Visiting family in Jamaica

I spent five days in Jamaica at the end of June visiting my mother’s side of the family. My mother grew up in Spur Tree, a rural community in the parish of Manchester. This trip was a wonderful opportunity to spend time with the family (including my grandmother, great-aunts, great-uncles, and family friends), learn more about our rich history, and be immersed in the culture while living in the community for a few days.

Diagnosing family members

The MCP and PIP joints are classically affected in
rheumatoid arthritis. Photo from here

While there, my great-aunts and uncles continued to express how proud they were of me for pursuing a medical degree. I found myself inadvertently making diagnoses left and right, which was especially easy to do coming off the Family Medicine clerkship. My aunt came to me first with complaints about joint pain in her hands. Upon further questioning, the history seemed to fit the description of rheumatoid arthritis, with the pain most prominent in the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. She also demonstrated slight ulnar deviation of the MCP joints (her hands tended to fan outwards away from her body). See photo below.

Ulnar deviation of the MCP joints in rheumatoid arthritis.
Photo from here

I recommended that she take a non-inflammatory medication like ibuprofen for the pain and encouraged her to see a physician in the town for a more thorough evaluation. She refused to see a “Jamaican” physician and preferred to wait until her next trip back to New York to see her physician there. I also noticed that a couple of my uncles had the classic Bouchard and Heberden nodes of osteoarthritis in the PIP and distal interphalangeal (DIP) joints of both hands. 

Photo from here

I didn’t think it was appropriate to bring it up out of the blue (“Oh by the way Uncle so and so, your hands are looking a bit mangled these days.”) They have upcoming visits with their physicians and hopefully will have these concerns addressed then.

One of my family members also expressed having a poor appetite for the past couple of weeks. This has also been in the context of a few significant stressors so I immediately became concerned about possible depression. I’d completed a number of PHQ-9 (Personal Health Questionnaire) depression screenings in the Family Medicine clinic recently, and poor appetite is a symptom to look out for as having occurred in the past couple of weeks. The next day I gently mentioned the poor appetite to my family member, and upon further discussion I was no longer concerned about depression. It certainly helps that this family member is surrounded by wonderful family and friends, which are protective factors.

There was another random instance when my mind began churning with concern over a situation that occurred years ago. During dinner one day, my aunt shared a story about our cousin who gave birth to her first child a number of years ago. In the two days following the birth, she suffered from an awful headache. I immediately thought of a possible bleed (post-partum hemorrhage) in the brain, though she did not suffer severe symptoms (according to my aunt), and the headache eventually resolved. I was so surprised that she never paid a visit to the emergency room for further evaluation.

The Baker family history (brief)

Anyway, let's stop the medical talk and move on to my family's interesting history. To the right is my legendary great-grandmother, Mrs. Frances Ernestina (“Miss Tina”) Baker (also known as “Mama” to her descendants), born September 1, 1904 in rural Nuttingham, Manchester, Jamaica, and passed away at the age of 107 in August 2012. Everyone in the community knew and respected her. She was a powerful matriarch who gave birth to and raised 10 children. She also raised four grandchildren, including my mother. I’m grateful to have met my great-grandmother in her 90s when I was younger.

It’s incredible to hear of her story from my aunts and uncles as they share their memories of growing up with her. Mama was a strong disciplinarian; she did not mess around. You knew not to cross her, or else you would get whipped with whatever she could get her hands on (usually a stick haha). My aunts and uncles have an abundance of stories about her scary beatings. But you know what? (And I know not everyone will agree with this) – Those beatings helped build their character and whipped them (literally) right into shape. I honestly believe that many children are not disciplined enough growing up, and as adults they are more likely to run amuck and get involved in catastrophic situations. (I’m speaking specifically about American children from what I’ve seen in my own experience growing up in the school system here).

My mother's elementary school: Fairfield Primary School
in Manchester, Jamaica

I visited Mama’s birthplace and her parents’ (my great-great grandparents’) burial ground in Nuttingham, as well as her own burial ground at the Ebenezer United Church where my mother, aunts, uncles, and cousins attended every Sunday as children. I also visited the elementary school and high school that my mother attended.

It has been incredible to experience the cultural context in which my mother was raised. It is nothing like the cushy, comfortable lifestyle that tourists may experience at the resorts near the beaches in Montego Bay or Negril, for example. When I told my friends and colleagues that I was going to (or recently returned from) Jamaica, the beaches must’ve been what they imagined. I’ll tell you this – that is not "real" Jamaica at all. The last time I visited family in Mandeville, Jamaica was 6 years ago. This time around, I admit I again experienced a little bit of a “culture shock” especially with regards to:

·    the bathing (there is no hot water from the spigot so you need to boil the water and mix it with the cold water in a basin to bathe)

·    driving on the roads (it almost seems like a free-for-all out there; on some of the roads in Mandeville there is no clear single or double solid line separating the left and right sides), and

·    the walks through the marketplace in Mandeville (some people will stare at you and automatically identify you as a foreigner; it doesn’t matter if you’re black and haven’t said a word for them to hear that you don't speak patois).

During my layover in Fort Lauderdale, FL on my way back from Kingston, I had a long chat with my mother on the phone. She mentioned that she wouldn’t trade her upbringing for anything in the world, not even for the upbringing of her kids. My siblings and I, born and raised in the U.S., grew up more privileged than our parents. We didn’t have a lot growing up to begin with, but my parents grew up with even less, especially my mother. My mom was raised in the 60s and 70s in rural Jamaica without electricity (they did everything by candlelight in the early mornings and late evenings), plumbing (they used outhouses and bathed in a big metal tub), telephones, or cars (they walked everywhere, including to school and church (which were 4 and 5 miles away from home, respectively). My mother loved it and hopes to return to her home and spend the rest of her life there.

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Thank you for reading!!