Well it's time to start packing.  My time in Jamaica is drawing near to close.  Luckily I got to snorkel just once before the storm began 'again' today.  Tomorrow back in the air heading to Southern California where many things have been put on hold for two weeks ready to be attended to when I arrive.

Part of me is sad, I haven't been much help to the people here, or to the providers for that matter; though I saw as many children as I could, the parents and children still need more.  More time with the physicians to help them understand their child better, more accessible resources at low or no cost.  But I learned.  I learned people here still care about their patients and try to give them the best have and the best of themselves.  I learned that physicians use their own money at times to help patients get the interventions they need!

I learned that the Accident and Emergency department in Annotto Bay is expected to see more patients per day or they may have money taken away from them.  Which is hard to believe isn't it?  One of the last patients I happen to look in on who came into the A/E at Annotto Bay was a lady who had a previous Subarachnoid Hemorrhage, sent home, then told to follow up.  She didn't make it to her appt because she got a headache and began vomiting beforehand.  Her family brought her in as fast as they could, but she was unresponsive on arrival.  Wouldn't it be faster to have called an ambulance?  Nope, her daughter said that would have taken way too long.  As it was, Annotto Bay had to transfer this woman to Kingston because they can't even do a CT at Annotto Bay.  Talk about limitations.  Of course, what we take for granted in the US; 7 minutes response time for an emergency 911 call.  CTs and specialists to handle bleeding in the brain.  We would have the resources to possibly save this woman, but here she lives just too far away from the care she needed.  And then to have money taken from that system?  I hope those providers will be able to have a voice to help advocate for themselves and their hospital system.  I hope the people who understand the situation do too.  Ms. Meeks, thank you for all you do!

But overall, it was a good experience, I enjoyed seeing so many lovely newborns too.  Remember I told you they smile earlier than in the US?  You know what else?  It has been my experience in the US that babies allow a physician exam up to about 1 year and then they cry on exam because we are so invasive with tongue blades and etc.  But you know what?  I hardly had any 1 year olds cry with my exam, even with a tongue blade!  Simple things.  What is it?  The early socialization, the early care provided by many in the family or extended family?  I don't know, but it was a pleasant surprise that most children of all ages did not cry on my exam at all.  Maybe they were just taken aback by my very white skin! LOL! Whatever it was, it was such a pleasant thing to help in any tiny way to make some difference for just a day.

Many thanks to the physician team at Annotto Bay and Dr. Ramos.  Wish I could have been more helpful for you!  But I learned from you and I wish you all the best in your endeavors.  Thank you for all you do for your children!  You provide the best care even though you don't have all the fancy technology of an NICU!  Kids are resilient and they do well under your watchful eyes.

Take care all of you!   And to those at Issa Trust, my deepest appreciation for providing this lovely trip and experience!  Diane, my hat is off to you, thank you so much for all your advocacy efforts.  And Firas Rabi, thank you for all the work you have done with this blogI will look forward to working with you and Issa Trust in the future!

Traci Williams, MD

Port Maria was busy today, worked in the ED and saw a lot of stuff.  Remember the little girl with the potential UTI?  Her Mom did follow the advice given her and took her to the lab to get the work done and followed up today.  And lo and behold, she did have positive leukocytes.  So it's a good thing she followed through.  This is probably a case of the child wiping back to front, instead of front to back, so it probably does not need a further work up.  Just a little anticipatory guidance and all should be ok.

Then another boy stepped on a sewing needle that was on the floor, it broke off, and the sharp end was presumably still in his foot.  You could feel a foreign body, but you couldn't see it anywhere.  He was sent for xray and this story will be continued if he comes back tomorrow when I am there.  I don't really look forward to finding the needle in the haystack!

Another boy stepped on a nail and had a nasty abscess, he was none to pleased to have us touch that!  Let alone the tetanus shot he got, oh and the IV.  He had calmed down by then, and accepted his fate.  I don't think he really wants to follow up tomorrow with me, we will see if he does!

Stay tuned!

Suddenly it's day 5 and I don't know where the time went!  Annotto Bay.  Everyone was very nice and helpful!  Saw many little babies just born from a few days ago to a few weeks.  I love the babies, and I tell you, those babies are smiling before one month old!  Sooner I think than American babies!  Some babies in the US don't smile for 2 months, like my nephew for example!  But it seemed many of those babies were smiling at me and they were only 1 month old and even less.  Even some cooing from the barely 2-4 weeks old.  It's so nice to see that!  That means parental attachment and language acquisition has already begun in a good place.  So often times in the high risk population especially, those things like communication and attuned parenting is lacking.  We struggle to affect change in the lives of children, but we can't put back together the relationship very well.  And sometimes (more often than not) the success of treating the child is so dependent on the quality of the parent child relationship.  Costly in long term morbidities too.  But the early attachment, the early signs of social reciprocation of the parent child dyad is a comfort to the soul.  Brings a hope.

I know, sounds like a psychologist doesn't it?  Can't help myself.  As I treat more and more kids, the more I appreciate the importance of the relationship of the family and support it provides in child development of health and well being.  I know it really can be a challenge to take care of some of these complex kids!  Especially in a place where lack of resource is an all too common issue.  But when that nurturing supportive environment is in place for the child, prognosis is still good!  Children have that resilience.  Love to see that.

Saw one little girl who was accidently burned all over her face, scalp and chest with hot water.  Oh it was heart breaking to see all the facial color change and scabbing on the scalp.  But guess what, she was the most social child of the group in the peds ward!  She smiled at me and engaged in play with a teddy bear with me and she even would play and giggle to herself while she was not being attended.  So even though she has a terrific, horrific incident to recover from, her resilience was already in place.  Even though there will be some reminder physically for her always, as long as her support is stable, she will be just fine!

It's Day 3, 645am and I get a phone call that my driver is here.  Whew, was luckily almost ready anyway, but still a bit earlier than expected!  May have to do room service for tomorrow.  Crammed in some cereal and yogurt and off to Annotto Bay.  Met Dr. Ramos and Dr. Fisher and Dr. Blake and Dr. Ravi. They all asked me to send regards to all the ISSA doctors and nurses. Hey Firas Rabi, Dr. Ramos gives you a special high five! (he said you'd know what he meant).  They are all very nice!  They discussed some of the difficulties getting studies on the very tiniest babies in the "NICU"/Peds ward.  They ran out of pediatric culture bottles, so they go without getting blood cultures on the potentially critically ill babies.  Well I just happened to have the administrator of the hospital give me a ride home and I casually mentioned this issue.  I thought perhaps a little advocacy may be helpful.  She said she would look into it, I know she is very busy, but she appeared concerned and I hope follow up will take place.  Cross your fingers.  Yah mon.

As I took a tour of the facilities, I didn't realize Hurricane Sandy hit Jamaica pretty hard last year, especially Annotto Bay.  The Maternity Ward roof collapsed and damaged the building significantly.  They are now in recontruction of that ward and other places around the site.  Of course in the US, New Jersey, New York were also hit pretty hard by that Hurricane, billions of dollars of damage, etc, etc.  Wow, hurricanes really make for hardship long distances apart!

Day 2 Steve was right.  The driver said the people didn't know the doctor was here so they didn't come.  Well word got out through the grapevine I guess.  I was busy most of the day in the ED.  In fact the ED was filled with both adults and kids.  Most of it was the usual stuff, coughs and colds, wounds and abdominal pain.  Most of the parents switch to English for me, luckily, and then say something I can't understand to the child.  It's the doctors that are hard to understand LOL! For me anyway! 

One little boy came in and I heard him coughing in the waiting room.  It sounded like that tight asthmatic cough.  Luckily he came in early.....he was there all day.  Never had asthma his Mom said, she was surprised that his reaction was so severe.  He actually had to be admitted before I left, we couldn't clear him and he sat at 94% thoughout the day after several treatments.

Another little girl had a little burning "down there" and I had to send her to the lab because the dipsticks only check for protein and glucose......and then, the lab closed at 11am so we couldn't check for UTI!  Hope she can get it done.  Her mom said she had to work today and didn't want to take her out of school another day.  So another little medical drama.  What to do.  Treat her for UTI?  Or send her home with anticipatory guidance and lots of fluids?  You don't want to miss a UTI.  She wasn't wiping correctly so we gave her that info.  A few sitz baths perhaps?

Day 1 Port Maria, a beautiful coast line.  They call its location in "the country" compared to Kingston where the head doctor is from.....hard to get coverage there she says.  Too far away from civilization!  But the people were very nice.  Windy here and rainy yesterday, brings in the asthmatics.  A boy's teacher brought him in because he got short of breath in her class.  I thanked her for bringing him.....that wouldn't happen in CA where I'm from.  But for some reason that started an argument.  The doctor thought it was her duty to bring him.  The teacher said she wasn't supposed to bring him.....and on and on.  Oh well, no problem, as they say.  :) Day 1

Sunday Day 1 before Day 1!

Well here I am, ready to start working in Jamaica!  Took a minute to get here from Southern California, from a desert region to a lush green tropical area with a beautiful ocean!  Makes me wonder why I live where I do!  There was a thunder storm last night, but I barely noticed I was so tired.  Then to the River Falls where many people climbed the water falls!  I came dressed NOT to get wet, not knowing that the whole plan was to get totally wet.  So I stayed on the "mainland" until perhaps next week! :)