Person to Person: Health Care Workers and Marginalized Jamaicans

There was “so much things to say”, as the Bob Marley song goes. At a stakeholder consultation with health care workers and local groups working with the LGBT community, words flowed in torrents as the participants tackled difficult issues head on. The organizers, Panos Caribbean, expertly guided the discussion, which is part of a broader communication initiative against stigma and discrimination funded by the United States Agency for International Development (USAID) through World Learning.

The project has largely focused on MSM (men who have sex with men), which, by the way, is a public health term and not a term that actually denotes sexual orientation.

The theme for the consultations, held in Ocho Rios, St. Ann was “Targeting Zero Discrimination, Enhancing Care”. Panos’ Indi Mclymont Lafayette and Dr. Hamlet Nation kicked off the discussion. After that, representatives of the LGBT community and health care workers from the parishes of St. Ann, St. Mary and Portland (covered by the Ministry of Health’s North East Regional Health Authority) all had their say.

This meeting was prompted by a significant document published by Panos Caribbean and launched in Kingston last September called “Speaking Out: Voices of Jamaican MSM”. These oral testimonies from 32 men, including one teen, were a“first”, vivid, wide-ranging expressions of how gay Jamaican men see their lives and confront their challenges. Many described the negative experience of seeking treatment at some (but not all) public health institutions.

MSM patients are ill at ease in health settings; they worry greatly about the confidentiality of their medical information. But are health care workers themselves comfortable, especially when giving specific information to these patients? Do they always seek to be non-judgmental? Most of this stakeholders group said they attended church. So, do their religious and personal perspectives influence their work? Do they encourage health-seeking behavior, and do they maintain professional standards at all times?

Jermaine Burton, founder of the Color Pink Group working with LGBT commercial sex workers in particular, was himself homeless two years ago. When he went to the hospital, the security guards immediately turned him away, so he never even got inside the building. If he did manage to speak to a nurse, he was afraid to disclose details of his health status. He believed his docket would be passed around among various employees — everyone would know. Andrew Higgins, from the National Anti-Discrimination Alliance (NADA), also pointed to issues of trust, and not only in public health facilities. Especially in small communities, news and gossip travel fast. Guess who I saw going into the AIDS clinic today?

J-FLAG’s Jaevion Nelson noted his organization’s key mission: to increase levels of tolerance of LGBT Jamaicans from the current 17 per cent to 50 per cent of the population. J-FLAG also works for improved primary health care for MSM. Mr. Nelson noted there are specific issues unique to the MSM community. Having visited public hospitals across Jamaica, he singled out the “fascination with dress codes”. People dress in different ways; but don’t they still have a right to be treated?’ he asked. If they are homeless, they likely don’t have smart or clean clothes to wear. Does this mean we should turn away patients who are most at risk and possibly in urgent need of treatment?

Rights come with responsibilities, responded one contact investigator, who works closely with MSM. Patients must dress properly to avoid “conflict” with authority. They must behave properly; some are loud and aggressive. Mr. Nelson suggested a more tempered response; health care workers must help their clients understand good behavior and what is acceptable or unacceptable. Health care centers should create an inclusive, calm physical environment, making everyone feel at home and reducing stress levels among patients (by the time they arrive, many gay patients are already extremely stressed). When they walk in, do clients know that this is a non-discriminatory space? If they have a complaint, do they know how to seek redress?

Regional Epidemiologist and HIV/STI Coordinator Dr. Carla Hoo said the dress code (no slippers, no spaghetti straps, no bare midriffs, etc) is not going to change any time soon. “We are not trying to be autocratic,” she explained. “The dress code is for our own good.” It is there for health reasons, to prevent the spread of infection.

So, dress and behavior are clearly major factors – two social constructs that have great bearing on human relationships, especially in a professional setting. They may constitute a barrier to harmonious relations between an LGBT patient and a nurse — a very tangible barrier.

The discussion kept returning to two less tangible, essential elements for good relations between two human beings: trust, and respect. They work both ways, all agreed. Like all relationships, there must be “give and take”. 

A recent Panos-led consultation with the Ministry of Youth and Culture has, encouragingly, prompted a determination by the Ministry to reach out to homeless LGBT men living on Jamaica’s streets — many of them very young.

The Ocho Rios meeting concluded that specific training for health care workers on working with the community is essential: only about 15 per cent have received such training. J-FLAG has a manual for health care workers on treating MSM patients in the works. There is a need for the MSM community itself to understand the system, and what is expected of them as individual patients. The health sector must examine procedures and systems that may not foster confidentiality and efficiency. And non-governmental organizations should empower LGBT clients and not encourage “victimhood.”

In other words, as Dr. Nation commented, the response should be a “team effort.”

This is part of the way forward — because move forward we must. If we could just take stigma and discrimination out of the situation, said one participant, there would be no problem.

See related blog at:

http://wordsfrompetre.webs.com/apps/blog/entries/show/42180413-call-for-more-inclusive-health-care-for-msm