Good morning! My name is Ajay Grewal and I am one of the visiting US resident physicians through the ISSA trust foundation.  I would like to begin my first blog post by thanking the Issa trust foundation for this wonderful opportunity.  I truly feel blessed to be able to work with this world’s most innocent beings through a foundation with an outstanding but difficult mission.  It has always been a dream of mine to volunteer throughout my life in developing nations as a physician and this one week alone has only fueled that passion. A little about myself: I am a Canadian who is currently doing his residency at HCMC in Minneapolis, Minnesota, USA.  I am in my final year of residency.  HCMC is a county hospital and equivalent to a parish hospital here in Jamaica.  These hospital are safety-net hospitals that serve the underserved urban and non-urban populations.  I always felt because I work in a county hospital in the US working in similar hospitals with similar missions would be a simpler transition for me but that assumption was wrong! This week has been both amazing and challenging for me in several ways.  From the time I wake up to the moment before I fall asleep I have constantly been humbled by the people who serve this mission and respect it.  My stay at Couples has been fabulous.  The resort is beautiful with a serene and peaceful ocean back drop.  There are endless activities but after a day of work I enjoy nothing more than grabbing a book in the evenings or just talking to the staff and getting to know them.  The staff at Couples Tower Isle are either great at smiling throughout their shifts as a prerequisite to their duties or are truly happy and appreciative folk (I favor the latter!).  They are incredibly respectful people who will go out of their way to assist me for the tiniest of tasks.  Their enthusiasm is infectious and they respect us visiting physicians so much I can say without hesitation I am not this deserving!  From my walk to morning breakfast to when I arrive in the evening, any uniformed staff I see will either say “good morning/evening”, “hey doc! *fist bump*”, “how was your day sir?” or “Ya mon you good!?”  I love it!  This instant connection between complete strangers is such a refreshing change from the world I come from where we often don’t even make eye contact with those we walk by in the hallways. Thus far I have visited all three hospitals/clinics at Port Maria, Annotto Bay and Port Antonio.  It is no secret that for visiting physicians the biggest challenges are adapting to a new health care system, working with paper charts (I can’t remember the last time I had written in a chart!), not knowing what medications are available, and being exposed to unfamiliar illnesses. I will never forget walking out of my villa Monday morning to find my driver (Steve – awesome man!) and head to Port Maria.  As I shut my door the first staff member I encountered in the front said “Doc is there any treatment for Chick V?”  I of course did not know what this was but soon figured out he was referring to the Chikungunya virus.  I had heard about the arrival of the virus in Jamaica but was unaware of how prevalent the illness had become until I arrived.  The poor man had obvious joint pain and discomfort and I felt terrible telling him “there is no cure friend, but I brought some Tylenol and that might help with the pain”.  I was a little nervous because I honestly had no idea if NSAIDs/analgesics were very effective and was afraid I’d disappoint the man.  I ended up giving him some and the next morning he was all smiles and told me he gave a bunch of the Tylenol to his neighbors who were also afflicted.  He was so thankful I couldn’t believe it – all I did was give an over the counter pill.  I now understand the locals appreciate gesture and goodwill as much as positive results.  I myself am nervous about contracting the viral illness but if an entire country has lived through it then what am I – I’ll be fine!  I find if I remember some of the endearing names for the illness I’ve heard I can lighten the worries.  I’ve heard Chik-V, chikun bit me, chikun got me, think I even heard chikun-gonorrhea once. I have absolutely loved my drives to each hospital/clinic along the coast line.  I’ve spent my entire life in industrialized urban concrete jungles so to me these AM coastal drives with mountainous terrain to my right and stunning blue ocean to the left is a novelty.  The drivers have been very patient, respectful and great conversationalists.  Most of what I about Jamaica are through these stand up gentlemen.  The roads are winding and I’m used to multilane expressways so my vestibular system has been tested but I have persevered without medication thus far. I can go on and on about each hospital and the people I have met there and I’ll speak more in later blogs.  I will say this: with limited resources the staff do a lot and have a very positive outlook.  A huge challenge for me has been knowing what to do with the resources that are available, what kind of cases are hospitalized here vs back home.  A luxury I have In the US is knowing that if there is diagnostic uncertainty with an acute illness, I am assured it is not very difficult for the parent to return to clinic for a follow-up and reassessment.  This is a challenge here as many of our patients either walk or travel distances to come to these hospitals so I am trying to do as much as I can in one visit.  I do want to thank all of the hospital staff from the registration folk, nurses, MDs that I have encountered.  Dr. Ramos, Dr. Ravi and Dr. Brown have been very helpful and have helped me feel comfortable in an unfamiliar setting for me. Coolest case of the week: asides from Chikungunya illnesses (new concept for me) I saw a child with Grave’s thyrotoxicosis in clinic and referred her to university hospital.  It took some education and diligence to convince the mother the child needs to go to Kingston but I think I got through to her.  It was a classic Grave’s case and maybe I’ll present it at rounds next week. I’ll post pics soon! Thanks all, respect!   Ajay