Jamaican January

Hi everyone! I wish I would have kept up with this as the weeks went by but I was having such a great time it was hard to sit down and write. Like the most recent entry I will try to cover each hospital I went to and the resort.

Annotto Bay:  This hospital is currently under reconstruction due to hurricane Sandy so the pediatric ward was located in the old administration section. I've seen pics of the new pediatric ward and it looks amazing! Hopefully by the time the next docs arrive they will have moved into the new section and will be again taking pediatric transfers from other hospitals. We only had about 5-8 inpatients at a time due to the limited space but I felt like the experience in the inpatient setting, directly working with the Jamaican pediatric specialists here was very helpful to me. Wednesdays I would show up around 9 am and pick a few patients to see and then we would round with Dr. Ramos and Dr. Fischer around 11 am. There are other general doctors covering the pediatric section available to answer any questions you have and divide up the patients with you. After rounds on Wednesdays I would often head over to A&E (ED) to see any pediatric patients they had there. By that time, there usually aren't too many children so I would head out around 2pm Wednesdays when there is a driver available. The administration is really helpful in finding someone to take you back so I would just ask for their help each day when I was ready.

Thursdays are clinic days at Annotto Bay. Sometimes there were 16 patients scheduled and sometimes 65. This is a pretty fast paced clinic and they would call the next patient up to see me as soon as the other patient walked out the door, so I found it helpful to jot down a few notes in the chart and do the rest of my charting at the end. I worked again with a general physician and sometimes Dr. Ramos so there is always someone available to answer questions regarding how to refer someone, how to write a script, what is available, etc.

The inpatient unit had a wide variety of types of patients, for example, I saw children with post strep glomerulonephritis, ill asthmatics, meconium aspiration syndrome infants, and osteomyolitis in a sickle cell kid to mention a few.

In clinic, we mostly saw children for asthma check ups and well baby checks. However every once in a while there would be a weird rash, or something more unusual. I actually saw a first time mother who likely had ectopic breast tissue with a nipple in her armpit that was lactating out of her armpit!!!

Port Maria:

At Port Maria, they would send me patients from A&E that they normally would either see in A&E or send to the clinic. The only physicians I had contact with here were the docs assigned to A&E that day. Make sure you let both the nurses in the back and in the front, AND the doc know you are there. They will clean the room for you and send you patients. You are kind of off in a corner outside of the ED, so if you need to ask questions or need more supplies it is more difficult. Try to anticipate what you will need at the beginning of the day and they will grab it for you. Especially because you can't leave your things in the room. I would grab my computer and bring it with me when I needed to go into the ED for something, and I never left the patients in the room when I wasn't there with my things. Mondays are pretty busy, I saw anywhere from 15-20 patients on Monday, Tuesdays were much more low key and I saw about 10. So, bring a good book on Tuesdays especially, because Steve (your driver to Port Maria) can't always bring you back when you are ready. He is usually there by 4pm, but I finished by 2 or 3 most days.

I saw more ED type patients here and often had to make a splint, read xrays on my own, and even admit people. The A&E physicans are willing to do anything you don't feel comfortable doing, you just need to tell them you can't or don't know how to do something and they will take care of it, but usually the patient has to wait much longer then. I had to refer a few people to orthopedics, which is in St. Anne's Bay (about 1 hour away), they can be seen the next day.

I also ran into problems with meds being available at this hospital that usually are available, such as prednisone, salambuterol, cephalexin etc. It helps to ask your patients to come back and let you know if something wasn't available. Some of them are willing to go into town and buy the meds, but those pharmacies close early also so if a child really needs something right away try to write for it in A&E. I would send children in to get neb treatments and prednisone before they could go home. You can usually get xrays within an hour and I would just ask the patients to come back with the film that day. Cultures get lost all the time, so I rarely ordered these...If I thought a kid looked classic strep I just gave them amox. I would never do that in the US but cultures take a month sometimes to get back here.

Port Antonio:

This was my favorite place to be. It is a really long drive, I was there 3 Fridays, but the drive is beautiful and felt I was the most useful at this hospital. I saw pediatric referral cases from the NP clinics so I would see some pretty interesting problems. Most of the time I just had to refer them to the children's hospital in Kingston but it was nice to know that they were seen quicker because I was there. I also would help out in the morning on the pediatric inpatient ward, discussing complicated cases with the general medicine doc. I could do some teaching and there were often complicated cases, such as an 11 yr old with hyperbilirubinemia and sick asthmatics. So my first 30 min-hour was spent on the inpatient ward, then I went to clinic and saw anywhere from 3-12 patients (mostly referrals or kids needing refills for asthma, seizure meds, etc), then I would go to A&E and help out with acute sick cases. I saw anywhere from 2-10 patients in A&E also. I left at 4pm each day, so it is also helpful to have a book along in case your case load is less for that day. Mr. Campbell, the hosptial administrator drives you there and back. He is really friendly and always on time.

I gave a presentation the last Friday I was there. I did a talk on acute abdominal pain in children and it went awesome because 10 people showed up including the surgeons and ob/gyn physician, Dr. Davis. We had a great discussion. I recommend bringing a powerpoint you have done before or something you have prepared ahead of time to present, as they really appreciate the presentations at this hospital. In the past, people have talked about bronchiolitis, vomiting and diarrhea, etc. Ok I am publishing this a little late, I left 2 weeks ago but hopefully this will still help. I will write about the resort next.