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May

end of week 2

Friday, Port Antonio
Today was our first day in Port Antonio as we were unable to go last week due to lack of transportation.
Very interesting day.
In the morning , we met with the director of the hospital, Dr. Davis who gave us an overview of the hospital. It was very helpful and informative.
Then we went to the pediatric ward and rounded on the patients there with an intern. There were some sick children there. For example, there was a patient with sickle cell disease, fever, and acute chest. We suggested obtaining some bloodwork, a chest xray, giving oxygen, and maximizing pain control. There was 1 week old baby brought in for lethargy who had severe electrolyte abnormalities, metabolic acidosis and elevated direct bilirubin We asked to repeat the blood work, and if it was still abnormal recommended transfer to Annotto Bay where the pediatricians could oversee the care of this child.
In the afternoon, we went to the pediatric clinic. As pediatricians are consultants, many of these cases were not so straight-forward and required some time and thought. I saw a child with nephritic syndrome, a girl with intermittent fevers x 5 months, a girl who had a lethargic episode 2 weeks prior among other cases.
I felt very useful at Port Antonio, which was a great feeling. Kind of nice to be in a place where pediatricians are so needed. Our driver that day was amazing, so kind to us. She totally went out of her way for us (Port Antonio is almost 2h away), and ensured we met with Dr. Davis.

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May

end of week 2

Blog, Uncategorized

Wednesday and Thursday, Annotto Bay

So on Wednesday morning my colleague went to Pediatric rounds at the Pediatric Ward, and I went to the “A and E” Department (Accident and Emergency Deaprtment). There ED works differently in ours. The physicians actually quickly triage the patients, and if the child does not warrant “ER” criteria, they are sent to clinics. I guess this is an effective way to decongest the ERs, because I only saw one child, who ended up having otitis media. Still, it was interesting to see how the A & E functions and tot alk to the other doctors. If you need labs done, your draaw them yourself. Ivs are completely different and there are no vacutainers or butterfly needles. If you want to give a patient a medication, you write down the order, and the patient then brings that to the ER to get to get the medication. They can do xrays and ulatrsounds, but they have no access to CT scanners. ER doctors read their own radiologic studies. It is a process to get a radiolgist to read something.

In talking with the Jamaican doctors, I learned more about the training system. You got medical school directly after highschool. Medical school is 6 years. Then you do 1.5 years of internship. Then you can start to work in the field you want to do residency in, but you need to get recommendations before you can do your training. REsidency is pretty competitive to get for most things, including pediatrics. Most of them take the USMLE exams just in case they train in the US.

Thursday, Annotto Bay

Today we had clinic which was very busy last week, but only a half day today. Saw a variety of newborn checks and sick children. Alot of children today with slow (or no) weight gain. There are no growth charts in the patinet’s charts due to lack of resources, so it is hard to tell if they fell of thir curve or not. Just have to look back and compare to previous weights. The day was shortened as there was a ceremony to celebrate the Issa Trust Foundation dontain some ventilatos and incubators to the hospital! Supplies greatly needed!!

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May

Week 2 – Port Maria

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Hello again from Jamaica!

The beginning of this week we spent two days in Port Maria with my colleague spending time in the A&E and myself working in the clinic. Here’s a photo of the front of the clinic. Each day we come there is a line of people who have been there since 8 am waiting for clinic to open. It seems to be first come, first serve with the clinic starting at 9 am.

It was Child’s Day on Tuesday so we got to see the children for their well checks. While seeing babies, I found a measuring tape useful to have since we measure the length and head circumference of each baby ourselves. I looked up each growth percentile in my Harriet Lane to ensure that the babies were growing well. There aren’t growth charts in all of the paper chart files due to resources so we document everything by percentile in the paper charts which is helpful for the next person who sees them in terms of following a growth trend. Also, if you think a baby is jaundiced and you want a bilirubin level, after 11 AM you would have to draw it yourself in clinic and have it dropped off at the lab. I was really surprised to hear from the lab how much blood is actually needed for a bili draw as the lab or nurses usually draw it at my home institution. Dr. San and Dr. Win have been a great help in asking questions about what is available in the pharmacy here and what is used to treat patients for certain diseases. The cases we saw ranged from scabies to viral gastroenteritis to parental concerns about worms.

One thing I take for granted in the states are strep swabs. In the states, if you hear a complaint of sore throat and suspect strep, you can get a strep screen and if it’s positive treat, which is important to prevent the complication of rheumatic fever. Here, there is no rapid strep screen so if you suspect, you treat. Dr. Win told us that there have been cases of rheumatic fever this past year and it reminded me of the child I saw last week who was being treated with month shots of penicillin for the past year after being diagnosed with rheumatic fever. I have only seen one case in the states of Rheumatic Fever and here it is definitely more prevalent.

On the second day of clinic, I saw this adorable 2 year old boy who had right periorbital cellulitis with bilateral bacterial conjunctivitis. I had the child admitted for IV antibiotics and observation and found out from the other ER doctors to refer him to A&E for admission. Port Maria also has a ward which we haven’t seen yet and I assume he went there since I did not see him the following day at Annoto Bay. One of the benefits of having electronic medical records back at home is being able to follow up on kids to ensure that they are seen and admitted.

After a busy day at the clinic, we have our 30 minute drive back to the resort. Here is a view of driving through Port Maria where you can see different stores and daily life.

At the end of the day, it is always so nice to come back to the resort. We have been welcomed by such friendly people and my colleague and I are always amazed of the beauty of this country.