Dr. Mark Carney loves late winter Caribbean getaways.
He and his wife, Jan Greer-Carney, director of Nutrition Services at Concord Hospital, plan all year for their week-long sojourn away from their hectic schedules.
The local pediatrician from Concord Hospital and Dartmouth-Hitchcock once went alone, but over the past 20 years, he started inviting
friends and colleagues.
But this is hardly a vacation.
Dr. Carney leads a group of medical professionals to a hamlet of fewer than 500 people in the Blue Mountains of central Jamaica to give medical care to anyone that comes by. Last year alone, Carney and two physcians assistants – Joanne Gutt and Elizabeth DeNauw – and nurse Erin Pike, along with his wife and two others cared for 450 patients who walked to the clinic that Carney first opened nearly two decades ago.
Carney first went to the tiny mountain town of Chantilly, Jamaica, as a chaperone with a group of 27 adult and youth parishioners from St. Paul’s Episcopal church in 1997. Besides dealing with a third of that group who contracted a nasty intestinal bug on the trip, Carney found the time to meet and connect with some of the residents.
It didn’t take him long to discover a desperate need for medical care. Without the clinic, a local doctor visits every three months and the only public hospital is in Mandaville, a trip down a steep, half-paved road with perilous switchbacks.
Carney quickly bonded with the famed godparents of the community, Rue and Daphne Gordon. The pair had grown up in the small village, left to find better work in England and came back wealthy and educated in the 1980s to give back to the community. Rue and friends built the Basic School and Community Center, the only real buildings in the center of town besides St. Steven’s church.
The Gordons opened up their home back then and still welcome the medical group that has come every year since. At first, it was just Carney offering what medical care he could in a small office in the community building.
But as the commitment from St. Paul’s church in Concord grew, so did the scope of the mission in Jamaica. Besides medical care, the church now provides tuition to every 3- to 5-year-old child to the basic school, or pre-school. St. Paul’s raises the money for two meals a day for the students, plus the teachers’ salaries. Once the children reach primary school, the educational system of Jamaica kicks in. However, St. Paul’s still helps with breakfast, something that Jan Greer-Carney spear-headed to get better nutrition in the school system.
“Hello, Dr. Mark,” a villager said to Carney as he walked along the area’s trails after he arrived. Word spreads quickly that care and medications will be available during the week. And not only residents of Chantilly show up – residents from other villages get word and walk to see him.
Early Monday morning, a crowd pushed against a fence to sign up to see the doctor and the two PA’s. In the same office where he first tackled the job alone, Carney concentrated on the children while Gutt and DeNauw tended to women and internal medicine respectively. Nurse Erin Pike, who worked with Dr. Carney for 10 years back in New Hampshire, funneled patients to him throughout the day while taking vital stats from all children and some older men.
Greer-Carney ran the clinic and pharmacy with medications donated from across Concord. The drugs were stuffed in large suitcases. Prescriptions for diabetes, high blood pressure, asthma and even family planning get dispensed throughout the week. Greer-Carney worked alongside Simone, a local woman who kept the charts for all patients.
For DeNauw, the morning quickly became over-whelming.
“I really know what to expect, but after the first couple of patients, I said, ‘Oh, my God, is the whole day going to be like this?’ ” she said.
Between the crush of people and discerning the Patwah, the native Creole-based language, DeNauw had to find her rhythm.
“The first day I saw 16 patients, but by Thursday I was seeing 30. As a group we saw 450,” she said. “We had to work out a system.”
Part of that system was letting Simone know that people had to be turned away and told to come back another day.
The team saw many ailments that could be easily treated and others that were more chronic.
DeNauw saw high blood sugar counts and diabetes, a reflection of poor diet.
“They opened up about their diets, starchy and fat which leads to acid reflux,” she said. “Untreated diabetes leads to vision problems, heart problems, renal failure, heart disease and stroke. I saw a lot of stomach pain too – the stress caused by their living conditions.”
At one point Pike was asked if she needed anything.
“Yes, a CAT scan and hospital, NOW!” she replied.
A young girl had passed out at school. Knowing Carney was with a patient, Pike went over and found the girl had been out for 30 minutes. She checked her vitals and lifted her arm, which flopped down with no resistance. She called Carney who examined unresponsive girl as a guardian arrived. The parent said the girl passes out often.
This is where the cultures diverge.
In the United States, an ambulance with EMT’s would have arrived within minutes. In Jamaica, the girl woke up after 45 minutes and was back in school the next day. Carney went on to write up a report and sat down with the girl’s mother to discuss further evaluation of her condition with MRI’s and CAT scans. Mostly, the urgings are met with stares, because such resourses in the area are scarce.
Life expectancy in Jamaica is five years less than in the United States. However, the infant mortality rate is double that of the U.S.
For the Carneys, there is one child in particular that highlights that situation – litte Jourdain. The couple met him three years earlier when his mother brought him in at seven months old. He weighted seven pounds and he struggled with breath. He was suffering from a heart issue that in the United States could have been addressed before a newborn leaves the hospital: Ventricular Septal Defect. The first time Carney used his stethoscope he could hear the telltale murmur.
“It was an obvious cardiac condition, and he was in congestive heart failure with so much of his energy just to breathe – just using all his calories just to exist,” Carney said.
They tried to put him on a more rich milk formula to augment Jourdain’s breast milk to help him gain weight.
“He just wasn’t getting what he needed,” Greer-Carney.
Now at 3 years old, Jourdain is still under-sized and the Carneys wonder about his future.
“So much of his energy is to just support his oxygenation, you have to wonder how does it affect his brain, for being able to grow and truly develop?” Carney said. “It’s difficult to see that. Certainly in the US it would be required for the parents to do something . He would have had cardiac surgery within days of birth; he’s 3 years old.”
Other members of the team saw patients that needed minor surgery to quickly resolve an issue.
Gutt saw one woman with a large fibroid tumor who was was in a lot of pain and bleeding. She was a welder from Kingston, which is a good job in a man’s world.
“She came to see me while visiting her parents,” Gutt said. “I told her she needs surgery.”
But that’s not a procedure the team could perform.
During their short time, Carney and the group did what they could. But like the blink of an eye, they are preparing to head back to Chantilly to do it again – one patient at a time.