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When I first choose medicine, I choose it because I saw the need for medical personnell in the world first hand. Though I consider that as real a reason as any, I was not any less nieve about what it meant to be a physician than any average budding med student. I thought my mere presence would save lives! LOL. I would have this fantasy that I am driving and there is an accident before my eyes. I would spring from my vehicle and magically by my mere presences the mangled would get up and be healed 🙂 I thought I would save the world. As the meaning of doctoring has gone from being fantasy, to tangible, to my real daily existence I have gone through many changes. Primary care has become my passion. But what does it mean? I realized that what I like about my time here with Issa Trust most is that it is very similar to a clinic month back home. I see them, assess as many things as I have time to, introduce interventions, help them navigate the system, see them back. As I would at home I am essentially trying to build some trust and provide the best care I know how to. Im doing that, mostly from the clinic, because I believe in prevention, monitoring for occult disease so it may not cause more significant illness or premature death later in life, and mostly (to be honest about my personal intentions), so that these young folks can have the best quality of life with fewer days of illness or complications. Primary peds is not sexy. Diagnosing a 3 yr old with a urinary tract anomaly and providing interventions to prevent long term kidney damage is not going to wow your grandparents at the dinner table. Preventing a case of rheumatic heart disease by treating a strept throat, or treating a teenager with chlamydia to decrease her odds of having complications that might involve her ability to conceive later in life… those things are not ‘your favorite doctor show exciting’. As I reflect on them it reminds me of why what we do matters and why offering pediatricans to a place where there are so few, is a significant contribution to this and any population where access to a pediatrician is limited.

I’ve only worked for 2 days, so this may be premature, but here are my very early observations: (1) Even in Ministry of Health hospitals, many of the medical officers are ex-pats, including Cubans, Burmese (!), and South Asians. It seems many Jamaican doctors emigrate to the US whenever the chance presents itself. Additionally, I am told the cost of medical education in Jamaica is quite high, further causing shortages in health providers. (2) I am surprised by how few “tropical” diseases there are here. For the most part, what I’ve encountered is not unlike what I see in the US: lots of viral URIs, AGEs, constipation, asthma, etc. (3) For good or for bad, practicing in Port Antonio or Annotto Bay is not too unlike practicing in low-income areas in the US. Here, limitations revolve around immediate access to diagnostics; in the US, limitations to treatment can be just as severe based on insurance status or ability to pay. (4) A nice change of pace from other parts of the world: Because of national health coverage, patients can actually get diagnostics and treatments, though they may have to travel 2+ hours to Kingston to do so… it’s uplifting to see after working in areas where even if a diagnostic test or treatment is available, unless payment is offered up front, the patient cannot access these. (5) It’s wonderful to have Dr. Ramos’, the pediatrician for the region, experience. He is practical and has a good sense of local epidemiology. So far, this is already proving to be a great experience. Will have more to report as time goes on.

Today I was in Annatto Bay. After being in Port Maria where we see tons of kids and are busy all day Annatto bay is a nice change of pace. There are 2 pediatrics trained folks consulting and a whole team of pediatric focused medical officers. I wasn’t very busy but I learned a lot from rounds and from a presentation one of the interns gave about pediatric UTI. We got to discuss the standard of care for UTI here as far as imaging is concerned and I got to hear how it differs from the US and what kind of studies that have been done to inform the recommendations. I feel like I help the least here because there are so many other amazing people seeing the kids, but I’m sooo glad we come here for my education. I got to run some cases that I saw in clinic yesterday by the pediatricians and learned a lot about hospital care. They were saying they have never had to put a child with asthma on continuos or bipap or anything like that in the 8 yrs since of the peds has been working there. And the kids get better. If I had come here but not had these interactions then I would not be up to speed on the local standards so I’m grateful to have the Annatto Bay experience. I went to the Emergency area after ward rounds and saw a few really good cases. I have seen clinic patients a lone with “attending backup” at home for many months now. But this experience really helps build my confidence when no one is there to just “run things by”. I have been here long enough to have some patients come back and have been pleased by the results I have seen. I’m also getting better at seeing patients faster. I’m still in awe at just how specialized it is to be a pediatrician and how valuable our knowledge base is even among very experienced practitioners. I had a really sick kid in A and E today that myself and 2 other doctors helped stabilize. I felt really good about our efforts. I was nervous but once I calmed down I realized that I know stuff lol and we worked together. There was an ER trained doc there for support and she thought we did great and just added a few recommendations. I’m also really having fun at work. The docs and nurses are just as awesome as they are back home and its been easy to joke and have fun despite working hard. Thats like the icing on the cake.

Hello everyone! I first studied abroad as a 20 year old undergraduate in 2004. I volunteered at a hospital while I was a student at the University of Ghana in Legon just outside of the capital city Accra. This was a small hospital, with a few wards and a few doctors. The only specialist there was a pediatrician, and every day she saw all of the children. Everyone else was a general practitioner with 1 year of internship then on the job training. I remember watching the long queues of people lined up every morning to see the 4 doctors and could only imagine what it would be like to be that one pediatrician. Today, I got goose bumps when one of the other 3 doctors at Port Antonio health department told me I was the only pediatrician there today. Since I left Ghana 10 years ago, I have thought a lot about global health. I thought about how to make a real impact, I’ve thought about the ways that sometimes well intentioned people with resources such as myself can sometimes be a burden as we try to help. This program is truly done well. My stay is not a burden on any person since no one has to feed me and house me. I am working under the auspices of the public medical system, so if I get Dengue fever and am down for the count there is always a doctor who can see the babies and we are reiterating continuity and the importance of using the medical system. Since Diane tries her hardest to get 1-2 pediatricians here every month there is some consistency and I can make a plan for 3 months from now that I can pass on to another team. There is bi-directional learning. I’m so proud to be here, and to be a part of this program.