Blog Archives

 

Wow, just like that 4 weeks have flown by!  Our experience here has been one that words will not adequately describe. On arrival, we were extremely overwhelmed with the health system, the lack of resources and the handwritten (rarely comprehensible) notes. Slowly but surely, we learned our way around and fell in love with the patients and the support staff. The nurses, doctors and residents were all extremely helpful at explaining how to navigate the system and helping us with day to day tasks.

During our time, we saw the cutest babies on the planet and were exposed to many diagnoses that we simply don’t encounter as frequently in the US such as rheumatic heart disease and myiasis. We also practiced independently and gained a new sense of autonomy. As we leave, we will take with us renewed strength (thanks Ms. Caryn for the massage), increased knowledge and the overwhelming amount of love that has been showered on us since day 1.

  Memorable moments:
  • Telling a mom that her baby’s name (Chloe) was beautiful and asking her where she got it from. Her responding pleasantly, “Thanks! At first I thought it was a white persons name but now I love it!”
  • Having 1 chair in my exam room and telling a young boy to sit down, then his mom walking in and him getting up to allow her to sit, stating, “Have a seat my love!”
  • Hearing patients describe ‘mold germs’ and ‘balloon germs’.
  • Riding in the ambulance to and from work.
  • Walking around the resort and at any given moment, someone walking by and recognizing you and yelling, “HEY DOC!!!!!”
  • Indulging in a beef patty every day after returning from work.
  • Taking our first Noni juice shots (my eyes are still cringing as I write this!)
  • Walking by the talking parrots (before knowing they were talking parrots of course) and hearing them say, “HELLO!” Then looking at each other for confirmation that we both heard the bird speak.
  • Super Bowl party on the beach (man Jamaicans really know how to party 🙂 )
  • Friday lobster nights at Eight Rivers!

Thank you to the people of Jamaica for instilling their trust in us and allowing us to care for their children, Issa Trust for the wonderful opportunity and the staff at Couples Resorts for taking us in and truly making this feel like home for us. One Love and we’ll meet again soon.

 

A little girl with Hand, Foot & Mouth showing off her fancy tongue

Our final dinner with Diane, Ernie and Carrie!

With all our love,

Shanna and Wanda

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The Issa Trust Foundation Presents: An Evening with Air Supply. Proceeds will support the St. Ann’s Bay Hospital Pediatric Ward. Save The Date: June 24th.

 

 

 

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So… this is something I never thought of and something you may never see in the USA… Myiasis… Maggot of the head!! We were stationed in Accident & Emergency when the patient was referred from a community clinic to the hospital for treatment and admission. Upon arrival the patient was having head pain and very hesitant to be examined.  While at the community clinic the area was dressed with gauze. Although hesitant the scalp was examined and we were shocked to see a tiny maggot poke its head out of the 1×1 cm wound and then retract back in. After examination labs were drawn, IV placed and patient was then admitted. This is obviously a condition that happens in tropical regions due the screw worm. Just thought I would share Until next time…. Wanda and Shanna
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While in Port Antonio, we saw a baby for the concern of enlarged breasts.  Grandmother had recently started taking care of her so she didn’t know the specifics as to how long they had been enlarged and so forth.  We didn’t think much of her examination because in infants, breast hypertrophy can be related to stimulation from maternal hormones, and can persist for several months in girls. Prior to her leaving, grandmother mentioned that the older sister (who was also present during the visit) also had enlarged breasts.  Her question was, “Can this run in the family?”  On examination of the older sister we noticed a striking difference in the size of her breasts- Unilateral Gynecomastia. A common normal variant in breast development is the unilateral onset of enlargement, which can be misdiagnosed as a tumor.  Unilateral breast development can exist as long as 2 years before the other breast even becomes palpable.  Although pathologic breast conditions are rare in children, we sent our patient for further evaluation of the breast with ultrasound.  Our hope– to identify normal breast tissue and a normal variation of breast development, while ruling out a tumor, cyst or abscess.

– Your friendly neighborhood pediatricians, Shanna and Wanda

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Week 2 brought more patients to see and a new location. Since we began in the middle of the week, we finally got to visit Port Maria Hospital and we absolutely loved it.  There was always a great steady flow of patients…with many of the common pediatric conditions… cough, viral illness and asthma. We are getting into the routine… wake up, work out, breakfast, to the hospital, back to the hotel, beef patty, cappuccino, dinner, sleep and repeat. The hotel is very welcoming and feels like home now… On Friday of last week we visited Port Antonio hospital for the first time. Although we were located at the hospital we only saw patients in the clinic and accident/emergency. The hospital advertised our presence so as soon as we arrived we were handed 10-11 charts of waiting patients.  We worked hard and was able to help a lot…. saw a child with unilateral breast mass, posterior auricular abscess that spontaneously began to drain during examination!! and a baby with bilateral polydactylyl. Can’t wait for week 3!! Until next time, Wanda Out!!
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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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I’ve seen the advertisements with Jamaica’s inviting cyan waters and the lure of a tropical climate, but what to expect in the clinics and hospitals was still a mystery as I arrived in Montego Bay. After all, I didn’t have much international clinical experience before coming to Jamaica. My only previous exposure was an educational opportunity teaching cardiology in Kathmandu. There was, however, no direct patient contact and we were working with students with fluency in English. This time around, I was traveling with a seasoned expert who had spent time in South Africa and Botswana – a very helpful accessory to the adventures ahead! Looking back on the 100 or so cases from the past 4 weeks, there was a whole lot of fever and viral illness floating around. The rainy season has arrived and school is back in session – the perfect recipe for spread of these kinds of infection. I encountered many cases of wheezing and tried to establish children on controller therapy for the first time. I was forced to learn a lot of dermatology with almost half of the cases coming in with some form of chronic or new skin lesions. In our last two weeks, we saw emerging cases of hand, foot, and mouth disease with more limb involvement and larger, angrier lesions than we’re used to seeing at home. With heavy rains and mosquitos on the loose, we came to recognize longstanding, difficult-to-treat cases of pustular urticaria. And the most impressive of all were the cases of tinea capitis with kerion formation. As I’m preparing to write our board exams in the spring, I won’t forget what a kerion looks or feels like and how to manage these fungal infections. And if you asked me for my favourite encounters, I loved seeing adorable newborns for their 6-week wellness check as they were thriving in the first weeks in the world. Besides the adorable babies and interesting cases, my main highlight was how we felt valued by parents. One of the things that we can offer as pediatric doctors is time. While there were many patients to be seen, parents valued having someone spend time hearing about their child and concerns, doing a full head-to-toe physical examination, and explaining what was going on. Parents – sometimes waiting up to 8 hours to be seen – were always thankful for the time that we dedicated to helping their children. I think that reflects how we saw Jamaicans. Whether we were in clinics, hospitals, wandering in cities, or back at our hotel, the staff, parents, and locals were almost universally warm, welcoming, friendly, and laid-back. The other highlight is the collegiality within the Issa team. I was very fortunate to have Alison with me. We traveled to the same sites together. Whenever there was a puzzling rash or an unclear diagnosis, it was helpful to have her weigh in on what was going. When I was unsure about how to navigate the system, she worked with me to find the best way forward. We were also fortunate to meet the Issa team with Diane and her colleagues coming down to Jamaica for other medical missions. Compared to others’ experiences, this elective was easy to “walk into”. Diane organized the details around accommodation, transportation, food, and clinics. And we can’t complain about sleeping in a beautiful location with delicious food, leisure activities, and access to fitness. We will miss Willis’ fruit smoothies and the fresh food that couldn’t possible survive through a Canadian winter. So, here we are on the last day of 4 weeks in Jamaica. While there are always bumps in the road, there lots of highlights that I will remember. The staff and patients keep asking when we are coming back. We haven’t decided just yet, but we will be back for more adventures!
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Unlocking doors by opening eyes

An amazing team of volunteers embarked on the Vision Mission to impact the lives of the children in health and education. This has been one of the most fulfilling experiences to watch the incredible gift of the volunteers, and teachers showing genuine sense of compassion and love. The team spent two days at the Ocho Rios Primary School, one day at the Oracabessa High School and Free Hill Primary School. In 4 days, the team provided 1, 505 eye exams, 293 glasses were dispensed in addition to 17 referrals at no cost.

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Port Maria Hospital Started Monday with our first work day at Port Maria Hospital. All of the staff was friendly and helpful. Thank goodness for Dr. Hayden-Peart!!! After being at work for more than 24 hours, she gracefully gave us a tour of the facility and a detailed orientation. It ended up being the A&E day of “twins”. We saw and evaluated 3 sets of twins by the end of the day. On Tuesday, we stayed in the A&E department and saw an array of patients including diagnoses of bronchiolitis, allergic reaction, broken arms and a patient with a history of G6PD deficiency. We ended our work day observing the ortho techs in action. On our way home with Ms. Nadia (one of the health administrators), she gave a great overview of the Jamaican health system. She gave great insight on programs or policies that could be implemented to help all involved – health providers and patients.
Our last set of twins for the day. Photo consent given by parent.

Our last set of twins for the day. Photo consent given by parent.

“Ramos Rounds”: There were six patients on the ward this week. Two premature infants, one term newborn admitted for respiratory distress as well as children with status epilepticus, status asthmatics and bronchiolitis. We had an review discussion on atypical pneumonia, bronchiolitis and hyperbilirubinemia. Clinic was filled with some newborns, but mainly follow up patients for asthma and referrals. The A&E was filled with lots of injuries secondary to Sports Day (field day) or falls. Roxanne had the pleasure of placing sutures in the eyebrow of a very anxious and strong 6 year old girl…without any versed or EMLA cream or lidocaine in a very hot room. Thanks to Nicole and helpful mother she still has both eyes and symmetrical eyebrows.
successful sutures and smiles. Consent given by parent for photo.

successful sutures and smiles. Consent given by parent for photo.

Dr. Wilson (Annotto Bay A&E) was awesome as usual! He always stops whatever he is doing to assist us with questions, obtaining supplies or navigating the health system. By the way he is super patient with you trying to get an IV in a 2 week old newborn (practice means less tears).  After it all, we ended the week with lots of hugs. Themes of the week:
  • Everyone was eating, ordering or buying Bun and cheese – EVERYONE, EVERYWHERE – Happy Easter!
  • Nicole discovered her love for June Plum juice
  • Home addresses are more like directions (e.g. District, Parish. Blue and white house on the left after turning left at the Baptist church).
  • You can make a spacer for albuterol (Ventolin) inhaler by cutting the bottom out of a Styrofoam cup or small water bottle.
  • There is nothing better than a hug from patient.
  • When in doubt call the pharmacy.
  Until next week, Nicole & Roxanne
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