Another great week!

This opportunity continues to be amazing and eye-opening. We spent Tuesday at Port Maria and Steph and I switched it up...her going to clinic and me in the A&E. Stephanie was referred many patients from the Matron for complaints found during their well checks. Common things being common, she diagnosed pneumonia, otitis media, and many rashes. She was able to follow up with a patient I had seen the day prior who had fever without a source and was given IM Ceftriaxone and asked to come back. The great news is that he looked much better and was smiling and playful. It's amazing that we're able to have continuity here as the moms often have to walk long distances to the hospital. The people here continue to put smiles on our faces and it's very apparent how much the mothers care for their children.

My time in the A&E at Port Maria was eventful to say the least. With the recent rain and "cold front" as the Jamaicans call it, I saw lots of asthma exacerbations. I did my best to educate each family and even found handouts about asthma in the clinic room. I sent two of them home with asthma action plans! The most exciting and challenging part of the day was a precious 3 year-old boy who needed his finger sutured. With no anxiolytic and only myself and Steph to hold him the process was extremely difficult but we got it done. Plus he is coming back next week for follow up.

Wednesday we returned to Annotto Bay Hospital and started the morning with rounds. We had extremely interesting patients and there was lots of good discussion not only about each patient's treatment plan but about medicine in general. A little boy had been admitted the night before with 4 days of cold and cough symptoms along with 2 days of alternating lethargy and irritability. The interesting part of his history was that he had been given "bush tea" over the past 2 days. He'd received IVFs overnight and the leading diagnosis had been intoxication from "bush tea". We learned on rounds that it's customary, especially in the rural areas of Jamaica, for mothers to make tea from various bushes as a cold remedy. But similar to being in the US,  we have no idea how safe these herbal remedies are. We ultimately determined after much discussion, that "bush tea" intoxication is truly a diagnosis of exclusion given the lack of reported cases. With that being said an encephalopathy/encephalitis needed to be ruled out with an LP.  Soooo...if there's a take home message to this story, it's don't give bush tea to your child!!!  We then finished up the day with Dr. Yandav doing procedures. We each performed an LP and drew blood for the lab. It was a wonderful day spent with sweet patients and great physicians.

We returned to the resort Wednesday night and rested a bit before having dinner at the Bayside restaurant (Asian cuisine). We had a delicious dinner and then we stayed up waaaaay too late to enjoy the steel band. They were amazing and full of energy. They played versions of popular songs like gangnam style and tons of Michael Jackson, my favorite. They had dance routines, outfit changes, and even did this crazy balancing stunt. It was incredible to say the least.

Today we spent the morning in clinic at Annotto Bay Hospital. Last week was filled with 2 week-old infants coming for hospital follow-up and weight checks but today we saw many older patients. Stephanie and I both saw many children with seizures, some with epilepsy on AEDs and others with febrile seizures. We both gave a lot of education to the families with children having febrile seizures, emphasizing that controlling the fever could prevent the seizure. Dr. Yandav joined in and made the very valid point that the seizures typically occur just prior to the fever or sometimes afterwards. His point was that parents should treat their child with either panadol (acetaminophen) or cataflam (diclofenac) at the first sign of warmth to touch. Interspersed between these patients was an asthma follow-up, phimosis, UTI, and well checks. The most exciting part of the day for me was following up with an infant I had seen just last week on the wards. The mom remembered me which made the visit all that more enjoyable. It's amazing that here in Jamaica we are able to have continuity. While the morning was bustling, the afternoon was rather slow in the A&E which is proving to be the trend. I think with all the damage from Hurricane Sandy there is limited knowledge that the A&E is up and running and ready for kids. This did give us the chance though to follow up on our patients from the wards and it was really rewarding to know that all of the LPs performed yesterday were normal. It was also nice to see all the precious patients again too. We ended the afternoon with a snack from the Tuck Shop, the local eatery here at the Hospital. We had beef and cheese patties, curtesy of Dr. Marshall, one of the A&E physicians. We were warned that Jamaicans have heartier stomachs so we can only blame ourselves if there are negative repercussions from our eating adventure. It was totally worth it though...patties are delicious!

We're heading back to the resort. It's cloudy and cool here...maybe another cold from is moving in. After our late night watching the steel band we're planning on naps and an early dinner. I say that but the idea of kayaking is being thrown around because even through our exhaustion we want to take advantage of the amazing opportunity we've been given. Well see :)

S&S