Wednesday reflections

Mid-week already, time seems to be moving at a steady clip. After Sunday's adventures in beach volleyball, I confess I was a bit sore on Monday. Nevertheless, I saw approx 25 patients at Port Maria. I've noticed a trend toward multiple diagnoses as everyone comes in with one chief complaint but then asks me to look at a skin infection or discuss a cough. No cases of Ackee poisoning for me as of yet, thank goodness.

Tuesday is Children's Health Day at Port Maria, which always signifies a busy clinic for me, especially after around 11 AM when most of the well-children have been seen for vaccinations. Several of my patients were referred from the nurse practitioner, generally for URI symptoms. I was thrilled to find that a patient from last week returned with completed lab work!

Today, I returned to Annotto Bay Hospital where the three young doctors were already hard at work seeing the 13 inpatients. The 25 week infant (I still suspect his gestational age to be closer to 28 wk) continues to do well and is now on room air. Sadly, the child we placed on CPAP last week died.

I greatly enjoy my trips to Annotto Bay and rounding with the team. Today, we discussed cases of likely and proven rheumatic heart disease -- a rare diagnosis at home. I also continue to marvel at how well staff handle the daily frustrations that come with working in a third world environment. Today, one of the younger doctors and I went to draw a blood culture from a child with likely meningitis (bulging fontanelle, fever) only to discover that there were no more blood culture bottles on the ward.

Tomorrow I shall return to ABH for clinic, then Port Antonio on Friday. I was asked by one of the younger doctors in Port Antonio to discuss fluid management based on their recent GE outbreak. Here, the mild-moderate-severe clinical appearance apply more readily than my textbook examples; I/Os are not generally monitored unless expressly written in the docket (chart), which is only done for the most ill patients and lab work, including electrolytes, may not return for several hours or until the following day.

In addition to Port Antonio on Friday, my fiance is scheduled to fly in on Friday for a weekend stay! I am very excited to try a few more of the resort activities and introduce him to some of the staff members. More adventures to come, I am sure....