“If I could do it again, I’d go to a Caribbean medical school,” my brother said. I was having dinner with my family, and we were discussing my future. I had just finished applying to medical school in Canada for the second time — it’s not unusual for prospective students to apply two, three times — and was considering my options if I wasn’t accepted. One option was to attend medical school away from home and outside North America.
“Will you be able to come back?” my mom asked me. “Are you sure you don’t want to just try applying a third time?” But the process of applying to medical school was exhausting. I wasn’t sure my chances the next year would be any different.
My brother, who had recently graduated from a Canadian medical school — Queen’s University — told me, “I did a rotation with someone who went to one of the Caribbean schools and he really knew his stuff. Plus, he said he went scuba diving every day and had a pet monkey too.”
So it was with ideas of scuba diving and pet monkeys that I applied and was interviewed for a spot in a medical school in Grenada.
My interviewer was a recent graduate of the school working as an orthopedic surgery resident in my home province of Ontario. I met him in his hospital for my interview. “So. Why medicine?” my interviewer asked, as he sat in a chair across from me. This was the most obvious question to be asked, but I was never sure how to answer it without sounding disingenuous or trite. I said something about wanting to be able to help people, to make a difference in people’s lives, to provide the care and treatment they’d need. The interviewer gave me a look that I couldn’t quite read. Too cliché, I thought to myself.
After the first question, the interview warmed up. By the end, the interviewer was sharing stories of his time in Grenada, and encouraged me to make the most of this opportunity.
“Some people have a hard time with island life,” the interviewer told me. He glanced down at my file. “Traveled to Barbados, Costa Rica, China, Mexico…” he read aloud. Throughout university, I spent my Christmas holidays overseas at swimming training camps and had recently returned from a volunteer trip to rural China where I had been keeping kids entertained with games and activities while they waited for their cleft palate surgeries.
The interviewer turned the page over. “But I think you’ll be fine.”
Grenada is a small, comma-shaped island nation in the Caribbean Sea. About 104,000 people live on the island, which is just a fraction of how many Grenadians can be found around the world. Grenada is one of the most southern of the Caribbean islands, being just 100 miles off the coast of Venezuela.
One of the days before leaving for Grenada, I received an email from a good friend of mine who was recently married. She congratulated me on getting into medical school and mentioned she’d be passing through Grenada during her honeymoon. We exchanged excited emails, gushing about the fantastic timing. It wasn’t until she suggested taking a train in from France that I realized something was off. Gren-eh-da / Gran-ah-da. Tom-eh-to / Tom-ah-ta. She had mistaken Grenada, the small island nation in the Caribbean Sea, with Granada, the city in Spain. My friend was just off by one syllable, 100,000 additional people (in favour of Spain), 100,000 additional beaches (in favour of Grenada), and countless miles.
A few weeks before the move to Grenada, I was sharing rumors with an American classmate about the upcoming move to the island. We had no idea what it would be like to study there, and had been fueling our apprehensions with posts on medical student internet message boards. “Make sure you ship all the school supplies you’ll need and a year’s worth of peanut butter,” the message boards advised. “You won’t find any on the island!”
My classmate suggested perhaps I wouldn’t find it too different. After all, she reasoned, Grenada is an English-speaking Commonwealth country. “So it’d be very similar to Canada, no?” Aside from still seeing the Queen on the currency, I wasn’t so sure.
It was night when I first arrived in Grenada with a few bags of luggage and the hand-drawn map to my apartment that my landlord had sent me. When I had asked him over the phone for the apartment’s address, he just laughed and said, “In Grenada we do things differently. We don’t have mailing addresses or house numbers. Most streets don’t have names! Just tell them to go to the professor’s house behind the Jerk Chicken place and they’ll know where to go.”
My cab driver drove his van up hill after hill, checking with the apartment buildings at the top if we were at the right place. After we’d driven up the third hill, only to knock at another wrong house, my driver lost his patience. “I’m just tryin’ to make my dollar!” he exclaimed, frustrated.
It took switching cabs and a phone call on a borrowed cell phone to find the professor’s house. My apartment was the first floor of the house, while the professor lived upstairs with his wife and dogs. The house was built on rows of thin concrete pillars, which held the house up like stilts on the crest of a steep hill. As I shuffled up the hill’s 45-degree slope, two small dogs barked at my feet and sniffed at the luggage I dragged behind me. The screen door banged shut behind me and I looked around my new home. The walls were painted concrete, and the floors were linoleum tile. Small caterpillars lay curled on the floor, and a tiny pale lizard clung to the corner of the ceiling. The previous tenants had left a few items behind on a bookshelf. There were a few dusty medical textbooks, bottles of sunscreen, binders, and a bucket of pens. The essentials, I supposed.
The next morning, I looked out from my balcony. Past the road and across a stretch of two-lane highway were the pointed peaks of Grenada’s hills, grazing the bottoms of wispy clouds. Beyond these clouds I could make out the summits of more distant hills that faded to pale grey in the mist. The hills were dotted with mint green, salmon, and pale yellow houses. I’d had no idea Grenada was so mountainous. Before arriving on the island, I had anticipated beaches with gemstone blue waters, brilliant sunlight, and flowers that bloomed on shrubs and tall trees alike. But Grenada was dominated by mountains.
Around Grenada, in places where only the locals know to look, there are patterns etched into rock. Faded but still discernible, the patterns consist of a series of circles. The circles are carved out to look like faces with round eyes and wide mouths that silently “hoo” at visitors. It’s the rock art of the indigenous people of Grenada, the Arawaks and Caribs. They called the island Camahogne, and were living here before Christopher Columbus made contact in 1498. By the time the French arrived in 1649 and gave the island the name La Grenade, the Arawaks had been eliminated by the Caribs.
At the northernmost point of the island there is a town called Sauteurs, which translates to “Jumpers” in French. In Sauteurs, a rocky cliff juts out atop the swirling waters of the Caribbean. It was here that the story of Grenada’s Caribs ended. By 1654, relations between the Caribs and the French colonisers had soured considerably. After Carib attacks on French settlements, the French decided to wipe them out. At the cliff in Sauteurs, the remaining Caribs found themselves surrounded by the French, outnumbered and outmatched. The last of Grenada’s Caribs jumped off the cliff to their deaths, choosing suicide over capture.
Grenada’s capital and largest city is not far from my school, just a 20-minute ride by mini-bus. The town is named St. George’s, but locals simply call it “Town.” For the best view of Town, tourists, cruise ship vacationers, and new students climb to the top of the highest peak in the city, where there’s an old stone fort: Fort George. The fort was built in the 17th century by the French but with a different name. Possession of the fort passed between the British and the French, who alternately ruled Grenada for hundreds of years. As the fort’s owners changed, so did the fort’s name.
The touch of the British and the French is still found in names of neighbourhoods and towns in Grenada. The French lingers in the names of places like Lance-Aux-Épines (a neighbourhood near the medical school, popular with students and expat professors), Grand Étang (the lake atop Grenada’s highest peak, formed in the crater of a still active volcano), and Petite Martinique (a small island North of Grenada that is home to 900 Grenadians). Then there’s the British touch in the names of parishes, the Grenadian equivalent to counties: Saint George, Saint Paul, Saint John, Saint Mark, Saint Andrew, Saint David, and Saint Patrick.
A few weeks before school began, I took a trip to St. George’s to explore. As I wandered out of the bus terminal, I was approached by a man in a yellow polo and faded jeans who told me I looked familiar. “You were in Town last week?” he asked.
When I said no, he insisted I must have been in Town last week, right on the same street corner. The man introduced himself as Paul and asked me where I was headed. When I told him I was out to explore, he encouraged me to go see the fort.
“I’m heading in the same direction,” Paul said to me with a smile. “I’ll show you the best viewpoints of the city along the way.”
Paul walked beside me, not on the sidewalk but in the street, and stopped to greet almost every other person we passed. I noticed that although Paul spoke to me in English, he spoke something entirely different to the Grenadians we passed. It sounded mostly like English but mixed with French words, tied together with Grenadian slang. I couldn’t tell what they were saying but it felt like I should.
As we climbed the hill toward Fort George, we passed a wall that had “THANK YOU AMERICA” hand-painted on it in wide, white brush-strokes. Paul began to explain the story of why that was there.
In 1951, Grenada was in upheaval. A newly formed union had sparked a widespread strike demanding improved working conditions. The strike escalated to such a degree that buildings were set on fire and the British military was sent to help subdue the protesters. “The fire was so great that the sky had turned red,” Paul said dramatically.
Grenada was still a British colony. That year was also an election year. Up until that point, only the wealthiest 4% of Grenadians were allowed to vote for 5 of 15 members of the Legislative Council. But this would be the first year where the entire adult Grenadian population would be allowed to vote. The union, which had become a political party, won 6 of 8 seats.
When Grenada achieved its independence from the British in 1974 (remaining a member of the Commonwealth), the leader of the union, Eric Gairy, was made Grenada’s first Prime Minister. However, Gairy’s election victory continued to be contested by other political parties.
Two years later, in 1976, my school, Grenada’s first and only medical school, was founded. “When we see you students we feel proud of you,” Paul said, smiling widely. When it first opened, the school had one classroom next to the beach. There were 630 students, mostly from America. Today, up to 800 new students arrive at the start of each term, twice a year. Most of the medical professors at the school are expatriates from North America, the clinical tutors are doctors from Nigeria or India, and the remainder of the staff running the school are Grenadian. The school is the country’s largest employer. My landlord had told me that the school generated 40% of Grenada’s economy. That may have been an exaggeration, but it was a believable one.
“But that is not the reason this is here,” Paul said, gesturing at the “THANK YOU AMERICA” on the wall.
In 1979, five years after he first came to power, Eric Gairy’s government was overthrown in a coup led by Maurice Bishop, leader of the Marxist party, the New Jewel Movement. When Bishop and the New Jewel Movement took power, all other political parties were declared illegal and elections were no longer held. This was justified by the formation of National Organizations which would participate in all policy decisions. There was an organization for women, education, health care, youth, farmers, workers, militia, and so on. In this system, Grenada underwent widespread reforms in agriculture, worker’s rights, towards gender equality, and the development of a larger military.
Grenada began constructing a new, stronger, longer airstrip. At the time, President Reagan loudly voiced concerns that this airstrip would be used to serve Soviet military aircraft on the way to Latin America. Bishop denied this, stating the airstrip was part of a plan to build Grenada’s tourism industry.
By 1983, Maurice Bishop’s government had become divided. Bishop’s Deputy Prime Minister accused him of no longer being revolutionary enough. These disputes culminated with the house arrest of Bishop, which sparked widespread demonstrations. Bishop was eventually freed but soon after was imprisoned and promptly executed by firing squad, along with seven other politicians and supporters.
Paul brought me to the location where Maurice Bishop was killed. The rocks in the wall were jagged, with multiple small holes — bullet holes, I realized. I put my fingers in them. The site had been converted into a basketball court. There was a plaque commemorating the lives and deaths of the people executed.
“They killed our Prime Minister,” Paul said to me, pressing his clenched hands into his chest. His voice had a hint of low-burning anger in his voice. It was the first time I felt the emotion in his voice was genuine, rather than for my sake.
The basketball court was on the top of a hill. From that vantage point, I could see my school in the distance and the airport directly next to it. A few weeks ago, myself and 799 other students had landed at that airport. It was the same airport Maurice Bishop had built. “From that direction,” Paul continued, “the Americans came up out of the water and killed those who killed our Prime Minister.”
Days after Bishop’s execution, in a move that was condemned by the United Nations General Assembly 108 to 9, US soldiers stormed Grenada. President Reagan had stated that the storming was necessary to save the American medical students from the dangers of the ongoing military coup. About 7,500 Americans fought 2,300 Grenadians and Cubans. Nineteen Americans, 45 Grenadians, and 25 Cubans were killed. No students were hurt. The day the American soldiers arrived is now celebrated in Grenada as Thanksgiving.
“So that is why we love Americans and say THANK YOU AMERICA,” Paul concluded, “because they saved us from the people who assassinated our Prime Minister.” The timing was perfect. We were back down the hill and standing beside the painted wall. I wondered if Paul had painted it himself.
Paul began to talk about the rough economic times the country has been going through with the global recession’s effect on tourism and destruction by Hurricane Ivan. He told me he’d appreciate anything I could provide. “Most give $200 Eastern Caribbean Dollars,” Paul advised.
John was a Peace Corps volunteer, and my roommate’s friend of a friend. He had been in Grenada for a few months before us, and already seemed to have a great deal of knowledge on how to navigate the island’s twisting narrow roads. Eager to explore more of the rest of the island, I had invited him to join my roommate and me on a road trip through Grenada.
As we drove along the island’s Western Coast, John told us about signing up for Peace Corps, and the anticipation of being assigned to a remote location. “I was hoping to be posted in rural Africa where I’d be the only American for days,” John admitted somewhat sheepishly. “I guess I was a little surprised to be sent to the Caribbean.”
We followed the road as it made a wide turn, and the forest to our left briefly cleared to reveal tall piles of trash. It was the landfill. “They say this landfill has been continuously burning since Hurricane Ivan in 2004,” John informed us. The message boards that had alleged peanut butter couldn’t be found on the island were wrong. In the supermarket, you can easily find all the brands we have back home — in plastic containers, glass bottles, Styrofoam, and everything else. But there is no recycling on the island; it’s too small for it to be financially viable. Everything ends up in the burning landfill.
To the other side of the car was a fence with a sign marking the area as a protected zone — the habitat of the critically endangered Grenadian dove. I felt guilty thinking of all the new items students had shipped to Grenada and would likely leave on the island when we left.
We eventually stopped for a bathroom break at a rum shack. It was an small, orange, one-roomed construction on stilts above the hillside that sloped down away from the road. Posted beside the entrance to the shack was a blue and yellow poster with the picture of a glistening bottle of locally brewed Carib beer and the tagline: “Know who you are. Drink what you like.”
The rum shack was a cross between a bar and a convenience store. There was a television in the upper corner with football playing, the bright colours of the screen reflecting off the smoky interior of the rum shack. One of the walls was covered with various confectioneries, which hung next to stacks of canned condensed milk and spam. Behind the counter, a tall, portly woman sat on a stool and a man chatted with John.
“Just giving her the island tour,” I heard John say to the man behind the counter in his friendly, neighbourly way. The comment irritated me. Even though I was more of an outsider to the island than he, it was only by a few months. The man said he hoped we were enjoying our day, and asked John where he was from.
“Grenville,” I heard John reply, referring to a town on the other side of the island. I thought that was a strange answer. Didn’t John just tell me he was from Boston. Maybe he’d misinterpreted what the man was asking.
The small space was full of men, casually dressed in t-shirts, jeans, some in tank tops and baseball hats. One standing next to me, an older man with grey cloudy eyes, had missing teeth. With so many people packed into the small space, there was nowhere to look without looking at a person. It felt too rude to stare so I looked up at the TV. A few of the men were commenting on the game, and although they were speaking English, at that early point in my time in Grenada, I was totally helpless in understanding what they were saying through their bouncing accent.
“Mango?” John asked as he turned to me and held out the small fruit, green with a streak of red. The man he had been chatting with was reaching into a cardboard box under the counter, pulling out mango after mango and handing them to John, who handed them to me. I bit into the mango and immediately had sweet sticky juice running down my hand, dribbling along the tendons and angles of my wrist. As I used my teeth to peel away the rind, revealing orange-yellow flesh, I heard a low hushed laugh. Looking up from my mango, the toothless man beside me was smiling, his lips split wide and his grey eyes crinkled. I bit into the mango flesh, and smiled at him, mango hairs sticking between my teeth. I lifted my hand to show him the juice streaking down toward my elbow and nodded to him. He nodded back, laughing softly again.
It was my first month of school. Campus was busy with students emerging from the frigidly air-conditioned buildings dressed in jeans and sweaters, lugging overstuffed shoulder bags or hiking bags full of books. Others were dressed as if on Spring Break, in sleeveless oversized t-shirts or loose shirts that draped to expose a shoulder. The students contrasted sharply with the Grenadian office workers who wore tailored woolen suits in conservative cuts with glamorous stiletto sandals.
I recalled how one of my classmates had tried to convince me that on campus, American laws applied, like how the compound of an American embassy was considered American soil. I could see why she was so sure of it, but despite the campus body being predominately made up of North American students, the campus was still a part of Grenada.
There’s a popular phrase among students of my school: TIG. It stands for “This is Grenada.” I would hear students say “TIG” after something happened that they figured could only happen here. For example, “Today, there was a notice that the laundry rooms will remain closed indefinitely due to a water shortage. It’s been raining nonstop for three days. TIG.”
Some students consider the phrase disrespectful; others find it humorous and harmless. Whether it’s a passive-aggressive dig or just humor, TIG is a way for some students to cope with life on an island they did not intend on coming to.
A friend of mine who grew up in Grenada once told me the story of meeting a particularly bitter student while out at a bar.
“You’re from Grenada?” the student had asked him.
“Yes,” my friend replied.
“I hate it here,” the student said.
My friend’s response was, “Well, because we Grenadians are so nice, welcoming you to our island, how about I give you a ride back to the airport right now.”
There is a stigma back in North America against students who study overseas at these offshore schools, although many students agree that the opinion depends on the individual you talk to. Nevertheless, students attending offshore schools are constantly reminded that we need to compensate by scoring higher on standardized exams if we want to be competitive with our colleagues back home.
Being so isolated in a new environment, culture, and community adds additional stress that can cause students to forget that, although studying in Grenada was not their first choice, it was a choice they made. There were times when I impressed myself (and those around me) with how much of an impossible a-hole I was capable of being. Stressed or not, I was often reminded that coming to Grenada was not an opportunity available to everyone. Tuition at medical school in Grenada was notoriously high, comparable to the higher-end of US private medical schools.
I passed around the side of the newest lecture theatre on campus and started down a steeply sloping path that followed the shoreline. This lecture hall could seat more than 600 students at a time, with electrical outlets in each seat, wireless, and two massive screens on which lecture slides were projected and filmed for students’ convenience. Students who returned to the island after a few years would find campus unrecognizable. My brother’s friend, for example, would be disappointed to know there were no students with pet monkeys.
Construction was always booming, as campus was always expanding to accommodate the ever-growing student class sizes. A quarter to a third of US doctors came from medical schools outside of the US, and the fastest growing proportion of these were US citizens who trained overseas. Multiple factors contributed to this, including an aging population, a medical education system that has not been keeping up with the increasing demand for doctors, and the never-ending line of pre-med hopefuls. Business was good for offshore schools.
The sun bounced off the water and the cream colored buildings of campus; the sky was cloudless. As I walked down the hill, I could see the water, which was a clear, almost neon blue with wide patches of green. Large, dark, rocky islands covered in cacti poked up a few hundred meters from the shore. There was a continual warm breeze, like I was being held against a heated pillow.
Suddenly, there was a high screeching sound. A plane was passing, taking off from the Maurice Bishop airport that neighbored campus. As the screech grew louder, I heard a nearby window shiver and conversations take a pause.
When I first arrived in Grenada, the sound of planes annoyed me a great deal. They were intrusive, at all hours of day and night, and there was nothing to do but stop the conversation and wait until they passed. It only took a few seconds, but to me, those few seconds emphasized the loss of control we had over our environments, our circumstances — a lesson that was more obvious in the heat of Grenada than it had been back home.
Just at the moment when the noise became unbearable, it quickly dropped away. The world exhaled.
Almost at my destination, a large peach-colored building with a terracotta tiled roof at the bottom of the hill, I walked past the water and a long dock with a single bench at the end. On the shore in front of me, there was a brightly painted boat. Painted along its side was the message: You know it don’t come easy.
I climbed the stairs to the top floor of the building. The entire floor was a simulation medical clinic, complete with front desk and waiting room. That day, like every day that week, I would be practicing taking a history and doing a physical exam on a standardized patient — a volunteer. They’re called standardized patients because they’re trained to produce a consistent patient interaction. That is, the experience is standardized for every medical student. It would be a few weeks before I would head to the Grenada General Hospital to see real patients.
The simulated patients were mostly Grenadians, young and old, from different parts of the island, and every socioeconomic background. They memorize a story ahead of time, which includes a backstory (name, age, occupation), why they came to the doctor, and a list of symptoms. The script often included other details, such as whether the patient was to seem cooperative, angry, depressed, to walk with a limp, or to refuse to move their arm.
Each script was designed to illustrate some skill for us to learn. It could be a simple skill like what to consider when someone says they have chest pain, to more difficult skills, like what to do when you suspect domestic abuse. Some of the simulated patients were so fantastic with their detailed backstories that some students were still unsure whether they were acting or not. Grenada being a small island, we’d sometimes see “our patients” at local events. Students would poke each other, pointing out the Angry Patient, the Woman Who Won’t Tell You She Has AIDS, or the Man With Erectile Dysfunction.
On occasion we would receive standardized patients who were just there for “a regular checkup” and had no script to follow. Today’s volunteer was one such patient; a genuine 70-year-old man who genuinely worked as a gardener. In the examination room with me were a tutor and a few classmates. We decided we would practice going over the examination for the central nervous system, with each of us taking a turn at a different part.
We began by taking a general history, which involved asking questions about the patient’s background, reasons for coming in, past medical history, family history, social history, and so on. At one point, I asked the patient what his stress level was.
“Stress?” he seemed slightly perplexed by the question. “Life has stress…you deal with it,” he said. “What else is there to do?”
This was the answer Grenadian simulated patients tended to give, while the expat simulated patients from the US or the UK would go into detail about the stress in their lives. Island living was supposed to be easier, more laid back. But I had seen how it was also harsher. I was beginning to think that the Caribbean people’s reputation for being laid back wasn’t because there wasn’t anything to stress about, but rather because of an acceptance of things the way they are — stress included. You know it don’t come easy.
One of my classmates took over the next part, which was the examination. He began with a few questions to test higher brain functioning. My classmate tried one test, which is to ask the patient to count down from 100 by 7. The patient thought for a moment then began: “100 … 97…94.” During his time with a different student group, the patient had memorized the answer to the other version of the test, which was to count down by 3.
My classmate tried a different test, which was to ask the patient to spell “world” backwards. Our patient hesitated for a long while but couldn’t do it. Some of the students in my group felt uncomfortable and laughed nervously to cover it up. Fortunately, my group member who was actually doing the test didn’t laugh and just waited patiently for the patient’s answer.
The patient had been sitting quietly, but spoke up to say, “Let me tell you something. My mother abandoned me when I was three weeks old. I was raised by an adoptive family. So they didn’t teach me to spell such words.” The room was much quieter after that.
The tutor suggested we move on to test the sensory system. Most of our tutors were graduates of medical schools from Nigeria or India seeking to immigrate to the US, Canada, or UK. Some were in their late 30s or 40s, having already had established practices in their home countries. All of the tutors were brilliant, but some brought with them an old-school style of teaching that took some getting used to. An “I talk, you listen” type of teaching, where information was given, not explored. Tutors came to my medical school for teaching fellowships. These fellowships were marketed as ways for the tutors to beef up their credentials as they sought to obtain residencies in their desired countries. As exceptional as these doctors were, being non-US citizens as well as international medical graduates meant they faced greater barriers than we students. Just as it was for the medical students, for the tutors, Grenada was an opportunity, a second chance.
The tutor suggested we test some dermatomes — patches of skin which are supplied by the same nerve. He reminded us to check T4 and T10, which are at the level of the nipple and belly button, respectively. My classmate opened up the patient’s gown and picked up the unfolded paperclip that was on the counter. He told the patient to let him know if he felt a sharp touch (the pointed end of the paperclip) or a dull touch (the bent end of the paperclip) and went ahead and poked the patient with the sharp end right on the patient’s areola.
“Sharp or dull?” He went on to poke the other nipple with the bent end.
“Please, avoid the nipple,” the tutor said in his slow-paced, rounded Nigerian accent.
My group member went on to test for the sensation of fine touch, which is done with a cotton wisp. Again, he went right for the nipple and brushed it with the cotton wisp, asking “Do you feel anything?”
My tutor repeated, “Again, please try to avoid the nipple.”
Sometimes when conducting an examination of a patient, it’s hard to keep things straight. Students are taught to do things to the patient that would seem to hurt, like sticking our fingers deep into someone’s neck to feel their thyroid, or tugging forcefully at someone’s knee to test their ligaments.
A tutor once advised me, “Even if you don’t know what to do or what the answer is, you must act confident so the other doctors assessing you will say ‘yeah, she’s one of us.’” We become so accustomed to being taught things that are new and unfamiliar, that common sense easily goes out the window when it comes to things we clearly shouldn’t be doing, like tickling someone’s nipple with a piece of cotton.
Once, sitting in the student center on campus, I overheard a conversation between two medical students at a table nearby. One of the students had just about finished his two years of study in Grenada and was getting ready to move to New York, where he would complete the final two years of medical school studying in hospitals.
“I’ve been here for two years,” he was saying to his friend, “and if a tourist were here for three days, by the end of his three days we’d know about the same amount about Grenada.”
The process of obtaining a medical education is long. With endless applications, exams, and interviews — first for medical school, next for residencies — it can come to seem as if there is much about students’ future that is out of their control. At this stage of medicine, studying seemed like the one way to take back control. Medical students already tend to have anxious, neurotic personalities, but the anxiety can become so high that some students won’t leave campus except to go to the grocery store.
But there was only so much studying I could stomach. One day, I arranged to spend some time working on a local organic farm, as a break from the isolation of days spent studying on campus.
The farm was cultivated by a young man named Royan. He was friendly, patient, enjoyed martial arts (including his own form he called “African Sword”), and had dreams of playing a concert from the hillside of his farm where he’d sing the songs he had created while working his fields. His songs were about the joy of farming, refusing drugs, avoiding gang-life, and the importance of coming together as a peaceful community. Of course, Royan was also happy to give me lessons about farming.
The first lesson was simple. “This is sweet potato,” he said, holding out the short green plant so that I had a clear view of the leaves. “Anything that is different looking? That’s a weed. Pull it out.” In the time it took me to identify one weed, Royan had pulled up five.
“Most Grenadians don’t like the idea of farming,” he explained, “because it reminds them of slavery, being tied to working the land.” He casually tossed a mass of weeds atop the pile by his feet. “But farming is free! You are independent, feeding yourself. And look at us now all here together farming, working together: Black, White, Asian!”
Royan inspected the row of sweet potatoes we had just cleared of weeds. “You see where the ground is cracked?” he pointed at the soil. “It means there’s a potato that’s ready.” He dug his fingers into the deep brown soil and pulled out a potato. After he wiped off the moist dirt, I saw it was fuchsia with white liquid leaking out of the ends of the tubers that had been snapped as he pulled it up.
“The potato is crying!” Royan joked.
He looked younger than his age, especially in a khaki vest and pants that hung loose on his thin frame. A sheathed machete dangled from his hip. He wore a thickly knitted clay-coloured bucket hat over a smooth dark face, marred by a scar that ran from the angle of his jaw to a point by the right side of his mouth.
“Do you know any antidotes to make a dog more aggressive?” he had asked me when I spotted his nameless but friendly pit bull, who was jumping up, straining against his chain to playfully push my thighs with his paws, encouraging me to push back.
“If an intruder comes onto the farm, this dog will just want to play with him.”
In one hand, Royan held a bunch of long-stemmed weeds. The fingers of his other were curled but empty. This hand had been injured in an attack on his farm by an intruder one night a few years ago, and the damaged nerves were still recovering. He had been in a dispute with the government over the rights to his farmland, which were given to him when he was 18 as part of a national program to encourage youth into agriculture. He had been cultivating the land on his own, filling the nearby lake with tilapia and pumping the lake water up the hill to irrigate his farm. The attacker was apprehended, and was said to be someone unrelated to the government. Royan, now 28, had bought a pit bull as a precaution.
“Will you be coming back to Grenada after you finish school?” Royan asked me.
“I’d like to. It’s hard to imagine leaving and never coming back.” It was my usual reply, truthful but not really an answer. I looked down at the plant leaves between my fingers, comparing them to the sweet potato leaves. Different looking, I decided, pulling up the weed, enjoying the satisfying sound of the roots ripping from the earth.
“Well, I will tell you,” he said, “many Grenadians, if they are to choose between a white doctor or a black doctor, they would choose the white doctor.” His tone was not accusing nor indignant, just matter-of-fact.
“Wha-at!” I exclaimed.
“I don’t know why it is!” Royan said, straightening up, anticipating my reaction. “I am the same. I know it doesn’t make sense. I don’t know why it is.”
I thought of the time I rear-ended a car while trying to navigate out of a narrow road outside a busy nightclub. Stopped taxis were blocking the oncoming lane, so a taxi-bus had started to drive the wrong way down the road toward my car. I backed up to give the bus room to pass the parked cars, but was not paying attention to the car behind me. I heard honking and almost immediately a small bump. In my side-view mirror I saw the driver get out of his car and stalk angrily towards me. He wanted me to pay for the damage to the front of his car, although neither of us could tell which of the many scratches were from my car. “You’ll just have to pay for the entirety,” the driver stated. A friend of mine, from Trinidad, happened to see the accident and came over to talk to him as I stood to the side. Eventually the driver agreed to let me go without paying. I had come to accept that being Caribbean helps when it came to having a rule bent, a generous break, or a lucky favour. What Royan was telling me was surprising.
I told Royan that my clinical teachers — the Grenadian doctors in the local hospitals and clinics — had all been smart, caring, good teachers. Royan didn’t say anything. “What about Asians?” I asked. “Do I count as white?”
“Yeah, you’re white,” Royan said not unkindly, with a laugh. “You’re all the same.”
After a few weeks, I graduated from working with standardized patients and moved on to the Grenada General Hospital’s Pediatrics ward as part of my med-school curriculum.
The ward was clean but crowded with cribs. A few babies were sitting up in their cribs, crying. Their little arms were bound up in bright white paper casts. These casts weren’t necessarily to set broken bones, but rather to prevent the babies from picking at their healing surgical wounds. I had seen these used in other countries. In China, doctors used cardboard and surgical tape to immobilize the babies’ arms and make it impossible for them to bend their elbows. “No-nos,” we called them.
I headed toward the back of the room and approached a young woman sitting next to one of the cribs. Her large gold-toned earrings and rings stood out beautifully against her plain, forest green shirt. Peering inside the crib, I saw a wiggling infant with a round belly, surprisingly tiny nose, and bright suspicious eyes. The baby girl was looking well, but she stayed in the hospital over the weekend.
“She was just flushin’ out. Everything,” the woman, her mother, told me. “I couldn’t feed her. She was vomitin’. I was so scared.”
Our clinical training included classes in communication skills. It felt strange at first, sitting in a circle with classmates and a tutor, being told how to have a conversation. One of the skills we were taught was how to show empathy. It may not be possible to teach how to feel empathy, but I guess teaching how to show it is the next best thing. The tools of the trade included echoing what the patient just said, validating feelings, even keeping silent. It had been helpful when we were interviewing the standardized patients who were following a script, but on the hospital ward, surrounded by cribs of sickly, lethargic infants, watching a mother hold back her tears, showing empathy wasn’t something I had to consciously remember to do.
I asked the mother if their house had running water, and it did. I asked if it was good water. It wasn’t. It would run brown after the rain, and even though she took precautions to boil the water thoroughly, she admitted that the children would drink whatever water they would find.
She lived in a neighbourhood just on the outskirts of Town. “A board house,” she said. In some of the poorer parts of Grenada, houses of wooden boards and corrugated steel were crammed together tightly. Some families had lived there for generations, but some moved into board houses after losing everything in Hurricane Ivan. The mother wanted to move, but her house was the only place she could afford. She worked at a small corner convenience shop, and business was at a complete standstill outside the Carnival and cruise ship seasons.
“Water,” the mother said, brown eyes looking into mine. “If there’s one thing you can do for Grenada, it would be something about the water.”
Early one Saturday morning, I helped out at a school health fair, a student-organized event where students and physician clinical tutors come out to screen the community for high blood pressure and diabetes. My job was to take blood pressure and ask a few questions before patients went on to see the physician.
I took a seat on a bench under a tent in the Carenage, a commercial area not far from campus, in a concrete room with two walls and no roof. It felt like an old construction site, perhaps abandoned after Hurricane Ivan. There were about 70 Grenadians patiently standing in line to sit beside me, ranging from middle aged to elderly. It had just started to drizzle.
The next patient in line was Helen, a well-dressed lady in her 50s or 60s wearing silver rimmed glasses and a white blouse. I asked her how she was doing, and she said, “Fine, just a little warm but that’s okay,” with a smile. It was humid and hot, with an occasional spattering of rain, but typical of Grenadians, the participants were patient and without complaints. I apologized for the lack of setup early on. There was a miscommunication with the organizers and although the volunteers and participants arrived on time, the equipment, tables, chairs, and tent were about an hour late.
“That’s fine,” Helen said, “we make do.”
I wrapped my blood pressure cuff around her arm and began to pump it up. The crowd around our small table leaned in slightly, watching the process. 160/90: it was high.
“Have you ever been checked for blood pressure?” I asked. She had. “What kinds of things are you doing to manage it?”
Helen looked at me and said, “Well, I have a prescription. But the pharmacy is out so I haven’t had it.”
“Do they know when they’ll be restocked?”
“They’re not sure.”
“Since when have they been out?”
“How often are you supposed to take the medication?”
“Every day, morning and afternoon.”
The next woman eased onto the bench beside me and I pulled the table closer for her to rest her arm. It was hard to tell her age, but she was young, perhaps in her 30s. She was very obese and had come during her break-time from work, as was clear from her green uniform shirt and baseball hat with the logo for a local grocery store. I introduced myself and asked her name.
“Angel,” she said. As I unwrapped and wrapped the cuff around her arm I noticed the “Diet” section of her questionnaire hadn’t been filled out. “Can I ask, how many meals a day do you have, typically?” I asked.
“One or two. Usually one.” she answered.
“Do you get to eat regularly? Or do you find yourself skipping meals here and there?” I started.
“I skip meals, maybe every other day. When things get busy.”
“And what’s your typical meal like?” I asked Angel.
“Juice, bread…” She trailed off, still looking around.
“Any vegetables or leafy greens?”
She looked at me for the first time since sitting down. She had hazel eyes and was not wearing makeup, unlike many of the young women who had previously come by. “I eat what I can find. When you have no money, you eat what you can find.”
I thought back to the brief training we had done for the health fair. “Offer a bit of counselling,” the coordinators advised us. “It’s easy, basic nutrition and healthy eating — balanced meals, being active however you can. You guys will do great.”
Later that night, I slipped awkwardly out the door to my apartment, rushing through with my gym bag to avoid letting mosquitoes in. I glanced around to see if anyone had noticed and saw two little boys, maybe 10 or 12 years old, drinking cartons and rummaging through the trash bins outside the apartment. Neither had looked up. Not wanting to embarrass them, or perhaps embarrass myself, I started walking towards school as if I hadn’t just seen two kids looking for food in my trash bin. About two minutes later I passed the security gate of the school, and as I approached the student center, I passed a group of students chatting and holding takeout containers full of food. I walked past students playing basketball on the lit-up court, filled up my bottle at the water fountain, and ran on the treadmill for a half hour.
Another week, and another visit to the Grenada General Hospital. This time, I was in the Intensive Care Unit, following an anesthesiologist. The anesthesiologist was Cuban-born and Cuba-trained, but had come to Grenada about five years ago. He was energetic, kind, and walked with a swagger. When he spoke, he would lean his body forward, squinting one eye and lowering his voice dramatically. He would finish his sentences by suddenly leaning back and pointing a finger in the air. I liked him.
That day there was only one patient in the ICU: a nurse, who had suffered complications from a surgery to remove her gallbladder. The anesthesiologist didn’t want us to disturb her with our examinations, “because she is a nurse and would know what we were doing.” I wasn’t sure what he meant.
During previous visits, I had noticed a nurse scowling at the medical students as we walked by. I asked a friend what he thought of it. Perhaps there were hard feelings amongst some Grenadians about us North American students, I suggested. He answered me, “You know, sometimes it’s not cultural. Sometimes people just don’t like med students bumbling around, slowing down their work and getting in the way.” True enough.
Since we weren’t going to do an examination of the nurse, the anesthesiologist led us to a sitting area outside the ICU. He quizzed us on a few “most common causes” of this or that disease, then looked directly at me and asked, “So. Why did you go into medicine?”
Just like every other time, I wasn’t sure how to answer. This time it wasn’t because I was afraid of sounding cliché. I thought of the baby who drank bad water, Helen without access to medications, and the kids drinking juice cartons out of the garbage.
Why was I here? To heal? To help?
“To learn,” I decided.