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Well here it is: my last blog post. Four weeks have come and gone much faster than I expected and my adventures in rural Jamaica have come to an end. A heartfelt thank you to the doctors, nurses, drivers, and administrators of Port Maria, Annotto Bay, and Port Antonio hospitals. You have been so kind, welcoming, and patient while I try to navigate the intricacies of Jamaican healthcare (and insert IVs for the first time in years).

I find that practicing medicine in a developing nation always sends me home with a renewed sense of appreciation for all that we have in the developed world. When a toddler presents with failure to thrive, the first thing on your differential is not usually malnutrition, secondary to food insecurity. If a patient has a urinary tract infection, obtaining a urine culture does not depend on the family’s ability to pay 2000 Jamaican dollars to get it (equivalent to about $16 Canadian dollars which most families in this part of Jamaica cannot afford).

Here are some of my final thoughts:

1. I have become so used to being called “My Lady” by all of the resort staff that I feel like I have been living in Downton Abbey. Or Game of Thrones. Minus the killing of my favourite characters.

2. Most absurd thing I heard on the local radio station: watermelon cures asthma. (Hint: it doesn’t).

3. Most bizarre thing told to me by a parent: worms cause teeth grinding at night. (Hint: they don’t).

4. I was surprised to discover how deeply religious many of my patients are. What is the politically correct response when a grateful mother wishes you “a blessed day” as she walks out the door? You too?

5. Infection Prevention & Control nightmare of the week: when the asthmatic with recurrent scabies was in the bed next to the infant with pertussis. (I seemed to be the only person concerned about this).

6. Couples Resort Tower Isle is the best all-inclusive resort I have ever been to. The beach, the food, and the staff are phenomenal. I highly recommend it to anyone interested in visiting Jamaica. (I would also recommend bringing your significant other to avoid the awkwardness that is being the only solo person at an all couples resort).

7. I think I have listened to a lifetime’s worth of reggae and Bob Marley.

And last but not least, a big thank you to the wonderful Diane Pollard who made this experience possible! I have highly enjoyed my adventures in rural Jamaica and look forward to returning some day as a staff Pediatrician.

(Final) Favourite Food of the Day: Curry coconut seafood

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I am starting this week’s blog with a big shout out to the dedicated team of doctors and nurses at Port Antonio Hospital. When an underweight newborn was urgently intubated in the middle of the night due to severe apnea, the medical team hand-bagged the neonate all night until the transport team arrived in the morning to take the baby to Kingston. Port Antonio does not have a functioning mechanical ventilator. In fact, none of these local hospitals have ventilators.

And here are some of my random observations for the week…

1. Every emergency department (or A&E as Jamaicans like to call them) at which I have worked has always had a Bollywood soap opera blaring from the one fuzzy TV in the waiting room. Who knew Jamaicans would be such devoted Bollywood fans?

2. It turns out that marijuana has a lot more side effects than you’d think.

3. There are no straight roads in Jamaica.

4. I think I’m experiencing reverse culture shock. I was so surprised to see a Caucasian person at the hospital this week that I had to remind myself not to stare and wave.

5. Jamaicans really like uniforms. School uniforms, nursing uniforms, drivers uniforms. And they all seem to be made of the thickest wool you’ve ever felt.

6. Children, especially boys, should not be allowed to wear shoes without socks when the temperature is more than 30 degrees Celsius.

7. Jamaica’s national fruit is ackee. When eaten before it is ripe, ackee will cause severe refractory hypoglycemia that may or may not kill you. Who wouldn’t want a poisonous food to be their national fruit?

8. I feel like I’m practicing hard-core, old school medicine every time I look at an X-ray on real film.

9. Every day, we drive by a little community where the excessive amount of pungent seaweed on the beach results in a game of how-long-can-you-hold-your-breath. It’s like rotten eggs had a baby with a durian. Times a thousand.

10. A nurse was robbed at gunpoint near one of the hospitals this week. Scary stuff.

11. In two days, I will be outside the 14-day incubation period for leptospirosis! Yay! I was exposed at Dunn’s River Falls, but so were all of the other tourists, they just don’t know it. Regardless, it was still worth climbing up a 950-foot waterfall in the jungle!

12. I have not stopped sweating since I arrived here. And I’m not even wearing a wool uniform.

Favourite Food of the Day: Lime panna cotta with tapioca pudding

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I have now been working in Jamaica for two weeks and am already halfway through this elective! I have adjusted to how things work here, although everyday something new surprises me. Just yesterday, I came across a family of goats who had wandered into the hospital compound and acted like they had always lived there.

Also, no matter where you live, kids…

1. Love Dora

2. Put rocks in their ears

3. Scream and cry when you remove rocks from their ears

4. Really like stickers

5. Get bitten by rats (okay that one is just Jamaica)

This week there was a Pseudomonas outbreak on the pediatric ward of one of the local hospitals. This, combined with the ongoing severe drought that was exacerbated by all the kids returning to school, has resulted in only the sickest of patients being admitted to hospital. Everyone else has to manage at home.

Here are the Patois phrases that I have mastered so far:

• Du du = poop

• Juk = needle

• Cold in the eyes = eye discharge

• Cold in the chest = could mean anything

• Me no wanna = I don’t want to buy that

• Soon come = they have no idea when it’s going to come

Favourite Food of the Day: Chicken patties. Also, coconut bread pudding with vanilla sauce.

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It has now been a full week of working and living in Jamaica and I’ve learned a lot, both about medicine in a resource-limited setting and about life in Jamaica.

My approach to medicine here is quite different from what I do back home. In Canada, I do my history and physical exam, create my differential diagnosis, and then order investigations to confirm the diagnosis, usually before proceeding to treatment. In Jamaica, I do my history and physical exam, create my differential diagnosis, and then treat whatever I can based on the limited medication options that are available.

Investigations are hard to come by here: other than the basic CBC, renal and liver panels, urinalysis, and X-rays (some of which are only available in the “bigger” local hospitals), I don’t have ready access to things like cultures and sensitivities, ultrasound, CT scan, interventional radiology, and MRI (they actually laughed at me when I mentioned that MRI is better than X-ray for diagnosing osteomyelitis).

“Free” healthcare in Jamaica is not the same as free in Canada. A lot of medications are not available at local hospitals which means families have to pay out of pocket at private pharmacies. Likewise, an abdominal ultrasound costs approximately 6000 Jamaican dollars (about $60 USD), which most families can’t afford. Even having a family doctor is not included in government-funded healthcare. Thus if my treatment recommendations include anything not provided by the local hospital, my patients will simply not do it.

Without these tools, I find myself treating patients for conditions that I’m not even sure they have. But it’s the best I can offer them with what’s available. Sometimes, it is unsatisfying: I miss that feeling I get when I know exactly what is wrong with a child and can offer definitive treatment.

I have also stopped asking about animal exposures because all of my patients are regularly exposed to dogs, chickens, lizards, and goats. Heck, so am I. At any given time, a stray chicken can be seen waddling across the hospital corridors.

Other lessons I have learned this week include the following:

If you don’t tilt the shower head just so, you will flood the entire bathroom and all your things in it.

The incessant “weet weet” sound that follows you from dusk until dawn is actually the call of the Jamaica tree frog. This lesson was brought to me by my husband who was amused by the mystery background noise present in all of our Skype sessions.

If I am in a car full of Jamaicans, I will be the only person wearing a seat belt. This is mildly terrifying given the nature of their driving (see previous post for full details).

The little island across from the resort, of which I have taken innumerable beautiful photos, is actually an all-nude island.

Things I have yet to learn include:

Understanding Patois, the version of “English” that Jamaicans speak which incorporates local phrases and slang.

Not feeling completely awkward as the only solo person at a couples resort.

How to set free the tiny lizard that is still trapped in the living room.

Favourite food of the day: pan-seared snapper!

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My first day of work started with an hour long drive up narrow, winding roads pockmarked with deep potholes every hundred meters or so. Thankfully, my driver was very familiar with said potholes and showed no sign of fear or hesitation when rounding tight corners at high speeds while simultaneously passing another car in the one and only lane. The views of the mountainous jungles were beautifully distracting as were the colourful shanty towns that dot the way. Stray dogs, chickens, and humans could often be found wandering dangerously close to our vehicle’s path.

The clinic I was headed for was actually a last minute change as the previously assigned clinic had been shut down because of crumbling infrastructure and “infestation” (I still don’t know what that really means). When we finally arrived at 9am, I was greeted by a group of lovely clinic workers who promptly told me that we couldn’t start seeing patients yet because there was no water. Apparently, there has been a nation-wide drought for months. The government deems it too expensive to pump water into these areas so the people (and the clinic) rely on “water trucks” to sporadically fill their reservoirs. Of course, the Jamaican “soon” turned out to be a four-hour wait. But, eventually, I did start seeing patients by 1:30pm.

Based on my first afternoon of clinic, I can confidently say that there is currently an outbreak of bullous impetigo in the area. Fortunately, the pharmacy’s large selection of exactly three different antibiotics (sarcasm intended) is sufficient to treat this condition. After a packed afternoon of not understanding what my patients were saying (I swear we’re not always speaking the same language) and realizing the only investigations I could reliably perform was basic blood work (50/50 chance for culture results, don’t even think about a chest X-ray), I finally managed to see all of the registered patients by 4pm.

Despite a crazy, sweaty (35 degrees Celsius without air conditioning), and slightly confusing first day, it was blissful to come “home” to an air-conditioned room and a cold shower. I finished my day in true tropical island style: cocktail party with live music, sumptuous dinner on the beach, and a fantastic acrobatic show complete with fire dancers!

Not a bad first day. Now if only I could figure out how to set free the tiny lizard that is trapped in the living room…

Favourite Food of the Day: fried plantain!

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