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The weather has been a little more chilly today with intermittent sprinkles — much like the rest of the week. Nevertheless, the planning for tonight’s party at the resort goes on. It is the 33rd Anniversary of the resort which means a lot of activity going on!

The rest of the week has also been full of activity for me. On Tuesday, I returned to Port Maria and saw 35 patients! My hand was cramping from writing prescriptions for clotrimazole cream and paracetamol. Wednesday I returned to Annotto Bay to find that the 25 weeker is still there and doing relatively well. I was very excited to see him. The team and I rounded on the other patients relatively quickly, then I tried to assist the team in carrying out the day’s plan. We obtained a urine culture (unlike at home where we use catheters, they do suprapubic taps here), a lumbar puncture (not successful, but in-process the child developed explosive diarrhea and provided a reason for his fever), and drew blood from several patients.

Thursday was also spent at Annotto Bay; this time in clinic. I took my time (unfortunately for the other doctor who saw 40!). I saw a few interesting cases, including a 3 week old infant who had lost weight since birth. Upon obtaining further history, I discovered his mother had stopped breast-feeding when he was ~10 days old, at which time he developed ‘cold in his chest’. She then tried formula for one day and decided it gave him constipation, and had been giving him nothing but bush tea (a local remedy) for at least a week. She resumed breast-feeding several days before the appointment, but had not been expressing much milk. Apparently cases such as these are not uncommon.

Friday was my first trip to Port Antonio. The drive was gorgeous. I only had 3 patients (this is a relatively new clinic and Dr. Ramos usually sees peds patients here on Tuesdays). All three of them were referrals, two of which I referred on to Bustamente Children’s Hospital. Of the referrals, one child had leukocoria and the other had severe vargus leg deformity. I then rounded on the inpatients where the theme of the day was vomiting/diarrhea.

Other interesting tidbits of the week: The Jamaican workday is approximately 6 hours, although the resort workers seem to double that. “Lasco” is what many children call a powdered milk they drink; however as Lasco is a large company, the term may refer to many other things. June plums are a fruit many Jamaicans eat — with or without salt / pepper. Oh, and apparently housekeeping does not have a key to the bedroom of our villa…so if you want your sheets changed / new towel, either be present or leave the bedroom door unlocked (oops!). 🙂 I think that is enough for now. I shall try to post pictures tonight or tomorrow.

Back to Port Maria today; I saw 26 patients. Lesson of the day: the Ackee fruit is the Jamaican national fruit. When prepared properly, the inner part is has high nutritional value. When not allowed to ripen or not boiled, the fruit can produce vomiting, seizures, hypoglycemia, and death due to alkaloid toxins. Apparently there has been an outbreak of this recently in Jamaica including several deaths. I will know to ask about this possibility of my patients tomorrow! Pictured above: my clinic room today and a cute Jamaican girl who was my first patient of the day. (Picture taken with written permission from her mother.)

Day 5, finally figured out the blog — I apologize in advance for the long copy/pasted version of my first week : ) .

I landed in Jamaica on Monday without problem. I actually slept through both flights – the beauty of leaving almost post-call. Customs was easy, and despite a brief oops at airport lounge when my name wasn’t on their list of guests, check-in went smoothly and I am now installed in villa #9 for the next month. In addition, I was able to recognize a vacationing couple who Diane knows and thoughtfully emailed me regarding and I ate dinner at the buffet (yummy) with them. Afterward, they showed me the parrots (really) and the view from their room – gorgeous, I would love to have the pictures they took off their balcony! I spoke with my driver, found the laptop/cell phones, and enjoyed some free time.

Wednesday was my first day on the job. I met my driver in the circle out front and we set off on the winding roads to Port Maria. Arriving at the complex, I discovered ‘my’ room had been damaged by recent rains, so I was taken to the clinic (first building encountered). I unloaded my two bags worth of necessities in a small room; my first 16 patients arrived shortly thereafter. Things I learned today: 1) Dramamine is a good idea, but it doesn’t take away driving down the ‘wrong’ side of the road and the random passing of Jamaican driving! 2) Clindamycin is not stocked at the Port Maria pharmacy. 2) Obtaining a urinalysis by dipstick here means you test pH, sugar, and protein. Diagnoses included abrasion, cellulitis, cellulitis, URI, dental abscess, URI, and my case for the day: a 7 mo with vesicles on her tongue, lip, and under her eye. I wish I had taken a picture and hope she continues to drink well to stay hydrated.

On Thursday, I returned to Port Maria. I was much more comfortable with my surroundings, but much to my chagrin, the first pediatric patient didn’t show up until 11 AM. However, based on the number of mothers who were there and took down my clinic dates for the month, I should have more than plenty from now on! Diagnoses today included: fungal infection, fungal infection, URI, URI, impetigo, and a child with tight heel cords who can’t walk yet/stands on his toes whom I sent to ortho for a referral. I learned today 1) A referral consists of a form that is filled out that the patient then takes to the specialist. I also obtained sheets for x-rays and labs for future use.

Today I headed for Annotto Bay Hospital. Despite it not being c-section day, it was newborn day and we received three admissions in a row. One was a 25 weeker; without a ventilator, incubator, and NVN, his chances will be limited. He will be in my thoughts this weekend. I did experience first-hand CPAP here while helping to combine tubing, a bottle of water, and an oxygen tank.

After three days full of eye-opening experiences, I’m very grateful for the tools I have at my disposal in Iowa. I’m also looking forward to a weekend off — sunshine, here I come!

Here is a quick recap of my last week.
Monday I worked at Port Maria for my last day. I saw 27 patients. I delivered the last batch of donated medical supplies that I brought (I had collected supplies for 4 months and filled my 2 checked luggage bags with them).
Tuesday I went shopping in the local market and then packed everything up. It didn’t feel like a whole month had passed already. One of the nurse’s house had caught on fire over the weekend. I left some of my clothes and travel sized toiletries for her. I ran into the general manager at Couples and told him about her. He took her name and number to send her some stuff too. I also had to say my goodbyes 🙁 I had made some good friends at the resort (some employees and some guests).
Wednesday was travel day. My flight took off at 7:55am but since it is an international flight and the airport is in a different city my taxi left the resort at 3:15, yes that is 3:15AM. When I got to the airport it was completely empty! Nobody inside, not even an employee yet. It opened about 15 minutes later. I flew from Montego Bay to Miami then home to Memphis. I was greeted by my hubby who then took me out to lunch but then had to go back to work. I didn’t mind though because I needed a nap.
Thursday I got to make my return to my residency as a speaker at our noon conference (not about Jamaica but that one will come). This weekend our hospital is making a huge move into a brand new building.

Overall my impressions: This rotation is great because it teaches you to feel confident in your physical exam (xrays and labs are not readily available), it gives you an opportunity to spread up to date information, it helps you appreciate what you have. The accommodations are awesome. The resort is so fun and the people there are happy and full of energy.
With all of the great things you should also know that not everyone would enjoy this rotation. You have to be comfortable treating without someone constantly over you. There is someone available if you run into a situation you are not comfortable with but most of the time you are on your own. You are the one making decisions. Also you have to be somewhat laid back. I’m a planner and organizer (of my time not my stuff) therefore I had a few frustrating moments mostly revolving around transportation.
If anyone has any questions about my experience feel free to email me at arouster@uthsc.edu