Blog

This past weekend was amazing as my fiance flew in and we were able to enjoy many of the resort perks as well as some time together. Amongst many other activities, we climbed the waterfall at Dunn’s River Falls, took a trip on the glass bottom boat, and talked to the man selling shells. We also ate dinner at Eight Rivers/Bayside, both of which were excellent. I even managed to eat my entire meal at Bayside with chopsticks!

My Monday morning had a somewhat rocky start as the driver did not arrive until 9 AM. Then I received a phone call while at work that the resort thought I was leaving today and was looking for me. Oops, apparently my fiance’s departure date had accidentally been recorded as mine as well! That was quickly fixed and the remainder of my day at Port Maria ran smoothly. Themes for the day were tinea, URI, and gastroenteritis although I also consulted on two inpatients; one with seizures and hypotonia in great need of a Pediatric Neurologist and the other with marked lymphadenitis.

Things I learned today or along the way:
Jamaican ambulances are staffed by a driver, a nurse, and a porter. They have nebulizer machines, oxygen, and scissors amongst other things on board. The few available ambulances remain busy transporting patients from home to the hospital in addition to hospital-to-hospital transfers for tests including x-rays!
Few families have paracetamol (tylenol) at home.
When an x-ray is ordered outpatient, it is generally given to the patient. This means a patient sometimes appears in clinic with xray or labwork in hand. Dockets (charts) are kept intra-facility while the patient may go to many facilities, so you may not have the reason behind the testing available.

Mid-week already, time seems to be moving at a steady clip. After Sunday’s adventures in beach volleyball, I confess I was a bit sore on Monday. Nevertheless, I saw approx 25 patients at Port Maria. I’ve noticed a trend toward multiple diagnoses as everyone comes in with one chief complaint but then asks me to look at a skin infection or discuss a cough. No cases of Ackee poisoning for me as of yet, thank goodness.

Tuesday is Children’s Health Day at Port Maria, which always signifies a busy clinic for me, especially after around 11 AM when most of the well-children have been seen for vaccinations. Several of my patients were referred from the nurse practitioner, generally for URI symptoms. I was thrilled to find that a patient from last week returned with completed lab work!

Today, I returned to Annotto Bay Hospital where the three young doctors were already hard at work seeing the 13 inpatients. The 25 week infant (I still suspect his gestational age to be closer to 28 wk) continues to do well and is now on room air. Sadly, the child we placed on CPAP last week died.

I greatly enjoy my trips to Annotto Bay and rounding with the team. Today, we discussed cases of likely and proven rheumatic heart disease — a rare diagnosis at home. I also continue to marvel at how well staff handle the daily frustrations that come with working in a third world environment. Today, one of the younger doctors and I went to draw a blood culture from a child with likely meningitis (bulging fontanelle, fever) only to discover that there were no more blood culture bottles on the ward.

Tomorrow I shall return to ABH for clinic, then Port Antonio on Friday. I was asked by one of the younger doctors in Port Antonio to discuss fluid management based on their recent GE outbreak. Here, the mild-moderate-severe clinical appearance apply more readily than my textbook examples; I/Os are not generally monitored unless expressly written in the docket (chart), which is only done for the most ill patients and lab work, including electrolytes, may not return for several hours or until the following day.

In addition to Port Antonio on Friday, my fiance is scheduled to fly in on Friday for a weekend stay! I am very excited to try a few more of the resort activities and introduce him to some of the staff members. More adventures to come, I am sure….

The weather has been a little more chilly today with intermittent sprinkles — much like the rest of the week. Nevertheless, the planning for tonight’s party at the resort goes on. It is the 33rd Anniversary of the resort which means a lot of activity going on!

The rest of the week has also been full of activity for me. On Tuesday, I returned to Port Maria and saw 35 patients! My hand was cramping from writing prescriptions for clotrimazole cream and paracetamol. Wednesday I returned to Annotto Bay to find that the 25 weeker is still there and doing relatively well. I was very excited to see him. The team and I rounded on the other patients relatively quickly, then I tried to assist the team in carrying out the day’s plan. We obtained a urine culture (unlike at home where we use catheters, they do suprapubic taps here), a lumbar puncture (not successful, but in-process the child developed explosive diarrhea and provided a reason for his fever), and drew blood from several patients.

Thursday was also spent at Annotto Bay; this time in clinic. I took my time (unfortunately for the other doctor who saw 40!). I saw a few interesting cases, including a 3 week old infant who had lost weight since birth. Upon obtaining further history, I discovered his mother had stopped breast-feeding when he was ~10 days old, at which time he developed ‘cold in his chest’. She then tried formula for one day and decided it gave him constipation, and had been giving him nothing but bush tea (a local remedy) for at least a week. She resumed breast-feeding several days before the appointment, but had not been expressing much milk. Apparently cases such as these are not uncommon.

Friday was my first trip to Port Antonio. The drive was gorgeous. I only had 3 patients (this is a relatively new clinic and Dr. Ramos usually sees peds patients here on Tuesdays). All three of them were referrals, two of which I referred on to Bustamente Children’s Hospital. Of the referrals, one child had leukocoria and the other had severe vargus leg deformity. I then rounded on the inpatients where the theme of the day was vomiting/diarrhea.

Other interesting tidbits of the week: The Jamaican workday is approximately 6 hours, although the resort workers seem to double that. “Lasco” is what many children call a powdered milk they drink; however as Lasco is a large company, the term may refer to many other things. June plums are a fruit many Jamaicans eat — with or without salt / pepper. Oh, and apparently housekeeping does not have a key to the bedroom of our villa…so if you want your sheets changed / new towel, either be present or leave the bedroom door unlocked (oops!). 🙂 I think that is enough for now. I shall try to post pictures tonight or tomorrow.