The Commonwealth (English-Speaking) Caribbean
HAROLD A. DRAYTON
Our concern in this chapter is the education and training of physicians for eighteen Caribbean countries, all of which, before the early 1960s, were colonies of the former British Empire. They are conveniently grouped together as the Commonwealth Caribbean. Today, this subregion, with a total land area of about one hundred five thousand square miles and a total population of about six million, includes 12 independent nations and six dependent territories.
Mention will be made of United States offshore medical schools in some Commonwealth Caribbean countries since the 1970s, but this chapter will deal almost exclusively with medical education programs of The University of the West Indies (UWI) in Jamaica, Barbados and Trinidad-Tobago. It will also examine the Medical Practitioner training program of the Faculty of Health Sciences of The University of Guyana (UG).
The Commonwealth Caribbean inherited at independence a government financed public assistance system, with major responsibility for both inpatient and outpatient services in public hospitals; some health centers/clinics offering first- level medical care and programs for health promotion and disease prevention, especially in rural communities; and sanitation services for refuse disposal and vector control. Although a private health sector with private physicians offering services for a fee always coexisted with the state system, medical care was generally available either free or at nominal cost. This is the foundation on which health care systems in the Commonwealth Caribbean have been developed.
Post-independence: who is really "in charge" ? Independence, with a politically appointed Minister responsible for health, split the persona of the old-style Director of Medical Services. A senior administrative civil servant, the Permanent Secretary (PS), was delegated authority for day-to-day management and financial control of the Ministry and all its departments. A Chief Medical