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Back to Port Maria today; I saw 26 patients. Lesson of the day: the Ackee fruit is the Jamaican national fruit. When prepared properly, the inner part is has high nutritional value. When not allowed to ripen or not boiled, the fruit can produce vomiting, seizures, hypoglycemia, and death due to alkaloid toxins. Apparently there has been an outbreak of this recently in Jamaica including several deaths. I will know to ask about this possibility of my patients tomorrow! Pictured above: my clinic room today and a cute Jamaican girl who was my first patient of the day. (Picture taken with written permission from her mother.)

Day 5, finally figured out the blog — I apologize in advance for the long copy/pasted version of my first week : ) .

I landed in Jamaica on Monday without problem. I actually slept through both flights – the beauty of leaving almost post-call. Customs was easy, and despite a brief oops at airport lounge when my name wasn’t on their list of guests, check-in went smoothly and I am now installed in villa #9 for the next month. In addition, I was able to recognize a vacationing couple who Diane knows and thoughtfully emailed me regarding and I ate dinner at the buffet (yummy) with them. Afterward, they showed me the parrots (really) and the view from their room – gorgeous, I would love to have the pictures they took off their balcony! I spoke with my driver, found the laptop/cell phones, and enjoyed some free time.

Wednesday was my first day on the job. I met my driver in the circle out front and we set off on the winding roads to Port Maria. Arriving at the complex, I discovered ‘my’ room had been damaged by recent rains, so I was taken to the clinic (first building encountered). I unloaded my two bags worth of necessities in a small room; my first 16 patients arrived shortly thereafter. Things I learned today: 1) Dramamine is a good idea, but it doesn’t take away driving down the ‘wrong’ side of the road and the random passing of Jamaican driving! 2) Clindamycin is not stocked at the Port Maria pharmacy. 2) Obtaining a urinalysis by dipstick here means you test pH, sugar, and protein. Diagnoses included abrasion, cellulitis, cellulitis, URI, dental abscess, URI, and my case for the day: a 7 mo with vesicles on her tongue, lip, and under her eye. I wish I had taken a picture and hope she continues to drink well to stay hydrated.

On Thursday, I returned to Port Maria. I was much more comfortable with my surroundings, but much to my chagrin, the first pediatric patient didn’t show up until 11 AM. However, based on the number of mothers who were there and took down my clinic dates for the month, I should have more than plenty from now on! Diagnoses today included: fungal infection, fungal infection, URI, URI, impetigo, and a child with tight heel cords who can’t walk yet/stands on his toes whom I sent to ortho for a referral. I learned today 1) A referral consists of a form that is filled out that the patient then takes to the specialist. I also obtained sheets for x-rays and labs for future use.

Today I headed for Annotto Bay Hospital. Despite it not being c-section day, it was newborn day and we received three admissions in a row. One was a 25 weeker; without a ventilator, incubator, and NVN, his chances will be limited. He will be in my thoughts this weekend. I did experience first-hand CPAP here while helping to combine tubing, a bottle of water, and an oxygen tank.

After three days full of eye-opening experiences, I’m very grateful for the tools I have at my disposal in Iowa. I’m also looking forward to a weekend off — sunshine, here I come!

Here is a quick recap of my last week.
Monday I worked at Port Maria for my last day. I saw 27 patients. I delivered the last batch of donated medical supplies that I brought (I had collected supplies for 4 months and filled my 2 checked luggage bags with them).
Tuesday I went shopping in the local market and then packed everything up. It didn’t feel like a whole month had passed already. One of the nurse’s house had caught on fire over the weekend. I left some of my clothes and travel sized toiletries for her. I ran into the general manager at Couples and told him about her. He took her name and number to send her some stuff too. I also had to say my goodbyes 🙁 I had made some good friends at the resort (some employees and some guests).
Wednesday was travel day. My flight took off at 7:55am but since it is an international flight and the airport is in a different city my taxi left the resort at 3:15, yes that is 3:15AM. When I got to the airport it was completely empty! Nobody inside, not even an employee yet. It opened about 15 minutes later. I flew from Montego Bay to Miami then home to Memphis. I was greeted by my hubby who then took me out to lunch but then had to go back to work. I didn’t mind though because I needed a nap.
Thursday I got to make my return to my residency as a speaker at our noon conference (not about Jamaica but that one will come). This weekend our hospital is making a huge move into a brand new building.

Overall my impressions: This rotation is great because it teaches you to feel confident in your physical exam (xrays and labs are not readily available), it gives you an opportunity to spread up to date information, it helps you appreciate what you have. The accommodations are awesome. The resort is so fun and the people there are happy and full of energy.
With all of the great things you should also know that not everyone would enjoy this rotation. You have to be comfortable treating without someone constantly over you. There is someone available if you run into a situation you are not comfortable with but most of the time you are on your own. You are the one making decisions. Also you have to be somewhat laid back. I’m a planner and organizer (of my time not my stuff) therefore I had a few frustrating moments mostly revolving around transportation.
If anyone has any questions about my experience feel free to email me at arouster@uthsc.edu

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.

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.