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This was my second time through the pediatric rotation in Jamaica. I had come initially March 2012. I felt it was a good experience in terms of being a balance of helping out as a pediatrician in  an underdeveloped country, while at the same time staying in a beautiful and safe location. Fortunately, both times my wife , who is a special education teacher, was able to accompany me. She will write separately of her experience. Since this is a repeat experience, one tends to compare this time to the previous. For sure, the weather in December is much more unsettled than it was in March. Many days this year would rain or be too windy for the water activities, but of course this is nothing compared to the snow storms we heard about occuring during this same time in the US. It was nice to see and be recognized by the doctors and nurses at the various facilities. At Port Maria, I seemed to be busier than I recalled in the past. I got to draw labs for a few of the kids-one with crampy ab pain and another with fainting episodes. The CBC machine was not working, so the blood needed to be sent out. Another child who was having RLQ ab pain and I felt should see a surgeon, had to be transferred to Annotto Bay. I saw a few rather significant abcesses at Port Maria, one a tennis ball sized axilla one who I walked over to the A/E for drainage and a dental one I started on Clindamycin and sent to a dentist. At Annotto Bay the next day I saw a one month old with several episodes of rectal bleeding and after discussion with the doctors there, was advised to send him to Bustamente Children’s Hospital in Kingston where he could be endoscoped. Of course there were multiple kids with wheezing and some who did not clear after the nebs needed admission. The doctors in the A&E and on the phone are approachable and helpful, so I did not feel unsupported even though I was doing more with less diagnostic and treatment options. I was not constantly busy. There were often down times were I could read a book or talk to some of the staff doctors who were trained in places like Cuba, India as well as Jamaica. Things I wish I brought were: a copy of the Harriett Lane Handbook, somehow it was not at the room at the resort; and a head lamp since once I needed to remove a foreign body from a child’s ear under less than ideal lighting. I concluded my two week stay with pretty much the same feelings after my first experience. While much is lacking materially in the medical experience, the children are being cared for by nurses and doctors who do their best under less than ideal circumstances. I appreciate Diane and the Issa Trust Foundation for enabling me to participate in this program. For sure it is an experience I will not forget.   RP
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Back home now. It’s Thanksgiving. What an ideal time to consider our experience in Jamaica. We were fortunate to spend 3 weeks on this beautiful island. Truly thankful for the opportunity. The work was difficult at times, limited resources, limited medication, less than ideal facilities. These were the difficulties. The beautiful children, charming parents, supportive and helpful health care providers easily offset these difficulties. We are proud to be associated with Issa Trust. This trust is striving to provide quality care for the children of Jamaica. On reflection of medical trips, I compare projects like Operation Smile to our role with Issa. Very different goals but both are exceptional projects. While we as Pediatricians are unable to fix cleft lip and palate, a spectacular accomplishment, we provide longitudinal care and take “baby steps” in optimizing the well being of many more children where we work. While Issa Trust also does big things, donating radiology equipment, ventilators etc. our contribution must be viewed in a longitudinal perspective. Each Pediatrician during their one month stay helps a small but significant number of children, the cumulative effect of all the Pediatricians who come to Jamaica substantially enhance the well being of all the children in the service area. This is one of the laudable achievements of Issa Trust and in our experience a unique aspect of medical care projects. We want to thank Issa Trust and the people at Port Maria, Annotto Bay and Port Antonio for the opportunity to help the children of Jamaica. We loved our time there and hope we can return soon. A special thanks to Diane Pollard and all the hard work she does to make this project so successful. AT and CT
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The Issa Trust Foundation is pleased to advise that Couples Resorts 2014 Calendars are ready for you to purchase!! For a donation of $25.00 or $20.00 each for two or more, we will send you a memorable calendar of beautiful pictures!  Just go to Issa Trust Foundation.  Be sure to put #2014 Calendar” in the comment field.  What a great stocking stuffer – a way to make a difference!!
picture of calendar

Perfect Stocking Stuffer!

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enjoying the time here. lots of work, averaging 20 patients a day in each of the different settings. Port Maria is the most consistent, seeing a mixture of typical office based issues from URI’s to constipation, last week however there was an outbreak of impetigo and saw multiple kids with identical histories. Doled out a lot of Augmentin and Mupirocin as Cephalexin is unavailable. Annotto Bay has been the hardest to get to, transportation issues a constant so one needs to learn to relax and get there when you get there. You can enjoy breakfast and ask front desk to call you when driver arrives. makes the wait better. Port Antonio has been great fun, stay mostly in A and E, see lots of kids and staff very grateful for the help. this week had a child with pneumonia and another with both bone forearm fracture that was 3 days old. Tough kid, parents just happy to have child evaluated. Did see a Mom with elephantiasis, had had illness for thirteen years. otherwise mostly typical illnesses seen in US with emphasis on derm here. Would recommend a few things on your visits to hospitals. would suggest hand sanitizer and if you want to wash your hands, bring your own soap and paper towels. should probably carry tissues as well. I happened to bring stickers for the kids, a big hit. They are definitely big sponge Bob fans, girls have liked the princesses. People do not complain about waiting and are thrilled to have Pediatric input. You do need to feel comfortable working independently, but people will try to help if you have questions. Looking forward to next week and some new experiences. AT
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Interview with Ms. Opal.  She shares her insights during the 2013 medical initiative in Oracabessa.  Oracabessa is a small town in St. Mary, Jamaica 10 miles east of Ocho Rios with a population of approximately 12,000. Click here to view video.  
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Great week so far. first day at each site a bit rough. Have to get in the swing of things, but then things roll. In Anotto Bay, hospital moderately larger than in Port Maria. Busy ward, interesting too. Multiple kids in ward like setting. Babies in with bigger kids, Dr. Ramos is very sharp as consulting attending, pushes general docs to consider all variables in diagnosis and management. Obviously very invested in the welfare of the children. today, second day seeing many newborns and up to 1-2 month old well babies, general pediatric care and beautiful children (and Mom’s). Very kind and gentle souls. Get to see them quickly though as there are many newborns. then on to the A and E (accidents and emergencies)area. today none to see so left a touch early. Gets pretty toasty in room with no AC and only open windows. But families happy to get care. Looking forward to seeing last site tomorrow. I am enjoying hanging out in the pool after work. Also even found time to work out before our ride arrives in AM.
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Great start to our trip. Enjoyed the first few days relaxing at Couples Resort, truly vacation like. First day at Port Maria quite the contrasting experience. Beautiful children, a true joy to see in the clinic. Very sweet and caring parents, obviously devoted, seeking out care for their kids. Not much in the way of supplies, pharmacy closed, radiology closed, but certainly able to evaluate kids clinically. Parents very appreciative of our efforts. 2 asthmatic children, one dog bite and one fussy little infant were the highlight patients of the day. All the kids wore big smiles.
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Today I realized that I only have one of each day of the week left to spend here. It has certainly gone by quickly. Each site has its own rhythm and I have learnt to have a different set of expectations based on the day of the week.  From the relatively steady pace of Mondays, one moves immediately to the barely controlled chaos of Tuesday vaccination day at Port Maria. Then Wednesday mornings come with their share of “thinking time” where we are afforded the luxury of engaging in academic speak and differential diagnoses.  Alternating Thursdays could be a seemingly unending line of newborns or a steady pace of old timers – ex premies, patients with asthma, sickle cell, epilepsy, the works. Depending on whether or not the charts are available for those chronic patients, you may have an easy time figuring out why they are there or be dependent on a mother (or random accompanying adult) who may very well give you a blank stare when asked why the child is there. Friday is never a bad day, because it means familiar places and faces, and only then am I truly home in every sense of the word. I have become quite accustomed to the undulating rhythm of my weeks here. But this week will be different.  It will be a week of good byes. A week of saying thanks to the many wonderful people at each site that I have met and come to know.  My first goodbye will be to the blog as I look forward to savoring my last few days in my sweet island home. I must begin to pick up the ends of my New York life that have been flapping merrily in the Caribbean sea breeze for the last 3 weeks. I must slowly begin to return to reality. Its been real, Jamaica. You never, ever, ever disappoint. Bless up. Much love. RH
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In Port Antonio again today.  Overall my experience at this site has been much less busy than at Annotto Bay or Port Maria. It is a 2 hour drive from the resort so usually by the time we arrive it is around 10am, and ward rounds are generally over. I find that we don’t get many patients (max 1 or 2 each week) by the referral appointment system here so I end up spending most of my day in the A&E, which is still quite enjoyable.  And Port Antonio always signals the beginning of weekends with family, so really no complaints whatsoever. One thing struck me today, which I hadn’t taken much notice of in the past 3 weeks.  In my entire time here I don’t think I have used standard English in more than a handful of my conversations with patients. Occasionally I find myself starting off in English and then subconsciously lapsing into Patois, when I truly need to make myself understood.  The same goes for my interaction with almost all of the Jamaican staff too – nurses, other doctors, drivers, people at the resort, everyone.  Its quite refreshing and relaxing for me, but I am curious as to what it is like for non-Jamaicans who volunteer. Communication of basic concepts in English would certainly not be a problem, but I wonder how many of the nuances and subtleties of patients’ stories get lost in translation. It makes me wonder what gets said and understood and even more importantly what is left unsaid and goes unnoticed. RH
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Newborn clinic at Annotto Bay is no joke.  There were definitely a LOT of patients to be seen today. It still amazes me how these mothers wait for hours before being seen, some of them essentially spending the whole day! Anyway, between newborn clinic and the A&E, I barely made it back to the resort in time for my birthday dinner reservation at Eight Rivers (one of the fancier restaurants here). I was so tired I was almost tempted to just skip dinner and go to bed. But you only get a birthday once a year after all, so I went.  And it was absolutely delicious.  I even got my own little personalized dessert with my name on it and a bunch of staff members singing me happy birthday!!  Hurray!! I will say that one of the oddest things so far has been the experience of being here alone. It is probably one of the few things I would change about the rotation.  Everything at Couples is designed for … well either two people, or multiples of two.  I would definitely recommend volunteering with a buddy, or ensuring somehow that there are two people working the month you are here.  Having someone to talk to definitely beats reading a book to keep oneself occupied during dinner. But on the plus side, I get to read a book for fun, which I haven’t been able to do for a while, and either way, it continues to be a great experience.  🙂 RH
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