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Our First Week
 
Well, we just finished  the first of our two week volunteer rotation here in Jamaica and it has been interesting,
educational, fun and at times tiring. Really, though, it has turned out much better than we could have hoped.
 
On the medical side, all of the clinics are a little different. Port Maria, where I spent Monday and Tuesday, was the most Spartan in
terms of facilities. Monday started off poorly when I was waiting in the lobby for a ride and after multiple phone call discovered no one knew I was to get picked up.
Dr Ramos interceded and put me in touch with the hospital administrator who then sent a driver. Even though I arrived about an hour and a half late, I was able to see all the
patients and leave at a reasonable hour. I met several of the hospital docs who were all friendly and happy to have me. They asked me to make an educational presentation next week, and I agreed
to give a talk next Monday on asthma, a subject I am quite familiar having championed it from my time at Kaiser -Permanente. I asked them to bring up a case on Tuesday as a spring board for a discussing of fluids and electrolytes.
Wednesday,  I was  in Annotto Bay on their Pediatric Unit. There Dr Ramos spent about three hours in a most didactic fashion reviewing with the residents the cases on the ward. There was a new nephrotic/nephritic,
a child with recurrent seizures and a baby with hypoglycemia among others. He is a great teacher and the process stirred memories of years ago when I was a resident physician. The next day, I was in the outpatient seeing children who had been recently discharged, either as newborns or with some other medical problem. The facilities were an improvement on Port Maria in that I had a real table to put my things and a
chair with wheels to sit in with an adjoining bathroom.
Friday I went to Port Antonio, a two hour drive. I was picked up by the hospital administrator, Patrick Campbell. We had a delightful conversation that spanned such topics and the economy, lifestyle and religion of Jamaica as contrasted to the USA. The time of the drive went by quickly and I was pleased that I did not suffer any car sickness like others had warned me about. In Port Antonio I saw a few children who were referred from local health centers for such conditions as poor growth, recurrent chest pain, etc. I had some free time and went to the A&E( their ER) and saw a few children with minor problems.
 
I will have to admit, staying here at the Couples Resort is a real treat. I am taking piano lessons at home and have been able to access the piano at the resort for some practicing every morning before going to work. When I return from work, on almost every day, I have taken a tennis lesson with the local pro. He is a wonderful teacher and was formerly #2 player in Jamaica. The food is great and there are activities every evening, though we tend to turn in early to be able to get enough rest to be prepared for the next day. Today, Saturday, Martha and I were off together and we went on a guided nature walk of the property and then a snorkeling trip to a local reef. It definitely has made us appreciate the beauty in the natural setting we find ourselves.
 
Now onto week #2 and we will see what new adventures we well encounter.

Richard
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Martha’s Blog:


My first week at the Edgehill School for Special Education, in Port Maria, formerly called the School of Hope, went well. There is a wonderful staff of patient, kind teachers. I have been working with each of the 3 classes (45 students) to teach some sign language, alphabet recognition, and some signs which might be helpful for the less verbal students. Each day, I presented art lessons using the art materials I brought with me from California: tempera paints, watercolors, fingerpaints, soft pastels, and colored marking pens. Since the director of the school told me that there will be an art contest in a few weeks, I’ve mounted some of their finished works for display. Working in with students to complete a project, build creativity and self esteem, has been part of my goal. Luckily, I brought some plastic aprons to protect their uniforms since some of these projects have been a bit messy.  I have taught some art theory, too, using a color wheel and some techniques for using the materials. I have found these wonderful students have been instilled with the admirable qualities of showing respect, taking care of materials, and cleaning up after themselves. Fortunately, Diane arranged for  a wonderful driver for pick ups at the Couples Resort and drop offs at the school . He has also gone with me to help me find additional supplies. The school has some art supplies, but they are in short supply of paper and other school supplies, and have no copy machine.  I’m looking forward to next week at the school.
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I thought we should introduce ourselves as the newest, but oldest in age, ISSA volunteers. My name is Richard Pastcan. I am a semi-retired pediatrician, having worked for Kaiser-Permanente in Northern California for 32 years. For the past three years I have been at a community health clinic serving mostly low income and Spanish speakers as a general pediatrician. So unlike the other volunteers who were in their last year of training,  I represent the other end of the career spectrum. I am anxious to experience a different form of health care in a different culture.
I am fortunate to have my wife here with me to share in this experience. Martha is a retired teacher of the deaf, and the ISSA program director Diana Pollard has connected here to a special ed school in Port Maria. Martha has come with a duffle bag full of art supplies and hopefully this will help to engage the students.
We arrive at the Couples Resort two days ago and it is really as nice as all the prior blogs have described. The setting is a tropical paradise, the food is great and the staff is most helpful. It was good to come a few days early to get used to all of this, and get to know the surroundings a little. Yesterday we went to Dunn’s River Falls which was a really memorable experience walking up a picturesque waterfall. I got to take a tennis lesson in the afternoon and this also made me very happy.
We’ll let you know how are first days work .

Richard and Martha
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Last week at Port Antonio Peds clinic we were referred a patient from the health center. He was a 6 month old male who was referred to us for concerns of hypotonia. Upon further history, we learned he was a term baby, growing and thriving, and mom had been concerned about his tone for quite some time. The nurse at the health center also noted some nystagmus at rest. On our exam, he was not dysmorphic, HEENT, CV, Lungs, Abd were normal, though neuro was not. He was hypotonic diffusely, though normal muscle bulk. He was also hyporeflexic in all major muscle groups. His Fontanelles were still open, and maybe a bit on the wide side. His eye exam was significant for horizontal nystagmus at rest, and exagerated with eye movement. His pupils responded to light and he blinked to light, though did not focus or react to any visual stimuli.
We had many concerns about this baby, specifically his tone and whether or not he could see, and he obviously needed some further testing, thought where to start? Of course the cell phone server was being worked on that day, so we were limited with our contacts, though I (Chris) did manage to get in touch with Dr. Judy Tapper in Kingston. She agreed that the baby needed to be seen, and didn’t want to suggest any tests until she saw the patient. Mom was very concerned about cost and had very limited resources. Dr. Tapper was very friendly and helpful, though explained that she was the only pediatric neurologist in the country of Jamaica, and therefore was very busy. If the patient wanted to go to the free clinic at Bustamante Children’s Hospital, there was a 6-9 month waiting list. She could go to Dr. Tapper’s private office, though would have to pay out of pocket for the visit (About $9500 Jamaican Dollars – roughly about $120 US) I explained all this to mom, and she understood, I told her to make the appointment at the free clinic, though stressed that if she could go to the private clinic, this would be preferred. As this was not an emergency and I had no true reason to admit the patient, these were the options. Mom understood and said she would try to figure out a way to find the money, and would make the appointment at BCH in the meantime, and would follow monthly at Peds clinic until further testing was done.
This case was interesting, though made us a bit sad, as if this boy and mom had more resources, she may get some answers a bit sooner. Hopefully it all works out and mom gets the answers and help that she needs, though at this point I’m not sure I’ll ever know how it turns out….
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4 month old male who was discharged from the ward 2 weeks prior for resolved bronchiolitis. On the day prior to discharge, he developed a rash on his left leg. They were told it was probably a reaction to one of the medications (he was on Azithro and Augmentin) and gave him some diphenhydramine which did not change. The rash then spread to other parts of his body like his other leg (and soles of feet), both arms, left shoulder, and abdomen. The rash was obviously pruritic, though he was otherwise comfortable and non-toxic. The rash appeared to be in clusters, though didn’t seem to follow a dermatome or other pattern that we could identify. The lesions were mixes of papules and vesicles vs pustules? Hard to really say what it was. Mom said it seemed to be spreading slowly over the past two weeks. Any thoughts???? We were between scabies and varicella, though we’re sold on either. Our plan was to treat for scabies and have her follow in a week, or sooner if it got worse.
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