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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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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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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: http://www.booster.com/issa-trust-foundation-education-fundraiser2

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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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For me, having grown up between Liberia and Ghana, Jamaica, while new, feels very familiar. From the lush green countryside to the old British colonial architecture in the small towns, it could have been transplanted from any of the British commonwealth countries that I’ve ever visited. Nevertheless, the beauty of this new familiar could never be lost. Driving along the main road with rolling clear blue waves to the left and rising rainforested mountains to the right is not a view one easily tires of. The resort, with the open air layout and, beautiful beaches and crisp white walls is just as beautiful as the country.
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