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soo after an awesome weekend of scuba diving, snorkeling, sailing, and realxing, back to work today. Today we went back to Port Maria. Felt much more comfrortable this week as compared to last week, as we knew where to go, who to talk to. I worked in the hospital and saw ED patients and also helped out the clinic and saw some of those patients as well. Pretty busy day. Saw a range of illness from URIs to many skin infections to knee pain. Kind of challenging to figure out how to manage patients without laboratory tests. Really relying on clinic skills. The patients are so appreciative and friendly.

Hello from Jamaica! It has been a wonderful first week and after getting settled in, we started our first day of clinic this Tuesday at Port Maria’s clinic and A&E department. We split up our time between the A&E and clinic but the ED was slow with not much pedi cases so we both ended up working the clinic which was busy with pedi patients. I ended up seeing 9 patients or so the first day and it was pretty busy in the morning! One difference I noticed was the lab is open in the morning for several hours and if you miss that window, you have to draw your own labs which we ended up having to do. A CBC is fast to run with results in 10 minutes, but we sent for coags which ended up being a send out and can take 3-4 days and cultures even longer. It makes you really think about whether you really need those labs and how to manage your patient given your clinical judgement knowing that it may take a while for labs to come back. I saw several gastroenteritis cases, a primary herpes gingivostomatitis, asthma exacerbations, and well checks. It all seemed similar to urgent care clinic that I see back in the States. In the beginning of the day, there was a long line outside of the clinic but by the afternoon we were able to finish seeing everyone.

so yesterday we went to Annotto Bay, a level B hospital, more advanced to Porta Maira. The pediatric Ward was very interesting, It was a NICU, well baby nusrery, and pediatrics ward in one large room. The residents were very welcoming and oriented us to t he facility. We saw the aptients in the Ward and then we got to sit in on the rounds with Dr. Ramos, Dr. Ramos is an amazing teacher. The residents were a mixture of general doctors and pediatric residents.

Today we went back to Annotto Bay and worked in the clinic which was very busy. I saw a variety of cases ranging from pulmonary stenosis with CHF to worms, to lots of well baby newborn exams. Patients were very patient and appreciative. Children adorable!!

the food at the resort is absolutely phenomenal!! fell like i’m eating iron chef food every night!!

I really enjoyed helping take care of the children down here. I was surprised at the variety of cases that I saw. Of course, there were plenty of cases of asthma, viral URIs, tinea and newborn checks but there was some other real interesting stuff mixed in too. I didn’t see as much tropical diseases as I anticipated. Some days were very busy with numbers seen in the 20s. Other days were a little slower and my last day at Port Antonio only two children were brought to the Friday pediatric clinic but I did get a chance to meet and get to know several people while waiting (Jamaican networking).

I also witnessed a bizarre incident driving into Port Antonio to pick up some others at the health department (usually we aren’t the only ones being driven to and from work). As we were slowly driving toward the town square, an old lady crossing the road reached down, picked up a baseball sized rock, reared back, yelled at us and then threw it at our truck. We all saw what was coming and our driver ducked behind the steering wheel. With a loud thud, the rock bounced off the front windshield. Fortunately, nothing was damaged. The lady continued on but we stopped because there was a police officer on the side walk. I couldn’t understand the animated discussion but I think the officer was telling the driver “What am I going to do? Arrest that mad lady?” I believe she was mentally ill. It’s one of those things that I don’t think I’ll ever forget– a walk-by stoning from a Jamaican elderly lady. And I also don’t think I’ll soon forget talking to all these different drivers on these long drives around the beautiful country side.

Considering a case that was most memorable…I think maybe the 19 month old girl with Down’s syndrome that had some major cardiac defects seen on an ECHO about a year prior. Mom had gone to the Cardiologist appointment in Kingston like she was supposed to but she never got the follow up phone call with instructions that she was told she was going to get. Despite Mom giving the heart failure medications as prescribed, the child had worsening failure to thrive at this visit. The cardiologist was unable to be reached so we tried to refer her again. She may need cardiac surgery but another ECHO and specialist visit first before making that decision. I hope she’s able to be taken care of soon.

Before I leave tropical paradise to go back home to flooding and tornado damage, I just want to thank all who help make this possible and give to help this next generation of Jamaicans. Hopefully, more help to soon follow. Thanks to Diane who was always a phone call or a quick email away to help. Her passion for the children here is so evident. I’m thankful for the help and the teaching from the local doctors especially the two pediatricians, Dr. Ramos and Dr. Fisher. Finally, many thanks to the most hospitable and warm staff for the royal treatment I received here at the hotel the past month.

I wish that I could stay much longer. This has really been a great experience and I hope to return to Jamaica soon.

So I expected certain things traveling to a “third world” country but some things I still found surprising so I thought I would list some of the eye openers on this trip.

1. A pediatric ward with a pediatric attending trained in critical care (ICU) that accepts as a regional referral center having no mechanical ventilators.
2. I heard a report of hospital ERs with no antiepileptic drugs like dilantin to stop a seizure.
3. Residents here are on call nightly for 3 nights or more in a row. (and I thought every 4th or 5th night call is bad as a resident)
4. All the hospitals in the northeast region with laboratories that have no ability to perform microbiology labs/cultures.
5. Send out labs that result by mail sometimes taking 4+ weeks to receive the results.
6. In the settings we were exposed to, a seemingly majority of foreign doctors providing care working long hours for comparatively little.
7. No land-line phones in some hospitals so doctors must use their own cell phone credits to call regarding patient care.
8. Often after making a diagnosis that requires a specialist care, if a specialist is available, obtaining transportation is often not feasible.
9. A hospital with a pediatric ward staffed by medical officers doing shift work with little pediatric training.
10. IV amoxicillin

Also at times I felt like I was taking care of the indigent in the inner city back home so similar problems still remain despite more resources or more health care dollars.