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04
September

First Week’s Lessons

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It has now been a full week of working and living in Jamaica and I’ve learned a lot, both about medicine in a resource-limited setting and about life in Jamaica.

My approach to medicine here is quite different from what I do back home. In Canada, I do my history and physical exam, create my differential diagnosis, and then order investigations to confirm the diagnosis, usually before proceeding to treatment. In Jamaica, I do my history and physical exam, create my differential diagnosis, and then treat whatever I can based on the limited medication options that are available.

Investigations are hard to come by here: other than the basic CBC, renal and liver panels, urinalysis, and X-rays (some of which are only available in the “bigger” local hospitals), I don’t have ready access to things like cultures and sensitivities, ultrasound, CT scan, interventional radiology, and MRI (they actually laughed at me when I mentioned that MRI is better than X-ray for diagnosing osteomyelitis).

“Free” healthcare in Jamaica is not the same as free in Canada. A lot of medications are not available at local hospitals which means families have to pay out of pocket at private pharmacies. Likewise, an abdominal ultrasound costs approximately 6000 Jamaican dollars (about $60 USD), which most families can’t afford. Even having a family doctor is not included in government-funded healthcare. Thus if my treatment recommendations include anything not provided by the local hospital, my patients will simply not do it.

Without these tools, I find myself treating patients for conditions that I’m not even sure they have. But it’s the best I can offer them with what’s available. Sometimes, it is unsatisfying: I miss that feeling I get when I know exactly what is wrong with a child and can offer definitive treatment.

I have also stopped asking about animal exposures because all of my patients are regularly exposed to dogs, chickens, lizards, and goats. Heck, so am I. At any given time, a stray chicken can be seen waddling across the hospital corridors.

Other lessons I have learned this week include the following:

If you don’t tilt the shower head just so, you will flood the entire bathroom and all your things in it.

The incessant “weet weet” sound that follows you from dusk until dawn is actually the call of the Jamaica tree frog. This lesson was brought to me by my husband who was amused by the mystery background noise present in all of our Skype sessions.

If I am in a car full of Jamaicans, I will be the only person wearing a seat belt. This is mildly terrifying given the nature of their driving (see previous post for full details).

The little island across from the resort, of which I have taken innumerable beautiful photos, is actually an all-nude island.

Things I have yet to learn include:

Understanding Patois, the version of “English” that Jamaicans speak which incorporates local phrases and slang.

Not feeling completely awkward as the only solo person at a couples resort.

How to set free the tiny lizard that is still trapped in the living room.

Favourite food of the day: pan-seared snapper!

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01
September

First Day Adventures

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My first day of work started with an hour long drive up narrow, winding roads pockmarked with deep potholes every hundred meters or so. Thankfully, my driver was very familiar with said potholes and showed no sign of fear or hesitation when rounding tight corners at high speeds while simultaneously passing another car in the one and only lane. The views of the mountainous jungles were beautifully distracting as were the colourful shanty towns that dot the way. Stray dogs, chickens, and humans could often be found wandering dangerously close to our vehicle’s path.

The clinic I was headed for was actually a last minute change as the previously assigned clinic had been shut down because of crumbling infrastructure and “infestation” (I still don’t know what that really means). When we finally arrived at 9am, I was greeted by a group of lovely clinic workers who promptly told me that we couldn’t start seeing patients yet because there was no water. Apparently, there has been a nation-wide drought for months. The government deems it too expensive to pump water into these areas so the people (and the clinic) rely on “water trucks” to sporadically fill their reservoirs. Of course, the Jamaican “soon” turned out to be a four-hour wait. But, eventually, I did start seeing patients by 1:30pm.

Based on my first afternoon of clinic, I can confidently say that there is currently an outbreak of bullous impetigo in the area. Fortunately, the pharmacy’s large selection of exactly three different antibiotics (sarcasm intended) is sufficient to treat this condition. After a packed afternoon of not understanding what my patients were saying (I swear we’re not always speaking the same language) and realizing the only investigations I could reliably perform was basic blood work (50/50 chance for culture results, don’t even think about a chest X-ray), I finally managed to see all of the registered patients by 4pm.

Despite a crazy, sweaty (35 degrees Celsius without air conditioning), and slightly confusing first day, it was blissful to come “home” to an air-conditioned room and a cold shower. I finished my day in true tropical island style: cocktail party with live music, sumptuous dinner on the beach, and a fantastic acrobatic show complete with fire dancers!

Not a bad first day. Now if only I could figure out how to set free the tiny lizard that is trapped in the living room…

Favourite Food of the Day: fried plantain!

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21
August

Issa Trust Foundation Featured in Jamaica Gleaner

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Gleaner From August 13, 2015 Jamaica Gleaner

The United States Agency for International Development (USAID), along with the Government of Jamaica and the Jamaica diaspora, recently hosted a five-week Camp Summer Plus programme in Jamaica. Participants were instructed in reading and mathematics and the arts. Careful thought was given to the medical, dietary, social behavioural and academic fortification of students.

The Issa Trust Foundation, chaired by Paul Issa, who is also the deputy chairman of Couples Resorts, facilitated medical clinics at Sam Sharpe Teachers’ College in Montego Bay, Cedar Grove Academy in St Catherine, and the College of Agriculture, Science and Education in Portland, from July 13-15.

Dr Jeff Segar led the team which gave 362 children a physical examination, basic blood tests, hearing and vision screening, pharmacy medications, when needed, and fluoride treatments. Eyeglasses were provided through a partnership with Michigan Lions Club to one in four of the children seen.

A questionnaire was developed to assist the team to identify risk factors for impaired learning, and also to assist in identifying potential future interventional measures designed to promote learning in this population. If parents had to pay out of their pockets for the medical care, eye examination and glasses, it would cost them approximately $75,000 each.
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04
August

Join Forces­ Backpack & School Supplies

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The Issa Trust Foundation was formed to make a measurable & sustainable difference for the children in Jamaica. You can help children in school by giving them the tools they need to succeed. Our goal is to raise the funding necessary to purchase 4,000 backpacks and school supplies.

Click here to support this campaign: https://www.booster.com/issa-trust-foundation-education-fundraiser2

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19
May

Annotto Bay Hospital

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I’m not sure I had truly considered that Jamaica was a mountainous island, and what that meant for the landscape, until the drive to Annotto Bay hospital on my first day at work. To my left was beautiful bright blue sea and to my right, forested hills. Coming from Miami, this view even beat my 15th floor bay/city view balconies. At the hospital, there was more of the new familiar- a modestly equipped open air style British colonial style hospital with friendly nurses and patients. I was greeted with a stream of “good morning”s and “good day”s and the smiles seem to be brighter once I mention that I am with Issa Trust, the Foundation clearly has a solid track record with the hospitals. In terms of work, rounding at Annotto Bay, and even clinic, is very independent. As the Issa trust pediatrician, I pre round on the patient (along with the general practitioner “medical officers” and present to Dr. Ramos, the attending pediatrician. He does fantastic teaching for the residents and  specialist, he usually invites me to chip in to teach. In clinic we function completely independently but can still ask Dr. Ramos or one of the house officers if we have questions on procedure, available medications, referrals etc. While all the charting in clinic is handwritten and often not too legible,most of these visits are well newborn checks and the infants have their health booklets with all pertinent antenatal and peripartum information on the baby. This serves as a very helpful portable medical record for the child and even has growth charts, vaccination records and slots to input information for all of their well child visits through to the school-age years! While the rooms are not as fully stocked as they would be in the states (otoscopes etc), with some effort, it’s possible to maintain the same standard of care/screening as we would have stateside. It’s mostly about remembering your basic history and anticipatory guidance skills and making sure to bring with you what you can (oto/ophthalmoscopes, tiips etc) from the states or from the villa. By nature, and training at Jackson Memorial, I try not to assume anything on behalf of the patients or the follow up system so when I doubt anything at all, I ask one of the other doctors to be sure that what I am doing will actually get them their referral, follow up, medication etc. Overall, it’s relatively easy to settle in and the other doctors and staff are very helpful and welcoming.
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