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So living in paradise and working in the tropics is amazing!!! I have been here 12days now, and my adventure is starting to wind down 🙁 but I plan on enjoying every bit of it.  Highlight of my week, there are many, but biggest is that I have a roommate!!! Yay Dr. Rena coming from Ohio to join the Issa fun.

I made it out to Port Maria this week on Monday.  I commandeered another corner of the A&E in the name of Paediatrics, saw a few sick visits but as it was a rainy day there was limited turnout.  What I did see was a pretty impressive L mandibular dental abscess which had been referred to the A&E from a local dentist.  I admitted her and started her on IV Augmentin, I attempted to use Clindamycin but there was none available.  The downside was that I knew that even once the antibiotics improved the inflammation, that she ultimately needed the tooth extraction.  This is a down point because access to dental care is even more limited than health care down here.  The happy ending is that when I returned to work on Tuesday, and visited her on the ward she was able to fully open her mouth and her pain was improved.  Though the ending is not ideal, I did make a difference.

Wednesday may be my favorite day of the week here.  The day starts with inpatient rounds, and the medicine is overall similar but the drugs of choices and incidence of drug resistance are worlds apart it seems.   There is always good discussion about Western trends in medicine and whether or not it is applicable herein Jamaica.   From there I wander down to the A&E.  It is always curious to me when the nurses ask me if I will see a child >12yo.  It was explained to me that their Pedi wards go from 0-12yo, but this limitation is due to the size of the beds.

Back down in the A&E my day was just about down when a frantic father brought in his 4yo son.  Seems the unfortunate little one was found at the other end of his sister’s bucket and had been hit directly in the eye.  His conjunctival edema was so impressive that I was very worried about a conjunctival laceration.  We were able to refer him fairly quickly to Bastamante Children’s to see ophthamology.  After this busy day I get to ride back along the countryside and watch the sunset as I rode.   Working in paradise, is a gift.


Working is great, but this is Jamaica we are talking about and I now have a fantastic partner in crime.  So far we’ve taken in tons of fantastic food, shopping and reggae dancing.  I look forward to the International Gala the resort is having tonight.   The setup looks fantastic and I am sure the food will be amazing as always! 

The view from Annotto Bay A&E

Port Antonio Paediatric Ward, about 10 beds and cribs in one large room.

Looking out at the island at the end of a long day…

Every morning I look to my left and there is the amazing Atlantic.  I am about one week into my rotation, and I’ve now been to the Annotto Bay and Port Antonio Hospitals.  The commute from the resort to Port Antonio is about two hours, I can’t tell you for certain because I was completely distracted as we were driving through the rain forest.  Crazy lush foliage going up hills/mountains, crossing over the Rio Grande and the Atlantic Ocean is pretty much always just over your left shoulder. This is all in a day’s commute.  Mr. Campbell,who is one of the adminstrators at Port Antonio, drove me on Friday I used this time during the commute to learn about the quality of life in Jamaica from education to shopping to roads. 

Once at Port Antonio, I had a chance to visit their Pedi Wards.  They are set up differently than ours in the US but they utilize what all of the resources are available.  There is definitely a need present.  Their facilities have relied on a lot of international donations, I am at total a 4hr flight from home and technically Hawaii or California is further but the difference in resources is night and day, Seeing how they are functioning on minimal resources(no code cart, limited number of nebulizer machines(like 2), no cardiac monitoring or unreliable pulse oximetry).   I never thought I’d actually be recommending the use of oral Albuterol, but the need forces your hand.  It forces you to rely on clinical judgment which I guess is why its the practice of medicine.

A common theme, seen both in the US and here in Jamaica, is the difficulty in chronic care management of our children with cerebral palsy and what to do when families become overburdened with their care.  I had a good discussion with Dr. Barrett about how best to optimize their care with simple interventions such as benzos and stretching to improve spasticity to increase their ease of care.  

Life back at Couples is fantastic, the staff is amazing.  It is the weekend, so I have tons of free time.  Between just enjoying the sun so far today I’ve been kayaking and sailing on a “Hobie” in the Atlantic.   I am pacing myself because all of these water adventures occur between delicious meal times and sunbathing.  Well cocoa bread is calling me and there is still some sun left, I will tell you guys more later. 

After a good nights rest and some medication both myself and Stephanie felt much better. It took awhile to get going on Friday but the Jamaica sunshine is a great motivator.We were unable to go to Port Antonio on Friday which made us both sad because we’ve seen so many great cases there and their need for Pediatricians is perhaps the greatest. Dr. Ramos only sees pediatric patients on Tuesdays and he has to limit the number to 15 given his other duties. Now that the community of Port Antonio is catching wind that we are present on Fridays the patients come in good number.

I have to say we took our last weekend by storm. We first decided to lay in the sun and relax as both of us had not felt well for the pat 24 hours but after watching everyone else on the resort participate in activities we were both itching to do something. We decided on snorkeling and had a blast. We saw tons of fish, my favorite were these amazing light blue ones that reminded me of Dori on ‘Finding Nemo’ and Stephanie loved the yellow fish with black stripes which she thought kind of resembled Nemo 🙂 She was also lucky enough to see a sting ray! I was soooojealous!! We were pretty exhausted after this one little excursion so we returned to the room for some rest and nearly slept through our dinner reservations made over a week ago. But no worries, we rallied and got ready in no time. After all…you can’t pass up the amazing food here on Couples resorts.





Saturday we awoke to go train for scuba diving. We had been looking forward to this the entire trip but typically they only do classes on weekdays. We first did a swim test (you have no idea how hard 4 laps
in pool can be) and luckily we both passed! We then watched a 30 minute video about the equipment and safety instructions for scuba diving. Then we were off to the pool in our gear. We like to think we looked fashionable but our wet suits were a little awkward fitting to say the least. We practiced in the pool for about 45 minutes but unfortunately I had a cold and was unable to clear my ears at just 6 feet (the depth of the pool) and that’s not safe for scuba diving. Steph and I had a blast practicing in the pool and our instructor was phenomenal. I guess I’ve just been loving up on too many sick Jamaican children in the A&E 🙂 Since scuba was out and we were feeling adventurous we decided to go skiing behind the boat. We’ve both have been water skiing behind boats in the lake but never the ocean so we were beyond excited. It was late morning and the water was a little choppy but we both managed to get up twice and had a blast. Our boat driver Kenneth was so nice and knew exactly how to pull skiers out of the water.
















 Later that afternoon we went on the Catamaran cruise (our 4th time…we know, a little excessive) but we love the crew and the peacefulness off being out on the ocean. Plus we met some great people this time who were spending their anniversary here and had some great conversation. The waves were a little crazy and Stephanie and I had a few scares sitting on the front of the boat (I lost my prized blue aviator sunglasses!!) but all in all it was a great time. I found myself in a back flipping competition off the boat with one of the staff, Odain, and I like to think I won. He was much more fearless than me though and his one foot back flip was a crowd pleaser. After returning back to the resort, we participated in a Reggae Dance class on the beach. I’m sure we provided great entertainment and a lot of laughing for those watching. We again had a great dinner and ended our night by skyping our fellow 2nd year residents. This weekend was our annual retreat and we were sad to miss it but we like to think we were there in spirit. After much laughing and telling them about our experiences here we hit the sack looking forward to our last weekend day on the resort.
We woke up Sunday and climbed Dunn’s River. We had both done this before, Stephanie 6 years ago on a cruise and me on my honeymoon 4 years ago, but we were up for a 2nd trip. The sun was out and we again
were feeling adventurous. Our bus driver, Gary, had to be one of the funniest people I’ve ever encountered. He gave us a full tour of Jamaica on our way to the falls telling us about everything we passed from an Electric Store with the motto “stronger for longer” (you can imagine the jokes made) to the only radio station on this side of the island called ‘Irie’ which plays only reggae music. He then gave us a run down of the geography of Jamaica, explaining that we had passed through 4 parishes from the airport to the resort which resides in St. Mary (interesting fact is that Port Maria where we work Monday and Tuesday is the capital of St. Mary). We arrived at Dunn’s River and after very strict instructions from Gary regarding vendors and video purchasing we were off. It was a great group of people from the resort and we had an absolute blast. Walking hand in hand with a bunch of strangers up a waterfall doesn’t sound like the safest thing but we were taken care of by our guides and each other. From falling backwards into the water to going down a natural slide made in the rocks we were smiling the entire time. We don’t have pictures because we forgot to bring a waterproof camera but it was beautiful and a great time overall! We got back to the resort and spent the rest of the afternoon relaxing in the sun and making tie-dye shirts!!! I was much more excited than Stephanie as tie-dying has long been a passion of mine, just playing, kind of.  We made late afternoon spa appointments for a facial and pedicure, both of which were wonderful and a must if you get time. By the end we were so relaxed and thankful for the much needed pampering. We then headed to dinner and like always the food was amazing. We also met this great couple who were on their 13th trip to this resort and had a son in his 2nd year of medical school!! We had great conversation with them and ended the dinner stuffed!

                      
 

Today was our last full day in Jamaica and Stephanie and I both woke up sad. We pumped each other up at breakfast and reminded ourselves we were dedicated to returning. The children of Jamaica have a huge piece of our heart and the need for their care is immense. We spent the day at Port Maria, which is perhaps my favorite hospital because we see the most volume there and the nurses are phenomenal and extremely helpful. We learned from our driver this morning that Port Maria serves 66 communities and 8 surrounding towns. No wonder the volume is so great! We also learned that they have no ultrasound machine or tech in the entire hospital. You must be referred to St.Ann’s which only accepts 2 patients a day. We are blessed to have so many resources in America, this trip has taught me never to take that for granted. Stephanie spent the day in A&E and myself in clinic but upon our arrival we were met by a concerned mother. I had seen her 3 year-old boy last Tuesday for an ear infection and possible right-sided inguinal hernia. Mom’s description of a bulge while crying or coughing was consistent and on my exam I could appreciate a bulge during valsalva. I made a referral for pediatric surgery at St. Ann’s which only holds clinic Tuesday and Thursday morning but mom had not gone. I also gave her instructions for seeking immediate medical treatment if the bulge became painful and constant, there was color change over the area, abdominal distention, or uncontrolled fever. She followed those instructions thankfully and today she explained that the bulge had been persistent for 2 days and he was now limping while he walked complaining of pain. Stephanie and I were absolutely concerned for incarceration and after our physical exam and a discussion with the A&E physician the plan was for immediate transfer to St.Ann’s to be evaluated by surgery. What an eventful way to start the morning! Clinic continues to be busy here at Port Maria and I saw many skin infections (a kerion being a new one) and lots of colds and ear infections. I had an especially adorable 1 year-old who was intrigued by my stethoscope. Sadly his newly erupting teeth posed a great threat so I eventually had to take it back but not before some great pictures!


Stephanie was in the A&E and had another appendicitis scare! Once again the lab was down so she only had an abdominal X-ray to help her in addition to her physical exam. And guess what? Constipation strikes again. She also had a little girl brought in by her Aunt for breathing difficulties. On exam she was wheezing with crackles on the right lower base and her vitals on presentation revealed hypoxia. She was placed on oxygen immediately and given a breathing treatment. Unfortunately she didn’t improve and was admitted to the hospital. She was treated with CTX and continued on oxygen with the admission diagnosis of bacterial pneumonia. Most of her labs and CXR will have to be done later since everything had closed down for the day.


Our last drive home from work was gorgeous like always. After you get out of the town of Port Maria it’s just ocean for a few kilometers and it’s breathtaking. Nothing can ever beat it.
Tonight were packing (and maybe crying) as we prepare to leave in the morning. We can’t believe it’s already over. We’re planning on going to the beach party tonight followed by Margaritaville with the rest of the resort-goers 🙂 it should be a great ending to a wonderful trip!






Fully blessed and sad to leave,
S&S