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I’m not sure I had truly considered that Jamaica was a mountainous island, and what that meant for the landscape, until the drive to Annotto Bay hospital on my first day at work. To my left was beautiful bright blue sea and to my right, forested hills. Coming from Miami, this view even beat my 15th floor bay/city view balconies. At the hospital, there was more of the new familiar- a modestly equipped open air style British colonial style hospital with friendly nurses and patients. I was greeted with a stream of “good morning”s and “good day”s and the smiles seem to be brighter once I mention that I am with Issa Trust, the Foundation clearly has a solid track record with the hospitals. In terms of work, rounding at Annotto Bay, and even clinic, is very independent. As the Issa trust pediatrician, I pre round on the patient (along with the general practitioner “medical officers” and present to Dr. Ramos, the attending pediatrician. He does fantastic teaching for the residents and  specialist, he usually invites me to chip in to teach. In clinic we function completely independently but can still ask Dr. Ramos or one of the house officers if we have questions on procedure, available medications, referrals etc. While all the charting in clinic is handwritten and often not too legible,most of these visits are well newborn checks and the infants have their health booklets with all pertinent antenatal and peripartum information on the baby. This serves as a very helpful portable medical record for the child and even has growth charts, vaccination records and slots to input information for all of their well child visits through to the school-age years! While the rooms are not as fully stocked as they would be in the states (otoscopes etc), with some effort, it’s possible to maintain the same standard of care/screening as we would have stateside. It’s mostly about remembering your basic history and anticipatory guidance skills and making sure to bring with you what you can (oto/ophthalmoscopes, tiips etc) from the states or from the villa. By nature, and training at Jackson Memorial, I try not to assume anything on behalf of the patients or the follow up system so when I doubt anything at all, I ask one of the other doctors to be sure that what I am doing will actually get them their referral, follow up, medication etc. Overall, it’s relatively easy to settle in and the other doctors and staff are very helpful and welcoming.