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In follow up per Dr. Stephanie’s blog, Dr. Ramos in Jamaica shares the following information:

Our recommend treatment for Ophthalmia Neonatorum or Neonatal Conjuctivitis does not differ from what is recommended and practiced elsewhere including many Pediatric hospitals
in North America.

Providing that the suspected etiology is infectious, then “triple antibiotic therapy” is
recommended. This consists of:

Topical: Tetracycline
Eye Ointment 1% for 7 days
Oral: Erythromycin,
50mg/kg/day (divided q 6-8 h) for 2-3 weeks.
Paraenteral: Ceftriaxone
50m/kg/ single dose (maximum dose 125mg).

Neonates treated as outpatients should be reviewed within 2 weeks.

Based on my experience (over 10 years) using this “triple antibiotic therapy”, the vast majority of cases (>95%) will resolve.

We do not routinely recommend admission, unless there is an indication for it,
example:

– Signs of systemic involvement (hyper, hypo or unstable body temperature, vomiting, coughing, sick looking baby, etc)
– Severe ocular signs (risk for intraocular complications)
– Concerns about treatment compliance or proper follow up.

If the baby is suspected to have a systemic sepsis in addition to the above outlined treatment regimen, we recommend a combination of Penicillin/ Aminoglycoside for at least 7 days or
until cultures reports are available.

It is to be remembered that cohorts differs from country to country, even from state to
state; therefore we must be aware of this when we approach a population of a different background than the one we are used to attend. Causative agents prevalences, popular practices, and socio-economic status all might also influence the way we approach these conditions.

Yesterday we went to Port Antonio Hospital. This hospital was in Portland Parish, about a 2 hour drive through winding, hilly, jungle roads from our hotel. When we arrived (thanks to our very polite ride and hospital administrator, Mr. Campbell), we were warmly welcomed and put to work. We tried to start in the Peds ward, though the docs had already rounded for the day, so we went to the outpatient clinic.

Yesterday we went to the Annotto Bay Health Center, an outpatient clinic in St. Mary’s Parish that is peacefully located on the water. Although the staff did not know we were coming, they were very welcoming and we knew we would be of use as there were rows of Moms and Children already lined up. Again, we saw a mix of URIs, rashes, Tinea, and constipation, but there was one patient that made us both skip a heartbeat, if only for a minute.

A mom was sent over to us with her 3 month baby from the nurse. She was quiet, though polite. She said that after her baby was born, he had to be admitted for a few days because he was breathing fast. The breathing was improved, though mom reports that he had a chest x-ray and EKG that per mom “showed that one side of his heart was bigger than the other” – cue Oh Crap! She was referred for an echocardiogram, though she could not afford it, and was subsequently referred to a cardiologist in Kingston that had an available appointment in September (7 months from now!). Upon further history, the baby was doing well, feeding and thriving (with occasional sweats), no pallor or cyanosis, and developmentally appropriate. His exam did reveal a very soft mid-systolic murmur at the apex and LLSB, though no signs of heart failure. Our portable pulse ox (Thank God and Dr. Gunkleman from Akron) showed sats of 96%. We were reassured by our findings and planned to look up the Xray and EKG tomorrow when we go to the hospital that the tests were performed. Our thoughts were that this baby was probably fine and maybe had a small VSD, and his EKG probably was just RVH (cue Dr. Bockoven, “RVH in a newborn is normal!” mantra). We told mom that we would check on all this and for her to follow up with us in 1-2 weeks, and to keep her appointment with cardiology in September. In the end we were much more comfortable, but what a scary chief complaint!!

Greetings from Jamaica! Let’s start with introducing ourselves. We are Chris and Stephanie, 3rd
year pediatric residents from Akron Children’s Hospital in Akron, OH. We are so excited to be starting our time
with Issa Trust Foundation, and sharing our experiences with the readers of
this blog. Before we get into the clinical
aspects of our trip, let’s first touch on the AMAZING accommodations at Couples
Tower Isle. The staff here, along with
Diane Pollard, have truly made us feel welcome and have made this a relatively
seamless start to our month.
Today
was our first day at Porto Maria Medical Center. The center is very busy, having inpatient
wards (adult, maternity, and pediatrics), a busy A&E (Accident and
Emergency Room), a busy walk-in health clinic, and a pharmacy. We were warmly greeted by the staff, nurses,
and other physicians there and quickly got to work. We split up right away, with Chris working in
the Outpatient Clinic and Stephanie in the A&E.
At the outpatient clinic, I (Chris)
saw a lot of general pediatrics issues. Main problems I encountered were Tinea
Capitis, other various rashes, URI’s, and GI worms. After only a few patients, my training kicked in and I started to feel more comfortable with the system. Right now my biggest obstacle is learning
what resources are and are not available.
It’s all well and good that I know what the problem is and how to treat
it, though if the pharmacy doesn’t have the treatment I order , then what good
am I doing. As I get more familiar with
our resources, I feel that my nerves will be more settled. Thankfully the staff is very welcoming and
patient, and is very open to questions.
(Thanks to Dr. Hines for the dose of Albendazole – Stephanie had the
formulary in A&E!)
In the A&E, I (Stephanie) was
sent the less acute patients, the ones who did not require nebulized treatments
or IV fluids. As I sat there waiting for
the first patient to arrive, I felt the nerves building up. The first patient had complaints of a
possible seizure, which I am normally comfortable with, but found myself having
a difficult time since I did not what resources were available for testing or
work up. After I had a few patients come in with URI
and asthma complaints I started to get the hang of things and felt more
comfortable. Dr. Facey in the A&E was a great resource
to me, especially when I wasn’t sure what to do with Ventolin Elixir or xray
turn around time. Deworming was a big
complaint which I fully embraced and prescribed mebendazole. The parents seem open to education,
especially on asthma. I even filled out
an asthma action plan (which would make Chris, our future pulmonologist,
proud).
Our first day is over, we are
feeling less nervous, but still getting comfortable with the resources. We can’t wait to see what the rest of the
week brings. We will be blogging again
soon! Ya mon!

My last blog . . . Last day in Jamaica, for now anyway. Bittersweet. I miss home, but have had such a rich and rewarding experience here that it will be hard to leave in the morning!

It has been challenging at times, and looking back it seems that the first and last weeks were the toughest. The first week, of course, because I was getting used to how to treat patients in this medical system. The last partly because I was, by that time, feeling homesick. The other difficulty was brought on by a discussion I had the end of the week prior with Dr. Ramos and I had some realizations about things I had been experiencing that for a while made me feel somewhat depressed. I had grown used to patients and their parents answering everything I said with “Yes Miss.” I tried my best to give education and explanations at the end of each visit and always ended with, “Do you have any questions?” Very rarely would anyone actually ask a question, and most times they would respond with a little giggle or chuckle, followed by “No.” I told this to Dr. Ramos, and he replied, “Well how can they ask a question when they didn’t understand anything you just said.” Excellent point. Even at home, at times it is difficult to explain to a parent what is going on with their child in terms they fully understand, trying to find the words in lay terms while trying to provide necessary education. But here in Jamaica, one also has to deal with a language barrier. Even though I have gotten better at understanding the mix of usually broken English and Patwa that most people speak, I also ask them when I don’t understand. Could they repeat, or tell me in a different way. But rarely would a parent ask me to do the same. I shouldn’t have assumed they could understand my English. I came to realize that just because they did not have questions or nodded their heads and said, “Yes Miss,” in a lot of cases it probably had nothing to do with whether they actually understood or not. Here what a doctor says goes, and most Jamaicans would never speak up to say they couldn’t understand me. There is also the aspect that it seems that a lot of time the people just don’t listen to what you say. I would be asked a question, and then as I proceeded to answer they would either start talking about something else, or a few times get up to leave the office. Anyway, after I realized all this about 3 weeks into my time here, I felt a bit helpless, wondered how much good I had been doing besides just writing a prescription when needed. When a mother comes in with her baby worried because that baby is having reflux (that is not in need of medication), the whole key is helping her to understand what is happening to her baby and why and when it will get better. That is whole idea of reassurance for me, education is the biggest part of it, knowing what is “normal” and what is cause for concern. But after a couple days, I just accepted that this is part of learning and part of working in an unfamiliar culture. It has been an amazing learning opportunity. I hope I can take this experience and become a better listener and a better educator for all people. It has been a very important lesson for me.

Overall, I hope that this whole experience will make me a better clinician in all aspects, as well as improve my cultural competence. I am truly grateful for the opportunity!

I encourage other physicians and health professionals to take advantage of this opportunity as well. The Issa Trust Foundation has room for 2 physicians here all year round! It would so wonderful if there were always pediatrians here, a consistent presence to serve the children here so they receive appropriate follow-up and care. You will be challenged, you will have fun, and you will leave feeling rewarded. The accommodations here are out of this world! You will have a lot of time for fun and relaxation in return for all the hard work you do during the week. Please, take advantage of this exciting opportunity to become a better clinician while helping the children of St. Mary and Portland!

So a HUGE thank you to everyone at the Issa Trust Foundation, all the many physicians and nurses I had the pleasure of working with here in Jamaica, and to my home program for allowing me the time to have this experience! I plan on coming back soon . . .

Dr. Arleen Haynes-Laing, a past volunteer coming to us from CHOP and is from Jamaica said that Black Dressing is a local poultice/wound dressing that’s used for infected wounds. Can be bought in store (don’t know) how it’s made but it smells “tarry” and is black. Families swear it works well. Another name is used for this dressing is “Heal and Draw.” It heals wound while it draws out the pus.

I’ve just finished my 3rd week here in Jamaica, and it was the busiest yet! Post Maria had so many Pedi patients, I saw 30 on Tuesday, and even had to give 5 extra back to A&E! It was an exhausting week, but full of so much great learning and good challenges.

One thing I’ve had to get used to here is that I am always “Dr. Westman,” not “Amy,” at least at the hospital. I come from a laid back California Pediatrics program where I am on a first name basis with everyone in my program, from interns to attendings and administrators. But here in Jamaica, it is more formal. A doctor is always “Dr. . .” and a nurse is always “Nurse . . .” The other doctors and even the interns introduce themselves as “Dr . . .” and I’ve noticed that even when they drop the doctor part, others refer to them by their last name only.  So now I’ve grown used to introducing myself as Dr. Westman, but it still feels strangely formal!

Another things that just goes with the territory here, and I presume for all global health rotations or missions, is that you just need to relax and go with the flow. Things are not a tightly regimented and scheduled here as in America, but everything gets taken care of in the end. The patients show up at 8am and register first come, first serve, but will wait all day to be seen, no appointment times. You, as a volunteer here, will always have someone to drive you to and from the hospitals and clinics, but it may not be the same person and they may not pick you up at the expected time. But you will get there and back safely! The doctors mentioned in the orientation packets may not be around, but there is always someone there to help with any questions. Even if there aren’t many clinic patients one day (my wide range has been from 2 to 30, but on average about 20), you can always find other ways to help out like seeing patients in A&E. Just go with the flow, and everything will work out. One of the big things I’ve learned in my time here!

One piece of advice for anyone else coming here to work, is to really brush up on your IV placement and blood drawing skills if its not one of your strongest areas. I have never really been very good at placing IVs in small children. While my home program of course has requirements and time built into our training so that we learn how to do this, there has never been much pressure to get really good at it, since there is always a nurse or phlebotomist to do these things for you. Since I don’t naturally love putting in IVs like some other residents, I haven’t perfected the skill. In Jamaica, however, the doctors draw all of the blood and place all the IVs, so I’ve actually gotten much better over these past few weeks by necessity! I was also surprised to learn, that the GPs here, although I knew they saw all ages, actually do some surgeries as well. One doctor at Port Maria said he will do “simple” procedures like appendectomies or inguinal hernia repairs himself, but prefers to only assist on more difficult operations like a biliary atresia repair. He has of course received specific training in surgery as part of his medical training, but I was impressed. At least I can do my own I&Ds and laceration repairs!

For my last comment this week, I wanted to mention every Jamaican’s apparent love for and confidence in diphenhydramine, or DPH elixir as its called here. Anytime a child has a cold, the parents demand DPH elixir. When I ask if it helps, they will either say, “I don’t know, you’re the doctor,” or they will admit that it isn’t helping the child’s cold symptoms, but they still ask for it. Many parents here really want you to give them a medicine for their child even if its just a virus, and are not as much into supportive care like bulb syringes and humidifiers, partly because they do not have access or the funds for such things. I have come to appreciate the usefulness of diphenhydramine at home, great for allergie reactions, nausea, and insomnia, but never though of using it for a cold! I do suppose it is safer than most “cold medicine” mixtures that many used to give their kids.

Oh, by the way, I’m still trying to find out what is actually in the “black dressing!” I know it is not as widely used any longer here in Jamaica, but I’m still curious. A google search didn’t help very much, and I keep asking every doctor and nurse I come into contact with, but no one yet has been able to tell me what’s in it! It just keeps me interested, but I think I might have to just let this one go!

To introduce myself, I am Amy Westman, pediatric resident from Kaiser Permanente in Oakland, California. I am now 2 weeks into my month long rotation here in Jamaica! I decided to come here for my global health rotation because a couple of residents from my program had already some here and had told me what a great experience it had been for them. Hi Thao and Chung!

I am having a great time here and learning a lot! What a 2 weeks it has been! Its been hard coming from working in the American medical system to working here in the Jamaican medical system, but it is getting easier everyday. I’ve had the opportunity to see many patients and work with many wonderful physicians here. Our goals as physicians both here in Jamaica and back in America are the same, to do what is best for our patients, we just get there in different ways sometimes.

My weeks begin at Port Maria Hospital in the clinic area. Here generally kids that have shown up for regular clinic that day get funneled to me, or are sent from A&E (the ED), lots of general complaints. The first patient the A&E doc sent me was a consult to rule out leishmaniasis. What do I know about leishmaniasis? I work in California! So I said, “Give me  a minute,” got out my atlas of tropical diseases, and read up quickly. Then I was able to say with some certainty that the child did not have leishmaniasis. But that’s how a lot of my experiences here have been, learning through doing and seeing. I have seen the typical childhood problems that I see so often at home: asthma, eczema, otitis, pharyngitis, and cellulitis. I have also seen things that I have never seen at home, but now have seen several times and feel confident in my diagnosis, such as miliaria crystallina. So many babies at their well checks have developed it here, and at first I wasn’t sure what I was seeing, but after looking it up on the internet (at night after clinic – no wifi or computers there) and seeing it over and over again, I can now confidently tell parents what it is and offer reassurance.

I am also visiting Annotto Bay Hospital in the middle of my weeks. There I see patients and participate in ward rounds, as well as being in the pediatric clinic where I see kids with problems that are followed by the pediatrician there, Dr. Ramos, and the physicians working there with pediatric experience. More asthma, anemia, and some follow-ups post discharge from the hospital. On the inpatient side the majority of the patients I’ve seen have been neonates with suspected sepsis or risk factors. Since it is very difficult to get cultures here (they must be sent to Kingston and most of the time never make it there due to transportation problems or make it there too late to be useful for making treatment decisions), most babies with any suspicion, those who would bet a 48 hours rule out in the states, get a full 5 day course of IV antibiotics and then are sent home on orals.

On Fridays I make the 2+ hour ride (thanks meclizine!) to Port Anotonio Hospital in the parish of Portland, where I visit the wards and then go to clinic. Here they do not have a pediatrician at all, but the general physicians round on the patients on the ward.

In general, most physicians here have been very helpful in offering assistance with navigating the health system here. Where a specialist is available, what days they have clinic, etc. I always have a lot of questions!

There are so many interesting cultural things to be learned as well. I quickly heard about black dressing, which is tar based (but I’m still not sure of its other components), an all purpose salve for infections and the like. It took me a while to figure out what the mothers were talking about when they said the baby had “coal” (not sure how they spell it!) in his emesis or diarrhea, now I think they mean mucus. I ask my patient’s parents a lot of questions about things like this as you can learn so much from them about attitudes toward health and nutrition and home remedies used.


When you have off time, which is every night and the weekends, it is wonderful to be at Tower Isle where you always have great food and entertainment, and can always relax on the beach and read a book, as I so often do after work. There are so many opportunities for trips outside the resort if you wish to join them. It has taken me a while to get used to people serving me everything and always asking me if I need anything here at the resort, but its a nice time to relax and enjoy you’re time off. A sincere thanks to the Issa Trust Foundation and Couples for giving me this opportunity to come and serve the children of Jamaica and learn so much from the people and my patients here! It has been amazing thus far, and I am so looking forward to my next 2 weeks with the adventures and learning opportunities they present.

Stayed tuned .  .  .

Well, today was my last day of what has been a memorable experience volunteering in Jamaica. I spent the morning in Port Maria seeing children for various urgent care issues. At the end of my brief time here, I’m a little more comfortable with the Patois (although I had to break down and call in a nurse to interpret for me today). I know to ask the nurse for the “docket” not the “chart”. I also know to take a minute, as I’m looking into a child’s mouth, to lecture every parent about brushing or wiping down teeth before bed and limiting box juices (I’ve seen so many rotten primary teeth, it makes me sad).

On that note, I’ve been so impressed at the high prevalence of breastfeeding here. Nearly every mother of a newborn child breastfeeds, popping the breast out so comfortably, it makes me blush in my Western prudishness. But I’m so proud of them. True, a large part of it is due to necessity and limited economic resources to purchase formula; but I commend them all the same.

Aside from clinic, I’ve enjoyed seeing parts of Jamaica that I had not seen before on my previous visits. For one, the drive to Port Antonio is nothing short of breathtaking. On the drive back the hotel on Friday, it had just finished raining as we were driving through the hills along the coast, and the sun shown brightly making every color so brilliant. Green-golden palm trees were glowing; the red flowers on the tops of trees glistened. The painter had come to accentuate the clouds in the sky with specials tones of blue and the Caribbean sea itself sent sapphire jewels crashing on the rocky shores. Have you ever been to someone’s amazing house and looked around you with awe and a little bit of envy? I glanced at my driver, wondering if he took all this beauty for granted as he traveled up and down the coast daily.

Enough waxing poetic, so in my first post, I had mentioned that I was not a frequenter of all-inclusive resorts but that I had come to understand and appreciate their appeal to so many people. A short while after I wrote that, one of my best friends asked me if I had “converted”. I told her that I’d have to see. So after my two weeks here at a beautiful resort in a beautiful country I have to qualify those earlier statements. I missed the spontaneity and adventure of my typical holiday. After a few days, I had to take a route taxi into town to soak up some local flavor. It was a great trip away and I got to stop by the grocery store to pick up some packets of the delicious corn meal porridge, laced with vanilla and nutmeg, that the resort has been serving up for breakfast. My 2 yr old son is going to love it.

OK… I’m signing off. I hope to do this again someday. I certainly encourage people to take ISSA up for the adventure! It’s a win-win.