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My last day at Port Maria is now finished…with a bang. As with most mornings, I sat on the wall of the little circle by the pathway leading to my villa until my driver arrived. As often is the case, I called around 8:10-8:15 to make sure someone is coming. We arrived shortly before 9 AM at Port Maria and I set out my supplies. I asked for more prescription paper and filled out a few in advance as Tuesdays tend to be busy. Patients began to trickle in, mostly referred from the nurse shortly thereafter then came in a flood by 11 AM — 37 of them! The number would have been 40, but 2 turned out to be adults and one disappeared before I got to her.

Once again, most of the dx for the day were tinea or URI. I also saw preauricular ear pits/neck pits in an infant — she is to see ENT in Bustamente, consider renal U/s as well. I also saw a few more such unusual cases. I had brought an apple, but never found time to eat it — I feel so sorry for those waiting. I finished up around 4 PM at which time my driver came to find me (usually I walk around the back to the administrative office to have someone arrange for a ride). Luckily, I had time (while I waited for him to drive to the gas station and return) for a few last photographs of the helpful office staff / nursing assistants and to say my good-byes to Dr. San San Win and a few other administrative staff. While this has definitely been my busiest site, I also felt very productive and helpful here!

This past weekend was amazing as my fiance flew in and we were able to enjoy many of the resort perks as well as some time together. Amongst many other activities, we climbed the waterfall at Dunn’s River Falls, took a trip on the glass bottom boat, and talked to the man selling shells. We also ate dinner at Eight Rivers/Bayside, both of which were excellent. I even managed to eat my entire meal at Bayside with chopsticks!

My Monday morning had a somewhat rocky start as the driver did not arrive until 9 AM. Then I received a phone call while at work that the resort thought I was leaving today and was looking for me. Oops, apparently my fiance’s departure date had accidentally been recorded as mine as well! That was quickly fixed and the remainder of my day at Port Maria ran smoothly. Themes for the day were tinea, URI, and gastroenteritis although I also consulted on two inpatients; one with seizures and hypotonia in great need of a Pediatric Neurologist and the other with marked lymphadenitis.

Things I learned today or along the way:
Jamaican ambulances are staffed by a driver, a nurse, and a porter. They have nebulizer machines, oxygen, and scissors amongst other things on board. The few available ambulances remain busy transporting patients from home to the hospital in addition to hospital-to-hospital transfers for tests including x-rays!
Few families have paracetamol (tylenol) at home.
When an x-ray is ordered outpatient, it is generally given to the patient. This means a patient sometimes appears in clinic with xray or labwork in hand. Dockets (charts) are kept intra-facility while the patient may go to many facilities, so you may not have the reason behind the testing available.

Mid-week already, time seems to be moving at a steady clip. After Sunday’s adventures in beach volleyball, I confess I was a bit sore on Monday. Nevertheless, I saw approx 25 patients at Port Maria. I’ve noticed a trend toward multiple diagnoses as everyone comes in with one chief complaint but then asks me to look at a skin infection or discuss a cough. No cases of Ackee poisoning for me as of yet, thank goodness.

Tuesday is Children’s Health Day at Port Maria, which always signifies a busy clinic for me, especially after around 11 AM when most of the well-children have been seen for vaccinations. Several of my patients were referred from the nurse practitioner, generally for URI symptoms. I was thrilled to find that a patient from last week returned with completed lab work!

Today, I returned to Annotto Bay Hospital where the three young doctors were already hard at work seeing the 13 inpatients. The 25 week infant (I still suspect his gestational age to be closer to 28 wk) continues to do well and is now on room air. Sadly, the child we placed on CPAP last week died.

I greatly enjoy my trips to Annotto Bay and rounding with the team. Today, we discussed cases of likely and proven rheumatic heart disease — a rare diagnosis at home. I also continue to marvel at how well staff handle the daily frustrations that come with working in a third world environment. Today, one of the younger doctors and I went to draw a blood culture from a child with likely meningitis (bulging fontanelle, fever) only to discover that there were no more blood culture bottles on the ward.

Tomorrow I shall return to ABH for clinic, then Port Antonio on Friday. I was asked by one of the younger doctors in Port Antonio to discuss fluid management based on their recent GE outbreak. Here, the mild-moderate-severe clinical appearance apply more readily than my textbook examples; I/Os are not generally monitored unless expressly written in the docket (chart), which is only done for the most ill patients and lab work, including electrolytes, may not return for several hours or until the following day.

In addition to Port Antonio on Friday, my fiance is scheduled to fly in on Friday for a weekend stay! I am very excited to try a few more of the resort activities and introduce him to some of the staff members. More adventures to come, I am sure….

The weather has been a little more chilly today with intermittent sprinkles — much like the rest of the week. Nevertheless, the planning for tonight’s party at the resort goes on. It is the 33rd Anniversary of the resort which means a lot of activity going on!

The rest of the week has also been full of activity for me. On Tuesday, I returned to Port Maria and saw 35 patients! My hand was cramping from writing prescriptions for clotrimazole cream and paracetamol. Wednesday I returned to Annotto Bay to find that the 25 weeker is still there and doing relatively well. I was very excited to see him. The team and I rounded on the other patients relatively quickly, then I tried to assist the team in carrying out the day’s plan. We obtained a urine culture (unlike at home where we use catheters, they do suprapubic taps here), a lumbar puncture (not successful, but in-process the child developed explosive diarrhea and provided a reason for his fever), and drew blood from several patients.

Thursday was also spent at Annotto Bay; this time in clinic. I took my time (unfortunately for the other doctor who saw 40!). I saw a few interesting cases, including a 3 week old infant who had lost weight since birth. Upon obtaining further history, I discovered his mother had stopped breast-feeding when he was ~10 days old, at which time he developed ‘cold in his chest’. She then tried formula for one day and decided it gave him constipation, and had been giving him nothing but bush tea (a local remedy) for at least a week. She resumed breast-feeding several days before the appointment, but had not been expressing much milk. Apparently cases such as these are not uncommon.

Friday was my first trip to Port Antonio. The drive was gorgeous. I only had 3 patients (this is a relatively new clinic and Dr. Ramos usually sees peds patients here on Tuesdays). All three of them were referrals, two of which I referred on to Bustamente Children’s Hospital. Of the referrals, one child had leukocoria and the other had severe vargus leg deformity. I then rounded on the inpatients where the theme of the day was vomiting/diarrhea.

Other interesting tidbits of the week: The Jamaican workday is approximately 6 hours, although the resort workers seem to double that. “Lasco” is what many children call a powdered milk they drink; however as Lasco is a large company, the term may refer to many other things. June plums are a fruit many Jamaicans eat — with or without salt / pepper. Oh, and apparently housekeeping does not have a key to the bedroom of our villa…so if you want your sheets changed / new towel, either be present or leave the bedroom door unlocked (oops!). 🙂 I think that is enough for now. I shall try to post pictures tonight or tomorrow.

Back to Port Maria today; I saw 26 patients. Lesson of the day: the Ackee fruit is the Jamaican national fruit. When prepared properly, the inner part is has high nutritional value. When not allowed to ripen or not boiled, the fruit can produce vomiting, seizures, hypoglycemia, and death due to alkaloid toxins. Apparently there has been an outbreak of this recently in Jamaica including several deaths. I will know to ask about this possibility of my patients tomorrow! Pictured above: my clinic room today and a cute Jamaican girl who was my first patient of the day. (Picture taken with written permission from her mother.)

Day 5, finally figured out the blog — I apologize in advance for the long copy/pasted version of my first week : ) .

I landed in Jamaica on Monday without problem. I actually slept through both flights – the beauty of leaving almost post-call. Customs was easy, and despite a brief oops at airport lounge when my name wasn’t on their list of guests, check-in went smoothly and I am now installed in villa #9 for the next month. In addition, I was able to recognize a vacationing couple who Diane knows and thoughtfully emailed me regarding and I ate dinner at the buffet (yummy) with them. Afterward, they showed me the parrots (really) and the view from their room – gorgeous, I would love to have the pictures they took off their balcony! I spoke with my driver, found the laptop/cell phones, and enjoyed some free time.

Wednesday was my first day on the job. I met my driver in the circle out front and we set off on the winding roads to Port Maria. Arriving at the complex, I discovered ‘my’ room had been damaged by recent rains, so I was taken to the clinic (first building encountered). I unloaded my two bags worth of necessities in a small room; my first 16 patients arrived shortly thereafter. Things I learned today: 1) Dramamine is a good idea, but it doesn’t take away driving down the ‘wrong’ side of the road and the random passing of Jamaican driving! 2) Clindamycin is not stocked at the Port Maria pharmacy. 2) Obtaining a urinalysis by dipstick here means you test pH, sugar, and protein. Diagnoses included abrasion, cellulitis, cellulitis, URI, dental abscess, URI, and my case for the day: a 7 mo with vesicles on her tongue, lip, and under her eye. I wish I had taken a picture and hope she continues to drink well to stay hydrated.

On Thursday, I returned to Port Maria. I was much more comfortable with my surroundings, but much to my chagrin, the first pediatric patient didn’t show up until 11 AM. However, based on the number of mothers who were there and took down my clinic dates for the month, I should have more than plenty from now on! Diagnoses today included: fungal infection, fungal infection, URI, URI, impetigo, and a child with tight heel cords who can’t walk yet/stands on his toes whom I sent to ortho for a referral. I learned today 1) A referral consists of a form that is filled out that the patient then takes to the specialist. I also obtained sheets for x-rays and labs for future use.

Today I headed for Annotto Bay Hospital. Despite it not being c-section day, it was newborn day and we received three admissions in a row. One was a 25 weeker; without a ventilator, incubator, and NVN, his chances will be limited. He will be in my thoughts this weekend. I did experience first-hand CPAP here while helping to combine tubing, a bottle of water, and an oxygen tank.

After three days full of eye-opening experiences, I’m very grateful for the tools I have at my disposal in Iowa. I’m also looking forward to a weekend off — sunshine, here I come!

Here is a quick recap of my last week.
Monday I worked at Port Maria for my last day. I saw 27 patients. I delivered the last batch of donated medical supplies that I brought (I had collected supplies for 4 months and filled my 2 checked luggage bags with them).
Tuesday I went shopping in the local market and then packed everything up. It didn’t feel like a whole month had passed already. One of the nurse’s house had caught on fire over the weekend. I left some of my clothes and travel sized toiletries for her. I ran into the general manager at Couples and told him about her. He took her name and number to send her some stuff too. I also had to say my goodbyes 🙁 I had made some good friends at the resort (some employees and some guests).
Wednesday was travel day. My flight took off at 7:55am but since it is an international flight and the airport is in a different city my taxi left the resort at 3:15, yes that is 3:15AM. When I got to the airport it was completely empty! Nobody inside, not even an employee yet. It opened about 15 minutes later. I flew from Montego Bay to Miami then home to Memphis. I was greeted by my hubby who then took me out to lunch but then had to go back to work. I didn’t mind though because I needed a nap.
Thursday I got to make my return to my residency as a speaker at our noon conference (not about Jamaica but that one will come). This weekend our hospital is making a huge move into a brand new building.

Overall my impressions: This rotation is great because it teaches you to feel confident in your physical exam (xrays and labs are not readily available), it gives you an opportunity to spread up to date information, it helps you appreciate what you have. The accommodations are awesome. The resort is so fun and the people there are happy and full of energy.
With all of the great things you should also know that not everyone would enjoy this rotation. You have to be comfortable treating without someone constantly over you. There is someone available if you run into a situation you are not comfortable with but most of the time you are on your own. You are the one making decisions. Also you have to be somewhat laid back. I’m a planner and organizer (of my time not my stuff) therefore I had a few frustrating moments mostly revolving around transportation.
If anyone has any questions about my experience feel free to email me at arouster@uthsc.edu

Happy Thanksgiving everyone! There’s a ton of things that I am thankful for, one of which is this experience. Since medical school I have wanted to participate in a medical mission trip. I came close last year. I had a trip to Guatemala planned but then fellowship interviews got in the way. The main roadblock has been the cost. I am grateful for the Issa Trust and Couple’s Resort for organizing such a wonderful program.
Yesterday I rounded on the Pediatric ward with the team. I had it wrong before when I thought the 3 young docs there were residents. They do not have residency programs. Medical school is longer (6 yrs instead of our 4yrs) but they are not required to do a 3 yr residency.
Rounds are similar to ours. A younger (and I use this word as experience not necessarily age) doctor presents their patients to the Attending doctor (aka the Boss). A plan is pretty much set ahead of time but fine tuned after some discussion.
After rounds blood is drawn for the labs ordered. Then LUNCH.
I rode home with Candi again. The hospital system is down a car (its in the shop) so any time she offers I accept. On the ride home we stopped at this jerk shop. I had heard from all of the drivers that it has the best jerk (chicken and pork). It was good but Doug cooks pork so well that I’m pretty spoiled (dry pork just doesn’t cut it anymore).
Today I watched the Macys parade and I’m going to watch Charlie Brown’s Thanksgiving at 8pm. I got to talk to my family after they had dinner. Hopefully next year I can sit down with them at the table (last year Doug’s grandma died so we were at his family’s, 2 yrs ago I was on call, 3 yrs ago I think we were also at Doug’s, so it must have been 4 yrs ago at my family).

FUN Jamaican stuff:
some schools have 2 shifts: 7-12 and 12-5. So if it seems like there are always kids walking around town, you’re right.
The biggest shopping day of the year here is Christmas Eve.
Some of the rural houses just have the living area and bedrooms inside. The bathroom and kitchen are outside.
Speaking of bathrooms there is something called a pit latrine. During rounds we talked about this and I thought they said piG latrine and asked if I knew what it was. I thought pig trough and said ‘where they eat.’ Oh no. It is an 8 ft hole in the ground with a seat at the top of it to do your business.
Coconuts are not brown while they are on the tree. They have an outer shell that is yellow/green. The sweeter the jelly (juice) inside means the older it is. Milk is NOT the liquid inside but made by grinding up the white meat.

Pandora, Hulu, and Netflix do not work outside of the US.