The first two problems play together very well in Dominica. Students work VERY hard down here as medical school in general is very hard. Since everybody else studies very hard that means you have to study very hard since the curve is getting raised. Then when you are stressed out there are not a lot of options for stress relief. Mr. James who runs the store across the street from the school is a big con artist and is not trustworthy but his sister Tina runs a great honest little store a mile or so away.
Most students also deal with culture shock.
The hardest thing is that they operate on island time meaning that they will get to it when they get to it. If you are in a hurry and it shows they only work slower. If you can t deal with their culture you should best apply to the US schools again next year. To a degree they also operate where you are expected to forgive them if they mess sometime up but are not forgiving if you mess it up. An American pastor working in Dominica that I am friends with has told me that it drives him nuts but even when someone walks in late to church they must publicly greet everybody when they come in or else they will be considered rude.