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Hello everyone! I first studied abroad as a 20 year old undergraduate in 2004. I volunteered at a hospital while I was a student at the University of Ghana in Legon just outside of the capital city Accra. This was a small hospital, with a few wards and a few doctors. The only specialist there was a pediatrician, and every day she saw all of the children. Everyone else was a general practitioner with 1 year of internship then on the job training. I remember watching the long queues of people lined up every morning to see the 4 doctors and could only imagine what it would be like to be that one pediatrician. Today, I got goose bumps when one of the other 3 doctors at Port Antonio health department told me I was the only pediatrician there today. Since I left Ghana 10 years ago, I have thought a lot about global health. I thought about how to make a real impact, I’ve thought about the ways that sometimes well intentioned people with resources such as myself can sometimes be a burden as we try to help. This program is truly done well. My stay is not a burden on any person since no one has to feed me and house me. I am working under the auspices of the public medical system, so if I get Dengue fever and am down for the count there is always a doctor who can see the babies and we are reiterating continuity and the importance of using the medical system. Since Diane tries her hardest to get 1-2 pediatricians here every month there is some consistency and I can make a plan for 3 months from now that I can pass on to another team. There is bi-directional learning. I’m so proud to be here, and to be a part of this program.

Our last full week in Jamaica was fabulous.  I feel so lucky to have had this experience.  The Issa trust foundation and the Jamaican children have a huge piece of my heart!! Monday and Tuesday we were back at Port Maria with me in the A&E and D in the clinic.   We both had two of our busiest days, multi-tasking and seeing as many patients as possible.  It felt just like being at home.  D saw 20 patients in less than 6 hours and I admitted 3 children out of the A&E.  This opportunity is a wonderful learning experience.  With limited resources it sometimes feels like you our working without all of the information but you really learn to trust your gut– sick vs not sick.  Often labs can’t come back for hours and you have to really work on communicating your concerns with patients and other providers.  The same is true at home but sometimes it feels magnified here!!  On Tuesday I had to start an IV and draw labs on a dehydrated 4 year old with gastroenteritis!  I love procedures but this helped make me even more grateful for all of our nurses at home!!  I also admitted a 9 month old with a fever and very complicated rash.  The rash was diffuse, non puritic and was seen on his palms and soles.  Some of the providers in the A&E thought it was varicella but as it was non puritic my money was on coxsachie virus and a possible superimposed bacterial infection!  I admitted him for observation to ensure the rash didn’t worsen.  I am very interested to see how things progress!!

We took advantage of a free afternoon on Wednesday and went zip lining in the Chukka Rain forest!!  It was amazing and a must for anyone in Ocho Rios.  The natural beauty in the rain forest is breath taking and zip lining is one of the funnest activities I have done in Jamaica.

We were back in Annotto Bay on Thursday for well baby clinic and D and I saw many babies.  From diagnosing murmurs and learning how to obtain echos to educating families about scabies, umbilical hernias and supranumerary digits, it  was a busy day!!  I want to take a moment to think D’s sister and brother in law for their generosity.  They came to visit last week and wanted to help the Jamaican children as well so they donated 50 bulb syringes for us to give out.  All the mother’s who received them were so excited and grateful!  It’s kind of crazy to think about all the things that we take for granted at home!!! I know the last few days of this trip will continue to be eye opening!  Thank you Issa Trust for the opportunity to experience this amazingly beautiful country and take care of these adorable children in a place where the medical need is so great!!  I am so excited to go home, but I know I will feel Jamaica pulling on my heart!! S&D

Wa’gwa! (We’re working on our Patwa).

Steph and I rounded out last week at Annotto Bay hospital. On our way to the hospital we made a stop at Port Maria Hospital for a quick pit stop and I was able to run up to the pediatrics ward and check on a couple patients. There was one young girl who had right sided facial swelling in the previous post who I was worried about. Her swelling was unchanged with the antibiotics. The doctors were unable to bring in a dentist to pull the infected tooth so they were going to send her out the next day for extraction. I was just glad that the infection had not spread and become preorbital or orbital cellulitis! She was not very thrilled to see me as I had put her in the hospital, but I was just glad she didn’t get worse! The other child I checked on was an 11 year old boy who had lost his mother and the teachers brought him to the emergency department for an asthma attack. He actually likely had a panic attack at school then on the the way to the emergency department attempted to jump out of the teacher’s car. This case broke my heart! He needed to be admitted as he was not safe to be discharged and actually had no place to go. I was happy to hear that there is a special grieving team made up of social workers and counselors. He was able to work with them and was in a better place even a couple days later. Again he was hesitant to speak with me again but I was just relieved that he was in a safe place. At Annotto Bay we were able to see quite a few children in the clinic primarily for follow-up of seizures and asthma. It was nice to be the ones managing seizure medications and when to stop them as this is primarily handled by specialists at home. We saw quite a few patients. We also spent some time in the emergency department where we were quickly handed multiple charts. One young girl needed casting for a left tibia/fibula fracture and another child needed sutures for a chin laceration. I was glad to have local anesthetic even though the only sutures available were much larger than what I would normally use. Always a little creative in whatever we do!     The weekend was amazing and extra special as my sister and brother-in-law, Maria and Dan came to visit. We spent the time relaxing, playing beach volleyball, paddle boarding and reading. They were very happy to get out of the cold Chicago winter and we were more than happy to show them around our home! Steph attempted to learn wind surfing which would have worked well if there was more wind 🙂 On Saturday we climbed Dunn’s River Waterfalls which was more challenging than expected and we each have a few scrapes to prove it. Our guide at one point wanted us to climb blindly through a vertical slope of the waterfall…needless to say we did not successfully complete that challenge. Regardless it was a great time and I would recommend it! We even shared a special Valentine’s Day dinner at Eight Rivers where we were serenaded by a Jamaican acapella men’s group! Can’t beat that! 

Gearing up for our last full week here in Jamaica!

With respect and love.

– S & D

Sunday we participated in our first excursion away from the resort when we went to Dolphin Cove and had a chance to swim with dolphins!!  Neither D nor I had ever done this and it was amazing!!! I highly recommend it for anyone coming to Jamaica!! Dolphin cove is beautiful.  At the cove we swam with Mitch (the alpha male dolphin who in his early 20s is already a dad to multiple baby dolphins at Dolphin Cove), watched 2 shark shows, held a sting ray and hung out with multiple parrots!!  And hey, I don’t want to brag but apparently Mitch thought I was the best kisser because he brought me the ring to throw for him after getting a kiss from everyone!!  We got back to the resort that afternoon and had a late lunch before relaxing and catching up with friends and family back home.  We then had mango sorbet for dinner.  I know an interesting choice for 2 adults but hey it’s true, in Jamaica no problems!!  All in all a great day!!

Monday and Tuesday we were back at Port Maria Hospital but we switched it up this week with me going to clinic and D going to the A&E.  Of all the hospitals we go to, Port Maria is by far the one with the greatest need for pediatricians and we are always busiest here but it’s our favorite!!  On Monday I saw a large kerion and even made a diagnosis of Gionati-Crosti!!  I have to pause here to thank Dr Brown for hammering home this viral exanthem to Stevie and I after our last month in Jamaica!!  You’re the best, Dr Brown!  In the A&E, D diagnosed several fractures and is becoming a pro at plaster casting–don’t worry guys, she still refers to Ortho once the cast is on!!

D also saw one of my patients from the week prior.  Last week I had seen a 17 year old male who was febrile, diaphoretic, complaining of pain on urination, bilateral CVA tenderness and that morning had noted blood in his urine.  His u/a showed 3+ blood and 1+ protein (unfortunately at Port Maria the dipsticks aren’t able to tell you if LE or nitrites are present and there are not sterile containers for sending urine cultures).  I was confident this teenager had a UTI but I was worried that he may have had pyelonephritis or an infection caused by an STI (although he denied sexual activity repeatedly).  As his vitals were stable and he did not want either a GU exam or admission, I decided to treat him with a 7 day course of augmentin and told him he had to return in 1 week for a repeat u/a.  My plan was to obtain labs and imaging at that time if he had any blood or protein in his urine.  When D saw him on Tuesday he looked and felt great!  He’d completed his antibiotics and his repeat u/a was completely clean!!  Look at that continuity of care even in Jamaica!!!  That same day in the A&E D saw an interesting patient with a tooth abscess that had progressed to facial swelling and edema.  We spent a long time trying to decide what antibiotics we should use based on availability and how we would be able to get this child to a dentist for tooth extraction.    Ultimately, we decided on clindamycin and CTX and she was admitted in order to find a dentist who would be willing to come to the hospital.  Prior to antibiotics and admission, D started an IV and drew both labs and a blood culture — in Jamaica all lab work is performed by physicians not the nursing staff!! It’s a great opportunity for D and I to work on our procedural skills!!

 

Monday night was our first time that we attended the “Returners Dinner”.  The dinner was possibly the best one I’ve had at Couples– amazing soup and salad followed by an entree of lobster and steak and then a wonderful dessert.  At the end of the dinner, the manager of Couples stood up to thank people for coming back and even spoke about the Issa Trust Foundation.  It’s great how much Couples is doing to help raise awareness and money for pediatric care!! On Wednesday we were back at Anotto Bay.  It was a slow morning on the wards but things really picked up when we went to the A&E.  Within 5 minutes of being there, we were handed 3 pediatric X-rays for review!   One child had a distal tib-fib fracture that needed casting and another had a chin laceration that needed repair.  We quickly got to work seeing as many kids as we could. The ambulance provided our ride home that afternoon!  Our driver was great and convinced us that we had to stop for “real Jamaican food”.  We stopped at one of his favorite restaurants for jerk chicken and red stripes.  Last year we were told that Jamaicans have heartier stomachs than we do so we have no one to blame but ourselves if there are negative repercussions from our eating adventures!!!  But local jerk chicken is fabulous! Back at the resort and the weather is gorgeous!!  We have dinner reservations at bayside tonight but are first going to enjoy a cocktail on the rooftop bar before we go!! Crazy that our friends and colleagues are dealing with snow at home while we are soaking up as much sunshine as possible here!! Still feeling so blessed, S&D

Our first week has flown by! Stephanie and I are grateful to be surrounded by such warm people that continue to help us become oriented to all the clinics we are working at! On Wednesday and Thursday we were at Annotto Bay Hospital. Our first day we were able to join the residents on the inpatient service. The pediatric ward struck me immediately as it is one open room with children of all ages from 3 days to 11 years old with the sickest patients closest to the nurses’ station. We were surprised to learn that if you are over 12 years old you go to the medicine unit! At home we have a hard time transitioning our 18 year olds to the adult units so that struck us by surprise. That continues to point how valuable and needed pediatricians are in Jamaica! We were able to join in on work rounds with Dr. Ramos and found a teaching point with every patient. It was nice to contribute and discuss pathophysiology and management on each disease process. There was a 3 day old infant with hypoxic ischemic encephalopathy who was continuing to have seizures despite being started on phenytoin. This led to a lively discussion of what else was available and prognosis as one of the medicine interns wanted to obtain a CT scan of the patient’s head. We talked about both cost efficient and responsible healthcare as we tried to stress that this imaging modality would not give us additional information and increases the patient’s risk for cancer in the future. Currently in Jamaica no hospital is capable of doing body cooling but an interesting teaching point that we were able to share. One of the residents then gave a presentation on shock. This reminded me of the many talks we have had with the intensivists both at noon conference and in the PICU. Stephanie and I stressed to them the importance of early recognition and quick action. Overall the day was great as we were able to share a lot of teaching points that our teachers and mentors have successfully stressed to us! On Thursday we were in well baby clinic where we each saw about 10-12 newborns. We fell in love with the infants and most were doing well and healthy. We had a couple of patients one with a new murmur that we sent to obtain echocardiogram and another that Stephanie was the one managing diuretics as the last echocardiogram showed a closed VSD with good function. In the afternoon we spent time in the A&E where we immediately admitted two patients. Stephanie saw a young boy with sickle cell disease who presented with pain crisis who was admitted for pain control. I saw a 14 year old boy with an asthma exacerbation that had failed 6 nebulized treatments in the A&E with Salbutamol and Atrovent. We had another lively debate about dosaging as he had been under-treated. Some of the generalist doctors had wanted me to obtain basic labwork to see if the white count was elevated which led to a debate of not ordering labwork when it will not change our management. We stuck to our guns and I like to think it was beneficial to all to think about these things before ordering labwork or imaging. On Friday we traveled to St. Antonio Hospital with Mr. Campbell, the CEO of the hospital. He was so gracious to drive us the almost 2 hours each way. There weren’t any patients in the outpatient clinic so we spent the day in Accident & Emergency. We saw a variety of conditions and have a knack for starting the day off with an admission. Stephanie saw a child with a hot water burn on the top of his foot. With good supplies there could’ve been the possibility of sending him home but as we didn’t even have appropriate wraps the patient was admitted to help prevent infection in this very vulnerable area. After seeing all the patients we were able to spend about an hour playing with the kids on the inpatient side. We read them books, colored and even told some scary (or not so scary) stories! We had a blast!       This weekend we are enjoying everything that Jamaica has to offer! Sailing, kayaking and tomorrow we are off to swim with the dolphins! We are definitely feeling blessed! Until next time, Steph and Diana