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Over the past month I have had the opportunity to participate in Ward rounds at Annotto Bay Hospital, Port Antonio Hospital and at St. Anne’s Bay Hospital.  Each had their unique challenges.  Port Antonio Hospital is a local hospital in a fairly remote location.  The “house officer” on duty is in charge of both the male and female medical wards.  A lot of the cases are similar to those that I have seen in the states including Hypertensive Emergency, Hyperosmotic Hyperglycemia State, Exacerbation of Congestive Heart Failure, and Stroke.  The resources are limited, and as I have shared in previous blogs many of the diagnostic tests have to be done privately as the hospital does not own a CT scanner, Echo machine, or Ultrasound.  The “house officer” that I worked with was very kind and sought advice on how he could improve in caring for his patients.  Given the tough circumstances I think he is doing an outstanding job.

Annotto Bay hospital is a referral hospital of sorts.  The female medical ward is currently undergoing repairs after it was damaged by Hurricane Sandy.  This has required intermingling of male and female patients on the male medical ward.  There is also overflow of patients onto the male and female surgical wards.  The construction is almost done and they should be moving the patients in the coming month.  Here two “house officers” and two “interns” manage both the male and female medical wards with input from a “consultant” who is board certified in Internal Medicine.  I would equate this to the attending, senior resident, and intern model.  However, the consultant is not their everyday, and may only physically round on patients 2 or 3 times a week.  He is always available by telephone if needed.  When he is there he is quick to teach and share his experience.  Annotto Bay has similar limitations and most of the diagnostic work-up must be done privately.  They do have the ability to perform basic x-ray and laboratory tests.  The morning is filled with pre-rounding and then rounding with the consultant.  The afternoon is consumed with coordination of care and phone conferencing with specialists in Kingston.  Discharges are performed in the afternoon, and their seems to be a disconnect between the hospital and the primary care physicians at the health centers.  There really is not good way to communicate hospital details to the physicians in the community.

I have spent the last week at St. Anne’s Bay Hospital which is the regional referral center.  The hospital is about twice as large as Annotto Bay hospital which is about twice as big as Port Antonio.  The hierarchy is similar with consultants, house officers, and interns.  Annotto Bay hospital is equipped with ultrasound and fluoroscopy, however, I understand that the ultrasound machine has been over heating and they are currently limited on the number of ultrasounds that they can perform each day.  Major testing such as CT scans and echocardiograms still have to be performed privately.  They do have two beds in a “High Dependency Unit,” which would be equivalent to our ICU without ventilators.  They have telemetry, continuous pulse oximetry, and they have one nurse that cares for the two patients.  I find that the cases are a little more severe at St. Anne’s Bay.  For example, a young many with Ackee poisoning, known to cause hypoglycemia and anion gap metabolic acidosis, had to be transferred from one of the smaller local hospitals to St. Anne’s as they lacked the resources to complete his work-up and give him adequate treatment.  Even with his transfer the patient did not do well and subsequently expired.  I can’t help but wonder if his outcome would be different if the proper resources were available.  The physicians are well trained and are as efficient as the system allows.

Drew

Our last few days in Jamaica have been spent at St. Ann’s Bay Regional Hospital. It has been wonderful to see the referral hospital. The pediatric unit is large and attached in a small room is the special nursery. The nursery has 2 ventilators and the physicians and nurses are very proud that the ISSA foundation donated the ventilators. While asking about the ventilators and how they monitor the neonates on the ventilators I was shocked to learn that the portable x-ray machine broke down months ago so the neonates never get a CXR. They also have a difficult time obtaining blood gasses. They don’t have CVN and the physician told me that the babies just get D5 0.2NS and starve. It was also interesting to note that they don’t have central line kits and many times use a foley catheter for a UVC. They are very innovative in the nursery and on the wards. They have learned to rely on physical exam findings instead of labs and images.

On the pediatric ward I see lots of asthma, bronchiolitis, and URI’s. The turn around rate is fast. Most of the children stay the night and get to leave the next morning. The beds are very close together and there is only room for a small chair (like a school room chair not a nice recliner.) Many of the parents sleep in the chair overnight so they can be close to their children. The parents that have been there a long time even sleep during the day in the chair because they are so tired. The children usually just sit in there beds and color or read but, I noticed a small playroom attached that has books, a TV and some games for the kids to use. I noticed that no one ever used the playroom. This morning I arrived at the pediatric unit early and asked why none of the kids are ever in the playroom. The nurse said it was because they needed a supervisor and the nurses are usually to busy. I told them that I would supervise the children and they gave me the key to the room. The kids were excited and after breakfast came to play. They loved the room and were sad to leave when rounds started. I was sad I couldn’t play more but was sweating profoundly after pushing children in carts and entertaining them.

The resort is AMAZING. Everyone has been so wonderful to us and they call doc wherever we go. The food is amazing and there is a large variety of food. The activities are wonderful and Drew even got scuba certified so we can go diving together. I couldn’t ask for better service or a nicer place to stay. It truly has been wonderful.