Aging, a charity which keeps records of the centenarians, there are currently 22 on the island in a total population of around 65,000, which is 3 times the average incidence of centenarians as in developed countries such as Britain and the United.

Dr Noel Boaz, an American professor of anatomy at the Ross Medical School in Dominica, has been researching the centenarians for the past 6 years. His findings so far suggest that the key to their longevity is diet and lifestyle, not genetics – who I agree with 110%.

According to Dr Boaz, Dominica is a mountainous island with its interior cloaked in dense rainforest. Roads were few until well into the 1960s, so when today’s elderly were young long distance walking on rough terrain was a necessity of everyday life, along with hard physical work. And their diet would have included natural products from the forest, herbs and herbal medicines, as well as that rich diversity of cultivated fruit and vegetables, almost all of it grown in their own gardens.

Not in so many words, but this was exactly what my grandma described to me in our conversation.

…but will it last?

It’s hard for me not to feel a surge of optimism in the presence of such people, but the story of Dominica’s remarkable centenarians like Violet Wilfreda Joseph, may not have an entirely happy ending. Dr Boaz doesn’t think the phenomenon will last more than another decade, and I can understand why - the lifestyle of younger Dominicans is changing rapidly.

Three American-style fast-food restaurants have recently opened in Roseau and with the help of TVs in every household, car ownership has risen to one in four of the population and farming is a last choice job for most young Dominicans.

But while living a pre-modern lifestyle will soon come to an end, the way things are going. I’m thankful to be able to have these long conversations with my grandma, because she gives me a glimpse of a way of life – poor in modernity but rich in wellbeing and human longevity.

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Getting a second opinion is standard medical practice these days is a must. There are thousands of surgical procedures performed in the Caribbean every year and the majority of these operations are necessary for the health and well being of the patient. But, according to recent studies, a large percentage of surgeries may be unnecessary.

Lots of people are now seeking second opinions, especially when it comes to surgery procedures and also insurance companies are encouraging second opinions for surgical procedures as more people are beginning to take an active role in their health care options.

Based on all of the surgeries performed, one can conclude that overall health system around the Caribbean is ok; particularly in the French islands of Guadeloupe and Martinique. However, we still hear of horror stories and failed operations from time to time, both in Dominica and around the Caribbean.

A second medical opinion can save you time and money, and it is possible that the condition in question can be treated by means other than surgery. Your doctor’s approach to treating your condition is influenced by his training, experience, and exposure to new techniques. Getting a second opinion is standard medical practice, and you will find that most physicians welcome second and even third opinions. You can be open with your physician about this as you tell him your feelings and how much more comfortable you’d feel getting another doctor’s opinion.

If you decide to get a second medical opinion on a surgical procedure, you may wish to ask your doctor to refer a colleague or specialist or you can seek out another doctor yourself. With help of the internet, you will be amazed to know the amount information you can get off the internet about illness you’ve and the doctors specializing in that particular medical field.

When you go to a second doctor, tell him or her name of the recommended surgical procedure and do over the various tests you have already had. This can save you the unnecessary expense of running duplicate medical tests. If the second doctor agrees that the surgery is necessary, he or she will usually send you back to the first doctor. If you make the decision to have the recommended surgery, there are a number of questions you may like to have answered such as from what medical school did the surgeon graduate, and in what specialty did the surgeon complete an accredited residency program, etc.

Once you are comfortable with your choice of a surgeon, find out what your options are. Ask about possible risks, complications and side effects, and the length of the recovery period. Talk to others who have had the same procedure. Also, don’t forget to check with your insurance company (if you’ve one) to learn if the surgical procedure is covered under your policy, and if so, whether it is covered as in-patient or out-patient surgery. Remember, you’ve the right to be informed of all your health care options, especially when it involves a surgical procedure.

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