Just because hes been officially appointed medical director of the Cayman Islands Health Services Authority does not mean that Dr. Delroy Jefferson will be disappearing from the Cayman Islands Hospitals wards and operating rooms.Dr. Jefferson, an anaesthetist and intensive care specialist, will spend a quarter of his time on clinical work and the rest doing the many administrative duties assigned to a medical director.Balancing the administrative management of the HSA while continuing to practise as a doctor is one of the challenges facing him, said Dr. Jefferson, who was appointed medical director last month.I am insisting on 25 per cent clinical work. Im in the operating room every week and Im doing ward rounds every week, said the 48-year-old doctor, who describes clinical practice as his first, second, third and fourth love.Why I want to do ward rounds is I want to keep my finger on the pulse of the clinical side. Despite this administrative load, I still am doing a significant amount of clinical work, he said.Dr. Jefferson is the first Caymanian to hold the post as medical director of the HSA in the health authoritys 11-year history. Born in Jamaica, he became a naturalised Caymanian in 2003, having worked at Faith Hospital on Cayman Brac since 1998. He initially worked at the hospital for two months as a locum and then was invited to return six weeks later to work in internal medicine and anaesthesia at the 18-bed hospital. He went on to become medical officer in charge at Faith Hospital.As well as wanting to keep his hand in with the latest in medical procedures, hes also keeping a promise to his late mother Etta, who was a major influence on his life.I promised my mother years ago, and again when she was ill towards the last part of her life ... that Id be a doctor and help to cause healing. I would be doing her an injustice after being intensively trained as a physician to sit behind a desk and administrate.As if to emphasise his intention to be both a doctor and an administrator, his stethoscope sits on his desk next to his computer, ready for action.Inspiring him to be a doctor was not the only influence Dr. Jeffersons mother had on his life, which got off to a rocky start. He is the third youngest of 21 - a big family made up of children from both his father and his mother, who had three children together.By the time I came on the scene, my parents had nothing much left for me - the others had gotten it all, Dr. Jefferson said. But one thing his mother, who passed away in 2004, had in abundance was words to motivate him to succeed in life.She always said whatever you set your mind to, you can accomplish. Her mantra was Always aim for the highest and youll get there, never allow anything to keep you from reaching the highest heights, he said, adding that his mother strongly believed that education was the path out of poverty.Not all his early inspiration was positive. He tells a fifth-form Spanish teacher who, because he was terrible at Spanish and had unruly hair that would not be tamed, did not have high hopes for him and told him so. That hurt. Its a rough thing to tell a child hell never achieve much, he said.Years later, when working at a hospital, his erstwhile teacher showed up with her mother who had heart failure and was delighted with Dr. Jeffersons care, telling him no other doctor had ever sat down and explained her mothers health problems so well to her. He then told her he was the same boy with the wild hair she had written off in fifth form.Theres nobody who could have give me enough money to replace the feeling I had when I saw the look in her face that this was the same fellow who in the years past she had concerns over whether I would amount to anything, he said. Brac days He described working at Faith Hospital and on the Brac as an opportunity to work in an ideal, unique niche.I spent a lot of time getting to know the people. I realised that once I went into the homes and got to know the people, I knew what their health needs were, he said.Among his priorities while working at Faith Hospital was building up the emergency services there and organising retraining for the emergency services crews. After that, he focused on the training of clinical staff to ensure that the hospital, being distant from Grand Cayman, could operate as a standalone healthcare centre and deal with resuscitations and other emergency care.In 2005, he returned to university to do a doctorate in anaesthesia and critical care medicine and a fellowship on pain management with the intention of returning to Grand Cayman to do two things - to open the first pain clinic within the Cayman Islands and to improve the critical care unit.Dr. Jefferson said his ultimate goal at the Cayman Islands Hospital is to ensure that the standard of care for patients is top notch.He admits that George Town hospital is an entirely distinct challenge to what he faced at the much smaller Faith Hospital. Here, not only are there many more patients to care for, there are also many more colleagues, from different backgrounds, nationalities, cultures and institutions, bringing a variety of approaches to clinical care. His challenge, said Dr. Jefferson, is to creatively use all those different experiences to bring cohesive, high-standard healthcare to patients.He is no stranger to the Cayman Islands Hospital, having been the acting chief medical officer for the past five years.To meet the goal of ensuring standards are maintained or improved at the hospital, programmes that include benchmarks for improvement are under way. These include evaluations of physicians by both patients and by medical colleagues and revisiting recruitment practices to make sure that the physicians youre recruiting are among the best, said Dr. Jefferson.Facilitating continued medical education for physicians is also included in the steps being taken to address standards at the hospital.In his role, he oversees not just the performance of the doctors and nurses, but also the emergency medical technicians, the pharmacists, laboratory staff, radiographers and others. Financial challenge Another challenge facing the new medical director is taking on the role at a time when there are considerable budgetary constraints across government - he has been acting medical director since early 2012.So far, Ive been able to keep the focus on clinical care and it has not really affected the delivery of care significantly. Were hoping that despite the financial constraints, we will still be able to deliver top-quality care. We just have to be cautious and we have to be smart in how we balance both things, Dr. Jefferson said.While cost cutting such as reduced overtime has occurred, there have been no layoffs at the hospital, although some vacant posts have not been filled. Would-be artist Dr. Jefferson is married to Winsome, a clinical pharmacist at the HSA, and is father to a 21-year-old daughter, who is at law school at the University of the West Indies. He has also adopted several children in Egypt, Haiti and Jamaica, mentoring them and helping with their education.On one wall of his second-floor office at the hospital in George Town is a painting by one of those adopted kids from Haiti who gave it to him as a gift and serves as a reminder of his own artistic leanings.If he hadnt become a doctor, he may well have become an artist, having been offered a scholarship for the Jamaican School of Arts as well as a scholarship for medical school.I chose to do medicine instead of art but I still have a passion for art, Dr. Jefferson said. Recently, a colleague gave me a new art pad and a whole set of pastels and I intend, as my new year resolution, to sit down and do some art work on the Brac. I get most of my inspiration on the Brac. Ive only done one piece of artwork since coming to Grand Cayman. On the Brac, I was painting a lot, he said.His adoption of children in Egypt stems from annual visits he makes there. Every year, he flies to Egypt and stays a month, volunteering in medical clinics. I go to different villages. Its one of my favourite things to do every summer, he said.