By Way of the Montserrat
The Question That Changed Everything
Field Notes Series: The Soft Side
Entry #5 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.
For most of my time in the Caribbean, Montserrat existed for me as an enigma — a place I knew almost entirely through other people’s memories of it.
I heard it in the past tense. When we were in Montserrat. Before the volcano. It surfaced, again and again, in the stories of people I came to know across the region, always carrying a particular weight — the weight of a place that had been a center of something, and then had changed, and that the people who loved it still spoke of with a tenderness reserved for what cannot be returned to.
I heard it in the past tense. When we were in Montserrat. Before the volcano. I knew the island, for years, only through the people who carried it with them.
My closest friend in Antigua — a Trinidadian physician who has spent most of her career there — was raised as a young child in Montserrat. A former landlord from St. Vincent, whose father worked in Plymouth, remembered the island vividly: the eclectic texture of life there in the 1970s, 1980s and 1990s, a childhood lived in a capital that no longer exists in the way he knew it. Friends in St. Kitts kept a summer home in Olveston. There were family ventures threaded across Antigua, St. Kitts and Nevis, and Montserrat — connections that persist today, in some form, decades on.
My own understanding was thinner, and more glancing. I knew, vaguely, that Montserrat had been the inspiration for one of Jimmy Buffett’s songs — Volcano — recorded at the island’s famous AIR Studios in its years as an unlikely capital of the recording world. I knew a St. Kitts physician whose father still lived in Montserrat, a prominent lawyer and regional statesman. I had worked, during my Antigua years, alongside a former Chief Minister of Montserrat who regularly performed surgery — though at the time I did not fully understand who he was, or what his presence represented. I would learn that later, as I learned most things about Montserrat: by arriving.
I had been collecting Montserrat for years without knowing it — in the stories of others, in diaspora threads across the region, in a place always referred to and never quite reached.
2021 — The Call
In 2021, during an ordinary regional search — the kind of scanning I had done for years, keeping abreast of what was happening across Caribbean health systems — I came across a new hospital project in Montserrat.
I read a few articles. Then I did something simple, almost embarrassingly simple. I called the government’s main telephone number and asked whether I could reach any of the names I had come across in the reporting.
That is the whole of it. There was no strategy. No introduction, no warm referral, no carefully engineered point of entry. There was curiosity, and a phone number, and the willingness to make a call without any guarantee that anyone would pick up.
Someone did. His name was Martin Parlett, Head of the Programme Management Office for the Government of Montserrat.
There was no strategy. There was curiosity, a phone number, and the willingness to make a call without any guarantee that anyone would answer.
Martin and I had a lovely conversation. He made no guarantees — there was nothing to guarantee — but he was generous with his time, and he directed me toward the channels through which I could express my interest and put forward my candidacy for roles that might be coming. It was an ordinary act of professional courtesy. It was also, though neither of us could have known it, the first link in a chain that would reshape the next several years of my life.
I can say more about Martin now, sitting in 2026, because I count him as a friend. He was, by his own account, somewhat perplexed that I had called — that someone would simply come across a project, pick up the phone, and ask. But he was interested in the curiosity behind it, and open to the possibility that my background might become part of the Montserrat landscape. That openness mattered more than he likely knew at the time.
Martin is a humble man, which is itself remarkable given the life he has led — a person of considerable accomplishment who wears none of it heavily. I mention this not to catalogue his credentials but to make a point that runs through everything I have learned in this region: the people who make the difference are rarely the ones who announce themselves. They are the ones who answer the phone, who are generous with a stranger’s curiosity, who hold the door open without needing credit for it.
The people who make the difference are rarely the ones who announce themselves. They are the ones who answer the phone.
The Soft Side, Again
I stayed in touch in the months that followed. I responded to job announcements. I put myself forward. I did not get the role I applied for.
Instead, I was asked to consider a different one — the soft side of the hospital project. The human systems, the service transformation, the work I have spent this entire series describing. It found me again. Not the role I had reached for, but the role that was, in retrospect, the one I had been preparing for since Antigua in 2009. The work I am most useful doing. The work the region most needs and least often resources.
There is a pattern in my life that I have stopped being surprised by. I reach for one thing, and the soft side reaches back. It happened in Antigua, in Santo Domingo, in St. Kitts. It happened again in Montserrat. The work knows its own.
I reach for one thing, and the soft side reaches back. The work knows its own.
January 2023 — Residence
In January 2023, I moved to Montserrat with my daughters. We ended our residence in July of that year, though my work did not end then and has not ended now. Those seven months of living on the island — not visiting, not advising from a distance, but waking up there, raising my daughters there, becoming part of the daily rhythm of the place — gave me a depth of understanding that no amount of remote work could have produced. I came to know the mechanics of progress in Montserrat: how things move, how decisions are made, what the island can do and what it cannot, and what it costs the people who carry the work forward.
I will speak about my work here with some restraint, because much of it is live and belongs, in its details, to the Ministry and the Government of Montserrat to tell. But I can share its shape, because I am proud of it and because it illustrates what the soft side looks like when it is given the chance to operate at the level of a whole system. It has been a privilege to architect an eight-year transformational plan for Montserrat’s health sector — and to integrate the resources of key partners, including the FCDO, UKHSA, and PAHO, in service of that plan. We have digitized. We have enhanced diagnostics. And we are now very close to the completion of the new hospital, working actively through the transition planning that will carry the health system from where it has been to where it is going.
Montserrat arrived in my life at the time it was supposed to. It brought me closer to the critical pillars of public health, and it questioned every assumption I had carried into it.
Montserrat has challenged me in ways I have never been challenged before. It has brought me closer to the critical pillars of public health than any prior role. It questioned all my prior assumptions — and that questioning has been one of the great gifts of my professional life, because assumptions that go unquestioned are assumptions that quietly limit what you believe is possible.
A Thirty-Year Wait
To understand what the new hospital means, you have to understand what came before it.
Shortly before the volcanic crisis escalated, a new hospital had been delivered to Montserrat. New building. New equipment. The infrastructure a community needs to deliver modern care. And then the Soufrière Hills volcano did what it did, and that hospital — the building, the equipment, the investment, the hope it represented — was buried. It lies today beneath the pyroclastic ash, beneath the grass that has grown over Plymouth, the buried capital. A modern hospital, swallowed almost as soon as it was given.
In the decades since, care in Montserrat has been delivered from a former school property. A community that had, for a moment, a new hospital, has spent nearly thirty years waiting for another one. Next year will bring that wait to a close — thirty years between the hospital that was buried and the hospital that is now nearly complete.
A modern hospital, buried almost as soon as it was given. Nearly thirty years of waiting for another. Soon, that wait comes to a close.
I do not know how to convey the weight of that without simply stating it plainly. The work I have been privileged to contribute to is not the building of a hospital in the abstract. It is the closing of a thirty-year gap. It is the delivery, at long last, of something a community lost to a catastrophe and has been waiting for across a generation. There are people who will receive care in that hospital who were not yet born when the last one was buried. There are healthcare workers who have spent their entire careers waiting for it.
From Recovery to Renewal
Next year, Montserrat will mark thirty years since the deadliest day of the volcanic crisis that changed the island forever — the June 1997 eruption in which nineteen people lost their lives. Thousands lost something harder to quantify — a portion of their history, their identity, their future. Two-thirds of the island became uninhabitable. Many who stayed had to start over entirely: redefine daily life, rebuild in the north, reconstitute a society around the part of the island that remained.
The volcano still steams. It has remained quiet for more than a decade, but it has not gone away, and Montserrat has not stood still in its shadow. This is the thing that is hardest to convey to people who have not spent time on the island: what looks from a distance like a story of loss is, up close, a story of renewal. A society redefined itself in the north and has spent three decades building forward, not merely back — and the new hospital is only the most visible expression of that momentum. The volcano was an ending for one Montserrat, and the beginning of another.
The volcano was an ending for one Montserrat, and the beginning of another — a society that has spent three decades building forward, not merely back.
And among the people who carried that renewal — who carry it still — are the healthcare workers. Many of them I have now known for over four years. They lived through the crisis and they never stopped. They held a health system together through a catastrophe that would have broken many systems many times their size, and then they kept holding it, year after year, long after the world’s attention had moved on. I have never known or worked with more resilient individuals. I was not brought to Montserrat to teach resilience — they have been living it since 1995. I was contracted to do something more specific: to build and support the structures, the plans, and the partnerships that would let that resilience be sustained, and let a long-delayed hospital finally be commissioned well.
I was not brought to Montserrat to teach resilience. They have been living it since 1995. I was contracted to build and support what would let it be sustained.
Crossing the Belham Valley
In July 2023, before my residence ended, I crossed the Belham Valley and took a tour into the exclusion zone — into the part of Montserrat that the volcano took. I will not describe the person who guided me, except to say that he had not returned in ten years, and that what should have been a passage through a landscape became, I slowly realized, a passage through his own memory. Two and a half hours. By the end, I understood that I had asked him, without meaning to, to relive something difficult. I have carried that ever since.
We stood in former home sites in Richmond Hill. We stood where the clock tower had been. These are not ruins in the way that ancient ruins are ruins — distant, depersonalized, softened by time into history. These are homes that people left, sometimes with minutes to decide, expecting in many cases to return within days. They did not return. Plymouth is, for many of the people I continue to work alongside, a modern-day Pompeii. Life stopped. Homes paused. Lives disrupted in an instant that then extended into permanence.
Having spent my adult life in this region — having formed the friendships of my twenties, my thirties, my forties with people of the Caribbean — I felt, standing in those silent former neighborhoods, a rush of loss that was not only for Montserrat but for all of them. For everyone whose history is held in a place they cannot fully return to. It was, without question, one of the most conflicting experiences of my life.
These are not ruins softened by time into history. These are homes that people left, sometimes with minutes to decide, expecting to return within days. They did not return.
Montserrat has enhanced my life in ways I am still coming to understand. It has given me a community that holds its history with a seriousness that changes how you think about the work. It arrived at the time it was supposed to arrive. It brought me closer to the critical pillars of public health, challenged every assumption I carried, and introduced me to the most resilient people I have ever known.
It has also given me the chain. Because what began with a phone call to Martin Parlett in 2021 did not end with a role in Montserrat. It continued — to an introduction, to a conversation, to a conference in Colombia, to a publication you are reading now. But that is the next part of the story.
For now, it is enough to say this: I called a government’s main telephone number because I was curious about a hospital. Someone answered. And the answering changed everything that followed.
That is how it begins, in this region. Not with a strategy. With a question, and a person willing to take it seriously.
The Soft Side so far
Part 1 · Part 2 · Part 3 · Part 4 · Part 5: By Way of Montserrat
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 6 — By Way of Colombia: And What Followed
October 2023. A room not planned for. A conversation not anticipated. And the moment a chain of human connection became Caribbean Currents.
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