Blog

September

Week 1

Hi Issa blog family!
Week 1 was a very great learning experience. Port Maria was the busiest of the 3 clinics/hospitals.
There were a lot of sick visits during my 2 days at Port Maris, there seems to be a viral illness going around, causing high fevers, uri, and h/a. One boy who was 13yo had h/a, fever and nucchal rigidity on exam and while my gut feeling was that he probably had a viral meningitis, I couldnt be 100% sure so I walked him and his mother over to the ED dept where I was able to draw labs, send off a blood culture, attempt a spinal tap (which was unsuccessful because there were no spinal needles available, I was using 21g angiocaths); but he was admitted and would receive IV ceftriaxone. He will probably be home by the time I go back next week.

Annotto Bay reminds me most of home; Dr Ramos is an excellent Pediatric clinician and functions as a ward attending; he had 2 pediatric residents and I made a 3rd as I pre-rounded on a few patients as well. Once Dr. Ramos arrives we rounded on the patients with him and he does sit down rounds and PIMPs the residents. One case I took care of was an infant with indirect hyperbilirubinemia, likely 2/2 ABO incompatability; he was on phototherapy however I was not able to discern whether he was getting high intensity; one of his treatments was phenobarb, initially i thought is he withdrawing froms drugs because this is a setting i see phenobarb used, but dr. Ramos explained to me that he was on it because phenobarb aids in liver maturation (this baby was 1wk premature as well). That day I also learned to do a femoral arterial stick! The second day is a well baby clinic; most of the infants born at the hospital get seen at 2wks of age; if there is nothing concerning on exam they are d/c from Anotto Bay clinic and f/u at a private doctor or the various health centers in the parish they live in. I saw an infant with ring worm to the forehead and mother’s lesion was on the R forearm; so I had to treat both with topical meds; there was another infant with an ear skin tag; where I am being trained we routinely do not get RUS as majority are wnl; however I confirmed what was standard of care with one of the residents and they do routine RUS so I gave the mother a lab slip to get it done when she could (she will be paying out of pocket ~10-20,000 Jamaican dollars).
Lastly coming home to couples resort is a real treat; for the real authentic jamaican food definitely the monday night beach party is where it is. Also personal trainer Alfred is really great and will customize a work out plan for you!
Till next week; I am going to read up on tinea infections and meconium aspiration syndrome.
~K. Godfrey, MD

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September

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Day 1: First day was on a Friday- the day you go to Port Antonio hospital/clinic, which is in the parish of Portland. The ride was very scenic, and while the roads were winding they were very pristine; coming from the Bronx, NY it was nice not having to go over any potholes!
I totally forgot to bring my camera, however next friday I will so that I can catch some pics of the livestock hanging on the road sides; the local pple selling their produce (ackee, bananas, guineps) in addition to getting a great shot of the houses espetially the ones that resemble mini-hotels…I even think I saw one that was in the shape of a ship..Ill be sure to post of pic of that to convince myself!

Anyway; the hospital at Port Antonia has 2 stories, with multiple areas. The pediatric ward is humble, 1 large room for all the patients and directly across is the playroom/sitting area for families that come to visit their children. I worked most of the day in the outpatient wing; there I was in an airconditioned room…was very grateful for that, as I completely forgot I am in Jamaica and brought a lot of polyester tops rather than cotton (lol). The room is partitioned by a curtain, beyond the curtain is the examining table.
The room had hand snaitizer, soap, a sink to wash hands; papertowels and tongue depressors.
All I really needed to bring was my doctoring tools; and maybe my Harriet and Lane.

The pharmacy is on the compound, I asked the pharmacist for a formulary; which was very handy as I was able to pick out the meds I would likely prescribe before seeing patients. So when I did prescribe something, I just placed it on provided Rx pads and patients were able to get what I prescribed w/o a hitch!

Overall the staff is helpful and pleasant to work with…shot out to Nurse Burks! she worked closely with me triaging patients and obtaining vitals.

The staff here also wanted me to discuss some topics, I did 2 of 6 so far. It was well received and interactive. We talked about Bronchiolitis and Fever in baby (0-60days old); overall they manage these patients well but do to some limited resources may not be able to do everything recommended i.e. urine culture/blood culture/csf culture or spinal tap may not be performed on an infant in that age ranges 2/2 cultures going all the way to Kingston (4+ hrs away) and not returning in time…so they just treat empirically with amp and gent. Or rather than treating initially with amoxicillin for an AOM, they jump right to Augmentin….
That’s all for now; Will see how the other two clinics are.
Ciao! going to enjoy a glassbottom boat ride.

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August

Pediatric Resident

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Excited about the trip; hope to learn a great deal!

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May

Governor General of Jamaica, Sir Patrick Allen Named Patron of the Issa Trust Foundation

Press Release

Miramar, FL, April 09, 2011 — His Excellency The Most Hon. Sir Patrick Allen, ON, GCMG, CD, was appointed Governor-General of Jamaica on February 26, 2009. A noted Christian, Sir Patrick Allen served the Seventh-day Adventist Church in various capacities for 28 years. He has served as Principal, Pastor, Director and President in the Central Jamaica Conference and West Indies Union Conference respectively. Sir Patrick is no stranger to public service in Jamaica, having taught in public schools for ten years, and while working with the church, served on the boards of the Government’s Public Broadcasting Commission, Police Civilian Oversight Authority, and the Strategic Oversight Commission. He was knighted by Her Majesty, Queen Elizabeth II in June, 2009. His Excellency stated, “The wellbeing of people goes beyond the scope of material and physical structures. It includes intangibles such as care, love, service and sympathy towards others, and this, merged with the physical provisions, determines overall wellness. “Since 2005, the Issa Trust Foundation, under the auspices of Couples Resorts, has been helping to provide health care and education for children and young adults in rural Jamaica. The focus on these two areas is important as they are critical to the development and prosperity of our country. “Your selfless service and volunteerism has helped to change the lives of many children and adolescents, who have experienced improved reading and writing skills. The access to much-needed medical services will enable many more persons to enjoy healthy, happier and more productive lives. “The Issa Foundation is a shining example of the positive results which come from acknowledging and effecting corporate responsibility in a practical way. I congratulate you and your local and international partners for the work which you continue to do. Your efforts are a true depiction of selfless love and service to others.” “We are extremely humbled and thankful for His Excellency’s acceptance, and for his enduring support of our work,” states Diane Pollard, President & CEO, Issa Trust Foundation (www.issatrustfoundation.com). “Giving children a healthy start in life, no matter where they are born or the circumstances of their birth, is the moral obligation of every one of us. We have a global responsibility to give of the utmost of ourselves, materially and morally.” “It is with deep gratitude that we salute his Excellency the Governor General, Sir Patrick Allen, for his willingness to serve as Distinguished Patron of the Issa Trust Foundation and his endorsement of the work of the Foundation,” states Paul Issa, Deputy Chairman of Couples Resorts. “Couples Resorts and its parent company, the House of Issa, have a long history of philanthropy in Jamaica, going back to the early 1900s when my grandfather Elias Issa became a successful merchant. He saw the need to ‘give back’ to his adopted home, Jamaica, where he settled with his father in 1893. From his humble beginnings as a pushcart peddler, he built a business empire that is still operating today, well over a hundred years later. Among the many charitable organizations he created were the Issa Scholarship and the Mary Issa Clinic. Today, as a result of the donations of many Couples guests and many other charitable entities, the Issa Trust Foundation continues in that tradition.”

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May

Goodbye..what a phenomenal two weeks!

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Hello…well I am back home stateside. Yesterday I said goodbye…for now to Jamaica. All I can say it was a wonderful 2.5 weeks. It was much more than I could have ever expected. As someone said it was well balanced….fulfilling work by day and peace, beauty and serenity by night. I think the best way to chronicle my experience is to do it by section….

1^st impression:

Well I have to say my first day began at Antonio Bay and was I in for a shock. My family is Jamaican and I have visited Jamaica many times since I was an infant and for some reason I do not think of Jamaica as a 3^rd world country. However I realized how much it is a 3^rd world country when I walked into the pediatric ward at Antonio bay. First all the babies and children are in one section…no separation for preemies (they would be in a controlled environment like a NICU here in the states) and regular sick children. The cribs were not of the best condition and were of different shapes and sizes. I guess you just have to see it to understand. On my way to the pediatric ward, I passed the maternity, women’s and men’s ward, and they were unlike anything I’ve ever seen. All the patients were in these huge room/wards with up to 20 patients in these wards. The 1^stdays at Port Maria and Annotto Bay was pretty much the same.

Patients:

Honestly I felt proud to be working with Jamaican children. I felt like I was giving back to a country of my ancestors. Most children came in with complaints of skin infections mostly eczema, scabies and fungal infections. There is A LOT of scabies. Not sure why…maybe it’s environmental…. Jamaica is a very lush, green island. And these kids came with chronic scabies infections. In some cases, due to scratching, they became super infected. I had to treat 2 kids with antibiotics due to super infection. In at least 2 cases, I could not identify the skin condition because I had never seen anything like them before. In one instance I referred a 10 week old for a severe fungal infection to Bustamante for dermatology. There was nothing more I could offer.

If there is anything that frustrated me was the lack of readily available resources. You really had to work with what you had which wasn’t a lot in many cases. For example I had a child with probable pica. 1^stthing I wanted to do was order a CBC to see if this child was anemic. But I knew that would be a waste because I would not get results quick enough and would probably lose the child to follow-up, so I just placed the child on MV with iron. And I guess I was a bit more aggressive with treatment than I would normally be because confirmatory tests were not easily available. I noticed this was done on the ward as well, when on rounds the GP told me he placed a child, who was admitted for bronchiolitis, on antibiotics because he was unsure if the patient would return for follow up i.e. a respiratory check. One child came into clinic with a questionable lung exam with some but really not impressive focal findings but in any case I placed him on antibiotics because I was unsure if he would come back and I couldn’t do any imaging. There was also a great deal of asthma, which for some unknown reason surprised me.

In terms of patient load, it ranged from say 8 kids to 15 or so. On one clinic day at Port Maria, I saw 20 patients during the morning session. In Jamaica, children are normally seen by a general practitioner not a pediatrician. Pediatricians are considered specialists, so if the patient guardian has a complaint, then they are referred to the Pediatrician if one is practicing that day. In other instances the GP would treat the child.

Resort:

What can I say…the ultimate in luxury. Couples lacked NOTHING. The accommodations were wonderful. The Issa doctors stay in a very roomy villa. We had separate entrances with our own bathroom. The living room and kitchen were shared spaces. Most time I stayed in my room and met up with the other doctor for meals or so. The staff were wonderful, kind and tended to my (and other guests) needs. If you are lying on the beach, there is a waiter there to take your drink order. The food in each of the 4 restaurants is absolutely delicious. I felt like I was dining in a 4 star restaurant every night. And since I am of Jamaican heritage, I was able to indulge in some of the islands traditional meals like ackee and saltfish, calloloo, and jerk chicken. Coming home to a place like this after a hard day’s work was perfect. It was just right. There are plenty of activities to partake in such as snorkeling, windsailing, glass bottom boating, shopping trips and trips to Dunns River.

I just have to say, this was one of the most memorable experiences in my medical career. This is the main reason why I switched careers from banking to medicine – to make a real difference in the lives of the underserved whether it’s here in our country or in other parts of the world. I chose Jamaica because it’s the land of my mother and father..and I still have many relatives that lived there. I felt like a real doctor! In just about all cases I had to use my judgment without the assistance of a readily available preceptor. This is particularly helpful to me since in just about 3 months I will be entering the “real” world as a full fledge pediatrician. It did wonders for my confidence and gave me great experience. I wish more residence knew about this program. It really offers the best of everything you would want in an overseas rotation.

Thank you Diane Pollard, the Issa Trust Foundation and Couples Resort for this extraordinary experience.

Randi B. Nelson MD