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13
April

Where does the time go????

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So living in paradise and working in the tropics is amazing!!! I have been here 12days now, and my adventure is starting to wind down 🙁 but I plan on enjoying every bit of it.  Highlight of my week, there are many, but biggest is that I have a roommate!!! Yay Dr. Rena coming from Ohio to join the Issa fun.

I made it out to Port Maria this week on Monday.  I commandeered another corner of the A&E in the name of Paediatrics, saw a few sick visits but as it was a rainy day there was limited turnout.  What I did see was a pretty impressive L mandibular dental abscess which had been referred to the A&E from a local dentist.  I admitted her and started her on IV Augmentin, I attempted to use Clindamycin but there was none available.  The downside was that I knew that even once the antibiotics improved the inflammation, that she ultimately needed the tooth extraction.  This is a down point because access to dental care is even more limited than health care down here.  The happy ending is that when I returned to work on Tuesday, and visited her on the ward she was able to fully open her mouth and her pain was improved.  Though the ending is not ideal, I did make a difference.

Wednesday may be my favorite day of the week here.  The day starts with inpatient rounds, and the medicine is overall similar but the drugs of choices and incidence of drug resistance are worlds apart it seems.   There is always good discussion about Western trends in medicine and whether or not it is applicable herein Jamaica.   From there I wander down to the A&E.  It is always curious to me when the nurses ask me if I will see a child >12yo.  It was explained to me that their Pedi wards go from 0-12yo, but this limitation is due to the size of the beds.

Back down in the A&E my day was just about down when a frantic father brought in his 4yo son.  Seems the unfortunate little one was found at the other end of his sister’s bucket and had been hit directly in the eye.  His conjunctival edema was so impressive that I was very worried about a conjunctival laceration.  We were able to refer him fairly quickly to Bastamante Children’s to see ophthamology.  After this busy day I get to ride back along the countryside and watch the sunset as I rode.   Working in paradise, is a gift.


Working is great, but this is Jamaica we are talking about and I now have a fantastic partner in crime.  So far we’ve taken in tons of fantastic food, shopping and reggae dancing.  I look forward to the International Gala the resort is having tonight.   The setup looks fantastic and I am sure the food will be amazing as always! 
The view from Annotto Bay A&E








Port Antonio Paediatric Ward, about 10 beds and cribs in one large room.

Looking out at the island at the end of a long day…
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06
April

Wait, Did we just drive over the Rio Grande???

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Every morning I look to my left and there is the amazing Atlantic.  I am about one week into my rotation, and I’ve now been to the Annotto Bay and Port Antonio Hospitals.  The commute from the resort to Port Antonio is about two hours, I can’t tell you for certain because I was completely distracted as we were driving through the rain forest.  Crazy lush foliage going up hills/mountains, crossing over the Rio Grande and the Atlantic Ocean is pretty much always just over your left shoulder. This is all in a day’s commute.  Mr. Campbell,who is one of the adminstrators at Port Antonio, drove me on Friday I used this time during the commute to learn about the quality of life in Jamaica from education to shopping to roads. 

Once at Port Antonio, I had a chance to visit their Pedi Wards.  They are set up differently than ours in the US but they utilize what all of the resources are available.  There is definitely a need present.  Their facilities have relied on a lot of international donations, I am at total a 4hr flight from home and technically Hawaii or California is further but the difference in resources is night and day, Seeing how they are functioning on minimal resources(no code cart, limited number of nebulizer machines(like 2), no cardiac monitoring or unreliable pulse oximetry).   I never thought I’d actually be recommending the use of oral Albuterol, but the need forces your hand.  It forces you to rely on clinical judgment which I guess is why its the practice of medicine.

A common theme, seen both in the US and here in Jamaica, is the difficulty in chronic care management of our children with cerebral palsy and what to do when families become overburdened with their care.  I had a good discussion with Dr. Barrett about how best to optimize their care with simple interventions such as benzos and stretching to improve spasticity to increase their ease of care.  

Life back at Couples is fantastic, the staff is amazing.  It is the weekend, so I have tons of free time.  Between just enjoying the sun so far today I’ve been kayaking and sailing on a “Hobie” in the Atlantic.   I am pacing myself because all of these water adventures occur between delicious meal times and sunbathing.  Well cocoa bread is calling me and there is still some sun left, I will tell you guys more later. 
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04
April

I’ve arrived!!!(is it too early to start planning my trip back??)

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To say it is beautiful here is a gross understatement.  The land, the water and the people have eased my transition into life on this amazing island. I know my predecessors have mentioned the amazing scenic views on the way to work, but I was still awestruck.  There is something fantastic about living and working within walking distance to the Atlantic.

I started out my adventure at the Annoto Bay Hospital on the inpatient ward. I was intrigued and impressed to see the team caring for a former 24wk infant( rocking out on bubble CPAP alone!!!) who was continuing to beat odds on a daily basis.  It was good opportunity to use my prior NICU experience to add additional insight, but I was reminded how spoiled I am back home with what seems like limitless resources. Here they’ve two incubators, and no ventilators at this facility with only limited numbers at other hospitals.  The care they provide here relies on clinical expertise.  I feel I both have much to give and so much to learn at the same time.

From the inpatient wards I wandered down to the A&E with Dr(s). Mitchell and Espinosa who also welcomed me with open arms, which translates to happily tolerated my frequent questions and requests for translations.  There I was able to see the variety of sick children who came in whose illnesses ranged from viral gastroenteritis to seizures.  The pharmaceutical trade names here are totally different, also your repertoire is limited to what is easily available to these patients.  Ever heard of Lucozade? Me either but between the patients and the other physicians they helped me figure it out, overall I had a great first day.  I can’t wait for day two!!!
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