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Reported by the Jamaica Gleaner Friday | April 22, 2016 | by Christopher Thomas

Director of the Western Regional Health Authority (WRHA) Dr Ken Garfield Douglas (left) exchanges a warm handshake with Chairman of the Issa Trust Foundation Paul Issa, while President and Chief Executive Officer of the foundation Diane Pollard shares the moment. Occasion was handover of neonatal equipment to the hospital’s special-care unit.

WESTERN BUREAU:

The Issa Trust Foundation has given a commitment to the Savanna-la-Mar Public General Hospital in Westmoreland to fully outfit the facility’s neonatal unit as well as finance the training of staff to care for premature babies.

The commitment was given on Tuesday by Paul Issa, the chairman of the Issa Trust Foundation, during a brief launch ceremony on the grounds of the hospital. He also used the opportunity to outline additional plans by the organisation to improve health care at the hospital as well as at other facilities islandwide.

“I think we know that this hospital, along with every other hospital in Jamaica, has had some severe challenges, but we hope to be able to help you bridge the gap and address these issues,” Issa told stakeholders in his brief address. “We want to help you to improve the service that you offer to the community of western Jamaica.”

The neonatal unit has been equipped at a cost of J$24 million. Additional funds will be provided for the training of the staff to operate and maintain the facility. The foundation has also donated US$2,000 (J$244,460.50) worth of disposable equipment, which includes tubing and hypodermic needles, to the unit.

“The unit is based on the model of the special-care nursery we did at the St Ann’s Bay Hospital a few years ago, which has reduced infant mortality rates by 30 per cent,” said Issa. “We have replicated that here, and I think it is really going to change the quality of the neonatal health care at this hospital. We are going to be in an ongoing relationship, and we are very excited about it.”

SIGNIFICANT BOOST

Dr Alfred Dawes, the hospital’s senior medical officer, said the gift of the neonatal unit is a significant boost to the hospital’s capacity to provide high-quality services.

“This unit has really boosted the hospital’s efforts at providing care. Before that, we were not equipped to deal with premature babies, and so they had to be transferred,” said Dawes. “If they were unfortunate enough to be the ones who were not accepted by Cornwall Regional Hospital, then we would not be able to care for them and they would die.”

“With the commitment of the Issa Foundation, and the training programme and the increased staffing that we expect to get, once the nursery is up and running fully, then we should be able to provide top-class care for these premature babies,” added Dawes.

Week in Review

• If you recall the 2 yr old who had a blade of grass stuck I his throat last week, you’ll be surprised to know that he was admitted several days after our meeting for allegedly ingestion Clopidogril ( an anti-platelet medication that can cause bleeding). But you”ll be happy to know that he finally swallowed the grass without needing the ENT referral.
• The x-ray machine was malfunctioning for several days in Annotto Bay, so we really had to put our clinical skills to the test.
• The team at Annotto Bay were able to facilitate a transfer for a newborn term infant to Bustamante Children’s Hospital in Kingston within hours of birth because of impending respiratory failure. The new intern had a look of fear on her face as they left. Our words of advice: you can use bag mask ventilation till the cows come home. Unfortunately the baby passed soon after arrival.
• The interesting cases for the week go to a 7 month of female at Annotto Bay hospital  who was admitted for failure to thrive and dehydration. She has multiple abnormal electrolytes along with pneumonia. At this time the working differentials were Cystic Fibrosis and Bartter’s Syndrome. With hydration she improves clinically but continues have abnormal labs. A nephrologist in Kingston has been consulted to evaluate her. The second case is a 14 yr ol female at Port Maria hospital who had significant right arm pain, limited range of motion at the elbow and severe point tenderness at the joint. Our concern at the time was fracture, septic joint, or osteomyelitis yet there was no history of recent trauma, fever, or joint swelling. An xray of the right elbow had what appears to be an intraossessous bone cyst/abscess. Orthopedics were consulted from the next parish in St. Ann but the patient will have to wait until next week to be seen.
• We have noticed over the course of the month that many newborn infants whether in the A&E or Clinic have a red ribbon or band on their wrist. When asked “what is this for” to the mothers, the common response is “Me nah kno, fi him/her grandmada did put ti pon deh”. After a quick google search we found that this is a Jamaican custom to place the red tie/band on the hand or foot to ward off evil spirits.
• 

  Dr Ravi working on patient transfer to Bustamante Children’s Hospital

  

  Dr. Nicole Davidson taking a brief and much needed break at Port maria A&E

  

  Dr. Roxanne Samuels,
  reviewing arm film of our 14yr old female.

  

  Dr. Hayden-Peart

  
  

  children in infant class at Free Hill Primary school

  

  Mr. Rory Suarez, great driver

  

  Dr. Wilson on our last day at annotto bay

Global Health Rotation in review: Nicole and I are very glad that we decided to do this rotation. We are both of Jamaican heritage , we have a special connection to the island and feed a personal responsibility to keep giving back. We recommend that other residents try to do the rotation in pairs. Working in pairs can be great when trying to manage patient loads and maneuver through the Jamaican health system. We both had the pleasure of meeting with a couple hospital administrator by happenstance but this that these introductions should be standard to provide an introduction to the healthcare system. While to orientation was helpful is seems to be out of date with what labs, ,medications, imaging, and consultations are available at each facility. Having these resources prior to the start would have helped with a smoother start. We recommend that any residents and volunteers visit the Free Hill Primary and Infant School excursion provided by Couples Resort. This gave us the opportunity to see the children you serve in a more natural state, the communities they live and learn about the structure of the education system in Jamaica. Special Thank You to…

• thank you Diane Pollard of the Issa Trust Foundation for assisting use prior to and during our ration. The hotel staff have treated use like family and we truly appreciate all the accommodations made on our behalf.
• Thank you to all the medical and hospital staff at Port Maria Hospital, Annotto Bay Hospital and Port Antonio Hospital.
• Thank you to the hospital administrators, Dr Sloley, Dr. Hayden-Peart and Ms Nunez of Port Maria, Drs. Ramos , Ravi, and Wilson of Annotto Bay, and Mr. Campbell and Dr. Levwok of Port Antonio. All these people have helped us and taught us many lessons for which we are grateful. These service that these people provide to the country of Jamaica s greatly appreciated. Keep trying to change to world.
• Thank you to all our drivers who got us to and from work safely. Special shout out to Mr. Munsie, Mr. Forbes, and Mr Steve.

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. https://jamaicans.com/jamaicaneasterbun/ 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