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04
May

first day

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so today was our first day at port maria!! until now we have been enjoying the luxurious resort with beautiful pools, beacches and fun activities, and of course the yummy food. today it was time to start working!
we arrived at port maria this morning, to see a line of patients waiting for us. my colleague went to the clinic and was immediately very busy seeing patients. I was stationed in the hospital, and only saw 1 patient in 2 hours. Then I asked to help out the clinic which was very busy, and then i got buisy. I saw a variety of patients ranging from gastroenteritis, constipation, rashes, and an abscess s/p dog bite. this hospital was very small and resources limited, but we did our best. took a little detective work to find the right people and supplies, but te other doctors and nurses were very helpful and friendly. it was good to start doing what i came here to do. funny to be in a country where we are “specialists.” parents seemed so grateful to have seen a pediatrician.
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01
May

Final thoughts & thanks

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I really enjoyed helping take care of the children down here. I was surprised at the variety of cases that I saw. Of course, there were plenty of cases of asthma, viral URIs, tinea and newborn checks but there was some other real interesting stuff mixed in too. I didn’t see as much tropical diseases as I anticipated. Some days were very busy with numbers seen in the 20s. Other days were a little slower and my last day at Port Antonio only two children were brought to the Friday pediatric clinic but I did get a chance to meet and get to know several people while waiting (Jamaican networking).

I also witnessed a bizarre incident driving into Port Antonio to pick up some others at the health department (usually we aren’t the only ones being driven to and from work). As we were slowly driving toward the town square, an old lady crossing the road reached down, picked up a baseball sized rock, reared back, yelled at us and then threw it at our truck. We all saw what was coming and our driver ducked behind the steering wheel. With a loud thud, the rock bounced off the front windshield. Fortunately, nothing was damaged. The lady continued on but we stopped because there was a police officer on the side walk. I couldn’t understand the animated discussion but I think the officer was telling the driver “What am I going to do? Arrest that mad lady?” I believe she was mentally ill. It’s one of those things that I don’t think I’ll ever forget– a walk-by stoning from a Jamaican elderly lady. And I also don’t think I’ll soon forget talking to all these different drivers on these long drives around the beautiful country side.

Considering a case that was most memorable…I think maybe the 19 month old girl with Down’s syndrome that had some major cardiac defects seen on an ECHO about a year prior. Mom had gone to the Cardiologist appointment in Kingston like she was supposed to but she never got the follow up phone call with instructions that she was told she was going to get. Despite Mom giving the heart failure medications as prescribed, the child had worsening failure to thrive at this visit. The cardiologist was unable to be reached so we tried to refer her again. She may need cardiac surgery but another ECHO and specialist visit first before making that decision. I hope she’s able to be taken care of soon.

Before I leave tropical paradise to go back home to flooding and tornado damage, I just want to thank all who help make this possible and give to help this next generation of Jamaicans. Hopefully, more help to soon follow. Thanks to Diane who was always a phone call or a quick email away to help. Her passion for the children here is so evident. I’m thankful for the help and the teaching from the local doctors especially the two pediatricians, Dr. Ramos and Dr. Fisher. Finally, many thanks to the most hospitable and warm staff for the royal treatment I received here at the hotel the past month.

I wish that I could stay much longer. This has really been a great experience and I hope to return to Jamaica soon.
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30
April

Last thoughts on my extra last day with Issa- April 2011

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Ok, so my flight was cancelled and I got an extra beautiful day in Jamaica. How awesome is that!

So this is likely my last blog. My last week was short but still great. Monday was Easter Monday, a holiday, and Friday I got the day off to finish and do any last minute things before I left.

On Tuesday, I saw about 30 kids. It was like the post holiday/school’s out rush as the week before there were only about 20. Tuesdays at Port Maria clinic has been the busiest days this month. You average about 25 patients. David and I figured out that maybe on those days we should both go to the clinic so that people who are there from 8am aren’t getting too upset when they are still there at 3pm being seen.


The picture above (taken with permission from Mom) is of a little girl I saw twice this month. Initially she came in for recurrent oral thrush and a neck rash that looked like tinea versicolor. She was on the appropriate medications and mom was using it correctly so I was a little curious as to why it hadn’t been getting better. I asked mom about her history (was worried about maybe some immunodeficiency, HIV etc) and sent her to get a CBC. Of course blood work wasn’t being done that day so mom was suppose to come back to see me once she got the results and to continue using the medication.


As is obvious in the picture, this child also had a large head. She had already been sent to have a head ultrasound for hydrocephalus, even though there had been no documented hydrocephalus or even head circumference in the chart…EVER. Mom reported that the ultrasound was normal.


On Tuesday, mom returned with the CBC results and a bottle of medicine that she said the child had been on daily since January for a vaginal discharge. It was Septra. This baby had been on antibiotics since January for what it didn’t sound like was a UTI or any type of VUR; The reason for the continual use was nothing more than a miscommunication. Mom was told to give the medication until it was finished (something we may say to our patients if we wrote a prescription for a specific amount). Unfortunately, she was given a large bottle of the medication and it was not finished. Her CBC was not grossly abnormal except for a slight anemia but I felt I knew the culprit for the recurrent thrush (I hope). So I had mom discontinue the antibiotics and return in 1-2 weeks.


I also did a head circumference and would like her to have serial head checks because unfortunately mom cannot afford a CT scan right away. I do not feel that this child’s head is normal and fear that it will progress until she starts having sunsetting of her eyes (they are, as is obvious in the pic, already large and somewhat bulging). She is currently developmentally normal and a delightful child. Because this was weighing so heavily on my mind I asked the pediatrician at Annotto Bay on Wednesday what he would do. He recommended just referring her to Neurosurgery in Kingston and letting them sort out imaging. Great advice! I would never do that at home because for a referral to neurosurgery I would likely need imaging to prove that a neurosurgical problem exists and not just a referral for macrosomia. Would like to know that this baby continues to do well.


On Wednesday and Thursday we saw a lot fewer patients at Annotto Bay than usual. We finished both days a little early and were excited that we may get to return to the hotel earlier to do some activities if possible; That didn’t happen. On Wednesday, we had a detour to the garage the hospitals use to work on the vehicle’s brakes (pic above is the garage). On Thursday, our transportation that the hospital arranged for us was in Kingston and we ended up waiting for about 3 hours since they had delays getting back.


My final thought: Many of the problems here in Jamaica with health care stem from lack of resources. As you read blogs you hear about a hospital with no mechanical ventilators, makeshift CPAP, no sub specialists, labs that cannot do urinalyses, clinics not equipped for pelvic exams. They are all needed but aren’t things that we can readily provide. However, there is one area I feel that we can leave an imprint in addition to our service. At Port Maria, the only vital taken is a weight. There are growth charts up to the age of 2 with only weight on SOME of the charts. I did not see them in the charts at Annotto Bay or Port Antonio BUT at Annotto Bay, all vitals incl temp are done and we were provided a copy of full growth charts (birth to 20, females and boys, wt, length and HC).


Maybe we can work to integrate full growth charts in EVERY chart as well as encourage full measurements incl temp, BP (age over 3 and would require they have the appropriate BP cuffs), HC, RR and weight. By doing this we could pick up the infants like the one admitted at Annotto Bay with meningitis at all the centers (the infant was clinically normal, mom came for well infant/newborn check and this was only identified because of a fever documented in clinic). We could avoid things like referral for 2 children who ‘look thin with ribs showing’ when they are growing well (50-75th percentile) and likely having more rapid height gain and from missing children that are failure to thrive because they have not been plotted in their last few visits. This is just my 2 cents and hope that maybe we can accomplish that.


Thanks again to Diane and Couples resort/Issa Trust Foundation for an amazing experience.

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