Beyond the Quads

Free For All

In Jamaica, Amara Ugwu, ’13, discovered that free health care can mean no health care at all.

Brooke E. O’Neill, AM’04 | Photo courtesy of Amara Ugwu

As the sun peeked over the horizon, the woman set out with her child. It was just past 5:00 a.m. and as they walked, she could feel the July heat rising. Soon it would envelop the entire parish, testing her patience as she waited outside the May Pen Health Clinic with dozens of other mothers. School was starting soon and everyone had flocked to the free clinic, little ones in tow, for mandatory immunizations.

The woman waited two hours to get an appointment number, then passed several more cramped in a hot, stuffy room. At 3:00 p.m., nearly ten hours after they’d left home that morning, her child finally saw the doctor.

“The practitioners are definitely overwhelmed by the number of people they have to take care of and the lack of re­­sources,” says Amara Ugwu, ’13, a public policy major who spent six weeks last summer studying health literacy in Jamaica’s rural Clarendon parish. Funded by a grant from the Strongin New Leaders Odyssey Scholarship Fund, she arrived in May Pen, the parish capital, looking to gauge local knowledge about hypertension. What did they already know about the chronic disease? Were they taking measures to prevent it? And how could existing community clinics and health-care facilities help?

What she discovered surprised her. Surveying 200 Clarendon adults, age 18 to 70, she found that nearly everyone had heard of hypertension, but there was a troubling disconnect between awareness and action. “Even people who knew they had high blood pressure weren’t doing anything about it,” Ugwu says. “They didn’t want to go to doctors because there was a lack of trust.”

Like the mother waiting ten hours for shots, Clarendon residents were frustrated. No one paid under Jamaica’s universal health care system, but long lines, dilapi­dated facilities, and overworked staff had made locals leery. “I realized that the issue may not only be health literacy and knowledge,” Ugwu wrote in her research summary, “but also the way that the people view the clinic and the health care system.”

Like many developing countries, Jamaica had long struggled with a cash-strapped medical infrastructure. The situation deteriorated further in April 2008, when the newly elected Jamaica Labour Party delivered on its campaign promise to remove all user fees for government-run hospitals and clinics. Previously, patients would pay on a sliding scale to see the doctor or dentist, with the poorest paying less.

Coupled with the global economic downturn, the shift pushed the system to its breaking point. “You have more people seeking treatment, but fewer resources and basically no money coming in,” Ugwu says. In the Clarendon clinics she visited, small, beleaguered staffs—the team might consist of one or two doctors and three or four nurses—scrambled to see dozens of patients.

“A lot of people felt that once the system had become completely free, the doctors and nurses did not really care about them or did not treat them as well as they wished,” Ugwu says. As one interviewee who could afford the old user fees confided, “It’s gotten so bad now, I wish that I could pay.” Several others agreed, suggesting the system stay free only for children and those who couldn’t afford it.

She recalls one pregnant woman who had been told she would need to pay for a private doctor if she wanted to get an ultrasound. Under government policy, clinics could only offer a certain number of procedures in a given day and they had reached their limit. For the expectant mother, Ugwu says, “that felt like they didn’t care about her baby.”

What many people don’t realize, she says, is how “the policy prevents the health-care practitioners from doing their jobs.” That misunderstanding then breeds distrust and deters locals from seeking medical help for chronic conditions like hypertension. Aside from acute illness or mandatory immunizations, most “just avoided the hospital because they felt like the doctors didn’t have their best interest at heart.”

For Ugwu, who interns at the Urban Health Initiative’s South Side Health and Vitality Studies, working in Jamaica solidified her interest in the complexities of public health policy. Despite negative public perceptions of parish clinics and hospitals, she found a great amount of dedication among the public health nurses, peer health educators, and community health aides she shadowed. “They would walk for hours under the hot sun, passing out condoms, visiting mothers, talking to the elderly,” says Ugwu of the health aides. “There’s a lot of engagement.”

It’s a realization that left a lasting effect. “Going in, I was hoping to improve health, but I left learning so much more than I taught,” says Ugwu. “It’s important to go in with an attitude of not only wanting to help the community, but also of learning from them, whether that’s on Chicago’s South Side or in rural Jamaica.”


Waiting outside May Pen Health Clinic at 7:30 a.m., an hour before it opens.