Opening pop-up health clinics in Jamaica

Nursing student Andrea Leiner examines a patient in Jamaica, where she helped set up and staff pop-up clinics to bring primary health care to rural locations.
By Andrea Leiner

Nursing student Andrea Leiner examines a patient in Jamaica, where she helped set up and staff pop-up clinics to bring primary health care to rural locations.

Opening pop-up health clinics in Jamaica

By Andrea Leiner
After switching careers from film to nursing, School of Nursing and Health Studies student Andrea Leiner goes ‘off the grid’ in Jamaica and strengthens her passion.

After producing music videos and films in New York City for 15 years, I changed careers to pursue my first love, medicine, and became an emergency room nurse. I am now set to graduate in August from the one-year accelerated Family Nurse Practitioner Program at the University of Miami School of Nursing and Health Studies.  

International travel had been a part of my job in film, and after the 2010 earthquake in Haiti, I volunteered with a humanitarian group at a field hospital in Port-au-Prince. There I saw how travel and medicine could be combined as a force for good, and I jumped at the chance to join 13 other nurse practitioner students in Jamaica this past June.

After safety concerns forced the cancellation of two scheduled trips to Haiti to staff rural clinics, Johis Ortega, associate dean for hemispheric and global initiatives at SONHS, leveraged our school’s ongoing relationship with the University of the West Indies in the Jamaican capital of Kingston to create a new opportunity. We went with the goal of gaining primary care experience by partnering with local physicians and nurse practitioners to open pop-up clinics in rural locations.

One of the challenges of providing primary care “off the grid” is that once you leave, there is little sustainability. Whether it’s in Appalachia or Haiti, follow up and access to medications are nearly impossible without a medical support system. So you do good while you’re there, but you feel a sense of helplessness knowing patients won’t continue to get the care they need, and that an easily treatable condition can become a death sentence.

Jamaica is different because Jamaica does have a national health system. Yet people there usually visit the clinic only when there’s a problem. Most of Jamaica is rural, so logistics can be quite an obstacle. The local clinic might be a 10-kilometer walk down a mountain road, and if you’re working every day and have children at home, getting there is a challenge. Enter our trusty bus and us.

Each morning, we hopped on the bus around 6 a.m. and drove two to three hours to a different rural location in the mountains to open a pop-up clinic in a town that the Ministry of Health identified. Whether it was a church, a community center, or a lean-to, we arrived with all of our equipment and made the location work. And since the University of West Indies has a well-established medical program, we partnered with their physicians, nurse practitioners, nurses, and students, co-staffing the clinics and potentiating the effect we had.

As the week progressed, word spread and different West Indies faculty jumped on the bus, bringing their students. We met an amazing professor from the pharmacy department who brought medications and her students on several days, providing invaluable support and education for both the students and the patients. A dentist also joined us to demonstrate oral hygiene with a giant toothbrush and a set of teeth that everyone found quite funny. As a result, we could go beyond addressing acute issues, like giving antibiotics for an ear infection, and assisting with chronic issues.

When our bus arrived each morning, 20 or 30 people already would be waiting for us. The residents were so grateful we were coming to them instead of the other way around. They helped us set up and solve some of the challenges of working half indoors and half outdoors in the summer heat. Everybody was excited to have a check-up, the first for a lot of people. They offered us food and water and brought their kids to see us. It was a very cool community experience, truly neighbors helping neighbors.

The first couple of days, I was able to draw on my producing skills to set up registration, triage, and lab stations, while our program director, Juan M. González, and nurse specialist, Amauri Quintana, supervised our patient interactions, taking reports, and making recommendations. Their breadth of knowledge and education helped us develop confidence as practitioners. We also worked with fantastic local physicians who helped us come up with solutions while pushing us to stretch beyond our comfort zones.

This interprofessional teamwork opened the way for a number of meaningful collaborations. I actually had two patients diagnosed with Marfan syndrome during one clinic. Working with Dr. González and a local doctor, we not only diagnosed this genetic disorder that affects the body’s connective tissue, but also addressed some of the very serious complications that can come with it, such as congenital heart conditions. Both patients were experiencing cardiac symptoms, and we were able to liaise with the doctor who would see them at the local clinic in a couple of days. We also were able to refer them for echocardiograms and EKGs.

It was awesome to collaborate and grow as a provider, especially outside of the very tidy, technology-based U.S. system. In another case, I saw a little boy with bloody diarrhea. In the U.S. geriatric hospital where I work, this symptom would signal one set of diagnostic concerns, but in this new environment, I had to explore a host of other possibilities. I learned quite a bit about the causes of diarrhea in children outside of the U.S., and I appreciated every second of this education. The diagnosis turned out to be parasites, which we were able to treat with medication. We referred the boy for follow up. His mom knew where to bring him, and everything was good.

Being in Jamaica gave us all a chance to focus, to be present in the moment, and push our everyday first-world concerns to the side. The cell phones didn’t work most of the time, and we were out in the heat 10 hours at a stretch. We’d return to our hotel exhausted and just try to get it together for the next day. For some, that meant just falling into bed after we packed for the next day. For others, that meant immersing ourselves in the culture as much as possible, or bonding with fellow students and professors in a way you can’t do in everyday life. Others simply reveled in the chance to play; it might be 10 at night, you’re dead tired, you’re walking to your hotel room, but, hey, there’s a soccer ball, why don’t we kick it around and laugh for a few minutes?

It’s really important for all of us, no matter what we do, to step outside of our world and experience something new. This experience expanded my perspective and got me out of the single-track mindset we can all fall prey to in our day-to-day lives. In a way, it offered a respite from it. I hope to continue to do humanitarian outreach programs like this, in the U.S. or abroad, and eventually help organize or work for an organization that leads them. Participating in the SONHS first mobile clinics in Jamaica reinforced my passion for medicine and belief that we are all our brothers’ and sisters’ keepers.