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Hi again- Writing again from the lovely (if not lately rainy in the middle of the night) Jamaica! We have been here for a bit over a week and have now been working for a week. Today was the first day it was not “new”, and there was definitely comfort in that. I have noticed now that we have visited all three hospitals, that each has their own nuance and style that you have to acclimate to. There are two things that specifically prompted this blog tonight. The first was the fun I had working with another physician in the A&E at Port Maria to get creative getting a foreign body out of a nose. As toddler’s do, a little girl had stuck a hair bead in her nose and was too young to understand how to blow it out. Back home we have these nifty tiny catheters that are smaller than spaghetti and we can slide behind objects, then inflate a balloon (like a Foley for a Hamster) and pull the object out. Well the smallest actual Foley was too large, and there were not traditional alligator clamps so the creativity was flowing. First I must say, the other physician did a great job presenting the options to the parents (we try creativity there and either are successful or could push it in further, or we transfer to BCH for possible sedation or possible ENT removal). The family opted for an attempt there so I wrapped the kid in a sheet and we got to work. When the catheter was clearly too large, the other physician fashioned a hook out of a paper-clip and was able to rotate the bead so the hole was visible and get it out. Out came the hair bead and after a few screams and some giant crocodile tears, the child went home with mom and dad. I also enjoy being part of ingenuity, especially when it saves a family a costly trip. The second event that I want to write about is a discussion about allocation of resources we had at Annotto Bay today. There has been discussion that due to budget issues across the board, it has been difficult to transport patients to Kingston for more specialized testing. It was noted that the pediatric patients, especially the babies, seem to get first dibs on transport. There was some talk about why this may be. Is it because everyone has a soft spot for children? Is it because they sometimes seem to have more advocates on their side (vocal care takers both in the medical field and their families)? Or is there another factor we are not evening considering. We see this debate over allocation of public spending dollars on health care at home as well. I do not have an answer, or even a formed opinion, but I was something to think about tonight. The third thing I must say, and I did not include this on the two because it is not medically related, but when I arrived in Jamaica I asked Bob if we could get a goat. He said no (he also vetoed a micro pig earlier this year, apparently three dogs are enough of a menagerie). After the beach party Monday, I now do not want a goat, because if I got attached, how would I later curry it… Having the best time, Becca

There were vary different experiences at the varied hospitals. Port Antonia was the most spectacular of the three locations. The hospital is situated on a bluff overlooking the bay, with the ocean views overlooking the city. The hospital was a journey from the resort with a travel time around 2 hours each way. Our day was much slower at Port Antonio. We spent the entire day in the A&E (Accident and Emergency). We shared a room there. We only had a pediatric patient (birth to 14 yo) about every hour. They highlight of the day was a darling 11 yo girl who just stopped in to our exam room to chat with us while we were waiting to see another patient. She was a fifth grade student who was watching her 2 yo nephew while her sister was being seen. She was a bright and articulate student who was also remarkably polite. She was the highlight of a good day. Port Maria was a crazy first day to say the least. We were divided in the morning, Becca worked in the A&E and I in the clinic. When I arrived at 8:30 there were patients lined up outside the clinic which did not open for another hour. When the clinic started I was handed a stack of eight chart (dockets as they are referred to here). While I was seeing my first few patients the nurse returned with several more stacks of charts. Between 9:30 and 2 I saw 16 patients from asthma follow up, viral illness, well child check, to septic arthritis. I did have one mother refuse to see me, requesting that she see the “black doctor”, none of which were there that day. When I finished clinic, I joined Becca in the A&E. She had been busy as well seeing more than a dozen patient’s in the time I was in clinic. She was seeing a wider variety of patient’s including children as old as 18. She was finishing up charting when I arrived. Several more patients came in while I was there. We only had the one exam room so we rotated patients. By the end of the day on Monday we saw 35 patients between the 2 of us. It was a great but tiring day.