Home > Archive by category "Uncategorized" (Page 10)

Blog Archives

It is with a definite sense of sadness that I find our stay coming to an end. I regard it as having been a wonderful opportunity to have experienced another culture, practice pediatrics and get a taste of a tropical paradise in an all-inclusive resort.
The time was a nice blend of culture, work and enjoyment. I found it mind expanding not to be so dependent on technological medicine we have come to be relie upon, and to free ourselves from are obsession with the clock. Jamaicans are polite, relaxed and respectful, at least all that I have encountered on this trip. What they lack in material possessions is made up for their joy and laid-back life style.
Thanks are due to the Issa Trust and its president Diana Pollard for arranging this opportunity for me and my wife, Martha, to partake of this most beautiful island’s culture.

Richard

This is my second week at the Edgehill School for Special Education in Port Maria. I am getting to know these bright eyed students better and learning their names, many are names I’ve never heard before. I taught the song “It’s a Wonderful World” in American Sign Language. One of the teachers found the Louis Armstrong version on the computer and played it along with our singing and signing. That was very effective!  I am leaving my Sign Language book with the school.

Since there are 45 students of various abilities and ages, I modify these lessons accordingly. Paper and pencils are ALWAYS in short supply, and the drawing pads I brought were used up, so I bought more at the local book store.  Dry erase pens are also something which is consumed (dried up) and need replacing. I bought more, but that is also in need as is a copy machine (someday).

Sometimes, I use patterns to trace around. All the art work was displayed in an Art Corner. Most of it I had covered with Saran Wrap, but one day, there was a torrid of rain, some blowing sideways through the windows, and some of the artwork was ruined, but much survived and is still displayed. The students stand in front admiring their artwork and that is a thrill for me!!!

There is an ART CORNER now at the school.

1. tracing their hands with pencils and using watercolors to fill in —taped together to make a big poster

2. used oil pastels (there was a set given but not used, since the teacher didn’t seem to know how to use them—she appreciated learning—I  brought in samples of Hibiscus, fern leaves, Mousetail pods, grape and almond leaves. The students made lovely botanical art which I taped together in a poster.

3. used soft pastels to create still life–I brought in pineapple, papaya, apples, banana, and star fruit for the students to draw and fill in with the pastels. I taught them about how to see and draw the shadows that these fruits cast on paper.  These pictures were mounted and displayed.

4. used old magazines (which the activity director at the resort gave me) and cut out photos of various people doing jobs. These were glued on paper and the students filled in with markers “the rest of the story” This tied in with their Career Day at the school. The speakers who were scheduled didn’t show up, perhaps due to the rain, so I was a speaker. I also taught a game to the whole school which seemed to be a hit. “A…my name is……and I live in ……..and I like……..” It’s a great game to teach thinking skills as well as geography.

5. I will be using watercolors and crayons to teach the concept of symmetry making butterfly pictures.

I think that I’ve enriched the lives of these young students as they have enriched my life, too!!

On Monday and Tuesday this week, I was working in the clinic in Port Maria and saw two complications of tinea capitus . The first child I saw on Monday was referred in from another clinic for an I&D of a scalp swelling that was not getting better on oral antibiotics. I sent the child to the A&E for the procedure. When I returned Tuesday, I spoke to the Dr. Mighty of the A&E and she told me when they opened up the swelling several live maggots came out. This she said happens when tinea goes untreated and the necrotic tissue is a source for the maggots. They were treating the child with a power that is cidal to the maggots, in addition to Griseofulvin and shampoos. This was a new one for me.
The second case I saw on Tuesday. A child brought in by his aunt, who had custody of him for most of his life. She said he had scalp lesions for several weeks. When she removed the bandana covering his head, I saw large bald spots that were boggy and oozing. It was a kerion, an inflammatory reaction to tinea. In thirty five years of practice in America I could only recall only one or two cases. I was advised to admit him for oral Griseofulvin, Prednisone, and to have the social worker access his home life.

Both these cases gave me a new respect for possible complications of untreated tinea capitus.

Richard

Martha’s Blog:

I thought we should introduce ourselves as the newest, but oldest in age, ISSA volunteers. My name is Richard Pastcan. I am a semi-retired pediatrician, having worked for Kaiser-Permanente in Northern California for 32 years. For the past three years I have been at a community health clinic serving mostly low income and Spanish speakers as a general pediatrician. So unlike the other volunteers who were in their last year of training,  I represent the other end of the career spectrum. I am anxious to experience a different form of health care in a different culture.
I am fortunate to have my wife here with me to share in this experience. Martha is a retired teacher of the deaf, and the ISSA program director Diana Pollard has connected here to a special ed school in Port Maria. Martha has come with a duffle bag full of art supplies and hopefully this will help to engage the students.
We arrive at the Couples Resort two days ago and it is really as nice as all the prior blogs have described. The setting is a tropical paradise, the food is great and the staff is most helpful. It was good to come a few days early to get used to all of this, and get to know the surroundings a little. Yesterday we went to Dunn’s River Falls which was a really memorable experience walking up a picturesque waterfall. I got to take a tennis lesson in the afternoon and this also made me very happy.
We’ll let you know how are first days work .

Richard and Martha

Last week at Port Antonio Peds clinic we were referred a patient from the health center. He was a 6 month old male who was referred to us for concerns of hypotonia. Upon further history, we learned he was a term baby, growing and thriving, and mom had been concerned about his tone for quite some time. The nurse at the health center also noted some nystagmus at rest. On our exam, he was not dysmorphic, HEENT, CV, Lungs, Abd were normal, though neuro was not. He was hypotonic diffusely, though normal muscle bulk. He was also hyporeflexic in all major muscle groups. His Fontanelles were still open, and maybe a bit on the wide side. His eye exam was significant for horizontal nystagmus at rest, and exagerated with eye movement. His pupils responded to light and he blinked to light, though did not focus or react to any visual stimuli.
We had many concerns about this baby, specifically his tone and whether or not he could see, and he obviously needed some further testing, thought where to start? Of course the cell phone server was being worked on that day, so we were limited with our contacts, though I (Chris) did manage to get in touch with Dr. Judy Tapper in Kingston. She agreed that the baby needed to be seen, and didn’t want to suggest any tests until she saw the patient. Mom was very concerned about cost and had very limited resources. Dr. Tapper was very friendly and helpful, though explained that she was the only pediatric neurologist in the country of Jamaica, and therefore was very busy. If the patient wanted to go to the free clinic at Bustamante Children’s Hospital, there was a 6-9 month waiting list. She could go to Dr. Tapper’s private office, though would have to pay out of pocket for the visit (About $9500 Jamaican Dollars – roughly about $120 US) I explained all this to mom, and she understood, I told her to make the appointment at the free clinic, though stressed that if she could go to the private clinic, this would be preferred. As this was not an emergency and I had no true reason to admit the patient, these were the options. Mom understood and said she would try to figure out a way to find the money, and would make the appointment at BCH in the meantime, and would follow monthly at Peds clinic until further testing was done.
This case was interesting, though made us a bit sad, as if this boy and mom had more resources, she may get some answers a bit sooner. Hopefully it all works out and mom gets the answers and help that she needs, though at this point I’m not sure I’ll ever know how it turns out….

4 month old male who was discharged from the ward 2 weeks prior for resolved bronchiolitis. On the day prior to discharge, he developed a rash on his left leg. They were told it was probably a reaction to one of the medications (he was on Azithro and Augmentin) and gave him some diphenhydramine which did not change. The rash then spread to other parts of his body like his other leg (and soles of feet), both arms, left shoulder, and abdomen. The rash was obviously pruritic, though he was otherwise comfortable and non-toxic. The rash appeared to be in clusters, though didn’t seem to follow a dermatome or other pattern that we could identify. The lesions were mixes of papules and vesicles vs pustules? Hard to really say what it was. Mom said it seemed to be spreading slowly over the past two weeks. Any thoughts???? We were between scabies and varicella, though we’re sold on either. Our plan was to treat for scabies and have her follow in a week, or sooner if it got worse.

Well, hard to believe we’ve already been here two weeks and our trip is half way over. The sites are becoming more familiar, the accents are becoming clearer, and we are starting to feel the exhaustion. Though,having said that, we are learning so much about the people, the healthcare system, and the island it is just great! We wanted to hi-light a few of the cases that we thought were interesting over the past week.