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Another interesting and busy day at Port Antonio Acute Care. Steady patient flow, until closing… Many patients with cold symptoms/ URI.  But one patient had acute onset facial rash and conjunctivitis (pictured below) treated for impetigo and bacterial conjunctivitis. Then I had another patient with presumed viral AGE, mother was giving coconut water and he was now well hydrated and active!!! Tried coconut water at the resort and it is delicious!! The nurses where great! For my first patient the nurse gathered much of the history before bringing the patient to me. Port Antonio had more resources than Annotto Bay.  There was an otoscope and ophthalmoscope in the room, gloves and tongue depressors. Also, I found the vaccination schedule… BCG at birth and a lot less shots than in the US. Great way to end the week.  Monday Port Maria for the first time, so I’m excited to see what’s it like there.                                                                                                                                                                                                                                                                                                                                                             ~      
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“Excuse me ma’am, is there anywhere to eat at this hospital?” I asked the resident at Annotto Bay.  She chuckled and responded, “Yes, there is a tuck shop right around that corner.”  I thanked her, but in the back of my mind I had no idea what she was talking about.  After multiple conversations with Diane, our driver Everton, and finally just breaking down and following the signs to the ‘Tuck Shop,’ I am pleased to say that I now know where to purchase my snacks! Yes, a snack shop! Now, for a little history on the origin of a Tuck Shop brought to you by our neighborhood sponsor…Le Google – The term “tuck”, meaning food, is slang and probably originates from such phrases as “to tuck into a meal”.

                   

Along with being enlightened, we also managed to squeeze in some clinical experience.  We saw, literally, the CUTEST babies everrrrrrrrr in clinic this morning.  I joked with the mom’s while giving lots of advice on seborrheic dermatitis and breastfeeding.  Meanwhile, Wanda saw a patient with congenital syphillis!

                   

To wrap up our day, we saw a little girl who had stubbed her toe on a dresser and developed a painful abscess.  We performed an I&D in A&E with the help of her mother and the sweetest nurse ever.  I’m sure that little girl will thank us….not today….but some day…perhaps.

     

Signing off,

Wanda and Shanna (while sipping smoothies at the fruit and veggie bar and watching the waves hit the shoreline)

…until next time!

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First day in Jamaica and we are loving the people and the place. Can’t wait to go the hospital and meet the staff and all the children. Day 1 of an incredible journey so let’s get started!!  
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There is plenty of variety this week-gingivostomatitis, possible appy, scabies, and a nursemaid’s elbow. I was able to call an Orthopedist on his cell for a consult and follow up with a few patients from previous visits. For the possible appy, I made sure I had an updated contact number to follow the patient’s symptoms, arranged follow up, and provided  a surgery consult referral in case her symptoms worsened. There’s a better workflow between the nurses and myself now that we’re familiar with each other’s expectations and I certainly pitch in and vitalize my patients when triage gets backed up. I also feel more at ease with documentation, accessing records, ordering films, and selecting appropriate referral centers.   Unfortunately, this was a short week for me due to a viral illness (flu season), but I’m feeling much better now and ready to get back to work.
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My first week went better than expected. The first few days were a bit rough working with little guidance or orientation but I figured things out soon enough. Once you figure out the system at one site, it’s pretty similar to others, so I didn’t need much orienting afterwards. Surprisingly, the resources weren’t as limited as I had been preparing for. I ordered and reviewed chest radiographs within one shift, selected several different antibiotics from the formulary to treat cellulitis, made a timely referral for a urologic emergency, and there was an otoscope at every site. I saw ~50 patients-plenty of asthma, URIs, cellulitis, and fungal infections. The communication between the nurses and myself varied from site to site. Most of the time, I had to request to keep a steady flow of patients and not assume I needed scheduled breaks. Nurses triage adults and children so getting orders filled in a timely manner, urgent or not, varied day to day. I surprised to see how much autonomy the nurses took in caring for the asthmatics, treating them with duonebs and steroids for 1-1.5hrs before I every laid eyes on them. By the time I listened to the patients, their mild exacerbations had been cleared. The patients and their families seemed grateful to be evaluated by a pediatrician. I spent a lot of time educating patients on inhaler+spacer use, controller vs rescue inhalers, monitoring for dehydration signs, and SIDs precautions. We’ll see how next week goes…
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