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On our first full day in Jamaica, we climbed the world famous Dunn’s River Falls all the way to the top. It was a great team building exercise to get us mentally ready for the week. The first few days of work have been filled with a mixture of interesting patients, new faces and trying to navigate systems-based practice in a developing country. Each morning, we awaken to melodic sounds from the birds outside of our windows as we prepare to start our day. Prior to reaching the health facilities, we spend 20 minutes to 2 hours traveling along narrow winding roads, but are privy to picturesque ocean views, scenic mountain greenery and the early hustle and bustle for local Jamaicans as they travel to work or school. Rounds on the ward: An ex-29 week preemie who is small yet vigorous laid in an incubator next to an ex-26 week preemie who has apnea and requires continuous resuscitation. Both babies are premature, both in need of ventilators not available, but the latter only survived six hours after we were first introduced to him. He is the fifth child lost for his mother (all born prematurely) and only to think if his life could be saved if the necessary equipment was available – all the incubators were being used at the referring facilities. Two other infants were discharged home having improved after meconium aspiration syndrome and neonatal seizures. The last two patients (4 and 10 years old) were admitted for sickle cell pain crises. The first child had a medical course complicated by a history of rheumatic fever with subsequent heart failure, now improved on aspirin and diuretics. The older intermittently cried out as he awaited his pain medication; no PCA’s are available. We did get to hold plain film radiographs for the first time!!! Accident & Emergency (A&E): The equivalent of the Emergency Room is staffed by non-pediatricians, but they were excited that we saw their pediatric patients (ages 12 and under). Trying to navigate the forms, resources available and medications in stock were the largest challenges. The staff was very friendly and helpful. Chief complaints ranged from upper respiratory tract symptoms to dehydration to imaging follow ups. The biggest concern by parents and health workers was H1N1 or flu as evident by the white masks worn by all the staff.   Annotto Bay Clinic: Thursday morning is typically newborn clinic and chronic disease (i.e. asthma) follow-ups. The day was commenced with torrential rain. A car we passed on the road had slid into the ditch and only a few mothers made it to clinic that day. We were greeted by a sea of infants, tightly bundled and breastfeeding in the waiting area as they awaited their first well baby visit. We were greeted by cooing smiles and their mothers gave us many thank-yous.   Port Antonio A&E: The busiest day of the week!!  After a two –hour commute, we were met with a room full of parents and children who waiting hours to be seen by a Pediatrician. We were directed into a small room (about the size of a standard bathroom) to see our patients. Initially we started with 8 dockets (aka patient charts), as we got settled in the nurse handed us 3 more dockets. It seemed like every few minutes a new patient were being added to the list. In about 3.5 hours we saw 13 patients. To close out the day we had to admit a 13yr old male with a textbook picture of new onset type 1 diabetes. Although we were able to get blood via venipuncture for initial labs, multiple attempts at IV placement were unsuccessful before departing for the day. As pediatricians we both have become accustomed to looking at the patient electronic medical record to follow up patient care even after hand-off, but here it’s more so,” I hope he will be okay” and that what we did was the right thing. It was surely a rough day; thankfully we were able to work as a team. Lessons Learned:

1. Dandelions supposedly help with preventing prostate cancer?
2. The pharmacy can close at any time, leaving patients having to return for medications or not obtain them at all if they have no means to travel back to fill their prescriptions.
3. Remember to ask if your patients have running water, a refrigerator or transportation to return for follow-up. This will play a role in clinical advice, management and decision-making.
4. “Yeh Mon” is used by as a noun, verb, adjective and greeting constantly by all the hotel guests and staff – absolutely hilarious!
5. Keep the patient charts in the correct order or your will corrected swiftly by frustrated parents, fussy children, and nurses.
6. Check in with the pharmacy for each location on the first time going to get a run down on what medications are available.

  Until next week, Nicole & Roxanne

I am half way through my time in Jamaica. It has definitely been an interesting experience. Mondays and Tuesdays are spent in the ED at Port Maria. There is a huge problem with space so the three of us have to share a single room. Wednesday mornings are ward rounds at Annotto Bay (if they have patients) followed by helping out in the ED. Thursdays are clinic at Annotto Bay and either consist of well checks or follow ups. Fridays are spent either at clinic or the ED in Port Antonio, the hospital with a view! Overall the hospital staff are gratful we are here and therefore are helpful and welcoming. Basic URIs , or “cold in the head Miss”, are very common. They have some very interesting cough syrups over here that the parents expect you to prescribe. They consist of a variety of ingredients including salbutamol or terbutaline, codeine, bromhexine, guaiphenesin, and menthol. My favorite one is called “Dawakof”, or “do away cough.” Along with the basic URIs, I’ve seen a lot of poorly-controlled asthma, tinea capitis, and scabies. Thankfully Ventolin inhalers are free from the hospital pharmacy and they even have an ICS! Unfortunately nebulizers are few and far between though making acute management of asthma in the ED a difficult situation. It also makes discharging a 2 or 3 year old home with an inhaler a less than ideal situation, especially when you have to just hope that the parent will spend the money on a spacer as these are not provided by the hospital pharmacy. I have possibly made some new diagnoses of sickle cell disease, although I may never know for sure. Newborn screen must not happen in Jamaica (I have yet to find out) but I have seen young children who appear to be in vaso-occlusive crisis with no diagnosis of SCD. My only clue is a Hb/Hct in the range of 7/22 with pending results for a “sickle cell screen” but no Hb electrophoresis.  Jamaica is in the midst of a hospital outbreak with Klebsiella and Serratia which has resulted in the death of 18 infants and many more infected. This seems to have resulted in multiple hospital inspections by the Health Department and results have been released but I have yet to read them. Hand sanitizer is hard to come by. Ear tips are washed and reused. The examination table sheet is only changed if absolutely necessary (I’m pretty sure this one would make the Health Department list of no-no’s. Available medications at the hospital pharmacy consist of a list that fits on two notecards. The wards are open air (and hot!) but thankfully the EDs and most of the clinics are air conditioned. Doctors do all of their own phlebotomy and IV cannulas, without EMLA or the papoose method, which makes for a very combative child. In contrast to this, accommodation at Couples Resort is lovely and comfortable. I’ve spent my weekends diving and relaxing on the beach, and trying to get used to being called “My Lady.” The hotel staff are lovely and the food is great. I actually feel guilty coming home to this after spending my days amongst patients who clearly have very little. Diane has been in town with some of her team and it’s been great to learn about the Issa Trust Foundation and everything that they have accomplished. I’m looking forward to seeing what my next two weeks consist of!

For me, having grown up between Liberia and Ghana, Jamaica, while new, feels very familiar. From the lush green countryside to the old British colonial architecture in the small towns, it could have been transplanted from any of the British commonwealth countries that I’ve ever visited. Nevertheless, the beauty of this new familiar could never be lost. Driving along the main road with rolling clear blue waves to the left and rising rainforested mountains to the right is not a view one easily tires of. The resort, with the open air layout and, beautiful beaches and crisp white walls is just as beautiful as the country.

Today was my first day on the job. It was definitely also a day of an emotional roller coaster. I woke up energized and excited, anticipating the day ahead. I met the spin instructor and we worked out together before showering and grabbing breakfast. I wasn’t sure what to load up for lunch and decided to make a trail mix of cranberries, walnuts and sunflower seeds and grabbed an apple and orange. I wasn’t quite sure where to go or what to do when i got to Port Maria Hospital, but everyone was so nice and willing to help me around. My driver, Mr. Munsey was the best. He pointed out things along the drive, had conversation about the healthcare system and how things work, and once we arrived he showed me to the pharmacy and walked me around to make sure I was where I needed to be. I met the OB attending who gave me a tour and helped met get situated. It was awesome to have my “own” office where I could set up shop with the computer and get started for the day, but before I even sat down, I was presented with a stack of four dockets. I definitely hit the ground running. I was basically left to be a pediatric ER attending- all of the pediatric cases were left to me. The decisions were mine. Of course I could ask questions if need be, but otherwise I was in charge. Before I finished the first patient, I was given a stack of two patients from clinic and another two from the emergency department. I had a hard time even figuring out the charting system- was I supposed to write notes? if so, where? why did some patients have a slip of paper with vitals recorded and others not. Lesson learned: if in doubt, ask. It may take extra time, but thats what you do when you are learning. The nurses in the emergency department are awesome with helping out with anything. It wasn’t until my fourth patient that I saw who had notes from a previous visit did I realize how notes were completed- of corse at this point I realized I was behind for the day (especially since I didn’t start seeing patients until noon!). The dockets kept coming in- nearly 20 in total for the day) I saw the line of patients growing and felt bad for making them wait, so I just kept going and seeing patient after patient without paying attention to the clock. Visits seemed to take a while longer than normal, and part of that was really just trying to figure out which medications are actually on formulary and writing prescriptions by hand- something I only had to do as a medical student! In addition there were some things I just wasn’t used to. My first prescription for amoxicillin- formulary states that they have amoxi-clav 457. What is that??? I quickly learned that 400mg amox/57mg clav per 5mL is just 457. You realize the things that you don’t really have committed to memory when you are used to the computer screen popping up an automated prompt with dosing, frequency, and duration almost as soon as you enter a diagnosis. As the day went on, I quickly got the hang of things and again didn’t notice the time until Mr. Munsey came to pick me up. I had no idea time went by so quickly! I still had 10 dockets waiting for me and still had an incision and drainage to do and the lab told me they couldn’t collect blood from the infant I was seeing and that I would have to do it myself. With the patients waiting and all that needed to be done, I wouldn’t even be done charting in time. Lesson learned: be aware that everything you do does in some way affect someone else. I don’t mind staying late and going over the “scheduled hours.” Not once did I stop to think that poor Mr. Munsey who was supposed to drive me home at the end of my shift had his own shift which was supposed to end at 5pm. I tried to figure out how I could hurry through things when I was told that if I don’t see the kids they could always return on monday when I am back. MONDAY!?!? Thats nearly a week!!! Of course I was later informed that the ER docs can see patients, but at the time, I thought that the patients just wouldn’t be seen. I completed all that I needed to do- the blood for the patient (that eventually clotted because the CBC machine was broken), the BMP (which wasn’t resulted after 5 hours because that machine was broken as well), the incision and drainage of the abscess that drained more than 15mLs. Of course there were many questions- how many tests that I NORMALLY order (because it is routine or the cultural norm at my home institution) are actually necessary? For the UTI that I am treating based on urinalysis and symptoms, do I really need the culture as well? If I order something that isn’t going to be back today, who will follow up on it? and how exactly are things followed up? As should be expected at this point in my career, I found that the “quick and easy” visits seldom are such, and had to find out how to call a social work consult and my role in contacting police as well as the OCR (office of the children’s registry). I finally wrapped up the last patient and although I felt terrible for how long some of them had to wait, everyone seemed very appreciative. After feeling like I am burned out and “over” residency, I felt excited about medicine again, about my ability to see, diagnose and treat. To decide what is best for the patient, to truly manage the situation. One other thing I feel: exhausted! I really would like to fall asleep right where I am, next to the pool staring at the brightest stars I have ever seen while feeling the breeze of the ocean and listening to the blues band playing on the main stage and all of the happy couples around the pool dancing. I look forward to an amazing night of sleep before an awesome second day on the job!

Hello readers, I am a new addition to the Issa Trust this month, your doctor du mois. I am visiting from Boston Children’s Hospital where I am a senior resident in Pediatrics. For supporters and future volunteers, I hope that this glimpse into the journey is enlightening and entertaining.

For the past near decade, I have wanted to get back out into the field. I first wanted to be a physician as a child, but I fell in love with medicine in Sierra Leone. I lived in Freetown and on the border with Liberia for 3 months, working and living in various hospitals as a non-medical professional, before starting medical school. What I saw there propelled me through school, from a nonchalant undergrad to a ravenous medical student. Fast forwarding through the next 7 years of training, the Issa Trust has given me an opportunity to be the person I wanted when I set out on this journey. I am ever grateful for the logistical help, transportation support, and incredible accommodations. It is was you expect–a wonderful place to stay.

Before coming down here, I was the senior on service on a busy ward in Boston’s urban medical center in January. In fact, the weekend before I left, I admitted a child returning from Jamaica (we don’t have a large Jamaican population in Boston) with typhoid fever. I didn’t have much time to plan ahead or go to a travel clinic due to the season and service, and I hadn’t planned to take the typhoid vaccine… needless to say, that changed about 2 days before leaving and I scrambled to find a way to transport a refrigerated vaccine in my luggage. I tell that story to say that, I was very nervous about the tropical medicine component of this month. How was I going to recognize dengue from mono, gastro from typhoid? I started reading the Oxford Handbook for tropical medicine on the way down, and that made me even more anxious! Not only is it recommending management of dehydration that is way different than my training, the meds and abbreviations are different! What’s co-trimoxazole and why are they recommending it for everything I would use bactrim for (which isn’t much, honestly).

Then I started at Annotto Bay. It was newborn day, the day where every baby born there gets to see a pediatrician, and I decide if they need to be seen by Pediatrics (or Paediatrics here) or can by followed by the generalist in the community. This is a relatively new program brought about by Dr. Ramos (the community pediatrician). But, gee, I don’t know. How do I know what they shouldn’t follow when I’ve never met them? Well, my first patient of the month wasn’t any of the things that I feared–he wasn’t a baby with a subtle defect, or a child with a tropical disease that I might miss. He was a child with Trisomy 21, a seizure disorder, FTT, likely autism, developmental delay and a surgically repaired VSD who came for hospital follow up after starting valproic acid for seizures. Now we’re in my wheel-house! As complicated as the patient could have been (and all the rehab services and other medicines I wanted to start for him), it really was quite simple. He was tolerating the valproic acid well, and he should be seen by Pediatrics (Dr. Ramos or YOU future Issa Trust rotators) in 3 months.

What an initiation! But, it was freeing to know that I know things, and that the medicine is the same.

It turns out that the problem is learning how to navigate the system. At Port Maria, I staff the A&E (accidents and emergency), functionally as a pediatrician working in a general ED. I see the all the kids, and I consult to the emergency physicians if there is a toxic child. I have been really impressed by some of the Jamaican physicians at Port Maria. They have been very helpful, and are knowledgeable about pediatrics. Of course, they are also very busy, and there are times where decisions just need to be made. The tricky part to me right now is knowing who needs to be admitted and who can go home. It’s a challenge for any pediatrician, but it seems extra difficult here. Do I admit the asthmatic who I think will space to every 2.5 hours? I would in Boston, but I know that they will probably be fine even if I sent them home. It turns out that the hospital stays for asthmatics are days long (not the 24-48 hour turnout I am used to), and that’s quite a stay to commit a child to just because that’s what I do back home. Plus, the beds on the wards are side by side, exposing this asthmatic to all the gastro and other viruses on the floor, and their parents can only visit during visiting hours (they can’t stay overnight). Do I REALLY need to admit this asthmatic? Also, standard protocol is that all admitted asthmatics need an IV–and docs put in all IVs. Talk about making me appreciate my IV team back home.

Finally, it’s good to know that I am doing more good than bad (I hope). Today, I admitted a child to the wards with the most classic orbital cellulitis I have ever seen. By every guideline I know, she would have had a CT scan, ophtho consult, and admitted on IV antibiotics with possible drainage in the OR. Well, I know what antibiotics I should start, and what labs I should order. CT scan? $150 US dollars out of pocket for the family, which they can’t afford. Ophtho? Four hours away in Kingston at Bastamante Children’s Hospital. How do I know what Ophtho wants to do? Well, after talking the case over with the senior medical officer, Dr. Sloley, I found the phone number for the eye clinic at Bastamante. I even had a cell phone (provided by the Issa Trust), and gave them a call. We talked over the case and came up with a treatment plan and transfer criteria. I obtained labs, placed the IV (I’m getting better! I think) and admitted to the wards with everything laboriously hand written in the paper chart.

It’s a learning curve. But the medicine is good! It’s a great experience. It can be scary in all the ways that it should be functioning with minimal/no oversight. Considering that I will be attending in 5 months, this is extraordinary preparation. So far, I highly recommend this to any senior resident who wants to stretch their clinical boundaries, enjoy the sunshine (I recommend the winter in Jamaica), and make some friends along the way.

Ya mon.    

I can’t believe two weeks have passed already!  I feel like I can divide my time here into hotel life at Couple’s and life at the hospitals.  Here goes… Hospital life: a usual week where we visit Port Maria, Annotto Bay and Port Antonio hospitals.  Each hospital has different capabilities and resources and no matter how much time I spend there I still have a lot to learn and understand about the system.  Let’s just say I feel I’ve been spoiled by the resources available to me in the USA.  I’ve had a few stimulating conversations with local physicians and hospital administrators about the contrast in the medical systems.  If I see a patient in the US in the inpatient wards, clinic or ED, I seldom have to ask myself “do we have this medication/lab study/consultant here?”  I have to ask myself this question after nearly every patient encounter here in Jamaica.  No matter how nice the people here are to me and let me know of their appreciation of my help, above all the system here is limited by funding and supplies.  I feel the staff are very competent and driven but can only do so much with a stethoscope, an examination, basic labs and a handful of medications.  The cases continue to vary: a lot of URIs which the locals curiously (I think) call “belly colds”.  The first few times I heard that I focused on abdominal exams but quickly realized it’s probably an issue neck and above.  Some parents seemed to be disappointed if I don’t prescribe Amoxicillin or Augmentin for every minor infection.  I try my best to explain the viral origins of disease and antibiotics contributing to resistance but this is falling short. Medical cases: I had a child with a febrile seizure while I was evaluating her in the ED.  At the time she had a “fever of unknown origin” and let’s just say the extensiveness of the workups differ from what I am used to.  There was a great physical exam on a 7 year old with a palpable thrill and what I think will end up being a septal defect that will end up requiring surgical repair.  I also had the usual broken bones that require casting.  We had a child who was not compliant and wouldn’t sit still during xrays for her broken arm and she had to be sent to a hospital further away for sedation (wasn’t available where I was).  I witnessed a lady die from a probable massive stroke and subsequent ACS in the ED.  She arrived with stroke-like symptoms and deteriorated quickly.  We didn’t have much in our hands to help her with in the ED.  It was very hard for me to stand by and not have any tools to intervene because back home a CT head would’ve been done (no CT machine at this hospital), several stat labs, stroke code would’ve been called with the near instant arrival of the neuro team etc.  The outcomes may not have changed but the inability to “act” is so difficult for me. Resort life: I can’t complain, the resort is amazing and I’m spoiled.  The people as usual have been great and very friendly.  I’m probably up to fist bump #347 already.  I unfortunately sliced the bottom of my foot on a sea shell that cracked playing volleyball and I have a new appreciation for the healing process for foot wounds (they don’t heal like your arms!).  The weather has been “terrible” by tourist standards meaning it’s been windy, rains several times a day and has been cloudy.  We’ve had a lot of seaweed and kelp wash up on to the beach and I had a ‘well duh’ moment because it was a nice reminder that beaches don’t naturally clean themselves, they require maintenance.  I still love it because I can wear t-shirts and shorts and am not defrosting my car windows!  There are some grumpy tourists and I think they easily forget a vacation with your significant other should be about spending time with him/her and not just constant sun!  Having said that, many of these tourists are much happier by evening and I’m sure Red Stripe and rum cocktails play a role here 🙂 Jamaica: I look forward to the drive along the coast to work every morning, what a scenic route!  Jamaica is so mountainous and it makes for stunning views from the coast.  I have spent way too much of my life in the urban jungles and that’s likely why such drives amaze me so much.  I want to venture out of the resort a little more and plan on doing a Kingston and Blue Mountain trip by the end of next week. These blogs and paper charts have also reminded me that I’ve become a terrible writer.  This used to be a strength of mine but after medical school it was all text books and staccato typed sentences in patient charts.  It’s time to revisit the art of penmanship.  

Good morning! My name is Ajay Grewal and I am one of the visiting US resident physicians through the ISSA trust foundation.  I would like to begin my first blog post by thanking the Issa trust foundation for this wonderful opportunity.  I truly feel blessed to be able to work with this world’s most innocent beings through a foundation with an outstanding but difficult mission.  It has always been a dream of mine to volunteer throughout my life in developing nations as a physician and this one week alone has only fueled that passion. A little about myself: I am a Canadian who is currently doing his residency at HCMC in Minneapolis, Minnesota, USA.  I am in my final year of residency.  HCMC is a county hospital and equivalent to a parish hospital here in Jamaica.  These hospital are safety-net hospitals that serve the underserved urban and non-urban populations.  I always felt because I work in a county hospital in the US working in similar hospitals with similar missions would be a simpler transition for me but that assumption was wrong! This week has been both amazing and challenging for me in several ways.  From the time I wake up to the moment before I fall asleep I have constantly been humbled by the people who serve this mission and respect it.  My stay at Couples has been fabulous.  The resort is beautiful with a serene and peaceful ocean back drop.  There are endless activities but after a day of work I enjoy nothing more than grabbing a book in the evenings or just talking to the staff and getting to know them.  The staff at Couples Tower Isle are either great at smiling throughout their shifts as a prerequisite to their duties or are truly happy and appreciative folk (I favor the latter!).  They are incredibly respectful people who will go out of their way to assist me for the tiniest of tasks.  Their enthusiasm is infectious and they respect us visiting physicians so much I can say without hesitation I am not this deserving!  From my walk to morning breakfast to when I arrive in the evening, any uniformed staff I see will either say “good morning/evening”, “hey doc! *fist bump*”, “how was your day sir?” or “Ya mon you good!?”  I love it!  This instant connection between complete strangers is such a refreshing change from the world I come from where we often don’t even make eye contact with those we walk by in the hallways. Thus far I have visited all three hospitals/clinics at Port Maria, Annotto Bay and Port Antonio.  It is no secret that for visiting physicians the biggest challenges are adapting to a new health care system, working with paper charts (I can’t remember the last time I had written in a chart!), not knowing what medications are available, and being exposed to unfamiliar illnesses. I will never forget walking out of my villa Monday morning to find my driver (Steve – awesome man!) and head to Port Maria.  As I shut my door the first staff member I encountered in the front said “Doc is there any treatment for Chick V?”  I of course did not know what this was but soon figured out he was referring to the Chikungunya virus.  I had heard about the arrival of the virus in Jamaica but was unaware of how prevalent the illness had become until I arrived.  The poor man had obvious joint pain and discomfort and I felt terrible telling him “there is no cure friend, but I brought some Tylenol and that might help with the pain”.  I was a little nervous because I honestly had no idea if NSAIDs/analgesics were very effective and was afraid I’d disappoint the man.  I ended up giving him some and the next morning he was all smiles and told me he gave a bunch of the Tylenol to his neighbors who were also afflicted.  He was so thankful I couldn’t believe it – all I did was give an over the counter pill.  I now understand the locals appreciate gesture and goodwill as much as positive results.  I myself am nervous about contracting the viral illness but if an entire country has lived through it then what am I – I’ll be fine!  I find if I remember some of the endearing names for the illness I’ve heard I can lighten the worries.  I’ve heard Chik-V, chikun bit me, chikun got me, think I even heard chikun-gonorrhea once. I have absolutely loved my drives to each hospital/clinic along the coast line.  I’ve spent my entire life in industrialized urban concrete jungles so to me these AM coastal drives with mountainous terrain to my right and stunning blue ocean to the left is a novelty.  The drivers have been very patient, respectful and great conversationalists.  Most of what I about Jamaica are through these stand up gentlemen.  The roads are winding and I’m used to multilane expressways so my vestibular system has been tested but I have persevered without medication thus far. I can go on and on about each hospital and the people I have met there and I’ll speak more in later blogs.  I will say this: with limited resources the staff do a lot and have a very positive outlook.  A huge challenge for me has been knowing what to do with the resources that are available, what kind of cases are hospitalized here vs back home.  A luxury I have In the US is knowing that if there is diagnostic uncertainty with an acute illness, I am assured it is not very difficult for the parent to return to clinic for a follow-up and reassessment.  This is a challenge here as many of our patients either walk or travel distances to come to these hospitals so I am trying to do as much as I can in one visit.  I do want to thank all of the hospital staff from the registration folk, nurses, MDs that I have encountered.  Dr. Ramos, Dr. Ravi and Dr. Brown have been very helpful and have helped me feel comfortable in an unfamiliar setting for me. Coolest case of the week: asides from Chikungunya illnesses (new concept for me) I saw a child with Grave’s thyrotoxicosis in clinic and referred her to university hospital.  It took some education and diligence to convince the mother the child needs to go to Kingston but I think I got through to her.  It was a classic Grave’s case and maybe I’ll present it at rounds next week. I’ll post pics soon! Thanks all, respect!   Ajay

  As I sit in the doorway of Couples Tower Isle, the wind blowing through my hair and the sound of the waves hitting the shore, I sit and reflect on my time here. I have been blessed beyond words to be able to be a part of the Issa Trust Foundation. 2014 was my 4th medical initiative and words cannot describe the utmost joy this 2 week trip brings to my life. Each year people ask me to describe the trip. One cannot describe this trip until you have lived it for yourself. I dont really have that one “ah ha” moment that I can talk about because each trip, each day becomes a memory etched in my heart. Each smile, each hug, the graciousness of the Jamaican people, and the feeling of the kind human spirit that flows through all humans no matter where our “home” is. That is what I leave here with the feeling that every mother, father aunt, uncle, and grandparent wants their child to be healthy and loved. Over the time I have spent here, I can see a substantial difference in the overall health of the Jamaican children. I remember that after I drew a hemoglobin level on a teenage girl, the level was low. I told her to eat more calaloo. I was able to draw her hemoglobin again this year, her number was substantially higher. She says to me “I remember you, and I listened to you. I have been eating my calaloo. I dont like it, but I am eating it.” Not only is the community of Jamaica so warm and friendly, but the staff at Couples Tower Isle make you feel like you are family. Each day, each person greets you with a warm smile. After a while, they all begin to call you by name. I was walking out to the boat dock, I heard “nurse, nurse!” I looked over and a employee at the watersports area says, “Welcome home, nurse!” Yes thank you my friend, I am home. So I am thankful for my time spent here. I am looking forward to more smiles, more hugs, more “welcome homes” and most of all looking forward to making more children healthier. Because one must never forget, these children our the future and we must always take care of them. So if you have the time or money please help the Issa Trust Foundation in their goal of helping the children of Jamaica become healthier. You will be rewarded in ways you never knew. I tell my friends and family back home that I go to Jamaica to help others, but every time I come back, it is I, indeed who has been helped. Kerri Cook, RN

We look around and see heroes among us.

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We are thankful for the opportunity to work alongside the general practitioners and pediatricians here. It has been a privilege to partner with you and to learn from each other. Thanks especially to Dr. San San Win, Dr. Iyer Ramos, and the hospital administrators who helped coordinate each day. Thank you to Dr. Candi, Dr. Min, Dr. Rico, Dr. Slolely, Dr. Ravi, and the many others who patiently helped us navigate hospital admissions, referrals, and the daily ins and outs of the medical system.

We appreciate the kindness of the Couples Tower Isle Staff at the resort and the Ministry of Health drivers on our daily commute, making us feel welcome and teaching us about Jamaica—its culture, music, food, language, values, and so much more. We miss your smiles and warmth already.

We are inspired by Diane Pollard, who shared over dinner the story of her dream and its reality in starting the Issa Trust Foundation.

We are indebted to the families of our patients– for entrusting us to care for their children.

We value our young patients and the chance to intersect with their lives.

We give thanks for the opportunity to be in Jamaica.

And as we return to the States, we consider for ourselves… How to continue to engage the world around us? How to respond to the poverty, economic inequality, injustice, and violence streaming across the headlines, in other countries, in our nation, and in our very own city? What to do when it hits us between the eyes? It’s a small, uncomfortable feeling, but one that grows with the truth that life is short and that we truly should live, not merely exist. And we remember the words of Mother Teresa: “Not all of us can do great things. But we can do small things with great love.”

So we seek to continue to respond with love—by doing small things, the hard things, and thus bringing hope for the future. We hope that you too are inspired.

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A sincere thank you to the Issa Trust Foundation and all who support its work.