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Jamaica! I can easily say that the Pediatrics rotation here was one of the best months during my residency. Looking back on my short time on the island, the one thing I remember and miss the most is the friendliness of the people. Issa Trust does an incredible job in coordinating and organizing these volunteer opportunities, which is no small feat when we cross country lines. The places we work at appreciate having assistance from the volunteer physicians and also guide us when needed about how to work in a completely different and new environment. When I first started thinking of packing for my Jamaica trip, I was worried about how the rotation will go. I am the first person from my residency program to have opted for this elective, and hence had no peer guidance available. If you find yourself in a similar situation, I would say that the guide that Ms Pollard sends you is pretty accurate about what to expect. Start planning a few months in advance. Go through the guide at one go, make mental or paper notes for yourself. If you are in a time crunch, use a notepad-like app on your smart phone – this keeps a packing and reminder list handy to add on to whenever you are inspired. I found this to be the most convenient way. Make sure you read the PDF again 1-2 weeks prior to departure, to go through the travel tips. The blog also offers a wealth of information. Once I started reading it, I could not stop. I wanted to know more, as most of it is practical and gives a good idea of what to expect in the clinical realm.

Today will be one of my less cheerful, slightly frustrated blogs. The reason is that today I felt like a burden. I must preface this with saying that one of the things I am very much looking forward to going back to is the ability to get in my car and go where I want on my own timetable and power. With that background, I felt very strongly like we were a thorn in people’s side today as our driver was late to pick us up, and then there did not seem to be a place for me to work today. I started my day like usual when I work in the A&E, but due to space constraints I was moved to another part of the hospital. Moving around does not bother me in the least as I would work out of a corner if I had to, but I felt like my presence was more of a nuisance than a benefit today. I want my work here to be a positive experience for my patients and for the people I work alongside. I know wishing that was the case every moment sounds very idealistic, but what else am I doing here if not to foster relationships and learn. I do not want to be an annoyance or any kind of bother and feeling even remotely like that has given me a definite case of the Mondays. On a more positive note (because I can never stay gloomy for long), we had a great time at the ISSA/CHUKKA Trust polo match. When Diane told me of the event, I had to chuckle because we started having a similar affair back in St. Louis. Starting last year we have an annual “Glennon Gallop” to benefit our primary care clinic at Cardinal Glennon. The patient population there is mainly Medicaid and reimbursement is not great, so fund-raising can benefit the clinic and patient population a great deal. The overall feel and goals were the same at both events, so experiencing this Jamaican version was a great treat. We also got to spend some time with one of the doctors from Annotto Bay outside of the hospital and that was a delight as well. That leads me to my overwhelming favorite part of this entire experience- the people. I have found Jamaica as a whole to be a friendly and welcoming place that has embraced our visit. We are often asked if this is our first time to Jamaica and then warmly welcomed. This question has come from resort staff, MOH drivers, other health care workers, and even the patients. There is a pride here that permeates much of the culture and it is truly special. We have also met some very interesting travelers along the way from many parts of the states and the world. I hope someday to be able to come back so I am not a neophyte, but a true Jamaica-phile. Please pardon my grumpy mood earlier. As it often is, writing was cathartic.

Hi again- Writing again from the lovely (if not lately rainy in the middle of the night) Jamaica! We have been here for a bit over a week and have now been working for a week. Today was the first day it was not “new”, and there was definitely comfort in that. I have noticed now that we have visited all three hospitals, that each has their own nuance and style that you have to acclimate to. There are two things that specifically prompted this blog tonight. The first was the fun I had working with another physician in the A&E at Port Maria to get creative getting a foreign body out of a nose. As toddler’s do, a little girl had stuck a hair bead in her nose and was too young to understand how to blow it out. Back home we have these nifty tiny catheters that are smaller than spaghetti and we can slide behind objects, then inflate a balloon (like a Foley for a Hamster) and pull the object out. Well the smallest actual Foley was too large, and there were not traditional alligator clamps so the creativity was flowing. First I must say, the other physician did a great job presenting the options to the parents (we try creativity there and either are successful or could push it in further, or we transfer to BCH for possible sedation or possible ENT removal). The family opted for an attempt there so I wrapped the kid in a sheet and we got to work. When the catheter was clearly too large, the other physician fashioned a hook out of a paper-clip and was able to rotate the bead so the hole was visible and get it out. Out came the hair bead and after a few screams and some giant crocodile tears, the child went home with mom and dad. I also enjoy being part of ingenuity, especially when it saves a family a costly trip. The second event that I want to write about is a discussion about allocation of resources we had at Annotto Bay today. There has been discussion that due to budget issues across the board, it has been difficult to transport patients to Kingston for more specialized testing. It was noted that the pediatric patients, especially the babies, seem to get first dibs on transport. There was some talk about why this may be. Is it because everyone has a soft spot for children? Is it because they sometimes seem to have more advocates on their side (vocal care takers both in the medical field and their families)? Or is there another factor we are not evening considering. We see this debate over allocation of public spending dollars on health care at home as well. I do not have an answer, or even a formed opinion, but I was something to think about tonight. The third thing I must say, and I did not include this on the two because it is not medically related, but when I arrived in Jamaica I asked Bob if we could get a goat. He said no (he also vetoed a micro pig earlier this year, apparently three dogs are enough of a menagerie). After the beach party Monday, I now do not want a goat, because if I got attached, how would I later curry it… Having the best time, Becca

There were vary different experiences at the varied hospitals. Port Antonia was the most spectacular of the three locations. The hospital is situated on a bluff overlooking the bay, with the ocean views overlooking the city. The hospital was a journey from the resort with a travel time around 2 hours each way. Our day was much slower at Port Antonio. We spent the entire day in the A&E (Accident and Emergency). We shared a room there. We only had a pediatric patient (birth to 14 yo) about every hour. They highlight of the day was a darling 11 yo girl who just stopped in to our exam room to chat with us while we were waiting to see another patient. She was a fifth grade student who was watching her 2 yo nephew while her sister was being seen. She was a bright and articulate student who was also remarkably polite. She was the highlight of a good day. Port Maria was a crazy first day to say the least. We were divided in the morning, Becca worked in the A&E and I in the clinic. When I arrived at 8:30 there were patients lined up outside the clinic which did not open for another hour. When the clinic started I was handed a stack of eight chart (dockets as they are referred to here). While I was seeing my first few patients the nurse returned with several more stacks of charts. Between 9:30 and 2 I saw 16 patients from asthma follow up, viral illness, well child check, to septic arthritis. I did have one mother refuse to see me, requesting that she see the “black doctor”, none of which were there that day. When I finished clinic, I joined Becca in the A&E. She had been busy as well seeing more than a dozen patient’s in the time I was in clinic. She was seeing a wider variety of patient’s including children as old as 18. She was finishing up charting when I arrived. Several more patients came in while I was there. We only had the one exam room so we rotated patients. By the end of the day on Monday we saw 35 patients between the 2 of us. It was a great but tiring day.