Tamara Green | When cancer turns lives upside down, care steps in

Cancer does not only affect the body. It turns lives upside down.

On this World Cancer Day, before we speak of systems, strategies, or statistics, we should first recognise the people who step forward when life is disrupted – quietly, persistently, and often without training or recognition.

Across Jamaica, an enduring, unsung care workforce carries the daily weight of cancer: domestic workers, daughters and sons, spouses, neighbours, church members, and friends. They provide unwavering care, advocate fiercely for loved ones in crowded clinics, and improvise solutions with remarkable ingenuity – often while navigating grief, work, and financial strain.

They do this not because there is a clear roadmap, but because care is demanded of them. Alongside them are community-based cancer support groups – many operating outside the spotlight of national media – offering transport, counselling, food, support, companionship, prayer, and practical guidance. These groups know the realities of cancer in Jamaica intimately. They fill gaps with courage and creativity, yet often without sustained support or formal recognition.

As a clinician working in palliative care, my professional journey began with strong clinical idealism. Over time, that idealism has matured through sustained exposure to inequity, resilience, and stalled implementation.

I have come to understand that compassion in medicine is not a soft skill, courtesy, or personal virtue. It is a professional and ethical duty, expressed through enforceable standards of care.

Compassion requires demonstrably adequate pain and symptom management before a patient is discharged home – especially when that patient is undecided about chemotherapy.

It requires clear, meaningful communication from pharmacists about medications, side effects, and expectations.

It requires nurses to assess distress, advocate for comfort, and escalate concerns.

It requires clinicians to respect patient autonomy not as rejection of care, but as a legitimate invitation to find another option.

When these duties are absent, compassion is not lacking in spirit – it is lacking in structure. This distinction matters, because cancer rarely travels alone.

Across the island, patients with advanced cancer, frailty, and complex chronic illness often remain on acute hospital wards not because they require high-intensity intervention, but because the recognised standard of care too often ends before palliative care is introduced.

The absence of integrated palliative services within the public health system leaves no meaningful alternatives that centre comfort, dignity, autonomy, and family involvement. As a result, hospitals become holding spaces, families become default caregivers, and suffering becomes normalised.

Palliative care offers a different approach – not as an end-of-life signal, but as an added layer of support. Evidence consistently shows that it can extend life while improving quality of life, increasing days of wellness, comfort, and meaning.

Crucially, it supports families and caregivers as much as patients: guiding decision-making, coordinating care, managing symptoms, and reducing avoidable hospitalisation.

JAMAICA IS NOT WITHOUT STRENGTHS

Recent humanitarian emergencies, including Hurricane Melissa, reminded us how fragile life – and care – can be. Disasters do not create new vulnerabilities so much as expose existing ones. People living with serious illness experience heightened physical and psychological distress during crises, yet they are often invisible within standard emergency responses.

Once again, families and communities become the safety net. At the same time, Jamaica is undergoing a profound demographic shift toward an ageing population. This means more people living longer with cancer and chronic illness, and more households providing extended care without guidance, relief, or support. Without accessible, community-based palliative care, the emotional, physical, and financial toll continues to fall disproportionately on families.

Jamaica is not without strengths. A quiet but committed palliative care community already exists – clinicians, nurses, social workers, volunteers, faith groups, caregivers, and grassroots organisations who have laid a foundation through years of service.

The opportunity before us is not to import another ideal unsupported by resources or mechanisms, but to intentionally strengthen and coordinate what is already here through collaboration at the community level.

On this World Cancer Day, as we acknowledge how cancer turns lives upside down, it is important to publicly recognise some of the organisations that have long stood with patients and families: the Joshua Ramsay Cure and Conquer Foundation, the Icyline Wallace Breast Cancer Foundation, Jamaica Multiple Myeloma Support, They Are Us and My Cancer Essentials! Their work reflects what is possible when care is rooted in community, dignity, and sustained commitment.

The opportunity to strengthen community-based palliative care is ripe, overdue, and achievable. Supporting those who already carry the weight of care is not only compassionate – it is responsible.

- Tamara Green, M.D, is a community- based Palliative Care Physician and Consultant in Psycho-Oncology, Cunningham Medical Services. Email feedback to columns@gleanerjm.com