2011 Grant Recipient 
Trinidad and Tobago
MSPH Program, Department of International Health, JHSPH
The Trinidad and Tobago Health Sciences Initiative (TTHSI) is an umbrella program being implemented by the Government of the Republic of Trinidad and Tobago. TTHSI representsa collaboration among the Ministiry of Health (MOH); the Ministry of Science, Technology and Tertiary Education (MSTTE); the University of Trinidad and Tobago (UTT); and Johns Hopkins Medicine International (JHMI), aimed at advancing medicine and health sciences in Trinidad and Tobago and the wider Caribbean. The ethnic population of Trinidad and Tobago is 40% Indian (South Asian) and 37.5% African. The Caribbean is witnessing an epidemic of lifestyle related chronic non-communicable diseases. Among these are obesity, diabetes, and hypertension, along with such complications as stroke, heart disease, and amputations. Diabetes is estimated to be the 3rd highest cause of mortality in Trinidad and Tobago. Several systematic efforts to date have targeted physicians or healthcare delivery with the goal of improving patient diabetes outcomes. However, these interventions alone are inadequate for improving diabetes outcomes because of they do not routinely intervene at the level of the patient, who is at the center of diabetes management. The Penal Health Centre Diabetes Patient Self-Care Study aims to: 1) collect data needed for designing future healthcare centre-based interventions and policies to promote effective patient diabetes self-management, and 2) implement an effective tool for conducting healthcare centre-based assessments of diabetes patient self-care barriers, risk factors, and intervention needs across health centres and Regional Health Authorities in Trinidad and Tobago.
I was born and raised a citizen of the Republic of Trinidad & Tobago, an island ‘paradise’ in the Caribbean. Though it is a developing country, Trinidad & Tobago is currently one of the wealthiest nations in the Caribbean, due in part to the fact that it has oil and natural gas reserves. However, despite the wealth of the nation, the standards of the health sector are, unfortunately, very mediocre – the hospitals and clinics are always poorly stocked and lack mandates on effective medical care access by rural and poor communities, the doctors are underpaid and overworked, and there are no strategies or policies in place with respect to increasing healthcare facilities for the country’s projected population growth and ageing. I had never worked in the healthcare sector in my country, leaving just after secondary school to attend university in the United States. Thus, I jumped at the opportunity to do my master’s practicum in Trinidad. I spent almost five months (August-December, 2011) as a GHEFP intern working on a diabetes research project with the Trinidad & Tobago Health Sciences Initiative (TTHSI).
Though I spent two-thirds of my life in Trinidad, I have always lived in the north which is much more developed. However this internship was located in the south of Trinidad, almost an hour’s drive away from the nearest city. I had never spent more than a couple of hours at a time in the south in my life, so I was able to experience a somewhat different culture and way of life. Though the town of Penal is large, it is mostly populated by low-income families and pensioners, and is very Indo-Trinidadian, as evidenced by the food, (mostly Indian, with lots of curry and fried dishes), the music, and the religious observances (heavily Hindu-oriented). The Penal Health Centre caters to anywhere from 3,000 to 10,000 people, most of whom are Indo-Trinidadian. The health centre itself was packed with people almost every day. Patients lined up at least a half-hour before opening and would file into the health centre and wait (sometimes there was only standing room available) for several hours before they could see the doctor. With usually only one doctor on duty, each patient would get 2-3 minutes at most with the doctor. The doctors and nurses were constantly busy and always on the move, with a perpetual stream of patients moving through the health centre. To run my project, I would go around the waiting room, talking to waiting patients and inviting diabetic patients to participate in the study. Most patients were pleasant and were anxious to chat with me about their health and I was truly surprised that most patients did not know much about their disease; they asked basic questions such as how they got the disease, what they should eat, what could happen to them, and how they should take care of themselves. Since the doctor spent such a short space of time with each patient, most diabetics were only told what medicine they should take and when they should come back for another visit. During my time in Trinidad, I interviewed about fifty persons and chatted with countless others. The firsthand experience of interviewing patients and learning what most people are struggling with in terms of healthcare was simultaneously disheartening and enlightening. Policy change, education, and funding are the key ingredients to creating a healthier population. I am grateful for the opportunity to spend such an extended period of time in my home country, immersing myself in an area that I had little familiarity with, and applying my theoretical public health knowledge in a real world healthcare setting. I am hopeful that I can help in some way to make my country’s future a healthy one.
 | A panoramic view of Port-of-Spain, the capital city of Trinidad & Tobago |  | The Penal Health Centre building where the Diabetes Research Project took place |  | The Penal Health Centre in the context of its rural surroundings. Note that though the health centre is made of brick, the houses surrounding (on the left of the photo) are all wooden shacks. Most of the patients are poor, with limited access to health services |  | Poster advertising the Diabetes Research Project |  | The waiting area of the health centre where patients sit and wait for hours before they see the doctor |
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