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… in Port Maria, and the radiology tech stuck her head in my door — “no x ray, we’re on generator.” Power and X ray came back up in time to determine that a happy toddler did not swallow a coin (his grandmother thought she saw one in his mouth). Hard to convince the mom of a vigorous premie that “no dudu for 3 days” is not a dangerous symptom– breastfed newborns can go 7 times a day or every 7 days or anything in between. At dinner the resort guests swarmed the buffet while Bob Marley sang “dem belly full but we hungry” in the background. I’ve always had a little trouble defining irony, but will look no further.
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….it’s hand foot and mouth disease, atopic dermatits, or my favorite generic diagnosis, viral exanthem. Can’t blame parents, who already have enough worries about their children, for being worried about one more threat. Got to love a dad who says, “her immune system has to take care of this, right?” about a viral illness. Right. At Port Antonio the district psychologist came by and borrowed the office I was using for about half an hour. Her task was to give the A&E (ER) nurses a course in mindfulness to help them de-stress about the difficult situations they see at work. She taught them some relaxation and breathing techniques and how to do a quick mini-meditation. Great idea — every workplace could use this! Love the drive to Port Antonio– nonstop ocean and mountain scenery. Thanks to Mr Campbell for going out of his way to drop me off in the evening. It’s Saturday morning — just took a kayak out for a paddle, now waiting on the morning snorkel boat. Hope to get a sailing lesson this afternoon, if the onshore breeze doesn’t pick up too much. Working in the clinics here is its own reward, but the accommodations are the icing on the cake!  
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I rode to work in the ambulance today. Cameron arrived bright and early. He said the usual MOH van was out, but the ambulance was free. I asked him, what happens when the ambulance is needed? he said it’s mainly used for transporting patients from one hospital to another, not for emergency response. He then launched into a discussion of the lack of EMT services in Jamaica. When a road accident happens, people just toss the victims into the nearest vehicle and make a run for the hospital — there’s no emergency services, no spine boards, etc. I did point out that he himself was not wearing his seat belt –to which he replied with an anecdote about someone who was severely injured by a seat belt — the proverbial smoker who lives to be 100. I said, pick your risks, I like my brain. When we drove into the gate of the hospital a funeral home van was coming out. Cameron told me someone was shot this morning. Jamaicans accept the risk of no seat belts. Both our countries accept the risk of too many guns. How do we change perceptions of risk? On a cheerier note, it was well babies in the pediatric clinic all morning. What’s more delightful than a nonstop stream of one to two month olds?
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As a family physician with mostly outpatient pediatric experience, I found the first patient of the day a little daunting — a 4 year old with congestive heart failure due to rheumatic heart disease, AND sickle cell disease. Where I live this kid would inhabit multiple subspecialty clinics at a university hospital. However, she looked great after her Lasix adjustment and was ready for discharge. A referral from the local health center of a kid with a fever and rash later in the day reminded me that outpatient experience counts for a lot. A sandpapery rash….and a red throat to go with it. I’ve seen enough scarlet fever over the years to recognize it immediately. And I’d had a reminder just this morning of how important it is to treat strep! I’m celebrating my birthday today….let’s see, with a sunset from my balcony, a stroll on the beach, and dinner with an ocean view. Guess I’m celebrating my birthday month! because I get to do that every day in July.    
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Almost every child has a “cold.” The symptoms are as follows: swollen eyes, fever, abdominal pain, and joint pain. Then you have to figure out what they have — the kid with pneumonia had the exact same chief complaint as everyone else (the difference being her respiratory rate of 44). The trick, wherever you are, is to figure out what your patient means and how to translate it into what you mean.(It took me the longest time to figure out that when my US patients say they’re “dehydrated,” they mean their mouth feels dry. Not dehydration as I understand it, any more than Jamaican kids have a cold as I understand it.) Moms are really on it. They have got the protocol on using oral rehydration solution when their kids have gastroenteritis. “DPH” seems to be quite a popular remedy for the ubiquitous cold. It took me a bit to figure out that this is diphenhydramine, aka Benadryl. Perhaps moms like it because it puts the kid to sleep while they get over whichever cold they have! On day two, I remembered to ask an important question — has your child had worm medication in the last 6 months?
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