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I can’t believe two weeks have passed already!  I feel like I can divide my time here into hotel life at Couple’s and life at the hospitals.  Here goes… Hospital life: a usual week where we visit Port Maria, Annotto Bay and Port Antonio hospitals.  Each hospital has different capabilities and resources and no matter how much time I spend there I still have a lot to learn and understand about the system.  Let’s just say I feel I’ve been spoiled by the resources available to me in the USA.  I’ve had a few stimulating conversations with local physicians and hospital administrators about the contrast in the medical systems.  If I see a patient in the US in the inpatient wards, clinic or ED, I seldom have to ask myself “do we have this medication/lab study/consultant here?”  I have to ask myself this question after nearly every patient encounter here in Jamaica.  No matter how nice the people here are to me and let me know of their appreciation of my help, above all the system here is limited by funding and supplies.  I feel the staff are very competent and driven but can only do so much with a stethoscope, an examination, basic labs and a handful of medications.  The cases continue to vary: a lot of URIs which the locals curiously (I think) call “belly colds”.  The first few times I heard that I focused on abdominal exams but quickly realized it’s probably an issue neck and above.  Some parents seemed to be disappointed if I don’t prescribe Amoxicillin or Augmentin for every minor infection.  I try my best to explain the viral origins of disease and antibiotics contributing to resistance but this is falling short. Medical cases: I had a child with a febrile seizure while I was evaluating her in the ED.  At the time she had a “fever of unknown origin” and let’s just say the extensiveness of the workups differ from what I am used to.  There was a great physical exam on a 7 year old with a palpable thrill and what I think will end up being a septal defect that will end up requiring surgical repair.  I also had the usual broken bones that require casting.  We had a child who was not compliant and wouldn’t sit still during xrays for her broken arm and she had to be sent to a hospital further away for sedation (wasn’t available where I was).  I witnessed a lady die from a probable massive stroke and subsequent ACS in the ED.  She arrived with stroke-like symptoms and deteriorated quickly.  We didn’t have much in our hands to help her with in the ED.  It was very hard for me to stand by and not have any tools to intervene because back home a CT head would’ve been done (no CT machine at this hospital), several stat labs, stroke code would’ve been called with the near instant arrival of the neuro team etc.  The outcomes may not have changed but the inability to “act” is so difficult for me. Resort life: I can’t complain, the resort is amazing and I’m spoiled.  The people as usual have been great and very friendly.  I’m probably up to fist bump #347 already.  I unfortunately sliced the bottom of my foot on a sea shell that cracked playing volleyball and I have a new appreciation for the healing process for foot wounds (they don’t heal like your arms!).  The weather has been “terrible” by tourist standards meaning it’s been windy, rains several times a day and has been cloudy.  We’ve had a lot of seaweed and kelp wash up on to the beach and I had a ‘well duh’ moment because it was a nice reminder that beaches don’t naturally clean themselves, they require maintenance.  I still love it because I can wear t-shirts and shorts and am not defrosting my car windows!  There are some grumpy tourists and I think they easily forget a vacation with your significant other should be about spending time with him/her and not just constant sun!  Having said that, many of these tourists are much happier by evening and I’m sure Red Stripe and rum cocktails play a role here 🙂 Jamaica: I look forward to the drive along the coast to work every morning, what a scenic route!  Jamaica is so mountainous and it makes for stunning views from the coast.  I have spent way too much of my life in the urban jungles and that’s likely why such drives amaze me so much.  I want to venture out of the resort a little more and plan on doing a Kingston and Blue Mountain trip by the end of next week. These blogs and paper charts have also reminded me that I’ve become a terrible writer.  This used to be a strength of mine but after medical school it was all text books and staccato typed sentences in patient charts.  It’s time to revisit the art of penmanship.  

On Wednesday October 1, 2014, My wife Gillian and I had the pleasure to travel to Free Hill Primary School with some other guests and Diane Pollard, CEO of the Issa Trust Foundation. The school is located up in the hills of St. Mary’s Parrish, and is very remote. Upon pulling into the driveway, I wasn’t sure that this was actually a school, as it looked more like a factory, not a place of education as we in Canada and the US are used to. First thing I noticed was there are no windows, only shutters and cinder blocks with decorative holes for ventilation. The principal, Mr. Murphy, greeted us with a warm smile and a handshake, and led us into the center courtyard. The school is basically “U” shaped, with an inner open area where the students play, have recess, snacks, and lunch. We did get to enter a couple of classes to observe, where we were greeted extremely politely by the teachers and students. Some students even sang for us, which was quite a treat. This is a school with very limited resources, but filled with caring teachers and students who are eager to learn. I could probably describe all the things that they do have, but I think describing what they don’t have may give a better sense of the conditions there. Windows.  As I said before, there are no windows, just shutters and cinder blocks with decorative openings on the exterior. There is no air conditioning. There are no walls between some of the classrooms. Only blackboards on stands used to divide the classes. The rooms are small, and not well lit.  There is no playground, just a couple of rusted basketball nets with no webbing and no backboards. There is a swing set without any swings. There is no soccer field, baseball field, monkey bars, or climbing sets. They have nothing of the sort. All things that we take for granted. This school’s students range in age from 4 to 12 years old, and it is certainly not a place that any of us would ever send our own kids to. Alas they do get by, even with the limited supplies and facilities they have.  In compared to what we have though, they have nothing. Thanks to the hard work and dedication of the Issa Trust and it’s staff, the school does have a new classroom, separate from the others for those student who need a more quiet area for learning, without the distraction of having to hear whats being taught in the next classroom. But they do need more. This 2 hour trip was a learning experience for both of us, to actually see how others live in this world. We have been humbled.   I urge all guests to take the trip and see for yourselves,  get an appreciation for what we take for granted. Bring some school supplies of pens and pencils, crayons and paper, books, and craft paper. Donate to the Issa Trust. If we all pitch in, even just a few dollars, we, as a group who travel from far and wide to enjoy our vacations in paradise, who have fallen in love with this little island and the people of Jamaica, will make a difference in a child’s life. We are all of this world, so please, support our world.    

Good morning! My name is Ajay Grewal and I am one of the visiting US resident physicians through the ISSA trust foundation.  I would like to begin my first blog post by thanking the Issa trust foundation for this wonderful opportunity.  I truly feel blessed to be able to work with this world’s most innocent beings through a foundation with an outstanding but difficult mission.  It has always been a dream of mine to volunteer throughout my life in developing nations as a physician and this one week alone has only fueled that passion. A little about myself: I am a Canadian who is currently doing his residency at HCMC in Minneapolis, Minnesota, USA.  I am in my final year of residency.  HCMC is a county hospital and equivalent to a parish hospital here in Jamaica.  These hospital are safety-net hospitals that serve the underserved urban and non-urban populations.  I always felt because I work in a county hospital in the US working in similar hospitals with similar missions would be a simpler transition for me but that assumption was wrong! This week has been both amazing and challenging for me in several ways.  From the time I wake up to the moment before I fall asleep I have constantly been humbled by the people who serve this mission and respect it.  My stay at Couples has been fabulous.  The resort is beautiful with a serene and peaceful ocean back drop.  There are endless activities but after a day of work I enjoy nothing more than grabbing a book in the evenings or just talking to the staff and getting to know them.  The staff at Couples Tower Isle are either great at smiling throughout their shifts as a prerequisite to their duties or are truly happy and appreciative folk (I favor the latter!).  They are incredibly respectful people who will go out of their way to assist me for the tiniest of tasks.  Their enthusiasm is infectious and they respect us visiting physicians so much I can say without hesitation I am not this deserving!  From my walk to morning breakfast to when I arrive in the evening, any uniformed staff I see will either say “good morning/evening”, “hey doc! *fist bump*”, “how was your day sir?” or “Ya mon you good!?”  I love it!  This instant connection between complete strangers is such a refreshing change from the world I come from where we often don’t even make eye contact with those we walk by in the hallways. Thus far I have visited all three hospitals/clinics at Port Maria, Annotto Bay and Port Antonio.  It is no secret that for visiting physicians the biggest challenges are adapting to a new health care system, working with paper charts (I can’t remember the last time I had written in a chart!), not knowing what medications are available, and being exposed to unfamiliar illnesses. I will never forget walking out of my villa Monday morning to find my driver (Steve – awesome man!) and head to Port Maria.  As I shut my door the first staff member I encountered in the front said “Doc is there any treatment for Chick V?”  I of course did not know what this was but soon figured out he was referring to the Chikungunya virus.  I had heard about the arrival of the virus in Jamaica but was unaware of how prevalent the illness had become until I arrived.  The poor man had obvious joint pain and discomfort and I felt terrible telling him “there is no cure friend, but I brought some Tylenol and that might help with the pain”.  I was a little nervous because I honestly had no idea if NSAIDs/analgesics were very effective and was afraid I’d disappoint the man.  I ended up giving him some and the next morning he was all smiles and told me he gave a bunch of the Tylenol to his neighbors who were also afflicted.  He was so thankful I couldn’t believe it – all I did was give an over the counter pill.  I now understand the locals appreciate gesture and goodwill as much as positive results.  I myself am nervous about contracting the viral illness but if an entire country has lived through it then what am I – I’ll be fine!  I find if I remember some of the endearing names for the illness I’ve heard I can lighten the worries.  I’ve heard Chik-V, chikun bit me, chikun got me, think I even heard chikun-gonorrhea once. I have absolutely loved my drives to each hospital/clinic along the coast line.  I’ve spent my entire life in industrialized urban concrete jungles so to me these AM coastal drives with mountainous terrain to my right and stunning blue ocean to the left is a novelty.  The drivers have been very patient, respectful and great conversationalists.  Most of what I about Jamaica are through these stand up gentlemen.  The roads are winding and I’m used to multilane expressways so my vestibular system has been tested but I have persevered without medication thus far. I can go on and on about each hospital and the people I have met there and I’ll speak more in later blogs.  I will say this: with limited resources the staff do a lot and have a very positive outlook.  A huge challenge for me has been knowing what to do with the resources that are available, what kind of cases are hospitalized here vs back home.  A luxury I have In the US is knowing that if there is diagnostic uncertainty with an acute illness, I am assured it is not very difficult for the parent to return to clinic for a follow-up and reassessment.  This is a challenge here as many of our patients either walk or travel distances to come to these hospitals so I am trying to do as much as I can in one visit.  I do want to thank all of the hospital staff from the registration folk, nurses, MDs that I have encountered.  Dr. Ramos, Dr. Ravi and Dr. Brown have been very helpful and have helped me feel comfortable in an unfamiliar setting for me. Coolest case of the week: asides from Chikungunya illnesses (new concept for me) I saw a child with Grave’s thyrotoxicosis in clinic and referred her to university hospital.  It took some education and diligence to convince the mother the child needs to go to Kingston but I think I got through to her.  It was a classic Grave’s case and maybe I’ll present it at rounds next week. I’ll post pics soon! Thanks all, respect!   Ajay

  As I sit in the doorway of Couples Tower Isle, the wind blowing through my hair and the sound of the waves hitting the shore, I sit and reflect on my time here. I have been blessed beyond words to be able to be a part of the Issa Trust Foundation. 2014 was my 4th medical initiative and words cannot describe the utmost joy this 2 week trip brings to my life. Each year people ask me to describe the trip. One cannot describe this trip until you have lived it for yourself. I dont really have that one “ah ha” moment that I can talk about because each trip, each day becomes a memory etched in my heart. Each smile, each hug, the graciousness of the Jamaican people, and the feeling of the kind human spirit that flows through all humans no matter where our “home” is. That is what I leave here with the feeling that every mother, father aunt, uncle, and grandparent wants their child to be healthy and loved. Over the time I have spent here, I can see a substantial difference in the overall health of the Jamaican children. I remember that after I drew a hemoglobin level on a teenage girl, the level was low. I told her to eat more calaloo. I was able to draw her hemoglobin again this year, her number was substantially higher. She says to me “I remember you, and I listened to you. I have been eating my calaloo. I dont like it, but I am eating it.” Not only is the community of Jamaica so warm and friendly, but the staff at Couples Tower Isle make you feel like you are family. Each day, each person greets you with a warm smile. After a while, they all begin to call you by name. I was walking out to the boat dock, I heard “nurse, nurse!” I looked over and a employee at the watersports area says, “Welcome home, nurse!” Yes thank you my friend, I am home. So I am thankful for my time spent here. I am looking forward to more smiles, more hugs, more “welcome homes” and most of all looking forward to making more children healthier. Because one must never forget, these children our the future and we must always take care of them. So if you have the time or money please help the Issa Trust Foundation in their goal of helping the children of Jamaica become healthier. You will be rewarded in ways you never knew. I tell my friends and family back home that I go to Jamaica to help others, but every time I come back, it is I, indeed who has been helped. Kerri Cook, RN