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Greetings from Jamaica! Let’s start with introducing ourselves. We are Chris and Stephanie, 3rd
year pediatric residents from Akron Children’s Hospital in Akron, OH. We are so excited to be starting our time
with Issa Trust Foundation, and sharing our experiences with the readers of
this blog. Before we get into the clinical
aspects of our trip, let’s first touch on the AMAZING accommodations at Couples
Tower Isle. The staff here, along with
Diane Pollard, have truly made us feel welcome and have made this a relatively
seamless start to our month.
Today
was our first day at Porto Maria Medical Center. The center is very busy, having inpatient
wards (adult, maternity, and pediatrics), a busy A&E (Accident and
Emergency Room), a busy walk-in health clinic, and a pharmacy. We were warmly greeted by the staff, nurses,
and other physicians there and quickly got to work. We split up right away, with Chris working in
the Outpatient Clinic and Stephanie in the A&E.
At the outpatient clinic, I (Chris)
saw a lot of general pediatrics issues. Main problems I encountered were Tinea
Capitis, other various rashes, URI’s, and GI worms. After only a few patients, my training kicked in and I started to feel more comfortable with the system. Right now my biggest obstacle is learning
what resources are and are not available.
It’s all well and good that I know what the problem is and how to treat
it, though if the pharmacy doesn’t have the treatment I order , then what good
am I doing. As I get more familiar with
our resources, I feel that my nerves will be more settled. Thankfully the staff is very welcoming and
patient, and is very open to questions.
(Thanks to Dr. Hines for the dose of Albendazole – Stephanie had the
formulary in A&E!)
In the A&E, I (Stephanie) was
sent the less acute patients, the ones who did not require nebulized treatments
or IV fluids. As I sat there waiting for
the first patient to arrive, I felt the nerves building up. The first patient had complaints of a
possible seizure, which I am normally comfortable with, but found myself having
a difficult time since I did not what resources were available for testing or
work up. After I had a few patients come in with URI
and asthma complaints I started to get the hang of things and felt more
comfortable. Dr. Facey in the A&E was a great resource
to me, especially when I wasn’t sure what to do with Ventolin Elixir or xray
turn around time. Deworming was a big
complaint which I fully embraced and prescribed mebendazole. The parents seem open to education,
especially on asthma. I even filled out
an asthma action plan (which would make Chris, our future pulmonologist,
proud).
Our first day is over, we are
feeling less nervous, but still getting comfortable with the resources. We can’t wait to see what the rest of the
week brings. We will be blogging again
soon! Ya mon!

My last blog . . . Last day in Jamaica, for now anyway. Bittersweet. I miss home, but have had such a rich and rewarding experience here that it will be hard to leave in the morning!

It has been challenging at times, and looking back it seems that the first and last weeks were the toughest. The first week, of course, because I was getting used to how to treat patients in this medical system. The last partly because I was, by that time, feeling homesick. The other difficulty was brought on by a discussion I had the end of the week prior with Dr. Ramos and I had some realizations about things I had been experiencing that for a while made me feel somewhat depressed. I had grown used to patients and their parents answering everything I said with “Yes Miss.” I tried my best to give education and explanations at the end of each visit and always ended with, “Do you have any questions?” Very rarely would anyone actually ask a question, and most times they would respond with a little giggle or chuckle, followed by “No.” I told this to Dr. Ramos, and he replied, “Well how can they ask a question when they didn’t understand anything you just said.” Excellent point. Even at home, at times it is difficult to explain to a parent what is going on with their child in terms they fully understand, trying to find the words in lay terms while trying to provide necessary education. But here in Jamaica, one also has to deal with a language barrier. Even though I have gotten better at understanding the mix of usually broken English and Patwa that most people speak, I also ask them when I don’t understand. Could they repeat, or tell me in a different way. But rarely would a parent ask me to do the same. I shouldn’t have assumed they could understand my English. I came to realize that just because they did not have questions or nodded their heads and said, “Yes Miss,” in a lot of cases it probably had nothing to do with whether they actually understood or not. Here what a doctor says goes, and most Jamaicans would never speak up to say they couldn’t understand me. There is also the aspect that it seems that a lot of time the people just don’t listen to what you say. I would be asked a question, and then as I proceeded to answer they would either start talking about something else, or a few times get up to leave the office. Anyway, after I realized all this about 3 weeks into my time here, I felt a bit helpless, wondered how much good I had been doing besides just writing a prescription when needed. When a mother comes in with her baby worried because that baby is having reflux (that is not in need of medication), the whole key is helping her to understand what is happening to her baby and why and when it will get better. That is whole idea of reassurance for me, education is the biggest part of it, knowing what is “normal” and what is cause for concern. But after a couple days, I just accepted that this is part of learning and part of working in an unfamiliar culture. It has been an amazing learning opportunity. I hope I can take this experience and become a better listener and a better educator for all people. It has been a very important lesson for me.

Overall, I hope that this whole experience will make me a better clinician in all aspects, as well as improve my cultural competence. I am truly grateful for the opportunity!

I encourage other physicians and health professionals to take advantage of this opportunity as well. The Issa Trust Foundation has room for 2 physicians here all year round! It would so wonderful if there were always pediatrians here, a consistent presence to serve the children here so they receive appropriate follow-up and care. You will be challenged, you will have fun, and you will leave feeling rewarded. The accommodations here are out of this world! You will have a lot of time for fun and relaxation in return for all the hard work you do during the week. Please, take advantage of this exciting opportunity to become a better clinician while helping the children of St. Mary and Portland!

So a HUGE thank you to everyone at the Issa Trust Foundation, all the many physicians and nurses I had the pleasure of working with here in Jamaica, and to my home program for allowing me the time to have this experience! I plan on coming back soon . . .

Dr. Arleen Haynes-Laing, a past volunteer coming to us from CHOP and is from Jamaica said that Black Dressing is a local poultice/wound dressing that’s used for infected wounds. Can be bought in store (don’t know) how it’s made but it smells “tarry” and is black. Families swear it works well. Another name is used for this dressing is “Heal and Draw.” It heals wound while it draws out the pus.

I’ve just finished my 3rd week here in Jamaica, and it was the busiest yet! Post Maria had so many Pedi patients, I saw 30 on Tuesday, and even had to give 5 extra back to A&E! It was an exhausting week, but full of so much great learning and good challenges.

One thing I’ve had to get used to here is that I am always “Dr. Westman,” not “Amy,” at least at the hospital. I come from a laid back California Pediatrics program where I am on a first name basis with everyone in my program, from interns to attendings and administrators. But here in Jamaica, it is more formal. A doctor is always “Dr. . .” and a nurse is always “Nurse . . .” The other doctors and even the interns introduce themselves as “Dr . . .” and I’ve noticed that even when they drop the doctor part, others refer to them by their last name only.  So now I’ve grown used to introducing myself as Dr. Westman, but it still feels strangely formal!

Another things that just goes with the territory here, and I presume for all global health rotations or missions, is that you just need to relax and go with the flow. Things are not a tightly regimented and scheduled here as in America, but everything gets taken care of in the end. The patients show up at 8am and register first come, first serve, but will wait all day to be seen, no appointment times. You, as a volunteer here, will always have someone to drive you to and from the hospitals and clinics, but it may not be the same person and they may not pick you up at the expected time. But you will get there and back safely! The doctors mentioned in the orientation packets may not be around, but there is always someone there to help with any questions. Even if there aren’t many clinic patients one day (my wide range has been from 2 to 30, but on average about 20), you can always find other ways to help out like seeing patients in A&E. Just go with the flow, and everything will work out. One of the big things I’ve learned in my time here!

One piece of advice for anyone else coming here to work, is to really brush up on your IV placement and blood drawing skills if its not one of your strongest areas. I have never really been very good at placing IVs in small children. While my home program of course has requirements and time built into our training so that we learn how to do this, there has never been much pressure to get really good at it, since there is always a nurse or phlebotomist to do these things for you. Since I don’t naturally love putting in IVs like some other residents, I haven’t perfected the skill. In Jamaica, however, the doctors draw all of the blood and place all the IVs, so I’ve actually gotten much better over these past few weeks by necessity! I was also surprised to learn, that the GPs here, although I knew they saw all ages, actually do some surgeries as well. One doctor at Port Maria said he will do “simple” procedures like appendectomies or inguinal hernia repairs himself, but prefers to only assist on more difficult operations like a biliary atresia repair. He has of course received specific training in surgery as part of his medical training, but I was impressed. At least I can do my own I&Ds and laceration repairs!

For my last comment this week, I wanted to mention every Jamaican’s apparent love for and confidence in diphenhydramine, or DPH elixir as its called here. Anytime a child has a cold, the parents demand DPH elixir. When I ask if it helps, they will either say, “I don’t know, you’re the doctor,” or they will admit that it isn’t helping the child’s cold symptoms, but they still ask for it. Many parents here really want you to give them a medicine for their child even if its just a virus, and are not as much into supportive care like bulb syringes and humidifiers, partly because they do not have access or the funds for such things. I have come to appreciate the usefulness of diphenhydramine at home, great for allergie reactions, nausea, and insomnia, but never though of using it for a cold! I do suppose it is safer than most “cold medicine” mixtures that many used to give their kids.

Oh, by the way, I’m still trying to find out what is actually in the “black dressing!” I know it is not as widely used any longer here in Jamaica, but I’m still curious. A google search didn’t help very much, and I keep asking every doctor and nurse I come into contact with, but no one yet has been able to tell me what’s in it! It just keeps me interested, but I think I might have to just let this one go!