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15
May

end of week 2

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Wednesday and Thursday, Annotto Bay
So on Wednesday morning my colleague went to Pediatric rounds at the Pediatric Ward, and I went to the “A and E” Department (Accident and Emergency Deaprtment). There ED works differently in ours. The physicians actually quickly triage the patients, and if the child does not warrant “ER” criteria, they are sent to clinics. I guess this is an effective way to decongest the ERs, because I only saw one child, who ended up having otitis media. Still, it was interesting to see how the A & E functions and tot alk to the other doctors. If you need labs done, your draaw them yourself. Ivs are completely different and there are no vacutainers or butterfly needles. If you want to give a patient a medication, you write down the order, and the patient then brings that to the ER to get to get the medication. They can do xrays and ulatrsounds, but they have no access to CT scanners. ER doctors read their own radiologic studies. It is a process to get a radiolgist to read something.
In talking with the Jamaican doctors, I learned more about the training system. You got medical school directly after highschool. Medical school is 6 years. Then you do 1.5 years of internship. Then you can start to work in the field you want to do residency in, but you need to get recommendations before you can do your training. REsidency is pretty competitive to get for most things, including pediatrics. Most of them take the USMLE exams just in case they train in the US.
Thursday, Annotto Bay
Today we had clinic which was very busy last week, but only a half day today. Saw a variety of newborn checks and sick children. Alot of children today with slow (or no) weight gain. There are no growth charts in the patinet’s charts due to lack of resources, so it is hard to tell if they fell of thir curve or not. Just have to look back and compare to previous weights. The day was shortened as there was a ceremony to celebrate the Issa Trust Foundation dontain some ventilatos and incubators to the hospital! Supplies greatly needed!!
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15
May

Week 2 – Port Maria

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Hello again from Jamaica!

The beginning of this week we spent two days in Port Maria with my colleague spending time in the A&E and myself working in the clinic. Here’s a photo of the front of the clinic. Each day we come there is a line of people who have been there since 8 am waiting for clinic to open. It seems to be first come, first serve with the clinic starting at 9 am.


It was Child’s Day on Tuesday so we got to see the children for their well checks. While seeing babies, I found a measuring tape useful to have since we measure the length and head circumference of each baby ourselves. I looked up each growth percentile in my Harriet Lane to ensure that the babies were growing well. There aren’t growth charts in all of the paper chart files due to resources so we document everything by percentile in the paper charts which is helpful for the next person who sees them in terms of following a growth trend. Also, if you think a baby is jaundiced and you want a bilirubin level, after 11 AM you would have to draw it yourself in clinic and have it dropped off at the lab. I was really surprised to hear from the lab how much blood is actually needed for a bili draw as the lab or nurses usually draw it at my home institution. Dr. San and Dr. Win have been a great help in asking questions about what is available in the pharmacy here and what is used to treat patients for certain diseases. The cases we saw ranged from scabies to viral gastroenteritis to parental concerns about worms.

One thing I take for granted in the states are strep swabs. In the states, if you hear a complaint of sore throat and suspect strep, you can get a strep screen and if it’s positive treat, which is important to prevent the complication of rheumatic fever. Here, there is no rapid strep screen so if you suspect, you treat. Dr. Win told us that there have been cases of rheumatic fever this past year and it reminded me of the child I saw last week who was being treated with month shots of penicillin for the past year after being diagnosed with rheumatic fever. I have only seen one case in the states of Rheumatic Fever and here it is definitely more prevalent.

On the second day of clinic, I saw this adorable 2 year old boy who had right periorbital cellulitis with bilateral bacterial conjunctivitis. I had the child admitted for IV antibiotics and observation and found out from the other ER doctors to refer him to A&E for admission. Port Maria also has a ward which we haven’t seen yet and I assume he went there since I did not see him the following day at Annoto Bay. One of the benefits of having electronic medical records back at home is being able to follow up on kids to ensure that they are seen and admitted.

After a busy day at the clinic, we have our 30 minute drive back to the resort. Here is a view of driving through Port Maria where you can see different stores and daily life.


At the end of the day, it is always so nice to come back to the resort. We have been welcomed by such friendly people and my colleague and I are always amazed of the beauty of this country.


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11
May

week 2 day 2

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So today we were again at Port Maria. I again saw mostly ED patients and a handful of clinic patients. I had an interesting case with a 4 yo M with bilataerl axillary abscesses which I was happy to drain. Interesting to make do with the resources that they have. The way we do procedures is very different than the way some of them are done here, in ways involving resources and in some ways not affected by resources b ut just in the way we practice. Interesting to see differences.
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10
May

week 2 day 1

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soo after an awesome weekend of scuba diving, snorkeling, sailing, and realxing, back to work today. Today we went back to Port Maria. Felt much more comfrortable this week as compared to last week, as we knew where to go, who to talk to. I worked in the hospital and saw ED patients and also helped out the clinic and saw some of those patients as well. Pretty busy day. Saw a range of illness from URIs to many skin infections to knee pain. Kind of challenging to figure out how to manage patients without laboratory tests. Really relying on clinic skills. The patients are so appreciative and friendly.
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06
May

week 1 – welcome to Jamaica 🙂

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Hello from Jamaica! It has been a wonderful first week and after getting settled in, we started our first day of clinic this Tuesday at Port Maria’s clinic and A&E department. We split up our time between the A&E and clinic but the ED was slow with not much pedi cases so we both ended up working the clinic which was busy with pedi patients. I ended up seeing 9 patients or so the first day and it was pretty busy in the morning! One difference I noticed was the lab is open in the morning for several hours and if you miss that window, you have to draw your own labs which we ended up having to do. A CBC is fast to run with results in 10 minutes, but we sent for coags which ended up being a send out and can take 3-4 days and cultures even longer. It makes you really think about whether you really need those labs and how to manage your patient given your clinical judgement knowing that it may take a while for labs to come back. I saw several gastroenteritis cases, a primary herpes gingivostomatitis, asthma exacerbations, and well checks. It all seemed similar to urgent care clinic that I see back in the States. In the beginning of the day, there was a long line outside of the clinic but by the afternoon we were able to finish seeing everyone.

The next day we went to Annoto Bay Health Center and participated in rounds on the ward. The set up had all the beds and cribs in one room with a mixture of pediatric ward, NICU, and well baby! I was really impressed by the rounding, the residents, and Dr. Ramos whose teaching was thorough and engaging. There were interesting cases from r/o sepsis, r/o ITP, RDS, IDM to discuss and it was basically sit down rounds. There is also a need for certain medical equipment including neonatal blood pressure cuffs which the physicians are working on getting and hopefully will come soon.

Today we had clinic at Annoto Bay Clinic and again saw a huge line of patients until everyone was seen. I saw a kid for a well check with a h/o rheumatic fever which is more prevalent here in Jamaica, as well as newborn well checks and urgent care visits. I did spend time making sure to give dental education for my patients during their well checks since there is not as much access to dentists here. It has so far been an amazing experience thus far and we have been so grateful for this opportunity!


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