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August

Small Things with Great Love

We look around and see heroes among us.

We are thankful for the opportunity to work alongside the general practitioners and pediatricians here. It has been a privilege to partner with you and to learn from each other. Thanks especially to Dr. San San Win, Dr. Iyer Ramos, and the hospital administrators who helped coordinate each day. Thank you to Dr. Candi, Dr. Min, Dr. Rico, Dr. Slolely, Dr. Ravi, and the many others who patiently helped us navigate hospital admissions, referrals, and the daily ins and outs of the medical system.

We appreciate the kindness of the Couples Tower Isle Staff at the resort and the Ministry of Health drivers on our daily commute, making us feel welcome and teaching us about Jamaica—its culture, music, food, language, values, and so much more. We miss your smiles and warmth already.

We are inspired by Diane Pollard, who shared over dinner the story of her dream and its reality in starting the Issa Trust Foundation.

We are indebted to the families of our patients– for entrusting us to care for their children.

We value our young patients and the chance to intersect with their lives.

We give thanks for the opportunity to be in Jamaica.

And as we return to the States, we consider for ourselves… How to continue to engage the world around us? How to respond to the poverty, economic inequality, injustice, and violence streaming across the headlines, in other countries, in our nation, and in our very own city? What to do when it hits us between the eyes? It’s a small, uncomfortable feeling, but one that grows with the truth that life is short and that we truly should live, not merely exist. And we remember the words of Mother Teresa: “Not all of us can do great things. But we can do small things with great love.”

So we seek to continue to respond with love—by doing small things, the hard things, and thus bringing hope for the future. We hope that you too are inspired.

A sincere thank you to the Issa Trust Foundation and all who support its work.

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August

Black, Gold, and Green

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Black for the strength and creativity of the people, gold for the beautiful sunshine, and green for the lush vegetation of the island. These are the colors of the Jamaican flag, and they reflect our experiences in Jamaica.

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We have witnessed the strength of the people in the hospital, A&E (also known as the ER), and clinic.

-The strength of a solo mother providing for and raising up children on her own.

-Three young boys sitting patiently with broken arms, waiting hours for the x-ray machine to be fixed.

-A grandmother’s hope and desire for a better future for her grandson, who is going blind after witnessing the murder of his father.

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We have treasured the beautiful sunshine, reflecting off the sparkling ocean. We have felt its power and heat.

-A drought has affected the island. The country did not receive the usual amount of rainfall during the typically wet months of May and June. Several of the country’s large reservoirs low, and the government is enforcing water restrictions.

-Hospitals are suffering from water shortages. In Kingston a few weeks ago, medical staff walked off the job as they reported being forced to work with little or no water.

-The Jamaica Agricultural Society reports 16000 farmers are affected by the drought, ruining crops and wiping out earnings of farming families.

-With the difficulty of high temperatures and windy conditions, the island has endured dozens of bush fires for the past few weeks. On our daily commute, we witness bush fires and fire fighters at work along the road. The air quality continues to decline due to dust, smoke, and pollution, bringing more children suffering from asthma to see us in the clinic and A&E.

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Even so, we are amazed by the beautiful landscape of Jamaica.

-The beauty of the deep ocean overwhelms and awakens my heart.

-The tropical fruits and vegetables from the land are so tasty—sugar cane, coconuts, ginger, mango, papaya, and the ackee fruit to name a few. The ackee fruit is the national fruit of Jamaica, which we’ve enjoyed in the national Jamaican dish of ackee and saltfish. Don’t worry; we’ve avoided eating unripe portions of the fruit and getting “Jamaican vomiting sickness” (profound hypoglycemia and intractable vomiting caused from the toxin hypoglycin A, which irreversibly binds coenzyme A, carnitine, and carnitine acyltransferases I and II, for those of you who are curious).

-We don’t say lush very often, but we’ve used it a lot here. The views take our breath away. Amidst hardship, we behold the extravagant beauty of the land and in its people. As our driver queried us on Monday, how can we deny the work and love of the Creator?

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We give thanks for the opportunity to share in the culture and beauty of Jamaica and its children, women, and men. We are grateful to those here who have shared pieces of their lives with us—pieces of hope, strength, and creativity. We appreciate the warm welcome and hospitality of the Couples Resort and its staff, the kindness and help of the doctors particularly at Port Maria Hospital, and the smiles and hugs of our young patients.

Thank you for reading and sharing in this experience with us.

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August

We are in Jamaica Mon!

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Hello to everyone reading about our time with the Issa Trust Foundation. Tiffany and I are so excited to be apart of this. The people and culture of Jamaica have been incredible. We are falling in love with them! Tiffany is going to write more about the culture tomorrow. I’m going to outline a few of the patient encounters we have had thus far:

Last week was our first week in the hospitals. We spend every Monday and Tuesday and Port Maria Hospital, which is a level C hospital (meaning they only have the most basic supplies available, and basic medical care without specialty services). These are the most rural of hospitals. We split ourselves between the health clinic and the ER (known as the Accident & Emergency Department here).

The very first patient I saw in the A&E was a young 16 y/o with Type I Diabetes Mellitus – she looked like she was nine years old- evidence of very poor nutrition and very poor diabetic control. She came in with a fever of 102 and was tachycardic to the 140s (normal should be ~60 for her size)… she had an incredibly distended abdomen and was complaining of butt pain. When I went to do a rectal exam she had stool just leaking out of her underwear- she was so impacted from constipation that she was having what we call “encoparesis”, meaning stool leaking around an impacted stool ball. But Diabetics also have the potential to get real sick real fast with a syndrome known as Diabetic Ketoacidosis. Her fever made me concerned that her constipation had led to colitis (inflammation of the colon) and that bacteria were now getting into her bloodstream. I know exactly what I would do for this girl in the States: IV fluids, IV antibiotics, lots of labs, and probably a CT scan of her abdomen. But there is no CT scanner here and the only x-ray machine is down for “servicing”. To get labs I have to draw my own, and I haven’t figured out how to get the nurses to do what I want them to do yet. Moreover, a lot of medications just aren’t available here and even if they are, many families can’t afford them. Will I be able to treat this patient appropriately? What if I miss something?

The following day, I saw a 2 y/o boy who was falling off his growth curve, was not putting words together yet like he should at this age, and had just been hospitalized with a fracture of his left leg. I’m afraid that he has Rickets, an uncommon disease in the United States nowadays, but previously very common and still present in many developing countries. It is usually due to a deficiency of Vitamin D and this causes your bones to not form as they should. If can also affect cognitive development. Unfortunately a lot of the damage is irreversible. I gave mom a prescription for high doses of Vitamin D and referred her to the only Children’s Hospital in the country of Jamaica. Will she get there? What will they be able to offer this family?

Something that I have been very struck by here in Jamaica is the number of broken families I have met. Almost every child I have treated does not have a father that lives at home. Most mothers are single moms and have several children from several different men. One doctor told me that 4 out of 5 families will have single moms. This leads to generation after generation of boys and girls being raised without father-figures. Another huge social factor is the high rate of homicide. I do not know the statistics, but in my first two days of clinic I met 4 children who had fathers or mothers that were murdered. The lack of fathers and “home units” certainly contributes to the mental, emotional, and hence physical health of these poor children. It breaks my heart actually. How can I help?

I will leave you for tonight, but look forward to writing more later!

Katie & Tiffany