Hello from Jamaica~
We are loving our time in Jamaica. Here is a run down of a normal week as a pediatrician.
Monday and Tuesday are at Port Maria Hospital. It is about 30 minutes away and is very rewarding. I have been working in the A&E (Jamaican ER) and have loved it. I have a room in the back and all of the children 12 and under wait on benches to be seen. The pediatricians in Jamaica only see children under 12 years old once they are 12 they have to go to adult medicine. Also, there are not a lot of pediatricians at the hospitals that we visit and it is very rewarding to see the patients and be able to explain the diagnosis. I have seen multiple different illness but URI is the most common diagnosis. Because the patients wait so long to be seen (they can wait a full day to be seen at the A&E) they always want to go home with a script for medication in their hand. I do a lot of counseling on cough physiology and what viruses are. Many patients think they need antibiotics and the cough will get better. Most of the patients understand once I explain why they do not need an antibiotic. If a patient needs an antibiotic they usually don't get the prescription that day. The pharmacy only takes a certain number of scripts a day and once they have that number they won't fill any more scripts. The patient can go to a private pharmacy but they will have to pay for the medication and many patients don't have the money for the prescription. If a child needs antibiotics, steroids, or nebs then it is usually best if they get the first dose in the A&E that way if they don't get there script right away they have at least one dose.
Wednesday and Thursday are at Anotto Bay which is about 1 hour from the resort. Here there is a pediatrician named Dr. Ramos . The days that I have been at Anotto Bay I have been in clinic or in the A&E. The census has been low so I haven't done any inpatient medicine. The 1st and 3rd Thursday on the month are well baby checks. They get their weights checked at 4-6 weeks and if they are growing well they are discharged to be follow up with their local health clinic. I love the well baby check days. I find that the majority of the mothers breast feed and the babies gain weight well. For the babies that aren't growing as well formula is expensive. A drug rep from Enfamil found me and gave me 5 large samples that I have been giving out which always helps. At Anotto Bay there are pediatric residents and medical officers who have worked with children for years and are knowledgeable. I had to ask lots of questions on my first day as the medications they use in Jamaica are different from the ones I am used to. They also have different protocols and I found it helpful to ask about admission criteria, asthma protocol, and dehydration protocol. There was a cricket match that we got to watch one afternoon which was a lot of fun. Our driver had to transport a patient and was 3 hours late to pick us up (patient care always comes first. Thank heavens there was a cricket match to watch.)
Friday is at Port Antonio which is 2 hours away. I started in the wards then went to clinic then the A&E. I enjoyed getting to see some inpatient children. The clinic at Port Antonio is also wonderful. I have seen scabies in a 4 week old with FTT, constipation, viral induced asthma, seizure disorder, sickle cell, G6PD, fracture, ITP ect... The patients are referred to see a pediatrician on Friday (and I am the only pediatrician available.) Thankfully I feel comfortable with the complaints and treatments and the patients are happy to wait if they can be seen by a pediatrician.
Medicine is different in Jamaica than in the United States and one of the medical officers put it best by saying, "just do the best you can for the patient with the resources available." I have learned that the people will listen to your advise if you take the time to explain the diagnosis and treatment. Next week I will write about the wonderful Couples Tower Isle Resort.
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