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Hello readers, I am a new addition to the Issa Trust this month, your doctor du mois. I am visiting from Boston Children’s Hospital where I am a senior resident in Pediatrics. For supporters and future volunteers, I hope that this glimpse into the journey is enlightening and entertaining.

For the past near decade, I have wanted to get back out into the field. I first wanted to be a physician as a child, but I fell in love with medicine in Sierra Leone. I lived in Freetown and on the border with Liberia for 3 months, working and living in various hospitals as a non-medical professional, before starting medical school. What I saw there propelled me through school, from a nonchalant undergrad to a ravenous medical student. Fast forwarding through the next 7 years of training, the Issa Trust has given me an opportunity to be the person I wanted when I set out on this journey. I am ever grateful for the logistical help, transportation support, and incredible accommodations. It is was you expect–a wonderful place to stay.

Before coming down here, I was the senior on service on a busy ward in Boston’s urban medical center in January. In fact, the weekend before I left, I admitted a child returning from Jamaica (we don’t have a large Jamaican population in Boston) with typhoid fever. I didn’t have much time to plan ahead or go to a travel clinic due to the season and service, and I hadn’t planned to take the typhoid vaccine… needless to say, that changed about 2 days before leaving and I scrambled to find a way to transport a refrigerated vaccine in my luggage. I tell that story to say that, I was very nervous about the tropical medicine component of this month. How was I going to recognize dengue from mono, gastro from typhoid? I started reading the Oxford Handbook for tropical medicine on the way down, and that made me even more anxious! Not only is it recommending management of dehydration that is way different than my training, the meds and abbreviations are different! What’s co-trimoxazole and why are they recommending it for everything I would use bactrim for (which isn’t much, honestly).

Then I started at Annotto Bay. It was newborn day, the day where every baby born there gets to see a pediatrician, and I decide if they need to be seen by Pediatrics (or Paediatrics here) or can by followed by the generalist in the community. This is a relatively new program brought about by Dr. Ramos (the community pediatrician). But, gee, I don’t know. How do I know what they shouldn’t follow when I’ve never met them? Well, my first patient of the month wasn’t any of the things that I feared–he wasn’t a baby with a subtle defect, or a child with a tropical disease that I might miss. He was a child with Trisomy 21, a seizure disorder, FTT, likely autism, developmental delay and a surgically repaired VSD who came for hospital follow up after starting valproic acid for seizures. Now we’re in my wheel-house! As complicated as the patient could have been (and all the rehab services and other medicines I wanted to start for him), it really was quite simple. He was tolerating the valproic acid well, and he should be seen by Pediatrics (Dr. Ramos or YOU future Issa Trust rotators) in 3 months.

What an initiation! But, it was freeing to know that I know things, and that the medicine is the same.

It turns out that the problem is learning how to navigate the system. At Port Maria, I staff the A&E (accidents and emergency), functionally as a pediatrician working in a general ED. I see the all the kids, and I consult to the emergency physicians if there is a toxic child. I have been really impressed by some of the Jamaican physicians at Port Maria. They have been very helpful, and are knowledgeable about pediatrics. Of course, they are also very busy, and there are times where decisions just need to be made. The tricky part to me right now is knowing who needs to be admitted and who can go home. It’s a challenge for any pediatrician, but it seems extra difficult here. Do I admit the asthmatic who I think will space to every 2.5 hours? I would in Boston, but I know that they will probably be fine even if I sent them home. It turns out that the hospital stays for asthmatics are days long (not the 24-48 hour turnout I am used to), and that’s quite a stay to commit a child to just because that’s what I do back home. Plus, the beds on the wards are side by side, exposing this asthmatic to all the gastro and other viruses on the floor, and their parents can only visit during visiting hours (they can’t stay overnight). Do I REALLY need to admit this asthmatic? Also, standard protocol is that all admitted asthmatics need an IV–and docs put in all IVs. Talk about making me appreciate my IV team back home.

Finally, it’s good to know that I am doing more good than bad (I hope). Today, I admitted a child to the wards with the most classic orbital cellulitis I have ever seen. By every guideline I know, she would have had a CT scan, ophtho consult, and admitted on IV antibiotics with possible drainage in the OR. Well, I know what antibiotics I should start, and what labs I should order. CT scan? $150 US dollars out of pocket for the family, which they can’t afford. Ophtho? Four hours away in Kingston at Bastamante Children’s Hospital. How do I know what Ophtho wants to do? Well, after talking the case over with the senior medical officer, Dr. Sloley, I found the phone number for the eye clinic at Bastamante. I even had a cell phone (provided by the Issa Trust), and gave them a call. We talked over the case and came up with a treatment plan and transfer criteria. I obtained labs, placed the IV (I’m getting better! I think) and admitted to the wards with everything laboriously hand written in the paper chart.

It’s a learning curve. But the medicine is good! It’s a great experience. It can be scary in all the ways that it should be functioning with minimal/no oversight. Considering that I will be attending in 5 months, this is extraordinary preparation. So far, I highly recommend this to any senior resident who wants to stretch their clinical boundaries, enjoy the sunshine (I recommend the winter in Jamaica), and make some friends along the way.

Ya mon.    

I can’t believe two weeks have passed already!  I feel like I can divide my time here into hotel life at Couple’s and life at the hospitals.  Here goes… Hospital life: a usual week where we visit Port Maria, Annotto Bay and Port Antonio hospitals.  Each hospital has different capabilities and resources and no matter how much time I spend there I still have a lot to learn and understand about the system.  Let’s just say I feel I’ve been spoiled by the resources available to me in the USA.  I’ve had a few stimulating conversations with local physicians and hospital administrators about the contrast in the medical systems.  If I see a patient in the US in the inpatient wards, clinic or ED, I seldom have to ask myself “do we have this medication/lab study/consultant here?”  I have to ask myself this question after nearly every patient encounter here in Jamaica.  No matter how nice the people here are to me and let me know of their appreciation of my help, above all the system here is limited by funding and supplies.  I feel the staff are very competent and driven but can only do so much with a stethoscope, an examination, basic labs and a handful of medications.  The cases continue to vary: a lot of URIs which the locals curiously (I think) call “belly colds”.  The first few times I heard that I focused on abdominal exams but quickly realized it’s probably an issue neck and above.  Some parents seemed to be disappointed if I don’t prescribe Amoxicillin or Augmentin for every minor infection.  I try my best to explain the viral origins of disease and antibiotics contributing to resistance but this is falling short. Medical cases: I had a child with a febrile seizure while I was evaluating her in the ED.  At the time she had a “fever of unknown origin” and let’s just say the extensiveness of the workups differ from what I am used to.  There was a great physical exam on a 7 year old with a palpable thrill and what I think will end up being a septal defect that will end up requiring surgical repair.  I also had the usual broken bones that require casting.  We had a child who was not compliant and wouldn’t sit still during xrays for her broken arm and she had to be sent to a hospital further away for sedation (wasn’t available where I was).  I witnessed a lady die from a probable massive stroke and subsequent ACS in the ED.  She arrived with stroke-like symptoms and deteriorated quickly.  We didn’t have much in our hands to help her with in the ED.  It was very hard for me to stand by and not have any tools to intervene because back home a CT head would’ve been done (no CT machine at this hospital), several stat labs, stroke code would’ve been called with the near instant arrival of the neuro team etc.  The outcomes may not have changed but the inability to “act” is so difficult for me. Resort life: I can’t complain, the resort is amazing and I’m spoiled.  The people as usual have been great and very friendly.  I’m probably up to fist bump #347 already.  I unfortunately sliced the bottom of my foot on a sea shell that cracked playing volleyball and I have a new appreciation for the healing process for foot wounds (they don’t heal like your arms!).  The weather has been “terrible” by tourist standards meaning it’s been windy, rains several times a day and has been cloudy.  We’ve had a lot of seaweed and kelp wash up on to the beach and I had a ‘well duh’ moment because it was a nice reminder that beaches don’t naturally clean themselves, they require maintenance.  I still love it because I can wear t-shirts and shorts and am not defrosting my car windows!  There are some grumpy tourists and I think they easily forget a vacation with your significant other should be about spending time with him/her and not just constant sun!  Having said that, many of these tourists are much happier by evening and I’m sure Red Stripe and rum cocktails play a role here 🙂 Jamaica: I look forward to the drive along the coast to work every morning, what a scenic route!  Jamaica is so mountainous and it makes for stunning views from the coast.  I have spent way too much of my life in the urban jungles and that’s likely why such drives amaze me so much.  I want to venture out of the resort a little more and plan on doing a Kingston and Blue Mountain trip by the end of next week. These blogs and paper charts have also reminded me that I’ve become a terrible writer.  This used to be a strength of mine but after medical school it was all text books and staccato typed sentences in patient charts.  It’s time to revisit the art of penmanship.  

On Wednesday October 1, 2014, My wife Gillian and I had the pleasure to travel to Free Hill Primary School with some other guests and Diane Pollard, CEO of the Issa Trust Foundation. The school is located up in the hills of St. Mary’s Parrish, and is very remote. Upon pulling into the driveway, I wasn’t sure that this was actually a school, as it looked more like a factory, not a place of education as we in Canada and the US are used to. First thing I noticed was there are no windows, only shutters and cinder blocks with decorative holes for ventilation. The principal, Mr. Murphy, greeted us with a warm smile and a handshake, and led us into the center courtyard. The school is basically “U” shaped, with an inner open area where the students play, have recess, snacks, and lunch. We did get to enter a couple of classes to observe, where we were greeted extremely politely by the teachers and students. Some students even sang for us, which was quite a treat. This is a school with very limited resources, but filled with caring teachers and students who are eager to learn. I could probably describe all the things that they do have, but I think describing what they don’t have may give a better sense of the conditions there. Windows.  As I said before, there are no windows, just shutters and cinder blocks with decorative openings on the exterior. There is no air conditioning. There are no walls between some of the classrooms. Only blackboards on stands used to divide the classes. The rooms are small, and not well lit.  There is no playground, just a couple of rusted basketball nets with no webbing and no backboards. There is a swing set without any swings. There is no soccer field, baseball field, monkey bars, or climbing sets. They have nothing of the sort. All things that we take for granted. This school’s students range in age from 4 to 12 years old, and it is certainly not a place that any of us would ever send our own kids to. Alas they do get by, even with the limited supplies and facilities they have.  In compared to what we have though, they have nothing. Thanks to the hard work and dedication of the Issa Trust and it’s staff, the school does have a new classroom, separate from the others for those student who need a more quiet area for learning, without the distraction of having to hear whats being taught in the next classroom. But they do need more. This 2 hour trip was a learning experience for both of us, to actually see how others live in this world. We have been humbled.   I urge all guests to take the trip and see for yourselves,  get an appreciation for what we take for granted. Bring some school supplies of pens and pencils, crayons and paper, books, and craft paper. Donate to the Issa Trust. If we all pitch in, even just a few dollars, we, as a group who travel from far and wide to enjoy our vacations in paradise, who have fallen in love with this little island and the people of Jamaica, will make a difference in a child’s life. We are all of this world, so please, support our world.