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So I have to make a correction/retraction for Dr. Ramos. We had the discussion during ward rounds at Annotto Bay regarding my post about peds patients being transferred to Bustamante being “very sick”. In fact many of the very sick patients stay at Annotto Bay (such as the 30 week premie on CPAP or the new-onset diabetic, among others that are currently there.) Usually the reason for transfer to Bustamante is because the patient requires Pediatric specialty care, such as surgery or oncology. And as I think on it – the care we give back home in our rural non-pediatric hospital is very similar. We are 5 hours away from pediatrics specialists and care for a very similar level of sick patients. I stand corrected! Dr. Jeff
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ventilatorDid you know in Jamaica there is Universal healthcare coverage?
•Hospitals run by government
•Governments spend $125/person vs $5000/person in USA
•Doctors ratio – 8.5:10,000 people
•Dentist 1:17,000 people
•Pediatricians are subspecialists (children < 12 yo)
•Medical transport is limited
•Healthcare centers provide free vaccines
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My first day (8/5) was at Port Maria Hospital. We had a substitute driver named Justin. Steve was not available – never heard why… Justin is actually the X-ray tech at the hospital but became the driver for the morning as the X-ray machine was down for the day. (Didn’t hear if it was fixed) Had a tour of the facility from Dr. Brown, the Parish Manager. (equivalent to a County Health Officer?) Then they put me right to work.I saw Urgent Care type cases – first come, first served. It was right next to the ED – Which they call A&E here (I believe it’s for accidents and emergencies).  Saw a total of 6 patients only – I guess it was a slow day as the A&E was not busy when I arrived and the Peds Ward was rather quiet.Two of the patients were infants w/ constipation but otherwise healthy (they say “Can’t du du” here) and a young man with a cellulitis from nail puncture on his foot. The last patient I saw had a second occurrence of fever w/ bad leg pain – so bad he had trouble walking. Otherwise healthy kid. We got some blood work (one of the Jamaican doctors helped me – I haven’t drawn blood in 15 years!) which should elevated CK. I think it’s a viralmyositis because I had 2 patients in the past with something similar. The rest of the day was very slow – no more patients. On Tuesday (8/6) I am actually sitting here writing this beside the pool. Apparently it’s Jamaican Independence Day and a holiday. We were told not to come in today and wouldn’t have a driver anyways.  Tomorrow I am scheduled to go to Annotto Bay Hospital, a little further to the east from Port Maria.
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Two infant ventilators valued at over J$2,000,000.00 were officially donated to the Paediatric ward of the St. Ann’s Bay Regional Hospital on November 12, 2012 by the Issa Trust Foundation. The Foundation’s donation is a significant upgrade to the manual technique being used by the facility, called bag mask ventilation. Ventilators are machines used to provide breathing support for ill or premature babies, as often they are too weak to breathe properly on their own. Twelve boxes of pharmaceuticals and medical supplies were also presented to the facility. Dr. Coralie Antoine, Paediatric Consultant at the facility thanked the Issa Trust Foundation saying, “We frequently manage extremely premature infants and very ill infants with various respiratory conditions who require ventilatory support. In the past, we have had to rely on the availability of ventilators at Type A hospitals necessitating the transport of unstable infants under less than ideal conditions. With these ventilators, we will be able to better manage our newborns on site. This donation will go a long way in improving our perinatal and infant morbidity and mortality rates and will reduce the need for transport of these ill infants to other facilities…” Eleven nurses and five doctors from the facility also benefitted from ‘hands on’ training in the use of the special equipment. Training encompassed a myriad of topics which include; the care of intubated neonatal patients, revision of the components of the baby log ventilator and bag mask ventilation, among other key topics. Training facilitators Cheryl Dominick, RRT-NPS and Christine Franciscovich, MSN, CRNP, NNP- BC, who are volunteers from the Children’s Hospital of Philadelphia, have been coming to the island for over five years to assist in the foundation’s mission. The critical nature of the machines and their necessity was brought immediately into focus as during the training two babies stopped breathing and were intubated by the volunteers, and the nurses and doctors who had just received training. One of the volunteers, Cheryl Dominick said, “We stood watching the baby’s chest not rising, saturations dropping …It became evident in that moment that more ventilators and immediate training were needed to save the lives of these babies in Jamaica.” Another team of volunteers is expected to return in January 2013 to continue the training as it was interrupted by the passing of Hurricane Sandy. Additionally, they will bring a biomedical technician to service the donated machines. Mrs. Diane Pollard, Chief Executive Officer of Issa Trust Foundation, said “Through our partnerships, our goal is to provide more kids and their families with what they need the most, their health; so that we can satisfy their boundless hopes and dreams of a healthy future.” The Issa Trust Foundation was established by the Couples Resorts and has been involved in the enhancement of paediatric health care in north-east Jamaica since January 2005. Their partnership with the North-East Regional Health Authority continues to yield positive results for patients, especially the paediatric clientele. The Foundation is also supported by the Fraternal Order of Eagles another donor organization in the USA, established in 1898. The Issa Trust Foundation has demonstrated a keen interest in the parish of St. Mary, targeting the hospitals, clinics and underserved areas in the parish. In July 2012 the Foundation donated a twenty foot container valued at US$ 150,000 to the St. Mary Health Services. They have also initiated strategic outreaches in Portland and St. Ann. Since 2012 they have also demonstrated much interest in developing the St. Ann’s Bay Regional Hospital. Contact: Shauna Llewellyn – Gordon Regional Public Relations and Advocacy Officer (Acting) North East Regional Health Authority (NERHA) Units 34-38 Ocean Village Shopping Centre Ocho Rios, Jamaica W. I. Tel: 795-0102, 795-3107 Mobile: 318-0104, 457-0638 Email: shauna.gordon@nerha.gov.jm and Diane Pollard President & CEO Issa Trust Foundation Email: issatrustfoundation@yahoo.com
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Written by Carl Gilchrist, Gleaner Writer via The Gleaner ST ANN’S BAY, St Ann:   ventilator According to the laws of nature, baby Khaliyah Smith was due to be born in February 2013.  “She is due next month,” joked her mom Karen Roberts while she held her little daughter in her arms with unbridled joy as she sat in the paediatric ward at the St Ann’s Bay Regional Hospital last week Saturday. The reality is, little Khaliyah was born two and a half months early, on November 7, 2012, the tiny bundle of joy weighing an astonishing one and a half pounds. Miraculously, she survived, but she had to spend 68 days in a ventilator at the hospital before being released and given the all-clear to go home. Chances are Khaliyah would not have been alive today were it not for two ventilators donated to the hospital by the Issa Trust Foundation (ITF). Two infant ventilators valued at more than J$2 million were officially donated to the facility last November by the ITF after having been installed at the institution for some time. The donation has been considered a significant upgrade to the bag-mask ventilation, a manual technique previously used by the hospital. Ventilators are machines that provide breathing support for ill or premature babies who are often too weak to breathe properly on their own. Expressing appreciation On Saturday, Roberts met the persons who made it possible. She spared no words in expressing her appreciation and described her joy over the survival of her baby and for being able to finally hold her and take her home. “This morning, I met the persons who donated the ventilator, and I’m so grateful,” Roberts told The Gleaner. “Because of them this is possible!” said the ecstatic mother. Speaking about the ventilator, Roberts said: “I have benefited greatly from it. My baby was born premature – six and a half months. She was very, very tiny. In fact, she’s big right now in comparison to where she was. She spent 68 days on the ventilator. It helped her, and she’s right here in my arms. A blessing! A miracle! I am overwhelmed.” For the nearly 10 weeks that baby Khaliyah spent on the ventilator, Roberts prayed and hoped for the best. She received moral support from all quarters – friends, family, co-workers. “It was overwhelming. I could not have done it without them – everybody!” Roberts said her son, Kevoy, “absolutely adores” his little sister. “He would say, ‘Mommy can I borrow her? I want to borrow her.’ She’s a blessing.” Diane Pollard, president and CEO of ITF and several members of a medical mission team from the United States of America, were at the hospital. The visiting team was involved in a second round of training of hospitalstaff members in the use of the ventilators. Jamie Sklar, a Registered Nurse from Philadelphia, has been working with the ITF for several years as a member of the medical mission. She explained that the ventilators were a donation from the Children’s Hospital of Philadelphia. “I think Jamaica is at a place where they need the help of technology and training, and that’s what we’ve been providing with these ventilators,” Sklar said. Keisha Bramwell, supervisor on the paediatric ward and one of the nurses trained in the use of the machines, said the equipment provided more in-depth care for patients. “With the help we are able to give now, we don’t have to transfer our patients that much. We now are able to give them the emergency care that they need in a short space of time,” Bramwell said. Pollard, commenting on ITF’s involvement, said what made the foundation different from others was that they not only brought much-needed equipment, but also provided training. “We do this because it’s the right thing to do. We love Jamaica, we want to make a difference, we are able to make a difference,” Pollard said. St Ann’s Bay Regional Hospital CEO Keith Richards said the partnership between ITF and the hospital had facilitated an improvement in the quality of service being offered at the institution. “We have saved a large number of lives! Babies have gone home with mommy much happier and much healthier. I believe the initiative and approach by Issa Trust paediatric care is going to go a very far way in this country,” Richards said. He also appealed for others to come on-board and support the hospital. rural@gleanerjm.com PHOTOS BY KAREN SUDU
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I finished my last day of work, and it was bittersweet. According to my patient logs, I have helped many children here in Jamaica (135 to be exact), while enjoying the beauty of lush rainforest and gorgeous beaches.

The view from the bridge of Annotto Bay


On the way between Ochos Rios and Annotto Bay


Typical bar in Jamaica

On my last day, I saw a patient for the second time at Port Antonio Hospital.  She was a 12 year old girl who had come last week  concerned because she was always thirsty, and always urinating, even at night.  In fact, mom was concerned because this wonderful, active 12 year old had never had a dry night in her life.  The mother had brought up this issue in the past with previous doctors, but no one had quite figured it out.  I had them obtain some basic labwork and a urine sample.  She had normal kidney function, her urine was negative for protein or blood or sugar, and she could properly concentrate her urine (ruling out a hormonal problem that could cause this issue).  The last test that we did was to check her hemoglobin A1c, which reflects the amount of sugar in the blood present over the past three months.  Normal is less than 6.3%.  Hers was 8.1%, indicating that she had diabetes (likely type 1).  I explained what happens in diabetes, warning signs to look out for, and referred her to an endocrinology specialist at Bastamante Bay. 

What I will remember most is the gratitude on the mother’s face because she finally knew what was wrong with her daughter.  The relief on my patient’s face was even more gratifying.  When I first saw her last week, she was so embarrassed because she was twelve and was still wetting the bed at night.  She wouldn’t make eye contact, and she barely said a word.  After she knew that it wasn’t her fault, that a disease was why she couldn’t keep dry at night, and that this problem was fixable once her diabetes was under control, she started smiling.

I have learned so much over this past month here in Jamaica, and am so sad that I will be leaving tomorrow. I have learned to be very self reliant, and this experience has shown me that I am ready (even if I didn’t think I was) to take up the mantle of being a full time pediatrician starting in July.  I am comfortable with procedures, and managing sick and not so sick patients at the same time.  I realized how adaptable I can be, and I am able to utilize limited resources to coordinate care of a patient.  I am so much more comfortable now with the idea of striking out on my own. 

Of course, I had wonderful nursing and physician support to help me all along the way.  As I said before, the people here in Jamaica are amazing…especially the parents and patients themselves.  They are so respectful of doctors (everyone takes off heir shoes when laying down on the exam table), and very patient.  They will wait hours to see a doctor in the heat.

Waiting area at PMH in the morning
The waiting area at PMH in the afternoon

Here in Jamaica, they speak both Patois, which is a very lyrical language of shorthand English, slang, and French, and regular English.  During my time here, many parents would speak with thick accents in Patois.  Sometimes I would struggle with understanding them, other times they would struggle with understanding me.  However, they never became frustrated. One of the physicians at PAH (Port Antonio Hospital) even gave me a short half hour lecture on Patois, and some of the rules. Like, never say I, just mi.  Th is pronounced “da”, and er becomes “a” like in “It ova dere”.  Each region of Jamaica has their own dialect of Patois, which makes it even more fun. It was like a puzzle sometimes, as I would do my best to figure out what was said.


So, mi a go home. However, I will always carry this experience with me.   Heading outside to enjoy my last bit of sunshine before I go!

Waving goodbye!



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