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Week 1: Learning the Ropes

Posted by Thao Nguyen, MD (a third year pediatric resident from Kaiser Permanente Oakland serving a global health elective at Issa Trust Foundation in Ocho Rios, Jamaica).

 9/10/10

 My first week in Jamaica has been extremely BUSY! I worked at three hospitals with adjacent outpatient clinics on different days of the week, saw a ton of patients, befriended many Jamaican medical staffs, picked up quite a few native Jamaican terms, learned to tolerate the humidity, AND already am the victim to mosquito bites despite my repellant. I am very much aware that there is currently a dengue fever outbreak warning in Jamaica.

The diagnosis themes for this week are skin infection, skin infection, AND skin infection. I honestly have never seen so many cases of impetigo and furuncles/carbuncles in my entire life. I’ve written god knows how many prescriptions for Keflex. Skin infection is VERY common here in Jamaica considering its tropical weather that is quite inviting for the mosquitoes. The children play outside a lot and wear short pants and skirts making them more susceptible to mosquitoes. Mosquito bites are incredibly ITCHY (I know!), scratching breaks the skin barrier, and leads to superimposed bacterial infection. Many children have scarring on their arms and legs from recurrent skin infections such as the picture here (I have obtained permission from the patient and her mother for taking the picture).

The clinics are very busy. There is always a long line of patients to been seen way before the clinic even opens. Often, I don’t even have time to eat lunch because as soon as I’m done with one patient, the next one comes in, and I just feel bad that they have been waiting for a long time so I just kept on going. At Port Maria clinic, I’m essentially the ONLY pediatrician there, so I get all the referrals from the main health complex and from the ER. One day I saw as many as 23 patients! It’s insane right? On the contrary, at Annotto Bay clinic, the workload is somewhat lighter since there are one regular pediatrician (Dr. Ramos) and one Jamaican resident working alongside with me.

Here is a picture of my office and exam room in Port Maria.

The biggest adjustment for me has been going back to the paper-style medical record. Deciphering handwritings from previous physicians who documented in the docket (medical chart) can be so tricky. Often the dockets are incomplete or out of order and can take sometime to figure out what has been going on with the child. Writing in the chart and prescriptions also takes time. Sometimes I feel so pressed when I know there is probably a long line of patient waiting outside my exam room. To my fellow residents back home in Oakland, California…we are so blessed with our electronic medical record!

Another challenge for me this week was understanding the native accent. Jamaicans speak English as well as their native dialect called Patois. Sometimes the accent is heavy and I can barely understand, but I’m learning. After I talked to some of the medical staff, here are some things that I’ve picked up… “water bump” means pustule that ruptured, “tonic” means appetite stimulant (mothers keep asking me to prescribe vitamins as “tonic” for their children), “du du” means poop…..

The drive to the hospitals is variably long (anywhere from 30-minute to 2-hour drive). The views of the majestic aqua Caribbean Sea and the lush green coconut and banana trees on the periphery somehow miraculously suppress my car sickness and made the drive quite pleasant.  I have yet to use my Meclizine.

Coconut and banana trees, and the Caribbean Sea (along the drive to Port Antonio).

My plans for this weekend:  hopefully testing out the Caribbean water with some fun water sports finally meeting the medical team from Children’s Hospital Iowa.

Until next week…

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