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First day in Jamaica and we are loving the people and the place. Can’t wait to go the hospital and meet the staff and all the children. Day 1 of an incredible journey so let’s get started!!  

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!

Started Monday with our first work day at Port Maria Hospital. All of the staff was friendly and helpful. Thank goodness for Dr. Hayden-Peart!!! After being at work for more than 24 hours, she gracefully gave us a tour of the facility and a detailed orientation. It ended up being the A&E day of “twins”. We saw and evaluated 3 sets of twins by the end of the day. On Tuesday, we stayed in the A&E department and saw an array of patients including diagnoses of bronchiolitis, allergic reaction, broken arms and a patient with a history of G6PD deficiency. We ended our work day observing the ortho techs in action. On our way home with Ms. Nadia (one of the health administrators), she gave a great overview of the Jamaican health system. She gave great insight on programs or policies that could be implemented to help all involved – health providers and patients. “Ramos Rounds”: There were six patients on the ward this week. Two premature infants, one term newborn admitted for respiratory distress as well as children with status epilepticus, status asthmatics and bronchiolitis. We had an review discussion on atypical pneumonia, bronchiolitis and hyperbilirubinemia. Clinic was filled with some newborns, but mainly follow up patients for asthma and referrals. The A&E was filled with lots of injuries secondary to Sports Day (field day) or falls. Roxanne had the pleasure of placing sutures in the eyebrow of a very anxious and strong 6 year old girl…without any versed or EMLA cream or lidocaine in a very hot room. Thanks to Nicole and helpful mother she still has both eyes and symmetrical eyebrows. Dr. Wilson (Annotto Bay A&E) was awesome as usual! He always stops whatever he is doing to assist us with questions, obtaining supplies or navigating the health system. By the way he is super patient with you trying to get an IV in a 2 week old newborn (practice means less tears).  After it all, we ended the week with lots of hugs. Themes of the week:

• Everyone was eating, ordering or buying Bun and cheese – EVERYONE, EVERYWHERE – Happy Easter!
• Nicole discovered her love for June Plum juice
• Home addresses are more like directions (e.g. District, Parish. Blue and white house on the left after turning left at the Baptist church).
• You can make a spacer for albuterol (Ventolin) inhaler by cutting the bottom out of a Styrofoam cup or small water bottle.
• There is nothing better than a hug from patient.
• When in doubt call the pharmacy.

  Until next week, Nicole & Roxanne

As my time in Jamaica comes to an end, I just want to thank all of the wonderful people I met throughout the month that have made this one of the best experiences of my life! I have learned so much over the past month and have grown as a person and clinician. For this being my first medical mission trip, it was pretty epic! Initially when I decided to do this, I was super nervous because I had never traveled alone before. When I told people I was going to Jamaica, everyone was worried about my safety. I can honestly say that I never once felt in danger. From the friendly staff at Couples Tower Isle to all the doctors, nurses, and drivers I met at the various hospitals, I always felt supported and secure.

Now to get to the good stuff…! When we  drove up to the first hospital, Port Maria Hospital, I honestly thought “This can not be a hospital”. Coming from the nice, shiny, tall, air conditioned hospitals in America, I was pretty shocked. I’m sure my face said it all while walking through the hospital and seeing the clinic room we would be working in. Port Maria Hospital was probably the least equipped hospital, but ended up being my favorite! The people there were amazing and so helpful!

We went to two other hospitals throughout the month: Annotto Bay and Port Antonio. We saw a variety of cases but still lots of gen peds cases like viral URIs and asthma. There was several things I had to get used to. The formulary and medications used in Jamaica was different than what I typically use in the US. I learned the many different brand names of Acetominophen like Panadol, Cetamol, and Paracetamol. In the hospitals I worked at, the doctors had to draw all the labs and start IVs on the patients. In the hospital I train at, the nurses do all the lab draws and IVs, so it was great practice for me!

I also had to get used to working with the limited resources available. I saw a patient that had paronychia, which is an infection around the nail bed. He had an infection in his toe that required an incision and drainage to get the pus out so his toe could start healing. The treatment room at the hospital was not nearly as well equipped as one would be in the US, but somehow the docs always found a way to treat the patients!

The patois that the Jamaican people speak was sometimes hard to understand! I had to fix my face sometimes because I could feel myself looking quizzical! And I’m sure parents got tired of having to repeat themselves multiple times because I just couldn’t understand what they were saying. Overall, the parents were really understanding and patient with me as I tried to talk with them and learn the system! The patients were great, and so adorable! I really appreciated how grateful the parents and patients were.

It wasn’t all work though! The resort was fabulous! We got to do any of the water sports, from sailing, paddle boarding, snorkeling, and going on the catamaran cruise. There were a few days that the driver didn’t pick us up, for whatever reason, so we enjoyed a random day off lounging at the beach! 

Overall, it has been the best clinical experience of my young, professional life! I learned so much about myself and how I want to practice medicine in the future. I gained so much more than I gave, and for that, I am forever grateful to the people of Jamaica and the ISSA Trust foundation for allowing me to have this opportunity. 

I did leave with a souvenir! I fractured by toe about halfway through the month and the docs at Annotto Bay Hospital took great care of me and fixed me right up!

 

Well here it is: my last blog post. Four weeks have come and gone much faster than I expected and my adventures in rural Jamaica have come to an end. A heartfelt thank you to the doctors, nurses, drivers, and administrators of Port Maria, Annotto Bay, and Port Antonio hospitals. You have been so kind, welcoming, and patient while I try to navigate the intricacies of Jamaican healthcare (and insert IVs for the first time in years).

I find that practicing medicine in a developing nation always sends me home with a renewed sense of appreciation for all that we have in the developed world. When a toddler presents with failure to thrive, the first thing on your differential is not usually malnutrition, secondary to food insecurity. If a patient has a urinary tract infection, obtaining a urine culture does not depend on the family’s ability to pay 2000 Jamaican dollars to get it (equivalent to about $16 Canadian dollars which most families in this part of Jamaica cannot afford).

Here are some of my final thoughts:

1. I have become so used to being called “My Lady” by all of the resort staff that I feel like I have been living in Downton Abbey. Or Game of Thrones. Minus the killing of my favourite characters.

2. Most absurd thing I heard on the local radio station: watermelon cures asthma. (Hint: it doesn’t).

3. Most bizarre thing told to me by a parent: worms cause teeth grinding at night. (Hint: they don’t).

4. I was surprised to discover how deeply religious many of my patients are. What is the politically correct response when a grateful mother wishes you “a blessed day” as she walks out the door? You too?

5. Infection Prevention & Control nightmare of the week: when the asthmatic with recurrent scabies was in the bed next to the infant with pertussis. (I seemed to be the only person concerned about this).

6. Couples Resort Tower Isle is the best all-inclusive resort I have ever been to. The beach, the food, and the staff are phenomenal. I highly recommend it to anyone interested in visiting Jamaica. (I would also recommend bringing your significant other to avoid the awkwardness that is being the only solo person at an all couples resort).

7. I think I have listened to a lifetime’s worth of reggae and Bob Marley.

And last but not least, a big thank you to the wonderful Diane Pollard who made this experience possible! I have highly enjoyed my adventures in rural Jamaica and look forward to returning some day as a staff Pediatrician.

(Final) Favourite Food of the Day: Curry coconut seafood

I am starting this week’s blog with a big shout out to the dedicated team of doctors and nurses at Port Antonio Hospital. When an underweight newborn was urgently intubated in the middle of the night due to severe apnea, the medical team hand-bagged the neonate all night until the transport team arrived in the morning to take the baby to Kingston. Port Antonio does not have a functioning mechanical ventilator. In fact, none of these local hospitals have ventilators.

And here are some of my random observations for the week…

1. Every emergency department (or A&E as Jamaicans like to call them) at which I have worked has always had a Bollywood soap opera blaring from the one fuzzy TV in the waiting room. Who knew Jamaicans would be such devoted Bollywood fans?

2. It turns out that marijuana has a lot more side effects than you’d think.

3. There are no straight roads in Jamaica.

4. I think I’m experiencing reverse culture shock. I was so surprised to see a Caucasian person at the hospital this week that I had to remind myself not to stare and wave.

5. Jamaicans really like uniforms. School uniforms, nursing uniforms, drivers uniforms. And they all seem to be made of the thickest wool you’ve ever felt.

6. Children, especially boys, should not be allowed to wear shoes without socks when the temperature is more than 30 degrees Celsius.

7. Jamaica’s national fruit is ackee. When eaten before it is ripe, ackee will cause severe refractory hypoglycemia that may or may not kill you. Who wouldn’t want a poisonous food to be their national fruit?

8. I feel like I’m practicing hard-core, old school medicine every time I look at an X-ray on real film.

9. Every day, we drive by a little community where the excessive amount of pungent seaweed on the beach results in a game of how-long-can-you-hold-your-breath. It’s like rotten eggs had a baby with a durian. Times a thousand.

10. A nurse was robbed at gunpoint near one of the hospitals this week. Scary stuff.

11. In two days, I will be outside the 14-day incubation period for leptospirosis! Yay! I was exposed at Dunn’s River Falls, but so were all of the other tourists, they just don’t know it. Regardless, it was still worth climbing up a 950-foot waterfall in the jungle!

12. I have not stopped sweating since I arrived here. And I’m not even wearing a wool uniform.

Favourite Food of the Day: Lime panna cotta with tapioca pudding

I have now been working in Jamaica for two weeks and am already halfway through this elective! I have adjusted to how things work here, although everyday something new surprises me. Just yesterday, I came across a family of goats who had wandered into the hospital compound and acted like they had always lived there.

Also, no matter where you live, kids…

1. Love Dora

2. Put rocks in their ears

3. Scream and cry when you remove rocks from their ears

4. Really like stickers

5. Get bitten by rats (okay that one is just Jamaica)

This week there was a Pseudomonas outbreak on the pediatric ward of one of the local hospitals. This, combined with the ongoing severe drought that was exacerbated by all the kids returning to school, has resulted in only the sickest of patients being admitted to hospital. Everyone else has to manage at home.

Here are the Patois phrases that I have mastered so far:

• Du du = poop

• Juk = needle

• Cold in the eyes = eye discharge

• Cold in the chest = could mean anything

• Me no wanna = I don’t want to buy that

• Soon come = they have no idea when it’s going to come

Favourite Food of the Day: Chicken patties. Also, coconut bread pudding with vanilla sauce.

It has now been a full week of working and living in Jamaica and I’ve learned a lot, both about medicine in a resource-limited setting and about life in Jamaica.

My approach to medicine here is quite different from what I do back home. In Canada, I do my history and physical exam, create my differential diagnosis, and then order investigations to confirm the diagnosis, usually before proceeding to treatment. In Jamaica, I do my history and physical exam, create my differential diagnosis, and then treat whatever I can based on the limited medication options that are available.

Investigations are hard to come by here: other than the basic CBC, renal and liver panels, urinalysis, and X-rays (some of which are only available in the “bigger” local hospitals), I don’t have ready access to things like cultures and sensitivities, ultrasound, CT scan, interventional radiology, and MRI (they actually laughed at me when I mentioned that MRI is better than X-ray for diagnosing osteomyelitis).

“Free” healthcare in Jamaica is not the same as free in Canada. A lot of medications are not available at local hospitals which means families have to pay out of pocket at private pharmacies. Likewise, an abdominal ultrasound costs approximately 6000 Jamaican dollars (about $60 USD), which most families can’t afford. Even having a family doctor is not included in government-funded healthcare. Thus if my treatment recommendations include anything not provided by the local hospital, my patients will simply not do it.

Without these tools, I find myself treating patients for conditions that I’m not even sure they have. But it’s the best I can offer them with what’s available. Sometimes, it is unsatisfying: I miss that feeling I get when I know exactly what is wrong with a child and can offer definitive treatment.

I have also stopped asking about animal exposures because all of my patients are regularly exposed to dogs, chickens, lizards, and goats. Heck, so am I. At any given time, a stray chicken can be seen waddling across the hospital corridors.

Other lessons I have learned this week include the following:

If you don’t tilt the shower head just so, you will flood the entire bathroom and all your things in it.

The incessant “weet weet” sound that follows you from dusk until dawn is actually the call of the Jamaica tree frog. This lesson was brought to me by my husband who was amused by the mystery background noise present in all of our Skype sessions.

If I am in a car full of Jamaicans, I will be the only person wearing a seat belt. This is mildly terrifying given the nature of their driving (see previous post for full details).

The little island across from the resort, of which I have taken innumerable beautiful photos, is actually an all-nude island.

Things I have yet to learn include:

Understanding Patois, the version of “English” that Jamaicans speak which incorporates local phrases and slang.

Not feeling completely awkward as the only solo person at a couples resort.

How to set free the tiny lizard that is still trapped in the living room.

Favourite food of the day: pan-seared snapper!