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Monday was very busy last week! I’m not sure if that’s usual for a Monday or if word has spread that there’s a pediatrician that is visiting. I have had plenty of people asking when I’d be returning so it may be a combination of both.

Earlier in the week I had an impressive case of a patient with left sided lymphadenitis and what appears to be a left peritonsilar abscess after trauma. He was punched in the neck the previous day while at school and the swelling had occurred overnight.

I also discussed an interesting patient with Dr. Ravi later in the week! She a young known asthmatic who began having an adverse behavioral reactions whenever given albuterol. According to the chart (called a docket here in Jamaica), the reaction happened both at home as well as at the hospital. The patient wound up being treated with Atrovent in addition to steroids with the plan to be sent home with atrovent for rescue. I’ve never seen a case of albuterol/ventolin allergy.



When it comes to language, while English is the official language, of course many patients speak creole or patois. I’ve been fortunate enough that I’ve been able to understand most people for the most part. Sometimes I need to ask for clarification but it’s relatively uncommon. Of course, even though we may speak English, my accent is obviously different from a Jamaican’s. I’ve had some people think I’m Jamaican and you can usually tell the confusion when I start speaking. So to head it off, I introduce myself as a visiting pediatrician from the US. This week while in clinic in Annotto Bay, I had a fun conversation with a 7 year old girl. While setting her up to go home she turns to her mother and asks in mock whisper: “She’s lives somewhere else?” Her mother responded: “Yes she’s from far away!” The girl paused a second before saying “That’s why she talks like that?” It was so cute I had to laugh. I turned to her and said: “Yes! That’s why I sound funny!” It made me wonder what Americans sounds like to Jamaicans.

My final day in Port Antonio was this past Friday and it was a busy one! At one point I had 7-8 charts waiting for me to be seen. I was able to get some help from the other Doctor in the A&E. I particularly remember two patients. One was an infant present with URI symptoms and wheezing. He overall was well appearing and mother already had an albuterol inhaler. Unfortunately she wasn’t instructed on the proper use of the inhaler and so the child was only getting his medication once a day for the wheezing. I spent the visit breaking down what was causing his wheezing, why he will likely wheeze unlike his sister, the effect of the medication, and the appropriate times and frequency to use it. She was very grateful. Its reminded me of our job to educate our patients and their families about their health so that that can own and improve their lives.

Until my next and final post!
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Completed my first full week here last Thursday. It was pretty amazing! Monday and Tuesday I was at Port Maria working in the A&E. (Accidents and Emergencies, pretty much similar to an American ER.) Since all of my clinic locations are in general hospitals I just help out with the Pediatric patients that present for evaluation.

This active boy tried to be serious for the picture but he couldn’t hold the smile in for long!

Wednesdays and Thursdays are at Annotto Bay and there I was able to work in the Pediatric clinic seeing patients presenting for their newborn exams and other scheduled patients. It was a busy day and I was able to work and consult with the other Medical Officers who work in the clinic seeing patients. Diagnosed a few murmurs in newborns which required ECHOs prior to being seen by Cardiology. I’m unsure when they will finally be able to have the imaging done (there’s a long scheduling process, especially if patient is overall well appearing.)

She wanted to listen to my heart.

There are many services that are available in my training hospital which we don’t generally have available here in Jamaica. I was consulted for a 3 year old with failure to thrive, which upon prompting I discovered was likely due to suboptimal nutritional intake as the patient had food aversion and would only eat small amounts of rice porridge. Back at my home institution I would get behavioral medicine and our eating specialist involved. In this case, all I could offer is that the patient be started on pediasure and to continue to attempt to feed with new and different foods.

Another service that is dificult would be Rheumatology, which may have been an issue for one of the patients I’d seen on Friday at the Portland Health Department. He was a 10 year old who presented with 1 month of joint pain in elbows and knees. But when prompted would agree that nearly every joint hurts. Yet through history and on physical exam there was no warmth, swelling, or redness to any of the joints. If directly asked he would complain of pain with movement of any joint and would wince as if in pain, but if redirected while I continued examination he didn’t not express or show signs of pain. I do believe he may have some morning stiffness but I didn’t think his symptoms were concerning for a rheumatological problem and so I decided to have the patient come back in 1-2 months if the symptoms continued.

For the most part I’ve seen plenty of the same pathology that I would see back home. The major challenge comes with navigating a different health system and knowing what services and treatments are available. This helps a lot in being judicious in my medical decisions.

I also learn much about Jamaica and the hospitals from the transportation drivers.

PS. On a different topic, after my visit to the Portland Health Dept, I developed hives! That’s a first for me as I’ve never had any allergic reactions before. If you’re wondering, they are not comfortable AT ALL. (I had Benadryl in my emergency kit but wound up having to start steroids since the hives persistently returned every 6 hours.) I’m still unsure of what has cause them and I’m currently still having intermittent break outs but the episodes have been improving.
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Hi All! I’m Iréal Fusco, a pediatric resident training at Nicklaus Children’s Hospital in Miami. I’ve been very excited about participating in the Issa Trust Pediatric rotation as a way to expand my Pediatric training.

My first day was this last Friday, March 10th, 2017 at the A&E in Port Antonio. It was a long drive to the location but there was gorgeous scenery along the way. Mr. Campbell is an administrator at the hospital. He picked me up and drove me to the hospital himself!



Once there, I felt a bit like an intern all over again starting at a new place. I was thrown right in seeing patients so I had to learn how the system worked as I worked. The overall pathology was similar to what I’d see back home at our ER. There was a bronchiolitis that I wound up admitting for further treatment. Some viral URIs, Constipation, Hand, Foot and Mouth disease as well as an AGE.

There was an infant with a new onset fever after several days of URI & diarrhea who looked great but the fevers were high! I was concerned for UTI (especially with the large water stools she was having and I witnessed) but we didn’t have the bags available to get a urine specimen and there were no catheters. I had to make a decision on whether to treat empirically or manage conservatively. That was a tough one.

I had another young lady presented with severe left sided abdominal pain with difficulty ambulating. She was diffusely tender on exam but her pain localized to the left. Urine pregnancy was negative. Urine dipstick was WNL (no blood). No flank pain and denied constipation. She had me very concerned for a surgical emergency and I was unable to obtain ultrasound for diagnosis. After a bit of discussion we got a flat and upright abdominal X ray which showed a large stool burden and after a glycerin suppository she felt much better. She even ran up to hug me and said thank you before she left. It was a reminder that I am helping in some ways (even if I’m not as efficient in the setting I was in.)

Overall, I had a wonderful but busy day! Coupled with the long drive home, I didn’t have the energy to write this post that day, but I’m excited to explore the other two clinical sites!

~ Iréal
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From the moment I signed up to come and serve in Jamaica, I had the expectation that it would be an incredibly rich experience for me as a person and as a pediatrician. The feeling of being in a different setting and having different resources is an awareness of what we daily take for granted. You come to learn that even though you are here to help, the experience helps you even more. Here you come to rely in what you have learned and not who you can consult. The contrast of having specialists, to you being the only one the patient can see is an awakening experience. It makes you want to be an even better physician. It’s incredibly gratifying to feel that you are useful and necessary, that our profession is even better than what we thought. To see the happy and grateful faces of the children and parents is priceless. To learn more about how different we can be when we grow up in a different country but at the same time that the values of love, gratitude, kindness, joy don’t change, makes you realize that we are more similar than what we think. I’m humbled by all that Issa trust has done and keeps doing for Jamaica, because many people are blessed but very few give back. I hope that what I have seen and experienced reminds me every day to never stop giving back.  I  can never pay back all that this rotation has done for me but I can keep on putting my grain of help.
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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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