Trinidad & Tobago


    IN 2011, WHEN I decided to apply to medical school, the idea of medicine being a lonely profession was nowhere in my mind. In fact, I was expecting it to be quite the opposite.

    At the time, I was working as a geophysicist trainee at the Ministry of Energy and Energy Affairs in Port of Spain. I was not happy. Working behind a computer on the 23rd floor of Tower C was not for me. I wanted a job with more human connection and I thought medicine would provide that. So, I applied to medical school.

    Initially, things appeared to be all hunky-dory. In medicine, we talked to patients everyday; we spoke to patients’ relatives everyday; we ran into colleagues everyday in the corridors, on the wards, in the elevators, in the doctors’ lounges; we “networked” annually at conferences; we dined at restaurants while we learned about the latest research. All the good stuff. And, not forgetting, when the rest of the world was in lockdown and isolation, we were at work in the company of our colleagues.

    So, when loneliness started to drive my heart rate up, especially over the last few years, I could not quite understand why. There was the obvious: I had left home. But at least I had medicine to buffer the loneliness, right? Alas, I did not understand medicine, neither did I understand loneliness.

    In an interview on the podcast A Slight Change of Plans, US Surgeon General Vivek Murthy – who recently declared loneliness a public health emergency in the US – described what loneliness was and was not.

    “We have this stereotype of loneliness. We think about the person who’s socially awkward, who’s sitting in the corner of a room at a party all by themselves."

    Loneliness, he pointed out, was different from isolation, an objective description of the number of people around us. “Loneliness is a subjective term (a subjective feeling). It’s when the connections we need in our life exceed the connections that we actually have.”

    In medicine, we were never isolated; there were many humans – sometimes too many – around. But we lacked connection. We zigzagged our way through exams, specialty training, temporary placements – each with its temporary connections – met many people along the way, formed WhatsApp group after WhatsApp group, but remained connected to a few. In the end, the false sense of security of having many people around allowed loneliness to creep in.

    A 2018 Harvard Business Review survey of 1,624 employees in the US found doctors and lawyers to be among the loneliest. In a 2021 study published in the Journal of the American Board of Family Medicine, 44.9 per cent of family physicians reported feeling lonely, answering yes to questions such as: How often do you feel that you lack companionship? How often do you feel left out? How often do you feel isolated from others? Lonely physicians were found to have higher rates of burnout and depression.

    From a public health point of view, loneliness increased the risk of premature death, heart disease, stroke, diabetes. Referencing studies done at Brigham Young University, Dr Murthy said the mortality impact of loneliness was comparable to smoking 15 cigarettes per day. He added: “It’s even greater than the mortality impact that we see with obesity and with substance use disorders.” Loneliness was a killer.

    The first step in preventing the cascade of health problems associated with loneliness was to submit to it. Over the last couple years I tried to do that. If I tried to ignore the feeling, my heart rate would remind me of it. There was no escape. I had to face it and figure it out.

    For over a decade, I had put a tremendous amount of effort into medicine – medical school, exams, internship, call shifts, exams again, specialty training, call shifts, exams again, subspecialty training, another exam pending – only to end up on the 23rd floor of Tower C, again. I had not put enough effort into building – or maintaining – meaningful connections.

    Recently, I have tried to make an effort to reconnect. I came together with two other colleagues and we formed our own “dinner club.” Every month we hit a different restaurant. Friday evenings, I make sure and visit my nephew and niece. On Fridays and Sundays, I go to mosque. I enjoy the solitude – defined by Dr Murthy as being physically alone but connected to something nourishing – of running. Small steps. But at least my heart rate feels more settled.

    Taureef Mohammed is a graduate of UWI and a geriatric medicine fellow at Western University, Canada

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  2. THE EDITOR:At a recent meeting of the UNC, political leader, Opposition Leader and Senior Counsel Kamla Persad-Bissessar, in all her glee, is reported to have triumphantly declared, "We have to win the San Fernando borough."

    Maybe Persad-Bissessar was still celebrating Indian Arrival Day and had not realised that San Fernando became a borough in 1853 and attained city status in 1988.

    Perhaps if the Opposition Leader had concentrated on local matters instead of writing to congratulate Britain's King Charles on his coronation or even breaching protocol in communicating with the Barbados Prime Minister on a matter which concerns the Government of TT, her followers would have been better informed.

    Persad-Bissessar has clearly insulted the intelligence of all San Fernandians who hold city status with a sense of pride.

    What a way to launch a back-in-times local government campaign!


    former deputy mayor

    City of San Fernando

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  3. The UNC has called on the Ministry of Health to do more for those dealing with the negative effects of the Zika virus, especially children who were born with deformities because their mothers were infected with the virus during pregnancy.

    Dr Rishad Seecharan, the UNC's shadow health minister and MP for Caroni East, made the comment during a UNC media conference on Sunday morning. He was accompanied by former education minister Dr Tim Gopeesingh.

    During a Zika outbreak in TT in 2016, 294 pregnant women contracted the virus. Pregnant women are not currently tested for Zika unless they are symptomatic.

    Zika can cause an array of serious birth defects including microcephaly and other brain abnormalities.

    The Centers for Disease Control (CDC) in the US describes microcephaly as "a condition where a baby's head is much smaller than expected.

    "During pregnancy, a baby's head grows because the baby's brain grows. Microcephaly can occur because a baby's brain has not developed properly during pregnancy or has stopped growing after birth, which results in a smaller head size."

    Children with microcephaly can suffer from seizures, feeding problems, hearing loss, vision problems and learning difficulties during their lifetime.

    Seecharan said, "I call on minister Deyalsingh to do his job and serve these families as they were his own. These children need specialised care to walk and to do many basic functions. It is a great burden on these affected families to undertake this care which they must do under personal cost."

    He added that the State should be willing to do more since microcephaly is a lifelong commitment. He also asked Deyalsingh for Zika rehabilitation centres like that of the Associacao de Assistencia a Crianca Deficiente in Brazil, a rehabilitation centre for disabled children in the city of Recife.

    Though TT lacks a rehabilitation centre, there is a Zika Foundation and its president is former chief of staff at the Mount Hope Women's Hospital, Dr Karen Sohan.

    Calls for 24/7 healthcare in Guayaguayare

    Seecharan also said the people of Guayaguayare are calling for round-the-clock health care. He said Guayaguayare residents were not able to get to the Mayaro Health Facility quickly enough in an emergency and ambulances coming from other health facilities took too long to arrive.

    Seecharan said a resident from the area claimed that elderly people and children suffering from asthma were unable to get the health care when needed, especially on weekends when the Guayaguayare Outreach Health Centre was closed.

    Speaking with Newsday on Sunday, Ronald Tsoi-a-Fatt CEO of the Eastern Regional Health Authority confirmed that Guayaguayare Outreach Health Centre was closed on the weekends since it was a remote facility.

    He added that the health centre did have the level of services necessary to be opened 24/7.

    Tsoi-a-Fatt clarified information on the Guayaguayare Outreach Health Centre which says that it opens on weekends saying, "Before covid19, we used to have a general-practice clinic opened on short hours on the weekends. But we used to have one patient sometimes, if that many. So we had to make some adjustments because of resources."

    Tsoi-a-Fatt did not say if the website would be updated.

    Seecharan added that the resident said many were unable to travel to the Mayaro District Health Facility – opened 24/7 – for care. The resident also claimed that a pregnant woman had to wait for an ambulance from Princes Town District Health Facility since there was none at the Mayaro District Health Facility.

    Tsoi-a-Fatt said, however, that the ambulance service at the Mayaro District Health Facility was very active in transferring cases to Guayaguayare to Mayaro. He added that people could also contact the Global Medical Response of TT if needed.

    "But the service is reliable and continuous from 8 am to 4 pm at Guayaguayare," he said.

    He said there were constant upgrades to the service in order to meet the needs of the people served. Tsoi-a-Fatt said, in conjunction with the other regional health authorities, the Health Ministry is working on improving ambulance services further in preparation for the rainy season and possible drastic flooding.

    He said they would ordering a number of new ambulances to improve effectiveness. He added that, every year, there have been consultations held within the communities to hear their concerns and offer them solutions.

    Legislation needed to combat childhood obesity, reduce prevalence of NCDs

    Seecharan said there was an urgent need for the Health Minister to initiate measures to combat childhood obesity and reduce the prevalence of non-communicable diseases (NCDs).

    "There is a need for legislation on front-of-package warning labels, national dietary guidelines as well as a national childhood obesity prevention programme."

    He said, as for NCDs, other entities must be involved in the fight against it, seeing as though many of the country's recorded covid19-related deaths were also dealing with one or more NCDs.

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  4. Consistent with the Ministry of Health’s overarching strategy to reduce the impact of non-communicable diseases (NCDs) in TT, especially in pregnant women, the North Central Regional Health Authority (NCRHA) established the Advanced Diabetes in Pregnancy Clinic at the Mt Hope Women’s Hospital in 2017. Since then, approximately 3,700 pregnant women have accessed specialist care to ensure the health and well-being of both baby and mother.

    Gestational diabetes can negatively affect the health of women and their babies, and for women with type 1 or type 2 diabetes, high blood sugar around the time of conception increases babies' risk of birth defects, stillbirth, and pre-term birth.

    “A woman’s reproductive system is already a delicate and complex system in the body; and when paired with a non-communicable disease like diabetes, it becomes increasingly imperative to take preventative steps to identify potential complications before they become life-threatening or require emergency care. This will result in safer pregnancies for both mother and baby,” medical chief of staff at the Women's Hospital, Prof Bharath Bassaw said.

    This multidisciplinary clinic, which focuses on antenatal care, was implemented to provide specialist medical intervention to pregnant women who are pre-disposed to non-communicable diseases such as diabetes. It includes educational sessions and workshops with experts in the field, as well as, access to medical care from ophthalmologists, cardiologists, haematologists, nutritionists and dieticians to name a few.

    Expecting mothers are also provided with diascan machines and are taught to use the equipment so they can monitor glucose levels on their own at home.

    “The North Central Regional Health Authority revised the initial process and adopted a systems approach which targeted at-risk mothers for increased monitoring and more frequent episodes of care,” said NCRHA CEO Davlin Thomas.

    “We’ve identified opportunities for improvement in the system and have successfully implemented radical innovations to ensure our citizens, in this case our women, receive efficient and quality healthcare...Our exceptional doctors, nurses and other members of staff deserve the commendation that they have been receiving from the public.”

    He said the NCRHA is keen on making healthcare accessible to all, especially women, and has executed outreach programmes such as The Great Pap Smear campaign which provides cervical screening and specialist medical care to our women.

    "We’ve also taken it a step further by expanding the Great Pap Smear initiative, with the launch of the mobile outreach programme, which aims to make cervical screening more accessible in rural communities.”

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    JUST NOW I believe we will have people waiting 20 years in remand for their trials. Laugh or scoff at me all you want, but this is my fear and genuine concern, which comes from seeing the amount of time murder accused spend in remand creeping upward over the years. Twelve years ago, I was appalled that it took four to six years for inmates to move through the justice system.

    Now I am seeing my former students, participants in my prison programmes and my former debaters on the Wishing for Wings/prison debate teams, coming out of prison after 12 to 14 years in remand. What’s to say we’re not heading towards inmates spending 20 years in remand since we have no law for a speedy trial?

    This delay in justice should be a grave concern for all of us. There’s one thing I fear more than crime in this country and that is how easy it is to get arrested here. It’s not a big concern for people who believe they’ll never be arrested, but it’s a constant fear in the culture of poverty.

    If you are following the features I have been writing on inmates I knew in prison, you will see how easy it is to get arrested. Just call someone’s name in a murder, produce an “eyewitness” and the accused can get tossed into prison for 12 to 14 years. They often win their cases because the forensic evidence doesn’t match "eyewitness" accounts.

    If you study the picture of what’s going on, you’ll see many murder charges stem from gangs playing off gangs and getting the police to remove a rival.

    You might fool yourself into believing you are safer every time someone is arrested for murder – or any crime – and put in prison, but there are many innocent people in prison. This gets highlighted in countries like the US, where inmates are often freed because of DNA evidence.

    The Central Statistical Office provides interesting figures for us to study. Here’s the link if you want to check it out yourself:

    That site says that in 2022, 39,640 crime reports were made to the police. Prosecutions were instituted for 10,698 people, which works out to be about one-quarter of the complaints, and convictions were secured for 1,319 people. That means only about ten per cent of prosecuted cases end up in convictions.

    Outside of my time in the Youth Transformation and Rehabilitation Centre (YTRC) where I taught teens in remand for murder, I have had one person in any of my programmes convicted of murder. Some of them pleaded guilty to get a reduced sentence or to avoid the long wait for their trials. Five inmates I know have won their cases.

    That sounds like a dismally low number of people to make an argument for, but the inmates I know are now having their trials 12 to 14 years after I met them. Only two inmates I have taught had their cases thrown out in the magistrates’ court.

    Every day I question the purpose of prisons in this country. In the latest story I wrote with Donnell Inniss, he said prison is another form of slavery. That’s what The New Jim Crow: Mass Incarceration in the Age of Colorblindness, a book by Michelle Alexander, claims about US prisons.

    We should be asking ourselves many questions about crime.

    1. What is the Government doing to better understand the culture of poverty and the crime that emerges from it?

    2. Why aren’t police held to higher standards for their “investigations?"

    3. How is it possible to have cases, where eyewitness accounts don’t match forensic evidence, pass through the magistrates’ court all the way to the High Court?

    4. Why are we not concerned about the growing divide between the culture of privilege and the culture of poverty?

    5. What are we doing about crime prevention?

    6. What are we doing about educational reform and offering more relevant education that reaches all levels of society?

    7. Why is the right to a speedy trial not in our Constitution and why aren’t we clamouring for a law that demands this?

    The biggest question of all is this: When will we realise that there must be justice for all?

    We can’t turn our backs on a certain faction of people in this country and think their needs and their issues are not our responsibility. When it comes to justice, we all deserve better than what we are getting.

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