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I’ve seen the advertisements with Jamaica’s inviting cyan waters and the lure of a tropical climate, but what to expect in the clinics and hospitals was still a mystery as I arrived in Montego Bay. After all, I didn’t have much international clinical experience before coming to Jamaica. My only previous exposure was an educational opportunity teaching cardiology in Kathmandu. There was, however, no direct patient contact and we were working with students with fluency in English. This time around, I was traveling with a seasoned expert who had spent time in South Africa and Botswana – a very helpful accessory to the adventures ahead! Looking back on the 100 or so cases from the past 4 weeks, there was a whole lot of fever and viral illness floating around. The rainy season has arrived and school is back in session – the perfect recipe for spread of these kinds of infection. I encountered many cases of wheezing and tried to establish children on controller therapy for the first time. I was forced to learn a lot of dermatology with almost half of the cases coming in with some form of chronic or new skin lesions. In our last two weeks, we saw emerging cases of hand, foot, and mouth disease with more limb involvement and larger, angrier lesions than we’re used to seeing at home. With heavy rains and mosquitos on the loose, we came to recognize longstanding, difficult-to-treat cases of pustular urticaria. And the most impressive of all were the cases of tinea capitis with kerion formation. As I’m preparing to write our board exams in the spring, I won’t forget what a kerion looks or feels like and how to manage these fungal infections. And if you asked me for my favourite encounters, I loved seeing adorable newborns for their 6-week wellness check as they were thriving in the first weeks in the world. Besides the adorable babies and interesting cases, my main highlight was how we felt valued by parents. One of the things that we can offer as pediatric doctors is time. While there were many patients to be seen, parents valued having someone spend time hearing about their child and concerns, doing a full head-to-toe physical examination, and explaining what was going on. Parents – sometimes waiting up to 8 hours to be seen – were always thankful for the time that we dedicated to helping their children. I think that reflects how we saw Jamaicans. Whether we were in clinics, hospitals, wandering in cities, or back at our hotel, the staff, parents, and locals were almost universally warm, welcoming, friendly, and laid-back. The other highlight is the collegiality within the Issa team. I was very fortunate to have Alison with me. We traveled to the same sites together. Whenever there was a puzzling rash or an unclear diagnosis, it was helpful to have her weigh in on what was going. When I was unsure about how to navigate the system, she worked with me to find the best way forward. We were also fortunate to meet the Issa team with Diane and her colleagues coming down to Jamaica for other medical missions. Compared to others’ experiences, this elective was easy to “walk into”. Diane organized the details around accommodation, transportation, food, and clinics. And we can’t complain about sleeping in a beautiful location with delicious food, leisure activities, and access to fitness. We will miss Willis’ fruit smoothies and the fresh food that couldn’t possible survive through a Canadian winter. So, here we are on the last day of 4 weeks in Jamaica. While there are always bumps in the road, there lots of highlights that I will remember. The staff and patients keep asking when we are coming back. We haven’t decided just yet, but we will be back for more adventures!
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Moms asking me for my number if they liked the care their children got. The minimalist pediatric ward at Port Antonio hospital. The doctors at Annotto Bay keeping a 900 gram 28 weeker alive with CPAP after Bustamante was unable to take him because one of their babies needed the only available ventilator. A road accident outside Port Maria with one of the victims lying in the road. Inep and naceberries. The way the sea turns pink at sunset. Running into the mom of a child I diagnosed with appendicitis in Port Maria, outside the surgical ward in Annotto Bay. Chickens in the courtyard and goats in the parking lot. Too many road accidents — nobody wears seatbelts. Reggae in the morning, reggae in the evening, reggae at nighttime, on Irie radio. A 7 year old yelling “please doctor! I beg of you!” while I was suturing a laceration on her foot, then jumping off the gurney and running screaming through A&E when I was only halfway done. A restaurant in Annotto Bay called “Juss Enuff”. My other favorite Jamaican business — Car Wash and Bar. Dr Ramos’ teaching rounds — What am I thinking of, doctor? Learning to sail the Hobie cat. An 8 year old rasta with his dreads in a tam. Ackee and saltfish. Conversations with the drivers, mostly about food. Seeing things I never see, like hemophilia, and things I always see, like asthma. Who Cook It Betta? Singing along to “Three Little Birds” on the way to Annotto Bay — Cameron, the driver, said we should all listen to it every morning of our lives — I agree. The kids of St Mary’s and Portland parishes. Soon come.
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Baby has G6PD deficiency. He’s well, but mom has lots of questions about what medications he should avoid. Can she look on the Internet? (I love being asked whether it’s a good idea to consult the internet, rather than being told what Dr Google has to say). I ask big sister if she knows that girls don’t have G6PD. Mom is fascinated — apparently dad is convinced he’s the one that passed it along to baby. So I launch into a discussion of X linked inheritance, and she asks me to write it out for her to share with dad. OK — mom is a carrier, her sons can have the disease and her daughters can be carriers. If dad has the disease his daughters can be carriers, but he can’t pass it along to his sons. Mom files away this matrix that I’ve written out for her, and she has a new level of understanding of her son’s condition. One more question — should he avoid bush tea? I can’t imagine that anyone has tested the myriad plant alkaloids found in the various bush teas to determine if they induce hemolysis in G6PD… though the natural experiment has probably been done somewhere along the way, given that 10% of the male population of African descent has this condition. So the answer is, no bush tea (I think that’s always the answer no matter what). Do they eat fava beans in Jamaica?
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The doctors here know things I don’t know, and vice versa. When was the last time I saw a case of rheumatic fever, or sickle cell, or congenital syphilis? (it’s the joke at Annotto Bay that Dr Ravi is the congenital syphilis expert because he’s had 4 cases this year to date). When did I last do the initial management of a kid with congenital heart disease ? (rural Tennessee, small hospital with level 1 nursery, 1980s). There are lots of things I know, up to date and evidence based. I hope I can offer some of them politely, with appropriate modifications for the local setting. And there are a lot of things they know, practical and hands-on and real-world, that I’m soaking up like a sponge! Dr. Ramos reminded me that just because mom nods her head and says yes when I give her a list of symptoms she should bring the baby back in for doesn’t mean she gets it. “This is a third world country!” he tells me. That doesn’t mean that medical literacy is widely distributed in other parts of the world, though — it behooves us all to make ourselves clear in language our patients understand. For another day, I have a lot to say, not about what’s lacking in low-resource countries, but about American medical bloat. Fortunately I’m between jobs and on sabbatical till September, so I don’t have to experience the reverse medical culture shock of jumping right back in to a US hospital setting. For the moment, I’ll just listen to the tree frogs before falling asleep.
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… in Port Maria, and the radiology tech stuck her head in my door — “no x ray, we’re on generator.” Power and X ray came back up in time to determine that a happy toddler did not swallow a coin (his grandmother thought she saw one in his mouth). Hard to convince the mom of a vigorous premie that “no dudu for 3 days” is not a dangerous symptom– breastfed newborns can go 7 times a day or every 7 days or anything in between. At dinner the resort guests swarmed the buffet while Bob Marley sang “dem belly full but we hungry” in the background. I’ve always had a little trouble defining irony, but will look no further.
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