Authors: Meghan Etsey, Vasthi Price, Dr. Katherine Simpson – on behalf of AMWA Gender Equity Task Force
“Our Voices, Our Future” is a podcast by the Gender Equity Task Force of the American Medical Women’s Association that explores the challenges, stories, and successes of those working to advance gender equity in medicine. Through candid conversations with changemakers, advocates, and leaders, each episode dives into issues like pay gaps, leadership disparities, and inclusive workplace culture. Tune in to be inspired, informed, and empowered to take action. Full episode listening links are available below the transcription.
Meghan: Welcome to Our Voices, Our Future, a podcast where we amplify the voices driving change in equity within medicine and beyond. Brought to you by the Gender Equity Task Force, a committee of the American Medical Women’s Association. We’re here to challenge norms, break barriers, and ignite conversations that matter.
Meghan: I’m Meghan Etsey, and in each episode, we bring you candid conversations with leaders, change makers, and advocates, working to create a more inclusive and just world. No more silence, no more waiting. It’s time to get Our Voices, Our Future. Today, we are welcoming Dr. Katherine Simpson. She’s a Jamaican-born, Cuban-trained general practitioner. She lives and works in Grenada, an island in the Caribbean, where I attended medical school and met her. She has a passion for public health and community outreach. When she’s not teaching at St. George’s University School of Medicine, she’s a lead faculty advisor for the Women in Medicine student organization and a Rotary Club of Grenada member. Today, she’s joining us to speak about her commitment to serving women in her community and how this has taught her many important lessons.
So first off, Dr. Simpson, can you just tell us how you came to have a heart to serve in your communities?
Dr. Simpson: Good day, everyone. Megan, thank you so much for having me here. Getting straight to the point, I have been passionate about helping since I was a little girl. I always wanted to do medicine. I just wasn’t sure what kind of medicine. I thought I would be a vet first, but then I realized that people’s medicine was preferred to animal medicine. After I finished med school, I started working in the hospitals in Jamaica, and I realized that. I wanted to help, but I was very limited in the hospitals because at a tertiary care facility, you’re looking at more of a fix or a patch-up thing. People are coming to see the doctor and are already in advanced stages of disease, and so on. So I felt like I was helping, but didn’t feel like I was doing enough. Then, when I went into primary care, I realized that I could prevent the number of people going to the hospital by trying to do preventive medicine, early curative medicine, and management of chronic diseases. I realized that it gave me great professional as well as personal fulfillment.
Meghan: That’s great. I know, you shared a story with me about a woman who was having symptoms of menopause. Could you share that story with us and tell us what you were able to take away from it?
Dr. Simpson: Sure. So that particular patient was one of my first patients when I started in primary care, and she came in for a routine health maintenance visit. When she came in, she was about 48 years old, and she was complaining about hot flashes and irregular menses. She was certain that she was going through menopause. So when I asked her a few more questions, I tried to educate her on the difference between perimenopause and menopause itself, and then just questioned a bit more on her other symptoms and her physical examination. So during her questioning, she told me that she was also having some breast tenderness and nausea. I told her that those were not the most common symptoms of menopause, but it is not impossible. Still, we should probably do a pregnancy test to be on the safe side, and it turned out she was actually pregnant at the time that she came in. She was probably about 14 weeks or so pregnant. Abortions are not legal in Jamaica, and I don’t think she was particularly distraught, but it wasn’t planned. It wasn’t a planned pregnancy at all. So the takeaway from me from that one was if she had not come in for a routine health maintenance visit, we would’ve caught that pregnancy much, much later. She would’ve probably attributed her symptoms of pregnancy to menopause in itself. If she didn’t get the proper prenatal care, that would probably mean peripartum complications, et cetera. So it was good that she was one of those patients who consulted. Still, also because of her decreased health literacy, she couldn’t identify that her symptoms were a little bit more than what she thought they were.
Meghan: I think most people listening to the podcast are probably in the United States. Could you elaborate on health literacy, like in Jamaica or the Caribbean? Like, how are people educated? Is it typical for the people there to go to like preventative visits at their doctor? Do they usually use the doctor only when they need to? What’s the culture around medicine and seeing your doctor?
Dr. Simpson: That’s a great question. I think the vast majority of people in the Caribbean. Come to the doctor for curative medicine, not preventative medicine. So their health literacy is, in general, extremely low. Of course, it would be lower amongst persons of lower to lower mid-class socioeconomic status. Still, people generally don’t come when they’re supposed to. I was quite surprised when I started practicing in Jamaica to see how well developed our public health system is. We have a system that allows every person in a particular community access to healthcare, where we try to ensure that we schedule routine visits. It’s not always possible because of the number of people one clinic cares for. Still, the services are there, but most people don’t know. So, in the Caribbean, preventative medicine is not great. You have to go out into the communities and tell them why they have to come in. You often have to do home visits because many patients will not come to the clinic. So even though the clinics are burdened, the actual percentage of the population coming to the clinic is quite low. I think it’s in 40% of the population. So in general, it’s not great throughout the entire Caribbean.
Meghan: To bounce off that and like these, and talking about these people having access to care. So yes, each community has access, but can you speak more about how it works with costs? Do people have insurance to help offset these costs? Does the government pay for any healthcare costs? What’s the look around that?
Dr. Simpson: The government provides consultations free of cost. Patients can visit the health center, see a general practitioner, midwife, or dentist. All of those are free of cost. The problem is getting an appointment. You may come in today, and your appointment date may be six to nine months in the future because of how many people are available as staff to see these patients. Then, how many patients are coming in? So, you may have to wait a while for an appointment. For those patients who are now becoming regular customers, we make sure that they have their regular appointments as close to what is normal as possible. For example, you should be seeing a diabetic patient every three months. We may not be able to see them every three months, but we try to get them in before the six-month mark. Now, if patients need medications, they have a pharmacy that comes in and sells subsidized medications. It may not be everything patients need, but it will cover the basics. So your very basic diabetic medications, for example, Metformin, or calcium channel blockers, which a lot of African-Americans or Afro-Caribbean persons use, those would be available. Then, for patients who need additional medication, so let’s say they’re on an ACE inhibitor or an ARB, they may need to purchase those. Lab testing, just the very basic things, is covered. You might get total cholesterol, HDL, and LDL, but if you want triglyceride levels, you might have to pay for that. If you want transaminase levels, you may have to pay for that. So, given that we are a developing country, what the government can give to these people is still great and better than nothing.
Meghan: Bouncing off all this, can you explain why, overall, educating women on their bodies and enforcing these regular checkups is so important?
Dr. Simpson: So, at the risk of sounding biased, the female body is a lot more complex than the male body in the sense that we are, I say, bound by all of these hormonal regulations, if you will. So our hormones are pretty much in charge, and we’re just going along for the ride. If patients aren’t aware of what is attributable to the influence of hormones or hormonal imbalance in their bodies. For them to understand that hormones are not responsible for the menstrual cycle, hormones are responsible for their day-to-day activities and their regular metabolism. If people can understand that, they might be able to do better in terms of what they can do to help make themselves a little bit healthier. Women need to understand that first, and that something we can teach from primary school and secondary school. Just giving women the education that they need.
Then, when they come into the clinic, let’s say, if someone comes into the clinic, ask them, “Have you ever had an appointment here to see a midwife? Have you done a pap smear?” These little things, such as educating them so they know what they’re supposed to be doing, will help their health literacy overall and help us diagnose and prevent illnesses much earlier. I just think the key to medicine has to be in prevention and not in curation. That’s where our goal should be.
Meghan: I know you also shared a story about a patient with diabetes with me. Could you share that for our listeners as well?
Dr. Simpson: Sure, and this one links back to my finding my niche in primary care. This is a patient that I met when I was in the hospital, and she came in on several occasions, admitted to the hospital for uncontrolled diabetes. She was quite young. She has type 2 diabetes, but I think she was in her early thirties. On the last occasion that I saw her in the hospital, she came in because she had an infected diabetic foot. She was supposed to have a digit removed, and she was very distraught. She said she didn’t know what to do or what to eat. She’s trying to exercise, she’s trying to take her meds, but it just doesn’t seem to be enough. I referred her back to me because we built rapport in the health center so that she could come to get some of the preventative medicine we’ve been discussing. Because of her, I started a diabetic clinic in the same clinic I told you about, where I worked primarily for. On the fifth Monday, I think it worked out like three times a year, I would group all the diabetics to give them some directed health education. Through that, she could do much better regarding her glycemic control. It wasn’t excellent because she was of a lower socioeconomic status and couldn’t always afford it. The things that she was supposed to be eating, but she could do better with what she could afford. As far as I know, up to when I left Jamaica, she never had any further need to go to the hospital for immediate glycemic control. She was doing pretty well. So that’s something I’m very happy about for her, and it really epitomizes why I loved primary care so much.
Meghan: Do you think there are any reasons why women in particular may hesitate to attend these regular checkups that they need to attend?
Dr. Simpson: I think we’re just so busy, and then we don’t prioritize ourselves. So, unfortunately, but especially in the Caribbean, we still have a lot of stereotypical gender roles. So you expect a woman to wake up in the morning, prepare the kids for school, prepare breakfast, pack lunch, iron the clothes, and clean the house. Then you’re also expected to go to work, return home, and do the same thing again. So we have a lot on our plates. We look at it to say, well, if I’m not sick, then why do I need to waste time that I don’t already have to go into the clinic or to see a doctor about what I don’t have any complaints about. They’re not practicing the preventative medicine because it’s not on their high list of priorities, given how busy they are and how expensive healthcare can be. Then this is where we need to target them to say, health, as cliched as it sounds, health is wealth. It’s something you have to invest time in. You have to invest money so that if you spend a little to do preventative medicine on a yearly or bi-yearly basis, it’s a lot less than you’ll have to spend on curative medicine on a weekly or a monthly basis. So we have our limitations, but still have to make room for our health.
Meghan: I know that this is incredibly important. Many people don’t recognize that you’re speaking about Jamaica, but we have these same conversations here in the US. I know many people who are like, I don’t need to see the doctor, the doctor’s just for when you’re sick but yeah, that’s a big culture. I think that, in the whole world, we need to work on saying things like, “Health is Wealth”. I think that’s beautifully put, that it really is so true. If you invest a little bit now, then maybe in 10 years, you don’t have to pay $10,000 to get that surgery that you could have prevented by having good, for example, glycemic control. Like I said, most of our listeners are likely from the United States. As someone like you who lives and practices in another country, why do you think that serving women is so important where you are?
Dr. Simpson: This information can go for anyone, anywhere in the world. Women are superheroes. We have a lot going on, and we are managing. We are getting by, but most of the time at our expense. It is our responsibility to acknowledge that we really are superheroes, but we also need help. This can come in the form of taking care of myself. So, irrespective of how difficult it is to attain adequate healthcare, we don’t always have to aim for a hundred percent. I’m not saying we should accept subpar treatment. If a person cannot access the best healthcare that exists, but can do something that will improve their standard of health, they definitely should do that.
So, not trying to bounce too much on the health is wealth. Our role as physicians or healthcare practitioners should be to educate persons, not just women, as early as possible, to at least the screening guidelines. Routine health maintenance visits aim to get people in more. If we launch from there, we should decrease the number of persons consulting for other reasons overall. So, irrespective of where you are in the world, you have to make time for your health, and the earlier that you start, the better it is for everyone involved.
Meghan: So, to wrap things up, if you could leave one tip for everyone that’s listening, what would that be?
Dr. Simpson: You don’t have to start big. The internet is there. We have AI models that are very helpful nowadays. You must pick somewhere if you’re lost and don’t know where to start. So you could ask anybody, a friend, a doctor, a nurse, or a nursing student. What can I do to improve my state of health now? Anything that is an elevation from where you are is an improvement; you build on that. It’s not something that you have to attain from one day to the next, but you have to start somewhere.
Meghan: So that’s a wrap on this episode of Our Voices Our Future. We hope today’s conversation inspired, challenged, and reminded you of the power of raising your voice. The fight for equity doesn’t stop here. Join us in the movement. Subscribe wherever you get your podcast. If you love this episode, share it with someone who needs to hear it. Until next time, stay bold, vocal, and keep the conversation going. This is Our Voices, Our Future.
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About the Authors
Meghan Etsey, MS4
Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Vashti Price, MS3
Vashti Price is a third-year medical student at St. George’s University. She holds a Bachelor of Science in Biology from the University of Louisiana at Lafayette, a Master’s in Biological Sciences from Alcorn State University, and a Master’s in Health Sciences from Meharry Medical College. With a strong passion for public health and health equity, Vashti has dedicated much of her time over the years to volunteering with underserved populations, including individuals experiencing homelessness and children in need. Her commitment to service continues through her involvement with the American Medical Women’s Association, where she serves on the Gender Equity Task Force and the Sex & Gender Health Collaborative Committees. Vashti is particularly interested in the intersection of medicine, public health, and community outreach. Outside of her academic and clinical pursuits, she enjoys spending time with friends and family, attending festivals, exploring new cities, and winding down with a good Netflix series.