After visiting a rural clinic in the remote Kalinago Territory on the island of Dominica, a group of medical students envisioned an organization that would improve the delivery of health care services to the last remaining indigenous population of the Caribbean. In March 2002, they initiated the Salybia Mission Project. Since its inception, the project has continuously staffed and supplied the clinic in the Kalinago Territory. It couples the need for health care services with stipended clinicians and aspiring medical physician volunteers from the neighbouring Ross University School of Medicine. It also participates in cultural and educational initiatives, as it believes that a community’s health needs extend beyond the clinic’s walls. Because of its vision and spirit of collaboration, Salybia Mission Project has become a nationally recognized non-profit organization and continues to play an integral role in the clinical education of students as well as the community it serves.

 

“Look not at the condition of the facilities, focus on the patients.... They will guide you.... They will teach you.” These are the words of Dr. Worrel Sanford, a physician, a mentor, and a member of the Kalinago people. Our paths crossed early in my medical education during a visit to a remote clinic where he volunteered his weekends providing free care to this sole surviving indigenous community in the Caribbean. Shortly after our arrival in 2002, we quickly learned that Dominica’s geographic remoteness translates into limited resources for all its citizens, especially for those in the Kalinago Territory.

 

Our small group of freshly minted medical students was disturbed by the dearth of medical supplies and medications, so we resolved to change that situation. Our efforts marked the inception of the Salybia Mission Project (SMP), an organization whose vision is to help provide medical care to the indigenous people of Dominica.

What started as a student-run association that provided clinic volunteers, solicited donations, and held fundraisers to finance the venture matured into a nationally recognized nonprofit organization charged with doing the same. Top

 

To demonstrate our commitment to the Kalinago people, our first collaborative project was to enhance the existing clinic and its services. In addition to importing basic equipment and pharmaceutical supplies, our group of founders made structural improvements by painting, tiling, and installing plumbing to provide clean running water. When the original clinic was irreparably damaged by an earthquake, SMP collaborated with the Kalinago Council, the Church of the Nazarene, the Canadian Fund for Local Initiatives, and other community supporters to finance and build a new one that opened its doors in March 2010. In the interlude, SMP worked to convert an early childhood centre into a functional clinic and provide volunteer and stipended staffing so that the community’s biweekly services were not interrupted.

 

The clinic’s supplies continue to be procured and donated primarily by SMP, which finances its ventures through student membership drives and a variety of fundraising events. However, SMP believes that its role extends beyond replenishing supplies and has, therefore, broadened its efforts to help cultivate a sense of communal self-sustainability. In the past decade, SMP has managed a Nursing Scholarship Fund that was established by its pioneers. To date, it has financed the education of six nursing graduates, who now form the pillars of the front-line community health services in the territory. These nurses not only staff the clinic, but also make regular house calls and spearhead community educational activities and public health initiatives. Top

 

The Kalinago people, once a great tribe that welcomed Christopher Columbus to its shores on a Sunday (hence the name Dominica), now consists of approximately 2200 people, who live on a 1500-hectare parcel of land in a corner of the island. To help discern the social elements that affect these inhabitants’ lives, the Kalinago Community Health Assessment Report1 was commissioned and published in December 2012. This two-year project marked a collaboration of the Kalinago Council, the Dominican Ministry of Health, SMP, the University of Manitoba, and Ross University School of Medicine. The data from the resulting report highlight the importance of the SMP’s expanded initiatives that focus on building housing, providing transportation, and supporting educational programs in the community. SMP is currently in the process of securing supplies and volunteers to build a home for a family whose precarious circumstances keep them from fully integrating into the community.

 

What continues to fuel SMP’s success is the unwavering commitment of those who nurture its vision by making it their own. Literally, thousands of Ross University School of Medicine students have carried on the work of the SMP’s pioneering members and, in so doing, have left their own indelible marks. What was once a fledgling organization is now recognized as one of the largest student groups associated with the island’s American offshore medical school. Top

 

On my recent trip to Dominica, I worked alongside students who exude the same passion for the work that we did as founders. Over the past decade, SMP has proven to be as beneficial to the development of the medical students as it is to that of the community it serves. Coincidentally, Ross University School of Medicine recently established a community clinical requirement as part of its basic sciences core curriculum, a requisite element of its clinical sciences courses that mirrors the patient–student engagement that is central to SMP’s clinics.

 

SMP takes great pride in the fact that its programs are devised and implemented by its membership. Its student-directed organizational structure, coupled with the guiding hand of its advisor, Mr. John Hawley, fosters the development of strong, independently minded and very successful student leaders. While I was chief resident of one of the largest internal medicine residency programs in New York, I enjoyed listening to candidates passionately describe how their experiences with SMP enriched their personal and professional lives. These lifetime members readily deploy their skills throughout their residency training and in their careers. Some use their exposure to tropical medicine in cities that are hubs of immigrant communities. Others use their knowledge in rural medicine to work in underserviced and geographically remote areas. And then, there are those like my fellow cofounder, Dr. Challie Minton, who used SMP’s model to establish a clinic in rural North Carolina. Top

 

When I embarked on my educational quest, I decided that my passion for practising medicine superseded the location where I would do it. Choosing an unconventional path meant I would face challenges not encountered by my domestic counterparts. What I could not have fathomed was that I would find myself in an environment that would become the wellspring for SMP. As I reflect from my home in Toronto, I recognize that this circuitous journey has molded me into the physician that I am today. Each day, I continue to look to my patients for guidance during our encounters, irrespective of the country or context that we find ourselves in.

 

If you wish to know about Salybia Mission Project, please visit us at www.salybia.org.

 

Reference

1.Mignone J, Elias B, Heinzel R, Carib Council and Salybia Mission. Kalinago community health assessment survey report. Winnipeg: University of Manitoba; 2011.

 

Author

Sylvia F. Marcos, a member of the CSPE, is currently with the Division of Internal Medicine, William Osler Health System, Toronto, Ontario. She is a cofounder and member of the Board of Directors of Salybia Mission Project, a student-run organization dedicated to improving the lives of the Kalinago people, the last remaining indigenous community in the Caribbean.

 

Correspondence to: sylmarcos@hotmail.com

 

 

This article has been reviewed by a panel of physician leaders.

Top