Ethan Jones: The Kittitian and Nevisian Experience

January of 2015 was the first occasion in which the possibility of conducting research abroad became real. It was thanks to the maintenance of strong relationships between Dr. Jeanita Richardson of UVa and her Kittitian and Nevisian partners in the Ministry of Health, which presented the opportunity to contribute to the understanding of the societal impact of pediatric asthma in St. Kitts and Nevis.

As we learned, great concern had been given to the impact of pediatric asthma by Ministry of Health officials and health care professionals. Their anecdotal evidence had depicted a high prevalence of pediatric asthma patients presenting to the emergency rooms of the two hospitals on the island federation. This was despite adequate and accessible care options for pediatric asthma patients located within Community Health Clinics, each distributed so that every household is located within three miles of a clinic. With the Community Health Clinics so crucially integrated into the provision of health care in St. Kitts and Nevis, our job was to assess the burden of pediatric asthma patients on their health system, who over utilize the services of the emergency rooms when they alternatively could have visited clinics. Research has proven that the mismanagement and improper care of asthma is the single largest contributor to asthma morbidity. This objective could only be accomplished by measuring the prevalence of pediatric asthma among all pediatric patients on St. Kitts and Nevis, and describing the characteristics of their visit to the emergency rooms by evaluating their medical records at each of the two hospitals.

Despite six months of anticipation of our project, close consultation with members and faculty of the Department of Public Health Sciences, the Center for Global Health, and the University of Virginia HSR-IRB, it has become increasingly evident that no level of careful planning leaves you fully prepared for your research experience abroad. As we have learned, nothing is more valuable than being in St. Kitts and Nevis, immersing yourself in their culture, talking with health care professionals face to face, and looking at the real data provided by real records.

Our ambitious goals prior to our departure expected us to be able to analyze a five year period of medical records for each hospital, providing an analysis for each distinct population. It wasn’t long after observing the quantity and organization of the medical records, as well as the steps which would be necessary for our analysis, that we may be required to provide a more comprehensive analysis on a shorter, three year period. Likewise, we have only been able to communicate with the members of the Ministry of Health on Nevis. As such our analysis is restricted to the emergency room at Alexandra Hospital on Nevis, until we are given permission to make the same contribution to Joseph N. France Hospital on St. Kitts.

In the time that we have been in St. Kitts and Nevis, we have completed a significant portion of our record review, we have refined our collection methods, and have built partnerships with many individuals from Alexandra hospital and the Ministry of Health. While we are merely a few weeks into our research, the experience of living and working in a culture different than my own, and to cultivate relationships with the nurses, physicians, and EMTs of Alexandra Hospital has been nothing short of invaluable. Members of the MHIRT research team and I have been given numerous opportunities to participate in a variety of local events, including music festivals and the children’s parade in celebration of children’s month. Likewise, we have engaged with members of the community whether that be through routine visits to the local food market, or hosting a dinner gathering where we welcomed our community partners and our fellow Kittitian and Nevisian team members. As we have learned first-hand, engaging with members of the community allows us to be culturally aware and respectful, which is critical to the success of our research and the longevity of our contributions and partnerships with the Ministry of Health and the population on St. Kitts and Nevis. With sincere gratitude for being given this opportunity, I greatly anticipate what the next five weeks of the Kittitian and Nevisian experience has to offer.

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