Jamaica Pediatric Medical Initiatives

I've just finished my 3rd week here in Jamaica, and it was the busiest yet! Post Maria had so many Pedi patients, I saw 30 on Tuesday, and even had to give 5 extra back to A&E! It was an exhausting week, but full of so much great learning and good challenges.

One thing I've had to get used to here is that I am always "Dr. Westman," not "Amy," at least at the hospital. I come from a laid back California Pediatrics program where I am on a first name basis with everyone in my program, from interns to attendings and administrators. But here in Jamaica, it is more formal. A doctor is always "Dr. . ." and a nurse is always "Nurse . . ." The other doctors and even the interns introduce themselves as "Dr . . ." and I've noticed that even when they drop the doctor part, others refer to them by their last name only.  So now I've grown used to introducing myself as Dr. Westman, but it still feels strangely formal!

Another things that just goes with the territory here, and I presume for all global health rotations or missions, is that you just need to relax and go with the flow. Things are not a tightly regimented and scheduled here as in America, but everything gets taken care of in the end. The patients show up at 8am and register first come, first serve, but will wait all day to be seen, no appointment times. You, as a volunteer here, will always have someone to drive you to and from the hospitals and clinics, but it may not be the same person and they may not pick you up at the expected time. But you will get there and back safely! The doctors mentioned in the orientation packets may not be around, but there is always someone there to help with any questions. Even if there aren't many clinic patients one day (my wide range has been from 2 to 30, but on average about 20), you can always find other ways to help out like seeing patients in A&E. Just go with the flow, and everything will work out. One of the big things I've learned in my time here!

One piece of advice for anyone else coming here to work, is to really brush up on your IV placement and blood drawing skills if its not one of your strongest areas. I have never really been very good at placing IVs in small children. While my home program of course has requirements and time built into our training so that we learn how to do this, there has never been much pressure to get really good at it, since there is always a nurse or phlebotomist to do these things for you. Since I don't naturally love putting in IVs like some other residents, I haven't perfected the skill. In Jamaica, however, the doctors draw all of the blood and place all the IVs, so I've actually gotten much better over these past few weeks by necessity! I was also surprised to learn, that the GPs here, although I knew they saw all ages, actually do some surgeries as well. One doctor at Port Maria said he will do "simple" procedures like appendectomies or inguinal hernia repairs himself, but prefers to only assist on more difficult operations like a biliary atresia repair. He has of course received specific training in surgery as part of his medical training, but I was impressed. At least I can do my own I&Ds and laceration repairs!

For my last comment this week, I wanted to mention every Jamaican's apparent love for and confidence in diphenhydramine, or DPH elixir as its called here. Anytime a child has a cold, the parents demand DPH elixir. When I ask if it helps, they will either say, "I don't know, you're the doctor," or they will admit that it isn't helping the child's cold symptoms, but they still ask for it. Many parents here really want you to give them a medicine for their child even if its just a virus, and are not as much into supportive care like bulb syringes and humidifiers, partly because they do not have access or the funds for such things. I have come to appreciate the usefulness of diphenhydramine at home, great for allergie reactions, nausea, and insomnia, but never though of using it for a cold! I do suppose it is safer than most "cold medicine" mixtures that many used to give their kids.

Oh, by the way, I'm still trying to find out what is actually in the "black dressing!" I know it is not as widely used any longer here in Jamaica, but I'm still curious. A google search didn't help very much, and I keep asking every doctor and nurse I come into contact with, but no one yet has been able to tell me what's in it! It just keeps me interested, but I think I might have to just let this one go!