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Last week went by very quickly. Out of all the hospitals, I am enjoying Annotto Bay the most, for its resident interaction and learning opportunities. Despite being a level B hospital, it is still very much in need, with minimal supplies. One afternoon, residents were drawing blood via needles to the femoral vein as there was a shortage of butterflies. For IVs, the end of a glove was ripped off to be used as a tourniquet, and the catheters placed and held haphazardly with paper tape. A rolled towel was used as the splint to prevent bending, and again bound by rolls of tape. Children walked around with little bumps of cotton taped to their arm, their scalp, and their inguinal area for lack of band-aids. What I previously thought of as basic necessities were all luxuries here, and was responded by laughter at the mention of things like Tegaderm, adhesive removers, or LMX anesthetic creams. The painstakingly gathered blood samples were then wrapped in lab order sheets, and sent with a driver, who would personally deliver them to a lab 2 hrs away from town. I was informed that this was a necessary process not only for blood cultures, but even for bilirubin levels, as their equipment was not reliable for levels above a certain threshold. Back home, parents wait in clinic while bilirubin levels return within minutes. If nurses or doctors have to walk all the way down the hall and into an elevator to deliver these samples to the in-house lab, it is met with eye rolling and sighs about how the hospital is a mess because the tubing system is malfunctioning. I’ve been here for 2 weeks now, and the more I see, the more amazed I am at how different things are here. In the same way, though, I think the residents look at me amazed when I tell them about bilimeters, 5 minute lab results, and EMRs with electronic films.

Today I was back in Port Maria. I’m growing to like it here a lot as there is the most need, and patients present with very manageable cases, where easy treatment options are available. While seeing one little girl with a viral URI, her older sister insisted on braiding my hair, and asking to see inside her sister’s ear. She was very curious, and many children are eager to learn, which makes clinic that much more fun for me. In the middle of the day, water became unavailable, and none of the sinks were available for hand washing. In any other clinic, this would have been a huge crisis, but here, things went on per usual, as if nothing significant had occurred. I am just happy to have brought all of my sanitation supplies with me today. It’s funny how accustomed I have become to all the limitations of working in Jamaica; I hope that when I return to Iowa, my gratitude for all that we have there is not as quickly fleeting.

After just my first week in Jamaica, I’m starting to realize how different everything is here. I went to Port Antonia yesterday, where I assisted with inpatient rounds and saw a few clinic patients as well. After an hour of waiting for the doctor to arrive on the Pediatric Ward, I was told he was actually not coming. Someone from the Emergency Department was asked to round in his place, and with neither of us knowing any of the children in the unit, the morning started off a little hectic. There were some very sick patients– a child with posterior urethral valves with now overlying pyelonephritis was there for IV antibiotics and ultrasound imaging. Looking through his chart, however, notes were written as “patient with unknown kidney disease with left flank pain” or “??kidney disease, rule out pyelonephritis”. There apparently isn’t a consistent doctor who works in the unit, so information is poorly relayed, and treatment reflected likewise. As the covering doc flipped through the boy’s chart, he informed me his ultrasound showed hydronephrosis. “What grade?” I asked. “A bad one,” he replied, moving on to the next patient.

Rounds continued on in this way until I was sent off to clinic. Sitting in an air-conditioned room, I felt a little guilty. Most of the patients here were follow ups after discharge from the hospital. I was seeing a boy after multiple episodes of febrile seizures, now with 1 week history of penis pain. During the physical exam, he became very upset, and slapped his mother, who was holding him down. Appalled, I asked him to apologize, but he refused. I thought to myself about all the clinic visits I spent talking about behavior management, and positive/negative reinforcement. It seemed like such a luxury now..! I reluctantly gave up my behavior talk, as the boy would not be overcome in one clinic visit, and continued to counsel the mother on other issues.

In Iowa, parents come in with a list of problems to discuss, and residents usually limit them to their top 3. Here, parents come in with just one problem to discuss, but watching them, and listening to them, you see hundreds of issues. You sleep with your baby and she sleeps on her tummy? Why are you starting solids at 2 months? Leaving your baby in the sun is different from phototherapy… I guess when I go back home, I will sympathize with them more now; it is hard to choose just 3.

Hello everyone! I am one of the pediatric residents from University of Iowa, and I just arrived to Jamaica 2 days ago. This is my first time in Jamaica, and hopefully I can share the experiences I have here with you.

I was scheduled to start today at Port Maria, a small rural hospital up a hill with unpaved roads; however, due to some mix ups with the driver, I was unexpectedly taken there yesterday morning. I saw maybe 7-8 patients within a short 2 hr period in the middle of the day, and then none for the rest of the day. Apparently, patients here are seen by their number in line, so even though I was free most of the morning, since it was not yet their turn, I waited in my room, until 1pm, when they all came through at once. During my waiting time, though, I did learn a few things: there are no alcohol wipes, no hand sanitizers, no gloves, let alone any otoscope attachments. It was stressful working in conditions you knew were far from acceptable, and as I desperately rubbed my stethoscope with my personal pink rose scented hand sanitizer, I understood how different everything would be here.

Today, I came prepared. After some rummaging in my room at the resort (which did stock a few of these supplies), I was able to bring my own mini travelling sanitation center. Life was so much better when I was able to properly clean everything between patients! The morning started out with 3 siblings, and from there, charts were brought in by the handful every 30 minutes. By 12pm, I had seen about 10 patients, but still had a stack of charts on my desk. With all these patients with their mothers, siblings, cousins, and friends waiting outside, all I could think about was how low our “patient satisfaction scores” would be if we were in the States…

I started getting stressed at 2pm, when it seemed like there would be no end to the day, and I lost track as to whether I was sweating (glistening) from the heat or from the pressure. I went out at 2:30 to call the next patient in, but saw that somehow, the herds of people had disappeared, and there were now only a few people left in the clinic. Although relieved, I knew most of them were probably sent home as it came near the end of the day. It was a sad thing, because most of these children didnt require long visits, and with a quick prescription, could have become better much faster. There was one boy with severe eczema all over his arms, and a history of secondary cellulitis due to skin breakdown during his last flare. One look, and I started searching through the formularly for steroids available at the clinic while his father told me the history. They had been waiting there for 6 hrs but only needed 10 minutes for a triamcinalone script and some quick reprimanding for a habit of hot showers and aggressive drying techniques. I felt bad there was nothing more to offer for their wait, so I unsatisfyingly handed the boy 3 packets of neosporin to use in case there is again any skin breakdown. It’s weird how giving people something (a script, medicine, food) is so gratifying…I’ll be running out of supplies fast at this rate.

On the drive back to the resort, I learned about soft Jamaican apples, the “akee fruit poisoning conspiracy”, and the behaviors of the local popo. I was glad to be back in Ocho Rios, but felt a little guilty getting off at a resort. Rural life and Resort life couldnt be more closely juxtaposed. I can already tell this is going to be a very eye-opening trip..!

Port Antonio

The next two weeks at Port Maria were busy and a week after the departure of my wonderful colleague Dr. Hack, I found myself incredibly busy seeing 26 patients in clinic one day from 9 AM to 4PM. I realized how just like at the end of any rotation, you start feeling comfortable with how things are run right when it’s about time to leave. One of my more complicated cases was a preadolescent boy diagnosed several months ago with HIV but who was not aware about his diagnosis. He came in with 3 weeks of cough and a rash which looked like tinea versicolor. I obtained a chest xray which revealed an infiltrate keeping in mind that the mother stated he had been on several weeks of an antibiotic which finished a week ago, but now was not on any medications and that his first appointment to discuss his condition was next month. None of this information was located in my paper chart and without any previous labs or other information about which antibiotic he previously was on, I discussed a plan of care with the ER doctor who knew him well and sent him to the A&E for further work-up including a CBC, viral load, CD4 count and initiation of antibiotics.