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This was my second time through the pediatric rotation in Jamaica. I had come initially March 2012. I felt it was a good experience in terms of being a balance of helping out as a pediatrician in  an underdeveloped country, while at the same time staying in a beautiful and safe location. Fortunately, both times my wife , who is a special education teacher, was able to accompany me. She will write separately of her experience. Since this is a repeat experience, one tends to compare this time to the previous. For sure, the weather in December is much more unsettled than it was in March. Many days this year would rain or be too windy for the water activities, but of course this is nothing compared to the snow storms we heard about occuring during this same time in the US. It was nice to see and be recognized by the doctors and nurses at the various facilities. At Port Maria, I seemed to be busier than I recalled in the past. I got to draw labs for a few of the kids-one with crampy ab pain and another with fainting episodes. The CBC machine was not working, so the blood needed to be sent out. Another child who was having RLQ ab pain and I felt should see a surgeon, had to be transferred to Annotto Bay. I saw a few rather significant abcesses at Port Maria, one a tennis ball sized axilla one who I walked over to the A/E for drainage and a dental one I started on Clindamycin and sent to a dentist. At Annotto Bay the next day I saw a one month old with several episodes of rectal bleeding and after discussion with the doctors there, was advised to send him to Bustamente Children’s Hospital in Kingston where he could be endoscoped. Of course there were multiple kids with wheezing and some who did not clear after the nebs needed admission. The doctors in the A&E and on the phone are approachable and helpful, so I did not feel unsupported even though I was doing more with less diagnostic and treatment options. I was not constantly busy. There were often down times were I could read a book or talk to some of the staff doctors who were trained in places like Cuba, India as well as Jamaica. Things I wish I brought were: a copy of the Harriett Lane Handbook, somehow it was not at the room at the resort; and a head lamp since once I needed to remove a foreign body from a child’s ear under less than ideal lighting. I concluded my two week stay with pretty much the same feelings after my first experience. While much is lacking materially in the medical experience, the children are being cared for by nurses and doctors who do their best under less than ideal circumstances. I appreciate Diane and the Issa Trust Foundation for enabling me to participate in this program. For sure it is an experience I will not forget.   RP