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From August 13, 2015 Jamaica Gleaner

The United States Agency for International Development (USAID), along with the Government of Jamaica and the Jamaica diaspora, recently hosted a five-week Camp Summer Plus programme in Jamaica. Participants were instructed in reading and mathematics and the arts. Careful thought was given to the medical, dietary, social behavioural and academic fortification of students.

The Issa Trust Foundation, chaired by Paul Issa, who is also the deputy chairman of Couples Resorts, facilitated medical clinics at Sam Sharpe Teachers’ College in Montego Bay, Cedar Grove Academy in St Catherine, and the College of Agriculture, Science and Education in Portland, from July 13-15.

Dr Jeff Segar led the team which gave 362 children a physical examination, basic blood tests, hearing and vision screening, pharmacy medications, when needed, and fluoride treatments. Eyeglasses were provided through a partnership with Michigan Lions Club to one in four of the children seen.

A questionnaire was developed to assist the team to identify risk factors for impaired learning, and also to assist in identifying potential future interventional measures designed to promote learning in this population. If parents had to pay out of their pockets for the medical care, eye examination and glasses, it would cost them approximately $75,000 each.

I’m not sure I had truly considered that Jamaica was a mountainous island, and what that meant for the landscape, until the drive to Annotto Bay hospital on my first day at work. To my left was beautiful bright blue sea and to my right, forested hills. Coming from Miami, this view even beat my 15th floor bay/city view balconies. At the hospital, there was more of the new familiar- a modestly equipped open air style British colonial style hospital with friendly nurses and patients. I was greeted with a stream of “good morning”s and “good day”s and the smiles seem to be brighter once I mention that I am with Issa Trust, the Foundation clearly has a solid track record with the hospitals. In terms of work, rounding at Annotto Bay, and even clinic, is very independent. As the Issa trust pediatrician, I pre round on the patient (along with the general practitioner “medical officers” and present to Dr. Ramos, the attending pediatrician. He does fantastic teaching for the residents and  specialist, he usually invites me to chip in to teach. In clinic we function completely independently but can still ask Dr. Ramos or one of the house officers if we have questions on procedure, available medications, referrals etc. While all the charting in clinic is handwritten and often not too legible,most of these visits are well newborn checks and the infants have their health booklets with all pertinent antenatal and peripartum information on the baby. This serves as a very helpful portable medical record for the child and even has growth charts, vaccination records and slots to input information for all of their well child visits through to the school-age years! While the rooms are not as fully stocked as they would be in the states (otoscopes etc), with some effort, it’s possible to maintain the same standard of care/screening as we would have stateside. It’s mostly about remembering your basic history and anticipatory guidance skills and making sure to bring with you what you can (oto/ophthalmoscopes, tiips etc) from the states or from the villa. By nature, and training at Jackson Memorial, I try not to assume anything on behalf of the patients or the follow up system so when I doubt anything at all, I ask one of the other doctors to be sure that what I am doing will actually get them their referral, follow up, medication etc. Overall, it’s relatively easy to settle in and the other doctors and staff are very helpful and welcoming.

For me, having grown up between Liberia and Ghana, Jamaica, while new, feels very familiar. From the lush green countryside to the old British colonial architecture in the small towns, it could have been transplanted from any of the British commonwealth countries that I’ve ever visited. Nevertheless, the beauty of this new familiar could never be lost. Driving along the main road with rolling clear blue waves to the left and rising rainforested mountains to the right is not a view one easily tires of. The resort, with the open air layout and, beautiful beaches and crisp white walls is just as beautiful as the country.

Today was my first day on the job. It was definitely also a day of an emotional roller coaster. I woke up energized and excited, anticipating the day ahead. I met the spin instructor and we worked out together before showering and grabbing breakfast. I wasn’t sure what to load up for lunch and decided to make a trail mix of cranberries, walnuts and sunflower seeds and grabbed an apple and orange. I wasn’t quite sure where to go or what to do when i got to Port Maria Hospital, but everyone was so nice and willing to help me around. My driver, Mr. Munsey was the best. He pointed out things along the drive, had conversation about the healthcare system and how things work, and once we arrived he showed me to the pharmacy and walked me around to make sure I was where I needed to be. I met the OB attending who gave me a tour and helped met get situated. It was awesome to have my “own” office where I could set up shop with the computer and get started for the day, but before I even sat down, I was presented with a stack of four dockets. I definitely hit the ground running. I was basically left to be a pediatric ER attending- all of the pediatric cases were left to me. The decisions were mine. Of course I could ask questions if need be, but otherwise I was in charge. Before I finished the first patient, I was given a stack of two patients from clinic and another two from the emergency department. I had a hard time even figuring out the charting system- was I supposed to write notes? if so, where? why did some patients have a slip of paper with vitals recorded and others not. Lesson learned: if in doubt, ask. It may take extra time, but thats what you do when you are learning. The nurses in the emergency department are awesome with helping out with anything. It wasn’t until my fourth patient that I saw who had notes from a previous visit did I realize how notes were completed- of corse at this point I realized I was behind for the day (especially since I didn’t start seeing patients until noon!). The dockets kept coming in- nearly 20 in total for the day) I saw the line of patients growing and felt bad for making them wait, so I just kept going and seeing patient after patient without paying attention to the clock. Visits seemed to take a while longer than normal, and part of that was really just trying to figure out which medications are actually on formulary and writing prescriptions by hand- something I only had to do as a medical student! In addition there were some things I just wasn’t used to. My first prescription for amoxicillin- formulary states that they have amoxi-clav 457. What is that??? I quickly learned that 400mg amox/57mg clav per 5mL is just 457. You realize the things that you don’t really have committed to memory when you are used to the computer screen popping up an automated prompt with dosing, frequency, and duration almost as soon as you enter a diagnosis. As the day went on, I quickly got the hang of things and again didn’t notice the time until Mr. Munsey came to pick me up. I had no idea time went by so quickly! I still had 10 dockets waiting for me and still had an incision and drainage to do and the lab told me they couldn’t collect blood from the infant I was seeing and that I would have to do it myself. With the patients waiting and all that needed to be done, I wouldn’t even be done charting in time. Lesson learned: be aware that everything you do does in some way affect someone else. I don’t mind staying late and going over the “scheduled hours.” Not once did I stop to think that poor Mr. Munsey who was supposed to drive me home at the end of my shift had his own shift which was supposed to end at 5pm. I tried to figure out how I could hurry through things when I was told that if I don’t see the kids they could always return on monday when I am back. MONDAY!?!? Thats nearly a week!!! Of course I was later informed that the ER docs can see patients, but at the time, I thought that the patients just wouldn’t be seen. I completed all that I needed to do- the blood for the patient (that eventually clotted because the CBC machine was broken), the BMP (which wasn’t resulted after 5 hours because that machine was broken as well), the incision and drainage of the abscess that drained more than 15mLs. Of course there were many questions- how many tests that I NORMALLY order (because it is routine or the cultural norm at my home institution) are actually necessary? For the UTI that I am treating based on urinalysis and symptoms, do I really need the culture as well? If I order something that isn’t going to be back today, who will follow up on it? and how exactly are things followed up? As should be expected at this point in my career, I found that the “quick and easy” visits seldom are such, and had to find out how to call a social work consult and my role in contacting police as well as the OCR (office of the children’s registry). I finally wrapped up the last patient and although I felt terrible for how long some of them had to wait, everyone seemed very appreciative. After feeling like I am burned out and “over” residency, I felt excited about medicine again, about my ability to see, diagnose and treat. To decide what is best for the patient, to truly manage the situation. One other thing I feel: exhausted! I really would like to fall asleep right where I am, next to the pool staring at the brightest stars I have ever seen while feeling the breeze of the ocean and listening to the blues band playing on the main stage and all of the happy couples around the pool dancing. I look forward to an amazing night of sleep before an awesome second day on the job!