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We were privileged to be able to start our day in Port Antonio with a brief presentation about febrile seizures to the doctors and nurses on staff at the hospital. While febrile seizures are quite a common issue for us as pediatricians, they can be daunting for doctors who are not as familiar with kids. A lively discussion followed the presentation (as are most discussions in Jamaica) and we all walked away with a deeper understanding of practicing medicine effectively with the resources available.

That being said, now that we’ve been in Jamaica for almost three weeks, I feel that poverty has become personal. There are now names and faces and images that come to mind when I think about “resource poor settings.” It is the legs of a child with a bacterial superinfection that has been ineffectively treated for months with an antibiotic known to have a high level of resistance because there was nothing else available. It is the back of an ambulance equip with little more than a pair of latex gloves, a bag of expired normal saline, and a small sliver of hope that anything useful would be able to be accomplished should a true emergency arise. It is the mother of an asthmatic who fashioned a spacer out of plastic cups because she couldn’t afford one but acknowledges its importance for her child’s health. And while these disparities become personal, they also become impossible to ignore.

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It’s been an exciting week here in Jamaica — both in clinics and at the resort. We returned to Annotto Bay Tuesday to round with the residents again which was one of the highlights of the week. I was able to see one of the same patients that I took care of last week which provided for some unexpected but welcome continuity. He is a 5 month old with failure to thrive thought to be secondary to congenital heart disease. The team was able to obtain an echo which was reportedly normal; however, the it lacked several key pieces of information. Cost and the availability of echo techs and cardiologists (much less pediatric echo techs and pediatric cardiologists) eliminate the option to repeat the study.  As is the case with much of the medicine we practice here, decisions must be made based more on clinical outcomes that lab results, imaging and other studies. He has been doing quite well on diuretic therapy and having failed a trial without it, he will continue to be treated as a patient with a cardiac anomaly despite his normal echo report.  Add proper nutrition to the mix and he looks like a new (little) man. Last weekend, the Couples Tower Isle celebrated it’s 36th anniversary. There was a celebration Saturday night which, despite the rain, was fantastic. Many new and old employees and guests were in attendance. Alison and I were able to help with some of the decorations. We were quite impressed with ourselves and our abilities to string lights flowered centerpieces. After admiring some of the other decorations Saturday night, I’m pretty sure they gave us the easy jobs.  And I’m convinced that some of our work was later revised…we’ll keep our day jobs for now.
This Monday and Tuesday we returned to Port Maria, where we are beginning to feel more comfortable with the resources available and how the clinics and the A&E function in general. The matron continues to be our hero and the children have not stopped being irresistible. If there are several Jamaican babies missing from Port Maria, check with us… I saw one 6 week old for a well child check whose mother asked me to look closely at the skin over her anterior fontanelle. When I asked why, she told me that her mother (the child’s grandmother) had poured rum over her soft spot to cure the child’s head cold (which turned out to be likely reflux). Luckily, the child’s scalp was unharmed. I am convinced the family will find other uses for one of Jamaica’s primary exports. Jamie and Alison