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Jamaica Pediatric Mission: August 4th , 2010 Port Maria Clinic: “Late yesterday, I found out here was a room a nearby, (technically in the hospital building )the pediatricians use for HIV clinic. I didn’t …”
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A hearty breakfast every morning. A great cup of coffee. Amazing view. Yeah, I can get used to this.

I was eager to get to Port Maria today so I could check in on the one-year-old boy we saw last week who had been scalded by boiling water. Stacy and I were worried about his pain management and the adequacy of monitoring such a young child’s fluid balance. I’m happy to report that he is doing much better. In fact, I couldn’t find him in his bed because he was out and playing around. He was scheduled to be discharged today. Dr. Fazul had followed our recommendations for pain management using morphine and he reports that the baby was very comfortable during the last week. He has been eating well, and his skin looks very healthy. His mother came and gave me a hug saying, “thank you for loving my child”. That’s it. That’s all the compensation I need.

Dr. Fazul and I rounded on another 8 patients. The pediatric ward here has the luxury of being split into three zones, so the four children admitted with gastroenteritis were physically separated from three newborns and another one-year-old girl who had been admitted two days ago with a burn eerily similar to the first boy’s burn. I learned an interesting tidbit of information when I asked if the babies were receiving expressed breastmilk and if the hospital provided mothers with breast pumps. Apparently, the mothers actually express their breast milk manually, using their hands (this is how). I didn’t know this was possible, and I’m happy to hear that it is, but a part of me wonders how many more mothers would provide expressed breast milk if they had the manual breast pumps that many US hospital provide free of charge to new mothers.

I saw five patients in the clinic after rounds: two were follow-ups for asthma, one was a well child visit for a month old newborn (yes, they do well child visits here), one was case of pretty bad tinea capitis that had failed management with shampoo that a private doctor had prescribed, and one was a child with occasional dizziness spells that I sent off for some tests and asked to follow-up next week.

I had a little time to speak with the folks at the registration and scheduling office. They are now offering parents who call for a pediatric appointment the choice of a Tuesday clinic (when Dr. Ramos is here) and a Friday clinic (when one of us will be here, hopefully regularly). They’ve integrated us, and I love it!

Before heading back to the resort one last time, Steve and I went to Scotchy’s, which has the reputation of being the absolute best place to have jerk bbq in Jamaica. I came here last week with Diane, Stacy, and Alex and I couldn’t bear to go home without pigging out again.



Today is my last day here and I’ll be happy to get back to my family. But I’ve had a tremendous experience here. Having a regular schedule, and actually filling in a gap in each clinic is very gratifying. Working with the hospitals rather than in parallel to them is beneficial to the long-term well-being of child care in Jamaica. I’ve gotten to know the pharmacists, the lab technicians, the attendants, and the other physicians and I feel that we are now a unified force. Great things are coming. We are learning new lessons every day, and the “orientation manual” that Stacy and Diane are writing is being updated on an almost daily basis. There will be kinks, but that’s the best way to learn and to improve. And being able to come home to the luxuries of a beautiful resort and rest in a great bed is nice icing on the cake.

This blog will be open to posts from the future physicians and nurses who take part in this mission. I’m looking forward to reading about others’ experience here. Thank you all for following my journey with me. The emails you sent me and the comments you posted were very inspiring.
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The outpatient department in Annotto Bay – the patients wait outside

I received some bit of good news today when I passed by the pediatric ward in Annotto Bay today. Baby B of the triplets has been able to come off of CPAP and he has been making good breathing efforts. This is the baby who had omphalitis so having one less thing to worry about makes his care a bit easier. I was able to uncover him completely to do a full exam. His omphalitis appears to be under good control. His breathing is unlabored. His right foot is a little poorly perfused and the little toe is looking a little dark. I asked the nurses to place some warm packs on the left leg to improve perfusion. The nurse tried to correct me and asked if I meant the right leg. A great opportunity for a teaching moment!

They are going to try Baby A off of CPAP today. They tried last night but he wasn’t quite ready. Dr. Ramos has to make an educated guess as to when a baby is ready to be taken off of CPAP. The babies have never had an X-Ray, because the machine has been broken (since February). We cannot monitor blood gases – they don’t have that capability at all.

Triplet C, our sickest one (with possible sepsis), was a little swollen. Dr. Fisher, the senior resident, said that he had low protein levels (hypoalbuminemia) and they had given him some intravenous albumin. This is only going to get exacerbated by the limited nutrition. But at this stage I’m also worried about the kidneys. We have no way of closely monitoring the urine output. On my way back from the clinic yesterday I stopped by two “supermarkets” but neither had a scale. Bobbi – the scales you are bringing will be a lifesaver! Literally. Thank you! Thank you! Thank you! (one from each of the triplets).

Our makeshift NICU has a new addition. A 29 weeker was born yesterday and he weighs about 3 pounds. He’s doing well. He is being kept in the nonfunctioning incubator, but at least it is a barrier from infections. He is breathing on his own and he may get fed today.

In the next bed I saw a mother cradling a baby who looked limp. I found out that this is an 8-month old baby with a severely malformed heart – DORV with TGA and VSD/ASD (for my PICU folks). This is a condition that typically requires intensive monitoring and very VERY close observation. He would typically require the collective efforts of a cardiologist, cardiac surgeon, intensivist, and nurses adept at caring for children with congenital heart disease. Yet, he’s had no X-Rays.No lactate levels. And he wasn’t hooked up to a heart monitor. Dr. Ramos explained that all the available heart monitors are being used. It is a tough decision, but I can’t help but agree with the premise. Limited resources must be distributed where they can have the greatest impact. This child’s condition is very complicated. He will likely require several cardiac surgeries or even a heart transplant. I spoke with the mother and she barely had enough money to get the first few echocardiograms. She said there is a traveling cardiac surgery team that will be in Jamaica in November. She hopes they will “fix his heart”. Dr. Ramos and I talked about how we can prepare him for surgery. We will try to get him to gain more weight. We will monitor his kidneys. We will monitor for heart failure. Dr. Ramos will try to get him transferred to the capital but he’s not sure if they will accept him.

Tomorrow is my last day. I will be going to Port Antonio. I’m looking forward to meeting Dr. Fazul again and seeing how he has been doing with our little kid with a severe burn.
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