At the Helm: Reflections from a Caribbean CMO on Crisis, Collaboration, and Building Resilient Health Systems

The Caribbean is no stranger to adversity, from natural disasters to global pandemics, our health systems are constantly tested by challenges that call for both swift action and long-term vision. As someone who has served in many areas of healthcare, including as a clinician, public health official, Chief Executive Officer of a Health Services Authority, and Chief Medical Officer, I have seen up close the complexity of leading in this space.

My career has spanned both the public and private sectors. I have worked at the bedside, in boardrooms, and at the national level. Each role has offered a different perspective on the strengths and vulnerabilities within our systems. I was on the front lines in 2017 when Hurricane Irma tore through the British Virgin Islands, and again in 2020, when COVID-19 shattered the assumptions we had about what it meant to be prepared. These moments did not just shape how I work; they reminded me of a central truth: resilience is not something we find in the middle of a crisis. It is something we build long before the crisis hits.

Facing the Front Lines: Today’s Pressing Health Challenges

Across the Caribbean, we are living through a major shift in public health. Noncommunicable diseases such as hypertension, diabetes, and obesity continue to not only lead the way in disease burden. But continue to extend that lead.  That does not mean we have left infectious diseases behind. Vector-borne illnesses and outbreaks still flare up, reminding us how exposed we continue to be, while recent pandemics remind us of how devastating infectious diseases can be.

In my time leading national strategies, I have come to see how crucial data, community involvement, and fair access are to meaningful progress. Whether we are launching mobile screening units, expanding chronic disease programs, or improving laboratory services, the key is finding ways to respond to today’s needs without losing sight of tomorrow.

Balancing Urgency with Strategy: Leading Through Crisis While Building for the Future

During my tenure as Chief Medical Officer, I learned that a crisis does not pause the long game of system building. The COVID-19 pandemic demanded rapid decisions under conditions of uncertainty. It stretched every part of the system, including workforce, infrastructure, supply chains, but it also catalyzed long-overdue reforms and innovations.  We all have examples of these.

We began integrating telehealth solutions, strengthening regional cooperation, and redefining primary care strategies. However, most importantly, we learned to lead with flexibility and transparency, which are traits just as essential in disaster response as they are in health system design.

As CMOs, our job is not to choose between crisis management and strategic planning. It is to do both at the same time, and to build institutional capacity that endures beyond our time in office.

A crisis does not pause the long game of system building.

Partnership as a Pillar: Leveraging Collective Strength

The most effective public health interventions I’ve witnessed have never been top-down mandates; they have all been the result of collaboration. As CMO, I’ve worked alongside international bodies like PAHO and CARPHA, alongside local community leaders, NGOs, and private partners. It was this ecosystem that made vaccine rollouts possible during COVID-19, that supported mental health access post-Irma, and that now drives national digital health and other strategies.

These collaborations are not just useful, they are essential. They bring technical expertise, financial resources, and community trust that no ministry can build alone. When we invite diverse voices to the table, we gain not only stronger programs, but more resilient societies.

The most effective public health interventions I’ve witnessed have never been top-down mandates, they have all been the result of collaboration.

A Call to Caribbean Leadership

As Caribbean CMOs, we are uniquely positioned to not just act as health experts, but as change agents. We are tasked with navigating the immediate while building for the long term, managing complexity while staying grounded in service.

The future of health in our region demands this kind of integrative leadership anchored in experience, informed by evidence, and driven by shared purpose. I remain committed to this path, knowing that the health of our people, and the resilience of our systems, depend on it.

Let us build boldly, lead collaboratively, and rise together.