Half Way Point

Well, hard to believe we've already been here two weeks and our trip is half way over. The sites are becoming more familiar, the accents are becoming clearer, and we are starting to feel the exhaustion. Though,having said that, we are learning so much about the people, the healthcare system, and the island it is just great! We wanted to hi-light a few of the cases that we thought were interesting over the past week.

1. Crush injury to the finger. Stephanie tried to save the finger tip of a 2 year old girl who got crushed by a bucket. I (Chris) held the best I could. What we wouldn't have given for a papoose and a digital block! Though all in all, turned out ok, and mom returned the following day for an Xray and wound check!

2. Testicular swelling. I (Chris) saw a 3 year old boy with 3 days of unilateral testicular swelling that mom thought was occasionally painful. His exam was non-tender, though definite swelling and firmness on the right. Testicles are on my list of "don't mess around", so I knew he needed an ultrasound - though where to send him? Port Maria does not have US, and Annotto bay likely didn't do scrotal US. The NP told me just to send them to a private ultrasound place and they would bring the results, though who knows how long it would take - and if it was positive, then what? So, I grabbed the yellow pages and called Bustamonte Children's Hospital in Kingston, ID'd myself as a doctor, and asked to speak to someone in Urology. Within a minute, I was transferred to the head of urology and surgery Dr. Abel, and he couldn't have been nicer. He agreed to see the patient the following morning and do an Ultrasound there, and mom was happy to take her son to Kingston. Glad this one worked out!

3. An interesting rash (see next post)

4. Chronic Diseases: I (Chris) saw a lot of patients for chronic disease follow up. While I relish at the opportunity to see asthmatics and give them education and stress the importance of the "brown pump" (QVar) and "blue pump" (Ventolin), there were a few that I wasn't as comfortable with. I saw multiple patients with Sickle Cell Anemia for their check up, they looked great and I just continued their prophylactic antibiotics and folic acid. I also saw a rheumatic heart disease check up, though he was in relatively great health, I was releived when mom told me he was going to see cardiology next month!

5. Holy Murmur! Stephanie and I saw a child (12 year old male) in the A&E at Port Antonio for follow up labs for syncope and Mom said, "oh yeah, he's a heart patient". Gulp. It sounded like his syncope 3 weeks ago was likely due to some dehydration and vasovagal activity, though we needed to know more about his heart. She said he had "a hole" in his heart, was seen in Kingston as a young child, and actually went to Richmond, Virginia for evaluation 4 years ago. Mom said they didn't do an operation, and she was never really told what kind of "hole" it was. Hmmm.. His exam was impressive, with a true 6/6 holosystolic murmur - yes, we didn't need a stethoscope. We assumed he had a VSD, and as there were no signs of failure and he was doing great otherwise, we thought it best that they reconnect with Cardio in Kingston and mom agreed.

We also stressed the importance of follow up and discussed signs of heart failure.

Until next time!

Peace Mon!