Let's start at the very beginning...it's a very good place to start!

I can't tell you how wonderful Jamaica has been so far!

I flew in on last Thursday, and started working this Monday on 4/14/13.  On Monday, Kasey and I shared a combined examination room at the Accident and Emergency Department at Port Maria Hospital.  We treated a ton of rashes that day (heat rash, papular urticaria, and tinea capitus).  I learned that when infants are taking Irish, they are actually eating mashed potatoes, and that "he du du" means pooping.   Good times.

Tuesday and Wednesday we enjoyed a wonderful drive to Annotto Bay (approximately 1 hr away from the hotel).   The coconut plantations were awesome, and the bay is breathtaking.  Outside the Annotto Bay Hospital, kids played soccer while a view of the Atlantic ocean stretched behind them.

Wednesday, we started off in the inpatient ward.  There were nine kids to round on.  The scariest part was that our sickest patient was a 4 yo male with sickle cell disease who had initially presented in vasoocclusive pain crisis in his back and abdomen, and subsequently developed acute chest syndrome.  In America, we would have this patient in the ICU and would probably be doing an exchange transfusion. Instead, the excellent nurses and doctors (guided by Dr. Ramos) were managing a very sick child on the ward, and doing a remarkable job with his pain control and fluid management.  I didn't know that in Jamaica there are only two pediatric ICU units, one in Kingston and one at University Hospitals.  Dr. Ravi pointed out how Dr. Firas Rabi had helped initiate a small ICU a few years ago. Most patients in their ICUs are on ventilators.  Luckily, our patient was maintaining his oxygen level on 4L via mask, and his pain was under good control with Morphine IV prn. 

Here I am, ready for sit down rounds with Dr. Ramos:   

In the afternoon, we headed over to the Accident & Emergency Department. I had the most interesting case, and 11 yo male who presented with R knee pain after a football (soccer) injury.  He was playing in his first game of soccer, jumped up to kick a ball, landed on his right leg, and another player collided with the front of his lower thigh.  He immediately felt pain, and was unable to bear weight or fully extend/flex his lower leg.  His exam was notable for swelling & tenderness around the lateral aspect of his R knee, his ligaments were intact, and he did have a positive McMurray sign (indicative of lateral meniscus tear).  We did X rays of his R knee, made him NPO, and gave him Voltarin IM (a medicine I wasn't familiar with, generic name diclofenac, an NSAID).  The X rays of his R knee revealed the surprise that Dr. Mitchell (ED doctor) had already predicted. He had an R femur fracture/epiphyseal lysis (a fracture of his thigh bone through his growth plate). I had NEVER seen something like that before!   We called the Orthopedic doctors and sent him to St. Ann's Bay.   

On Thursday, there was a well clinic at Annotto Bay.  Kasey and I enjoyed the plethora of adorable Jamaican babies who were primarily being seen at their two week and 1 mth check ups.   Both Kasey and |I were humbled by the trust that these parents placed in us...we wore stethoscopes, so we must be doctors.  We were able to give good anticipatory guidance about umbilical hernias, fevers, and no free water!

Thursday afternoon, we again went to the A&E department.  Kasey saw infantile dyschezia, while I saw a 15 year old F with diffuse abdominal pain (started periumbilically, and radiating to RLQ) concerning for possible appendicitis.  X rays of the abdomen were done and showed a nonobstructive bowel gas pattern.  I successfully obtained bloodwork, and started my first IV here in Jamaica!  When the IV fluids started dripping down the tubing, I knew the IV was good and I was proud.  In Jamaica, ED physicians regularly obtain their own bloodwork and start their own IVs.  However, in America it is very different.  I realized how lucky I am to have IV teams, scheduled phebotomists, or ED nurses willing to place IVs and obtain bloodwork.

Today we are at Port Antonio, and it rained this morning.  Kasey says that means that fewer patients will come.  We will have to see what happens next.   

I can't wait for what the next week will bring!