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As a family physician with mostly outpatient pediatric experience, I found the first patient of the day a little daunting — a 4 year old with congestive heart failure due to rheumatic heart disease, AND sickle cell disease. Where I live this kid would inhabit multiple subspecialty clinics at a university hospital. However, she looked great after her Lasix adjustment and was ready for discharge. A referral from the local health center of a kid with a fever and rash later in the day reminded me that outpatient experience counts for a lot. A sandpapery rash….and a red throat to go with it. I’ve seen enough scarlet fever over the years to recognize it immediately. And I’d had a reminder just this morning of how important it is to treat strep! I’m celebrating my birthday today….let’s see, with a sunset from my balcony, a stroll on the beach, and dinner with an ocean view. Guess I’m celebrating my birthday month! because I get to do that every day in July.    

Almost every child has a “cold.” The symptoms are as follows: swollen eyes, fever, abdominal pain, and joint pain. Then you have to figure out what they have — the kid with pneumonia had the exact same chief complaint as everyone else (the difference being her respiratory rate of 44). The trick, wherever you are, is to figure out what your patient means and how to translate it into what you mean.(It took me the longest time to figure out that when my US patients say they’re “dehydrated,” they mean their mouth feels dry. Not dehydration as I understand it, any more than Jamaican kids have a cold as I understand it.) Moms are really on it. They have got the protocol on using oral rehydration solution when their kids have gastroenteritis. “DPH” seems to be quite a popular remedy for the ubiquitous cold. It took me a bit to figure out that this is diphenhydramine, aka Benadryl. Perhaps moms like it because it puts the kid to sleep while they get over whichever cold they have! On day two, I remembered to ask an important question — has your child had worm medication in the last 6 months?

are the same the world over. They run and tussle push each other and fall and break things. I saw two of them today — a distal humerus fracture and a radius/ulna fracture. Both got placed in posterior splints and send to the ortho clinic at St Ann’s Bay. Week one, day one. Medicine — it’s the same the world over. Nurses are helpful, colleagues answer questions, moms have lots of concerns about their kids. Oh wait…I haven’t had any moms in California ask (about pink eye and allergic rashes) “could it be Zika?”

Friday I returned to Port Antonio. I alternate Friday’s working between the Hospital (top of the hill) and Health Centre (bottom of the hill). Since its a 2 hour drive from my base in Tower Isle, Fridays involve a lot of commuting. It’s a beautiful hilly winding drive, though, especially in eastern Portland Parish where Port Antonio is. “Lush” is the word that comes to mind. The “bush” as it is called here, is filled with palms, orchids, wild bananas, and huge flowering tropical trees. Portland Parish is called “the Garden Parish” and is decidedly less developed than the western end of the north coast. The bush itself is very dense and wild feeling. I’ve read that Port Antonio was THE tourist center in the 1940s and 50s . The actor Errol Flynn ran his yacht ashore off of Port Antonio and liked it so much he ended up staying. His Hollywood friends followed and Port Antonio became THE destination of the rich and famous. Today its pretty quiet though a yacht harbor here bears his name. The town itself has become somewhat of a backwater despite its natural beauty. There are no pediatricians here that I”m aware of. I function as a consultant while here rotating between the local health centre and the hospital/ED. Sicker kids are referred to Annotto Bay or Bustamante Children’s Hospital in Kingston. Finally, I was asked a question this week by a concerned Mom (Mummy) in Jamaica. I had just finished seeing her daughter who had a very obvious case of impetigo on her face and arms. I had completed her prescription and talked about treatment with Mummy. “But wait, doctor, what about her sugar medicine”. Whoa! did I miss something important? She sure didn’t look like a new diabetic, there had been no history of diabetes, she sure wasn’t ketotic….. As I started to ask Mummy about symptoms and diabetes, she replied “no doctor, every time she eats sugar this comes”. Her favorite food? Sweets of course…..problem solved!! No more medicines needed, Mummy, just stop the sweets!! and Mummy smiled