Our driver, Steve, picked us at promptly 8AM from the resort’s lobby and we set off on our one-hour car ride to Port Maria. It is a breathtaking ride that I don’t think I’ll ever get tired of. During most of the trip you can see the ocean on your left, and homes on your right. Further to the right are often mountains covered in lush greenery. It is amazing how the wild trees that grow here bear coconuts, breadfruit, acai fruit, and even bananas. I asked Steve if there are many farmers that take advantage of the obviously fertile land and plentiful rain for farming, he said most farmers are concentrated more inland. Then he chuckled and said most of everything you would need on the shore grows wild! That’s a little better than the weeds, poison ivy, and grass that I’m used to seeing in our “wild lands” (those around the highway).

The road is quite curvy, with several very acute turns, and for the most part single-lane each way. If you are the queasy type, you should probably take a dose of dramamine before setting off. The car will swerve quite close to trees, animals such as goats and dogs, and pedestrians but yet somehow always miss them. Steve is a great driver, but there were more than a few times where I wanted to close my eyes (but that would just make me more car-sick). So I just concentrated on the beautiful scenery, and I never ran out of things at which to marvel.

We arrived at Port Maria hospital one hour later. There was already a long line of people waiting to be seen, but at the clinic and at the “emergency room” office, which is probably better defined as the acute care clinic. I settled in a clinic office and my partner, Stacy McConkey, started to see patients in the acute care clinic. Each of us had a nurse assigned to us and she introduced herself. They were both extremely polite and brought us our patient dockets which we stacked in order on our desk.

My clinic room was rather comfortable. I didn’t have an air conditioner, but I did have a fan. I sat at a desk on which I placed my computer and my equipment (stethoscope, otoscope, hand sanitizer, and water bottle). My first patient folder belonged to 5-year old Lashane. I poked my head out my door and said her name and she and her mom made there way inside. Lashane was the cutest girl who’s mother had been taking her to several pediatricians trying to find an answer for what she thought were seizures. Local doctors were making her get tests done (an EEG, a head CT, several blood tests, etc.) all of which she had to pay for out-of-pocket. She became exasperated when a private doctor she went to asked her to pretty much repeat all of those tests. I suspect it was because he received some sort of kickback from the diagnostic laboratory. Don’t get me wrong … in the United States I would have probably sent for those same exact tests when presented with a 5-year-old with a history of “seizure-type events”. However, when I dug deeper in the history, Lashane’s mother reported no history of head trauma, drug use, or family history of seizures; Lashane had no aura-type symptoms, no post-ictal phase, and she was able to walk around when she was so-called “seizing”. Deeper history revealed that she only gets these “events” when she is asleep. The events themselves are usually a sudden scream, followed by guttural sounds, and no response to commands. She would be nonresponsive to her mother but walked when led to the bathroom by her mother (who thought she might vomit). These symptoms sounded a lot less like seizures, but a lot more like night-terrors, a diagnosis I would have come to in the United States only after a head CT, head MRI, one or more EEGs, perhaps a sleep-study, and a variety of electrolyte and other blood tests. But night-terrors, academically, is a diagnosis that should be made by history alone.

Lashane was the first of 12 patients I saw that day. I saw four infants for well-child checks (one of whom needed a BCG vaccine, two of whom were brought by the mother’s friend, so I couldn’t get much of a history), one with pharyngitis, three with atopic dermatitis and/or rhinitis, another with tinea capitis, one follow-up for asthma, and two brothers with scabies. A good day!

I had about an hour between some patients when I could’ve had lunch. I had brought a banana and an apple with me, but I didn’t really feel like eating. Those who need some mid-day sustenance would probably do well with a protein bar.

Lessons learned today:
1. For the ride – look at distant objects, or bring dramamine.
2. Take a VERY good history
3. Learn the differences in vaccinations. Infants here get BCG at birth.
4. Bring protein bars if needed.
5. Keep a personal supply of permethrin – you will see scabies and you’ll need it for peace-of-mind.
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This is my third time here, and it went as smoothly as always. Arrival in the airport is much like many other international airports. About 30 minutes before landing, we each received a Customs Declaration form to fill out. Having a pen on the airplane saves you from having to ask around.

The process afterwards was rather straight forward. Deboarding, getting your passport checked, picking up luggage from the carousel, then going through customs all took about 10 minutes combined. I was lucky having arrived when the airport was empty (7:30PM on a Tuesday evening), and I’ve heard that the process took about three hours for Stacy McConkey who arrived only a few days earlier.

I lounged around in the Couple Resort Airport Lounge which was on my left as I walked out of the Customs area. I happened to be the only one there. I told the cheerful man at the desk that I was going to Tower Isle resort, he tagged my luggage, and offered me a Red Stripe. I waited for about 20 minutes and then my bus was off. It was an hour’s ride to the resort.

Checking-in is much like checking into any other hotel, except you are greeted by a “welcoming committee” with cold drinks and a cold wet towel. I took my key to Villa 9 and was escorted to my room. I met up with Stacy McConkey and Diane Pollard in our villa. I knew the mission was off to a good start when I saw our accommodations – two-bedrooms, each with its own bathroom, and a large living room and an attached kitchen and dining area. Three 32-inch flat screen TVs, a fridge, and free wireless internet access made our home away from home much more comfortable than I expected. I’m told a microwave will be made available, but I’m not sure if one is necessary since food is offered at the resort pretty much 24-hours a day.

We are even given an option for having breakfast delivered to our room. This will be a welcome option when we are scheduled to leave the resort earlier in the morning than the 7:30AM buffet opening. And this is a rather strict time. Most everything in Jamaica runs on “Jamiaca time” where things are often, and unapologetically, delayed 30 minutes or more. But when it comes to breakfast, 7:30AM is strict and not a minute before. It’s fun seeing the breakfast servers grumble at guests who try to hit the buffet a few minutes earlier.

Sleeping after the long day of travel will be easy. Tomorrow we leave to Port Maria at 8AM.
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