New Issa Trust Addition

 
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.    

Leave a Reply

Your email address will not be published.