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13
August

Wax and Cannon (Kernel) aka lymph nodes

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The time has certainly passed swiftly even as I am becoming more familiar with the practice of pediatrics in rural Ja. I have seen some interesting cases: branchial cysts, diabetes inspidus etc. This past tuesday I experienced the ride of a lifetime in transporting a 30wkr in respiratory distress from Port Maria to St. Anns Bay hospital which had better capabilities. It was a harrowing 20 minutes (normally 40-45min ride) driving at an average of 95km/hr on the curvy narrow roads in a…taxi! The baby was in the backseat receiving O2 via mask. I was so scared!! But baby and us made it safely and it was a familiar scene of incubators and cpap devices once we arrived.
But still these and otheres are reminders that I am in a developing nation. There was the cutest little 2mth old boy who was hospitalized in respiratory distress, known to have transposition of the great vessels, thriving but still in need of surgical intervention. Unfortunately, there is not a dedicated cardiac team in Jamaica so I was told that he would be sent home to die eventually UNLESS the visiting cardiac teams (from US or Great Britain) gets to him in time. Ughhh..Stark reality of life in Jamaica.
Or how about no new born screening in JA (but to be fair this was only been in vogue for the last 20-30yrs in the US). Waiting a day or two or three for CBC, inflammatory markers, urine analysis. No abgs available in certain rural hospitals of Ja…arrgghhh.
The parents and patients are so much more appreciative and respectful than what I am used to in NYC. I cannot forget counseling this young man re asthma and his humble “Yes miss, no miss, yes miss” responses. The general population honor the doctors AND nurses. It is a tremendous, tremendous opportunity to educate and they WILL listen and improve. Knowledge is indeed power.
Case in point: A pair of premature twins were foremost in my mind because they were 4 pds, barely, and not gaining weight. They also had very bad diaper dermatitis, formula was mixed incorrectly etc. So I educated the parents, gave them some A&D along with Rx and advised a return. The parents were extremely grateful and thanked me profusely. Today they returned for weight check and while the rash was much improved, formula and breasfeeding was appropriate, Twin A was gaining weight beautifully, Twin B was actually losing weight so I had to admit her. I know she will be well taken care of. But I was so glad that I was able to help as a doctor and educator. I love, love, love to help them.
I promised to talk more about Couples in my last blog. It is simply paradise! The food is divine, the ambiance is the best of island life, and the staff is EXCEPTIONAL. They have, without a doubt, made my stay so very comfortable, and I will miss them so much!!!
Water sports, pools, blue and bluer beaches, trips to Dunn’s river falls (a must), Mystic Mountain, horseback riding, plus daily in house entertainment are just some of the activities available. But my personal favorite is tennis! I absolutely love tennis, and the pro instructor, Colin, is the best! I played tennis almost everyday after work and on weekends ( I prefer this to the gym).
Is there a more genuine set of people than Jamaicans (no bias here.lol).Shout-out to all the medical staff at the various hospitals/clinics who held my hand and instructed me on the proper medications and procedures; Dr. Ramos, Ravi, Cleary, Dr. Fisher, Dr. San San, the nurses and Mina (previous volunteer). Love you all.
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04
August

First week. First blog

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Hello to all!! I am a Jamaican living in NYC now back in JA as a volunteer pediatrician. Just finished up my first week. I specifically wanted to volunteer in Jamaica so I could forego any potential culture shock and focus on the nitty gritty from the get go.
Well I have visited all the clinics so far, and Port Maria has been the biggest learning experience so far. I had to see 18 pts in 4 hrs (no more complaints about the clinic in NYC) while learning the protocol for labs, imaging and admitting to inpt service. It is all about doing what you can with what you have, a common theme among Jamaicans on a daily basis.
The problems are quite similar, with a fair amt of semi-acute care. When a pt comes in respiratory distress there was no pulse oximeter to take O2 sats, or nebulized solution…this calls for quick clinical judgement and a referral to the ED. A 3mth old boy with fevers for one wk and a large axillary mass. Unable to do CRP, CBC, and bld cx then and there because the lab was closed so I was entrusted with the unenviable task of doubling as a phlebotomist while the charts are being brought in 3 at a time. Nevertheless, another quick referral to the ED for an admission.
What we deem as necessary medical amenities (ear curretes, tongue depressors, otoscope specula, alcohol pads, covering for the bed etc) are not readily available and I stuffed as much as possible in my little black bag. But even in the rural parts of Ja appropriate medication is pretty much available and many a times, free at cost to the pt. That is reassuring.
But after a hard, day in the heat and rush, going back to Couples is a definite treat. I promise to talk more about that in my next blog so stay tuned. Ciao!
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28
July

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I cant believe its already my last week in Jamaica. This weekend was (sadly) the first time I took advantage of resort activities, touring Dunn’s River Falls, and laying by the pool with a nice book. It is times like this I regret that ‘I’ in my personality test profile. Things seem to be winding to a close pretty naturally though, and I even received my first follow up in clinic today. The mother of a girl I treated a couple of weeks ago at Port Maria stopped me in the hall just to report that her daughter’s skin infection had completely resolved. I think that is one of the most satisfying parts about working internationally: there are some diseases that are so easily treated that you feel guilty taking credit for its treatment. Infection? Antibiotics. Done! But of course, that comes with its sad stories as well. People my age would have parents who had died of some readily treatable illness, or a sibling who died from pneumonia. Pneumonia? What healthy child dies from pneumonia? “Well, that’s life,” they would reply to my sad expression. Not any life I’ve lived, I thought.

Yesterday was a particularly exciting day in Annotto Bay. There was a child requiring a CT Head, and due to the lack of resources at that hospital, we traveled to University of the West Indies (UWI: eu-wee) in Kingston via ambulance. After I was done feeling nauseated and dizzy, I had the opportunity to explore this new hospital. Dr Ravi made the journey with me, and was a wonderful tour guide while we were there. The rooms, the emergency department, the wonderful wonderful machines! What a huge difference it was from the clinics I’ve been frequenting up to this point. Being in Kingston really made me feel like Jamaica wasn’t so foreign after all. If you have some Dramamine on hand, and forgot to eat your lunch, I definitely recommend giving the trip a try.

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