Tomlin J Paul

Identification of childhood disability in Jamaica: the ten question screen.

This is the first in a series of papers that report the testing of two instruments for the identification and assessment of childhood disability by community workers (CWs) in Third World countries. It is part of the International Epidemiologic Study on Childhood Disability. The Ten Question Screen (TQ) was used as the main instrument to identify disability in a two stage population-based survey of 5478 children aged 2-9 years in Clarendon, Jamaica. In the second stage, TQ positive and 8% of the screen negative controls were professionally assessed by a doctor and a psychologist using standard criteria based on the main classification system of the ICIDH. Sensitivity of the TQ as a whole varied in different strata of the group and amongst different disabilities, from perfect in girls under 6 years, fits and motor disabilities and for serious disability in all group except boys over 5 years with cognitive disability. Specificity was good but the false positive rate was unacceptably high at 74%. It was concluded, firstly, that the validation of a simple questionnaire of perceptions of behaviour against objective measurements of impairments was perhaps not fair to the TQ. In spite of this, the TQ would be a very useful instrument in collecting disability data or for identifying people in need of rehabilitation help, if a way of reducing false positives could be found.

Service needs of children with disabilities in Jamaica.

We investigated the service needs of children attending a medical assessment as part of a two stage survey of 2 to 9-year-old children in mid and south Clarendon, Jamaica. Parents were asked about symptoms relating to six different disabilities: visual, hearing, speech, motor, cognitive and fits. Following medical and psychological assessment, a diagnosis of mild, moderate, severe or no disability was made. For children with disabilities, the frequencies of five possible types of intervention recommended by the physician were analysed and related to the prevalence of the six disabilities in the parish. To estimate the needs of the Jamaican child population the figures were extrapolated based on an estimate of 1 million children under the age of 15 years. These needs were then compared with places in existing services. Of the disabled children, 62% needed special education, 29.5% needed community-based services, 21% needed spectacles, 21% needed specialist referral, and 6% required medical treatment. Although the vast majority of these needs are not met, many more could be met in the community if existing health and education personnel are trained in basic techniques of screening and assessment.

Public and private health care utilization differences between socioeconomic strata in Jamaica

Objective: To assess trends in the use of private and public health care services among Jamaicans over a 15-year period (1991–2007). Design and methods: Statistics on the use of health care services were taken from the Jamaica Survey of Living Conditions (JSLC) for the 15-year period 1993 to 2007. Use of hospital services were represented in income quintiles and compared for private and public facilities. The difference in percentage use between public and private was compared by quintiles over the period and the variability in those differentials assessed. Results: This study highlights the increasing use of private services by increasing wealth, exaggerated for the wealthiest quintile. There is a widening of the differences in utilization between public and private centers as income level increases (P < 0.001). Conclusions: Internal and external economic conditions influence the use of private and public health care services in Jamaica. Although the relative increase in the cost (to the user) of public health care is more than that for private health care, the actual cost to use the public health care system is still significantly cheaper than using the private system. Lower income health care users tend to take the lesser cost option.

Health sector challenges and responses beyond the Alma-Ata Declaration: a Caribbean perspective

Al igual que el resto del mundo, el Caribe ha sido testigo del drastico paso de las enfermedades nutricionales y transmisibles a las enfermedades no transmisibles y cronicas. No obstante, en el Caribe este cambio ha coincidido con una nueva dinamica, creada por la emergencia de enfermedades transmisibles -como la infeccion por el VIH/sida- junto con los problemas relacionados con el envejecimiento, las enfermedades cardiovasculares, la violencia y las lesiones, entre otros. En este articulo se hace una revision de la historia de la atencion sanitaria en el Caribe, los retos y enfoques del sector salud y la nueva orientacion en la atencion primaria de salud (APS). Las observaciones se basan en trabajos publicados. En el Caribe, la Declaracion de Alma-Ata sirvio como importante punto de giro y ofrecio orientacion, apoyo y direccion a medida que los paises perfilaban sus servicios de salud para satisfacer sus necesidades. La creatividad y el ingenio surgieron como rasgos distintivos del enfoque caribeno en la reestructuracion de la APS, ante los retos economicos, sociales, culturales, de recursos humanos y de politicas que enfrentaban. El fortalecimiento de de la capacidad institucional, la extension de los programas sociales, los esquemas nacionales de seguros de salud, los programas especificos de promocion de salud y la ampliacion de la investigacion en apoyo al desarrollo de politicas continuan evidenciando el esfuerzo caribeno para responder a los cruciales retos epidemiologicos. A pesar de esos retos, se han establecido alianzas dentro y fuera del Caribe. Ademas, la Carta del Caribe para la Promocion de la Salud ha servido como elemento critico para el desarrollo de la APS.

Family medicine training by distance education

A postgraduate programme is developed to provide Family Medicine training to practising General Practitioners. The programme provides physicians with didactic material by distance education while enhancing clinical competence through face-to-face sessions in ambulatory clinics. Assessment of participating physicians is based on the responses to distance education assignments, case presentations during clinical sessions, clinical examinations at the end of year 2 and the defense of a research project in year 3. Initial programme evaluations demonstrate that the distance education format is successfully incorporated in the discipline of Family Medicine postgraduate training.

Teaching medical students in their last leg of the undergraduate journey

Background: This short biographical piece provides a brief description of the experience of a medical teacher at the University of the West Indies in Jamaica. It traces his initial response to being chosen as a teacher and shows movement from self-doubt to assertive thinking about the role of the teacher. The development of the teacher, though buttressed by a formal training intervention, is couched within a sensitive understanding of the whole student.

More questions than answers? Expanding students' reflections from a community health experience.

Medical schools’ curricular content ranges widely from precise basic science material to a heterogeneous mix of clinical presentations to diffuse social and life issues. The context within which this content is delivered is also variable, covering precisely designed laboratory settings, structured clinical ward settings, and uncontrolled community settings. Educators in medical schools, while able to cover curriculum content didactically, may find it challenging to adequately facilitate a wide and varied exposure to relevant learning issues. This challenge becomes greater when moving from the basic science laboratory to the community setting. The response of the student to community-oriented programmes is an important consideration in helping educators to assess possible learning outcomes beyond the stated learning objectives. This adds an important dimension to the restricted learning environment of the lecture room. It is in fact noted that some of the skills doctors require, can only be gained through planned practical learning experiences in a representative range of health problems encountered in their normal setting (World Health Organization, 1985). Ideally student learning should be permanent and pertinent and of value to the student at present and in the future. This is, in essence fostering a deeper

Student learning experiences with Jamaican practitioners

Due to the destruction of teaching facilities in primary care by a recent hurricane, first clinical year medical students were placed with general practitioners, in order to fulfil the requirements of a community medicine clerkship. Student feedback indicated a very high level of interest, with a variety of learning experiences--the attitudinal attributes of general practitioners ranking highest. This experience has provided a useful opportunity to enhance the training of medical students and to develop collaborative links with non-university physicians. This paper summarizes the experiences of the first 39 students involved in the clerkship.