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This paper recounts the development of family medicine postgraduate training in Jamaica, the challenges faced and lessons learned. A self-administered questionnaire was completed by past trainees exploring the perceived usefulness, strengths and weaknesses of the programme. The results of this study helped guide the strengthening of family medicine training in a resource-limited setting.

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A Pre-hospital Emergency Medical Service (PHEMS) is a vital component of a country's health service because it provides early medical care to critically ill and injured persons in the field There is evidence to show that early care reduces mortality and morbidity and offers the patient the best chance of survival and improved quality of life. Caribbean territories have been developing their PHEMS as part of a programme of health sector reform. In a study of PHEMS in 12 Caribbean countries, the Pan American Health Organization reported that there were no clear guidelines with respect to the roles and responsibilities of the physician in PHEMS in the majority of countries. In fact, a few countries had services where there was no direct physician involvement. We present a brief review of the internationally recognized roles and responsibilities of physicians in PHEMS, and make recommendations with particular reference to the Caribbean. We suggest that there is a need for direct and active involvement of physicians in the development of PHEMS because the Emergency Medical Technician is recognized as an extension of the physician in the field and is supposed to be protected by the physician's licence to deliver medical care.

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A Pre-hospital Emergency Medical Service (PHEMS) is a vital component of a country's health service because it provides early medical care to critically ill and injured persons in the field There is evidence to show that early care reduces mortality and morbidity and offers the patient the best chance of survival and improved quality of life. Caribbean territories have been developing their PHEMS as part of a programme of health sector reform. In a study of PHEMS in 12 Caribbean countries, the Pan American Health Organization reported that there were no clear guidelines with respect to the roles and responsibilities of the physician in PHEMS in the majority of countries. In fact, a few countries had services where there was no direct physician involvement. We present a brief review of the internationally recognized roles and responsibilities of physicians in PHEMS, and make recommendations with particular reference to the Caribbean. We suggest that there is a need for direct and active involvement of physicians in the development of PHEMS because the Emergency Medical Technician is recognized as an extension of the physician in the field and is supposed to be protected by the physician's licence to deliver medical care.

El servicio médico de emergencia pre-hospitalaria (SMEPH) es un componente vital del servicio de salud de un país, porque provee atención médica temprana y sobre el terreno a personas accidentadas o enfermas en estado crítico. Las evidencias indican que la atención temprana reduce la mortalidad y la morbosidad, a la vez que ofrece al paciente la mejor oportunidad posible de sobrevivir y mejorar la calidad de vida. Los territorios caribeños han estado desarrollando su SMEPH como parte de un programa de reforma del sector de la salud. En un estudio del SMEPH en 12 países caribeños, la Organización Panamericana de la Salud informó que no había directrices claras con respecto a las funciones y responsabilidades del médico en el SMEPH en la mayoría de países. De hecho, unos países tenían servicios en los que no había participación directa del médico. Presentamos aquí una revisión breve de las funciones y responsabilidades reconocidas internacionalmente para los médicos en el SMEPH, y hacemos recomendaciones con referencia particular al Caribe. Sugerimos que hay necesidad de que los médicos participen de manera activa y directa en el desarrollo del SMEPH, porque el técnico médico de emergencia es reconocido como una extensión del médico sobre el terreno, y se supone que esté amparado por una licencia para impartir atención médica.

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In recent years, increased attention has been given to the development of health promotion programmes in a number of countries worldwide. Although health promotion itself is not new, a number of issues have emerged as the underlying concepts are articulated and put into practice. These relate to its relevance and ownership and to practical issues such as measurement of outcomes. This article provides a brief discussion on some of these issues and makes reference to a Caribbean framework for implementing health promotion.

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The Department of Community Health and Psychiatry was contracted by the Ministry of Health to assist with the implementation of a pilot programme in the Western Health Region to train fire fighters as basic level Emergency Medical Technicians (EMTs), and was responsible for its design, implementation and monitoring for the first 18 months. The course was covered in 440 hours over a 10 week period, and included training in emergency medical response, driving an emergency medical vehicle, emergency medical dispatching and inventory control. Of 76 fire fighters selected for training, 62 graduated, receiving Certificates of Merit from the Ministry of Health, Jamaica and were deployed into service on 17th April 1996. During the period 17 April to 31 December, 1996, the newly trained EMTs responded to 1,299 calls. Medical and surgical cases represented approximately 55of all calls, followed by trauma (19), motor vehicle accidents (9) and obstetric emergencies (8). Between 15and 20of calls in Montego Bay and Negril involved tourists. This first group of EMTs has performed well and was well received by the communities and the persons who used the service.

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The Department of Community Health and Psychiatry was contracted by the Ministry of Health to assist with the implementation of a pilot programme in the Western Health Region to train fire fighters as basic level Emergency Medical Technicians (EMTs), and was responsible for its design, implementation and monitoring for the first 18 months. The course was covered in 440 hours over a 10 week period, and included training in emergency medical response, driving an emergency medical vehicle, emergency medical dispatching and inventory control. Of 76 fire fighters selected for training, 62 graduated, receiving Certificates of Merit from the Ministry of Health, Jamaica and were deployed into service on 17th April 1996. During the period 17 April to 31 December, 1996, the newly trained EMTs responded to 1,299 calls. Medical and surgical cases represented approximately 55% of all calls, followed by trauma (19%), motor vehicle accidents (9%) and obstetric emergencies (8%). Between 15% and 20% of calls in Montego Bay and Negril involved tourists. This first group of EMTs has performed well and was well received by the communities and the persons who used the service.

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In recent years, increased attention has been given to the development of health promotion programmes in a number of countries worldwide. Although health promotion itself is not new, a number of issues have emerged as the underlying concepts are articulated and put into practice. These relate to its relevance and ownership and to practical issues such as measurement of outcomes. This article provides a brief discussion on some of these issues and makes reference to a Caribbean framework for implementing health promotion.

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This article describes the development of a school environment questionnaire to assess students' perception of their school environment. The dimensions and internal consistency reliability were examined utilizing various statistical methods-factor analysis and alpha coefficient. The sample consisted of 705 students from two high schools with ages ranging from ten to nineteen years. Results showed that the students perceived their school as having various aspects, rather than a global point of view. Factor analysis identified seven dimensions in the school environment: external characteristics of the environment, aesthetic and functional elements of the classroom, students' bathroom, the canteen and staffroom, the aesthetic and functional elements of the school as a whole and sanitation. Overall the internal reliability of the factors was high. Implications for school health programs are addressed.

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Breast feeding promotion has been a national priority in Jamaica since the mid-1970s. Despite this effort, breast feeding rates have continued to decline there, especially in urban areas. Studies of the role of health professionals in promoting breast feeding have shown that specific practices encourage breast feeding, while others discourage it. In the context of declining breast feeding in a nation committed to promoting it, the goal of this study was to explore the relationship between specific health professional practices, mothers' breast feeding, and mothers' knowledge of breast feeding in rural and urban Jamaica. To accomplish this goal, a structured interview was administered to 113 mothers of infants age 0-6 months at one urban (n = 62) and one rural (n = 51) hospital, regarding (1) physician and nurse practices known to affect breast feeding, (2) mothers' own breast feeding practices, and (3) mothers knowledge of breast feeding issues. Physician and nurse visits were also directly observed to confirm responses given to the questionnaire and to assess the resources devoted to teaching mothers about breast feeding. While extensive lectures, posters and pamphlets promoting breast feeding were provided for mothers at the urban hospital, far fewer educational resources were available for mothers at the rural hospital. Overall, however, health professional practices discouraging breast feeding were observed more frequently at the urban hospital than at the rural hospital, whereas practices promoting breast feeding were more common at the rural hospital. At the rural hospital, mothers' breast feeding practices more closely approximated recommendations than at the urban hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

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A one-year retrisoective study of paediatric emergencies seen at the Bustamante Hospital for Children for the period January 16 to December 31, 1986 is presentad. Thirty-four per cent (3,918) of a total of 14,495 patients seen in the Casualty Department for 100 randomly days were assessed as emergencies. The most frequently seen emergencies were gastroenteritis (42.55% of total emergencies)followedby bronchcial asthma (23.0%) ans shortness of breath (16.51%). The rigid classification o emergencies by disease category needs to be reappraised

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