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Our first week has flown by! Stephanie and I are grateful to be surrounded by such warm people that continue to help us become oriented to all the clinics we are working at! On Wednesday and Thursday we were at Annotto Bay Hospital. Our first day we were able to join the residents on the inpatient service. The pediatric ward struck me immediately as it is one open room with children of all ages from 3 days to 11 years old with the sickest patients closest to the nurses’ station. We were surprised to learn that if you are over 12 years old you go to the medicine unit! At home we have a hard time transitioning our 18 year olds to the adult units so that struck us by surprise. That continues to point how valuable and needed pediatricians are in Jamaica! We were able to join in on work rounds with Dr. Ramos and found a teaching point with every patient. It was nice to contribute and discuss pathophysiology and management on each disease process. There was a 3 day old infant with hypoxic ischemic encephalopathy who was continuing to have seizures despite being started on phenytoin. This led to a lively discussion of what else was available and prognosis as one of the medicine interns wanted to obtain a CT scan of the patient’s head. We talked about both cost efficient and responsible healthcare as we tried to stress that this imaging modality would not give us additional information and increases the patient’s risk for cancer in the future. Currently in Jamaica no hospital is capable of doing body cooling but an interesting teaching point that we were able to share. One of the residents then gave a presentation on shock. This reminded me of the many talks we have had with the intensivists both at noon conference and in the PICU. Stephanie and I stressed to them the importance of early recognition and quick action. Overall the day was great as we were able to share a lot of teaching points that our teachers and mentors have successfully stressed to us! On Thursday we were in well baby clinic where we each saw about 10-12 newborns. We fell in love with the infants and most were doing well and healthy. We had a couple of patients one with a new murmur that we sent to obtain echocardiogram and another that Stephanie was the one managing diuretics as the last echocardiogram showed a closed VSD with good function. In the afternoon we spent time in the A&E where we immediately admitted two patients. Stephanie saw a young boy with sickle cell disease who presented with pain crisis who was admitted for pain control. I saw a 14 year old boy with an asthma exacerbation that had failed 6 nebulized treatments in the A&E with Salbutamol and Atrovent. We had another lively debate about dosaging as he had been under-treated. Some of the generalist doctors had wanted me to obtain basic labwork to see if the white count was elevated which led to a debate of not ordering labwork when it will not change our management. We stuck to our guns and I like to think it was beneficial to all to think about these things before ordering labwork or imaging. On Friday we traveled to St. Antonio Hospital with Mr. Campbell, the CEO of the hospital. He was so gracious to drive us the almost 2 hours each way. There weren’t any patients in the outpatient clinic so we spent the day in Accident & Emergency. We saw a variety of conditions and have a knack for starting the day off with an admission. Stephanie saw a child with a hot water burn on the top of his foot. With good supplies there could’ve been the possibility of sending him home but as we didn’t even have appropriate wraps the patient was admitted to help prevent infection in this very vulnerable area. After seeing all the patients we were able to spend about an hour playing with the kids on the inpatient side. We read them books, colored and even told some scary (or not so scary) stories! We had a blast!       This weekend we are enjoying everything that Jamaica has to offer! Sailing, kayaking and tomorrow we are off to swim with the dolphins! We are definitely feeling blessed! Until next time, Steph and Diana