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My last blog . . . Last day in Jamaica, for now anyway. Bittersweet. I miss home, but have had such a rich and rewarding experience here that it will be hard to leave in the morning!

It has been challenging at times, and looking back it seems that the first and last weeks were the toughest. The first week, of course, because I was getting used to how to treat patients in this medical system. The last partly because I was, by that time, feeling homesick. The other difficulty was brought on by a discussion I had the end of the week prior with Dr. Ramos and I had some realizations about things I had been experiencing that for a while made me feel somewhat depressed. I had grown used to patients and their parents answering everything I said with “Yes Miss.” I tried my best to give education and explanations at the end of each visit and always ended with, “Do you have any questions?” Very rarely would anyone actually ask a question, and most times they would respond with a little giggle or chuckle, followed by “No.” I told this to Dr. Ramos, and he replied, “Well how can they ask a question when they didn’t understand anything you just said.” Excellent point. Even at home, at times it is difficult to explain to a parent what is going on with their child in terms they fully understand, trying to find the words in lay terms while trying to provide necessary education. But here in Jamaica, one also has to deal with a language barrier. Even though I have gotten better at understanding the mix of usually broken English and Patwa that most people speak, I also ask them when I don’t understand. Could they repeat, or tell me in a different way. But rarely would a parent ask me to do the same. I shouldn’t have assumed they could understand my English. I came to realize that just because they did not have questions or nodded their heads and said, “Yes Miss,” in a lot of cases it probably had nothing to do with whether they actually understood or not. Here what a doctor says goes, and most Jamaicans would never speak up to say they couldn’t understand me. There is also the aspect that it seems that a lot of time the people just don’t listen to what you say. I would be asked a question, and then as I proceeded to answer they would either start talking about something else, or a few times get up to leave the office. Anyway, after I realized all this about 3 weeks into my time here, I felt a bit helpless, wondered how much good I had been doing besides just writing a prescription when needed. When a mother comes in with her baby worried because that baby is having reflux (that is not in need of medication), the whole key is helping her to understand what is happening to her baby and why and when it will get better. That is whole idea of reassurance for me, education is the biggest part of it, knowing what is “normal” and what is cause for concern. But after a couple days, I just accepted that this is part of learning and part of working in an unfamiliar culture. It has been an amazing learning opportunity. I hope I can take this experience and become a better listener and a better educator for all people. It has been a very important lesson for me.

Overall, I hope that this whole experience will make me a better clinician in all aspects, as well as improve my cultural competence. I am truly grateful for the opportunity!

I encourage other physicians and health professionals to take advantage of this opportunity as well. The Issa Trust Foundation has room for 2 physicians here all year round! It would so wonderful if there were always pediatrians here, a consistent presence to serve the children here so they receive appropriate follow-up and care. You will be challenged, you will have fun, and you will leave feeling rewarded. The accommodations here are out of this world! You will have a lot of time for fun and relaxation in return for all the hard work you do during the week. Please, take advantage of this exciting opportunity to become a better clinician while helping the children of St. Mary and Portland!

So a HUGE thank you to everyone at the Issa Trust Foundation, all the many physicians and nurses I had the pleasure of working with here in Jamaica, and to my home program for allowing me the time to have this experience! I plan on coming back soon . . .

Dr. Arleen Haynes-Laing, a past volunteer coming to us from CHOP and is from Jamaica said that Black Dressing is a local poultice/wound dressing that’s used for infected wounds. Can be bought in store (don’t know) how it’s made but it smells “tarry” and is black. Families swear it works well. Another name is used for this dressing is “Heal and Draw.” It heals wound while it draws out the pus.