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Over the Easter extended holiday, we were able to venture outside Ocho Rios and visited Kingston (family), St. Elizabeth (YS falls, Black River) and Westmoreland (Bluefield beach). Remember to take advantage of your days off.

The Story of the Jamaican Easter Bun Tradition From The Hot Cross Buns

We started off the week at Port Maria A&E seeing a variety of patients including a family with scabies and multiple complaints of “tin allergies” or allergies to canned foods (tin corned beef, tin mackerel) … quite interesting. Wish we could do some allergy skin testing to find out what’s going on.     Dr. Roxanne Samuels next to 1 of Port Maria Hospital’s 2 ambulances. Typically there is a driver that picks up non life-threatening cases. During transport of critical patients, a nurse +/- a physician will travel as well. On Wednesday, was National Doctor’s Day (celebrated in the US). Highlights of the day at Annotto Bay were: (1)     Meeting a 113 year old patient in the A&E. Per her granddaughter, she was walking up until 13 months ago and does not take any medications for any chronic illnesses. Her 114^th birthday was on April 1^st.  Happy Birthday! After a “google search”, per the Jamaican Observer newspaper: the oldest known alive Jamaican is a woman named Viola Moss Brown, who was 115 years old in 2015. So, maybe this lady is the second oldest living Jamaican…just maybe. (2)    A 2 year old male who brought in for evaluation by his mother. Per the mother, he saw a goat or cow eating grass and wanted to be like the animal. He got a single long blade of grass stuck in this throat. He was stable without any respiratory compromise and was eating and drinking without issues. Unfortunately, after two different physicians attempting removal – he was referred to ENT. He was quite a playful, cooperative and happy patient – Will never forget him.  The rest of the week was filled with multiple dog bites and other interesting patients including a new sickle cell diagnosis and trying to navigate the Jamaican health system for complex medical patients in need of special services (8 year old girl with Down syndrome, 18 month old boy with presumed cerebral palsy). Interestingly, we learned that patient families would have to pay out of pocket for MRIs if needed.  We ended the week with a busy clinic at the Port Antonio Health Center. The drive was long and through many narrow roadways, but the view outside the car window and the gracious patients make the long drive worth it.  Dr. Lenock and staff (wonderful nurses and pharmacy tech) were very helpful and greeted us with open arms. We ended the week with a car ride home with Mr. Campbell (Port Antonio Health Administrator) who answered all our questions on how we could give back to the Jamaican health system after completion of residency.   pictures from our quick  after work tour of James Bond Beach (about 10 minutes drive on highway from Couples hotel). Thoughts of the week

• Remember Jamaica is small, you may find out that one of the doctors you work with is a distant cousin or that your patient may be related to you.
• Success during this experience is greatly based upon understanding the system. Don’t be afraid to ask for help, calling the lab, calling Dr. Ramos/Ravi, or calling the pharmacy. At the end of the day its about doing your best with what you have for your patient at that moment.
• By this time you may feel like your impact is minuscule but every day, every week the staff are happy to see you because the help you provide (big or small) is very valuable.

one more week to go                 Nicole & Roxanne

Started Monday with our first work day at Port Maria Hospital. All of the staff was friendly and helpful. Thank goodness for Dr. Hayden-Peart!!! After being at work for more than 24 hours, she gracefully gave us a tour of the facility and a detailed orientation. It ended up being the A&E day of “twins”. We saw and evaluated 3 sets of twins by the end of the day. On Tuesday, we stayed in the A&E department and saw an array of patients including diagnoses of bronchiolitis, allergic reaction, broken arms and a patient with a history of G6PD deficiency. We ended our work day observing the ortho techs in action. On our way home with Ms. Nadia (one of the health administrators), she gave a great overview of the Jamaican health system. She gave great insight on programs or policies that could be implemented to help all involved – health providers and patients. “Ramos Rounds”: There were six patients on the ward this week. Two premature infants, one term newborn admitted for respiratory distress as well as children with status epilepticus, status asthmatics and bronchiolitis. We had an review discussion on atypical pneumonia, bronchiolitis and hyperbilirubinemia. Clinic was filled with some newborns, but mainly follow up patients for asthma and referrals. The A&E was filled with lots of injuries secondary to Sports Day (field day) or falls. Roxanne had the pleasure of placing sutures in the eyebrow of a very anxious and strong 6 year old girl…without any versed or EMLA cream or lidocaine in a very hot room. Thanks to Nicole and helpful mother she still has both eyes and symmetrical eyebrows. Dr. Wilson (Annotto Bay A&E) was awesome as usual! He always stops whatever he is doing to assist us with questions, obtaining supplies or navigating the health system. By the way he is super patient with you trying to get an IV in a 2 week old newborn (practice means less tears).  After it all, we ended the week with lots of hugs. Themes of the week:

• Everyone was eating, ordering or buying Bun and cheese – EVERYONE, EVERYWHERE – Happy Easter!
• Nicole discovered her love for June Plum juice
• Home addresses are more like directions (e.g. District, Parish. Blue and white house on the left after turning left at the Baptist church).
• You can make a spacer for albuterol (Ventolin) inhaler by cutting the bottom out of a Styrofoam cup or small water bottle.
• There is nothing better than a hug from patient.
• When in doubt call the pharmacy.

  Until next week, Nicole & Roxanne

On our first full day in Jamaica, we climbed the world famous Dunn’s River Falls all the way to the top. It was a great team building exercise to get us mentally ready for the week. The first few days of work have been filled with a mixture of interesting patients, new faces and trying to navigate systems-based practice in a developing country. Each morning, we awaken to melodic sounds from the birds outside of our windows as we prepare to start our day. Prior to reaching the health facilities, we spend 20 minutes to 2 hours traveling along narrow winding roads, but are privy to picturesque ocean views, scenic mountain greenery and the early hustle and bustle for local Jamaicans as they travel to work or school. Rounds on the ward: An ex-29 week preemie who is small yet vigorous laid in an incubator next to an ex-26 week preemie who has apnea and requires continuous resuscitation. Both babies are premature, both in need of ventilators not available, but the latter only survived six hours after we were first introduced to him. He is the fifth child lost for his mother (all born prematurely) and only to think if his life could be saved if the necessary equipment was available – all the incubators were being used at the referring facilities. Two other infants were discharged home having improved after meconium aspiration syndrome and neonatal seizures. The last two patients (4 and 10 years old) were admitted for sickle cell pain crises. The first child had a medical course complicated by a history of rheumatic fever with subsequent heart failure, now improved on aspirin and diuretics. The older intermittently cried out as he awaited his pain medication; no PCA’s are available. We did get to hold plain film radiographs for the first time!!! Accident & Emergency (A&E): The equivalent of the Emergency Room is staffed by non-pediatricians, but they were excited that we saw their pediatric patients (ages 12 and under). Trying to navigate the forms, resources available and medications in stock were the largest challenges. The staff was very friendly and helpful. Chief complaints ranged from upper respiratory tract symptoms to dehydration to imaging follow ups. The biggest concern by parents and health workers was H1N1 or flu as evident by the white masks worn by all the staff.   Annotto Bay Clinic: Thursday morning is typically newborn clinic and chronic disease (i.e. asthma) follow-ups. The day was commenced with torrential rain. A car we passed on the road had slid into the ditch and only a few mothers made it to clinic that day. We were greeted by a sea of infants, tightly bundled and breastfeeding in the waiting area as they awaited their first well baby visit. We were greeted by cooing smiles and their mothers gave us many thank-yous.   Port Antonio A&E: The busiest day of the week!!  After a two –hour commute, we were met with a room full of parents and children who waiting hours to be seen by a Pediatrician. We were directed into a small room (about the size of a standard bathroom) to see our patients. Initially we started with 8 dockets (aka patient charts), as we got settled in the nurse handed us 3 more dockets. It seemed like every few minutes a new patient were being added to the list. In about 3.5 hours we saw 13 patients. To close out the day we had to admit a 13yr old male with a textbook picture of new onset type 1 diabetes. Although we were able to get blood via venipuncture for initial labs, multiple attempts at IV placement were unsuccessful before departing for the day. As pediatricians we both have become accustomed to looking at the patient electronic medical record to follow up patient care even after hand-off, but here it’s more so,” I hope he will be okay” and that what we did was the right thing. It was surely a rough day; thankfully we were able to work as a team. Lessons Learned:

1. Dandelions supposedly help with preventing prostate cancer?
2. The pharmacy can close at any time, leaving patients having to return for medications or not obtain them at all if they have no means to travel back to fill their prescriptions.
3. Remember to ask if your patients have running water, a refrigerator or transportation to return for follow-up. This will play a role in clinical advice, management and decision-making.
4. “Yeh Mon” is used by as a noun, verb, adjective and greeting constantly by all the hotel guests and staff – absolutely hilarious!
5. Keep the patient charts in the correct order or your will corrected swiftly by frustrated parents, fussy children, and nurses.
6. Check in with the pharmacy for each location on the first time going to get a run down on what medications are available.

  Until next week, Nicole & Roxanne