The Tribune

By DR KENNETH D KEMP

SPREAD across the Atlantic Ocean and the Caribbean Sea, the chain of islands that encompass The West Indies are ripe with cultural observances. Locally here in The Bahamas, Junkanoo is by far our most celebrated and globally acknowledged ethnic tradition. For those unfamiliar, Junkanoo is a street parade held historically during the winter, on both Boxing and New Year’s Day. Participants spend months designing breathtaking colourful costumes and rehearsing original dance choreographies. The accompanying music is then bolstered by a steady unmitigated anthem of goatskin drums, cowbells, whistles and horns. Onlookers are left amazed because Junkanoo is more than just a visual marvel of the Bahamian culture, it’s one that is felt deep within the soul.

At the age of six, my Uncle Monty took me to my first Junkanoo parade. With microscopic clarity I can recall feeling like my heart was vibrating with the beat of the drums and as we got nearer to the group performing, it felt as though the ground pulsated in unison. With a height of six feet, four inches, he hoisted me on his shoulders and gifted me with the stunning all-encompassing view of the hundreds of dramatic and intricate costumes competing that year. Nothing else compares because once you see it, you feel it and once you feel it, you understand it.

The patient in today’s report understands this feeling better than anyone I know because, now at the age of 36, she’s been intricately involved with Junkanoo for almost 20 years. An artist by trade, she is one of the few female costume designers in The Bahamas, drawn to this marriage of culture and industry because it includes every aspect of the arts; namely literary (creating a narrative & research), design and planning, building the costume, creating the music, the dances and then the actual performance. She appreciates every step in this process and performed in every Junkanoo parade for over 10 years but was recently forced to stop because of health complications.

Her story is in fact one of the most poignant cases of cascading medical events that I’ve ever heard where it remains challenging to treat one condition without affecting another. It began when she was a child. She remembers the intense fear she felt the first time her chest tightened and her airways swelled. She panicked, struggling to catch her next breath. That was when she was first diagnosed with asthma. After several terrifying episodes that became progressively worse, she developed pneumonia and had to be hospitalized because of the repetitive damage inflicted on her lung tissue. Asthma is unfortunately incurable but her acute attacks have been controlled with a steroid inhaler.

Then, in her early 20s, without warning she began experiencing excruciating pain in her core that radiated from her abdomen to her back. Her stomach started to swell like a fully-inflated balloon and the pain was so sharply debilitating that she lost consciousness. Her symptoms included a dangerously high fever, vomiting, severe nausea and constipation one day and then diarrhea the next, which left her weakened and critically malnourished. She was ultimately diagnosed with Crohn’s disease, which is a type of inflammatory bowel disease where the digestive tract becomes inflamed. A serious side effect is that the inflammation, rather than remain stationary, often spreads to the deeper layers of the bowel resulting in other life-threatening complications. The exact cause is unknown but the spread of that inflammation can lead to colon cancer, blood clots, bowel obstruction and other serious health impediments. In her case the spread of that inflammation led to gall bladder disease. Eventually her gall bladder had to be removed to save her life. Today, she is in remission and her symptoms are now controlled with a regimen of oral steroids, which she takes in conjunction with the inhaler for her asthma.

Unfortunately the prolonged use of high dose steroids can lead to migraines and diabetes and she developed both conditions. She began experiencing cluster headaches so severe her scalp became tender even to light touch. Her cluster periods can last anywhere from weeks to months. She describes it as a feeling of someone beating you in the head with a jack hammer repeatedly. Once it lasted a full 24 hours before she experienced any relief but even then she was too agitated to fall asleep afraid that she might never wake back up. The situation left her sleep deprived and suffering with depression. She also works as a teacher and every day she went to work, stood on her feet constantly and then went home to paint, which is a tool she uses to manage her stress levels.

The inflammation caused by Crohn’s disease can also block the normal function of hormones and create an imbalance, which then affects the menstrual cycle. This patient discovered that she had developed polyps on her ovaries. She was diagnosed with Polycystic Ovary Syndrome after one of her menstrual cycles lasted for six months. She then oscillated between heavy to no menstruation at all. For treatment she was prescribed birth control pills with oestrogen but the sustained use of the medication caused her to develop high blood pressure. She is now struggling to manage her hormone levels without her blood pressure being deleteriously affected. Simultaneously she is managing her diabetes via diet but the steroids used to manage her Crohn’s and asthma continuously cause her blood sugar levels to spike. In an exasperating domino effect, augmenting her efforts with exercise then triggers her asthma.

Despite her multiple health issues and the strain it has placed on her relationships and finances, this patient is enjoying life. She takes her medication on time, visits her doctor regularly and has a complete blood test and urine analysis performed every two months. Specifically she stressed the importance of doing your own research and always questioning medical providers about test results and the side effect of prescribed medications. Beyond that, she also wanted people to take from her story the importance of eating healthy, appropriately managing stress levels and being verbally appreciative of the individuals that provide constant love and support, particularly during your most difficult times. In her case, she has her mother and sister who she can constantly lean on for support. She’s had some very dark days but they’ve helped her to survive in more ways than she can express.

Junkanoo is believed to have started in The Bahamas over 300 years ago during the 17th Century. During that time, slaves covered their faces with a thick white paste made out of flour and by the 1920s they adorned full costume regalia made out of sea sponges. This was changed to newspapers by the mid- 30s and then crepe paper soon thereafter. Today, costumes and parade floats are created using Styrofoam cardboard, wire and multi-coloured paper mache. It wasn’t until the 1960s that women were allowed to participate so today, my patient passionately and eagerly looks forward to performing once again as she has so many times before. Often while painting, she closes her eyes and remembers what that felt like and that same passion is then infused in each painting. With each brush stroke she reveals the memories of her soldiering along Bay Street in the early dusk of the New Year, a consummate survivor still laughing and dancing inconsequentially to the drummer’s rhythmic beat as the cowbells shake and sing.