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So… this is something I never thought of and something you may never see in the USA… Myiasis… Maggot of the head!! We were stationed in Accident & Emergency when the patient was referred from a community clinic to the hospital for treatment and admission. Upon arrival the patient was having head pain and very hesitant to be examined.  While at the community clinic the area was dressed with gauze. Although hesitant the scalp was examined and we were shocked to see a tiny maggot poke its head out of the 1×1 cm wound and then retract back in. After examination labs were drawn, IV placed and patient was then admitted. This is obviously a condition that happens in tropical regions due the screw worm. Just thought I would share Until next time…. Wanda and Shanna
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While in Port Antonio, we saw a baby for the concern of enlarged breasts.  Grandmother had recently started taking care of her so she didn’t know the specifics as to how long they had been enlarged and so forth.  We didn’t think much of her examination because in infants, breast hypertrophy can be related to stimulation from maternal hormones, and can persist for several months in girls. Prior to her leaving, grandmother mentioned that the older sister (who was also present during the visit) also had enlarged breasts.  Her question was, “Can this run in the family?”  On examination of the older sister we noticed a striking difference in the size of her breasts- Unilateral Gynecomastia. A common normal variant in breast development is the unilateral onset of enlargement, which can be misdiagnosed as a tumor.  Unilateral breast development can exist as long as 2 years before the other breast even becomes palpable.  Although pathologic breast conditions are rare in children, we sent our patient for further evaluation of the breast with ultrasound.  Our hope– to identify normal breast tissue and a normal variation of breast development, while ruling out a tumor, cyst or abscess.

– Your friendly neighborhood pediatricians, Shanna and Wanda

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Your support saves lives! The story of little Grace sums up the sustainable programs created by the foundation. If it had not been for the training, the donations we provided to St. Ann’s Bay Hospital and the dedication of Dr. Woodham-Auden, her outstanding team of doctors and nurses along Fabia Lamm, Regional Director, the outcome would not have been so joyous. Taken from the Jamaica Gleaner:
Mandeville, Manchester: There is no pain greater than that of a mother who thinks she may lose the precious life she was entrusted to bring into this world. Shelly-Gaye Cuff endured much: having to fight for her own life and reserve strength enough to pray and fight for her baby’s survival. But God showed up and granted the Cuffs a blessing in the form of doctors and nurses at the St Ann’s Bay Hospital. “I was 26 weeks pregnant on Friday August 26 of this year (2016). I had just run a few errands and came home to prepare some light dinner. While there I felt a gush – I thought it was urine at first,” she explained. She ‘Googled’ the normality or abnormality of what had just taken place and even sought the help of a friend who was a medical practitioner. Soon after, Cuff went to her doctor’s office and yet again experienced another gush of fluid down her thighs. After an examination it was confirmed that she needed to go to the hospital because she was about to have the baby. With shock and fear of the unknown in less than unfavourable conditions, the soon-to-be mom, with a ruptured membrane and a vulnerable baby, sought to push pass the worst. “In the early morning of Wednesday, August 31, I started feeling contractions: I wasn’t dilating. I then developed a fever; I was hot then cold, shaking uncontrollably and I couldn’t breathe, my complexion had changed and at that point my body was becoming septic – my body was literally shutting down and I thought I was going to die – my family thought I was going to die.” By then a doctor advised Cuff that an emergency C-section had to be done, but priority would be given to saving her life, as her baby could very well be dead as a result of an infection. “When the baby came out she wasn’t breathing, they kept resuscitating her but it wasn’t until after 20 minutes that she gasped. A doctor told my husband that the baby was slowly deteriorating and it was highly unlikely that she would make it to morning.” She continued, “My baby was there – just panting and the hospital had no ventilator to help her breathe. On September 2, she flat lined three times.” When it felt it as though hope was diminishing, God reminded the Cuffs who He was and what He can do. A call came in from the St Ann’s Bay Hospital enquiring if the baby they were told about in Mandeville still needed the ventilator, as a baby had just been discharged. “JDF (Jamaica Defense Force) came and took the baby to St Ann’s Bay Hospital and the baby not only received the ventilator, but top-class care, I felt as though my baby was the only patient there.” She continued, “Initially the doctors and nurses said the baby didn’t look promising: they said they were only instruments, it was all God’s doing. Every doctor on call came to the assistance of my baby; it was just a different experience, state-of-the-art care… I want to say thanks to St Ann’s Bay because they didn’t have to take her and to have spent such a great deal of time on her – 59 days – was awesome. I must thank Elaine Johnson-Kelly from NERHA (North Eastern Regional Health Authority) who pretty much opened her home to accommodate me for the period.” Cuff said upon leaving the hospital, after being granted the go-ahead to take her baby home, she watched all the members of the medical team who knew and worked with her baby, cry. “They called my baby ‘Miracle’ and ‘Grace’. I’m happy to know that in Jamaica there are still health practitioners who don’t deal with humans as statistics but as persons, amid the negativity around there is a beacon up there in St Ann.s Bay. I’m forever indebted to them for the care they gave to me and my baby.” With a new found joy; 17-week-old Aaryn-Grace, the Cuffs have, for now, completed their happy home.
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Week 2 brought more patients to see and a new location. Since we began in the middle of the week, we finally got to visit Port Maria Hospital and we absolutely loved it.  There was always a great steady flow of patients…with many of the common pediatric conditions… cough, viral illness and asthma. We are getting into the routine… wake up, work out, breakfast, to the hospital, back to the hotel, beef patty, cappuccino, dinner, sleep and repeat. The hotel is very welcoming and feels like home now… On Friday of last week we visited Port Antonio hospital for the first time. Although we were located at the hospital we only saw patients in the clinic and accident/emergency. The hospital advertised our presence so as soon as we arrived we were handed 10-11 charts of waiting patients.  We worked hard and was able to help a lot…. saw a child with unilateral breast mass, posterior auricular abscess that spontaneously began to drain during examination!! and a baby with bilateral polydactylyl. Can’t wait for week 3!! Until next time, Wanda Out!!
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Another interesting and busy day at Port Antonio Acute Care. Steady patient flow, until closing… Many patients with cold symptoms/ URI.  But one patient had acute onset facial rash and conjunctivitis (pictured below) treated for impetigo and bacterial conjunctivitis. Then I had another patient with presumed viral AGE, mother was giving coconut water and he was now well hydrated and active!!! Tried coconut water at the resort and it is delicious!! The nurses where great! For my first patient the nurse gathered much of the history before bringing the patient to me. Port Antonio had more resources than Annotto Bay.  There was an otoscope and ophthalmoscope in the room, gloves and tongue depressors. Also, I found the vaccination schedule… BCG at birth and a lot less shots than in the US. Great way to end the week.  Monday Port Maria for the first time, so I’m excited to see what’s it like there.                                                                                                                                                                                                                                                                                                                                                             ~      
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“Excuse me ma’am, is there anywhere to eat at this hospital?” I asked the resident at Annotto Bay.  She chuckled and responded, “Yes, there is a tuck shop right around that corner.”  I thanked her, but in the back of my mind I had no idea what she was talking about.  After multiple conversations with Diane, our driver Everton, and finally just breaking down and following the signs to the ‘Tuck Shop,’ I am pleased to say that I now know where to purchase my snacks! Yes, a snack shop! Now, for a little history on the origin of a Tuck Shop brought to you by our neighborhood sponsor…Le Google – The term “tuck”, meaning food, is slang and probably originates from such phrases as “to tuck into a meal”.


Along with being enlightened, we also managed to squeeze in some clinical experience.  We saw, literally, the CUTEST babies everrrrrrrrr in clinic this morning.  I joked with the mom’s while giving lots of advice on seborrheic dermatitis and breastfeeding.  Meanwhile, Wanda saw a patient with congenital syphillis!


To wrap up our day, we saw a little girl who had stubbed her toe on a dresser and developed a painful abscess.  We performed an I&D in A&E with the help of her mother and the sweetest nurse ever.  I’m sure that little girl will thank us….not today….but some day…perhaps.


Signing off,

Wanda and Shanna (while sipping smoothies at the fruit and veggie bar and watching the waves hit the shoreline)

…until next time!

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