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29
April

Last days in April

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So I have somewhat of a potpourri of things to write so I will probably break it down into 2 blogs…one patient related and one not so much.
As I looked back on my month I have been super blessed for this opportunity. I thank Diane and the trust for it.
Things might be helpful for the next group:
1.PLEASE MAKE sure you walk with toilet paper and something to dry your hands. Some of the bathrooms are equipped with toilet paper, most dont have anything to dry your hands.
2. If you are a light sleeper walk with ear plugs….if you are not use to the island sleeping there are crickets and frogs that chirp all night (for most you just drown it out). Also, if you are in the inside room its a little closer to the road so you may hear an 18 wheeler trucking by once in a while (none of these are problems if you arent too light of a sleeper)
3. If you are in the clinic and you want to admit a child you refer them to A&E (ED) department!
4. There are 2 types of referral forms…an interfacility referral white form (form B) and a triplicate copied referral BOOK for outside referrals (i.e all pediatric specialists, most of which will be in Kingston at Bustamante Children’s ; this is referral form A)
5. You can get laundry at the resort done without cost ( I washed many small items in my room
and then big things with the resort)
6. Get familiar with the drugs and their concentrations..Qvar inhaled spray I think is 100mcg, I had never used chloramphenicol eye or ear drops and it was not found in any epocrates so I had no idea the dosage initially. Same goes for their analgesics. DPH cough medicine IS diphenydramine as well as a brand..so plain DPH is benadryl then there is DPH cold that would have an expectorant in addition to benadryl. It is widely used for colds from birth onward.
7. Pediatrics is anything under 13 yrs old. All the children older than that stay on the adult floors/wards.
8. Vitals arent very common at Port Maria. They do a good job at Annotto bay but you only get a weight at Port Maria.
9. If possible do tours outside of the resort. IF you are adventurous the zip line and boblsed ride is fun. There is a blue mountain bicycle tour as well as some rafting tours. I enjoyed Dunn’s River falls.
Hope this is helpful
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29
April

Eye openers

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So I expected certain things traveling to a “third world” country but some things I still found surprising so I thought I would list some of the eye openers on this trip.

1. A pediatric ward with a pediatric attending trained in critical care (ICU) that accepts as a regional referral center having no mechanical ventilators.
2. I heard a report of hospital ERs with no antiepileptic drugs like dilantin to stop a seizure.
3. Residents here are on call nightly for 3 nights or more in a row. (and I thought every 4th or 5th night call is bad as a resident)
4. All the hospitals in the northeast region with laboratories that have no ability to perform microbiology labs/cultures.
5. Send out labs that result by mail sometimes taking 4+ weeks to receive the results.
6. In the settings we were exposed to, a seemingly majority of foreign doctors providing care working long hours for comparatively little.
7. No land-line phones in some hospitals so doctors must use their own cell phone credits to call regarding patient care.
8. Often after making a diagnosis that requires a specialist care, if a specialist is available, obtaining transportation is often not feasible.
9. A hospital with a pediatric ward staffed by medical officers doing shift work with little pediatric training.
10. IV amoxicillin

Also at times I felt like I was taking care of the indigent in the inner city back home so similar problems still remain despite more resources or more health care dollars.
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24
April

Last week of April 2011

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This blog is LONG overdue. As the last week rolls around its only fitting that I write SOMETHING.
For the last 2 weeks I have to say that many of the patients seen have similar ailments as you would see in the US except probably alot more tineas. However, there has been a few cases thrown in that were interesting.
On one of the days we rounded with the pediatric team, we had a 9 year old boy who came in after having his first time seizure the evening before. Per reports the seizure happened during his sleep. Its funny I got a slightly different story from the boy (I’m thinking the way I phrased my questions probably werent the best). Anyway the going diagnosis was possible benign rolandic epilepsy. It’s the right age group and description but of course without the EEG available it is something that will need more occurrences before a firm diagnosis is made.
In the clinic we also saw an infant with diffuse papular lesions on his face and extremities. The infant was very uncomfortable and scratching. Dr Ramos, one of the pediatricians, called us in to see the infant and asked what we thought. It really looked like maybe a scabies type infestation but more papular. He described it as a papular urticaria seen in response to insect bites. It made so much sense as he pointed out that the lesions were only in the areas that were uncovered when the infant slept. I have seen insect bites but never a reaction so widespread before. It was great to have someone show us things that may not be as prevalent at home.
There is one other case, more unfortunate than anything else but may help any one else who encounters a similar case and don’t know how to proceed. I saw a 12 year old girl in the clinic with her mom. Per mom she had been complaining of vaginal itching, foul odor and ‘bumps’ for about 3 days or so. She did tell mom that she had her first sexual encounter with a 16 or 17 year old boy although he didnt ‘go all the way in’. Turns out she had what appeared to be primary herpes outbreak. At home we would call our Child Assessment team and they would get right on it since the girl is a minor (under 16 here). However I was not sure how the system worked or who to inform and it became somewhat frustrating since I did not know the protocol. However, I got in touch with the Child and Mental Health nurse and the matron who assisted me in the protocol—–in essence you refer the child to the A&E department (Emergency room) where the hospital’s social worker and the assault division of the police department can get all the information and deal with the case. Its imperative to get all that information and sometimes even admit the child for observation to obtain these things because most houses dont have addresses like we do in the US and also most families do not have phones. So for fear of the family disappearing (not intentionally) you may have to admit a child just to get all information sorted and proper treatment.
On a lighter note, we were able to have extra time off this week for Easter (both Good Friday and Easter Monday are holidays). I was able to go Mystic Mountain and try the bobsled rides as well as the zip line…it was fun! If anyone comes for Easter, you can show how much you know about Jamaican culture by mentioning ‘bun and cheese’; this is a tradition that involves eating a ‘bun’ (looks like fruit cake) with cheese in the center for Good Friday. The resort had some as desserts so David, my coworker, was able to try it.
I must say that everyone I have encountered have been so warm and welcoming. I feel I have inherited a new family of sorts with the workers here. It saddens me that I soon have to leave.
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