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When I first choose medicine, I choose it because I saw the need for medical personnell in the world first hand. Though I consider that as real a reason as any, I was not any less nieve about what it meant to be a physician than any average budding med student. I thought my mere presence would save lives! LOL. I would have this fantasy that I am driving and there is an accident before my eyes. I would spring from my vehicle and magically by my mere presences the mangled would get up and be healed 🙂 I thought I would save the world. As the meaning of doctoring has gone from being fantasy, to tangible, to my real daily existence I have gone through many changes. Primary care has become my passion. But what does it mean? I realized that what I like about my time here with Issa Trust most is that it is very similar to a clinic month back home. I see them, assess as many things as I have time to, introduce interventions, help them navigate the system, see them back. As I would at home I am essentially trying to build some trust and provide the best care I know how to. Im doing that, mostly from the clinic, because I believe in prevention, monitoring for occult disease so it may not cause more significant illness or premature death later in life, and mostly (to be honest about my personal intentions), so that these young folks can have the best quality of life with fewer days of illness or complications. Primary peds is not sexy. Diagnosing a 3 yr old with a urinary tract anomaly and providing interventions to prevent long term kidney damage is not going to wow your grandparents at the dinner table. Preventing a case of rheumatic heart disease by treating a strept throat, or treating a teenager with chlamydia to decrease her odds of having complications that might involve her ability to conceive later in life… those things are not ‘your favorite doctor show exciting’. As I reflect on them it reminds me of why what we do matters and why offering pediatricans to a place where there are so few, is a significant contribution to this and any population where access to a pediatrician is limited.

I’ve only worked for 2 days, so this may be premature, but here are my very early observations: (1) Even in Ministry of Health hospitals, many of the medical officers are ex-pats, including Cubans, Burmese (!), and South Asians. It seems many Jamaican doctors emigrate to the US whenever the chance presents itself. Additionally, I am told the cost of medical education in Jamaica is quite high, further causing shortages in health providers. (2) I am surprised by how few “tropical” diseases there are here. For the most part, what I’ve encountered is not unlike what I see in the US: lots of viral URIs, AGEs, constipation, asthma, etc. (3) For good or for bad, practicing in Port Antonio or Annotto Bay is not too unlike practicing in low-income areas in the US. Here, limitations revolve around immediate access to diagnostics; in the US, limitations to treatment can be just as severe based on insurance status or ability to pay. (4) A nice change of pace from other parts of the world: Because of national health coverage, patients can actually get diagnostics and treatments, though they may have to travel 2+ hours to Kingston to do so… it’s uplifting to see after working in areas where even if a diagnostic test or treatment is available, unless payment is offered up front, the patient cannot access these. (5) It’s wonderful to have Dr. Ramos’, the pediatrician for the region, experience. He is practical and has a good sense of local epidemiology. So far, this is already proving to be a great experience. Will have more to report as time goes on.