How many neurologists are in the West Indies?
This sounds like the opening line of a gag (and no, I have no idea how many neurologists are needed to change a light bulb). But I have been seriously wondering about neurologist resources after a trip to the Caribbean. I was stunned at the fragility of the infrastructure, of which one part is the medical infrastructure. From the Bahamas down to Curacao, there live more than 44 million people, three times as many as the Pacific NW (WA, OR, ID, MT, AK) . You have to assume among the Caribbean population are people afflicted with Parkinson’s, Alzheimer’s, epilepsy, multiple sclerosis, cranial injuries, and all the myriad brain ailments neurologists treat.
Damage is still evident to the islands from back-to-back hurricanes (Irma and Marie) in September 2017. But this is a part of the world that had a fragile infrastructure even before the hurricanes. For starters: Water. I was reminded of why castaways are always landing on “desert” islands. Desert can mean “deserted” but in the West Indies desert means “dry”. I had this romantic jungle-y “Pirates of the Caribbean” image in my mind, and was surprised to find how dry and scrubby the islands were – cactus everywhere! Turns out the West Indies is a hotbed (pardon the pun) of desalination plants (such as the one pictured in St. Martin).. I can vouch the water tastes fine. But this is a far more power-intensive way to get your water than from the heavens.
Further challenging the environment in the Caribbean is the legacy of sugar cane. 18th century Europeans had no concept of soil management or crop rotation and quickly depleted what little nutrients the volcanic soil held. They also chopped down the tropical hardwoods (think mahogany) to use for all those wooden sailing ships. So, between the lack of water and the poor soil, not a promising agricultural location: I saw one small commercial garden, no farms, not even backyard gardens. This is despite the fact that nearly all food must be shipped in. All the food on the cruise I was on came from Miami.
I was surprised to learn that sugar cane has not been grown on an economic basis since the 1840s. Why? Most countries emancipated slaves in the 1840s – without slaves, the sugar cane no longer made economic sense. So with no cash crop, no agriculture, no industry, what is the Caribbean economy based on? What pays for the infrastructure? The obvious answer is tourism — but keep in mind most tourists arrive by cruise ship – so their hotel and (most) restaurant dollars are…on the ship. We stayed a number of nights in St. Martin, and finding dinner was a challenge. Most restaurants closed at night after the cruise ship passengers were back on board.
Another challenge to establishing and maintaining infrastructure is government — both too much and too little. There is no “Union of West Indies”. Instead, there are more than 7,000 individual islands in an approximately 1-million-square-mile region. There are 13 sovereign island nations and 12 dependent territories, The tiny island of Sint Maarten/St. Martin where we stayed (pre-hurricane population of about 77,000) had the absurd comic opera situation of half the island being Dutch and half being French. Since 2010, the Dutch part has almost full autonomy from the Netherlands while the French part remains an “overseas collective” of France. How do you coordinate rebuilding infrastructure with a governmental structure(s) like this?
So back to the original question: How many neurologists are there in the West Indies? Answer: No idea. Some Google searching found neurologists in Barbados, Jamaica, Puerto Rico (even a Puerto Rico Academy of Neurology!) including a Puerto Rico VA hospital. But it’s a safe bet that there’s not very many – not enough neurologists to serve 44 million people.