By Way of Colombia
And What Followed
Field Notes Series: The Soft Side
Entry #6 of 6
Disclaimer
Field Notes reflect the editorial analysis and personal reflection of the Managing Editor, informed by direct professional experience across Caribbean healthcare systems. These observations are the author’s own and do not represent the official positions of any government, institution, or commercial partner.
Every part of this series has ended where the next begins. Part 5 closed with a chain: a phone call to a government switchboard in 2021, a stranger generous enough to answer it, and a role on the soft side of a hospital project in Montserrat. And it closed with a promise — that the chain did not stop there. It continued, I wrote, to an introduction, to a conversation, to a conference in Colombia, to the platform you are reading now.
This is the story of how. And if you are reading it on the morning it publishes, there is a symmetry I did not engineer: it was three years ago to the day — October 4, 2023 — that the conference at the center of this story opened its doors in Bucaramanga, Colombia.
Three years ago to the day, a conference opened its doors in Colombia. I walked into a room I had not planned to be in. Everything in your hands now followed.
October 2023 — Bucaramanga
The 15th Caribbean Conference on National Health Financing Initiatives convened in Bucaramanga, Colombia, in October 2023 — the long-running regional gathering shepherded by the HEU, Centre for Health Economics at The University of the West Indies, and hosted that year by the Fundación Cardiovascular de Colombia and its Hospital Internacional. I traveled there carrying the work this series has been describing: Montserrat’s health transformation, and the particular lessons of building systems in small places. On paper, it was an ordinary professional trip. An agenda. A presentation. A flight home.
It was not an ordinary trip. Fourteen years into the story this series tells, I should have known better than to expect one. The sessions at a conference are the reason you board the plane. They are rarely the reason the trip matters. The trips that matter turn on the rooms you did not plan to be in, and the conversations you did not see coming.
The sessions are the reason you board the plane. They are rarely the reason the trip matters.
The Spark
In one of those rooms, I met Dr. Ricky Brathwaite, Chief Executive Officer of the Bermuda Health Council. Ricky is a health economist by training and a systems thinker by instinct, and he had spent years inside a question I had spent years inside from a different door: what it actually takes for a small health system to be sustainable — not in a framework, not in a donor report, but in the lived arithmetic of a small population, a finite budget, and an ocean between you and everything you cannot produce yourself. Bermuda sits far north of the Caribbean Sea itself, and belongs to this community anyway — a reminder that the region is not only a geography. It is a condition, and a kinship.
What I remember about that first conversation is the recognition — the particular energy of meeting someone whose curiosity runs on the same current as your own. We talked about our islands and their systems. We talked about how much hard-won knowledge moves through rooms like that one — insights earned over whole careers, in systems the textbooks were not written for — and how little of it is ever captured somewhere the region can keep it, return to it, and build on it. The Caribbean produces extraordinary health knowledge. It has never had enough places that hold it.
We left that meeting with a mutual spark, and a shared curiosity about what we might build together. Nothing more concrete than that. No plan, no name, no structure — just the sense, carried out of Bucaramanga in both directions, that the conversation was not finished.
We left Colombia with a mutual spark and a shared curiosity about what we might build together. No plan. No name. Just the sense that the conversation was not finished.
The Space Between
Here the story could easily have ended, the way most conference conversations end — warmly, sincerely, and permanently. The forces working against it were real. The conference itself skipped a year; there would be no 2024 gathering, no reunion on the calendar to force the idea forward. An idea with no deadline has to survive on its own merits.
And we were both, to put it mildly, occupied. Ricky remained at the helm of the Bermuda Health Council as its CEO, stewarding one small system through everything this decade has asked of small systems. I continued my work with the Government of Montserrat — the eight-year transformation plan, the digitization, the diagnostics, the long preparation to commission a hospital a generation in the waiting. Neither of us was looking for more work. Both of us kept returning to the idea anyway.
That, I have learned, is the test. Not whether an idea survives the excitement of the room where it was born — most do. Whether it survives two years of ordinary life, full calendars, and no obligation whatsoever to anyone. This one did.
The test of an idea is not whether it survives the room where it was born. It is whether it survives two years of ordinary life with no obligation to anyone. This one did.
October 2025 — Nassau
Two years after Bucaramanga, the 16th Conference convened at last — October 2025, Nassau, The Bahamas, co-hosted by The UWI-HEU and the National Health Insurance Authority of The Bahamas. I was there again for Montserrat, presenting on capacity-building for health information systems in small countries. Ricky was there again for Bermuda. The community that had last gathered in Colombia reassembled on new ground.
And this time, in the segment of the program reserved for new developments in the region’s health landscape, we stood together and presented something that had not existed the last time that community was in one room: Caribbean Currents, and its first issue — launched there, in The Bahamas, into the hands of the very network whose knowledge it was built to carry.
I want to be precise about what that moment was, because it is easy to inflate and easier to undersell. It was not a product launch. It was the closing of a loop. A platform conceived in the margins of one conference delivered its first issue at the next — to the same community, in service of the same region. The spark had become a current.
A platform conceived in the margins of one conference delivered its first issue at the next. The spark had become a current.
The Current, One Year On
As I write this, Caribbean Currents is days from the first anniversary of that launch, and it has already outgrown the word publication. It is a multimedia platform — and the distinction matters. There is the digital publication at its core, now approaching its third issue. And there is everything the platform carries alongside it: Field Notes each Sunday; webinars convening the region’s practitioners, most recently on workforce strengthening through High Commissioner Juliette Bynoe-Sutherland’s experience across Barbados and Ghana; and our first podcast episode, about to be released. Ricky serves as Editor-in-Chief of Caribbean Currents while remaining at the helm of the Bermuda Health Council; I serve as Managing Editor. And next month, the chain adds its newest link: in November, the 17th Conference convenes in Bermuda — co-hosted, this time, by the Bermuda Health Council itself, under a theme of resilience, change, transition and transformation in health financing.
Sit with that sequence for a moment. The gathering where this platform was imagined. The gathering where its first issue was launched. And now a gathering convened on the home ground of one of the people who imagined it. I do not know a cleaner illustration of how this region actually works. The conferences are not events. They are a relay — and what gets passed between them is not paper. It is people, and what people decide to build when they recognize one another.
Five parts ago, I began making an argument: that the soft side — the human systems, the relationships, the unglamorous connective tissue — is where everything decisive happens. Here, at the end of Part 6, is the whole argument in a single chain: a phone call answered in Montserrat led to a conference in Colombia, which led to a conversation, which led to a spark, which led — two years and one skipped conference later — to Caribbean Currents, and to the page of it you are reading right now.
Nothing about that chain was strategic. All of it was human.
Nothing about that chain was strategic. All of it was human. That is the soft side. It has been the soft side all along.
The Soft Side so far
Part 1 · Part 2 · Part 3 · Part 4 · Part 5 · Part 6: By Way of Colombia (this piece)
About This Series
The Soft Side is a seven-part Field Notes series tracing seventeen years of health system work across the Caribbean — and the people, places, and lessons that shaped it. New parts publish each Sunday.
Coming next Sunday:
Part 7 — The Soft Side, In Full
The final part. Seventeen years, gathered into their lessons — what the soft side taught, and the case for finally resourcing the work that changes health systems.
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