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Sunday we participated in our first excursion away from the resort when we went to Dolphin Cove and had a chance to swim with dolphins!!  Neither D nor I had ever done this and it was amazing!!! I highly recommend it for anyone coming to Jamaica!! Dolphin cove is beautiful.  At the cove we swam with Mitch (the alpha male dolphin who in his early 20s is already a dad to multiple baby dolphins at Dolphin Cove), watched 2 shark shows, held a sting ray and hung out with multiple parrots!!  And hey, I don’t want to brag but apparently Mitch thought I was the best kisser because he brought me the ring to throw for him after getting a kiss from everyone!!  We got back to the resort that afternoon and had a late lunch before relaxing and catching up with friends and family back home.  We then had mango sorbet for dinner.  I know an interesting choice for 2 adults but hey it’s true, in Jamaica no problems!!  All in all a great day!!

Monday and Tuesday we were back at Port Maria Hospital but we switched it up this week with me going to clinic and D going to the A&E.  Of all the hospitals we go to, Port Maria is by far the one with the greatest need for pediatricians and we are always busiest here but it’s our favorite!!  On Monday I saw a large kerion and even made a diagnosis of Gionati-Crosti!!  I have to pause here to thank Dr Brown for hammering home this viral exanthem to Stevie and I after our last month in Jamaica!!  You’re the best, Dr Brown!  In the A&E, D diagnosed several fractures and is becoming a pro at plaster casting–don’t worry guys, she still refers to Ortho once the cast is on!!

D also saw one of my patients from the week prior.  Last week I had seen a 17 year old male who was febrile, diaphoretic, complaining of pain on urination, bilateral CVA tenderness and that morning had noted blood in his urine.  His u/a showed 3+ blood and 1+ protein (unfortunately at Port Maria the dipsticks aren’t able to tell you if LE or nitrites are present and there are not sterile containers for sending urine cultures).  I was confident this teenager had a UTI but I was worried that he may have had pyelonephritis or an infection caused by an STI (although he denied sexual activity repeatedly).  As his vitals were stable and he did not want either a GU exam or admission, I decided to treat him with a 7 day course of augmentin and told him he had to return in 1 week for a repeat u/a.  My plan was to obtain labs and imaging at that time if he had any blood or protein in his urine.  When D saw him on Tuesday he looked and felt great!  He’d completed his antibiotics and his repeat u/a was completely clean!!  Look at that continuity of care even in Jamaica!!!  That same day in the A&E D saw an interesting patient with a tooth abscess that had progressed to facial swelling and edema.  We spent a long time trying to decide what antibiotics we should use based on availability and how we would be able to get this child to a dentist for tooth extraction.    Ultimately, we decided on clindamycin and CTX and she was admitted in order to find a dentist who would be willing to come to the hospital.  Prior to antibiotics and admission, D started an IV and drew both labs and a blood culture — in Jamaica all lab work is performed by physicians not the nursing staff!! It’s a great opportunity for D and I to work on our procedural skills!!

 

Monday night was our first time that we attended the “Returners Dinner”.  The dinner was possibly the best one I’ve had at Couples– amazing soup and salad followed by an entree of lobster and steak and then a wonderful dessert.  At the end of the dinner, the manager of Couples stood up to thank people for coming back and even spoke about the Issa Trust Foundation.  It’s great how much Couples is doing to help raise awareness and money for pediatric care!! On Wednesday we were back at Anotto Bay.  It was a slow morning on the wards but things really picked up when we went to the A&E.  Within 5 minutes of being there, we were handed 3 pediatric X-rays for review!   One child had a distal tib-fib fracture that needed casting and another had a chin laceration that needed repair.  We quickly got to work seeing as many kids as we could. The ambulance provided our ride home that afternoon!  Our driver was great and convinced us that we had to stop for “real Jamaican food”.  We stopped at one of his favorite restaurants for jerk chicken and red stripes.  Last year we were told that Jamaicans have heartier stomachs than we do so we have no one to blame but ourselves if there are negative repercussions from our eating adventures!!!  But local jerk chicken is fabulous! Back at the resort and the weather is gorgeous!!  We have dinner reservations at bayside tonight but are first going to enjoy a cocktail on the rooftop bar before we go!! Crazy that our friends and colleagues are dealing with snow at home while we are soaking up as much sunshine as possible here!! Still feeling so blessed, S&D

Our first week has flown by! Stephanie and I are grateful to be surrounded by such warm people that continue to help us become oriented to all the clinics we are working at! On Wednesday and Thursday we were at Annotto Bay Hospital. Our first day we were able to join the residents on the inpatient service. The pediatric ward struck me immediately as it is one open room with children of all ages from 3 days to 11 years old with the sickest patients closest to the nurses’ station. We were surprised to learn that if you are over 12 years old you go to the medicine unit! At home we have a hard time transitioning our 18 year olds to the adult units so that struck us by surprise. That continues to point how valuable and needed pediatricians are in Jamaica! We were able to join in on work rounds with Dr. Ramos and found a teaching point with every patient. It was nice to contribute and discuss pathophysiology and management on each disease process. There was a 3 day old infant with hypoxic ischemic encephalopathy who was continuing to have seizures despite being started on phenytoin. This led to a lively discussion of what else was available and prognosis as one of the medicine interns wanted to obtain a CT scan of the patient’s head. We talked about both cost efficient and responsible healthcare as we tried to stress that this imaging modality would not give us additional information and increases the patient’s risk for cancer in the future. Currently in Jamaica no hospital is capable of doing body cooling but an interesting teaching point that we were able to share. One of the residents then gave a presentation on shock. This reminded me of the many talks we have had with the intensivists both at noon conference and in the PICU. Stephanie and I stressed to them the importance of early recognition and quick action. Overall the day was great as we were able to share a lot of teaching points that our teachers and mentors have successfully stressed to us! On Thursday we were in well baby clinic where we each saw about 10-12 newborns. We fell in love with the infants and most were doing well and healthy. We had a couple of patients one with a new murmur that we sent to obtain echocardiogram and another that Stephanie was the one managing diuretics as the last echocardiogram showed a closed VSD with good function. In the afternoon we spent time in the A&E where we immediately admitted two patients. Stephanie saw a young boy with sickle cell disease who presented with pain crisis who was admitted for pain control. I saw a 14 year old boy with an asthma exacerbation that had failed 6 nebulized treatments in the A&E with Salbutamol and Atrovent. We had another lively debate about dosaging as he had been under-treated. Some of the generalist doctors had wanted me to obtain basic labwork to see if the white count was elevated which led to a debate of not ordering labwork when it will not change our management. We stuck to our guns and I like to think it was beneficial to all to think about these things before ordering labwork or imaging. On Friday we traveled to St. Antonio Hospital with Mr. Campbell, the CEO of the hospital. He was so gracious to drive us the almost 2 hours each way. There weren’t any patients in the outpatient clinic so we spent the day in Accident & Emergency. We saw a variety of conditions and have a knack for starting the day off with an admission. Stephanie saw a child with a hot water burn on the top of his foot. With good supplies there could’ve been the possibility of sending him home but as we didn’t even have appropriate wraps the patient was admitted to help prevent infection in this very vulnerable area. After seeing all the patients we were able to spend about an hour playing with the kids on the inpatient side. We read them books, colored and even told some scary (or not so scary) stories! We had a blast!       This weekend we are enjoying everything that Jamaica has to offer! Sailing, kayaking and tomorrow we are off to swim with the dolphins! We are definitely feeling blessed! Until next time, Steph and Diana

It is so wonderful to be back in Jamaica!!  Diana and I landed in Jamaica on Friday.  Walking back into Couples resort after 11 months honestly felt like coming home.  The staff at the resort are wonderful and it was so nice to be remembered and hugged by so many of them.  It’s great to walk through the halls and hear “hey doc” and see a familiar face!!  Enough cannot be said about the wonderful lodging that Couples provides to all the doctors volunteering with Issa Trust.  From the beautiful and safe facility to the amazing food and drinks to the countless entertainment, this place cannot be beat!  All the staff also asked about Stevie and were sad she wasn’t joining me this year but were excited to hear she is expecting her first little one and also excited to meet Diana!! Diana and I were very excited to get to meet Diane Pollard and Pat Brophy, the CEO and chief medical officer of the Issa Trust Foundation.  I have been talking with Diane for over a year now but it was great to finally put a face to the name!! We have had so much fun hanging out with these two and getting to know them better.  I continue to be amazed at what these two have accomplished for advancing pediatric care in Jamaica.  The need is so great in this beautiful country and the Issa Trust Foundation continues to do everything it can to reach out and help.

Our first weekend in Jamaica was spent relaxing and enjoying this beautiful weather!!  It was snowing in NC when we left so I can’t tell you how grateful I was for 80 degrees and sunshine.  Friday night started with an amazing lobster dinner,  great wine and wonderful conversation about the beginning of Issa Trust!!  Saturday we spent the morning laying out on the beach relaxing.  D and I both just completed very busy months working 80 hours per week so I can’t stress how important having a couple of days to decompress was!!  In the afternoon we took the catamaran cruise.  Anyone who red the blog last time knows how much I love the catamaran cruise!!  Again, it was perfect– tasty drinks, catching up with the friendly staff, swimming in the ocean and completing it all with an awesome dance party with all the others on board!!  Saturday night was the weekly gala.  Although D and I were both tired, the entertainment here cannot be beat and we were on our feet dancing in no time!!  Sunday we spent the day on the beach and I must admit we both got a little too much sun.  However it was Super Bowl Sunday so we spent that night eating tailgate food and watching football on a big screen projector on a rooftop bar in the middle of the Caribbean — that my friends, is a tough night to beat!!

On Monday we got to work which is the real reason we came to Jamaica — to take care of these adorable children!!  Monday and Tuesday were spent at Port Maria Hospital which was one of my favorite hospitals we worked at last year because the need is so great.  D was in the clinic and I was in the A&E.  We saw plenty of cases of rashes, viral gastro, fungal infections and asthma exacerbations.  On Tuesday my morning started by seeing a 7 month old female with an incarcerated inguinal hernia.  Mom stated that she’d noticed the mass protruding and getting hard about 15 hours prior.  When I saw the child the inguinal hernia was hard, painful and not reducible.  The child was also vomiting every time mom tried to feed her.  As this was a surgical emergency and Port Maria has no pediatric surgeons, I worked quickly to try to get the child to Bustamante Children’s Hospital in Kingston– the only children’s hospital for all of the English speaking Caribbean countries.  After several attempts I was able to get in touch with a pediatric surgeon who was wonderful and said to get her there as soon as I could.  I made her NPO and placed her on the ambulance.  I am hoping to speak with the surgeon again to see how she did.  Even in Jamaica continuity is great!!!

After work, D and I had an interesting conversation about vaccines here in Jamaica.  Here oral polio is still used instead of the IPV vaccine we use at home.  She had a 19 month old who was having diarrhea but was due for oral polio.  This led to an interesting conversation about  possible immunocompromised family members, shedding of a live vaccine, multiple concerns regarding oral polio and whether now was the best time to complete the series.  However, there was also concern on whether the mom would actually bring her back and if this could be the only opportunity to vaccinate her.  Just like at home, we have to weigh risks and benefits with every patient we see.  It’s so nice to sit down and talk about patients and medicine.  We are constantly talking about the patients we saw that day, reviewing their presentations, and running our plans by one another.  Especially after coming off of busy months, it is such a blessing to have time after a long day to really process what you did. The opportunity to process rarely, if ever, comes when working at home. I think most residents would agree that in an age where so much of medicine has switched to shift work, by the time you’re off work you’re often so exhausted that the only thing you can do is eat dinner, shower, and go sleep as you prepare for the next day.  It is wonderful to just sit and talk about medicine.  With all that Couples has to offer I’m sure it may seem like medicine is the last thing that would be on our minds but that’s simply not the case.  I continue to be grateful not only for this amazing opportunity but also for the much needed downtime.  This rotation provides a great opportunity to help people in need, sharpen your physical exam skills, and enjoy the beautiful country of Jamaica.

We’re driving back from Port Maria now and this view is breathtaking.  It’s a beautiful Caribbean day and we want to soak up every second!! Happy and so grateful, D & S

We were privileged to be able to start our day in Port Antonio with a brief presentation about febrile seizures to the doctors and nurses on staff at the hospital. While febrile seizures are quite a common issue for us as pediatricians, they can be daunting for doctors who are not as familiar with kids. A lively discussion followed the presentation (as are most discussions in Jamaica) and we all walked away with a deeper understanding of practicing medicine effectively with the resources available.

That being said, now that we’ve been in Jamaica for almost three weeks, I feel that poverty has become personal. There are now names and faces and images that come to mind when I think about “resource poor settings.” It is the legs of a child with a bacterial superinfection that has been ineffectively treated for months with an antibiotic known to have a high level of resistance because there was nothing else available. It is the back of an ambulance equip with little more than a pair of latex gloves, a bag of expired normal saline, and a small sliver of hope that anything useful would be able to be accomplished should a true emergency arise. It is the mother of an asthmatic who fashioned a spacer out of plastic cups because she couldn’t afford one but acknowledges its importance for her child’s health. And while these disparities become personal, they also become impossible to ignore.