Total Immersion

Winter 1979

After my first ever transatlantic flight, my plane touches down at Kingston Airport, Jamaica. As we taxi towards the gate, I think back on the events leading up to this moment.

Earlier this year, I’d resolved to leave my native Scotland. Two years out of medical school, having done my internship and three stints as a locum in several specialties, I still had no idea for my future. I wrote to hospitals from Singapore to Mauritius to the island of St. Helena, asking about openings for a junior doctor. Medicine was my ticket into the world, to adventure, to finding my path in life.

“ACCEPTED FOR JOB STOP START IMMEDIATELY STOP,” said the telegram from the University of West Indies Hospital in Jamaica. I walked to the post office and filled out a response: “ARRIVING DECEMBER TEN AT FOUR IN AFTERNOON STOP MEET ME AT AIRPORT STOP.”

Despite my resolve to leave, I did my due diligence and met with the wife of the dean of the University of Glasgow Medical School. Her husband had been integral in setting up the medical school at the University of the West Indies, and they’d lived in Kingston for many years. (He himself did not offer to talk to me, although I’d been one of his students. I chalked this up to my being female; women weren’t viewed as serious prospects in medicine.)

“Don’t go!” His wife spoke adamantly, leaning forward and looking into my eyes. She might have clasped my hands in hers; I don’t remember.

“The country is on the brink of civil war!…There is nothing in the shops, no food!…It’s dangerous, really. People are being killed!…Everyone is leaving as soon as they can.”

I listened politely, but I’d already made up my mind.

Now, two months later, here I am at Kingston Airport.

An ambulance sits quietly outside the airport, and I know it is for me. We make our way through the city, up through Mona Heights, past Bob Marley’s house and recording studio and into the hospital compound. I am deposited outside a small white concrete row house.

The darkening sky, filling with tropical constellations, looks closer than a sky has ever been, and the crickets are chirping and the frogs are croaking and there are sweet smells of blossoms in the warm, humid air. I can’t quite believe what I see, what I hear, what I smell—but most of all I cannot believe the feeling of warmth on my skin.

The front door is open, and the key lies inside on the kitchen counter. The kitchen window looks out on the parking spot in front, and the laden lime tree. A few steps further in, I enter a large room whose French doors open onto a small garden and, beyond that, a grassy knoll with a spreading mango tree. Upstairs, the small bathroom is flanked by two bedrooms. I pull out some sheets and place them on one of the beds. The breeze blows gently in through the wooden latticed windows, down from the mountain beyond. I lie and watch the moon rising.

The toilet cistern roars all night. Cockroaches run about as soon as the sun sets. The fridge doesn’t work. The front-door latch is loose. I let the hospital maintenance crew know of these needed repairs.

“Yes, yes,” they say, “come soon, come soon.” Soon they come—to take the coffee table away for polishing. This is what survives in the wake of the British Empire, these last, clinging vestiges of routine.

The University of the West Indies Hospital surprises me with its excellence. Its physicians make diagnoses without advanced technology, using their hands and their brains, and its nurses, mostly British-trained, are exceptionally skilled. The nurses wear white starched uniforms, with a white cap carrying the familiar thin green stripes indicating rank—one for the lowest, three for the highest. The Ward Sister wears a frilled hat: That’s how you can tell who is in charge. The doctors wear starched white coats, fresh from the laundry each week. It is a University Hospital, and it has its British standards.

The staff is welcoming, gracious and helpful, but the patients’ diseases confound me. I’ve only seen such pathology in textbooks that depict disease in white bodies. I left a country that was 99 percent white-skinned to practice in a country 95 percent of whose citizens are of African descent—people who have suffered unspeakable cruelty at the hands of white people. The best compliment, I discover, is “You okay for a white woman.”

My eyes are wide open all day long: The clinical panorama is at once thrilling and horrifying. After exhausting the home remedies and the Obeah man’s medicines, the people come to the hospital with diseases beyond recovery. Fulminant tuberculosis with bright red blood coughed up onto the bedclothes, heart valves so distorted by infection that you can see them struggle to beat through the chest wall, eyes blinded by diabetes, unexplained sores from toes to buttocks, perhaps a dose of syphilis thrown in. The nurses dress cleaned open wounds with sliced green pawpaw, then drape them with wet gauze. The doctors prescribe antibiotics, antihypertensives, intravenous fluids and lots of IV glucose, trying to revive the moribund souls who show up day and night. Despite their skill, nothing much helps; the patients have come too late.

It is early one evening, shortly after my arrival, and Dr. Wu is busy with a new admission. He gives the patient a deep sternal rub, trying to awaken her. She groans as air escapes from her lungs, but remains unconscious.

Everyone who’s unconscious, I’ve learned, gets a lumber puncture and a pulmonary tap or a peritoneal explorative tap, depending on the results of his prolonged auscultation.

“This one might have a collapsed lung,” he says. “I don’t get any breath sounds on this side. I’ll stick a needle in and see what I get.”

As I go to check lab results, the electricity blinks off—but the lab technician has an oil lamp lit, and the lab-results book is open. I write down the results in my small binder. Walking back to the ward, I hear the generator start in the operating room. The oil lamps are lit at the nurses’ station, and the patients are peaceful. I copy the results into each chart and approach Dr. Wu.

“I’m off then, I’ve seen everyone. Nothing new to report. I’ve written all my notes, and the lab results are all in. There’s nothing significant. Mr. Jones’ liver-function tests are about the same. Mrs. Knight’s hemoglobin is a bit better.”

He nods, and I leave the hospital. The moon rises, and a cool breeze pours down the mountain. Satisfied with myself and my work, I smile as I walk home through the evening air.

It is decent work. There’s a lot to do. I put in long hours, learning so much medicine and caring well for my patients. I have found my stride.

After three and a half years, though, I decide to leave. From the start, and increasingly, I’ve been heckled in the streets for being white. I’ve energetically rebuffed the comments; but I’m realizing that, as a visible remnant of the colonial empire, I cannot live safely in this proud country on the rise.

I flew into Jamaica believing that we’re masters of our own minds—that anything is possible if we try hard enough. But the bitter aftereffects of the country’s history of slavery and racism are profound and palpable, even if unnamed.

I feel sad to be leaving, but also relieved: I know that I can never belong, and I’m tired of trying to fit in.

“What did your time in Jamaica teach you?” I’m asked. I’ve learned that we are all shaped—in our perceptions of ourselves, and of our health, illness and potential for recovery—by the culture into which we’re born. And my deep immersion in this formerly colonized culture has brought home to me the suffering that we, the British, have caused.

In 2018, the University of Glasgow signed a restorative-justice agreement with the University of the West Indies (UWI), pledging to provide £20 million for research into development initiatives to be jointly carried out with UWI over two decades. The University of Glasgow disclosed that, between the 1780s and 1880s, it had received grants and endowments from Scottish and English slave owners amounting to as much as £198 million in today’s money.

It has taken a long time for Scotland, and my alma mater, to acknowledge complicity in colonization. It is with sadness that I reflect that the medical education that gave me my ticket to the world was created, in part, on the backs of the enslaved people of Jamaica’s plantations.