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Apart from missing my family tremendously, I’ve been having a great time volunteering in Jamaica so far. On Friday was my first day going to Port Antonio and I’ve spent the last two days in Port Maria.

The patients and their parents have been very polite and grateful to me in general. I did see a mom today in Port Maria though who was frustrated at the tinea versicolor on her son’s chest and back which seemed to keep coming back despite her treatments and visits to the clinic. Her son had a classic rash. After giving her some selenium sulfide and some clotrimazole, she wanted oral medication which I didn’t feel was indicated. I did my best to explain that it can be a very frustrating problem in Jamaica as well as in the US. She was the exception though. Another parent totally made my day when he returned with his daughter today to bring me a bag full of ripe ackee fruit, freshly picked green bananas and plantain. I had seen his daughter in clinic the day before and she looked much better (OK, so she had a viral illness and got better on her own…fine). I was so happy, thanked him profusely. Unfortunately since I’m staying at the resort without any kitchen facilities, I had to give away my fruit to the nurses who were working with me.

Practicing medicine in a foreign country has its many rewards but also quite a few challenges that one can’t readily appreciate. There are different home remedies, different names of body parts, different perceived etiologies of disease and conditions that can totally throw you off while you’re talking to a patient. For instance, who knew that toilet paper can cause a vaginal infection or that a rubber band can give a child fungus in the hair? Plus, I’ve been totally inundated with all sorts of rashes that I would have been quick to refer to a dermatologist at home in the US. On top of that, there’ve been cases of measles in the area so I’ve been on the lookout for those potential cases as well. Luckily, the health department here has a rockin immunization program and parents are serious about giving their children shots.

Even as I say this, there is one similarity that I was surprised to find here in my rural clinic experience—pharm reps! Yes, I actually got approached with gifts and flatteries by a Jamaican pharm rep who handed me a printed bag, a pen, and a little speech on some new cough syrup for children…I was quite tickled about it. I actually would have appreciated a good ol’ Pharm lunch though—I was getting hungry. Too hungry and not enough energy to go into how I will be following my AAP recommendations and not prescribing cough syrup to children under 6, thanks very much.
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It’s been less than 24 hours that I’ve been here, but I thought a blog about my first impressions would be useful, especially for future volunteers.

Before that though, a snippet about me. My name is Maureen Ben-Davies. I finished my pediatric residency at the University of Chicago this past July. Currently, I’m a primary care research fellow at my alma mater, the University of North Carolina at Chapel Hill and pursuing my masters in public health at the Gillings School of Global Public Health. I have travelled to Jamaica many times before on vacation and for my wedding, which is why I can’t believe I had the good fortune of finding an organization which would allow me to put my skills to use and “give back” to a country that I’ve loved for a long time.

I’ve never stayed a Couples resort before–or any other all-inclusive for that matter. My husband and I have prided ourselves on traveling “off the beaten path” when we venture abroad and everytime we’ve stayed here in Jamaica, we’ve chosen smaller hotels with few amenities so it’d force us to meet locals and feel like locals. That said, Couples is a really nice place. I’ll say that on our previous vacations here, we’ve found it hard to “do nothing” for more than three days, then we get bored. There is no reason for you to feel bored here. You can be as idle or as busy as you like. Today was a day off for me to get acclimated so I went on an orientation for new guests and was blown away by how many activities you could do. Call me naive, but I was like “this is why people keep coming back to all-inclusives…This is sweet.” Not as cheesy as I thought it’d be either. I’ll see if I have time/energy after volunteering to take advantage of some of the resources. The staff have been amazingly helpful, friendly and resourceful.

The bag that I picked up from reception containing my laptop and pre-paid cell phone was very handy. I wouldn’t have stressed about what kind of walk-around bag to use if I’d known this would be available. It has everything that you need to get started seeing patients: laptop, mouse, latex gloves, reflex hammer, a print out of the ISSA Trust Foundation mission orientation manual that had the contact numbers for everyone, a medication formulary print out. All I need to add is my otoscope/ophthalmoscope, stethoscope and pen and I’m good to go! Also, the villa that I’m staying at has many useful handbooks that I didn’t even think (or have room) to pack! Harriet Lane, Handbook of Medicine in Developing Countries, Atlas of Pediatrics in the Tropics, the AAP Red Book.
…Oh! No need to pack a water bottle either; the resort gives you a very durable plastic one with a clasp to hook it onto any bag you’re carrying…super handy!

Tomorrow is my first day and I’m going to Port Antonio, it’s a long ride, about 2 hours so it should be a pretty long day.



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When I think of some of the challanges I have recenntly faced…
  1. I am thankful for the sun, the ocean, the sand, good food and drink. Oh yes, and Skype!
  2. I, for one, am also thankful for nurses drawing blood, but since we draw our own here, I am thankful that I still remember how.
  3. I am thankful for transdermal bilirubin devices. These would have made managing several of the patients this week (inpatient and outpatient) more efficient. Tempermental lab equipment makes bilirubin a send-out lab, of course when least convenient. Since bili lights are limited and the bulbs do not last forever, transdermal bilis could be quite cost and resource effective.
  4. I am thankful for urinalysis and urine dips being completed the same day. It was frustrating to evaluate for UTI when it took two days to determine whether or not leukocytes and bacteria were present. I’m still unclear as to why this happens here because the dipsticks are the same that we use.
  5. Mostly, though, I am thankful for the opportunity to volunteer in Jamaica. The relationships and experiences here are priceless ones. I am defineately more savvy that when I first arrived.
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One of the great things about being here on the resort is having so many of the things that I love to do right here in one place. After work, on most days I immediately change clothes and hit the tennis court. My game has much improved! On the weekends, its water sports and napping on the beach. Now I will say this, I am a whole lot more tired that I was back in the States but not for the reasons you might think. Basically before work in the mornings Amanda and I have been hitting the gym. So after tennis in the evening, I’m uttery exhausted! Why so much in one day you ask? Well around here there’s way too much great food (and beverage) around in one day. So the choice is clear, burn calories or buy new clothes!
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There has been so much going on this week, I hardly know what to say. All three clinics that we visit are right on the ocean-such a beautiful view. Not what I normally see when I look out the window from clinic. I will say that I will definitely be taking dramamine before my next trip to Port Antonio. I had no idea that Jamaica was so hilly. I saw a lot of typical skin issues this week: eczema, tinea, scabies, etc. I am also becoming familiar with “Deworming”. This is definitely not something I need to do regularly on my usual clinic patients. I had a 3 1/2 year old boy come to see me in clinic on Thursday who has Autism and though mom is sure she has heard that word, I don’t think her son has ever officially had the diagnosis. He has only 5 words and as expected, has many social problems which do not allow him to engage in preschool at all. He receives speech therapy only once every 3 months and has seen a psychologist for behaviors only once. After discussion with Dr. Ramos, I referred him to the child Neurologist in Kingston that usually evaluates in these cases. I actually heard on the radio earlier in the week that the social support for Autism is lacking in Jamaica, but I really hope that the Neurologist is able to provide some more appropriate referrals for this child-at least more that I was able to do. It is difficult to treat some of the children who present,simply because I am not at all familiar with the system of medical care here. I really appreciate all of the help I have been receiving from Dr. Ramos, Dr. San San and all of the other general practice physicians who have been more than willing to answer all of my MANY questions. I did get to enjoy some relaxation time on the beach this weekend as well. There is no better place to read than on a beautiful beach.
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