2/21/12 Posted by Amy Westman, MD (a third year pediatric resident from Kaiser Permanente Oakland in…
This week began with two days in Port Maria, with my colleague spending time in the A&E while I worked in the clinic. Here’s a photo of the front of the clinic. Each day we arrived to a line of people who have been there since 8 am waiting for clinic to open. It seems to be first come, first served with the clinic starting at 9 am.
It was Child’s Day on Tuesday so we got to see the children for their well checks. While seeing babies, I found a measuring tape useful to have since we measure the length and head circumference of each baby ourselves. I looked up each growth percentile in my Harriet Lane Handbook to ensure that the babies were growing well. There aren’t growth charts in all of the paper chart files due to resources, so we document everything by percentile in the paper charts, which is helpful for the next person who sees them in terms of following a growth trend. Also, if you think a baby is jaundiced and you want a bilirubin level, after 11 AM you would have to draw it yourself in clinic and have it dropped off at the lab. I was really surprised to hear from the lab how much blood is actually needed for a bili draw as the lab or nurses usually draw it at my home institution. Dr. San and Dr. Win have been a great help in asking questions about what is available in the pharmacy here and what is used to treat patients for certain diseases. The cases we saw ranged from scabies to viral gastroenteritis to parental concerns about worms.
One thing I take for granted in the states are strep swabs. In the states, if you hear a complaint of sore throat and suspect strep, you can get a strep screen and if it’s a positive treat, which is important to prevent the complication of rheumatic fever. Here, there is no rapid strep screen so if you suspect, you treat. Dr. Win told us that there have been cases of rheumatic fever this past year and it reminded me of the child I saw last week who was being treated with month shots of penicillin for the past year after being diagnosed with rheumatic fever. I have only seen one case in the states of Rheumatic Fever and here it is definitely more prevalent.
On the second day of clinic, I saw this adorable 2 year old boy who had right periorbital cellulitis with bilateral bacterial conjunctivitis. I had the child admitted for IV antibiotics and observation and found out from the other ER doctors to refer him to A&E for admission. Port Maria also has a ward which we haven’t seen yet and I assume he went there since I did not see him the following day at Annoto Bay. One of the benefits of having electronic medical records back at home is being able to follow up on kids to ensure that they are seen and admitted.
After a busy day at the clinic, we have our 30 minute drive back to the resort. Here is a view of driving through Port Maria where you can see different stores and daily life.
At the end of the day, it is always so nice to come back to the resort. We have been welcomed by such friendly people and my colleague and I are always amazed of the beauty of this country.