....ok maybe marrying a native isn't such a great idea.
I think you will find that English is spoken just about everywhere, even though it may not be the Official language.
One of the caveats of a work permit in the Bahamas was, I could only work in the one business that I was employed, it's not like a US Green Card, where one can work anywhere. When the business that I worked for was sold I lost my Immigration status and could only stay as a tourist, a max of 60 days, but had to leave the country then re-enter. I haven't been back since (16 yrs.)
Most Island nations are Independent and have their own Sovereignty, but since most are small they still use the same Laws as their former "occupants", if you will. The Bahamas, Turks and Caicos, British Virgins, Montserrat still answer to the Queen on matters of great political importance and use the Laws of the United Kingdom as its base. The Queen does appoint A Governor General to these places as her Representative to the Crown in which the respective Prime Ministers "report" to.
Plus they drive on the wrong side of the road, just wait when you take a right hand turn.
I am sure this would be similar to St Kitts, Antigua etc.
St Thomas and Puerto Rico since are they US territories you have a better chance of finding work.
I would imagine if you contacted the various Hospitals by formal letter, they will give you the lowdown on positions and and Immigration Requirements.
Island living IS
very expensive, but thats another thread.
Hope this helps....