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I can’t believe the time here is passing so rapidly!! My second week started with a challenging Monday at Port Maria. On arrival I became immediately involved with an asthmatic boy. He repsonded to treatment but as I was writing up his chart I heard faint labored stridor from the A&ED. Wandering over, I found it was a small 6 month old girl with significant croup…. croup you that may cause airway obstruction. !!!! Again, working with the local A&E doctors, racemic epinephrine eased the symptoms significantly. But with the baby’s age and presentation she was soon on her way to Annotto Bay for admission and more care than could be done at Port Maria. Off to a busy start! Unfortunately the day ended sadly with the stabbing death of a 15 year old boy. He was in an altercation with a classmate at his local high school and arrived dead…..in the back of a pickup truck trying to get him to care in time. He was still in his school uniform….. My experience so far here has been one of warm, caring, friendly people. Not just at the resort that I’m staying at, but with the staff in the A&ED (ER), the parents in my clinics, all the Jamaicans I’ve met. They’re very proud of their country, they’re very concerned about family, and they have gone out of their way to thank me for volunteering. I saw how shaken many were with this boy’s needless death and their concern for their own children. Violence is sadly present in both of our cultures. Perhaps by volunteering we can help, just a little, better lives both in Jamaica and at home.

In general, many of the patients I see in Jamaica have similar issues to my patients in Minnesota. Some things, however, are distinctly different. What did I know about Ackee fruit before coming here…..well, Nothing! Yet I’ve been told that ackee is Jamaica’s national fruit. It’s served with saltfish for breakfast and is probably the most popular dish besides Jerked “fill-in-the-meat”. It’s even frequently on our breakfast buffet here at Couples tower Isle. that’s all well and good until you find out that ackee, if eaten less than fully ripe, causes a rapid and profound hypoglycemic reaction that can be potentially fatal. You sure can’t say that about your morning poached egg or bowl of Wheaties!! As a result Docs here take ackee poisoning very seriously and screen any potential victim very closely. Ackee ingestion is even the leadoff question on the ER’s triage screening form. Hmmmmm, I did have ackee and saltfish this morning………. Another Jamaican custom I’ve been introduced to is Bush Tea. Initially I thought it might be a local brand of tea (why not, they grow great coffee here) or perhaps a type of specialty tea from the more remote inland mountains. Wrong on both counts. Bush tea is a traditional medicinal tea, or I should say teas, made quite literally from a bush. Which bush you may ask? Well from a variety of bushes depending on the illness being treated and the grandmother involved. Some, like peppermint tea, are benign. Others, like “Leaf of Life” buy you a ticket to a Hospital bed. Teas are made from plants like “Dog Blood” (yum) and “Spirit Weed” (you’ll soon be one?). One local doc joked that the stranger the name the more trouble you may be in. It’s a real issue here as bush teas are still commonly given for a wide range of complaints. In kids especially, the “safe” range…if there is one….may be very narrow due to body size. in addition, patients or parents may not know of their bush teas ingredients or may be reluctant to say. That brings up another issue: that of Jamaican culture and traditions……but I’ll save that for another post.

I’ve finished my first week working in Jamaica and all is well. My routine is Monday and Tuesday at Port Maria, Wednesday and Thursday at Port Annotto, and Friday at Port Antonio. The clinics/health services see a range of children from well infants to complicated medical issues for local followup. In addition, I made hospital teaching rounds on Wednesday with Dr Ramos and the junior officers (residents) at Annotto Bay, a real treat. There haven’t been any completely new problems so far, but a real mix of typical and atypical pediatric problems. My most “exotic” patient was a 7 year old otherwise healthy girl who had coughed up an nightcrawler sized (Ascaris lumbricodes) worm. Fortunately, I have seen this before (SE Asia, and Indiana…of all places) and treatment was easy. By the way, Mom said she also had seen these before!! Can you even imagine gagging up something like this????!! The beastie has a very complex life cycle and in this case matures in the lungs to be coughed up and out to start the next generation. Lesson: eat well cooked food and wear sandals!! The resort Issa Trust has put me up at is beautiful with wonderful food and services. Last year at this time I was working with Issa’s US partner (and my co-sponsor) Heart To Heart International on a disaster team in rural Nepal after the Kathmandu earthquake. We were living in tents with limited food and no reliable source of clean water amid ruins. The contrast is stark although when you get down to it, the basic paediatric health needs aren’t that dissimilar. Issa Trust is obviously very well respected among the Jamaicans I’ve worked with and those I’ve seen as patients. I’m very happy to be here and have the chance to work with this exceptional organisation!!

Reported by the Jamaica Gleaner Friday | April 22, 2016 | by Christopher Thomas

Director of the Western Regional Health Authority (WRHA) Dr Ken Garfield Douglas (left) exchanges a warm handshake with Chairman of the Issa Trust Foundation Paul Issa, while President and Chief Executive Officer of the foundation Diane Pollard shares the moment. Occasion was handover of neonatal equipment to the hospital’s special-care unit.

WESTERN BUREAU:

The Issa Trust Foundation has given a commitment to the Savanna-la-Mar Public General Hospital in Westmoreland to fully outfit the facility’s neonatal unit as well as finance the training of staff to care for premature babies.

The commitment was given on Tuesday by Paul Issa, the chairman of the Issa Trust Foundation, during a brief launch ceremony on the grounds of the hospital. He also used the opportunity to outline additional plans by the organisation to improve health care at the hospital as well as at other facilities islandwide.

“I think we know that this hospital, along with every other hospital in Jamaica, has had some severe challenges, but we hope to be able to help you bridge the gap and address these issues,” Issa told stakeholders in his brief address. “We want to help you to improve the service that you offer to the community of western Jamaica.”

The neonatal unit has been equipped at a cost of J$24 million. Additional funds will be provided for the training of the staff to operate and maintain the facility. The foundation has also donated US$2,000 (J$244,460.50) worth of disposable equipment, which includes tubing and hypodermic needles, to the unit.

“The unit is based on the model of the special-care nursery we did at the St Ann’s Bay Hospital a few years ago, which has reduced infant mortality rates by 30 per cent,” said Issa. “We have replicated that here, and I think it is really going to change the quality of the neonatal health care at this hospital. We are going to be in an ongoing relationship, and we are very excited about it.”

SIGNIFICANT BOOST

Dr Alfred Dawes, the hospital’s senior medical officer, said the gift of the neonatal unit is a significant boost to the hospital’s capacity to provide high-quality services.

“This unit has really boosted the hospital’s efforts at providing care. Before that, we were not equipped to deal with premature babies, and so they had to be transferred,” said Dawes. “If they were unfortunate enough to be the ones who were not accepted by Cornwall Regional Hospital, then we would not be able to care for them and they would die.”

“With the commitment of the Issa Foundation, and the training programme and the increased staffing that we expect to get, once the nursery is up and running fully, then we should be able to provide top-class care for these premature babies,” added Dawes.

Week in Review

• If you recall the 2 yr old who had a blade of grass stuck I his throat last week, you’ll be surprised to know that he was admitted several days after our meeting for allegedly ingestion Clopidogril ( an anti-platelet medication that can cause bleeding). But you”ll be happy to know that he finally swallowed the grass without needing the ENT referral.
• The x-ray machine was malfunctioning for several days in Annotto Bay, so we really had to put our clinical skills to the test.
• The team at Annotto Bay were able to facilitate a transfer for a newborn term infant to Bustamante Children’s Hospital in Kingston within hours of birth because of impending respiratory failure. The new intern had a look of fear on her face as they left. Our words of advice: you can use bag mask ventilation till the cows come home. Unfortunately the baby passed soon after arrival.
• The interesting cases for the week go to a 7 month of female at Annotto Bay hospital  who was admitted for failure to thrive and dehydration. She has multiple abnormal electrolytes along with pneumonia. At this time the working differentials were Cystic Fibrosis and Bartter’s Syndrome. With hydration she improves clinically but continues have abnormal labs. A nephrologist in Kingston has been consulted to evaluate her. The second case is a 14 yr ol female at Port Maria hospital who had significant right arm pain, limited range of motion at the elbow and severe point tenderness at the joint. Our concern at the time was fracture, septic joint, or osteomyelitis yet there was no history of recent trauma, fever, or joint swelling. An xray of the right elbow had what appears to be an intraossessous bone cyst/abscess. Orthopedics were consulted from the next parish in St. Ann but the patient will have to wait until next week to be seen.
• We have noticed over the course of the month that many newborn infants whether in the A&E or Clinic have a red ribbon or band on their wrist. When asked “what is this for” to the mothers, the common response is “Me nah kno, fi him/her grandmada did put ti pon deh”. After a quick google search we found that this is a Jamaican custom to place the red tie/band on the hand or foot to ward off evil spirits.
• 

  Dr Ravi working on patient transfer to Bustamante Children’s Hospital

  

  Dr. Nicole Davidson taking a brief and much needed break at Port maria A&E

  

  Dr. Roxanne Samuels,
  reviewing arm film of our 14yr old female.

  

  Dr. Hayden-Peart

  
  

  children in infant class at Free Hill Primary school

  

  Mr. Rory Suarez, great driver

  

  Dr. Wilson on our last day at annotto bay

Global Health Rotation in review: Nicole and I are very glad that we decided to do this rotation. We are both of Jamaican heritage , we have a special connection to the island and feed a personal responsibility to keep giving back. We recommend that other residents try to do the rotation in pairs. Working in pairs can be great when trying to manage patient loads and maneuver through the Jamaican health system. We both had the pleasure of meeting with a couple hospital administrator by happenstance but this that these introductions should be standard to provide an introduction to the healthcare system. While to orientation was helpful is seems to be out of date with what labs, ,medications, imaging, and consultations are available at each facility. Having these resources prior to the start would have helped with a smoother start. We recommend that any residents and volunteers visit the Free Hill Primary and Infant School excursion provided by Couples Resort. This gave us the opportunity to see the children you serve in a more natural state, the communities they live and learn about the structure of the education system in Jamaica. Special Thank You to…

• thank you Diane Pollard of the Issa Trust Foundation for assisting use prior to and during our ration. The hotel staff have treated use like family and we truly appreciate all the accommodations made on our behalf.
• Thank you to all the medical and hospital staff at Port Maria Hospital, Annotto Bay Hospital and Port Antonio Hospital.
• Thank you to the hospital administrators, Dr Sloley, Dr. Hayden-Peart and Ms Nunez of Port Maria, Drs. Ramos , Ravi, and Wilson of Annotto Bay, and Mr. Campbell and Dr. Levwok of Port Antonio. All these people have helped us and taught us many lessons for which we are grateful. These service that these people provide to the country of Jamaica s greatly appreciated. Keep trying to change to world.
• Thank you to all our drivers who got us to and from work safely. Special shout out to Mr. Munsie, Mr. Forbes, and Mr Steve.