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Sunday, January 22, 2012

First 2 weeks!

To introduce myself, I am Amy Westman, pediatric resident from Kaiser Permanente in Oakland, California. I am now 2 weeks into my month long rotation here in Jamaica! I decided to come here for my global health rotation because a couple of residents from my program had already some here and had told me what a great experience it had been for them. Hi Thao and Chung!

I am having a great time here and learning a lot! What a 2 weeks it has been! Its been hard coming from working in the American medical system to working here in the Jamaican medical system, but it is getting easier everyday. I've had the opportunity to see many patients and work with many wonderful physicians here. Our goals as physicians both here in Jamaica and back in America are the same, to do what is best for our patients, we just get there in different ways sometimes.

My weeks begin at Port Maria Hospital in the clinic area. Here generally kids that have shown up for regular clinic that day get funneled to me, or are sent from A&E (the ED), lots of general complaints. The first patient the A&E doc sent me was a consult to rule out leishmaniasis. What do I know about leishmaniasis? I work in California! So I said, "Give me  a minute," got out my atlas of tropical diseases, and read up quickly. Then I was able to say with some certainty that the child did not have leishmaniasis. But that's how a lot of my experiences here have been, learning through doing and seeing. I have seen the typical childhood problems that I see so often at home: asthma, eczema, otitis, pharyngitis, and cellulitis. I have also seen things that I have never seen at home, but now have seen several times and feel confident in my diagnosis, such as miliaria crystallina. So many babies at their well checks have developed it here, and at first I wasn't sure what I was seeing, but after looking it up on the internet (at night after clinic - no wifi or computers there) and seeing it over and over again, I can now confidently tell parents what it is and offer reassurance.

I am also visiting Annotto Bay Hospital in the middle of my weeks. There I see patients and participate in ward rounds, as well as being in the pediatric clinic where I see kids with problems that are followed by the pediatrician there, Dr. Ramos, and the physicians working there with pediatric experience. More asthma, anemia, and some follow-ups post discharge from the hospital. On the inpatient side the majority of the patients I've seen have been neonates with suspected sepsis or risk factors. Since it is very difficult to get cultures here (they must be sent to Kingston and most of the time never make it there due to transportation problems or make it there too late to be useful for making treatment decisions), most babies with any suspicion, those who would bet a 48 hours rule out in the states, get a full 5 day course of IV antibiotics and then are sent home on orals.

On Fridays I make the 2+ hour ride (thanks meclizine!) to Port Anotonio Hospital in the parish of Portland, where I visit the wards and then go to clinic. Here they do not have a pediatrician at all, but the general physicians round on the patients on the ward.

In general, most physicians here have been very helpful in offering assistance with navigating the health system here. Where a specialist is available, what days they have clinic, etc. I always have a lot of questions!

There are so many interesting cultural things to be learned as well. I quickly heard about black dressing, which is tar based (but I'm still not sure of its other components), an all purpose salve for infections and the like. It took me a while to figure out what the mothers were talking about when they said the baby had "coal" (not sure how they spell it!) in his emesis or diarrhea, now I think they mean mucus. I ask my patient's parents a lot of questions about things like this as you can learn so much from them about attitudes toward health and nutrition and home remedies used.


When you have off time, which is every night and the weekends, it is wonderful to be at Tower Isle where you always have great food and entertainment, and can always relax on the beach and read a book, as I so often do after work. There are so many opportunities for trips outside the resort if you wish to join them. It has taken me a while to get used to people serving me everything and always asking me if I need anything here at the resort, but its a nice time to relax and enjoy you're time off. A sincere thanks to the Issa Trust Foundation and Couples for giving me this opportunity to come and serve the children of Jamaica and learn so much from the people and my patients here! It has been amazing thus far, and I am so looking forward to my next 2 weeks with the adventures and learning opportunities they present.

Stayed tuned .  .  .

1 comment:

  1. Bless you Amy for your courage and passion to help and learn.
    I read your BLOG with interest as my daughter is a Pediatric Nurse here in Lincolnshire in England and has loved the job for over 17 years.I will be staying at Couples Negril late April/May if you are still there maybe we could connect for an update on how you are doing. I really believe in what ISSA Trust Foundation is doing and trust they will go from strength to strength!
    Blessings Eva

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