Darcus Howe on the price of being ill in Trinidad

My sister gets expelled from the emergency ward because she can't pay on the spot

Mrs Howe tells me that several friends expressed their concern about my violent mishap in Tobago, of which I wrote last week. But there were no broken bones, only a badly bruised arm that improves daily with the consumption of cubes of aloe vera from the neighbours' yard. All is well.

But only abroad do we Britons who originated in the Caribbean really appreciate the importance of a free National Health Service. Without the herbal remedy, my bruised arm would have cost another arm - and a leg as well.

While I was here in Trinidad, my sister's blood pressure ran up to alarming levels. The hospital authorities expelled her from the emergency ward because she was unable to pay on the spot. I rushed from cashpoint to cashpoint and took a taxi a long distance in order to deliver the hundred Trinidadian dollars needed to reinstate her.

The notes were received by a cashier, who gave me a receipt that was written out in triplicate. It was an exchange of a commodity for cash. It could have been mangoes from the local supermarket.

This twin island state is set for huge economic gains. But the Americans are most likely to be the beneficiaries. I remember the days when we socialist activists in the Caribbean were hunted and undermined by the Central Intelligence Agency. The CIA crushed the late Michael Manley's quest for a socialist Jamaica in the 1970s, contributed to the demise of the Grenadian revolution and made incalculable mischief here in Trinidad and Tobago.

But American influence is no longer clandestine. It is out in the open. A report calls for US businessmen to invest in Trinidad. The conditions are ideal, it says. An abundance of natural gas and a newly discovered oil reserve are the points of attraction.

No one speaks about socialism here now, though you may occasionally find an oasis of egalitarian thought. Greed stands tall everywhere. Yet, with all these riches at one end of the social scale, there exists a mass of suffering at the other which is not far from the condition of Haitian slaves 200 years ago. The resulting violence is intense: 233 murders in the past year (up 70 on 2002) out of a population of 1.2 million. And four more killings just 72 hours into 2004.

In the face of all this, the US ambassador complains bitterly about anti-Americanism in the population at large. Seventy-five per cent of Trinidadians and Tobagonians are hostile to the invasion and occupation of Iraq. There was a hell of a blow-up when Trinidad and Tobago refused to boycott the International Court of Justice. As a result, the Yanks withheld military aid.

The ambassador says he does not feel physically secure in Trinidad, even though he has disfigured the area around the embassy in the name of his security.

But nothing, including murder at its most violent, will stop the carnival. The tempo is up and rising, the calypsos are rippling through the air, and notwithstanding a damaged arm, I am still able to shake other parts of my body.