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I am half way through my time in Jamaica. It has definitely been an interesting experience. Mondays and Tuesdays are spent in the ED at Port Maria. There is a huge problem with space so the three of us have to share a single room. Wednesday mornings are ward rounds at Annotto Bay (if they have patients) followed by helping out in the ED. Thursdays are clinic at Annotto Bay and either consist of well checks or follow ups. Fridays are spent either at clinic or the ED in Port Antonio, the hospital with a view! Overall the hospital staff are gratful we are here and therefore are helpful and welcoming. Basic URIs , or “cold in the head Miss”, are very common. They have some very interesting cough syrups over here that the parents expect you to prescribe. They consist of a variety of ingredients including salbutamol or terbutaline, codeine, bromhexine, guaiphenesin, and menthol. My favorite one is called “Dawakof”, or “do away cough.” Along with the basic URIs, I’ve seen a lot of poorly-controlled asthma, tinea capitis, and scabies. Thankfully Ventolin inhalers are free from the hospital pharmacy and they even have an ICS! Unfortunately nebulizers are few and far between though making acute management of asthma in the ED a difficult situation. It also makes discharging a 2 or 3 year old home with an inhaler a less than ideal situation, especially when you have to just hope that the parent will spend the money on a spacer as these are not provided by the hospital pharmacy. I have possibly made some new diagnoses of sickle cell disease, although I may never know for sure. Newborn screen must not happen in Jamaica (I have yet to find out) but I have seen young children who appear to be in vaso-occlusive crisis with no diagnosis of SCD. My only clue is a Hb/Hct in the range of 7/22 with pending results for a “sickle cell screen” but no Hb electrophoresis.  Jamaica is in the midst of a hospital outbreak with Klebsiella and Serratia which has resulted in the death of 18 infants and many more infected. This seems to have resulted in multiple hospital inspections by the Health Department and results have been released but I have yet to read them. Hand sanitizer is hard to come by. Ear tips are washed and reused. The examination table sheet is only changed if absolutely necessary (I’m pretty sure this one would make the Health Department list of no-no’s. Available medications at the hospital pharmacy consist of a list that fits on two notecards. The wards are open air (and hot!) but thankfully the EDs and most of the clinics are air conditioned. Doctors do all of their own phlebotomy and IV cannulas, without EMLA or the papoose method, which makes for a very combative child. In contrast to this, accommodation at Couples Resort is lovely and comfortable. I’ve spent my weekends diving and relaxing on the beach, and trying to get used to being called “My Lady.” The hotel staff are lovely and the food is great. I actually feel guilty coming home to this after spending my days amongst patients who clearly have very little. Diane has been in town with some of her team and it’s been great to learn about the Issa Trust Foundation and everything that they have accomplished. I’m looking forward to seeing what my next two weeks consist of!