MY LaST DAYS!!

Well its Friday night and 2 days before i have to go home and back to the reality that is residency... the good news is i only have 3 mo and 2 weeks of that...

Monday I found myself at Port Maria A&E, seeing a lot of URIs and fungal infections, big bites, AGE, ect. There was a 12 y/o male whom i was told that he had been diagnosed with Pneumonia about a week ago but the fevers have not gone away.. I began asking the mother a little more history and find out that he was given a 10 day course of amoxil, and she has been using paracetamol for fevers...on further questioning I was told that he had completed all 10 days... ( he didn't look half bad today), but some how mom pulls out this bag of pills to show me the exact name.. WHY where there 24 pills in the little baggie of 30.... SO i counted the pills infront of the mother and said there is no way he could have taken all the pills there are only 6 missing.. I turn to the young man and he starts mumbling.. LOL.. So i politely told them he needed to finish the meds completely to get cured... and explained ABX resistance... I hope it sunk in.. LOL.. this scenario is not unlike some i have run across in New Orleans... All in all i saw about 19 pt that day...Not bad.. NOT bad at all..

Tuesday clinic was off to a slow start, I got there at 830 , and despite my heading to the front a few times to ask about pts, didn't get my first pt until 11 am... BUT then it was PT diarrhea.. LOL.. they just kept bringing me 5-6 charts at a time... YIKES.. I saw a total of 27 pts this day... and I Was EXHAUSTED by the end of it.. Cases included the again many colds, a couple of scabies, some MS pain, need for deworming and the such.. notable case was a little girl with dysuria ( pain with urination). Whom, after a thorough history and physical, I had decided that she needed a UA/UCX... Now in the clinic there are no immediate access to labs, so i needed to send her to the hospital lab.. Mother came back in 10 min saying that the machine was down and she didn't have any money to go to an outside lab to run the test (this is sometimes needed for certain labs, or xrays).. I ended up treating for UTI but giving firm instructions to return to the clinic if it wasn't better in 2-3days..

Wednesday I went to Annotto Bay A&E, and saw quite a few gastro enteritis.. it seems that this is the season for it.. I think that i was told that the outbreak at Port Antonio had a few rota virus positive cases.. I hope that's not whats here as well... It seemed like every one was on ORS ( oral rehydration salts).. They do almost the same thing we do.. I put quite a few kids on PO challenge..I didn't have to admit anyone thank God. I think that their ( GPs) threshold for admitting these kids is quite low, so that they don't get behind the 8 ball. Again anti emetics are not an option.

I did have a teacher bring in a student with the complaint that he has asthma and he has a fever. So i asked if he was wheezing (NO), but has a little cough, How high was the fever (he just felt hot). HE looks very comfortable now..why r u here today? well I called his father and he said that every time he gets a fever his asthma acts up.. I had her call dad and try and get some more history from him.. he stated that he has had a slight cough but has been using his inhalers as prescribed but there was no wheezing or SOB at home and has maintained his activity level. After a complete exam showing normal Sat's, no fever, normal respiratory rate, and basically a lil boy siting there and just talking like he didn't have a care in the world.. I let them go.. I did give the teacher a talk on what to look for that would signify emergency, as I didn't want her to feel that she could not come back if there was a real problem... I think that is important.

We got off to a late start on Thursday due to a flat tire.... but made it to clinic in time to help out with a few of the pts.. saw quite a few asthma follow up visits, and then well baby visits... I gave all my new mothers the BACK TO SLEEP talk and again discouraged co bedding, reprimanded a mother who was giving her 2 week old glucose water?, and explained y this was inappropriate.... I have also noticed in the month I have been here, thermometers are not a household appliance.. ( maybe two people were able to tell me how high the fever was). I did try and encourage , especially new mothers, to buy one if they could afford it, as well as bulb suctions.. ( I did not however discourage them coming in if they felt like the child was febrile and sick...

Well our last week was likely the most fruitful.... we were able to say our goodbyes to all the docs we worked with, It was kinda sad...;-(. Its been a great experience and I would really love to do it again.... I Leave for NOLA on Sunday morning...there is not escaping that.

I'll see if i can pull out one more blog to give the new people some pointers and the I wish I had known tidbits...

off to bed I go...

Cannot believe the End is Near!

So I have been very poor at updating this frequently! My apologies!

I had a very busy week last week. Ended up admitting several children to the hospital, and the parent's weren't very happy about it. They tried convincing me that the kids were okay, and I almost relented, but my sixth sense kicked in and I admitted the children.

The first was a 1 week old baby with jaundice who was discharged home with jaundice and was supposed to follow up with me. The baby's blood type was known, but mother's blood type and Rh factor (rhesus factor, the + or -) were not known. So the baby was potentially set up for problems with having different blood types than mom. Mom was also breastfeeding, and the baby could have had breast feeding jaundice. The third problem was that mom told me that the baby was only breastfeeding about 4 times a day! When asked, the mom said it was because the baby was sleeping the rest of the time. After I raised a stink, the mom started to change her story saying she was feeding more than that... but I just couldn't risk it. The child was admitted and had labs drawn... better to be cautious than cavalier about that.

The other was a 12 year old asthmatic with an exacerbation. He had several nebulized treatments in the A+E (accident and emergency, our ER) and said he was finally feeling better. However, his mother was not going to be able to fill his prescriptions until the next day, so he would be going home without any albuterol or his needed steroids. I had to draw the line and say that when mom got his meds filled, he'd be able to go home the next day, just didn't want him getting home and the exacerbation getting worse.

I've seen a large portion of run-of-the-mill respiratory infections. Rotavirus has hit Port Antonio, and it looks like it's spread to Annoto Bay and Port Maria, as I've seen an increasing amount of acute gastroenteritis.

Still occasionally have some problems understanding accents, but I think I am getting better.

on Friday I gave a small "lunch and learn" presentation on asthma exacerbations and management of asthma in the acute and chronic settings at Port Antonio. A lot of the doctors and nurses from the peds ward were there. They asked great questions and seemed to enjoy it. I hope it was useful. They did ask that the next group prepare some topic dealing with nephritis/nephritic/nephrotic syndrome, as they've seen an increase in those patient's recently.

I would definitely recommend to future volunteers to get a presentation done before you come down!

Will try to update later this week.

LAST week

Good day,
It is the begining of the last week... I am not yet gone and already I dont want to go home.. LOL.. I cant belive how fast the month went.

I am looking forward to the last week. we will do two days at Port Maria, and then two at Annotto Bay..

Last wednesday, We waited an extra 45 min for out ride to Annotto bay. I was assigned to the PD ward where they are having an out break of AGE. (similar to Port Antonio last week, they also had a couple of pneumonias, and a kid with seizure ( likely due to DPH either overdose or withdrawl)all of which were doing well. Rounds ran for about 4 hrs. Then i went down to the A and E to help out...

Annotto Bay was mostly well baby clinic, and a few asthma visits...Had an early day and made it back to the hotel in time for step class..


Friday... oh friday...The clinic at port Antonio is a lot slower than Annotto Bay or Port Maria, but we basically see the same kind of patients.. Follow ups from hospitalization, URI, Stomach pains, sprains Knees, and poor appitite ( the lil boy was > 95% for weight). My colleague Dr Gleason was able to give his Presentation which I think was beneficial to the staff that showed...They asked a lot of relevant questions and we were able to compare our management techniques...

Had a great weekend and look forward to my last week here.... Of all the sites we have been privileged to visit.. I feel the most useful at Port Maria...I hope that they will be able to get more help especially in the pediatric department... until then they are very thankful for us helping out.. I hope we are able to continue filling that void with pediatric residents until that time...

well i'm off to bed...
good night

TUES

Hope every one had a great v day...

I did... not cuz I was celebrating valentines or anything, but I found yesterday finally my Air Force assignment... YES... for those that dont know I am a Captain in the USAF.. I was waiting patiently for them to tell me where i would be stationed after i finish residency... SO i was extremly happy to find out i'll be at Tyndall Airforce base near Panama city FL.. SO YEA ME!!!! Best news for me since I really didnt want to get stuck anywhere cold like Alaska..

OK well enough about me.. thats not what yall come to read about..

We made it TO Port Maria hospital and I took the Health Center duty... I started seeing pts almost immediately.. today the illness de jour was URI... LOl... i'm getting good at this.... I have still not given one person antibiotics for this yet... And I have been able to hold my ground on not giving Cough syrup to babies and young kids... AND you know what.. when you explain it to the parents they really seem to understand and actually dont even get mad... LOL.. Now I dont know if they leave my room and go next door and ask the next doc for ABX/cough surup... BUT I feel good that I can ? reach them....

CAse of the day:
9 mo old with SCABIES every where, between toes, fingers, on face in neck folds.. etc... the Kicker is that she was seen by jessica last month and prescribed permethrin.. However when she went to the pharmacy she said they gave her RID ( not permethrin) and she did use it.. infact she used it three times... She was fustrated and said the "bumps" never went away and maybe even got worse.. WEll what to do..... I gave her a bit of a lecture on scabies and told her that the bumps and itching may last 2 weeks after treatment...BUT new bumps.. I decided to re treat her and gave her strict instructions to wash all clothes and bedding with HOT water...( even toys that she plays with).. TO make sure to ask the pharmacy to give PERMETHRIN, If they didnt have it to BUY it at a local pharmacy. (the hospital phamacy has a limited formulary).. The child had been scratching a lot as well so i gave Rx for a minimal dose of benadryl ... I Also told her to come back next week monday when we will be there so i can reassess her... SHe is too young for Ivermectin so I'm not sure what the next step would be... I have some reading to do.. hmmm

well tmrw we go to Annotto bay.. I will be in the wards.. looking forward to see what intersting cases await..

ttyl

Monday

Howdy yall, And Happy Valentines day if ur into that kind of stuff

Hope you all had a great weekend.. I Know i did... Went horse back riding on Sat.. Didn't get a chance to learn wind surfing. cuz there was nooo wind.. kinda a necessity...LOL.. got in some R&R.


Arrived at POrt Maria A&E ready for business at 830ish... But however, did not see my first pt until 10:30.. ?? Thats ok.. It seemed that they register pts and keep them up front for some time before they send them back to my lil room.. But when it rains it pours... I only saw 21 pt today... 9 0f which were URIs and then there was the abundance of tineas, Otitis, strep throat, flu like illnesses and gastroenteritis.. OH i almost forgot there were a few stable asthma pts as well... Case of the day was a 4 y/o male who was hit in the eye with a knife by a friend the day before... OK well not really the eye.. he was lucky as snot.. it hit him in the lower lid and it was thrown by a 1 yr old neighbor so it really missed all the vital stuff. However, as i was taking my history and questioning the person that brought him she tells me she has no idea about his past medical hx, allergies, ect.. that she is only the friend of the mother... SO I asked her well where is his mother.. she went to work! so why are you here with him?? Because his mother said since my child hit him, she said I had to bring him.... HHMMM.. OK.. Well good news for him was that by my preliminary exam, HIS EYEBALL was intact, vision was fine, there were no obvious corneal abrasions ( I had no access to flouricine to really check), and he was not experiencing any pain.. THE bad news was the when I pulled his eye lid down he looked like he had a pocket of pus in on the inner lower lid (which corresponded to the small lac on the outer lid) that neither I was equiped or experienced to deal with.. SO it looked like the wound was becoming infected.. I asked the DOC in the ED and she said that his best bet was to refer him to Bustamante Eye clinic in Kingston... ( really far).. SO that they could drain it.. I tried to explain this to the young girl that was there with him and for her to tell the mother.. He was sent out with antibiotics and a referral.... I hope that they take him for a complete eye exam....

I have been eating like a pig at the resort.... I will have to hit the gym hard when I get back to NOLA...

well off to bed now... ttyl

Fridays finished???

Where did the week go??



Already Friday already the weekend.... slow down time..PLS



We went to Port Antonio today ( we didn't have Gonzales TUG - thank u GOD)... it is a 2 hr drive from the hotel.... but a beautiful 2 hr ride... Plus i had my book along to occupy time.... ( BTW great book.. ).. Port Antonio Hospital sits on a hill (mountain) and has a gorgeous view of the water.. there is so much greenery here, it really is just Beautiful....



I went to the Peds ward while Michael went to clinic.. The PD ward here was bigger than the other hospitals ( or seemed to be) and was overflowing with patients... I worked with the GP there and gave advice on a few of the pts.. Interesting cases included a 7 y/o with complete white out of the right lung on Xray and a 2 week history if high fevers.. she was being transferred to Bustamante in KIngston for CT surgery for a possible drainage of her plural effusion... There was also a 16 mo old with a very croupy like cough who i suggested racemic epi and decadron...otherwise there seemed to be an out break of gastroenteritis. I was told that they try not to give AGE any antiemetic ( which we hand out like water in the ER in the US) and that they will admit for fluids...a lil 2 mo old who was only 2.7 kgs (FTT)...but had been growing appropriately since he had been hospitalized...I think mom needed some more education on feeding..

Michael had prepared a lecture on Asthma to give during lunch.. HOWEVER... no one showed up for it.. a lil disappointing. so he will try again next week...I will prepare one for fluids and dehydration for a possible presentation....

The journey home was long as well...and we have been getting rides from random people...NO biggie as long as its not Gonzales...

Was listening to the radio on our ride and they were talking about lame pick up lines.... some notable ones were
--gul u must be barbwire...cuz i just cant get over u..
--gul, u just like diarrhea, u just keep getting away ( or something like that)
LOL... I wish some one would say this silliness to me.. LOL..

Gonna go horseback riding tmrw then maybe learn how to wind surf... COOL..

tata for now

OH yeah , I found a phone book and have about 20 numbers of persons with my grandfathers last name.. I will try calling some tmrw.. feeling like Nancy Drew...

Hey Mon!

Hello World! My name is Michael, and I am going to try to take a small foray into the blogging world. I am a third year general pediatrics resident from the University of Tennessee (Memphis) and fellow class mate of Audra from November. I have Joined Tayo down here in Jamaica for the month of February.

I've been in Jamaica a week now, and so much to say!

I don't know what I really expected this month to be like. Discussions with Audra had prepared me for some of the things I would experience, but hearing about it and experiencing it are two different things.

This is my first time to Jamaica and really my first time to travel internationally (alone). I lived in El Paso before and would travel across the border to Ciudad Juarez (back when it was still safe to do so), but leaving the States and entering another country for a few hours is not like leaving for a month.

On Thursday the 3rd I got to get acclimated to the weather (that didn't take long, let me tell you!) and met Tayo. We went off to Annotto Bay on Friday morning and the drive there is beautiful. Very pretty country side with amazing ocean views. This place truly is paradise.

We made it to the Annotto Bay Hospital (ABH) and found our way back to the peds ward. The hospital there is many buildings connected by covered walkways. Each building houses a different subset of patients (peds ward, Male Med/Surg, Female Med/Surg, OB). Walking into the peds ward, there are a few small rooms to the side (one a kitchen, the other a treament room and a few others) and then the ward opens up to house all the patients in a large room. Walking up to the peds ward there is a very cute little patio where alot of the patients were hanging out in the fantastic weather with their families. Very different from what I was used to, where we expect our patients to be in their room, or sign out when they disappear for a bit.

Rounds were fantastic. The attending, Dr. Ramos, is a very intelligent man and I have had great pleasure getting to partake in rounds. We would open with a patient presentation, and he would start asking questions, reviewing physiology, differential diagnoses, treatment options. It's very thorough and a fantastic learning session/review. After rounds, Tayo and I went down to A&E (accident and emergency) to help out by seeing the peds patients. One of the patients I saw was a teenage girl (16 years) who passed out (or as we call it in Memphis "Done fell out") after becoming emotional because she lost her cell phone (life's tough as a teenage girl). The only problem was that as she was passing out, she hit the back of her head on a desk and lost consciousness for more than 20 minutes. If I were back at home, she would have been run through the CT scan to look for a bleed. That wasn't an option for me down here. She ended up getting admitted to the wards, which was an ordeal for me. I was in charge of drawing her blood and starting her IV... something I've never really been responsible for back home. We have phlebotomists and an "IV team" that will handle all that. After torturing the young lady trying for an IV, one of the other doctors helped her (and me) out by showing me what I was doing wrong.

The weekend was a nice relaxing time and I felt finally rested after a very long month of January. Tayo and I started back up on Monday where we went to Port Maria. She took the clinic and I was in the A&E there. I had a steady stream of patients and saw 19(!) in a 6 hr period, which was alot more than I have been used too. Most of it was run of the mill diagnoses of colds and tinea capitis. Like my patients at home, the families request antibiotics for viral illnesses. I have been standing strong about not writing for antibiotics when they weren't needed.

Tuesday was back at Port Maria where I was over in the health clinic. More viral illnesses, fungal disease and a couple of complaints about worms. Wednesday we went back to Annotto Bay where I sat in on rounds again. We had a lengthy discussion about hypoxic-ischemic encephalopathy, the possible causes of hypoxia (broken into maternal causes, placental causes and then baby causes, then further divided into pre-natal, peri-natal and post-natal). We then went on to management once the infant was delivered. We talked about some of the differences between the management in Jamaica and the States. I got to describe the technique of head-cooling which I've seen a few times in our NICU. I'm really enjoying sitting for these rounds.

Today we ran the follow up peds clinic at Annotto Bay. I got to do several well babies which are probably my favorite visits. You get to play with the cute 2 week old babies and show off to mom all the baby reflexes.

We head off to Port Antonio tomorrow, that will be my first time there. I am currently working on a lunch and learn presentation about Asthma. Sadly, my new laptop doesn't have powerpoint on it, so I am having to adjust on the fly.

Overall impressions: I love the island. Everyone here is very friendly and the weather is perfect. The children are wonderful (as expected). I am having a hard time understanding the accents, but I'm getting better. And I am learning that I have a heavy reliance on supporting labs to make diagnoses instead of relying on my clinical skills. I am definitely doing lots of learning and reading while down here! I am excited for the potential that the rest of the month holds.

THIRSTY THURSDAY

Today was the first day at Annotto Bay Children's clinic.

We arrived a little early..well ...cause we had Gonzales get us there.. MAN I thought at any moment we would take off and orbit for a while around the moon before crashing back down to earth and end the terror. But we arrived safe and sound. LOL...


Patients rolled in, we had mostly well baby checks coming for their two week follow ups as well as F/U from hospitalizations and Asthma follow ups. Case of the day was a 5 y/o lil girl who had severe developmental delay and seizure disorder who came in with a ?2 week history of not passing stools and now presenting with occassional NB/NB vomiting none X 2 days)... easy peasy... Her vitals were stable, she was well hydrated and her physical exam was very benign... good bowel sounds and all..I was gonna give her some miralax and gave instructions to F/U in one mo. However, her parents then started asking me for information about homes that they could send her to. Her father said that they were no longer able to provide for her and wanted to put her in a place that could. From all the interaction that I observed between them, both parents seemed to really love their daughter. I was confused, Plus i needed to call in the Calvary if they were serious.. I had no Idea about how this would work in Jamaica.... I Spoke with Dr Ramos ( the pediatrician at Annotto Bay), who informed me that there were really no resources on this side of the island for this... and that the fam was well know to him and has broached this subject to him on numerous occasions but never really went through with it... He also says that they really love their daughter but need just a little help that is often needed with Special Needs kids. Even harder to do here since the resources are very scarce.. So on behalf of the family who is willing to take any donations in any form ( Formula, pedialyte, diapers, stroller for a larger special needs child, Clothes for a girl, etc).. Please contact me if you are able and willing to help out.. I know there will be two residents next mo, so if ur looking for a way to contribute this may be it..




Miss Shaneka ( permission given by parents)

OK its late, I'm going to go in search of food at the buffet..

I head to Port Antonio hospital tmrw, the birth place of my grandfather...

Good NIght..

Time Does FLY!!

Well its wed night. and three days into week two.. I have seen a lot of pts between Port Maria ER and Health center and today made it to Annotto Bay ER... Saw the usual run of the mill URIs and fevers.. with a sprinkling of the common tinea and scabies.. But my case of the day was a 3 y/o with green penile discharge??? really. I had to call in back up.. I had never seen this before in someone so young.. with a negative urine DIP We swabbed and sent for cultures and treated him for the usual suspects...AND got social work on the case.. However i was told it takes a week for the cx to come back so we will see...

There is definitely a real need here and the all the doctors and nurses are very friendly and forthcoming and tell us they are happy that we are there to help out..
Pediatricians are in severe shortage over here therefore the kids are usually seen by the general practitioners. Even the some of the wards are covered by them. I am hoping that as the word gets out more pediatric residents interested in international medicine will want to volunteer. ON average I have been seeing between 15- 20 pts a day, some days more some days less.. But well worth the experience.. I am learning a lot about the health care system here and also getting a chance to see a lot of interesting cases. Having to treat the kids with limited resources is a bit tricky but has to be done..


NOW WE all know ......all work and no play makes TAYO a dull girl so...

Last weekend I went scuba Diving and explored a ship wreck.. I had a so much fun and if I pay thirty bucks I can get the dive on video( not sure i want to though). I was a bit apprehensive since i haven't been since 2005.. I will do it again this weekend...

FIRST FEW DAYS!

Well the first few days are done and the weekend is here

I arrived safely on Monday and settled in to the villa. Explored the resort sipped on a light drink.. ;-)

I started out at Port Maria ER as i guess a fast track doc?? Mrs Showed me around and introduced me to everyone.. and then I was led to my "office".. Well it was actually just a small room with one chair and a hospital tray table to serve as my desk.. there was a sink so i could wash my hands and one additional chair for the Pt. I did not get to take a pic but will next time.
we also had a quite a few boxes in the corner... SO very limited space... BUT doable with a little imagination. Made my way to the Pharmacy to give my signature, but forgot to ask for a list of meds ( so i just told parents to come back to me if they didnt have the Rx and only one did).

I started seeing Pts right away, and saw almost the same thing we see in the ER in the US... URIs, rashes, muscular skeletal pain, otitis externa ect. Many of the mothers of URI wanted abx.. But i held my ground.... NO ABX FOR VIRAL STUFF.... I may have made a few enemies.... but everyone was very thankful for my seeing them.. ( BTW they all left saying that they understood why they didnt get antibiotics) I hope I did some good... I only saw 24 pts.. Which for the record is the most pts I have ever seen in a day... MY fingers hurt...( nothing a lil ibuprofen didnt help).. Yet I survived...

Port Maria was also the next day's destination, however I was stationed in the health center.. I arrived ready to see another 24 pts, but apparently that was not in the stars for me that day... I saw quite a few less and actually was able to go home an hr early. Cases included, pharyngitis, Quite a few URIs, AGE, well child check, vag discharge... the basic bread and butter of clinic... NO PROBLEM MON...

Today we ( yes my partner Dr Gleason has arrived), and we were taken to Annotto BAY PD ward. The ward actually houses both ped pts and NICU babys. there were only about 11 pts on the ward and we sat in for their rounds. Rounds ran very similar to ours back home.. and the "intern" took most of the brunt of the questions.. however there was no feeling of intimidation between attending and residents... There were a few infants with hyperbili, and twins with FTT, Congenital syphilis, asthma exacerbation, and viral gastritis. We then went to help out at the A&E ( ED) and saw a few kids there. There was a little girl with nurse maid elbow who I unsuccessfully tried to reduce. After Xrays showed no fractures, I asked Dr Gleason to give it another try and he was successful. She was so scared to move that arm (after we traumatized her) so I waited for her to stop crying and then tricked her into reaching for something and then bending her elbow.. CURED!!! even she cracked a smile when she realised what i did...

I was able to bring a RED book to Annotto Bay, they were very appreciative.. I hope it will come in handy..

Having grown up in a developing country, I am not surprised by the things i see here, but having been partially trained in the US, I have to remember to step back and use more of my physical exam to diagnose things...I am feeling quite independent in my management which is also new for me.. I have always had an attending very close by in the US, and as pediatric residents we often do not have much autonomy... SO I am liking this new found freedom.. There are docs there with us, however they let us do our thing but are available for the rare question or to once over Xrays..

well its friday night and its reggae dance at the resort. havent quited decided if i will join them or read my book.. I am reading The girl who played with fire.. and if the girl with the dragon tattoo is any indication i know its a worth while read...

well I hope i will be able to see a lil bit of Jamaica this weekend..

TTYL