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You will find that there will be many opportunities for procedures, some as simple as drawing blood and placing IV’s.  The physicians are responsible for collecting all blood specimens for urgent lab testing and for placing IV’s in those patients who are to be admitted.  I found this a bit daunting at first as I do not get much opportunity to perform such procedures at my home institution.    As when performing any procedure, I would recommend familiarizing yourself with the equipment first.  I had to remove a perfectly placed IV simply because I did not know how to secure it once it had been placed.

There is also quite a bit of obstructive uropathy secondary to benign prostatic hypertrophy.  This has given me the opportunity to replace several urinary and suprapubic catheters while I have been here.  While they have all of the supplies you will need, they are not all assembled in an organized kit.  It can be quite difficult to get everything together without the help of a nurse, and on a busy day in the A&E the help of a nurse is not always available.

I have also had the opportunity to do some suturing.  In both cases it was man versus machete, and the machete won.  Most cannot remember the last time they got a tetanus shot, so they all get one for good measure.  Most are not familiar with the term Tetanus but rather know of the disease by “Lock Jaw.”  In both cases the patients were very cooperative and the suturing went quick and easy.  I understand that sutures can be in short supply at times, so I found myself being very conservative with my thread so as not to waste.  In any case I can’t even imagine how difficult it would be to perform any of these procedures on kids, like my wife had to do!

Drew

Over the past month I have had the opportunity to participate in Ward rounds at Annotto Bay Hospital, Port Antonio Hospital and at St. Anne’s Bay Hospital.  Each had their unique challenges.  Port Antonio Hospital is a local hospital in a fairly remote location.  The “house officer” on duty is in charge of both the male and female medical wards.  A lot of the cases are similar to those that I have seen in the states including Hypertensive Emergency, Hyperosmotic Hyperglycemia State, Exacerbation of Congestive Heart Failure, and Stroke.  The resources are limited, and as I have shared in previous blogs many of the diagnostic tests have to be done privately as the hospital does not own a CT scanner, Echo machine, or Ultrasound.  The “house officer” that I worked with was very kind and sought advice on how he could improve in caring for his patients.  Given the tough circumstances I think he is doing an outstanding job.

Annotto Bay hospital is a referral hospital of sorts.  The female medical ward is currently undergoing repairs after it was damaged by Hurricane Sandy.  This has required intermingling of male and female patients on the male medical ward.  There is also overflow of patients onto the male and female surgical wards.  The construction is almost done and they should be moving the patients in the coming month.  Here two “house officers” and two “interns” manage both the male and female medical wards with input from a “consultant” who is board certified in Internal Medicine.  I would equate this to the attending, senior resident, and intern model.  However, the consultant is not their everyday, and may only physically round on patients 2 or 3 times a week.  He is always available by telephone if needed.  When he is there he is quick to teach and share his experience.  Annotto Bay has similar limitations and most of the diagnostic work-up must be done privately.  They do have the ability to perform basic x-ray and laboratory tests.  The morning is filled with pre-rounding and then rounding with the consultant.  The afternoon is consumed with coordination of care and phone conferencing with specialists in Kingston.  Discharges are performed in the afternoon, and their seems to be a disconnect between the hospital and the primary care physicians at the health centers.  There really is not good way to communicate hospital details to the physicians in the community.

I have spent the last week at St. Anne’s Bay Hospital which is the regional referral center.  The hospital is about twice as large as Annotto Bay hospital which is about twice as big as Port Antonio.  The hierarchy is similar with consultants, house officers, and interns.  Annotto Bay hospital is equipped with ultrasound and fluoroscopy, however, I understand that the ultrasound machine has been over heating and they are currently limited on the number of ultrasounds that they can perform each day.  Major testing such as CT scans and echocardiograms still have to be performed privately.  They do have two beds in a “High Dependency Unit,” which would be equivalent to our ICU without ventilators.  They have telemetry, continuous pulse oximetry, and they have one nurse that cares for the two patients.  I find that the cases are a little more severe at St. Anne’s Bay.  For example, a young many with Ackee poisoning, known to cause hypoglycemia and anion gap metabolic acidosis, had to be transferred from one of the smaller local hospitals to St. Anne’s as they lacked the resources to complete his work-up and give him adequate treatment.  Even with his transfer the patient did not do well and subsequently expired.  I can’t help but wonder if his outcome would be different if the proper resources were available.  The physicians are well trained and are as efficient as the system allows.

Drew