University of the West Indies at St. Augustine Mothers of adult children killed by homicide experience traumatic grief that is unique to this population. Yet, there is limited research on their experience and its impact on mothers' physical and mental health status. A total of 20 mothers were interviewed about their physical and mental health status after the homicide of their adult children in the small Caribbean island state of Trinidad and Tobago. This phenomenological study utilized a thematic narrative analysis method to interpret the data. Findings revealed that 17 mothers experienced mental and physical health deterioration and attributed this to the death of their child. In all, 11 mothers were actively utilizing mental health services, and 5 mothers continued to exhibit depressive symptoms but were not seeking mental health services. The study revealed that the mothers attributed adverse mental and physical health outcomes to the death of their child by homicide. The findings highlighted avenues for assessment and for creating services for this grieving population.

PurposeIncreased migration to small island developing states poses major challenges on receiving countries' healthcare systems. Due to public health policy on treating migrants in Trinidad and Tobago, Venezuelan migrants are experiencing less than optimal care. This paper examines the retrospective accounts of physicians treating Venezuelan migrants with limited access to healthcare.Design/methodology/approachTen in depth, semi-structured interviews were conducted with physicians working in primary healthcare and emergency departments about their clinical decision-making process in providing care for Venezuelan migrants. A narrative approach was used to highlight the personal experiences of participants. Participants were recruited by their response to an online advertisement on social media (i.e. Facebook and Instagram) and via email invitations. Interviews were transcribed verbatim and coded using NVIVO-12 software.FindingsFindings revealed language barriers between Venezuelan migrants and Trinidad and Tobago-based physicians hindered providing optimal care coordination. Physicians indicated the use of a translator app to bridge the service gap but questioned their ethics. Participants noted tensions between junior and senior physicians regarding referrals of Venezuelan migrants to outpatient care. The data suggests physicians' felt constrained providing additional services such as primary care due to the Provision of Public Healthcare Services Policy which forbids primary care services to migrants.Originality/valueSparse research on the barriers to accessing healthcare for Venezuelan migrants residing in the small island states.

Purpose This study aims to examine primary care physicians who are in a tenable position to identify signs of abuse in older adults as well as provide an opportunity to safeguard them from abuse. Yet little is known about their clinical decision-making process during a clinic visit to detect abuse of older adults and provide adequate support in the Caribbean. Design/methodology/approach Fourteen primary care physicians working in a government operated free clinic were interviewed about their clinical decision-making process, in a narrative analysis format on the small island state of Trinidad and Tobago. Findings Primary care physicians expressed lack of knowledge about the primary health-care clinics’ protocols and procedures regarding abuse of older adults. Lack of attendance to educational in-service programs on recognizing and reporting abuse of older adults. A hands-off approach with non-medical abuse issues. Last there is no uniform assessments among the different types of physicians. Practical implications Although these findings are among primary care physicians located in Trinidad and Tobago, the context may be applied to primary care settings in other Caribbean islands. Major focus should be geared towards increasing awareness among the public and health-care professionals. Originality/value Sparse research on small island states regarding safeguarding policies for older adults who experience abuse.

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