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4 weeks in Jamaica has flown by!  This rotation has been one of the highlights of the year, and we are a day away from heading back to 5 degree weather and rain.  I will miss the people of Jamaica – their friendly smiles, greetings, and the adorable babies with full heads of hair!  The variety of clinical settings we have worked in has been a great.  We worked in 3 different community sites – Port Maria Hospital on Mondays and Tuesdays, Annotto Bay Hospital on Wednesday and Thursdays, and Port Antonio on Fridays. We worked on the inpatient wards, the A&E (accident and emergency) department, the hospital clinic, and a health clinic. This elective has been a great opportunity to solidify 4 years of pediatric training, and work autonomously within a medical system with limited resources. Though we may have had the most dedicated pediatric training in the A&Es and health clinic, medical knowledge is only one part of patient care, and learning to navigate the medical system, choosing the most appropriate (and available) investigations and treatment, and accessing interdisciplinary resources was a challenge that pushed me to better refine my critical thinking and clinical skills.   The medicine here is great for a general pediatrician. There was some common pathology here that I rarely saw at home (scabies, tinea capitus and kerion, furuncles, tinea corporis, extranumerary digit, large abdominal hernias, infected styes). There was pathology I was very familiar with (asthma, eczema, viral illness, AOM, gastroenteritis, concussion, bronchiolitis, Coxsackie virus, febrile seizures etc), and there were some interesting cases (gasoline burn, vitamin ingestion, motor vehicle accident). Having come during “winter time” in Jamaica, there were many viruses going around. While many patients presented with viral symptoms, some had convincing history and physical exams suggestive of bacterial infections. Choosing the most appropriate antibiotic based on what was available at the pharmacy, or what the parents could afford at the private pharmacy had challenges, and often times, second line or third line antibiotics would be prescribed due to these limitations. Getting cultures done were often futile as samples (if not lost) and results are shipped out to and back from Kingston, and could take weeks. Without an EMR system, bloodwork is labelled by hand, paper blood results are physically transported, X-rays are printed on films, and all patient information is recorded by hand. I learned to actively ask myself why I was ordering specific investigations and how results would change my management, something I will take home with me, especially in my future career as a pediatric emergency physician.   The most enjoyable part of the elective has been interacting with the Jamaican people – they are friendly, kind, and genuine. They appreciate the work that we do, and ask us when we will be back. Parents who came from areas more than an hour away came to clinics before 7am in the morning to register, and waited patiently until physicians were able to see their child. Parents were only grateful and appreciative to have a physician see them, despite sometimes waiting for more than 8 hours. One of the biggest impacts we can have on the patients we see is education – teaching parents about their child’s condition, explaining what we think their child may have, and what the medications we prescribe do and how to take them.   I am also fortunate to have had a colleague and great friend come work beside me over the last 4 weeks. The benefits of having his clinical perspective and expertise in discussing cases where the diagnosis or treatment plan was not straight forward helped me feel more comfortable in my final management.  I am grateful we were able to support each other in learning around our cumulative interesting cases, and navigating an unfamiliar medical system.   Lastly, I would like to acknowledge the great work that the Issa Foundation does to help improve the health and quality of life for young Jamaicans. During my time here, we saw grass roots progress being made: sustainable equipment delivered to hospitals with in-service teaching provided, and vision screening at schools with glasses given out to children who needed them. For me, working within a fantastic organization was important in participating in an elective to ensure that there was continuity with the work we do.