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It is so wonderful to be back in Jamaica!!  Diana and I landed in Jamaica on Friday.  Walking back into Couples resort after 11 months honestly felt like coming home.  The staff at the resort are wonderful and it was so nice to be remembered and hugged by so many of them.  It’s great to walk through the halls and hear “hey doc” and see a familiar face!!  Enough cannot be said about the wonderful lodging that Couples provides to all the doctors volunteering with Issa Trust.  From the beautiful and safe facility to the amazing food and drinks to the countless entertainment, this place cannot be beat!  All the staff also asked about Stevie and were sad she wasn’t joining me this year but were excited to hear she is expecting her first little one and also excited to meet Diana!! Diana and I were very excited to get to meet Diane Pollard and Pat Brophy, the CEO and chief medical officer of the Issa Trust Foundation.  I have been talking with Diane for over a year now but it was great to finally put a face to the name!! We have had so much fun hanging out with these two and getting to know them better.  I continue to be amazed at what these two have accomplished for advancing pediatric care in Jamaica.  The need is so great in this beautiful country and the Issa Trust Foundation continues to do everything it can to reach out and help.

Our first weekend in Jamaica was spent relaxing and enjoying this beautiful weather!!  It was snowing in NC when we left so I can’t tell you how grateful I was for 80 degrees and sunshine.  Friday night started with an amazing lobster dinner,  great wine and wonderful conversation about the beginning of Issa Trust!!  Saturday we spent the morning laying out on the beach relaxing.  D and I both just completed very busy months working 80 hours per week so I can’t stress how important having a couple of days to decompress was!!  In the afternoon we took the catamaran cruise.  Anyone who red the blog last time knows how much I love the catamaran cruise!!  Again, it was perfect– tasty drinks, catching up with the friendly staff, swimming in the ocean and completing it all with an awesome dance party with all the others on board!!  Saturday night was the weekly gala.  Although D and I were both tired, the entertainment here cannot be beat and we were on our feet dancing in no time!!  Sunday we spent the day on the beach and I must admit we both got a little too much sun.  However it was Super Bowl Sunday so we spent that night eating tailgate food and watching football on a big screen projector on a rooftop bar in the middle of the Caribbean — that my friends, is a tough night to beat!!

On Monday we got to work which is the real reason we came to Jamaica — to take care of these adorable children!!  Monday and Tuesday were spent at Port Maria Hospital which was one of my favorite hospitals we worked at last year because the need is so great.  D was in the clinic and I was in the A&E.  We saw plenty of cases of rashes, viral gastro, fungal infections and asthma exacerbations.  On Tuesday my morning started by seeing a 7 month old female with an incarcerated inguinal hernia.  Mom stated that she’d noticed the mass protruding and getting hard about 15 hours prior.  When I saw the child the inguinal hernia was hard, painful and not reducible.  The child was also vomiting every time mom tried to feed her.  As this was a surgical emergency and Port Maria has no pediatric surgeons, I worked quickly to try to get the child to Bustamante Children’s Hospital in Kingston– the only children’s hospital for all of the English speaking Caribbean countries.  After several attempts I was able to get in touch with a pediatric surgeon who was wonderful and said to get her there as soon as I could.  I made her NPO and placed her on the ambulance.  I am hoping to speak with the surgeon again to see how she did.  Even in Jamaica continuity is great!!!

After work, D and I had an interesting conversation about vaccines here in Jamaica.  Here oral polio is still used instead of the IPV vaccine we use at home.  She had a 19 month old who was having diarrhea but was due for oral polio.  This led to an interesting conversation about  possible immunocompromised family members, shedding of a live vaccine, multiple concerns regarding oral polio and whether now was the best time to complete the series.  However, there was also concern on whether the mom would actually bring her back and if this could be the only opportunity to vaccinate her.  Just like at home, we have to weigh risks and benefits with every patient we see.  It’s so nice to sit down and talk about patients and medicine.  We are constantly talking about the patients we saw that day, reviewing their presentations, and running our plans by one another.  Especially after coming off of busy months, it is such a blessing to have time after a long day to really process what you did. The opportunity to process rarely, if ever, comes when working at home. I think most residents would agree that in an age where so much of medicine has switched to shift work, by the time you’re off work you’re often so exhausted that the only thing you can do is eat dinner, shower, and go sleep as you prepare for the next day.  It is wonderful to just sit and talk about medicine.  With all that Couples has to offer I’m sure it may seem like medicine is the last thing that would be on our minds but that’s simply not the case.  I continue to be grateful not only for this amazing opportunity but also for the much needed downtime.  This rotation provides a great opportunity to help people in need, sharpen your physical exam skills, and enjoy the beautiful country of Jamaica.

We’re driving back from Port Maria now and this view is breathtaking.  It’s a beautiful Caribbean day and we want to soak up every second!! Happy and so grateful, D & S

We were privileged to be able to start our day in Port Antonio with a brief presentation about febrile seizures to the doctors and nurses on staff at the hospital. While febrile seizures are quite a common issue for us as pediatricians, they can be daunting for doctors who are not as familiar with kids. A lively discussion followed the presentation (as are most discussions in Jamaica) and we all walked away with a deeper understanding of practicing medicine effectively with the resources available.

That being said, now that we’ve been in Jamaica for almost three weeks, I feel that poverty has become personal. There are now names and faces and images that come to mind when I think about “resource poor settings.” It is the legs of a child with a bacterial superinfection that has been ineffectively treated for months with an antibiotic known to have a high level of resistance because there was nothing else available. It is the back of an ambulance equip with little more than a pair of latex gloves, a bag of expired normal saline, and a small sliver of hope that anything useful would be able to be accomplished should a true emergency arise. It is the mother of an asthmatic who fashioned a spacer out of plastic cups because she couldn’t afford one but acknowledges its importance for her child’s health. And while these disparities become personal, they also become impossible to ignore.

Rounding on the inpatients with Dr. Ramos and the residents at Annotto Bay continues to be one of the highlights of our week. One patient in particular has captured our hearts, and we have had the opportunity to watch him improve and become more interactive from week to week. Such an amazing experience!  

It’s been an exciting week here in Jamaica — both in clinics and at the resort. We returned to Annotto Bay Tuesday to round with the residents again which was one of the highlights of the week. I was able to see one of the same patients that I took care of last week which provided for some unexpected but welcome continuity. He is a 5 month old with failure to thrive thought to be secondary to congenital heart disease. The team was able to obtain an echo which was reportedly normal; however, the it lacked several key pieces of information. Cost and the availability of echo techs and cardiologists (much less pediatric echo techs and pediatric cardiologists) eliminate the option to repeat the study.  As is the case with much of the medicine we practice here, decisions must be made based more on clinical outcomes that lab results, imaging and other studies. He has been doing quite well on diuretic therapy and having failed a trial without it, he will continue to be treated as a patient with a cardiac anomaly despite his normal echo report.  Add proper nutrition to the mix and he looks like a new (little) man. Last weekend, the Couples Tower Isle celebrated it’s 36th anniversary. There was a celebration Saturday night which, despite the rain, was fantastic. Many new and old employees and guests were in attendance. Alison and I were able to help with some of the decorations. We were quite impressed with ourselves and our abilities to string lights flowered centerpieces. After admiring some of the other decorations Saturday night, I’m pretty sure they gave us the easy jobs.  And I’m convinced that some of our work was later revised…we’ll keep our day jobs for now.