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Completed my first full week here last Thursday. It was pretty amazing! Monday and Tuesday I was at Port Maria working in the A&E. (Accidents and Emergencies, pretty much similar to an American ER.) Since all of my clinic locations are in general hospitals I just help out with the Pediatric patients that present for evaluation.

Wednesdays and Thursdays are at Annotto Bay and there I was able to work in the Pediatric clinic seeing patients presenting for their newborn exams and other scheduled patients. It was a busy day and I was able to work and consult with the other Medical Officers who work in the clinic seeing patients. Diagnosed a few murmurs in newborns which required ECHOs prior to being seen by Cardiology. I’m unsure when they will finally be able to have the imaging done (there’s a long scheduling process, especially if patient is overall well appearing.)

There are many services that are available in my training hospital which we don’t generally have available here in Jamaica. I was consulted for a 3 year old with failure to thrive, which upon prompting I discovered was likely due to suboptimal nutritional intake as the patient had food aversion and would only eat small amounts of rice porridge. Back at my home institution I would get behavioral medicine and our eating specialist involved. In this case, all I could offer is that the patient be started on pediasure and to continue to attempt to feed with new and different foods.

Another service that is dificult would be Rheumatology, which may have been an issue for one of the patients I’d seen on Friday at the Portland Health Department. He was a 10 year old who presented with 1 month of joint pain in elbows and knees. But when prompted would agree that nearly every joint hurts. Yet through history and on physical exam there was no warmth, swelling, or redness to any of the joints. If directly asked he would complain of pain with movement of any joint and would wince as if in pain, but if redirected while I continued examination he didn’t not express or show signs of pain. I do believe he may have some morning stiffness but I didn’t think his symptoms were concerning for a rheumatological problem and so I decided to have the patient come back in 1-2 months if the symptoms continued.

For the most part I’ve seen plenty of the same pathology that I would see back home. The major challenge comes with navigating a different health system and knowing what services and treatments are available. This helps a lot in being judicious in my medical decisions.

PS. On a different topic, after my visit to the Portland Health Dept, I developed hives! That’s a first for me as I’ve never had any allergic reactions before. If you’re wondering, they are not comfortable AT ALL. (I had Benadryl in my emergency kit but wound up having to start steroids since the hives persistently returned every 6 hours.) I’m still unsure of what has cause them and I’m currently still having intermittent break outs but the episodes have been improving.

Hi All! I’m Iréal Fusco, a pediatric resident training at Nicklaus Children’s Hospital in Miami. I’ve been very excited about participating in the Issa Trust Pediatric rotation as a way to expand my Pediatric training.

My first day was this last Friday, March 10th, 2017 at the A&E in Port Antonio. It was a long drive to the location but there was gorgeous scenery along the way. Mr. Campbell is an administrator at the hospital. He picked me up and drove me to the hospital himself!



Once there, I felt a bit like an intern all over again starting at a new place. I was thrown right in seeing patients so I had to learn how the system worked as I worked. The overall pathology was similar to what I’d see back home at our ER. There was a bronchiolitis that I wound up admitting for further treatment. Some viral URIs, Constipation, Hand, Foot and Mouth disease as well as an AGE.

There was an infant with a new onset fever after several days of URI & diarrhea who looked great but the fevers were high! I was concerned for UTI (especially with the large water stools she was having and I witnessed) but we didn’t have the bags available to get a urine specimen and there were no catheters. I had to make a decision on whether to treat empirically or manage conservatively. That was a tough one.

I had another young lady presented with severe left sided abdominal pain with difficulty ambulating. She was diffusely tender on exam but her pain localized to the left. Urine pregnancy was negative. Urine dipstick was WNL (no blood). No flank pain and denied constipation. She had me very concerned for a surgical emergency and I was unable to obtain ultrasound for diagnosis. After a bit of discussion we got a flat and upright abdominal X ray which showed a large stool burden and after a glycerin suppository she felt much better. She even ran up to hug me and said thank you before she left. It was a reminder that I am helping in some ways (even if I’m not as efficient in the setting I was in.)

Overall, I had a wonderful but busy day! Coupled with the long drive home, I didn’t have the energy to write this post that day, but I’m excited to explore the other two clinical sites!

~ Iréal

From the moment I signed up to come and serve in Jamaica, I had the expectation that it would be an incredibly rich experience for me as a person and as a pediatrician. The feeling of being in a different setting and having different resources is an awareness of what we daily take for granted. You come to learn that even though you are here to help, the experience helps you even more. Here you come to rely in what you have learned and not who you can consult. The contrast of having specialists, to you being the only one the patient can see is an awakening experience. It makes you want to be an even better physician. It’s incredibly gratifying to feel that you are useful and necessary, that our profession is even better than what we thought. To see the happy and grateful faces of the children and parents is priceless. To learn more about how different we can be when we grow up in a different country but at the same time that the values of love, gratitude, kindness, joy don’t change, makes you realize that we are more similar than what we think. I’m humbled by all that Issa trust has done and keeps doing for Jamaica, because many people are blessed but very few give back. I hope that what I have seen and experienced reminds me every day to never stop giving back.  I  can never pay back all that this rotation has done for me but I can keep on putting my grain of help.