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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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Yesterday, I worked at Port Maria’s Accident and Emergency Department.  The morning was quiet, the calm before the storm.  I didn’t have a single patient in the morning.  In the course of three hours during the afternoon, I admitted two patients and had to transfer one patient directly to Bastamante Hospital (three hours away) for emergent surgery. 

My first patient to be admitted was a 5 wk old baby boy who came in with fever and cough (likely with a cold).  However, because of his age and his immune system is not strong (and thus he is at risk for a serious bacterial infection), we had to admit him for IV antibiotics and check his blood and urine for infection. I obtained the labwork without problem, but the urine was another story.  In
Jamaica, it is routine to obtain urine specimens from children via suprapubic aspiration as opposed
to catheterization.  While it is the gold standard to obtain urine specimens this way, it is not routinely done in America.  Instead, we do urine catheterizations.  It was fascinating to see how this was done, and it seems surprisingly simple.  All you need is betadine, sterile needle and gloves, and a syringe.  You insert the needle directly into the bladder and draw back on the syringe to get the urine. 



The second patient I admitted was a very active 7 month old boy who had wriggled off his bed while
his mom was trying to change his diaper, and fell three feet onto a hard tiled floor.  He cried immediately, and was otherwise acting normally.  His exam was completely normal for his age except for a large bruise over his left forehead.  I admitted him for observation overnight.

The last patient was a 7 month old girl.  The moment the mom brought her in to the exam room, I knew something was wrong.  She was crying and whining nonstop, and nothing mom was doing was
helping.  Mom told me that she had started throwing up yesterday, and had become increasingly more
fussy overnight.  Yesterday, mom noticed that she had bright red blood in her diaper, and this
morning she noticed scarlet mucousy poop.  Her exam was notable for an increased heart rate, extreme tenderness over her entire belly, and guarding (trying to push my hands away).  Her diaper was filled with poop that looked like currant jelly.  I had never seen that before, but that sign is
pathognomonic for intussussception (the telescoping of one part of your bowel into another that can
cause death of the bowel if not repaired quickly). 





I spoke with the supervising ED doctor, who had never seen intussussception before. One of the
nurses had, and she confirmed that this was consistent with intussussception.  We called over
to Bastamante Bay Hospital, put in an IV and started IV fluids, and transferred her immediately
to the pediatric surgery service there (as there was none available at Port Maria).  Unfortunately,
Bastamante Bay is over 3 hrs from Port Maria Hospital, and is located in Kingston.



My day yesterday was very interesting, if not slightly terrifying.  I am so grateful for the help
that the ED doctor and the nurses here gave me as I was trying to take care of my patients without
knowing the system well or where things were. They patiently helped me out without making me feel
bad for not knowing.  I really appreciated that they did so, but I am not surprised.  Jamaican
people are amazingly warm, welcoming, and hospitable.  

Looking forward to what today will bring. 
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