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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.