Episcopal Medical Missions Foundation
Jamaica - Its People and
Site Visit and Needs Assessment
by Thomas E. Williams, MD, FAAP and Peggy Williams, RN-C (Public Health)
Dr. Thomas E. Williams, Executive Directory of EMMF, and Peggy Williams, RN-C (Public Health) visited the city of Montego Bay, Jamaica, at the invitation of The Very Rev. Justin A Nembhard, Rector of The St. James Parish Church and its Missions, during the dates of July 26-27, 1997.
The purpose of the visit was to become familiar with the medical and spiritual needs of the people of St. James Parish, in particular those poor served by the mission churches in the shanty towns surrounding Montego Bay.
Preparation: The plight of the people of Jamaica was first brought to the attention of EMMF by Father Laurens A. Hall, Rector of St. John the Divine in Houston, and some of the parishioners who have traveled extensively to Montego Bay, in particular Paul and Evelyn Howell, who have a home there and invited the site visitors to be their house guests. They directed EMMF to Father Nembhard who extended the invitation to come to St. James Parish Church and to consult with him.
Vaccinations: Both site-visitors have current diphtheria, tetanus, polio, and hepatitis A and B vaccinations. Malaria is not endemic to Jamaica. Visitors should be aware that Denque Fever is endemic and should wear appropriate clothing and mosquito repellent.
Travel: Passports are required. There are daily flights to Montego Bay from Miami. Round trip airfare from San Antonio was $556.95. The site-visitors flew from San Antonio to Miami on a domestic airline during the evening of Friday, July 25, 1997, spent the night in Miami and departed Miami on the following morning via Air Jamaica. The original direct flight Miami-Montego Bay was cancelled, an all travel was diverted through Kingston. This created a delay of three hours in arriving into Montego bay. Passage through customs was speedy, and the luggage was not searched. Site visitors were met at the airport by Father Nembhard, and taken directly to his office at the church, Departure tax was $15.00 US. Travel while in Montego Bay was provided by Father Nembhard on Saturday. We also hired a van for Sunday for $80.00 negotiated.
Housing: As the site visitors were house guests of the Howells, comments on local hostelries cannot be made.
Roads: The roads are good.
Climate: The climate is tropical, i.e. hot and humid. We were uncomfortable in coat and tie.
Montego Bay, Jamaica, St. James Parish Church and its Missions:
An island paradise? To the tourist, perhaps. The typical visitor to Jamaica pays only passing attention to the squalor and poverty of the island's almost three million people. The magnificent scenery, the luxurious hotels, the British colonial facade of the resort areas all prove too distracting and pleasurable for the vacationer to spend his holiday commiserating over seemingly insoluble social and economic problems. The handsome waiter serving rum punch or the plump vegetable vendor at her stall belies a populace plagued with numerous medical conditions, "silent killers" such as hypertension, diabetes, glaucoma, and sickle cell anemia. Whether one reads the latest report from the World Health Organization or speaks to the priests and prominent lay people of the Anglican churches in Jamaica, the message is consistent and clear. This island nation, only 35 years since gaining its independence from colonial rule, is trying desperately to feed, clothe, and educate its people while developing its natural and human resources so that it can take its rightful place among the nations of the world. It has experimented with Cuban style socialism. It imposes a burdensome sales and income tax on the wage earners which frustrates their efforts to care for themselves and their families. A government provided system of social programs is long on promises. When medical care is sought, the condition is often too far long on promises. When medical care is sought, the condition is often too far advanced for medicinal correction, and when the condition is diagnosed early enough, the medications prescribed are usually beyond the means of the poor and the elderly.
This is at the core of the many problems facing the rector and parishioners of St. James Parish Church in Montego Bay. The Very Rev. Justin Nembhard, Dean St. James, leads a congregation of approximately 750 Montegonians and an equal number in five missions scattered through the parish. Built in 1775 when the island was home to more than 3.5 million slaves and to a prosperous plantation economy, St. James has been the center of city life for more that 200 years and counts among its members many of the government leaders and professionals that have taken the lead in the development of the city. In the past forty years the population of Montego bay has more than quadrupled. St. James parish church has centered its activities on programs of outreach to meet the needs, both spiritual and educational of the people of a fast-developing city. For more than 70 years it has maintained a consistent interest in the education of its people. A preschool in the mission community of Glendevon and an elementary school at St. Augustine's in Coral Gardens, as well as the St. James Preparatory School, contributes to the educational needs of more than 200 children. In secondary education, the church has kept strong ties with the government-operated Montego Bay High School for girls and Cornwill College for boys from the time these schools were founded. Successive rectors have been chairmen of the school board of High School and served a board members of the boy's school.
To meet the spiritual needs of the Montego Bay area, St. James has established missions in the suburbs of Glendevon (St. Francis), Granville (St. Mary Magdalene) Coral Gardens (St. Augustine's), Grance Hill (St. John's) and Blue Hole (St. Leonard's). Father N. is responsible for these six churches and was particularly proud to announce that on the morrow there would be the ordination of a woman deacon at St. James. For a number of reasons, the development of these mission churches has not been an easy task. At the same time, for instance, that money was being spent on the outreach thrust of the Parish Church in the development of the missions to serve the growing population, an appeal was launched to raise funds for the restoration of the Parish Church itself heavily damaged by an earthquake in 1957. Both projects have been successfully completed, however, and today St. James is one of the most beautiful churches on the island. Designed on the Greek cross plan, its limestone edifice is Georgian in character and features an imposing bell tower and clock. Its East Window is situated behind the altar and is said to be the most beautiful of its kind in the West Indies.
Interview with Father Nembhard: There are many unmet socio economic needs in Jamaica. One of the major ones is joblessness. Fortunately, however, although the unemployment rate is high and there has been a great deal of downsizing which has impacted the young worker and ghetto dwellers in the main, inflation is under control, and the prospects for attracting major employers to the island are encouraging.
Another major problem is drug addiction which in some portions of Jamaica is glorified and tolerated. There is a particular need for half-way houses for drug counseling, a need only recently acknowledged and addressed by the Church.
A third major unmet need is housing, particularly for the elderly, most of whom have no relatives or friends and no where to go. habitat for Humanity is active in Kingston where the program is chaired by Fr. Granier, a Roman Catholic priest who once worked with the Minister for Construction. In addition the Church has four homes for the aged on the island, but none are in Montego Bay.
Sex education, particularly for the young, is unsuccessful. Despite sex education in the schools and attempts by the government to promote family planning programs, teenage pregnancy and illegitimacy rates are high. This, along with a large number of STDs suggests that much of the information being given is not being followed. The Minister of Health, a member of St. James Parish Church, has shown particular interest in this area and has instituted a community survey of the Montego Bay area, that can be made available. In fact it was Father Nembhard's recommendation that all efforts made for EMMF teams in this area be coordinated with the Minister of Health.
There are pockets of malnutrition that St. James Parish Church is attempting to address by distributing food items as powdered milk. The parish has a formal feeding program, independent of the government, in which thirty parishioners administer a program of food vouchers. This program could be expanded were the resources available.
In the past St. James Parish Church has been the site of medical clinics for glaucoma, diabetes and hypertension. The people learn about these clinics by posters and by announcements at the church and its missions and schools. These have not been regularly scheduled, however, with the exception of a vision clinic conducted by the local Lions Club which is well attended and where eye glasses are provided, and a hypertension clinic conducted by parish nurses who are retired and who are not employees of the local health ministry. There is a "type 5" clinic for primary health care that is provided by the public health program in Jamaica, and Montego bay is served by Cornwall Regional Hospital, a government hospital that has recently undergone a major refurbishing. This hospital serves the entire Western region of the island, Its services are limited, however. For example it does not perform renal dialysis. This is provided in Kingston to the southeast where there is also a medical school and a university hospital and where there is an Episcopal hospital that is for paying patients only. The major clinic for sickle cell anemia is also in Kingston -- al 175 miles away and over the mountains. It is Father Nembhard's judgement that the government medical services are underfunded and that there is a need for more glaucoma, diabetes and hypertension clinics that are more centrally located since the population is spread over three regions. There has not been an Anglican (Church of England) health care team to Jamaica; however and Episcopal church in Orlando has conducted a series of "health fairs". Fr. Nembhard feels the combination of a health fair with or shortly followed by actual medical services would be a successful model in Montego bay. he asked what Episcopal Medical Missions Foundation could offer to address their needs, and what would be the minimum requirements from the parish in response. EMMF answered that after the needs assessment is completed and all the factual information has been analyzed, it would be the intent of the site-visit team to draw up a formal document to present to Father Nembhard and the parishioners of St. James Parish Church and its Missions and to the Board of EMMF for formal approval of any plan. Then a church in the US would be responsible for assembling the teams that would be in turn sent only on the invitation of the church in Jamaica. Regardless of what the might eventually become, a place to conduct the program would be necessary. For their part, the parishioners of St. James and its Missions can offer space in church buildings and preparatory schools all within easy commuting distance from St. James. St. James has members who will drive buses for the teams. Fr. Nembhard specifically would like to see a teams to address diabetes, dental care, ophthalmic conditions (glaucoma), pediatrics, and family medicine. He will extend the invitation on behalf of St. James.
Father Nembhard suggested that we also seek the opinion of Barbara Smith, organist at St. James and a retired principal of the Montego bay High School. After the service on Sunday, July 26, we spoke to Ms. Smith at the church. Ms. Smith indicated that one of the greatest unmet medical needs of the community was an effective program to diagnose and treat glaucoma.
Father Nembhard also recommended that we speak to Ms. Annette Mellish, a member of the Parish church, who has dedicated a great deal of her time and talents toward the training of the young people and children at St. Francis mission Church on Sun Valley Road in the ghetto of Glendevon. EMMF found Ms. Mellish and another parishioner, Mr. Barrington Fleming, an unemployed radio announcer and part-time computer salesman, at the mission church and spent three hours with them on the afternoon of Sunday, July 26. Mr. Benjamin Wauchope, our driver, whose wife was once a teacher a Glendevon and who know the community well, joined in the conversation. Ms. Mellish was clearly disappointed about the government's closing of a vocational school that had been established on the campus of the mission and was the pride of the community. Many of the graduates of the school had found employment as plumbers, masons, carpenters, welders, and garment workers. Ms. Mellish confirmed the comments of Father Nembhard, mainly that the people of the Glendevon ghetto need information about nutrition, instructions on the proper administration of medications, and treatment for obesity, hypertension, diabetes, and glaucoma.
For matters relating to credentialing for the practice of medicine, dentistry, and nursing in Jamaica, Father Nembhard referred us to Dr. Myers, the local Medical officer for St. James Parish, or to the Office of the Minister of Health, 10 Caledonia Avenue, Kingston 5, Jamaica, W.I.
Fr. Nembhard made mention of other needs of St. James Parish Church. The church needs any kind of training program as many of the neighborhood training programs run by the government have been closed training.
Lastly Fr. Nembhard noted that there is need for programs in pastoral care to nurture the faith; programs to teach classes, and programs in general Christian education, He need resources and personnel; he could use a Sunday School workshop for 30-40 teachers, and he needs and education resource center. He is interested in methodology.
St. James Parish Church and Missions
The Very Rev. Justin A. Nembhard, Rector
Office: (876) 952-2775
Fax: (876) 952-8847
Home (874) 952-3255
Mr. Benjamin Wauchope
Hanover, Jamaica, W.I.
Work: (809) 952-5909
Home: (809) 0956-5467
Episcopal Medical Missions Foundation
501 E. 32nd St.
Austin, Texas 78705
Fax: 830-899-2135 Phone: 210-422-4779
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