Blog

I’ve been slacking on my posts!
So I worked Monday and Tuesday in the clinic in Port Maria. Monday 15 patients. Tuesday 22 patients. Most common diagnoses: fungal infections and colds. I did send someone for labs and asked them to come back next week so we will see how this process goes (will the results make it into the chart? will the mom come back?). She was about 18 months old and had fallen pretty drastically off of the growth chart.
Wednesday I went to Annotto Bay and rounded on the inpatients. Attended another Csection delivery. This one was only 32 weeks gestation so I was nervous but he did great. Oh I needed to give Thao an update- I saw one of the triplets, baby #3. He was admitted but for just a bad cold. He is doing good! Today I went back to Annotto and worked in an outpatient clinic. Mostly hospital follow ups. I had a long conversation with one of the other Peds doctors. He takes call overnight at the hospital 3-4 nights a week. It is just him and another doctor to split up the days. This is because of the shortage of doctors (one took a few months maternity leave and I forget why another had to take some time off).
Fun Jamaican stuff- they use a lot of concrete when they build here (houses, fences, etc).
The vast majority of women breastfeed here, which is wonderful. It is normal to breastfeed in public and for children to still be breastfeeding at older ages than in the US.
There is a college in Kingston which services a large area. You go there for almost any degree you want but they will charge you differently based on your intended degree.
Animals I see daily- lots of stray dogs, goats, and chickens.
Kids don’t have to be in carseats but you will get a ticket if someone under 12 years old is in the front seat.
They do not observe daylight savings time so I was on Central time when I first got here and now I’m on Eastern time.

Ok so tomorrow I head to Port Antonio. It is in a different parish (like a state here) so a new driver will pick me up. Called today to confirm this so tomorrow should be smooth (fingers crossed). I didn’t go last week because of the storm and it is pretty far away.

So work was cut short last week due to tropical storm Tomas. Roads flood easily here and with the heavy rains I was stuck at the resort (sounds awful doesn’t it).
I had a wonderful weekend: played pool volleyball, cricket, almost finished my book.
Today my day started out wonderfully because I learned they have peanut butter here!! I made a peanut butter and jelly sandwich to pack for lunch.
Arrived at the clinic, which was packed with kids waiting to be seen. I saw 15 kids again today. Diagnoses included: scabies, tinea, tinea, tinea, scabies, strep, virus, virus, virus.
I asked the ladies in the clinic what they needed and their response: a scale for infants and a bassinet to put infants in if the mom has to leave the room (I think they are called Moses baskets at Babies R Us).
Interesting Jamaica facts: all kids start school at the age of 3yrs.
They write the date starting with the day then month then year. This messed up all of my medical records the first day because I couldn’t get the birthdates right.
Packing tips: you may be here by yourself so spray on sunscreen is a must and check your clothes before you leave- no sense in a dress that you can’t button up by yourself.

Today I went to the hospital in Annotto Bay. When I arrived I was greeted very kindly and escorted to the Pediatric Ward of the hospital. The 3 residents were there working. They seem particular about about which year they are (first year=intern, second year=resident, third year=house officer). As an intern I used to get mad when people made the distinction between me and a resident. Residents are residents but that has no point here.
Due to the impending storm (aka Tomas) most patients had been discharged. There were only 6 there today. 3 of them were Once rounds started Dr. Ramos did some teaching and we quickly noted some major differences in our practices. In the US we test every baby’s bilirubin before discharge. We also have a device that will test it without drawing blood (transcutaneous bilimeter). Here they have to stick an artery for blood! This may not sound like a big deal but when we draw blood at home we do what is called a heel stick. Basically we prick the heel and milk out blood. They don’t have equipment to measure capillary blood sample (which is what the heel stick is). They draw all their own blood samples and walk them to the lab!
During rounds we were called to the operating room (which they call the OT or operating theater) for a Csection delivery. I invited myself along. WOW this was different. In the US when a pediatric resident goes to a delivery they are accompanied by a respiratory therapist and a nurse (if it is an intern an upper level resident also goes). Just the intern went (and me)! She had to test all the equipment herself and actually wait at the foot of the bed to take the baby (they bring the baby to us). In the US we are obsessed with keeping the baby warm (put on the hat, use about 5 blankets because as soon as one is wet you throw it off the table, and the baby is not allowed off the warmer for more than a few seconds to get weighed). Now this being said we are in an air conditioned delivery room where there are people who like to turn the temp way down. Here we had 2 blankets and no hat. The first was used the entire time we resuscitated the baby and the second only when we took the baby out of the room (by the way no triple checking identification bracelets and getting footprints- we just took the baby out the door after saying loudly to the room- Baby girl X delivered at 11:48 am). We took the baby to the maternity ward where we took all of the measurements, wrote a note and left the baby with the nurse.
When we got back to the Pediatric ward rounds were over so we headed back to the maternity ward to discharge babies. Here they give the BCG shot (for tuberculosis) which we do not give in the US. They do not however give the hepatitis B vaccine that we give before discharge. Baby boys are not circumcised before leaving the hospital either (most are never done).
This was a long blog today so I am just going to stop babbling.
Take home point: a transcutaneous bilimeter would be awesome here!
Fun Jamaican fact of the day: if you were a car horn you would be very busy
One last random thing I have to tell you about because it blows my mind. They do not have school buses here. When school lets out the kids walk down the side of the road and random people pick them up and drive them down the street! This happens with everyone, not just school kids. People just pull over and pick you up if you are walking. People are just nice to each other. Nobody worries about kidnapping, rape, and all that. Crazy- but in an awesome way.

After a small delay I was off and running this am at the clinic in Port Maria. My exam room was small but sufficient.
Equipment I used today: stethoscope, otoscope and tips, ear curettes, measuring tape, and a pen light. I also used hand sanitizer and sanitizing wipes (out of my awesome fanny pack).
Diagnoses made: well child, fungal infections, seasonal allergies, headache due to poor vision (refer for glasses), tonsillitis (recurrent- refer to ENT), strep, viral gastroenteritis, and foreign body in the eye (sand).
Survival tip: take food. I took a plantain and apple from the breakfast buffet.
Interesting point of the day: my father in law has a saying “drive fast and take chances.” I think the drivers in Jamaica live by that phrase as well.