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Monday, March 18, 2013

I can't believe its already been 2 weeks!!

Friday was spent back at Port Antonio Hospital.  Stevie and I decided to switch it up again-- her going to the A&E and me going to clinic.   I was really looking forward to the complex consultant cases Stevie had seen the week prior but unfortunately it started to rain again on Friday as well.  We were told when we first got here that Jamaicans don't like to leave their houses when it is raining and I think that must be true because I had my first slow morning!!  At home I would kill for a morning like that but with access to care so limited here, I was chomping at the bit for more patients so I joined Stevie in the A&E.  The rain didn't keep patients out of the A&E!!  Stevie and I both had a busy day seeing several common pediatric complaints-- viral processes, strep pharyngitis and a few lacerations as well.  I mentioned earlier how Jamaican physicians learn to rely on their history and physical exams more than anything else-- volunteering here is a wonderful opportunity to pick up on these exam skills.  I saw a 6 year old little boy with 2 days of fever, sore throat, headache and vomiting with no cough or respiratory symptoms.  He had large tonsils with exudate noted, a white strawberry tongue and even pastia's lines in his antecubital fossa--- I didn't need a rapid strep to confirm this was strep pharyngitis!  No lab tests were ordered and I was able to send him home with a 10 day course of amoxicillin and maternal education about keeping him hydrated.  I finished my day by seeing a newborn in the maternity ward that I was asked to evaluate because the mother was VDRL positive and meconium staining was noted at delivery.  In addition to this the infant was noted to be mildly tachypnic with nasal flaring so the nurses in the maternity ward had placed him on oxygen.  There is not pulse oximetry available in the maternity ward so we had no way to document exactly what his O2 sat was.  When I saw the infant (about 1 hour after birth) he looked well.  The differential included congenital syphilis, TTNB, Meconium Aspiration syndrome vs congenital heart defect.  The general physicians asked me how we handled meconium deliveries -- although the infant was improving they were planning on a gastric lavage to prevent vomiting.  I explained that we don't do that back home and explained our process for meconium at deliveries.  The 2 generalist and I then had a great discussion regarding congenital syphilis and what is medically indicated when mom states she was treated but we have no documentation of this.  It was a great learning opportunity for all of us!!!  Ultimately we decided to treat the infant with PCN until lab results returned and admit him to the peds wards for monitoring of his respiratory status.  Oh and we didn't perform a gastric lavage!!  I'm curious to see what happened with that little one when we return next week!

Friday night was the first night that we ate dinner at 8 Rivers which is the nicest restaurant here at Couples Resort.  We were treated to an amazing 5 course meal and wonderful wine!  We left stuffed but happy and spent the rest of the night enjoying the live music on a beautiful Jamaican night!!

On Saturday we were excited to spend the morning scuba diving but unfortunately the weather did not cooperate and we weren't able to go this weekend-- hopefully we'll be swimming with the fish next Saturday!  Jamaica is such a beautiful country even on a cloudy, rainy day so we were still able to have wonderful day despite the weather!!  We went back on the catamaran cruise in the afternoon and had another wonderful trip.   It was the same crew as our previous cruise and they all remembered us and treated us like old friends from the start.  We spent the afternoon laughing, dancing and enjoying being out on the ocean.  Even with the occasional rain showers, that is hard day to beat!! 

 Sunday was a beautiful tropical Jamaican day!!  After the last Saturday Stevie and I were well prepared with lots of sunscreen and we had a fabulous day playing in the ocean.  We even went kayaking around the island.  It was so much fun that we are already planning our next kayaking trip back home-- that or we're going to be on amazing race.  Do you think they'd give us time off from residency to compete?? 


We spent the late afternoon treating ourselves to a massage at the spa here at Couples Resort.   The amenities here really are too good to be true and the massage was one of the best massages I've ever had!!  I'd highly recommend it to anyone staying here at the resort.  After the massage we showered and got ready for another fun night with great food, good wine and live music.  Because it was St Patty's day back home we wore our green out to celebrate.  No green beers here in Jamaica but it was still a great night!!

I can't believe we've already been here 2 weeks.  I can't wait to see what the rest of this trip has in store...



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