Today was my first day of work, which was at Annotto Bay Hospital. To say I got thrown right in would be nothing short of a gross understatement, but I somehow managed to get a handle on what I was supposed to be doing by the end of the day. Today was a chronic disease follow up clinic, so I saw a mix of patients with asthma, sickle cell, epilepsy,G6PD deficiency, Trisomy 21 and a few ex-premies – quite an impressive range, actually. I was pretty excited to see the sickle cell patients, particularly because I plan to pursue subspecialty training in pediatric hematology/oncology. (Not so) fun fact: there are no pediatric heme/onc physicians in the entire island of Jamaica. As hard as it is to imagine there being zero, it is equally difficult for me to imagine what it would be like to be the only one. Peds heme/onc was certainly not designed to be practiced in isolation, and the extremely cooperative culture is one of the reasons I am drawn to it.
So what exactly happens here? Turns out oncology patients are treated at Bustamante Children’s Hospital in consultation with physicians from St. Jude’s for protocols and such. Hematology wise, there is a Sickle Cell Unit at the University Hospital of the West Indies that will see patients for initial consultations, for vaccines such as Pneumovax, and for management of complicated cases. However both of these institutions are in Kingston, which means often significant transportation costs for patients’ families. So the majority of heme care takes place in clinics like the one at Annotto Bay.
The patients I saw with sickle cell today brought several issues to my mind, the foremost being the lack of universal newborn screening for the disease. Given the prevalence of the sickle trait in Jamaica (1 in 10 persons), about 1 in 150 newborns will have some form of sickle cell disease.* From what I can gather, only babies born at the University Hospital of the West Indies, Victoria Jubilee and Spanish Town Hospitals get their cord blood screened for SCD. All patients that I saw today were diagnosed after some acute illness that unveiled their SCD. The first was an 11 year old boy carrying a presumptive diagnosis of SCD (in addition to his diagnosis of asthma) after CBC on an admission for respiratory distress showed Hb 5.8 and subsequent sickle screen was positive. Another was a 3 year old girl diagnosed after an episode of splenic sequestration and yet another was an 8 year old boy who presented with abdominal pain, and had an appendectomy. His appendix was not inflamed after removal and subsequent testing showed HbSS, so it was likely abdominal VOC all along!
Overall it was a tough but exhilarating first day. I think my favorite moment was when the dad of the 3 year old (the only dad I saw in clinic today) showed me how he palpates his daughter’s spleen, and he was spot on! Yes, yes, yes – for so many reasons!
RH
* Info from http://www.sicklecelltrustjamaica.com/
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