Good morning! My name is Ajay Grewal and I am one of the visiting US resident physicians through the ISSA trust foundation.  I would like to begin my first blog post by thanking the Issa trust foundation for this wonderful opportunity.  I truly feel blessed to be able to work with this world’s most innocent beings through a foundation with an outstanding but difficult mission.  It has always been a dream of mine to volunteer throughout my life in developing nations as a physician and this one week alone has only fueled that passion. A little about myself: I am a Canadian who is currently doing his residency at HCMC in Minneapolis, Minnesota, USA.  I am in my final year of residency.  HCMC is a county hospital and equivalent to a parish hospital here in Jamaica.  These hospital are safety-net hospitals that serve the underserved urban and non-urban populations.  I always felt because I work in a county hospital in the US working in similar hospitals with similar missions would be a simpler transition for me but that assumption was wrong! This week has been both amazing and challenging for me in several ways.  From the time I wake up to the moment before I fall asleep I have constantly been humbled by the people who serve this mission and respect it.  My stay at Couples has been fabulous.  The resort is beautiful with a serene and peaceful ocean back drop.  There are endless activities but after a day of work I enjoy nothing more than grabbing a book in the evenings or just talking to the staff and getting to know them.  The staff at Couples Tower Isle are either great at smiling throughout their shifts as a prerequisite to their duties or are truly happy and appreciative folk (I favor the latter!).  They are incredibly respectful people who will go out of their way to assist me for the tiniest of tasks.  Their enthusiasm is infectious and they respect us visiting physicians so much I can say without hesitation I am not this deserving!  From my walk to morning breakfast to when I arrive in the evening, any uniformed staff I see will either say “good morning/evening”, “hey doc! *fist bump*”, “how was your day sir?” or “Ya mon you good!?”  I love it!  This instant connection between complete strangers is such a refreshing change from the world I come from where we often don’t even make eye contact with those we walk by in the hallways. Thus far I have visited all three hospitals/clinics at Port Maria, Annotto Bay and Port Antonio.  It is no secret that for visiting physicians the biggest challenges are adapting to a new health care system, working with paper charts (I can’t remember the last time I had written in a chart!), not knowing what medications are available, and being exposed to unfamiliar illnesses. I will never forget walking out of my villa Monday morning to find my driver (Steve – awesome man!) and head to Port Maria.  As I shut my door the first staff member I encountered in the front said “Doc is there any treatment for Chick V?”  I of course did not know what this was but soon figured out he was referring to the Chikungunya virus.  I had heard about the arrival of the virus in Jamaica but was unaware of how prevalent the illness had become until I arrived.  The poor man had obvious joint pain and discomfort and I felt terrible telling him “there is no cure friend, but I brought some Tylenol and that might help with the pain”.  I was a little nervous because I honestly had no idea if NSAIDs/analgesics were very effective and was afraid I’d disappoint the man.  I ended up giving him some and the next morning he was all smiles and told me he gave a bunch of the Tylenol to his neighbors who were also afflicted.  He was so thankful I couldn’t believe it – all I did was give an over the counter pill.  I now understand the locals appreciate gesture and goodwill as much as positive results.  I myself am nervous about contracting the viral illness but if an entire country has lived through it then what am I – I’ll be fine!  I find if I remember some of the endearing names for the illness I’ve heard I can lighten the worries.  I’ve heard Chik-V, chikun bit me, chikun got me, think I even heard chikun-gonorrhea once. I have absolutely loved my drives to each hospital/clinic along the coast line.  I’ve spent my entire life in industrialized urban concrete jungles so to me these AM coastal drives with mountainous terrain to my right and stunning blue ocean to the left is a novelty.  The drivers have been very patient, respectful and great conversationalists.  Most of what I about Jamaica are through these stand up gentlemen.  The roads are winding and I’m used to multilane expressways so my vestibular system has been tested but I have persevered without medication thus far. I can go on and on about each hospital and the people I have met there and I’ll speak more in later blogs.  I will say this: with limited resources the staff do a lot and have a very positive outlook.  A huge challenge for me has been knowing what to do with the resources that are available, what kind of cases are hospitalized here vs back home.  A luxury I have In the US is knowing that if there is diagnostic uncertainty with an acute illness, I am assured it is not very difficult for the parent to return to clinic for a follow-up and reassessment.  This is a challenge here as many of our patients either walk or travel distances to come to these hospitals so I am trying to do as much as I can in one visit.  I do want to thank all of the hospital staff from the registration folk, nurses, MDs that I have encountered.  Dr. Ramos, Dr. Ravi and Dr. Brown have been very helpful and have helped me feel comfortable in an unfamiliar setting for me. Coolest case of the week: asides from Chikungunya illnesses (new concept for me) I saw a child with Grave’s thyrotoxicosis in clinic and referred her to university hospital.  It took some education and diligence to convince the mother the child needs to go to Kingston but I think I got through to her.  It was a classic Grave’s case and maybe I’ll present it at rounds next week. I’ll post pics soon! Thanks all, respect!   Ajay

  As I sit in the doorway of Couples Tower Isle, the wind blowing through my hair and the sound of the waves hitting the shore, I sit and reflect on my time here. I have been blessed beyond words to be able to be a part of the Issa Trust Foundation. 2014 was my 4th medical initiative and words cannot describe the utmost joy this 2 week trip brings to my life. Each year people ask me to describe the trip. One cannot describe this trip until you have lived it for yourself. I dont really have that one “ah ha” moment that I can talk about because each trip, each day becomes a memory etched in my heart. Each smile, each hug, the graciousness of the Jamaican people, and the feeling of the kind human spirit that flows through all humans no matter where our “home” is. That is what I leave here with the feeling that every mother, father aunt, uncle, and grandparent wants their child to be healthy and loved. Over the time I have spent here, I can see a substantial difference in the overall health of the Jamaican children. I remember that after I drew a hemoglobin level on a teenage girl, the level was low. I told her to eat more calaloo. I was able to draw her hemoglobin again this year, her number was substantially higher. She says to me “I remember you, and I listened to you. I have been eating my calaloo. I dont like it, but I am eating it.” Not only is the community of Jamaica so warm and friendly, but the staff at Couples Tower Isle make you feel like you are family. Each day, each person greets you with a warm smile. After a while, they all begin to call you by name. I was walking out to the boat dock, I heard “nurse, nurse!” I looked over and a employee at the watersports area says, “Welcome home, nurse!” Yes thank you my friend, I am home. So I am thankful for my time spent here. I am looking forward to more smiles, more hugs, more “welcome homes” and most of all looking forward to making more children healthier. Because one must never forget, these children our the future and we must always take care of them. So if you have the time or money please help the Issa Trust Foundation in their goal of helping the children of Jamaica become healthier. You will be rewarded in ways you never knew. I tell my friends and family back home that I go to Jamaica to help others, but every time I come back, it is I, indeed who has been helped. Kerri Cook, RN

We look around and see heroes among us.

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We are thankful for the opportunity to work alongside the general practitioners and pediatricians here. It has been a privilege to partner with you and to learn from each other. Thanks especially to Dr. San San Win, Dr. Iyer Ramos, and the hospital administrators who helped coordinate each day. Thank you to Dr. Candi, Dr. Min, Dr. Rico, Dr. Slolely, Dr. Ravi, and the many others who patiently helped us navigate hospital admissions, referrals, and the daily ins and outs of the medical system.

We appreciate the kindness of the Couples Tower Isle Staff at the resort and the Ministry of Health drivers on our daily commute, making us feel welcome and teaching us about Jamaica—its culture, music, food, language, values, and so much more. We miss your smiles and warmth already.

We are inspired by Diane Pollard, who shared over dinner the story of her dream and its reality in starting the Issa Trust Foundation.

We are indebted to the families of our patients– for entrusting us to care for their children.

We value our young patients and the chance to intersect with their lives.

We give thanks for the opportunity to be in Jamaica.

And as we return to the States, we consider for ourselves… How to continue to engage the world around us? How to respond to the poverty, economic inequality, injustice, and violence streaming across the headlines, in other countries, in our nation, and in our very own city? What to do when it hits us between the eyes? It’s a small, uncomfortable feeling, but one that grows with the truth that life is short and that we truly should live, not merely exist. And we remember the words of Mother Teresa: “Not all of us can do great things. But we can do small things with great love.”

So we seek to continue to respond with love—by doing small things, the hard things, and thus bringing hope for the future. We hope that you too are inspired.

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A sincere thank you to the Issa Trust Foundation and all who support its work.

Black for the strength and creativity of the people, gold for the beautiful sunshine, and green for the lush vegetation of the island. These are the colors of the Jamaican flag, and they reflect our experiences in Jamaica.

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We have witnessed the strength of the people in the hospital, A&E (also known as the ER), and clinic.

-The strength of a solo mother providing for and raising up children on her own.

-Three young boys sitting patiently with broken arms, waiting hours for the x-ray machine to be fixed.

-A grandmother’s hope and desire for a better future for her grandson, who is going blind after witnessing the murder of his father.

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We have treasured the beautiful sunshine, reflecting off the sparkling ocean. We have felt its power and heat.

-A drought has affected the island. The country did not receive the usual amount of rainfall during the typically wet months of May and June. Several of the country’s large reservoirs low, and the government is enforcing water restrictions.

-Hospitals are suffering from water shortages. In Kingston a few weeks ago, medical staff walked off the job as they reported being forced to work with little or no water.

-The Jamaica Agricultural Society reports 16000 farmers are affected by the drought, ruining crops and wiping out earnings of farming families.

-With the difficulty of high temperatures and windy conditions, the island has endured dozens of bush fires for the past few weeks. On our daily commute, we witness bush fires and fire fighters at work along the road. The air quality continues to decline due to dust, smoke, and pollution, bringing more children suffering from asthma to see us in the clinic and A&E.

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Even so, we are amazed by the beautiful landscape of Jamaica.

-The beauty of the deep ocean overwhelms and awakens my heart.

-The tropical fruits and vegetables from the land are so tasty—sugar cane, coconuts, ginger, mango, papaya, and the ackee fruit to name a few. The ackee fruit is the national fruit of Jamaica, which we’ve enjoyed in the national Jamaican dish of ackee and saltfish. Don’t worry; we’ve avoided eating unripe portions of the fruit and getting “Jamaican vomiting sickness” (profound hypoglycemia and intractable vomiting caused from the toxin hypoglycin A, which irreversibly binds coenzyme A, carnitine, and carnitine acyltransferases I and II, for those of you who are curious).

-We don’t say lush very often, but we’ve used it a lot here. The views take our breath away. Amidst hardship, we behold the extravagant beauty of the land and in its people. As our driver queried us on Monday, how can we deny the work and love of the Creator?

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We give thanks for the opportunity to share in the culture and beauty of Jamaica and its children, women, and men. We are grateful to those here who have shared pieces of their lives with us—pieces of hope, strength, and creativity. We appreciate the warm welcome and hospitality of the Couples Resort and its staff, the kindness and help of the doctors particularly at Port Maria Hospital, and the smiles and hugs of our young patients.

Thank you for reading and sharing in this experience with us.