First Week with Issa

Hi all,

I am also a resident from the University of Tennessee. I am 4th year Med/Peds. I am SO Blessed to have this opportunity to come and work with the people of Jamaica. It has already been quite a week.

I had a rocky start getting here with delayed flights and lost luggage. It was a good thing I came a few days before starting work. It is absolutely calming and tranquil here and the people at the resort are very welcoming and accommodating. The food is plentiful, to be modest, and I now feel I have to work out twice a day on weekends.

We spent our first 2 days in Port Maria, the next 2 in Annotto Bay and the last day in Port Antonio. At Port Maria for the first 2 days I worked in the Health Clinic.

I saw the general run of the mill cases like viral illnesses, lots of tineas, candidal vulvovaginitis and complaints of worms. Many of the parents expected medications for their children's 'chest colds'. Down here cough medicine is DPH and that's not a brand name. It is actually Diphenhydramine. I spent some time educating the families on the ineffectiveness and detrimental effects of cough medicines. Most were receptive, a few didn't seem too happy.

The first day I saw about 16 patients, which was hard because I had to stop every minute to ask how things were done and what was available. The second day I saw 25 kids. In our residency, we never get to see that many in our continuity clinics because you have to check out to a superior etc so I was amazed that I could see that many in 6 hrs. I had a few pneumonias and a teenager who came in for many different complaints including vulvovaginitis, anxiety attacks and irregular menses. My interesting case of the day was a set of siblings who came in for generalized itching for 3 weeks after they were swimming in a river. I was SO out of my element because that differential is broader with tropical diseases esp ones transmitted from river water. They do have leptospirosis down here but the symptomology was no where close to that. Could it be schistosomiasis, or some other parasitic infection? I treated them as best I could and recommended they returned if things worsen or did not improve.

At Annotto bay I worked in the A&E department one day and the clinic the next. The clinic was mainly well child visits. It appears that about 3-6 weeks after birth the children are seen by a physician for an examination. After that they receive their "well child checks" at the health clinics with nurses and thereafter see a physician if they are ill. This is unlike our American system where the physicians are the ones doing the Well child visits.

You also are required to draw your own labs and start your own IVs. So far the children here have been spared from me but I do look forward to maybe perfecting those crafts. The most interesting child I saw at the A&E was a referral for a possible glomerulonephritis. The patient had no previous illnesses but was noted to have swollen legs and face prior to admission. I was very excited about working the child up and reaching a diagnosis, however many of the labs such as complement levels, renal ultrasound and maybe urine electrolytes were not available at that hospital.

At Port Antonio, it was a very light day with only 4 children on the ward and 6 total in the clinic (3 seen each by David and I). Two of my 3 cases were referrals for orthopedic issues that I unfortunately could not help. One was a beautiful 4 month old with club feet. The parents do not have the transportation available to get to the referral hospital. I hope they find a way because I am sure with braces she will correct well. In the meantime I tried to recommend a temporary way to get her feet to straighten by recommending buying stiff shoes that ae a direct fit.

While we were on a tour of the facilities (Port Antonio sits on a hill overlooking a lagoon) we got called into A&E to look at a chest xray of an 18month old boy who at a glance looked quite well. The xray looked like he had a whited out R lung with a mediastinal shift to the right and elevation of his right hemidiaphragm...looked like a possible foreign body aspiration. He had to be transferred to Kingston. He was still out in the yard of the hospital playing when we left, definitely in no distress and a little bit of a lady's man already.

All in all this week identified the biggest obstacle to care in the area....resources. There are few physicians and few resources available to a poorer population that arent able to travel very far for optimal care. I'm looking forward to what the remaining weeks will bring.