Goodbye..what a phenomenal two weeks!


Hello…well I am back home stateside. Yesterday I said goodbye…for now to Jamaica. All I can say it was a wonderful 2.5 weeks. It was much more than I could have ever expected. As someone said it was well balanced….fulfilling work by day and peace, beauty and serenity by night. I think the best way to chronicle my experience is to do it by section….
1st impression:
 Well I have to say my first day began at Antonio Bay and was I in for a shock. My family is Jamaican and I have visited Jamaica many times since I was an infant and for some reason I do not think of Jamaica as a 3rd world country. However I realized how much it is a 3rd world country when I walked into the pediatric ward at Antonio bay. First all the babies and children are in one section…no separation for preemies (they would be in a controlled environment like a NICU here in the states) and regular sick children. The cribs were not of the best condition and were of different shapes and sizes. I guess you just have to see it to understand. On my way to the pediatric ward, I passed the maternity, women’s and men’s ward, and they were unlike anything I’ve ever seen. All the patients were in these huge room/wards with up to 20 patients in these wards. The 1stdays at Port Maria and Annotto Bay was pretty much the same.
Honestly I felt proud to be working with Jamaican children. I felt like I was giving back to a country of my ancestors. Most children came in with complaints of skin infections mostly eczema, scabies and fungal infections. There is A LOT of scabies. Not sure why…maybe it’s environmental…. Jamaica is a very lush, green island. And these kids came with chronic scabies infections. In some cases, due to scratching, they became super infected. I had to treat 2 kids with antibiotics due to super infection. In at least 2 cases, I could not identify the skin condition because I had never seen anything like them before.  In one instance I referred a 10 week old for a severe fungal infection to Bustamante for dermatology. There was nothing more I could offer.
If there is anything that frustrated me was the lack of readily available resources. You really had to work with what you had which wasn’t a lot in many cases. For example I had a child with probable pica. 1stthing I wanted to do was order a CBC to see if this child was anemic. But I knew that would be a waste because I would not get results quick enough and would probably lose the child to follow-up, so I just placed the child on MV with iron. And I guess I was a bit more aggressive with treatment than I would normally be because confirmatory tests were not easily available. I noticed this was done on the ward as well, when on rounds the GP told me he placed a child, who was admitted for bronchiolitis, on antibiotics because he was unsure if the patient would return for follow up i.e. a respiratory check. One child came into clinic with a questionable lung exam with some but really not impressive focal findings but in any case I placed him on antibiotics because I was unsure if he would come back and I couldn’t do any imaging. There was also a great deal of asthma, which for some unknown reason surprised me.
In terms of patient load, it ranged from say 8 kids to 15 or so. On one clinic day at Port Maria, I saw 20 patients during the morning session. In Jamaica, children are normally seen by a general practitioner not a pediatrician. Pediatricians are considered specialists, so if the patient guardian has a complaint, then they are referred to the Pediatrician if one is practicing that day.  In other instances the GP would treat the child.
What can I say…the ultimate in luxury. Couples lacked NOTHING. The accommodations were wonderful. The Issa doctors stay in a very roomy villa. We had separate entrances with our own bathroom. The living room and kitchen were shared spaces. Most time I stayed in my room and met up with the other doctor for meals or so. The staff were wonderful, kind and tended to my (and other guests) needs. If you are lying on the beach, there is a waiter there to take your drink order.  The food in each of the 4 restaurants is absolutely delicious.  I felt like I was dining in a 4 star restaurant every night. And since I am of Jamaican heritage, I was able to indulge in some of the islands traditional meals like ackee and saltfish, calloloo, and jerk chicken. Coming home to a place like this after a hard day’s work was perfect. It was just right. There are plenty of activities to partake in such as snorkeling, windsailing, glass bottom boating, shopping trips and trips to Dunns River.
I just have to say, this was one of the most memorable experiences in my medical career. This is the main reason why I switched careers from banking to medicine – to make a real difference in the lives of the underserved whether it’s here in our country or in other parts of the world. I chose Jamaica because it’s the land of my mother and father..and I still have many relatives that lived there.  I felt like a real doctor! In just about all cases I had to use my judgment without the assistance of a readily available preceptor. This is particularly helpful to me since in just about 3 months I will be entering the “real” world as a full fledge pediatrician. It did wonders for my confidence and gave me great experience. I wish more residence knew about this program.  It really offers the best of everything you would want in an overseas rotation.

Thank you Diane Pollard, the Issa Trust Foundation and Couples Resort for this extraordinary experience.

Randi B. Nelson MD

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