Week 1 in Jamaica

After just my first week in Jamaica, I'm starting to realize how different everything is here. I went to Port Antonia yesterday, where I assisted with inpatient rounds and saw a few clinic patients as well. After an hour of waiting for the doctor to arrive on the Pediatric Ward, I was told he was actually not coming. Someone from the Emergency Department was asked to round in his place, and with neither of us knowing any of the children in the unit, the morning started off a little hectic. There were some very sick patients-- a child with posterior urethral valves with now overlying pyelonephritis was there for IV antibiotics and ultrasound imaging. Looking through his chart, however, notes were written as "patient with unknown kidney disease with left flank pain" or "??kidney disease, rule out pyelonephritis". There apparently isn't a consistent doctor who works in the unit, so information is poorly relayed, and treatment reflected likewise. As the covering doc flipped through the boy's chart, he informed me his ultrasound showed hydronephrosis. "What grade?" I asked. "A bad one," he replied, moving on to the next patient.

Rounds continued on in this way until I was sent off to clinic. Sitting in an air-conditioned room, I felt a little guilty. Most of the patients here were follow ups after discharge from the hospital. I was seeing a boy after multiple episodes of febrile seizures, now with 1 week history of penis pain. During the physical exam, he became very upset, and slapped his mother, who was holding him down. Appalled, I asked him to apologize, but he refused. I thought to myself about all the clinic visits I spent talking about behavior management, and positive/negative reinforcement. It seemed like such a luxury now..! I reluctantly gave up my behavior talk, as the boy would not be overcome in one clinic visit, and continued to counsel the mother on other issues.

In Iowa, parents come in with a list of problems to discuss, and residents usually limit them to their top 3. Here, parents come in with just one problem to discuss, but watching them, and listening to them, you see hundreds of issues. You sleep with your baby and she sleeps on her tummy? Why are you starting solids at 2 months? Leaving your baby in the sun is different from phototherapy... I guess when I go back home, I will sympathize with them more now; it is hard to choose just 3.