I am a third world doctor.

My patients have first world expectations.

Somewhere in the middle, I end up working too hard and then going home feeling cheated. For I too have expectations. I am in a tension between the reality and my aspirations.

In Jamaica, health care is free. Day after day, and night after night its freeness is confirmed, tested. But the system is inanimate. It doesn’t feel its own failure, it cannot rejoice at its success. Its us, the workers within it that feel it, or don’t.

I cannot help but feel it. Still, after 2 years in the very matrix of free health care. I practice in the largest hospital in Jamaica, in the capital city, Kingston.

The patients look to me, to us, daily, with expectation. How to tell that, 11 years after the new millenium we cannot offer our patients a CT? Haemodialysis for their failed kidneys? Red top tubes for their U and Es?

Each day I contrive to bend the system, to push the system, to circumvent the system. The system pushes back, it always wins. In my body, in my mind, I bear with its exertions.

Workers in this system are stuck with the feeling of the great wrongness of health care, gratis. We can’t afford it they assert. Others seem to rue the greater numbers that come to use it. For me, I think the discussion has got to get beyond this. What free health care has categorically shown is how sick this country is, its people and how the systems treat them.

I have lost track of how many young men I have diagnosed with end stage cardiomyopathy, endstage kidney disease. AIDS. Admission night after admission night the heart failures, the cancers, holding out their nicotine stained fingers. The parasuicides, the post-marijuana psychosis.

And we have to treat them and their expectations. It is our unique curse and the blessing, that the third world doctor still has to care. It is care that pushes us beyond the system,  beyond ourselves.

Those who work in system know that they don’t win against it. They find ways to survive. They leave. They become embittered. They stay within a tightly circumscribed area of comfort and impact. Or they wrestle daily against the death of their humanity and compassion daily and continue to go it out. Heroes?

Or fools?

Ryan Brooks is a medical resident in Jamaica.

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