First Week’s Lessons


It has now been a full week of working and living in Jamaica and I’ve learned a lot, both about medicine in a resource-limited setting and about life in Jamaica.

My approach to medicine here is quite different from what I do back home. In Canada, I do my history and physical exam, create my differential diagnosis, and then order investigations to confirm the diagnosis, usually before proceeding to treatment. In Jamaica, I do my history and physical exam, create my differential diagnosis, and then treat whatever I can based on the limited medication options that are available.

Investigations are hard to come by here: other than the basic CBC, renal and liver panels, urinalysis, and X-rays (some of which are only available in the “bigger” local hospitals), I don’t have ready access to things like cultures and sensitivities, ultrasound, CT scan, interventional radiology, and MRI (they actually laughed at me when I mentioned that MRI is better than X-ray for diagnosing osteomyelitis).

“Free” healthcare in Jamaica is not the same as free in Canada. A lot of medications are not available at local hospitals which means families have to pay out of pocket at private pharmacies. Likewise, an abdominal ultrasound costs approximately 6000 Jamaican dollars (about $60 USD), which most families can’t afford. Even having a family doctor is not included in government-funded healthcare. Thus if my treatment recommendations include anything not provided by the local hospital, my patients will simply not do it.

Without these tools, I find myself treating patients for conditions that I’m not even sure they have. But it’s the best I can offer them with what’s available. Sometimes, it is unsatisfying: I miss that feeling I get when I know exactly what is wrong with a child and can offer definitive treatment.

I have also stopped asking about animal exposures because all of my patients are regularly exposed to dogs, chickens, lizards, and goats. Heck, so am I. At any given time, a stray chicken can be seen waddling across the hospital corridors.

Other lessons I have learned this week include the following:

If you don’t tilt the shower head just so, you will flood the entire bathroom and all your things in it.

The incessant “weet weet” sound that follows you from dusk until dawn is actually the call of the Jamaica tree frog. This lesson was brought to me by my husband who was amused by the mystery background noise present in all of our Skype sessions.

If I am in a car full of Jamaicans, I will be the only person wearing a seat belt. This is mildly terrifying given the nature of their driving (see previous post for full details).

The little island across from the resort, of which I have taken innumerable beautiful photos, is actually an all-nude island.

Things I have yet to learn include:

Understanding Patois, the version of “English” that Jamaicans speak which incorporates local phrases and slang.

Not feeling completely awkward as the only solo person at a couples resort.

How to set free the tiny lizard that is still trapped in the living room.

Favourite food of the day: pan-seared snapper!

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