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During the second week of our stay, I enjoyed rounding with Dr. Fisher and the ward team on the inpatient service. There were several interesting cases ranging from rule out kawasaki disease, seizure disorders, and asthma exacerbations. There was one case where a parent believed that bad spirits were causing the medical disorder, and did not believe giving the anti-epileptic medications recommended to treat the disorder would help, asking instead to take her child out of the hospital to see a medicine man that day. One of the doctors and an ambulance worker explained to me that there are people with voodoo beliefs and they can be suspicious of medical treatment, preferring to go instead to those they believe can make the bad spirits go away. This can present as a challenge for medical doctors who are trying to give a child the medical treatment they need and to educate a parent about the condition.

Annotto Bay Ward

The following day, we had a short clinic day where I saw several well checks, a follow up for sickle cell disease, and a girl diagnosed and treated for kawasaki disease whose coronary aneurysm had resolved and was getting ready to graduate the clinic. I was surprised to hear that there was no clinic in the afternoon, and then was informed of a special event that afternoon where the ISSA Trust Foundation was donating incubators and a combination incubator and ventilator to Annotto Bay! Everyone was very excited because this equipment would help improve the care of premature babies in keeping them warm instead of having to improvise by wrapping them in cotton which is not as effective in maintaining their temperature. It was a very exciting day for Annotto Bay!

Here is a great article on the event ~ Incubators for Annotto Bay.

The following day, we headed towards Port Antonio which was a 2 hour drive. We were very thankful for the kind employees who drove us back and forth to this hospital where there are no pediatricians. We helped run rounds where we saw a sick baby with abnormal electrolytes and a boy with sickle cell pain crisis and acute chest syndrome. We made recommendations to get a CBC, BCx, CXR, and give oxygen and were concerned enough about the progression of one of the children that we called over to Annotto Bay for a possible transfer. I was informed later that the baby’s electrolytes normalized but the patient with sickle cell ended up having to be transferred to Bustamante. It is nice to know that we can easily call the ward team or Dr. Ramos with any questions about patients who give us reason to be concerned. One thing that struck me after having rounded on the patient with sickle cell was that there are no pediatric subspecialists on the island particularly hematologist-oncologists. That is still a fact that I am trying to digest.

Afterwards, we attended to clinic and did not eat lunch in order to see all the patients there. We ended up having to split one room which felt chaotic but were able to see everyone by the time we had to leave. Overall, we agreed that there seems to be a great need for pediatricians at Port Antonio and were thankful for the experience to participate in the care of children there.

Port Antonio Ward

That weekend, we had the pleasure of having dinner with Diane Pollard, Dr. McConkey, her husband, and two Biomed volunteers. It was such an inspiration to hear their ideas and new developments coming in the future for the hospitals and the rotation that will make a positive impact by improving pediatric care. During my experience here, I have had times where I initially felt powerless as a physician when certain resources were not available, but after these weeks, I realize it is empowering to know that one can help out by donating needed resources, spreading awareness, or volunteering.

After a long busy week, we were able to enjoy Jamaica by going bobsledding and ziplining through the Jamaican Rainforest at Magic Mountain in Ochos Rios. Here is a beautiful view from a sky lift showing the coast.



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Week 3
Day 1, Port Maria
The weekend was awesome!! Scuba diving at the resort, and ziplining and bobsled riding at Mystic Mountain Rainforest were amazing!! We also had dinner with Diane Pollard, Dr. McConkey, her husband , and two Biomed volunteers. It was lovely to meet them all and learn about the many things that Issa Trust Foundation does to improve medical care in Jamaica.
Today was back to work. Super busy day today. I saw 2 children who had stepped on nails, 1 had developed an abscess which I drained. I saw a child with spina bifida who was having chronic knee pain. An overweight male with chronic knee pain who I was sure who had have a SCFE who did not. Saw multiple other lacerations which were too old to repair. I saw a little girl with a history of macrocephaly and recurrent and persistent thrush. In my time here I have become more reliant on my clinical skills and my instincts. I have also found myself treating with antibiotics more than I would at home, especially for pharyngitis symptoms after learning there is a significant amount of rheumatic fever here and there is no rapid strep or throat cultures available. Perhaps, the biggest surprise of the day was when a mother of a 3 month old boy asked me to be her child’s godmother! I felt honored, but unfortunately as I am leaving in 2 days, I could not.

Day 2, Port Maria,-My Last Day
Today I felt as if I was in an ED and not a clinic. Multiple cases of asthma exacerbations. A case of abdominal pain which is challenging to evaluate without imaging. The girl kept crying that her stomach hurt, but had only mild tenderness on exam. I did an AXR which showed lots of stool, asked for bloodwork, and kept her for several hours for observation. Had to rely on my exam and the wbc alone to r/o appendicitis. Thankfully after several hours her pain and tenderness resolved

This has been an amazing opportunity in so many ways. It is a great learning experience to evaluate and treat children without so many of the tools that you become reliant on. It is fascinating to learn about the healthcare system in Jamaica. It is interesting work in a different culture and really getting to know the people. The resort is absolutely amazing, the food was some of the best I have ever had, the staff could have not have been any nicer or more helpful, and the activities were awesome. I have definitely gotten a little spoiled at nighttime and on the weekends here!!
I would like to thank Diane Pollard and Dr. McConkey for all of their hard work in setting up this rotation. I am grateful to the medical staff and all of the different sites for helping us out with our endless questions. Thank you to all of our kind drivers!!! Thanks to The Couples Tower Isle and the amazing staff for hosting us.
A very special thank you to Dr. Chung Lee, my colleague and friend for the last 18 days!! Thanks for all of your help, and all of the fun memories!! I hope to see you again!!!
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Friday, Port Antonio
Today was our first day in Port Antonio as we were unable to go last week due to lack of transportation.
Very interesting day.
In the morning , we met with the director of the hospital, Dr. Davis who gave us an overview of the hospital. It was very helpful and informative.
Then we went to the pediatric ward and rounded on the patients there with an intern. There were some sick children there. For example, there was a patient with sickle cell disease, fever, and acute chest. We suggested obtaining some bloodwork, a chest xray, giving oxygen, and maximizing pain control. There was 1 week old baby brought in for lethargy who had severe electrolyte abnormalities, metabolic acidosis and elevated direct bilirubin We asked to repeat the blood work, and if it was still abnormal recommended transfer to Annotto Bay where the pediatricians could oversee the care of this child.
In the afternoon, we went to the pediatric clinic. As pediatricians are consultants, many of these cases were not so straight-forward and required some time and thought. I saw a child with nephritic syndrome, a girl with intermittent fevers x 5 months, a girl who had a lethargic episode 2 weeks prior among other cases.
I felt very useful at Port Antonio, which was a great feeling. Kind of nice to be in a place where pediatricians are so needed. Our driver that day was amazing, so kind to us. She totally went out of her way for us (Port Antonio is almost 2h away), and ensured we met with Dr. Davis.
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