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Friday, April 19, 2013

Post #132....P.S. Jamaica I love you

This has been a remarkable three week experience.  I am amazed, honored and humbled everyday when I put on my stethoscope.  Funny story from Rena's first day at Port Maria, there was a 5yo F w/ severe genu varum(bow legs) which had required surgical intervention with external fixation pins still in place.  She refused to believe that our fantastic Dr. Chandra was a doctor.  The reasons she listed were that her other doctors didn't have eyelashes or long hair, her mother simply corrected her by saying but "ah but she has a stethoscope."  The respect with which we are given by our patients, the staff, the nurses and other physicians by simply wearing our stethoscopes is humbling.  I am greeted with "Yes, doctor." Which is extraordinarily formal to me, but to decline would be disrespectful.  I accept it and work harder to earn the privilege.

I know I shouldn't pick favorites but I will likely always cherish my Annotto Bay experience the most.  Coming back for my third week, I am finally feeling familiar with my surroundings in both the pedi ward and the A&E.  I have been able to orient Rena to the general jist of our day to day activities, and I continue to watch our favorite 24wker grow.  She is doing fantastic, almost up to full feeds.  

In regard to the medicine side of things what I learn is heat + asthma= a full A&E experience.  I was able to care for a fantastic 13yo, who had instead of telling her family about her difficulty breathing been sleeping with her inhaler for the previous two days.  It was a good teaching moment of reviewing proper use of her inhaler, and why we shouldn't ignore the warning signs of an asthma attack.  It is clear that the dilemma of transitioning the care of adolescence with chronic diseases is an international weak spot. I think the most valuable things I bring with me on a daily basis are a)my brain b)stethoscope c)otoscope and d)portable pulse oximeter.  We just stumbled upon this delightful pulse oximeter which was hidden away in Rena's computer case, it has been key in my management of the various wheezers. 

Out at Port Antonio today, we met a Swedish pediatrician who was also visiting the region.  We were able to share our experiences.  I think our common theme is that here, or any third world, clinical skills direct management and he reiterated the value of a good physical exam.  The ability to share these experiences is just amazing.  My experience here has made me more thoughtful with my lab ordering and mindful of medication selection.  I will likely post again before I leave, but if I don't this has been phenomenal.  

P.S. Jamaica I love you

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