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Happy Thanksgiving everyone! There’s a ton of things that I am thankful for, one of which is this experience. Since medical school I have wanted to participate in a medical mission trip. I came close last year. I had a trip to Guatemala planned but then fellowship interviews got in the way. The main roadblock has been the cost. I am grateful for the Issa Trust and Couple’s Resort for organizing such a wonderful program.
Yesterday I rounded on the Pediatric ward with the team. I had it wrong before when I thought the 3 young docs there were residents. They do not have residency programs. Medical school is longer (6 yrs instead of our 4yrs) but they are not required to do a 3 yr residency.
Rounds are similar to ours. A younger (and I use this word as experience not necessarily age) doctor presents their patients to the Attending doctor (aka the Boss). A plan is pretty much set ahead of time but fine tuned after some discussion.
After rounds blood is drawn for the labs ordered. Then LUNCH.
I rode home with Candi again. The hospital system is down a car (its in the shop) so any time she offers I accept. On the ride home we stopped at this jerk shop. I had heard from all of the drivers that it has the best jerk (chicken and pork). It was good but Doug cooks pork so well that I’m pretty spoiled (dry pork just doesn’t cut it anymore).
Today I watched the Macys parade and I’m going to watch Charlie Brown’s Thanksgiving at 8pm. I got to talk to my family after they had dinner. Hopefully next year I can sit down with them at the table (last year Doug’s grandma died so we were at his family’s, 2 yrs ago I was on call, 3 yrs ago I think we were also at Doug’s, so it must have been 4 yrs ago at my family).

FUN Jamaican stuff:
some schools have 2 shifts: 7-12 and 12-5. So if it seems like there are always kids walking around town, you’re right.
The biggest shopping day of the year here is Christmas Eve.
Some of the rural houses just have the living area and bedrooms inside. The bathroom and kitchen are outside.
Speaking of bathrooms there is something called a pit latrine. During rounds we talked about this and I thought they said piG latrine and asked if I knew what it was. I thought pig trough and said ‘where they eat.’ Oh no. It is an 8 ft hole in the ground with a seat at the top of it to do your business.
Coconuts are not brown while they are on the tree. They have an outer shell that is yellow/green. The sweeter the jelly (juice) inside means the older it is. Milk is NOT the liquid inside but made by grinding up the white meat.

Pandora, Hulu, and Netflix do not work outside of the US.

Last Wedneday I was rained out of clinic (flash flooding of some of the roads). Here things bounce back quickly though. In September they had bad flooding during tropical storm Nichole. I was told that there was 3 ft of water in all of the buildings in downtown Port Maria. The whole city was back up and running in 2 days. The water receeds quickly and since everything is concrete they just swept out the mud and went about business as usual.
Thursday I worked in the Annotto Bay clinic. You see a mixture of newborn exams, hospital follow ups and sick kids. Mostly well though. I rode back with Candi (one of the other docs at Annotto Bay) and she said we should go to the market sometime. What better time than right then? We poked around at the market. I bought one thing at the very end (shirt for my dad). I appreciated her going with me. When we got back to the resort SURPRISE my husband had flown in for our anniversary (5 yrs Nov 19th).
Friday he went with me to Port Antonio. It was great because that is my longest drive and he got to see all of the countryside. I also do outpatient and inpatient work there so he got to see it all.
We had a wonderful weekend. The resort has a flag system (green= all water sports are on, yellow= some of them, red= no sports). It was really windy so Sat and Sun were both red flag days. We still had an awesome anniversary!
Doug left Monday at 3am (I take the same early flight next Wed morning).
Yesterday and today were outpatient clinic days at Port Maria. I set a personal record for the # of patients seen in a day (27)!
Tomorrow is inpatient Annotto Bay. Thursday I will celebrate Thanksgiving. Friday back to Port Antonio. One last weekend of fun. Last work day is Monday!
I can’t believe how fast this month has gone.
Now time for fun Jamaican stuff:
When you ask a kid what grade they are in the will say one, two, etc. Not first, second.
Many people here believe strongly in home remedies (pepper in your mouth for a sore throat, the leaf of a certain tree placed on the head for a fever, different roots and plants etc).
Once you finish grade 11 there is an option to do grades 12 and 13 but you have to be accepted. I don’t think many people do it.
People complain about the government here too.
Ummmm I’m running out of things.

Today was another clinic day in Port Maria (roughly 30 minute drive). It seemed slower but that was because there was a heart screening going on at the same time. This made the patients flow more steady instead of a huge rush.
I saw 19 patients today.
Found out that they don’t carry Claritin/Loratadine in the pharmacy (I’ve probably written 10 scripts for it and today was the first time someone came back in to tell me the pharmacy didn’t carry it).
The very last patient I saw was a bit frustrating. She had viral pharyngitis. I spent awhile explaining the difference between a virus and bacteria and how we do not treat viruses with antibiotics. Mom and 12 year old seemed ok with this but then they came out and told the lady that had asked me to see them about my diagnosis/treatment plan. I had to leave my room to walk to the pharmacy. When I came back they had taken the chart (which they call a docket) and put her in line to see the nurse practitioner!
This is a common battle we fight in the US as well. Viruses are not treated with antibiotics but families sometimes get upset when you explain this. Studies have supposedly shown that if the doctor explains the nature of the illness that they family is ok with not getting a prescription. I have not found this to be very true (here or at home). Also, we are not supposed to give cough and cold medicine to anyone under the age of 6 years. I had a mother last week tell me that she wanted a prescription for their local cold medicine for her 9 month old baby. I explained why we don’t give the medicine (risk is greater than benefit). She demanded 2 more times for me to write it and I finally had to say “you can leave now because I will not write you a prescription.”
Please don’t get me wrong. The vast majority of my patient encounters are pleasant and the families accept what I tell them. I just needed to vent about those.
Today I admitted a child to the Annotto Bay hospital. I hope he is still there on Wednesday when I do hospital rounds there. He is not growing and developing and has frequent infections (this is not a good combination).
Tip of the day: Don’t travel with black luggage.
Time for Jamaican fun:
They report time like this: 1 day= 1/7, 1 week = 1/52, 1 month = 1/12
$1 US = $84 Jamaican
Their version of Sprite is called Ting
Kids here do not think of Santa Claus like we do. He is a figure at Christmas but he doesn’t come down the chimney (they don’t have them) and bring all of the presents. He rides on a donkey that pulls a cart with some toys in it. On Christmas Eve kids dress up in their finest clothing and walk around the town with their parents. They buy toys and candy that night as their gifts.

Friday was my first trip to Port Antonio. As with any first day it started a bit rocky. I called the day before and confirmed a driver, apparently the staff knew I was coming but nobody told the driver 🙁 I finally made it to the clinic around 1:30 and there was a whole waiting room of babies. There were 5 scheduled but word spread and a few extras showed up (I think there were only about 10 total but the waiting area seemed packed). After I saw clinic patients they took me to the inpatient area where I saw the 3 admitted babies, all 3 wks or younger. I actually had a wonderful day it just started late. My driver was really nice and he navigated the windy, pothole stricken road with grace. The nurse that helped during the clinic was fantastic. She actually stayed in the room with me to learn and to help with any language issues (we didn’t have any).
Packing tip: Harriet Lane!!! I am using it frequently (for those that don’t know it is just a reference text that fits in your pocket, well your very large pocket).
I had been told that flexibility is needed to do well at mission work. I understand what they mean now. We frequently stop at the gas station. We make stops at hospitals along the way to trade supplies. I have traveled with patients that are being transported to other hospitals (when you transfer to a higher level of care they do not go by ambulance but they just sit in the back of the car with a nurse). I don’t mind any of it because this stuff has to happen anyway so conserve in your trips from here to there.
Fun Jamaican stuff: Almost half the cars here are Toyota. Originally I thought they must be the best then but I learned that the parts are the cheapest and easiest to get. By the way if you own a Toyota I can tell you that one of the first things to go out is the speedometer followed by the passenger windshield wiper. The horn though seems everlasting.
Many Jamaicans opt not to get officially married and just do the common law thing. Even if they do get married rings are not always involved.
You will commonly see an infant with a red hair tie on their wrist. Apparently they are supposed to have something red on so that they are watched over.
They dislike the cable companies as much as we do!
I mentioned before most of the buildings are concrete. They have metal roofs. Mostly concrete flooring. No air conditioning (mainly only for businesses) and of course no heater (no need). Instead of billboards and free standing signs they mostly paint on the concrete wall to advertise.
People do with what they have. Unlike Americans if a sister passes down a pink backpack or a purple bike the Jamaican boys will use it. Keep this in mind when examining babies because sometimes boys will have on pink and purple striped socks.
You can’t get a license until you’re 18. You can also drink at 18.

Ok so the title of the post was time for fun. It is Saturday so I didn’t work today. I went to Dunn’s River falls, which was fun. Played 3 games of beach volleyball. Read a book by the pool and now its dinner time! Sorry I can’t post pictures but I forgot the adapter for my camera to load images onto the computer. I am taking plenty though so when I get it I will add them.