Week 2: rain, volleyball injury, spoiled by the US system?

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.