weekend travels: treasure beach

So I finally made it to the beach this weekend! As I'm currently slathered in aloe gel, you should all know it was a successful weekend--and ironically, came back to rain in Mandeville. For future reference, the new lotion + sunscreen combos, like Aveeno, are better than Banana Boat. I have nothing against Banana Boat and have carried a tube of it with me faithfully for years, but the reason I'm sunburned today is because it didn't rub in certain places, so I have stripes where I was less forceful in rubbing it...that doesn't happen with the Aveeno. Plus Aveeno is awesome anyway. Regardless, I'm not that burned and not at all on my face, so it was a good weekend.

The weekend epitomized a lot of American-Jamaican interactions, so I'll go through it in some detail and annotate some lovely photos.

First off, Tora and I were going together. Tora is from Norway and she was looking for the same thing I was for this weekend, relaxation. It was my birthday weekend, so I wanted somewhere I could swim and relax and just enjoy life (away from the party lifestyle to which some of the volunteers adhere).

In grand Jamaican tradition, we took route taxis to get there. Taxis here are uniquely Jamaican, complete with one person in the front seat and AT LEAST four people in the backseat, more if there are children. I will always claim the front if I can, but you generally have to be the first person in to get it. Jamaican routes are set amounts of money, more if you're dropped off at your door, so the more people they can fit, the better. Tora and I hadn't even made it up to the taxi stand when a driver leaned out his window and goes "Treasure Beach?" like we had it written on our foreheads. We have to get to Junction and then switch to Treasure Beach, so he was on the ball. But that's how they make their money.

He was exceptionally nice, as most of the taxi drivers are. His name was Pablo, he put our bags in his trunk and we sat there until the taxi was full. He didn't charge us more, which some of the drivers will do since they know the 'whiteys' don't know the cost of some of the routes. And when we got to Junction, he tried to find us a reputable driver to take us to Treasure Beach. We stand out as two white girls, so we had already had "Treasure Beach!" shouted at us and found one, which makes things easy. This driver wasn't so friendly, so we didn't have to part with a history of our lives to get to TB.

As I've learned in Jamaica, there are universal questions to ask the whiteys--and that's not a derogatory term, it's just cause they don't know your name so they call you whitey. They want to know your name (and Pam doesn't work well here, so it's always Pamela--Pam-ella in the accent), where you're from, and is this your first time from Jamaica. Conversation progresses from there--I usually get where in the US/America are you from, and then what are you doing in Jamaica.

But we made it to our lovely hostel in Treasure Beach and immediately headed down to the beach.

One minute's walk from the hostel.

Just in time for a glorious sunset! There was a cloud across the sun, so it was stripy across the top and bottom, but it progressed too fast for me to get a good picture. This is also the view from the veranda of the restaurant where we got dinner.

My authentically Jamaican birthday dinner--curry goat, festivals, and Red Stripe. I've been enjoying the curry here, spicy but not too much. Festivals are delicious blobs of fried dough. Red Stripe is a fairly decent lager, product of Jamaica. It was a great dinner to eat on the veranda and a good way to end the week. We trekked back along the beach to the hostel, and the stars were incredible. I have never seen so many in my life, just scattered everywhere! Truly beautiful.

We made it to the beach early in the morning, slathered in more sunscreen than many people would use in an entire summer but the sun in burningly hot. It can be relentless, and I would feel burned in certain places and slather even more sunscreen there, but never turned up burned there. It was difficult to keep reapplying sunscreen because the sand gets everywhere and you feel rather exfoliated in a terrible way because of it. The salinity of the Caribbean is also somewhat different than what I'm used to in the Atlantic, so that added to the exfoliative feel.

We were at Frenchman's Bay, protected by two outcroppings of land to either end, which affects the waves in some way I can't remember from physics class. The waves are high and come up without warning, and frequently claim lives. This is not the lifeguard, only swim in protected areas I'm used to from the Jersey Shore, but a wholeheartedly swim at your own risk. I actually ended up keeping an eye on some Germans who were swimming far to close to some rocks. And I'm a strong swimmer, yet was frequently surprised by huge waves coming up on me. They're not incredibly powerful, but they will still knock you over if you're caught in one as it breaks.

The Caribbean is a spectrum of blues and greens, and I am so glad I was able to capture this melding of the blue sky into the more aquamarine ocean. You can use thousands of different words to describe the beauty of this water! (Again, this is the view from the veranda of the restaurant)

We spent the afternoon relaxing indoors, since the sun was so hot. Water bottles are essential around here to those of us not accustomed to the heat, as I know I sweat out probably half of what I take in by mouth. So we reemerged from the hostel to climb these rocks on the eastern end of the bay. A storm was trying to come in, though it never materialized. The surf was pounding against the rocks, and once again, I am pleased to see that the photo captures the swirling colors and intensity of the Caribbean.

It was also really windy, but Tora and I managed. 

The other Jamaican experience that is unique--I mentioned that the taxis drivers always want to know who you are and where you're from, but this happens on the beach too. Particularly to the two 'beautiful white girls'; I acquired a self-professed Jamaican boyfriend, we had a few offers of marijuana, a few men trying to sell us things, requests to go on boat tours, etc etc. I commented to Tora that I've gone to the beach every single year of my life and never has a man ever approached me, regardless of the potential invitation of the bikini. I'm all for light flirtation, but it can be difficult to get the Jamaican men to understand you're not interested and I can't be rude here (though I will be if necessary).

To check out of the hostel, we just had to leave the key in the door. It's a real key, one of those old silver ones that I'd only seen in the movies/books--like in Harry Potter and his room of flying keys. We left behind the glorious Treasure Beach to pouring rain in Mandeville and I was finally able to wash all the sand off.

The other thing about Jamaica--not everywhere has hot water to shower! It's actually a bit refreshing after being on the beach, but even here in Mandeville where it can get chilly, not everyone has hot water. I do here, and it's actually solar powered/warmed. At the beach, it was sun warmed too so it wasn't freezing, but up in Mandeville it can be. Since it's been raining today, the shower wasn't hot but better than lukewarm. Regardless, I'm starting to radiate heat from my splotchy sunburn so it'll be okay. 

Tomorrow I get to meet a local official as an ambassador for Projects Abroad and the USA, then Tuesday is an International Festival, and Wednesday it's off to Kingston to meet the Minister of Local Government and Community. Not so much medicine this week, but the chance to explain why I came here and represent myself, my school, and my country is a rather exceptional opportunity.

it gives you perspective

Almost done with another week...and another time to be reflective on the medicine here.

It's interesting working with the University of the West Indies medical students. First off, their curriculum is five years and they're taking all the final exams now--they haven't taken anything, like we have earlier. So their studying right now is far more rigorous than anything I've encountered. Their exams are also partially oral, in a practical sense; they'll be interpreting x-rays, examining patients with actually pathology, etc.

So 'lectures' are completely different. I was explaining today about the huge lecture halls and projectors, and apparently they have that on campus. Out here in the satellite sites, there's nothing like that. In fact, we have to go get one of the two projectors the hospital owns when a lecturer brings a powerpoint. Usually it's just the socratic method, so you have to know your stuff.

For example, a few days ago, we started talking about peripheral artery disease (PAD). Pathogenesis of PAD? Atherosclerosis, we can all answer that. How does atherosclerosis happen? That was met with pure silence, which didn't make me feel so bad. I could contribute a bit about the foam cells developing from macrophages, but we all struggled to get to that point and to how it contributes to PAD. It's a way to test how well you know your stuff--did you skim the surface or did you actually dig deep and do you know it.

I obviously took to this quite well, since I don't like being all that embarrassed and having to say I don't know...which I really don't like saying as the 'American medical student.' I feel a lot of pride in being an American and representing America here, in addition to my own personal pride. So the next day was aneurysms and I totally showed my stuff, but I didn't hold it over the UWI students. It made the whole lecture more comfortable, and now I know aneurysms really well myself. Win-win.

Oral examinations meant that you have to know what you're talking about, and quite frankly, it points out to me all the things I've forgotten in being on clinical rotations and learning about how the computer system works, and those kind of practical things. It sets up an interesting conundrum for taking step three in the upcoming months (the last of the board exams--you take it after you graduate).

The pathology has changed some too...I evaluated a patient with a goiter today, something you wouldn't see in the US. Particularly not one this big. I knew what it was at once, but it's not something I've seen in person before today. We also had an interesting moment later, when a patient's culture had come back with Pseudomonas, a fairly resistant and hard to treat bacterium. We had to switch the antibiotics, and the residents had no idea about double coverage and also what to switch to give pseudomonal coverage. It was a little hard to cover my surprise, but considering they don't even talk about MRSA here, why should the residents know about pseudomonal double coverage?

I can't get over the wards. This photo is deliberately blurry, but you can see how there are three beds fairly packed in with just the half-hearted attempt at curtains to shield. We had to tell a patient today that we had to amputate below the knee, and she got to cry and try to deal with this information with absolutely no privacy.

This is the most technologically advanced their medical records get. There's also no sort of order--I saw a patient in clinic the other day whose appointment for 24/3/14 (European style dates here!) was shoved in the middle of her records from 2002. There are no tabs for lab results, consultant's notes, or imaging. We're talking about patients who are actively bleeding and the last check of their hemoglobin was three days ago. There's also no blood to give patients right now (and if I were convinced of the sterility of the procedure, I would donate some, but there are about 10 patients on the wards right now who need blood...one donation can't stem that tide).

This is their ER, or A&E as they call it here--accident and emergency. There's a separate section for 'actual' emergencies, this is rather like a holding area. Consultants go see patients down here, and they could be here for days. Beds are just lined up, as many as you can fit in the small space.

On a lighter note, you do have to dress modestly! I can't wear anything less than short sleeves, and if I do, I have to wear my cardigan over it. And remember, it's 80 degrees shortly after sunrise and often will be humid so the heat index is frequently 95ish.

And for the lightest note possible, I was doing blood sugar checks recently on an outreach day and got to find out that they use a different scale than we do in the US! We use a mg/dL scale, so you want a fasting sugar under 100 and somewhere not too much higher for random sugar. I checked mine to make sure the machine was working, and the number popped up 5.2! I was like what the heck! That makes no sense! The girls from the UK and Norway filled me in--it's mmol/L. So 114 on my scale, a number I can interpret.

weekend travels: kingston and the blue mountains

Actually, I should probably start with Friday. As I'm here as a medical volunteer with Projects Abroad, occasionally the PA volunteers get recruited to do other volunteer tasks. As such, on Friday we went to St. Elizabeth to do a beach clean up.

It's a beautiful beach isn't it? Well, imagine what it looked like before we raked up all the trash. In Jamaica, there's no real system of municipal waste such as public trash cans. I've noticed not one since I've started looking. So what happens here is the fishermen just toss their trash out of their boats. It was rather unbelievable how much trash there ended up being in short distances of the beach, but it wasn't too strenuous of work to clean it up and how much better it looks for it!

My first Jamaican beach photo! And yes, I know I have a bit of sand on my face. It's interestingly a mix of dark and lighter sand. Actually, one of the guys was saying that it's so dirty, that's why the sand is dark but I know enough geology to point that out as false. 

Regardless, it was hot and sunny and the beach was beautiful. Onwards, to Kingston!

I went with my friend Helena, from Sweden. She had booked a music tour of Kingston for her only weekend in Jamaica, so I tagged along as the music lover I am. We had a lovely tour guide, and we started off with listening to the music, getting the history of reggae and ska starting with Harry Belafonte (whom many Americans would consider calypso, but the beats develop from there). We headed directly to the Bob Marley Museum, which was really cool.

There's all these great photos of Bob in a mural on the wall, and some great statues too.

Bob was apparently only 5'6", so the statue is life sized. A very interesting life, and I always wonder what would have happened had he amputated the melanomatous toe, instead of keeping it because of his love of soccer. What he could have done! It's amazing what he did in his short life. Also, they have a Grammy in the museum, so I was really quite excited to be in the presence of a real Grammy statue. It's his old house, his wife donated it to make the museum, so there's lots of fun stories to be had and the tour guides here are great too! We had a rousing rendition of "One Love," all six of our group. :)

From there, we headed to National Heroes Park and I got to hear a lovely bit about Jamaican history and its national heroes. Did you know that's where Marcus Garvey ended up? I dredged up some of my Civil Rights history background and got to supply some information for the tour. 

We ended up driving through Kingston and getting to see some of the statues and sights (Hello Port Royal off in the harbor! No pirates or Johnny Depp sightings however...) but then headed to an apparently famous restaurant near the harbor. They served curry, and considering I can't eat beef or chicken...this is curry goat!

It was rather good, even though I don't eat a lot of meat and can't really tell you what texture goat is. The curry was spicy, but not too so overall a lovely win.

After that, we were off to Trench Town to see where Bob Marley grew up and took his first music lessons, and we got it from a genuine Rastafarian man, named Stone Man. There was an undeniable marijuana smell around the house and the people hanging about, but it ended up being atmospheric, considering the culture.

We finished our day with ice cream from Devon House, which is apparently rated the 4th best place in the world to get ice cream (by National Geographic). As a big fan of ice cream, I have some issues with this, but it was still good ice cream.


Onwards to the Blue Mountains on Sunday!

This is Jerome, our tour guide on the coffee plantation we visited. He's pointing out some of the coffee beans, and it's a very interesting culture on the island. He was wonderful--he knew all kinds of dates in the history of coffee, and plenty particular to the coffee industry in Jamaica. ALL the coffee plants are derived from the original plant. This man departed from France (the coffee plant had been brought to Versailles by Louis XV) with six plants, and through storms, attack by pirates, and attack by his fellow shipmates, one plant survived to Jamaica. And a whole industry is grown from that one plant! 

Jamaican now is home to the Blue Mountain coffee, rated the second best coffee in the world. It's a very particular industry, and the elevation at which the coffee is grown determines how good it is, and lots of other things like moisture and acidity and sulphur. Also, it's good coffee because it generates its own sucrose and glucose, and doesn't release bitter acids.

I tried it, and I still don't like coffee, but it's the best of the bunch I've tried!

We climbed all the way up the mountain, viewing the coffee and wonderful vistas throughout the climb (and it was worth the pulled quadriceps I got somewhere along the way).

This is still the vista from the top of the mountain, in the glorious  Blue Mountain range. We spent the rest of the day hiking and enjoying the lovely flowers growing throughout. I took some photos, but this was my favorite of the bunch, crouching amongst the flowers which enclosed the entrance to a waterfall.

It was a glorious day, though misty and rather atmospheric once we were in the mountains. A nice change from the medicine, even with having to read and prepare for lecture the next morning hanging over me on the trip back to Kingston. And it was nice to safely make it back to Mandeville and negotiate the taxi trip home even though twilight had passed and night had definitely fallen.

If anyone is ever in the Blue Mountains or Kingston, they should stay at this lovely B&B called RafJam. The view from our little treehouse:

And despite the problem of stray dogs, there are puppies that go with said stray dogs, and they're just adorable! (Despite the likely profusion of fleas, I couldn't resist!)

medical differences, so far.

So my first week of surgery is done, since tomorrow all the Projects Abroad volunteers are heading out to do a beach clean up (and I will probably take the Jamaican beach photo you've all been anticipating!), and the differences are both stark and reassuringly similar.

(for those of you who aren't medical people, this might not make too much sense...)

One of the residents here asked me that, actually. And the best thing I could tell her was that the pathology and presentation and even some of the treatment is the same. The differential diagnoses may be different, as they have higher rates of malnutrition so things like goiter come to mind more quickly for them than they do for me. Also, they have a much higher incidence of HIV/AIDS, so they have to treat infections more aggressively, so I see more Flagyl/metronidazole being given out to cover a wider variety of bugs.

On the other side, things are vastly different. A reliance on Augmentin and Flagyl because of immunocompromised patients is a far different end of the spectrum than Zosyn and Vancomycin for MRSA. I have YET to hear the word/phrase MRSA while I've been here.

Also, no one wears masks/gowns/gloves. There are isolation rooms, which would be as close to a private room you'd get, and I still think there are 2-3 patients per isolation room. This was a hard sell for me to the Jamaican residents, saying how all of our patients have private rooms and if not private, not with a patient within a foot of your bed.

Speaking of the beds, yes, they are that close. So you're very intimate with everyone around you, and there's nothing like HIPPA to protect your health information. It's all out there--how can you help from hearing what's going around you? We round and share the information right in front of the patients.

Oh, rounding. You know, pre-rounds, getting the printouts, potentially having a laptop, etc with you while rounding? No such luck here! First off, pre-rounds don't exist. (A 7:30 lecture is very early here!) The residents don't seem nearly as prepared as we are in America, but there's a big difference--paper charts! With things just thrown rather haphazardly in them. Labs may be 2 days old and that's the newest information you've got to work with. I have yet to see a computer in use anywhere in the hospital. Nurses work with ledgers of the patients on the floors. Things don't flow as smoothly in rounds because the information isn't all the tips of your fingers, and we actually encountered--twice--patients that no one had seen because it's so easy for them to fall through the cracks.

Patients are often expected to provide and drink their own fluids, rather than to get IV fluids. In fact, patients aren't fed and have to have their family bring them food. They have to walk down the hall by themselves to the bathroom, carrying their own toilet paper. The sheets on the beds are likely donated, as none of them match and a lot of them are floral prints.

There's other differences in the operating theatre also--very few lap sponges or 4x4s are used, and the saline is often squeezed out of IV bags instead of opening new bottles. The instruments are generally the same, but without the variety of retractors you can see/request in the OR back home. Also, no air conditioning in some of the theatres makes it very hot. Also, this is a big hospital, considered the city's hospital. It has four operating theatres. In comparison, many community hospitals have 10-15 and places like VCU have 40.

The scrub technique, as I already commented, is completely different. There's no foaming in/out of patient rooms; first off, there are no patient rooms, and there's no gel/foam/soap. There are NO supplies not locked up.

Lectures are different too; the topics are generally the same, but there are subtle differences in some lectures and huge differences in others--like the cancer lecture I sat through with the University of West Indies medical students yesterday. I was asked a question at one point and responded with how I would treat the patient and informed I was wrong. I wasn't, it's just the difference in the way cancer is treated in the US and the options available here.

That's what it comes down to--in America, we have a surfeit of options and choices while here, there are none.

Or take this for example: a young man with pancreatitis, turns out to have obstructive pancreatitis from gallstones, and sickle cell disease--no big deal in America, right? Easily dealt with on a tele monitor, since he's a little hypoxic from the pain and splinting. Here, he had to be transferred to the University hospital in Kingston because they don't have the ability to take care of him on the floor here.

first day in surgery

this might be a quick one, and no pictures; it was a long day.

I've been waking up quite early for some reason, but it's very peaceful to listen to the birds and yes, the rain. although i may strangle the rooster down the street by the end of the six weeks i'm here--i know one thing about roosters, and that is that they're supposed to crow when the SUN IS UP.

I had my scrubs and white coat going on this morning, and my host mom dropped me off so I didn't have to catch the route taxi. It's an experience here to catch one, as taxis are completely different than in the US. I walked on down the road, feeling quite conspicuous in my scrubs and coat, but a man passed me and said "Hey gorgeous" which is rather flattering. It's fairly common to be complimented walking down the street, and the men aren't usually too aggressive about it, just wanting to compliment you, so it was a confidence booster.

I had my first experience with Jamaican time this morning, waiting 45 minutes for the person to show up to introduce me to the "attending," which is not what they call them here. But we got it sorted.

[this is all medical stuff, which may/may not appeal to everyone!]

I ended up on my first surgery with one of the doctors, but i'm not sure how trained he was--if he would be our version of a resident or fellow or what, because he wasn't treated the same way as the attendings (in the plural because there are two! total!). But he asked if i've ever assisted in surgery, i said yes, so i got scrubbed in.

Which is a completely different experience here. They directed me to the scrub room, with a nurse assisting me to show me things. She offered me a bar of soap or the liquid soap. I inquired after brushes, but there is no such thing here. I took the bar of soap, sitting on the shelf, clearly used for multiple scrubs, and scrubbed the way I've been taught to find out that it's not the way they do it here, but it was sufficient. You also have to use the other hand to wash off the soap, so that was different, and the nurse has to turn the water off for you. I had to pick up my own towel, which was fine, but I'm not sure they knew what I was doing as I flipped it from one side to the other to dry each individual hand. Also, they pile your materials in a different order so that caused a bit of a disruption as I tried to figure that out. You also do this all yourself, so I'm doing the best I can, considering I've never done this without the scrub tech watching me like a hawk. I double-gloved in the same size (after having to defend the fact that I'm a 6 1/2 glove, no one EVER believes me about that, the world over!). No latex free, so here's to hoping the allergy doesn't get out of hand before these two weeks are over. The gowns are cloth and reused. No face shields, or eye protection offered at all.

And later, one of the surgeons was observing a cholecystectomy and his mask just fell off his nose and then off his mouth and no one bothered to correct him. Having your mask on in the OR is a rather flexible concept here...

The surgeries themselves are the same, so no need to bore you on the inguinal hernia repair.

I made a friend afterwards of a Jamaican medical student, so things should go smoothly. But apparently in Jamaica, I should just go into any OR and observe; I shouldn't introduce myself or expect to be introduced to anyone. Also, the school system and intern/residency is completely different here...so are start times and hours worked. I finished at 1:30 today.

I spent some time chatting with the attendings about the differences in the American medical system and the Jamaican, and I can get into the later because it was a fascinating discussion.

It's a bit dispiriting actually, to think about in toto.

Regardless, I headed out to the PA office and got to meet another American, a Canadian, and another Scandinavian, before we all headed out to meet the rest of the PA volunteers and have the PA Olympics--two teams of volunteers and one of staff. Our team was valiantly defeated, as all females and one male might have a tendency to do in sporting events. We did well in tug of war, thanks to a bit of physics theory that I can spout as how to how to win (I also did not participate in the three legged race, but it's good to know that adults have figured out what children haven't). And Jamaicans will always win sprinting events. Always.

More sunburned today, even with judicious sunscreen application. Actually, I have a red neck--interesting that I had to come to Jamaica to get the red neck for which West Virginians are known.

Off to the hospital early tomorrow--7:30. It's a very early start here!

day one

in case anyone was wondering, it's 86 degrees and feels like 96. glorious. and i'm sunburned. note to self: ALWAYS put sunscreen on in the morning.

I made it here safely, though the journey was not without its own difficulties. but this view out my front window is worth it:

I may not have said that when I got up at 3:30 yesterday morning; it wasn't like I had really slept well the night before, thinking about had I forgotten to pack anything (most definitely no!). It took about two minutes to check in and check my bag! I told Mom she better not forget to pick me up in April, and that was that (anything more and either one of us would probably have started crying). In security, I was randomized into the check your hands for explosives line (!) but the nice thing about that line is that you don't have to take your shoes off, put your toiletries in the bin, etc. So that was beneficial since I don't always wear socks (I've had to walk barefoot through the airport before and that just grosses me out).

The most ridiculous thing was that this was for a flight to Dulles. It's handy to go through Richmond because of the abovementioned quickness, but the ascension and immediate descent in Washington was silly. I think it was 39 minutes total. 

There was a problem in Dulles though--a connecting flight from Chicago with 30 people on the flight to Montego Bay was delayed, so they delayed our flight. The plane was there though, so we loaded and got out only an hour and a half late. I ended up next to a pair of honeymooners, and we chatted as we got closer to Jamaica, so that was nice.

The views flying over the Caribbean are unbelievable. Suddenly it's turquoise, not blue. And the little islands! They pop up, little spits of sandy shapes. The underwater ones are absolutely the most beautiful though--you know how sand dunes get when the wind's been blowing, partially golden and then partially black where the wind's been? The underwater islands are like that, except aqua instead of golden.

Immigration...mmmmm, herding cattle. The couple behind me joked that it was 27 degrees when they left Milwaukee, and 27 degrees arriving in Jamaica--a play on the difference between Fahrenheit and Celsius.  I talked with them a little, and it was super cool--they had been talking about Doctors Without Borders, and the conversation came around later to the fact that I was doing something similar and they thanked me! It was different. Cool. Like I was a military member offering service to country, except I'm not as awesome as the soldiers.

I got through after awhile, but hundreds of sweaty bodies have a distinct smell, particularly when it's not sticky hot but just hot. Cell phone use was strictly forbidden, which lends its own distinction to a crowd. It was nice. 

I had a driver from Projects Abroad waiting--he shook my finger, which was cute--I had my passport in one hand and was pulling my suitcase in the other. There were two other Americans being picked up too, so we all trudged out to the car in the heat. Jamaicans drive on the other side of the road, and the driver's side is not where we all assumed, as we piled into the car--the girl in the front did a stop and start when she started towards the car.

It's a 2 and a half hour drive through the mountains to Mandeville, in the center of the country. Mountainous like West Virginia, but imagine--no guardrails, no signage to guide you that you're approaching a switchback, and potholes in washed out roads. Also, no giving room to pedestrians or cyclists. It was like riding the Knight Bus from Harry Potter. My hair was blowing everywhere since there's no a/c, and I felt like a bobblehead. Lots of eyes closed moments as we approached pedestrians or other cars with not enough room (although there was always enough room!). The irony of all this was that leaving Montego Bay airport, there's a sign with the number of traffic fatalities over the last few years...with their driving style, I am absolutely shocked there aren't more! 

But we made it. We also drove through the Bamboo Avenue, which I couldn't get a picture, but it's a broad highway with bamboo trees the size of Redwoods on either side of the road, and they grow over the road and make an archway over it. Fabulous.

Also spotted along the route--Mormons. Recognizable the world over. Enjoy your mission in Jamaica, elders!

I made it here, and my host family is very nice. Ingrid, my host mom, showed me around, and I met Earl, the host dad, this morning. His accent is much stronger than hers, but we'll get along well. I have my own bedroom, for now, and bathroom too. There's another American coming next week, so I'll have a roommate soon enough.

I passed out asleep not long after getting here and unpacking, because between it all, I was exhausted. I also lost an hour--they don't have daylight savings here.

Would you have all laughed to know I woke up to the sound of rain? Sunny, sunny Jamaica! Also, a rooster. A ROOSTER.

8 am, got picked up and taken on a taxi to the Projects Abroad office. The thing about Jamaican taxis is that they're called "route taxis" and they follow a specific route, so you can pick them up at a specified place around your house and go to the town center, and vice versa. But since fares and whatnot are set (and no tipping!), they cram as many people in them as possible. As in four grown adults in the backseat of a Toyota sedan. I was luckily the first one in, and I managed okay by shifting my shoulders and hips as best I could when the others got in. The taxi driver quipped "Welcome to Jamaica" when we expressed concern over getting a fourth adult in the backseat.

We made it, got a tour through the town center, walking around and pointing out landmarks. Changed some money--$100 USD gave me $10,500 Jamaican. It's baffling to do the conversions. A taxi ride costs $100JD. Approximately $1USD. 

Made it to the PA office, where we took pictures and got debriefed.

This is me and Helena, a journalism volunteer from Sweden. Just finished walking across town, so forgive some of the flushing. I soon got taken to the hospital, where the PA staff member walking with me and I got sent to the matron's office, because they thought I was a nursing student. Meanwhile, I was shocked to walk in the "emergency" entrance, which clearly wasn't like any ER I've been in. It was a vestibule of sorts, and filled with people with casts, in wheelchairs, on crutches, and even one man on a gurney. Absolutely filled with sick, poor people. It was rather heartbreaking, an exquisite reminder of the developing country I was in. We eventually got sent along to the right person, and I'm starting tomorrow. Scrubs and white coat, which I am apparently quite safe to walk through town in (though I probably won't wear the white coat until I get in). I was already hit on multiple times; as a white person, you stand out exactly for what you are--not Jamaican. But there's apparently a bunch of American medical students who started recently, so I'll make some friends.

Speaking of making friends, apparently the PA volunteers from all over Mandeville spend their afternoons, after finishing work, at the "food court." I was confused a little by this term, but it made more sense this afternoon when we ate lunch there. It's an open air mall, with a similar type of mall food court like you'd see in America. Not American food...I had saltfish and ackee, and I was not a fan of the ackee. Also, boiled bananas and boiled potatoes, which don't taste nearly the way they do in America (maybe it's because we don't boil bananas in America?). Also, fried and boiled dumplings. Those were good. Something made me nauseous, but I'm kinda hoping it was the ackee, since I don't plan on eating any more of that.

But so the plan is to head to the food court in the afternoon and make friends, because that's how you travel out on the weekends--with the other volunteers. As the only hospital volunteer right now, I was a little concerned, but we'll figure it out. Regardless, tomorrow is volunteer vs staff Olympics, so I'll meet more people anyway. 

 Despite the rain this morning, it has definitely cleared up. My face isn't too sunburned, since my light makeup has SPF in it, but my arms are. I may end up looking odd by the end of this, if I get a scrubs-based tan. On Friday, we're heading to one of the local beaches to clean it up (as a PA project, not a medicine-volunteer project), so I'll get a different kind of tan there.

Either way, the freckles on my nose are already starting to stand out.

and oh yeah, trying to explain the match to Jamaicans was impossible. I had NO cell service, so had I even wanted to turn the data on my phone on to check it, I couldn't've. I eventually ended up on a computer in the office, about three hours after the news had been released, and checked in. Matched!

Happy St. Patty's Day everyone--a nonexistent holiday here!

themes

I took this week as vacation in order to prepare for Jamaica, but it turns out I didn't have that much preparation left to do. There's been a lot to do, but I've been chipping away at it for the longest time that it didn't end up being too bad this week.

It seems that more than anything, I've been listening to music this week. The things I am doing keep triggering songs in  my head--I got my hair cut and my nails done, so Destiny's Child's "Jumpin' Jumpin'" was stuck in my head.

I went downstairs to pack my suitcase. See...there was this mess.

 I had been carrying things downstairs and throwing them in my suitcase. Or thinking, "oh, this might be good to take" and tossing it in there. Our dining room is empty right now, so it got to be where my giant suitcase was stored. The cats would investigate new scents as things kept piling up...up...and up. So I finally got myself together, put my iPod on and began to pack. It made me laugh to be packing to Michael Buble's "Come Fly With Me."

This is much more manageable right? I shouldn't tell you how long it took. Also, my mom pointed out that everything I brought down was blue...so I had to start from scratch. The scrubs have to be blue or green, but not everything else! It was a big attempt of trying to find clothes that are multipurpose--dress up, dress down, beach ready, etc, and enough for six weeks. Luckily, the temperature in Jamaica isn't too variable--lows in the 70s, highs in the 80s.

How many people in the US are snowed in right now? :)

The other thing was that I got an email from the Projects Abroad people saying that on April 1st they're having an International Day type festival, so if I could bring flags, pictures/postcards, snacks, small musical instruments, or ethnic dress, that would be great. Okay, it's a great idea, I wholeheartedly agree with that. But oh my, do I have to represent the ENTIRE US?! Hopefully there will be other people from the US there. That's why you can see there US flags and the Christmas lights (which are not actually Christmas lights--they're red, white, and blue!) tucked in my suitcase, raided from the outdoor Fourth of July decorations. Also, the Phillies cap--multipurpose in good for the beach and as a sun visor, as well as representing the great sport of baseball. Other than that, I go armed with the Mormon Tabernacle Choir's cd of "The Spirit of America" (also awesome that it's the MoTab too-- very American!) and my history degree from the venerable historical institution of The College of William and Mary. Plus I'm from Virginia, so I can ramble on about American history quite well...Jamestown to Richmond in the Civil War...etc.

Can I take my piano? Does that count as a "small musical instrument"? :)

So in addition to the other songs in my head, I've been listening to the Star Spangled Banner et al, as I cull through my photos of trips to various landmarks--Times Square, Hollywood, the Capitol.

Other than that, I'm making my list and checking it twice. Counting out my meds to make sure I have enough (I do), checking for the spare contacts and making sure I have my glasse...making note to ask how safe the tap water is. I'm down mostly to deciding what books to take, and downloading free ones from Project Gutenberg onto my nook. Preparing for London as I add Pride and Prejudice, Jane Eyre, Much Ado About Nothing...

Listening to music, going over my list, and coming to a fairly zen-like state considering it all. As long as I have the essentials, it'll all be okay. I'm really not nervous--Saturday I may be, but not today.

Another song deserves mention because I've been listening to it over and over since I first heard in a few weeks ago. Kristin Chenoweth has done some solo albums, and I finally got to hear them after all those times I listened to Wicked. It's called "I Was Here" and I think the chorus really personifies the answer to why I'm going to Jamaica, why I was originally planning to go to South Africa.

"I wanna do something that matters

Say something different

Something that sets the whole world on its ear

I wanna do something better

With the time I was given

I wanna try to touch a few hearts in this life

Leave nothing less than something that says

I was here."

We have been given so much, growing up in America, the land of opportunity. I've known from when I first got into medical school that I wanted to go abroad--I wanted to see what medical care and the culture was like elsewhere. The original plan, considering my love for infectious diseases, was to go to the forefront of the HIV/AIDS epidemic in South Africa. That became impossible due to circumstances beyond my control, and instead I get to go to Jamaica. I'll spent two weeks each in surgery, OB/GYN, and general medicine. 

I have no idea what it's going to be like, but I always want people to know--the patients have the power to affect me just as much as I do them. So like Kristin sings-- "I wanna try to touch a few hearts in this life." I want the experience, I want to see it firsthand, I want my horizons broadened and my perspectives altered...

Next time I posted, it'll be from Jamaica! I leave Sunday, very early to arrive noon-ish in Montego Bay, and then it'll be about a three hour drive to Mandeville. Sunday will be a long day, but I'll gain an hour somewhere along the way--no daylight savings! So much for trying to adjust this week...

And my suitcase currently weighs 51 pounds. Will they forgive me the one pound, do you think? :)

Trip preparations

I think international travel is testing even my OCD organizational skills.

There's Jamaica (via Projects Abroad, or PA if I abbreviate it) from March 16-April 26th. That's six weeks in a medical clinic, finishing up my fourth year electives and actually, the end of my fourth year curriculum and as such--medical school overall! When I come back from Jamaica, I'll be done with school!

I'll be in the US for three days before jetting off to the UK on the evening of April 30th--arriving in London on the morning of May 1. I'll be returning from London on May 15 after touring London and Scotland.

So in total, it's two months. Six weeks in Jamaica and two weeks in the UK, or March 16-May 15. Leaving the country for two months is a bit challenging.

There's little things like packing. It's not too bad on the clothes front because the very disparate climates. I can theoretically pack my suitcase for the UK before I depart for Jamaica, because there will be very little overlap (plus I probably have enough clothes regardless). There are a few necessities that will switch suitcases, but that's small things.

There's things that you have to think about--the electrical converters, for one. I don't need it for Jamaica, but I do for the UK. How extensive of a first aid kit/medicines do I need to take. It's obviously more comprehensive for being gone for six weeks--my mom even came up with some ankle braces for Jamaica "because I know you," she told me. I probably am more likely to need them in London, for the walking, but who knows.

Or the money--I'll convert US dollars to Jamaican dollars in Jamaica, because our dollar is stronger than theirs, it'll be a favorable rate. Versus the pound is stronger than the dollar, it'll likely be more favorable to switch that currency here. Plus I don't want to waste precious time in London to wait to convert my money over. There's also the little fact to find out if your credit card company charges international fees; mine doesn't, but that took a few minutes of research to find out and an email to track down the real information. I also went into my bank to find out that there's the usual ATM fees if I use one internationally, plus a change of currency fee at the ATM. I can only imagine how high that one is.

Cell phone use is another--we tend to think of everything as "free," with our limitless plans. I remember the days of having limits, and this is vaguely reminiscent. There's a fee per minute of telephone use ($1.99!), text sent or received ($0.50 per!) and also data usage (per KB). So needless, I'll have it for emergencies but not use it--so don't text or call me!

As such, it was a blessing to find out that my host family in Jamaica has internet! (And a washing machine! Living the high life! But really, this is awesome.) So hopefully I'll be able to stay in touch via emails and blogging.

There's also figuring out the itinerary--not so worrisome for Jamaica, because I'll be in the clinic. There'll be weekend outings, but things will be a little more free flowing. In London, there's a plan of attack to conquer the city as best I can and see as many things as I can. Same goes for the trip north to Scotland--and what can I see in Northern England on my way there? I have spent countless hours working out these things, plus operating hours, train schedules, etc to see if it's possible to do what I want. So far, so good. :)

Plus there's things here to not forget--I had to get the oil changed on my car, and we have to figure out what to do to keep the battery from dying while I'm gone for two months. My mom doesn't drive a manual, so I have to see if one of my siblings can maybe drive it around a bit.

Also, hair cuts. I need one. I want to get a pedicure before I head to the Caribbean (this makes complete sense to me!). There's also the logistics of the fact that the match is happening the first week I'm in Jamaica, so I'll find out where I'm doing my residency while I'm gone. I have to be set to find housing when I come back from the UK--I have a brief period of time before graduation (May 31) and starting residency--more information will come after I match. I had to make sure I had my taxes and financial aid stuff done--taxes are due in April while I'm gone, and financial aid stuff had to be done by May 15--the day I'll be flying back from London. Also, stuff for graduation has to be done by May 15.

See how this is taxing my organizational skills? It's getting there though. I have one week left on rotation here at home (medical examiner's office--tons of fun, not how it looks on tv!) and then I'm taking a week of vacation to get everything sorted before taking off.

Keep this bookmarked--this will be where I do my most frequent updates. I'm also a big picture taker, so hopefully plenty of pictures will get to make all of you jealous--Spring can't come fast enough for so many of us in the US!