The messenger isn’t spreading messages well: health crises in Jamaica 

I’ve lost track of how many times Dr. Marion Bullock-Ducasse has been on the radio (or TV, though I watch the news only rarely), or been cited in the written press, but it’s a lot. Why has that happened? 

Jamaica has been plagued (sorry), recently, by waves of health issues, and as chief medical officer (CMO), she has become the face of blame, shame, and explanation about the recurrent health problems. I shy away from saying crises because that may be alarmist. But, public health matters matter much to most people. So, when people hear of, or experience, things that put their health at risk, naturally, they become afraid. 

So, when a new mosquito-borne virus seemed close to our shores, people sought information and assurances. We know such diseases, because dengue fever is prevalent. But what was this new-fangled thing, called chikungunya? The ministry of health turned its head and looked the other way, offering little concrete information, then denying its widespread existence and effect, then scurried to deal with what became  a full-fledged epidemic. People suffered the pain of the virus, struggled to get the simple pharmaceutical medication that would alleviate the worst bone-aching symptoms, reverted to various forms of herbal medicines which many swore were effective, hoped and prayed that aedes egyptae mosquitoes were not biting them. They scoured for and scoured out plant pots, dog feeding bowls, old tyres. They went on ‘clean-up’ campaigns to get trash out of gullies. The message came that people were to blame, because their nastiness provided the right conditions for breeding these insects. Some people died because Chik-v worsened existing health conditions.  Bad people! 

What marks would you give those guiding national health policies and services based on that? High or low? Low, we agree. 

But, the minister in charge asked us to not judge him on Chik-v. He wanted to get it, so he’d feel like most people. I’ve still not understood that wish. A stunt? But, let’s give him his wish and hold off judgement based on our wonderful discovery of the joys of drinking bitter green papaya leaf juice andliving with the smell of mosquito repellent.

Ebola didn’t hit our shores, but it came close, according to reports of people with similar symptoms sighted on land or nearby. The mere hint of it sent hospital staff into panic in Mandeville regional hospital, with them locking up a suspected victim. The country began bans on return travel from some affected countries. 

The health ministry began issuing cards to arriving visitors from overseas about communicable diseases and that people should look out for symptoms (especially, fever) over the following 6 weeks. 

We had a massive fire at Riverton dump, that covered the Kingston metropolitan area with a pall of noxious fumes for days. It was so bad that the responsible minister would only visit the dump wearing a gas mask. (Note that image, and check where your mask is…😫) Out came the CMO to tell us how badly affected we would be by the poisons released into the air we had to breathe. I remember driving through Washington Boulevard and thinking about all the benzine coursing though the lungs of the children waiting for transport to school as we looked at the grey haze. Our long-term suffering isn’t clear, but maybe future generations will be able to study what impact that polluting episode had.

Now, we’ve learned that two outbreaks of infectious bacterial diseases in neonatal units in two major hospitals caused the death of 18 infants since June this year, having infected 42. The minister told us that he only heard about the cases a week ago, and acted as soon as he knew. He didn’t act that fast in the sense that he delayed for 4 days calling a press conference, after disclosing what he knew. Whatever he needed to do, that delay in addressing the public and media speaks volumes about understanding what health issues mean, especially about a story that was broken by the media. Four days during a health emergency is like an eternity. 

Many will suspend belief on the minster’s claim. Why? 

It beggars belief that medical professionals, seeing a spike in infections and deaths would not pass that information to their superiors. If they thought they had things under control, good management practices would suggest that a report would show that the outbreak occurred, was contained, and give kudos to those who did such good jobs. That would have been music to the minister’s ears, as he tries to convince the country that health provision is improving. 

If the infections were not contained, a different report would be made pointing to problems and failings and how to avoid their recurring. That would also be music to the minister, as it would show good focus on problem-solving. Maybe, people would be disciplined if it was clear that humans failed. 

But, not reporting up the line? No, that makes little sense. More likely, reports were made but the gravity of the problem was understated. Let’s leave speculation there. 

Back to Dr. Bullock-Ducasse. As spokesperson during the various problems, she’s sounded calm and assured. Clearly, she wants to convey absence of chaos and panic. She often gives good advice on how to proceed. But, each time she appears, and also when the minister speaks, one thing seems glaringly missing. That is a clear sense of what those suffering may be going through on the ‘worry index’, that measures people’s anxiety over their health. That reached new numbing insensitivity when the message came across that such infections and deaths of premature infants is ‘normal’. Whatever statistics may show, losing a newborn in NEVER normal. 

The health ministry has many problems, caused by many things material and cultural. More money going to the sector won’t change that culture, which has deep in it a tendency to hide the truth. That’s what can explain that the minister did not know for so long. That’s fear at work. Why is it there?

What does it take to dismiss an official? Whose health is more important?

Back in May, I wrote about a certain leadership problem in Jamaican politics that was clear as day. At that time, how the PM positioned herself to address accountability of executive appointees was hard to understand. In a post entitled ‘Beware what you ask for: an insight into Jamaican leadership and thoughts on accountability‘, I wrote this about the PM’s actions (or lack of them): ‘Maybe, I’m mistaken, but they seemed to suggest that the frequent mishaps were somehow a good reason to absolve a manager from blame. I’ve struggled to fathom what logic was at play there…‘. We were looking at what justification was given for not acting on clear management failings at NSWMA. Jokingly, we could call this the ‘She didn’t start the fire’ defence. 

The health minister has been overseeing a portfolio that seems to be categorized by failures, even crises. Some of these failings appear to be the results of some simple human failings: eg, people not acting in line with established procedures. Some seem to reflect systemic failings, such as poor inventory controls, and approaches to communication that seem geared towards denial, evasion, and defence. Some failings seem to be a combination of these. What compounds these failings is a pervasive unwillingness to tell the nation what is, or went, wrong, why it went wrong, and what then will be done to avoid repetition. Instead, we get a form of bluster or downright refusal to share the truth. The most baffling instance of this seems to be the results of recent audits of health facilities. The minister refuses to share its details, instead telling people to be content with a summary. You can’t fix things without knowing the devilish details. As a dentist, the minister can easily understand how inadequate it is to know that a patient’s mouth hurts, than that the pain is in a tooth, or in the gums, is recent, or long-standing. But, somehow, the big problems of health facilities cannot be detailed? 

What has been bothersome is that the PM burdened us with a fulsome defence of her health minister by telling us that he “had done nothing wrong” during what many saw as the mismanagement of the chik-V crisis. The outbreak of that virus crippled people and the economy. Remember, the Private Sector Organisation of Jamaica estimated approximately J$6 billion and 13 million man hours were lost because of the virus. But, Dr. Ferguson was given a ‘clean bill of health’. Not even a hint that mistakes were made? Let’s call this the ‘doing nothing wrong’ defence. It’s akin to keeping your nose clean. It shouldn’t have been used, then, but it was. 

But, it’s clear that if nothing wrong was done, little right was done. As I noted before, the correct questions were not being posed of the person managing the portfolio. 

It seems to be hard for the PM to call to public account those whose policy decisions and actions show clear failings. It’s not just the health portfolio. I talked about how good leaders ‘feel the moment’. Numbness seems more evident than feeling, in this regard and others. That numbness is especially troublesome when dealing with the sensitive matter of people’s health. 

While we ponder this, we have to figure out why the highest level of political leadership has certain difficulties? To me, it boils down to some simple questions. First, can the country handle the truth? Second, are politicians capable to, and willing to, share the truth? Third, if the truth is shared, what should be done next? 

The clear impression is that the government doesn’t believe people can handle the truth. Which means, that less than the truth must be shared, varying from nothing at all to some downright untruths. 

Politicians show constantly that the have problems being truthful, consistently.

What should be done with the truth is to find ways to fix problems.  

It’s my view that the last point drives much else. Fixing problems is not currently a prime objective of many in government. Instead, being safe and sound in posts trumps much else. 

UK prison offer: Time for some out-of-the box thinking?

The sting that many Jamaicans felt afterBritain’s  PM, David Cameron, not only told us to “move on” from the legacy of slavery but also offered the sweetener of conditional funding for a prison, in part to house unwanted ‘Jamaican’ criminals in the UK still burns. But, like the itch from a mosquito bite, it only gets worse with scratching; it needs some salve, like witch hazel. So, let’s try to take Dave’s advice and ‘move on’. Let’s show that we’ve matured from being chattel and of no worth, and come up with some different and positive ways out of this Pandora’s box that has been opened.

Maybe, the thing to do is to see how best we can use only the money offered by the UK–£25 million. Our dire fiscal situation demands that approach. That would help deal with the tough ask of trying to build a prison, if that funding represents only 40% of the total cost. Now, no one has yet shared with the public the specifications for the prison that we would get for £25 million. So far, the talk has been about building something that is ‘state-of-the-art’, to give better conditions and help with a move towards rehabilitative imprisonment. The talk has also been to build a jailhouse that will hold 1500-2000 prisoners. But, here is a thought. How about we try to build the prison Caribbean-style.

That could mean it’s built ‘piece-by-piece’, eg enough to build just a ground floor, or as much as £25 million will allow. Let’s say that the ‘1st phase’ will hold only one-third of the anticipated total, say 500-700. That would be enough to house the anticipated maximum due to be sent by the UK, ie 300. So the Brits couldn’t complain that we’ve not lived up to our end of the ‘deal’. That appeals to my economics brain, as we then don’t have any massive fiscal burden added to the country. Yes, we still have to fund the upkeep and integration of the new arrivals from Blighty.

That running cost need lends itself to more creative thinking. I’m all for rehabilitating criminals, but society generally, and Jamaica, in particular, has a punitive bent. So, let’s work with that. We need to find ways in which some/most of the cost of upkeep falls onto prisoners themselves. That goes in the direction of ‘repaying a debt’ to society. We should be thinking about how the labour and mental skills of the criminals can be best used to generate revenue to help defray their costs to the country. I’m not stacked with all the ideas, but many options exist to do rehabilitation and earn from the process. If what the criminals could teach us were not so antisocial, the easy option would be to have them assigned as tutors, who could earn from sharing their knowledge. The recent news of how a team of prisoners beat out Harvard students in a debating contests is exciting and tells people that there’s more than a glimmer of hope for those in prisons with the right aptitude, attitude, and opportunities. Let’s stop prisons being schools for scoundrels. Educators, come up with some creative options.

All those graduates who cannot find work, get ready to lend your training to help others who need to learn. If a stint in schools in not for you, then get to a prison, buddy!

In that vein, I’m all for enhancing opportunities to learn skills while in jail, so would be keen to see incentives that point towards a productive and legal life after a few years in the pokey. That lends itself to thinking about how education could be a ‘meal ticket’ or ‘early exit’ pass for those who apply themselves. Could we think about a reward (of less time) for those who gain academic qualifications? Say, 6 months less for each CSEC exam passed, or scale it depending on passing grades? How about offering long-term prisoners three years off for taking and passing a three-year degree course? In the world of the Internet, the online course is just a button away.

Incentives like these could be worked to make time at the new-fangled ‘Sing Sing’ something to which good behaviour in another jail can lead. Think about it!

What about the location? It should not be anywhere near Kingston, which is already overcrowded and whose resources are so under strain as to be crazy. Let’s use the opportunity to ‘redevelop’ elsewhere. With a wry smile, I eye the north coast.

One option is to consider using land and/or buildings already in place and doing some kind of retrofit. To my crazed mind, it’s perhaps fitting to think about a new use for the ‘white elephant’ that is the Trelawny Mulitpurpose Stadium. Could one of its multipurposes be to house prisoners? Obviously, some thinking would have to go into doing this, but perhaps the site already has basically much of what is needed.

Trelawny Multipurpose Stadium
Something appealing about Trelawny as a location is the fact that, much as we shudder at the thought, crime is escalating in the western areas of the island, and now outstrips that in the Kingston/St. Andrews/St. Catherine area. Somehow, in a compassionate sense, it may be more palatable in this country of essentially struggling people that a new prison caters more to the visiting needs of those connected with this new wave of crime. Head west!

The other out-of-the-box western location may be the Outameni site, which so far has found no bidders. Let’s see how that one goes, though, because it would be preferable to keep a cultural touristic site, if it can be sold as such. Chances to earn foreign exchange shouldn’t be thrown away too easily.

Once we’ve fixed on a site, how about we think differently about what kind of prison we should build? How impossible is it to envisage a prison that reflects the tropical nature of the island? I’m not suggesting that the prison be open-air, with bamboo fences, waterfalls, and banana leaf roofing, but maybe that is not so crazy a starting point.

Let the inmates turn their hands at making all the furniture and fittings for the prison, and then make a business of that. In Britain, Cargo furniture (founded 130 years ago) is based around the use of pallet-style wood framing. We’re good and working with wood and have lots of it. Couldn’t we turn this into an opportunity? Likewise, Ikea furniture is based on some simple design lines for self-assembly wood furniture. Isn’t it possible to turn out a sort of Irie-kea line, built by prisoners?

Ikea furniture
Ikea furniture
Cargo

The idea of high walls and barbed wire is to keep prisoners from escaping easily. So, too is the use of electronic surveillance or deterrents. Maybe, we can merge technology and culture. How about we revert to some ‘old-fashioned’ thinking and go for lower cost deterrents, like a deep, wide moat, stocked with alligators and piranhas? That may not be ideal, because some friends may just throw poison in the water and kill the predators and so lay the stage for escape attempts. But, you see where I’m going?

Let’s use this poisoned chalice from Britain to do something other than grumble about how we continue to be mistreated. Screen Shot 2015-10-14 at 11.07.18 AM

Nine days wondering about prison deal or no deal

Jamaicans are good at getting excited about things, but just for a short while. The habit of having a ‘nine day wonder’ is common. The past nine days have been consumed by the badly managed announcement that Britain and Jamaica are cozying up to build a new prison in Jamaica, part-paid by the UK government, but on the condition that it be used to house at least up to 300 ‘Jamaican’ prisoners currently serving time in Blighty.

During these past nine days, we’ve heard a lot about how insulted we were by the British PM not only coming to give us this (wrongly termed) ‘gift’, but also telling us, and the rest of the world who feel aggrieved by the harsh history of trans-Atlantic slavery that we should “move on” from its painful legacy. I have no idea what he really meant. Suffice to say, that because he was ready to tell survivors of the Jewish Holocaust recently that the world should never forget their pain and suffering, means that his ‘move on’ suggestion had more than the bitter taste of gall.

But, the British PM left behind not just that bitter taste, but the now swirling storm over the new jailhouse.

My view is that, uncommon for diplomatic visits, which usually have a good dose of complimentary words and good karma associated with them, this recent landing by the British PM has turned into a PR disaster. It got that way from its beginning. The idea of not allowing the local media to question him was a mistake (how big depends on where you stand). Dissembling by the British High Commissioner about whose idea it was showed up the very thin layer of constant ‘pulling of wool over people’s eyes’ that is all too common in politics. Scrambling around to make the deal sound good for Jamaica could be the beginning of the end of some political careers. The whole thing is getting messy and like the broken egg, it’s contents can’t be put back into the shell. But, let’s try to get a few things straight.

Jamaica needs new accommodation for those who’ve broken the law. It needs to find funding for that, during a time when the government’s freedom to spend is about as tight as it’s ever been. But, it needs to do those two things without there being any deal that one of the financiers should add the ‘sweetner’ of sending a batch of villains to take up some of the new spaces.

We can argue the toss about whether the villains are truly Jamaican or not. What’s clear is that they committed crimes in Britain, not Jamaica, and should be the burden of the British penal system, not Jamaica’s. Admittedly, in the supposed sifting of whether the potential prisoners should be sent from Britain (as they are already due to be deported after their time in the clink) will be whether they committed crimes in Britain which are also crimes here. But, the Brits want rid of them.

British political realities may make it easier for its PM to want to do, and been seen to do, something significant to (1) get rid of ‘foreigners’ in British jails; (2) save the British taxpayers a good amount of wonga; and (3) maybe, appear to do something positive for one/some of its former colonies. Truth is, those labeled as Jamaicans have a disproportionate place in British jails, and for crimes (especially violent and drug-related ones) that really don’t sit well with most people. Truth is, the British taxpayers wants to get an ease, just like most others would anywhere in the world. Truth is, the stinking prisons we have in Jamaica–dating from slavery days, in the 1700s and 1800s–were built and left here, unmodernized by the British, while in full control of the island. Whatever would become of relations between newly independent Jamaica and Britain was not something that anyone could see in a crystal ball. But, c’mon, those jails were decrepit for decades. Maybe, what Mr. Cameron meant with his “move on” remark was to get rid of the stinking pits that had been used to house Jamaican villains. Moving on…

Truth is, Jamaica has been really slow (as is its wont) to act to improve prison conditions. It’s not been a national priority, because we have a ‘lock them up and throw away the key’ mentality to crime. The national mood is into vengeance and vindictiveness for wrongdoers and really doesn’t have time for any cuddly approach that focuses on rehabilitation. Well, sadly for those who feel that way, the rest of the world doesn’t. So, once again, we’re in the naughty corner, and can’t get out unless we decide to play by the rules that the other boys use. Well, the government has a way to start grappling with that, and some nice lolly to help in the form of 25 million pounds, if…

The Minister of National Security is now fast-moving on a media blitz to ‘explain’ what appears to be going on. Over the weekend, the newspapers had a colorful 2 page ad trying to outline the basic numbers and ideas behind the deal. Just yesterday, he took to Twitter to tell us about an online chat today! That is after trying to explain to Parliament on Tuesday what was going on, and then holding a media briefing on the issues yesterday. Enough! Can we take so many attempts at openness?

Chat to Peter on a mobile device or computer near you, during today’s lunch break…
Good luck with all of that, Peter, I say.

One of the flies in the ointment is that the news flow that the Jamaican government is trying to shape keeps getting messed up by UK ‘misinformation’. It started with an official press release that stated an agreement had been signed to transfer prisoners as part of the prison-build deal. That is not so, Mr. Bunting said: there’s a non-binding memorandum of understanding that has to be fleshed out, and a transfer agreement yet to work out. The High Commissioner added his pennyworth. If only the British could be encouraged to just let the Jamaican government squirm its way to clarity without constantly interrupting!

I’ve a feeling that this nine-day thing may run quite a while. The official Opposition is miffed because their leader got a wigging in Parliament and a reminder from Mr. Bunting to not be so uppity, and act like he’s still the PM, and then decided to take their marbles and run home. Parliamentary walkouts are a familiar thing in Jamaica, and it’s a pity that the International Olympics Committee has not yet seen fit to add this ‘sport’. Anyway, they then said they’re not going to be party (sic) to any discussions about any deal. Yah-boo!

Oh, where would we be without some good political posturing? The deal idea is not new, and was considered by the Opposition, when in power (so said former Security Minister, Dwight Nelson–fresh from not recalling certain things to do with Tivoli…but, let’s move on from that…). Maybe, their upset is about how little of the funding the Brits are willing to put up. Who knows?

Meanwhile, some on social media are having a whale of a time Googling and trying to find information that shows that a deal has just been signed, or that one was signed some time ago, and that the government is ‘being economical with the truth’. I suspect that some of them will be presenting their findings to Minister Bunting later today.

In all this was the sideshow of the Information Minister taking umbrage at having her integrity questioned. I’m not going to put my oar in there, not least because I did not hear her interview. But, it has the taste of ‘that’s what you get for…’. No, don’t go there!

So, let’s look forward to how we moved from putting out the bunting for the visit of the British to the putting out of the Bunting to explain why the British flag bunting was not well appreciated. I’m sure that last week it wasn’t expected to have gotten so messy. But, as the late Harold Wilson reportedly said:  ‘A week is a long time in politics’. Let’s see where we are in nine days’ time.

Fly the bunting!
Fly the bunting!
This discovery of the power of conversation could be infectious. Who knows where it may lead?

So much things to say, right now: A firestorm over the suggestion that we “move on”

I began the day wanting to write about UK PM David Cameron’s suggestion that Jamaicans, in particular, and Caribbean people, in general should “move on” from the legacy of slavery. It came over in our Parliament as at best an insensitive choice of words and at best a deeply offensive notion. I and many were quick to note that, not long ago, the same politician had urged Britons to “never forget” the Jewish Holocaust. There’s no attempt to out-horror the world, but on the scale of human suffering and injustices, these two instances of systematic and systemic demeaning abuse and torture of groups of humans are hard to beat.

My own anger is deep, but most of it and other sentiments are well reflected in an excellent blog post by a Jamaican blogger, ‘Jahmekyagal’, which I share here (“Move on?” Never Gonna Happen chap!).

Read and reflect on the post. You need not be a cynic to find the contradictions troublesome. You won’t solve them easily, so don’t fear if you’re confused for a long time. We have lots of thinking time because we should never forget either.