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Today I realized that I only have one of each day of the week left to spend here. It has certainly gone by quickly. Each site has its own rhythm and I have learnt to have a different set of expectations based on the day of the week.  From the relatively steady pace of Mondays, one moves immediately to the barely controlled chaos of Tuesday vaccination day at Port Maria. Then Wednesday mornings come with their share of “thinking time” where we are afforded the luxury of engaging in academic speak and differential diagnoses.  Alternating Thursdays could be a seemingly unending line of newborns or a steady pace of old timers – ex premies, patients with asthma, sickle cell, epilepsy, the works. Depending on whether or not the charts are available for those chronic patients, you may have an easy time figuring out why they are there or be dependent on a mother (or random accompanying adult) who may very well give you a blank stare when asked why the child is there. Friday is never a bad day, because it means familiar places and faces, and only then am I truly home in every sense of the word. I have become quite accustomed to the undulating rhythm of my weeks here. But this week will be different.  It will be a week of good byes. A week of saying thanks to the many wonderful people at each site that I have met and come to know.  My first goodbye will be to the blog as I look forward to savoring my last few days in my sweet island home. I must begin to pick up the ends of my New York life that have been flapping merrily in the Caribbean sea breeze for the last 3 weeks. I must slowly begin to return to reality. Its been real, Jamaica. You never, ever, ever disappoint. Bless up. Much love. RH

In Port Antonio again today.  Overall my experience at this site has been much less busy than at Annotto Bay or Port Maria. It is a 2 hour drive from the resort so usually by the time we arrive it is around 10am, and ward rounds are generally over. I find that we don’t get many patients (max 1 or 2 each week) by the referral appointment system here so I end up spending most of my day in the A&E, which is still quite enjoyable.  And Port Antonio always signals the beginning of weekends with family, so really no complaints whatsoever. One thing struck me today, which I hadn’t taken much notice of in the past 3 weeks.  In my entire time here I don’t think I have used standard English in more than a handful of my conversations with patients. Occasionally I find myself starting off in English and then subconsciously lapsing into Patois, when I truly need to make myself understood.  The same goes for my interaction with almost all of the Jamaican staff too – nurses, other doctors, drivers, people at the resort, everyone.  Its quite refreshing and relaxing for me, but I am curious as to what it is like for non-Jamaicans who volunteer. Communication of basic concepts in English would certainly not be a problem, but I wonder how many of the nuances and subtleties of patients’ stories get lost in translation. It makes me wonder what gets said and understood and even more importantly what is left unsaid and goes unnoticed. RH

Newborn clinic at Annotto Bay is no joke.  There were definitely a LOT of patients to be seen today. It still amazes me how these mothers wait for hours before being seen, some of them essentially spending the whole day! Anyway, between newborn clinic and the A&E, I barely made it back to the resort in time for my birthday dinner reservation at Eight Rivers (one of the fancier restaurants here). I was so tired I was almost tempted to just skip dinner and go to bed. But you only get a birthday once a year after all, so I went.  And it was absolutely delicious.  I even got my own little personalized dessert with my name on it and a bunch of staff members singing me happy birthday!!  Hurray!! I will say that one of the oddest things so far has been the experience of being here alone. It is probably one of the few things I would change about the rotation.  Everything at Couples is designed for … well either two people, or multiples of two.  I would definitely recommend volunteering with a buddy, or ensuring somehow that there are two people working the month you are here.  Having someone to talk to definitely beats reading a book to keep oneself occupied during dinner. But on the plus side, I get to read a book for fun, which I haven’t been able to do for a while, and either way, it continues to be a great experience.  🙂 RH

Today was ward rounds at Annotto Bay, which was an excellent learning experience. Typically the morning on the ward is a combination of “ward reviews” which is a brief follow up visit for (mostly) recently discharged patients who need a sooner follow up than the next available clinic date. I was able to see a baby that I had admitted for dehydration and failure to regain birthweight on my very first day of work. He was discharged a few days ago and is doing great now, has surpassed birthweight and is feeding well – I’m so happy about that! The remainder of the morning is spent discussing patients currently admitted to the ward. I never realized how much I enjoyed the whole process of reviewing management and differential diagnoses and now I realize how much more important this process becomes in a setting such as this where management decisions are largely based on your clinical judgment and a limited number of available tests.  There are quite a few patients currently admitted, most of them neonates, and quite a few admitted for jaundice.  The management of neonatal jaundice here is an interesting mix of some quite familiar therapies mixed in with some (such as giving phenobarbital and albumin) that I had never heard of, but when explained, made intuitive sense.  There is no universal bilirubin screening for newborns here and so only babies with clinical concern for jaundice end up getting a level. Even with mild jaundice, mothers are sometimes encouraged to expose the babies to sunlight and advised to return to care if jaundice does not improve. Here in Annotto Bay there is the capability for phototherapy as well as exchange transfusion if the need arises. Overall a great day, and definitely the most “academic” day so far, which is a nice contrast to the constant buzz of the clinic setting. RH