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Monday was very busy last week! I’m not sure if that’s usual for a Monday or if word has spread that there’s a pediatrician that is visiting. I have had plenty of people asking when I’d be returning so it may be a combination of both.

Earlier in the week I had an impressive case of a patient with left sided lymphadenitis and what appears to be a left peritonsilar abscess after trauma. He was punched in the neck the previous day while at school and the swelling had occurred overnight.

I also discussed an interesting patient with Dr. Ravi later in the week! She a young known asthmatic who began having an adverse behavioral reactions whenever given albuterol. According to the chart (called a docket here in Jamaica), the reaction happened both at home as well as at the hospital. The patient wound up being treated with Atrovent in addition to steroids with the plan to be sent home with atrovent for rescue. I’ve never seen a case of albuterol/ventolin allergy.



When it comes to language, while English is the official language, of course many patients speak creole or patois. I’ve been fortunate enough that I’ve been able to understand most people for the most part. Sometimes I need to ask for clarification but it’s relatively uncommon. Of course, even though we may speak English, my accent is obviously different from a Jamaican’s. I’ve had some people think I’m Jamaican and you can usually tell the confusion when I start speaking. So to head it off, I introduce myself as a visiting pediatrician from the US. This week while in clinic in Annotto Bay, I had a fun conversation with a 7 year old girl. While setting her up to go home she turns to her mother and asks in mock whisper: “She’s lives somewhere else?” Her mother responded: “Yes she’s from far away!” The girl paused a second before saying “That’s why she talks like that?” It was so cute I had to laugh. I turned to her and said: “Yes! That’s why I sound funny!” It made me wonder what Americans sounds like to Jamaicans.

My final day in Port Antonio was this past Friday and it was a busy one! At one point I had 7-8 charts waiting for me to be seen. I was able to get some help from the other Doctor in the A&E. I particularly remember two patients. One was an infant present with URI symptoms and wheezing. He overall was well appearing and mother already had an albuterol inhaler. Unfortunately she wasn’t instructed on the proper use of the inhaler and so the child was only getting his medication once a day for the wheezing. I spent the visit breaking down what was causing his wheezing, why he will likely wheeze unlike his sister, the effect of the medication, and the appropriate times and frequency to use it. She was very grateful. Its reminded me of our job to educate our patients and their families about their health so that that can own and improve their lives.

Until my next and final post!

Completed my first full week here last Thursday. It was pretty amazing! Monday and Tuesday I was at Port Maria working in the A&E. (Accidents and Emergencies, pretty much similar to an American ER.) Since all of my clinic locations are in general hospitals I just help out with the Pediatric patients that present for evaluation.

Wednesdays and Thursdays are at Annotto Bay and there I was able to work in the Pediatric clinic seeing patients presenting for their newborn exams and other scheduled patients. It was a busy day and I was able to work and consult with the other Medical Officers who work in the clinic seeing patients. Diagnosed a few murmurs in newborns which required ECHOs prior to being seen by Cardiology. I’m unsure when they will finally be able to have the imaging done (there’s a long scheduling process, especially if patient is overall well appearing.)

There are many services that are available in my training hospital which we don’t generally have available here in Jamaica. I was consulted for a 3 year old with failure to thrive, which upon prompting I discovered was likely due to suboptimal nutritional intake as the patient had food aversion and would only eat small amounts of rice porridge. Back at my home institution I would get behavioral medicine and our eating specialist involved. In this case, all I could offer is that the patient be started on pediasure and to continue to attempt to feed with new and different foods.

Another service that is dificult would be Rheumatology, which may have been an issue for one of the patients I’d seen on Friday at the Portland Health Department. He was a 10 year old who presented with 1 month of joint pain in elbows and knees. But when prompted would agree that nearly every joint hurts. Yet through history and on physical exam there was no warmth, swelling, or redness to any of the joints. If directly asked he would complain of pain with movement of any joint and would wince as if in pain, but if redirected while I continued examination he didn’t not express or show signs of pain. I do believe he may have some morning stiffness but I didn’t think his symptoms were concerning for a rheumatological problem and so I decided to have the patient come back in 1-2 months if the symptoms continued.

For the most part I’ve seen plenty of the same pathology that I would see back home. The major challenge comes with navigating a different health system and knowing what services and treatments are available. This helps a lot in being judicious in my medical decisions.

PS. On a different topic, after my visit to the Portland Health Dept, I developed hives! That’s a first for me as I’ve never had any allergic reactions before. If you’re wondering, they are not comfortable AT ALL. (I had Benadryl in my emergency kit but wound up having to start steroids since the hives persistently returned every 6 hours.) I’m still unsure of what has cause them and I’m currently still having intermittent break outs but the episodes have been improving.