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So I have been very poor at updating this frequently! My apologies!

I had a very busy week last week. Ended up admitting several children to the hospital, and the parent’s weren’t very happy about it. They tried convincing me that the kids were okay, and I almost relented, but my sixth sense kicked in and I admitted the children.

The first was a 1 week old baby with jaundice who was discharged home with jaundice and was supposed to follow up with me. The baby’s blood type was known, but mother’s blood type and Rh factor (rhesus factor, the + or -) were not known. So the baby was potentially set up for problems with having different blood types than mom. Mom was also breastfeeding, and the baby could have had breast feeding jaundice. The third problem was that mom told me that the baby was only breastfeeding about 4 times a day! When asked, the mom said it was because the baby was sleeping the rest of the time. After I raised a stink, the mom started to change her story saying she was feeding more than that… but I just couldn’t risk it. The child was admitted and had labs drawn… better to be cautious than cavalier about that.

The other was a 12 year old asthmatic with an exacerbation. He had several nebulized treatments in the A+E (accident and emergency, our ER) and said he was finally feeling better. However, his mother was not going to be able to fill his prescriptions until the next day, so he would be going home without any albuterol or his needed steroids. I had to draw the line and say that when mom got his meds filled, he’d be able to go home the next day, just didn’t want him getting home and the exacerbation getting worse.

I’ve seen a large portion of run-of-the-mill respiratory infections. Rotavirus has hit Port Antonio, and it looks like it’s spread to Annoto Bay and Port Maria, as I’ve seen an increasing amount of acute gastroenteritis.

Still occasionally have some problems understanding accents, but I think I am getting better.

on Friday I gave a small “lunch and learn” presentation on asthma exacerbations and management of asthma in the acute and chronic settings at Port Antonio. A lot of the doctors and nurses from the peds ward were there. They asked great questions and seemed to enjoy it. I hope it was useful. They did ask that the next group prepare some topic dealing with nephritis/nephritic/nephrotic syndrome, as they’ve seen an increase in those patient’s recently.

I would definitely recommend to future volunteers to get a presentation done before you come down!

Will try to update later this week.

Hello World! My name is Michael, and I am going to try to take a small foray into the blogging world. I am a third year general pediatrics resident from the University of Tennessee (Memphis) and fellow class mate of Audra from November. I have Joined Tayo down here in Jamaica for the month of February.

I’ve been in Jamaica a week now, and so much to say!

I don’t know what I really expected this month to be like. Discussions with Audra had prepared me for some of the things I would experience, but hearing about it and experiencing it are two different things.

This is my first time to Jamaica and really my first time to travel internationally (alone). I lived in El Paso before and would travel across the border to Ciudad Juarez (back when it was still safe to do so), but leaving the States and entering another country for a few hours is not like leaving for a month.

On Thursday the 3rd I got to get acclimated to the weather (that didn’t take long, let me tell you!) and met Tayo. We went off to Annotto Bay on Friday morning and the drive there is beautiful. Very pretty country side with amazing ocean views. This place truly is paradise.

We made it to the Annotto Bay Hospital (ABH) and found our way back to the peds ward. The hospital there is many buildings connected by covered walkways. Each building houses a different subset of patients (peds ward, Male Med/Surg, Female Med/Surg, OB). Walking into the peds ward, there are a few small rooms to the side (one a kitchen, the other a treament room and a few others) and then the ward opens up to house all the patients in a large room. Walking up to the peds ward there is a very cute little patio where alot of the patients were hanging out in the fantastic weather with their families. Very different from what I was used to, where we expect our patients to be in their room, or sign out when they disappear for a bit.

Rounds were fantastic. The attending, Dr. Ramos, is a very intelligent man and I have had great pleasure getting to partake in rounds. We would open with a patient presentation, and he would start asking questions, reviewing physiology, differential diagnoses, treatment options. It’s very thorough and a fantastic learning session/review. After rounds, Tayo and I went down to A&E (accident and emergency) to help out by seeing the peds patients. One of the patients I saw was a teenage girl (16 years) who passed out (or as we call it in Memphis “Done fell out”) after becoming emotional because she lost her cell phone (life’s tough as a teenage girl). The only problem was that as she was passing out, she hit the back of her head on a desk and lost consciousness for more than 20 minutes. If I were back at home, she would have been run through the CT scan to look for a bleed. That wasn’t an option for me down here. She ended up getting admitted to the wards, which was an ordeal for me. I was in charge of drawing her blood and starting her IV… something I’ve never really been responsible for back home. We have phlebotomists and an “IV team” that will handle all that. After torturing the young lady trying for an IV, one of the other doctors helped her (and me) out by showing me what I was doing wrong.

The weekend was a nice relaxing time and I felt finally rested after a very long month of January. Tayo and I started back up on Monday where we went to Port Maria. She took the clinic and I was in the A&E there. I had a steady stream of patients and saw 19(!) in a 6 hr period, which was alot more than I have been used too. Most of it was run of the mill diagnoses of colds and tinea capitis. Like my patients at home, the families request antibiotics for viral illnesses. I have been standing strong about not writing for antibiotics when they weren’t needed.

Tuesday was back at Port Maria where I was over in the health clinic. More viral illnesses, fungal disease and a couple of complaints about worms. Wednesday we went back to Annotto Bay where I sat in on rounds again. We had a lengthy discussion about hypoxic-ischemic encephalopathy, the possible causes of hypoxia (broken into maternal causes, placental causes and then baby causes, then further divided into pre-natal, peri-natal and post-natal). We then went on to management once the infant was delivered. We talked about some of the differences between the management in Jamaica and the States. I got to describe the technique of head-cooling which I’ve seen a few times in our NICU. I’m really enjoying sitting for these rounds.

Today we ran the follow up peds clinic at Annotto Bay. I got to do several well babies which are probably my favorite visits. You get to play with the cute 2 week old babies and show off to mom all the baby reflexes.

We head off to Port Antonio tomorrow, that will be my first time there. I am currently working on a lunch and learn presentation about Asthma. Sadly, my new laptop doesn’t have powerpoint on it, so I am having to adjust on the fly.

Overall impressions: I love the island. Everyone here is very friendly and the weather is perfect. The children are wonderful (as expected). I am having a hard time understanding the accents, but I’m getting better. And I am learning that I have a heavy reliance on supporting labs to make diagnoses instead of relying on my clinical skills. I am definitely doing lots of learning and reading while down here! I am excited for the potential that the rest of the month holds.

Having reached home (brrrr, it’s cold), I thought I would summarize the last week as well as give a few thoughts about the last month. My last few days flew by — the 25 wk preemie was holding his own on CPAP, I admitted a child with failure to thrive (less than the third percentile for weight/height/head circumference), went to Ocho Rios for coffee (yum, Jamaican coffee…) and a movie, and wrote a few more referrals to Bustamente. Saturday I soaked up as much sunshine as I could while saying ‘good-byes’. Despite my best effort, I am still ‘white with spots’ (freckles) as one of the children at Annotto Bay described me :)! My return flight was smooth including customs, and I discovered that it is indeed 20 degrees in Iowa as well as Jamaica…unfortunately, one is Fahrenheit and one is Celcius.

It is incredibly hard to believe that the month is over. At the beginning, I was slightly skeptical about what this experience would be like. I have no more doubts now! For those looking into trying this rotation, I definitely recommend it. It is a great chance to ‘try your wings’ before entering fellowship or taking a real-world job, since you get to function a lot by yourself. Also, the rotation exposes you to a few things that you don’t see often here (at least I haven’t — such as lots of versions of fungal infections, worms, rheumatic fever).

Helpful hints: Take something to read or study with you every day…you never know when your driver will stop at the airport, another clinic, or any number of places on the way. Not to mention that during the majority of my stay, I rode with other hospital employees rather than the drivers as the hospital vehicles were often in the shop. Therefore, you may be waiting for he/she to finish work. On the bright side, you can obtain many different perspectives of Jamaican healthcare by talking to the numerous people who provide rides — I learned a lot from the hospital administrator, parish manager, parish accountant, health officer, and a taxi driver in addition to the regular drivers.
Along the same lines, always take something to eat / drink.
Play volleyball at the resort — apparently, I am the 3rd of 3 of us to do so…it would be fun to continue this tradition :).

Most helpful items I brought with me daily: Otoscope/opthalmoscope & tips…could have used curettes. Harriet Lane, hand sanitizer, stethoscope, toilet paper. Needs I encountered: Port Maria clinic could use some Pap Smear swabs, Annotto Bay would love a Red Book…and I don’t know for sure about Port Antonio.

Enjoy! Feel free to email regarding any questions you have. Thanks for following my journey!

Pictures from the last week:

My last day at Port Maria is now finished…with a bang. As with most mornings, I sat on the wall of the little circle by the pathway leading to my villa until my driver arrived. As often is the case, I called around 8:10-8:15 to make sure someone is coming. We arrived shortly before 9 AM at Port Maria and I set out my supplies. I asked for more prescription paper and filled out a few in advance as Tuesdays tend to be busy. Patients began to trickle in, mostly referred from the nurse shortly thereafter then came in a flood by 11 AM — 37 of them! The number would have been 40, but 2 turned out to be adults and one disappeared before I got to her.

Once again, most of the dx for the day were tinea or URI. I also saw preauricular ear pits/neck pits in an infant — she is to see ENT in Bustamente, consider renal U/s as well. I also saw a few more such unusual cases. I had brought an apple, but never found time to eat it — I feel so sorry for those waiting. I finished up around 4 PM at which time my driver came to find me (usually I walk around the back to the administrative office to have someone arrange for a ride). Luckily, I had time (while I waited for him to drive to the gas station and return) for a few last photographs of the helpful office staff / nursing assistants and to say my good-byes to Dr. San San Win and a few other administrative staff. While this has definitely been my busiest site, I also felt very productive and helpful here!

This past weekend was amazing as my fiance flew in and we were able to enjoy many of the resort perks as well as some time together. Amongst many other activities, we climbed the waterfall at Dunn’s River Falls, took a trip on the glass bottom boat, and talked to the man selling shells. We also ate dinner at Eight Rivers/Bayside, both of which were excellent. I even managed to eat my entire meal at Bayside with chopsticks!

My Monday morning had a somewhat rocky start as the driver did not arrive until 9 AM. Then I received a phone call while at work that the resort thought I was leaving today and was looking for me. Oops, apparently my fiance’s departure date had accidentally been recorded as mine as well! That was quickly fixed and the remainder of my day at Port Maria ran smoothly. Themes for the day were tinea, URI, and gastroenteritis although I also consulted on two inpatients; one with seizures and hypotonia in great need of a Pediatric Neurologist and the other with marked lymphadenitis.

Things I learned today or along the way:
Jamaican ambulances are staffed by a driver, a nurse, and a porter. They have nebulizer machines, oxygen, and scissors amongst other things on board. The few available ambulances remain busy transporting patients from home to the hospital in addition to hospital-to-hospital transfers for tests including x-rays!
Few families have paracetamol (tylenol) at home.
When an x-ray is ordered outpatient, it is generally given to the patient. This means a patient sometimes appears in clinic with xray or labwork in hand. Dockets (charts) are kept intra-facility while the patient may go to many facilities, so you may not have the reason behind the testing available.

Mid-week already, time seems to be moving at a steady clip. After Sunday’s adventures in beach volleyball, I confess I was a bit sore on Monday. Nevertheless, I saw approx 25 patients at Port Maria. I’ve noticed a trend toward multiple diagnoses as everyone comes in with one chief complaint but then asks me to look at a skin infection or discuss a cough. No cases of Ackee poisoning for me as of yet, thank goodness.

Tuesday is Children’s Health Day at Port Maria, which always signifies a busy clinic for me, especially after around 11 AM when most of the well-children have been seen for vaccinations. Several of my patients were referred from the nurse practitioner, generally for URI symptoms. I was thrilled to find that a patient from last week returned with completed lab work!

Today, I returned to Annotto Bay Hospital where the three young doctors were already hard at work seeing the 13 inpatients. The 25 week infant (I still suspect his gestational age to be closer to 28 wk) continues to do well and is now on room air. Sadly, the child we placed on CPAP last week died.

I greatly enjoy my trips to Annotto Bay and rounding with the team. Today, we discussed cases of likely and proven rheumatic heart disease — a rare diagnosis at home. I also continue to marvel at how well staff handle the daily frustrations that come with working in a third world environment. Today, one of the younger doctors and I went to draw a blood culture from a child with likely meningitis (bulging fontanelle, fever) only to discover that there were no more blood culture bottles on the ward.

Tomorrow I shall return to ABH for clinic, then Port Antonio on Friday. I was asked by one of the younger doctors in Port Antonio to discuss fluid management based on their recent GE outbreak. Here, the mild-moderate-severe clinical appearance apply more readily than my textbook examples; I/Os are not generally monitored unless expressly written in the docket (chart), which is only done for the most ill patients and lab work, including electrolytes, may not return for several hours or until the following day.

In addition to Port Antonio on Friday, my fiance is scheduled to fly in on Friday for a weekend stay! I am very excited to try a few more of the resort activities and introduce him to some of the staff members. More adventures to come, I am sure….