I HAD COME TO GRENADA, in the West Indies, for my second year of medical school at St. George’s University. My school was based in Grenada, but I was enrolled in an unusual program through which I spent my first year of med school studying in Newcastle, in northeast England, and would spend my third and fourth years back in North America.
“Why does Grenada need so many doctors?” I had been asked once back in Newcastle. Grenada does need more doctors, but that’s not why so many students leave home to study there.
SGU primarily catered to North American students who wished to return to practice in North America. But there were also students from around the world: from Botswana, Nigeria, Trinidad, South Africa, and of course, Grenada. No one profile fit every student. Some came from Ivy League schools, some held PhDs, many held Masters degrees. Some had decided to start a new career after working as nurses or lawyers, in finance or in professional sports. But the common theme was that attending this school had not been Plan A.
“It’s a numbers game,” my landlord, who was also a professor at the school, told me. “There simply aren’t enough spots in U.S. and Canadian schools for all qualified applicants. Here, you get a chance.”
My classmate Vivek received a more blunt perspective after he had been accepted to medical school. Vivek’s interviewer was an alumnus of our medical school and the chief cardiology resident at Georgetown. When Vivek wrote to his interviewer to let him know about his acceptance, the interviewer congratulated Vivek and wrote back:
“I hope you have a great time, but take school seriously. I felt like all of us down there were in the Caribbean for a reason (basically, some character or academic flaw), so take this opportunity to turn a new leaf. Going there was kinda a blessing in disguise for me because it put a big chip on my shoulder … it was like Tupac going to jail: it made my venom more potent.”
We laughed about the last line, but what the interviewer wrote was true. Most medical students were here because, for one reason or another, it was the last option they had.
The morning sun was shining off the ocean and the air was so thick it was drinkable. Thankfully there was a breeze that touched the hospital at the top of the hill, slipping through the metal slats covering the windows.
Before entering the ward behind the rest of my classmates, I shrugged on my white coat and adjusted the stethoscope around my neck. Our coats were meant to make us look professional, but mine just made me feel uncomfortable, as though I were playing dress-up at my first job interview. Still, these hospital visits were my first experience interviewing true patients, and appearances could be important. This was especially true on a small island like Grenada, where word of unprofessional-looking students could travel fast.
As my eyes adjusted to the relative darkness of the interior of the hospital ward, I took a spot next to the head of a hospital bed. In it, a man was reclining with an arm behind his head, the other arm connected to an IV. Under his burgundy shorts, his left leg ended a few inches below the knee in a rounded stump, and his right foot only had three toes.
“Morning morning morning,” he greeted us as we arranged ourselves around his bed, three on either side. I introduced myself and asked if I could ask him a few questions. He agreed and as the interview proceeded, a mental record of my report started to take form in my head.
“C.B. is a 47-year-old unemployed black male from St.George’s who presented two days ago with abdominal pain of seven days’ duration…”
C.B. and I talked for over an hour — way beyond what would ever happen in real practice. I appreciated his willingness to answer my questions, as bizarre as they must have seemed to him — he hooted and chortled when I insisted he describe the look of his recent bowel movements, smiled slyly when we talked about his sexual history, and patiently repeated his answers when I had trouble understanding the music and rhythm of his Caribbean accent. He seemed to enjoy being interviewed, an interruption in his otherwise monotonous hospital stay.
About a week prior, C.B. had had sudden sharp pain in his abdomen just as he was about to sit down to dinner. Electing to head to bed rather than deal with the pain, he skipped the meal and tried to get some sleep. The next morning he was sweaty, vomiting, and confused.
“The pain was so much. I couldn’t talk. Couldn’t think,” C.B. tapped his temple with a thick finger, adding, “The doctor said it was a sugar problem.” When he got to the hospital they found the amount of sugar in his blood was so low his brain was essentially being starved into a coma.
This wasn’t the first time he had had sugar problems. C.B. was diagnosed with diabetes in his thirties, his body had long ago lost the ability to control the level of sugar in his blood, and the damage was beginning to show. First he lost sensation in his extremities. Without feeling in the bottom of his foot, ulcers broke through unnoticed. These quickly became infected and festered with bacteria, feeding off the high level of sugar in his vessels. The gangrene spread thoroughly through his leg, blackening the tissues as it crawled upwards. His leg and toes were amputated to stop the spread.
C.B.’s mother had also suffered from diabetic complications requiring amputations, eventually dying in her seventies. Not long ago, his sister had lost both feet to diabetes as well.
C.B. lay there, with one arm behind his head under his long thin dreads. “I was very active before,” he told us, “a painter.” He smiled mischievously as he described spending weeknights and weekends drinking with his friends. “Those were good times. Liming, with bush rum, a case of beer a day. Good times.”
C.B. was taking insulin, but since he sometimes skipped meals he would sometimes skip the insulin. He’d see a doctor once every other week to have his blood sugar levels checked, something that should be checked throughout the day. Like insulin, testing strips and glucose monitors were expensive and in short supply on the island.
Since the amputation two years ago, he had been unemployed, living with his brother and nephew in a small house by the National Stadium. His demeanor darkened quickly as he described his home life. After a night out drinking, his brother comes home drunk and threatens him. “He comes to my room, and whispers in my ear that he’ll cut off my head. That I’m useless, he hates me, and he’ll cut off my head one day.”
I had seen the kind of houses C.B. lived in. Next to the massive National Stadium, which had been built for the 2007 Cricket World Cup, was a steep hillside covered in small wooden-sided houses that sat close to each other, almost touching.
“Who looks after you?” I asked. “Myself,” he answered bluntly, as though it should be obvious. “If you don’t look after yourself, who will? You do what you do to survive,” C.B. said, resting back into his bed.
For the first time, he seemed tired of being interviewed.
Along with a few other students, I had organized a workshop for medical students on “Assets and Challenges to Grenada’s Sustainable Development: Our role as medical students in the community.” We were a small group of students who had arrived in Grenada from Newcastle with ideas of doing outreach projects in the areas outside campus, or what the students would often just call “The Community.” Wanting to learn more about our new home, we had invited a panel of speakers to introduce us to Grenada: a Peace Corps volunteer, a sports and youth worker, and a development consultant.
The projector screen glowed as the development consultant began her presentation.
“Too poor to ensure health, education, and a certain quality of life for everyone. Too rich to qualify for international development schemes. Grenada is a middle income country with pockets of deep poverty that remain,” she explained. The slide projected on the screen changed. “What are the major challenges facing Grenada?” she continued. “The top two: climate change and chronic metabolic diseases.”
With two years of drought followed by a year of incessant rain, the seasons were becoming increasingly unpredictable, placing major strains on the nutmeg and cocoa producers, once a major part of Grenada’s economy.
“But for Grenada, climate change isn’t an economic issue,” the development consultant said. “It’s an existential issue.” The impact of climate change and intensifying weather patterns most dramatically played out in 2004, when Hurricane Ivan hit Grenada and destroyed 9 out of every 10 homes; the shells of some of these still dot Grenada, roofless, floorless, abandoned.
A second panelist, the sports and youth worker, added, “You may see in your hospital rotations here, or even just in people walking down the street, young people in their thirties, even twenties, with missing limbs from diabetes. You’d never see that where you’re from.”
Diabetes is a chronic disease; there is no cure. Instead, there is management with expensive drugs that need to be taken multiple times a day, often by syringe. Management demands daily monitoring, regular doctor visits, and lifestyle changes. I thought back to C.B. lying on his hospital bed with his leg ending in a stump. Unable to manage his diabetes, he lost his leg. After losing his leg, he was unable to find work. Unable to find work, he had no funds to manage his diabetes. Just as how climate change wasn’t solely an economic issue, diabetes wasn’t solely a health issue.
Diabetes is often discussed as a disease of excess, increasing side by side with obesity. The message is often: Exercise, eat right, and you can avoid diabetes all together. Grenada is a bountiful country, with abundant fruits, vegetables, local chicken and fish. Although traditional meals tend to be low on vegetables but cooked heavy with oil, meat, and “provision” — starches like dasheen, plantain, and breadfruit — the rise in diabetes has been a relatively recent problem. A professor once told me anecdotally that the island’s increasing obesity, growing the fastest among young women, coincided with the opening of Grenada’s first KFC.
Diabetes is a silent disease, making itself known after the damage has been done. I could imagine C.B. in the years after he was diagnosed, before he lost his limbs, happily drinking rum with his friends. Diabetic or not, why bother wasting your time at the clinic when you’re feeling fine?
Once diagnosed, C.B., unable to afford a private clinic, would have gone to a public family practice clinic, where people would be lined up waiting to see the clinic’s one doctor. Even if he could afford the drugs he needed, chances were high that they weren’t available. It wasn’t unusual to go to the pharmacy, prescription in hand, only to be told the medication wasn’t in and they didn’t know when the next shipment would arrive.
Diseases like diabetes are multifactorial: Genetic predisposition, environmental factors, lifestyle, diet, exercise, money for care, knowledge to know when to seek care, and availability of resources on the island all play a role. The richest countries in the world haven’t yet managed to control diabetes, despite their well-developed healthcare infrastructure and relatively high accessibility to drugs, public awareness, and prevention initiatives. What chance would Grenada have?
“Grenada’s a small country, which certainly presents a challenge,” the development consultant said, “But the strength of a small country is that small changes have a greater potential for creating a nationwide ripple effect.”
So what is there for us students, taking our first steps in medicine, to do?
“Education,” the development consultant continued, “Go out and talk to people. You never know what impact you might have.”
A few weeks later, Vivek was trying to convince me to work with him and another student, Darius, to develop a diabetes education program for local schools.
Before medical school, Vivek had worked as a massage therapist, and before that, had spent a year in India working on HIV/AIDS prevention in minority tribes. Despite being one of the older people in our class, Vivek looked younger than his age, with an air of open sensitivity.
Darius, another second-year med student, was extremely active on campus. He was president of the Persian Students Association, had achieved the Most Volunteer Hours Award from the Honor Society, and was always organizing basketball tournaments or hookah parties. Whenever I spotted him on campus, he was playing soccer or basketball or running across campus to a lecture or tutorial, always with his red water bottle in hand. In soccer games he was shorter and leaner than the other players, almost scrawny, but quicker and with more finesse. Darius was one of those players who seemed to be able to make a pass from one end of the field and receive it at the other end, his dark curly hair popping out of nowhere.
“Isn’t this what you always talked about in Newcastle?” Vivek asked me, “All those workshops you’d organize about ‘our role as medical students in this or that other social justice issue’? Well here’s a perfect opportunity to apply all that theory. Everyone talks and talks, but [Darius] is the guy who is actually going out there and doing it. He just needs the people to back him up, to go with him.”
“Why do you guys need my help?” I asked him. I was still feeling reluctant. Diabetes wasn’t something I found particularly interesting, but there was something else that made me unsure. It was a feeling like standing at the top of a tubed water slide, looking down. Once I jumped in, there was no stopping until whenever the slide ended.
“Darius is all about action. And that’s great but it’s like ‘Let’s do this and this and this, oh I’ve already done this and made this happen.’ Meanwhile I am saying ‘Ah, wait, I want to think more about it. What about training? What about measuring our impact? What about making sure this program continues after we leave?’” Vivek paused. “You could help balance things out.”
Not long after, the three of us were in Vivek’s studio apartment looking down at three bowls of stringy dark green soup and three plates of bright yellow bean sauce on top of rice. Vivek had made us callaloo soup and lentils. “Is this food?” Darius joked when Vivek went to the kitchen to cut three thick slices of locally baked bread.
When we had all sat down Darius began, “I’ve just been calling this Healthy Grenada…but we can change it.” He was overflowing with ideas, almost interrupting himself as he quoted research studies, shared healthy living lessons, described soccer drills, and pulled out a quiz he had found online for teaching healthy food choices to primary school children. It was clear Darius had been thinking about this for a long time. I took out my laptop and was typing furiously to keep up, asking questions whenever I could. Could we make life skills a part of the program? How could we talk about peer pressure? Would the topic of sex be considered too taboo? What about discussing drugs?
Vivek sat to the side, once in a while throwing in a suggestion, but mostly smiling as Healthy Grenada bloomed and took form on my laptop screen.
It was the beginning of my Ethics in Medicine lecture and the professor was looking for some class participation.
“Let’s try this together,” he said as he clicked to the next slide in the presentation. Students stirred and shuffled, looking up from their laptops and notes to the screen, taking out clickers from their bags to plug in their answers to the question.
On the screen was a thought experiment on justice versus utility. You are given two populations, one worse off than the other but neither group doing all that well. You have limited resources and two options. Do you raise the well-being of the worse-off group, alleviating the disparity between the groups but leaving neither group well off? Or do you maximize the well-being of the better-off group, lifting one group out of hardship at the expense of widening the disparity between the groups? A timer counted down as the last few students clicked in their answers. The screen refreshed and with a flash the responses were in.
The professor seemed pleased with the input. “When I do this with law students, the split in the class is about the same. Most of the law students choose justice, to decrease the inequality between the two groups.” He craned his neck up to look at the results projected on the massive screen. “When I do this with medical students, this is the typical result I get.” 80% of the class would increase the overall well-being, even if it meant increasing the disparity between the two groups: utility.
During the ten-minute break before the next class, I watched from across the lecture hall as Darius and Vivek approached Karen. Karen and I had been assigned as roommates in first year, and had quickly found we shared passion for social causes. Originally from rural Pennsylvania, Karen had been an essential partner of mine in organizing workshops throughout medical school, including the workshop that brought Darius and Vivek together. I watched Darius gesture as he explained how they’d like her to be involved in the project. Her dangly earrings, which she’d picked up during her years training community health workers in Ghana, swung as she shook her head no.
When I asked Karen about it later, she told me, “I’ve just seen how easy it is for initiatives — especially health initiatives — to totally fuck up communities.” Her voice wasn’t raised but there was a hint of anger as she spoke. “There’s such a risk, especially when you’re working with kids. It’s too easy to overlook the limits of our training. Medical school doesn’t train us for this stuff. We need to leave the development work to development professionals.”
Once, when we were living together in first year, I saw a picture of three young children on Karen’s laptop background. Each was wrapped in a bright patterned cloth. They were huddled on each other, unsmiling and peering curiously at the camera. I had asked Karen about her time in Ghana.
“It was humbling work,” she told me. “But the people were amazing. Leaving was just so hard.” When I asked about the three kids in the picture, she told me they were three girls from her village in Ghana.
“The one in the middle was my neighbor,” Karen said, pointing at the screen. “Their parents had died but the one in the middle helped to look after the other two. I used to read with her.” Karen’s earrings brushed her face as she looked down. “She was so angry when she found out I was leaving. She felt I was abandoning her.”
Later that week, Darius, Vivek, and I drove out to a school to talk to the principal about running Healthy Grenada. She was expressionless as we described to her our idea to work with the Grade Sixes once a week during their Physical Education class. Healthy Grenada would run like a friendly competition, where teams of students would become experts on a health topic of their choosing and eventually teach other groups about their topic. We emphasized the goals of empowering youth, partnering with the school, making learning fun, getting the parents involved, and of course, a final Poster Presentation day celebrating the achievements of the Grade Sixes, to be held at our medical school and open for the entire community to attend.
She said she’d need to get the teachers’ approval first, but the teachers felt their curriculum was already too full to include any new programming. In an effort to raise Grenada’s education standards to match the rest of the Caribbean, there had been new changes made to the curriculum, including new national exams for the Grade Sixes before they headed off to begin high school with Grade Seven. Grenadian schools were under greater scrutiny than ever. Aside from that, I wondered how the teachers felt about a group of North Americans coming to teach their kids how to live, what to eat, and what to do in their spare time.
“Don’t worry,” Darius reassured us. “There are other schools. But, we’ll need to get Felix on board.” Originally from Trinidad, Felix now worked at our medical school’s Sports Department, and ran soccer programs for youth on the side.
As we were leaving, two girls in pleated dresses, giggling, followed behind us for a few steps, and in the instant just before we pulled away, I heard one say, “I want to be white too.”
The next week, the three of us took a bus to the Blessed Sacrament Grand Anse Roman Catholic School. On the way, we rehearsed how we would pitch our program to the principal and the teachers, and who would say what.
I spotted Felix standing next to the school when we’d gotten off the bus and were walking up an alleyway. Lanky and tall, he looked like a soldier at ease, except that he was wearing a bright blue Chelsea soccer jersey, matching shorts that went to his knees, and white and black-striped oversized plastic sunglasses pushed up onto his forehead. Darius called out, “Ey, Felix!” and when Felix saw the group of us approaching, he broke into a toothy smile.
“It’s all set,” Felix said, putting his sunglasses back on and walking towards us, ready to head back to the bus stop.
“I’ve already talked to the principal, to the P.E. teacher, it’s all set. You wanted to come out on Fridays right? 12:30 okay?”
Like that, it was done.
“Amazing,” Darius laughed.
Weeks later, I was back at Blessed Sacrament. It was lunchtime and I was keeping my back to the wall as students ran past, up the stairs, down the stairs, calling to each other loudly. The students’ uniforms of white short-sleeved dress shirts and burgundy pants made the noise and activity seem all the more chaotic in contrast.
A classroom door opened and Vivek stepped out to tell me all the Grade Six students had arrived. I walked in and saw five young students seated in a circle, with our volunteers squashed in awkwardly amongst them in tiny chairs. We were there to do a focus group with a few sixth graders, to learn more about them and to hear their feedback about our proposed program.
Vivek was sitting next to a sixth grader named Sade. “Like the singer?” Vivek asked Sade, and she nodded with a close-mouthed smile. Sade sat straight backed in her chair, her hair pulled tightly into a round bun atop her head. Vivek asked Sade if she knew what diabetes was. She did.
- “When you have uncontrolled glucose levels because your pancreas has stopped producing insulin,” Sade explained precociously.
“What can you do to help it?” Vivek looked charmed and surprised. “Can you eat the insulin?”
“No, you can’t eat insulin! That’s silly!” Sade giggled. “You have to inject it.”
Vivek laughed and looked down at his paper for the next question to ask Sade.
“Sade, who is your hero?”
The sixth grader’s brow furrowed slightly. “What do you mean?”
“Who do you look up to? Maybe your mom or your dad, a sister –”
“I don’t have a mom. My mom is dead.”
For a moment, Vivek floundered to find what to say — whether to politely avoid the subject of Sade’s mom and move on, or to tell Sade he was sorry for a loss that he didn’t really understand.
- Sade spoke up again, “I’m my own hero.”
The school looked different in the evening. The kids were gone, replaced by a quiet, hazy pink glow from the sky. Vivek and I were in the principal’s office, talking with the principal, Ms. Jane.
Despite her short stature, in her pantsuit and half-rimmed glasses Ms. Jane felt like the tallest person in the room. She had bouncing curly hair, round doll-like eyes, and a quick smile. But she also carried an air of practiced sternness that commanded respect. Hanging from the side of her pinky was a round ball of flesh. It had a small nail which was perfectly groomed to match the rest of her nails. I watched the small nub bounce against the principal’s pinky finger as she gesticulated. I wondered if she was ever teased as a young girl for her extra finger. Something about her suggested that if anyone had ever teased her, they probably ended up regretting it.
“Welcome again. The parents are still arriving,” Ms. Jane greeted us. She was a fast talker but with impeccable enunciation. “The parents meeting will be upstairs.”
The entire second floor of the school was divided into two classrooms that spanned the length of the building, with a hallway running between them. During the day, each classroom was divided into three smaller classrooms by chalkboards. But that evening, there were desks filling the entire room, facing one end where there was a raised platform and podium. Only a few parents had arrived to take their seats so far. They looked tired and the room was quiet.
We waited for a few minutes before Ms. Jane tapped us on our shoulders and asked us to follow her into the other classroom across the hall. The room was empty.
“So. Who will be leading the presentation?” Ms. Jane asked in a lowered voice.
Vivek looked at me. “Both of us.”
“And you have a letter you wanted to give to each parent?”
“Right here,” I said, and produced the letter to parents one of our volunteers had prepared. It introduced our program and asked parents for their support in helping the kids develop healthy habits.
“No. You,” she looked at Vivek, “may do the presentation.” She put her hand on my shoulder. “You may hand out the letter but you cannot go on the stage like that,” Ms. Jane said, looking down at my shorts.
In Grenada, it’s possible to be fined for driving shirtless or for walking around town in a swimsuit. The other day I was walking to school and passed two tourists waiting for the bus in beach wear. One was wearing a sheer sarong through which her white string bikini was clearly visible. Behind my sunglasses I had rolled my eyes at them for being so out of touch with their surroundings.
“I understand, you know how women can be,” Ms. Jane smiled at me kindly, “wanting to display everything.”
I felt my face warm. I had worn these shorts to the school before, worked with the kids in them. Not for the first time, I felt frustrated for living up to the stereotype of the abrasive North American, clueless and uncultured.
By the time I had gone home to change and returned, parents filled about half the seats in the classroom. Vivek and I sat in the front, a few rows from the platform where Ms. Jane sat next to the vice principal, Mr. Francique.
I turned and saw rows of empty desks between us and the parents.
Ms. Jane began by imploring the parents to help make sure the children get to school on time. “Many of the parents at this school work during the night and early morning in hotels or resorts,” Ms. Jane had told us. “The children must not just prepare themselves for the day, but their younger siblings as well.” I’d often seen pairs of schoolchildren, one tall and one small, identically dressed in burgundy pants and cream dress shirts, walking together down the road to school.
When it was our turn to present, Ms. Jane introduced us as “students from the School of Medicine, who have decided to take an interest in our children.” It felt awkward to be described that way. She brought up the rectangular gash of exposed soil and rocks in the school’s field, where there used to be a large rust-colored shipping container, dropped off by an American company during Hurricane Ivan and left behind, forgotten. “I asked them when they would move it,” she’d told us, “but I was told it would cost 4000 Eastern Caribbean Dollars [about $1480 USD].” Ms. Jane didn’t seem angry or even annoyed, as if it was just the way things went when a primary school tried to ask an international company to clean up after itself.
With fundraising from our medical school’s student body, we raised enough funds to have the container removed. We were proud of this accomplishment, but had been wary of being valued as a source of money rather than for our program. Despite this, Ms. Jane certainly seemed more impressed by our success in moving the container than our efforts to educate the kids.
“Thanks to these students. Please welcome them.”
Vivek took the microphone as I walked through the rows of parents, handing each a letter. They were silent, few making eye contact with me. Several reached out for letters, but many did not touch them after I placed them on the desks. In the back of the classroom, Vivek’s voice sounded distant through the microphone, “And we’re looking for the support of you, the parents…”
Once the meeting had ended, we thanked Ms. Jane and Mr. Francique for letting us come and speak. They seemed more relaxed, smiling freely. We wanted the school to have greater input as well.
“If there’s ever anything you’d like to see, or if you’d like,” I blabbered on, “we’d be happy to run the program by you before we begin it –” Ms. Jane interrupted us. She put her hand on my shoulder and said, “This is your project. We are happy to have you here. But this is your project.”
I thought she would want greater control over the program, greater input. Instead, I had the sense she felt we were shrugging off the work. I clarified, “I know we have a lot to learn still, as much as we want to give, we just want to acknowledge what we still don’t know, and don’t want to step on any toes.”
Ms. Jane took her hand off my shoulder and moved it in a small circle from herself toward Vivek, then to me, and back to herself. “We can all learn. From each other, our cultures can learn much from each other.”
Word began to spread through our campus about a program where “med students go to schools to play with kids on Fridays.” Although it admittedly made it easier to recruit students who were eager to leave campus and do good in the community, it was a description that frustrated us. We weren’t the only student-led group working with kids, we were often reminded. What about the group that plays with orphans on the beach every Saturday? Or the after-school program, run by the Significant Others group?
This one is different, we’d reply. It focuses on diabetes and on working in partnership with the Blessed Sacrament school. It requires a commitment from volunteers, and isn’t just about playing. In truth, the different programs had more in common than we likely wanted to admit. This project had become so personal, and we were becoming very protective of it.
We had just finished studying a module on Behavioral Sciences when Darius approached Vivek and I between classes. “What do you think of making Healthy Grenada an NGO?” I looked at Darius and wondered if he was manic. “I just got an email from an alumnus in the States who is working on doing a similar project. They’re calling it ‘Plantation to Plate’ and they want to work with us.”
Darius opened his laptop and showed us an email from the alumnus. The email described a project aimed at educating Grenadian children and eventually the rest of the Caribbean on healthy eating. The goal was to help the kids develop good habits at an early age, “before the influence of ‘Western pop cultures’ corrupts their ideas of what is ‘good’ eating.”
I remembered how I felt when Vivek asked me to become a part of the project. I was at the top of that water slide again, looking down into the tunnel with water rushing through. Things were getting overwhelming with Healthy Grenada and we hadn’t even begun. Everyone’s excitement to get involved was growing faster than the program was developing. Every day, volunteers asked us when we would get to start at the school. This was a small operation, and although we had a growing number of volunteers, the entire development, training, content, and logistics of the program had fallen on three medical students who were fumbling as they went.
“I don’t think that’d be a good idea…” I began, slowly. Then the lights dimmed and class was about to start again. “Ah, out of time. We can talk more about this later,” Darius said, and was gone back to his seat.
We walked up the long road toward Blessed Sacrament with 17 of our volunteers and a folder full of quizzes, worksheets, and activities we had planned for our first session of Healthy Grenada. Alongside us were a group of young boys, about 9 years old, in burgundy pants and white polo shirts, laughing and running around. One of the boys was making growling noises. He held a long thin stick and was swinging it violently, trying to hit the other boys. They told us they were playing a game they made up called Daddy. “It’s a different culture,” I heard one volunteer say to another, “let it go.”
The Healthy Grenada volunteers lined up in a row at the front of the classroom of Grade Six students and introduced themselves one by one. Except for Felix, all of us were from North America.
Introductions over, the volunteers split into pairs, and the classroom was divided into teams. The students in each group chose their own team name. There were the Lovebirds, a group of friendly and pleasant girls and one good-natured boy; Shaq Lightening, a rambunctious group led by the class clown; the Charging Saints; the Pakistan Grenada Bright Stars; the Angry Fast Jaguars; and Self Made.
It came time for each team to choose a health topic from the list we had prepared: obesity, smoking, hypertension, alcohol, exercise, and diabetes. Each team selected a representative according to the time-tested method of who-has-the-next-birthday, and each representative came to the front of the class to announce their chosen topic. As teams got into discussions about their health topics, I walked around the classroom, listening in on conversations and watching the volunteers work with their kids.
“What is obese?” one volunteer asked his group, the Charging Saints. No one knew. We had asked the volunteers to be sensitive with these topics.
“It’s like when you’re bigger…” the volunteer began, diplomatically. “Like her!” one boy jumped up, an outstretched arm pointing at a tall girl in his group. “Hey. No. That’s not okay,” the volunteer struggled.
Nearby, a volunteer was losing the attention of his group, the Angry Fast Jaguars.
“Alright,” he began, “so what do you know about the negative health effects of stress?” It sounded bizarre in this classroom, perhaps more appropriate for a lab presentation. A boy in his group had his head on his palm, watching the antics of Shaq Lightening across the room. One girl was smiling at the volunteer, but no one was answering.
During the training session for volunteers, we asked Grenadian classmates about their childhoods, to help us get a better idea of what differences there were between us and the Grade Six kids we were going to be talking to. The Grenadian students did not have much to say, and what they did say about growing up in Grenada sounded quite familiar — wanting to be with friends, stress about relationships with parents, just wanting to have fun.
Looking back, it dawned on me how unfair it was to ask three individuals to explain the perspectives of a generation of children. How arrogant we were to assume the experiences of all Grenadians were the same, and that we could extrapolate any knowledge about what life is like for a sixth grader from the memories of a Grenadian university student.
Laughter erupted from the corner of the classroom. I looked over to where it was coming from and saw Felix leaning over the desks of the Angry Fast Jaguars. Felix’s tall frame was bent at the hip, with one finger in the air and another pointed at a boy.
“What’s your favorite food? What’s your favorite food?” Felix was asking the kids, rapidly pointing a finger at one then another like an animated scarecrow. The volunteers were sitting back in their chairs, watching Felix.
“Chicken, mm chicken,” Felix said, rubbing his belly. He then pointed at another student, “What’s your favorite food?”
Felix paused dramatically, and placed a hand over his chest. “I love carrots,” he sighed. The group of children were leaning forward, sitting up, totally engaged.
“Blergers!” yelled a boy, the one who had been gazing off.
“Blergers! What kind of blergers?” Felix continued, his energy infectious. “You like blergers? What kind of blergers you like?” He continued to point and question as the kids laughed, eyes shining.
When it was time, the students and volunteers moved to the field where Felix had brought out some cricket equipment. The boys immediately began setting up the field and choosing their teams.
I saw a girl standing alone by the corner of the school, watching her classmates. It was the tall girl whom the boy had declared obese. I asked her why she wasn’t out playing, and she told me, “Miss, I can’t go out in the sun.” She looked up at me and I saw that her eyes were crossed. “Miss, it’s bad for my eyes and sometimes I’ll fall down.”
We stood together in the shade, quiet for a moment, both of us watching a boy pitch to a batter, who swung and missed. She told me her name was Narissa.
“Miss, I can sing, you know,” Narissa told me. I asked her to sing me a song, and she smiled. She started, “Oh oo oh oo oh oo ohh… You know you love me, I know you care.” As Narissa sang, the school bell rang and the volunteers started packing up to head to the bus stop. Narissa kept singing, “Just shout whenever, and I’ll be there.”
A small boy walking back toward the classroom stopped to listen. A line of second graders marched past us silently in single file with their fingers over their lips, led by a teacher proud of her class’s discipline. There was the sweet smell of burning garbage in the air, almost like chocolate but heavy and with an unnatural tinge of metal that filled the sinuses. Narissa continued to sing without a break, unhurried by the end of the school day.
Over the next three months, we visited Blessed Sacrament as often as their schedule and our exams would allow. Hour by hour, we slowly learned a little about the kids’ personalities: the friendly one who loved to help, the one who grew angry when he didn’t get to touch the ball during a soccer game, the one who didn’t like to talk, or the one who liked to talk too much. “School of med!” kids yelled, recognizing us as we ambled up the alleyway. Seeing Felix they called out, “Tall man!” and ran to hug him in twos and threes.
One of our volunteers, Michaela, had been taking on a greater role in leading the program. She had been volunteering with us since the beginning, recruiting volunteers and helping to draft the letter to the parents. A first year medical student, we anticipated that she would take over for Darius, Vivek, and me after we finished our year in Grenada. When Darius, Vivek and I couldn’t make it to sessions because of our exams, Michaela stepped in to oversee the visits.
During one visit, the Healthy Grenada volunteers were showing the kids how to take a pulse, to show them the effect of exercise on their bodies. One boy didn’t want to get involved. “This is dumb,” he said as Michaela walked by. Michaela grabbed his arm and put her fingers on his wrist. “Oh my…what is that?” she gasped. “What? What? Let me see,” the boy said, taking his wrist back and holding his own fingers to it. He looked up at Michaela, wide eyed. “I can feel it!” he exclaimed.
Later that day, after the kids had played Red Light Green Light and a short game of cricket, the school bell rang and they headed back toward the school. “Bye Miss!” the girls in the class waved to Michaela as they climbed the stairs back up to their classroom. “Wait!” Michaela called back, and she held her fingers to her wrist. The girls gasped, having almost forgotten to check, and then laughed as they continued up the stairs, feeling their pulses beat in their wrists.
The night was cool and breezy at Prickly Bay Marina, where I was sitting at a sticky plastic table with Darius, Vivek, Felix, and Dr. Shah. Dr. Shah was a neurologist now working in New York, but was in Grenada as a visiting professor for the medical school. He was the alumnus who had contacted Darius months ago with the idea of making Healthy Grenada an NGO. Darius had recognized him and approached him after lecture.
It had just rained, hard but short, so the air felt fresh and light. Dr. Shah had his iPad in front of him, punching in notes on the touchpad as the rest of us watched. Darius, Vivek, and I were tired. It was our last school term on the island, and our final exams were just around the corner. After that, we’d be leaving, moving to New York City for the final two years of medical school. Considering the years of residency that waited for us after graduation, it would be unlikely any of us would be able to return to Grenada any time soon.
We hadn’t met to talk about Healthy Grenada in a while. The last session had finished, but not the way we had hoped. We had told the kids the final session would be on campus where they would present their health topics to students, staff, and their families and friends. But there were sessions where the Healthy Grenada volunteers arrived at the school only to be told the students were busy writing a test. Or sessions where we called ahead to let them know we were on our way, only to find out school was on holiday for the next two weeks. Sessions were delayed and delayed until we had run out of time. At the last session, Sixth Graders still presented their health topics, but to each other in their own classroom at school.
Dr. Shah was telling us about his wish to use Healthy Grenada and the Blessed Sacrament school as a national model.
“I’m meeting with the Ministry of Education and Ministry of Health tomorrow,” he told us, “and they are extremely interested in taking this program to every parish in Grenada.”
“I do a lot of volunteering for the school with the alumni network,” Dr. Shah continued, “So I can confidently say that you’ll also have the power of the entire alumni network behind you. It’s yours to tap in to whenever you need it.”
I wasn’t sure what I thought of Healthy Grenada anymore. I had so many worries. I was worried about its sustainability, about the amount left to do to build it. I worried about what would happen to it after the three of us left. I started to wonder if it was better for the program to fold than for it to continue to run as a burden on the volunteers: sessions rushed and children disappointed.
Were we just adventuring, getting more out of visiting the children than the children were getting out of us? I wondered if the future volunteers understood, and more importantly, bought into the core of Healthy Grenada. Did they see the importance of working with people like Felix, the importance of building relationships with the school? Were they disappointed with how the sessions had turned out? Or worse, were they pleased?
I felt deflated. I felt cynical. I felt like perhaps we should never have even tried. I didn’t want to think about Healthy Grenada.
“You’ll never have to worry about funding again,” Dr. Shah announced. There was a point during the term when I daydreamed about how much easier it would be if all it took was money to make the program a success.
“That’s great, thank you,” I told Dr. Shah. “But one of the main challenges for this program is training the volunteers to work with the kids. We may have the textbook knowledge, but we’re not teachers, it’s not what we’ve been trained to do.”
Darius jumped in. “Yes, but training for volunteers doesn’t need to be an obstacle. They can be trained.” Dr. Shah added, “Even if we try and it fails horribly, at least we tried, right?”
Karen would have been horrified.
It was a few minutes before the start of the final meeting with our 28 Healthy Grenada volunteers. This was a chance for them to reflect on the term’s sessions and for us to get their feedback on the program. It was also the last time we’d be seeing the volunteers as a group, one last opportunity to offer any ideas we had before we left for good.
I decided the final thing I could do for Healthy Grenada was to share my cynicism and doubt with the volunteers. Darius wasn’t sure it was a good idea. A few weeks ago, Vivek had sent me a speech he had come across during his undergrad. It was To Hell with Good Intentions, Ivan Illich’s 1968 address to an organisation of American students who were spending a summer on a service mission in Cuernavaca, Mexico.
Illich, a philosopher, priest, and writer critical of the Western approach to “third world development,” had been invited to speak at the Conference on InterAmerican Student Projects. I wanted to share some excerpts with our volunteers.
The slide I had sent Darius read:
To hell with good intentions.
Next to money and guns, the third largest North American export is the U.S. idealist, who turns up in every theater of the world: the teacher, the volunteer, the missionary, the community organizer, the economic developer, and the vacationing do-gooders. Ideally, these people define their role as service. Actually, they frequently wind up alleviating the damage done by money and weapons, or ‘seducing’ the ‘underdeveloped’ to the benefits of the world of affluence and achievement.
Not only is there a gulf between what you have and what others have […], but there is also a gulf between what you feel and what the Mexican people feel that is incomparably greater.
I am here to suggest that you voluntarily renounce exercising the power which being an American gives you. I am here to entreat you to freely, consciously and humbly give up the legal right you have to impose your benevolence on Mexico. I am here to challenge you to recognize your inability, your powerlessness and your incapacity to do the ‘good’ which you intended to do.
“You can’t read this to them, not you,” Darius told me.
“It’s to get them to think,” I replied.
We had been going back and forth about this over email for a few days. Initially just unsure, with each email Darius had become more set against the idea.
“This is a great message, an important message. But we should leave it for the beginning of the term, for the first meeting, before they have gone out,” Darius said. But the next term wouldn’t be for months, we wouldn’t be there for it, and I was sure that by then, this idea would have been forgotten.
“These volunteers haven’t had the same amount of time as you to reflect on this speech and to come to the same conclusions as you,” Darius was saying. “They can’t come to those same conclusions in just ten to fifteen minutes.” He seemed to be losing a bit of his patience, the first time I had seen it happen.
But stubbornly, I wanted to see this through. Perhaps it was more for myself than for the volunteers.
“I’ll be gentle,” I told Darius.
To his credit, even with his strong feelings against it, he had still prepared a slide in the presentation for me.
“You’re here because you care,” I began. “We’re here because we all care and we have the best of intentions.” The volunteers looked tired. I noticed a few were missing. “But I want to share something with you that may make you feel uncomfortable. When I first read it I felt angry, defensive, and basically, that it hit a little too close to home.”
As my slide was projected, I saw the volunteers look up at the screen behind me. “The man giving this speech had wanted the volunteers to do three things. One, he wanted the volunteers to stop trying to help these communities. Two, he wanted them to realize there was a vast difference between the realities of the volunteers, and the realities of the communities they were trying to help. And three, he wanted the volunteers to recognize the limits of what they could do.”
I glanced at Darius and Vivek, who were standing off to the side of the room, looking up at the slide.
“So that’s why we’re here,” I continued. “Despite having the best of intentions, it’s still possible for us to mess up and to actually do harm. We’re here to celebrate what we’ve accomplished, but more than that, we’re here to keep growing.” I looked out at the volunteers and they looked back at me. “Let’s hear your feedback, good or bad. Be as critical as you can.”
I had expected a few moments of silence before anyone would open the discussion, but one volunteer’s hand went up immediately.
“There was a good balance between structure and improvisation,” one volunteer began, “but the time was too short for the amount of stuff we wanted to do. In the end we were rushed and it took away from the meaning.”
“I didn’t have so much of an issue of getting stuff done,” another volunteer offered, “but I wish we could have gotten to know the kids better.”
“I felt bad,” a third volunteer said, “like we were abandoning them. We spent a few hours with them then they’re gone to the next grade. The kids could have felt neglected. Could there be some way to give them a way to stay in contact with us?”
As the discussion continued, Darius came to the front of the room to reply to the volunteers’ concerns. At one point, he looked back at me and smiled, knowing he had underestimated them. The volunteers didn’t want to be patted on the back after all. They had faced their own limits and the limits of Healthy Grenada to make an impact, and I was grateful for it.
For everything that we wanted to do for Grenada, Grenada still had so much to teach us first.