trading suitcases

Acclimating back to the States is a very different thing that I thought.

The insomnia is crazy--no problems almost the entire time I was in Jamaica, but back in the US and the dark circles are back. My mom pointed that out this morning. :( the one thing is funny about this--I had very vivid dreams in Jamaica and they have definitely continued! But this all probably a result of getting about four hours of sleep after I got home very early Sunday morning, and just not being able to 'catch up.'

The carpet feels SO odd under my feet too! And every so often I catch sight of how tan I am in contrast to my shirt sleeves, which makes me laugh. Also, trading in tank tops and swimsuits for sweaters and my rain coat...not so fair. :) I am so cold here, trying to avoid wearing my turtlenecks to be so obviously cold and instead reaching for the lightweight sweaters.

Regardless of all that, I'm really trading up from my rotation-vacation to real vacation. I am packed and ready to take off for London! I'm very happy looking at the forecast though, since it will rain the first day I'm there but looks rather clear for the remaining few days. My trusty umbrella is still prominently packed a la Mary Poppins.

I'm really posting to tell everyone I will not be taking my laptop with me on this trip. I'm really consolidating and basically backpacking it, so I chose to take an extra sweater instead of my laptop. I'm anticipating having good access to WiFi through my iPhone, which I can carry more confidently in England than Jamaica. Plus I don't have to sign any contracts or find an apartment while I'm in Great Britain, so I'm really taking this vacation concept seriously and taking a break from some technology.

As such, pictures will be limited until I come home and upload them all in one burst. You also won't have to deal with the giddy ramblings of a history nerd unleashed on some of the world's greatest historical sites...

In the meantime, try some festivals! They're delicious and very Jamaican. If you can find some Red Stripe and curry goat to drink and eat with them, all the better. I think they taste like funnel cake, but these are more log-like than the thin strips of dough that make up funnel cake.

1 ½ c flour

3 T cornmeal

1 c water

½ t salt

3 T sugar

1 t baking powder

1 t vanilla

Sieve the flour into a bowl and stir in the cornmeal, salt, sugar, and baking powder. Add the vanilla to the water. Add a small amount of water into the mixture, work the water in with your fingertips. Keep adding small amounts of water to the mixture—when half the cup has been added, it should resemble breadcrumbs. Keep adding water until it becomes a firm dough which is only slightly sticky—you should not need the whole cup. If it becomes too sticky, add more flour.

Cover and leave to stand for half an hour.

Divide into eight portions. Knead each portion and roll it into a small sausage shape.

Cover each festival in a mixture of flour and cornmeal.

Deep fry until golden brown.

(Serve with any Jamaican dish. Festival goes very well with jerk dishes and spicy fish recipes where the sweet festivals provide a delicious complimentary taste.)

home!

Whee, I’m back in the States! Though it was not without its difficulties…

It started with one last taxi drive, starting at 9am. I took some pictures with my host family and then I was off! Got to Montego Bay at 11:30 for my 3:15 flight, and I was thinking all would be well and I could change the last bit of Jamaican money back to US and get a good lunch and be ready to fly home. I should have known better! This was Jamaica we’re talking about after all.

The computers were broken. They had to check us in manually. The line, which I was near the front of, took 3.5 hours to get through. The girls in front of me were going to Newark and the family behind me to LAX via Houston. The Houston flight departed first, then Newark, then my flight to Dulles. I was literally the first person in line when they started calling for the Houston flyers—so I let the family go, and then I stood there with a pitiful look on my face until they checked me. They had to label my bag by hand and give me a physical receipt for the cash—no credit card machines.

I got through security after a bit of a laugh—I set off the metal detector, and when they scanned me with the wand, it turned out that it was the underwire on my bra that set it off (way to go, Victoria’s Secret!). 

Grabbed some snacks and found my gate, still optimistic at this point. The computers can’t be down all day, can they?

Oh, they can. The 3:15 flight time passed without any announcement from the staff, but an enterprising traveler asked—there were still 89 people waiting to be checked in. They had filtered through the Houston and Newark travelers, so all the Dulles ones had been waiting in line.

We finally took off at 5:15 or so (which is 6:15 Eastern), and landed at 9:20. They made up a lot of time on the flight, but my connection was departing at 9:50. I hurried off the plane, tapped my foot through the bus trip to the customs terminal, and dashed down stairs in my platform sandals. I was at the front of the line at customs when I saw this:

I took the photo Sunday morning, so don't mind the time at the top.

 

It left EARLY! So there was no rush anymore. I called my mom to see if she wanted to drive up, and she suggested renting a car. Mostly because I was this close to home after six weeks, I wasn’t letting anything hold me up. The lady in front of me was shocked to hear I had been gone that long and gave me a hug for all my troubles after all. She was really sweet, and wanted to hear all about my experiences. They missed their connection to Syracuse, their plane also taking off early.

I had a hotel voucher, but ended up with a rental car instead. It was a miracle I had my driver’s license with me, but I did. Also a miracle—I ended up in a Corolla, which is the car my mom drives some I’m family with its size and the location of all the buttons. It was a 2014, which was weird for me with all the technology.

Let me tell you—after six weeks of no driving AND being on the wrong side of the road, DC traffic at night is not the best way to reacclimate. Seven lanes merging…lights…rain…65mph…good times.

I made it home at 2am. Hot food and mommy hugs were waiting. The sad part is that my internal clock was still going strong—I woke up at 6am.

The carpet feels odd under my feet…I’m so cold in the 60 degree weather…and the food tastes different! But I’m so happy to be home.   

United says I'll get a refund for the missed flight--it's apparently $240 to fly from Dulles to Richmond which is simply ridiculous but I'll take it. :) Plus a potential refund for the rental car. It would come close to totally the entire round trip tickets if I get that all.

Regardless, this is what I got to come home to, so I'll just be grateful for everything that I have.

Off to the UK Wednesday!

medical wards

Well, this is it. my final week! And it's a new ward this week: the medical wards.

Which means general medicine, and I happen to be on the female ward because that's the one that I found first this morning. This part of the hospital is undergoing renovation--so this ward has actually already been renovated. It reminds me ever so slightly of home, too! AKA it actually looks like a more modern ward. There is oxygen on the walls so tubes can be plugged into that. There's still no suction, but there are lights and outlets. There's even a cabinet installed between two of the sets of beds which creates a semi-private room at one end of the ward! Hallelujah! Still no decent sharps box, the blood still goes in a paper slip made envelope and in the box, and the medicines are now kept under the desk instead of in a cabinet.

Interestingly, there's also only fifteen beds. I don't know if this is because the other six beds are used for the psych ward, or because the medical doctors in charge of the wards are often going to consultations on other wards but when I'm used to 35-40 patients per ward, this is far easier to manage. Plus with the new renovations, these fifteen patients get the room they should have because the ward probably used to house 20-30 patients.

Regardless, the medicine is fabulously interesting.

I've had the distinctly memorable experience of seeing Steven's Johnson Syndrome (SJS) and actually also Toxic Epidermal Necrolysis (TEN), the worse cousin of SJS. Basically in SJS your skin only peels to about 30% of your body's surface area, while TEN it's more than 30%. As you can imagine, mortality is quite high. It's a terrible thing to see and watch and know that the patient is likely going to die no matter what you do. So imagine SJS in Jamaica. The dressings that we use in America would cost probably $5,000 a day. That is impossible here--I can't imagine any of them have even SEEN the dressings, let alone consider getting one in Mandeville if there is one in Jamaica at all. So we have to leave the skin in place as a biological dressing; a rather creative solution here but there is always the risk of secondary infection. It's also complicated in this patient by an AIDS diagnosis that the patient is in denial about and thus is not treating. It's a very interesting medical question of how/if the AIDS contributed to the immunologic reaction that is causing the SJS. From what I've seen, she's really not in terrible shape, but time will tell. We definitely need to get IV access on this woman also and while we would have already gotten a central line in America, there isn't even peripheral access here.

There was a woman who is questionably having seizures or tardive dyskinesia, and she's not faking it like some of the other doctors had assumed. When you lift her hand over her face, she lets it hit her in the face. Fakers don't let their hand hit them. She was interesting because she can clearly hear us, but she can't respond.

There's a woman with a herniated brainstem...which in America is steps from brain death if not actually there yet. But they're considering their options here and if she's getting any better--I found this exceptionally odd, in addition to the fact that she's not on any monitors. I have no idea if they do transplantation here, but she would likely be a good candidate.

I mentioned above--no monitors. I haven't seen a single working telemetry monitor in the whole flipping hospital. I've spotted one monitor, but it wasn't working. When you consider the prevalence in America, that would probably be a significant visual difference every healthcare worker would pick up on.

Otherwise, mostly normal stuff here. Diabetic nephropathy, aspiration pneumonia, avascular necrosis from sickle cell crisis...

And then the psych patients. One of whom was wandering the ward and told me I wasn't from the US, but from Canada. There are worse things to be called, eh?

the long week continues...

So we got back on Tuesday night, and I had outreach on Wednesday morning. We (the medical and care volunteers) were going to a primary school to do presentations. I was in the group on nutrition. It’s an interesting topic down here because they have a different version of the food pyramid or food groups, and of course some of the fruits and vegetables down here are different. Vitamins and minerals are luckily the same, so I just did a quick review.

Being in a Jamaican classroom is not at all the same as an American one. I had been warned by some of the teaching volunteers about the differences, but it’s not the same as experiencing it yourself. There is a bell/class schedule, but it’s not always adhered to. The kids often talk through class. They hit each other. They get up and leave and come back. They’re polite enough to say “Yes, miss” to everything I say, but not enough to stop talking and listen to what I have to say.

I can’t even say which classroom was worse, the older or the younger. It’s a good thing we only did the presentation twice, because I likely would have lost my voice having to speak so loudly over all the talking.  The younger ones were rowdy and difficult to even try to keep on task. The older ones, the ten-twelve year olds, make obscenely sexual gestures towards my peers and me.  And I can’t imagine that any of them paid enough attention to remember anything I said.

In fact, I couldn’t help but remark later that a sex ed class would have been much more beneficial. The culture here is an interesting dichotomy of religion and sexuality. Jamaica has the highest number of churches per square mile of anywhere in the world, and they’re always full. In fact, it’s Easter weekend right now and both Friday and Monday were/are public holidays. There’s that side, and then there’s the bars on every corner with voluptuously painted women on them. I was invited to a go-go club last weekend in Negril. I’ve heard that nine year olds are having sex. I see teenagers more commonly on the maternity ward than women in their 20s and 30s. STIs are incredibly prevalent, as is HIV/AIDS. We had to do a c-section on an 18 year old last week because her genital warts were so bad.

It reminds me somewhat of the right-wing Christian conservatives attitude in America, where abstinence only sex education is enough. It’s not. Especially in a country like Jamaica, where people can’t afford to pay for the ultrasound when they’ve got oligohydramnios, how can people afford their children? So why can’t sex education happen so contraception is a possibility? Oral contraceptive pills are available here without a prescription, yet I’ve met women with eight or nine children. Who are my age—27.

It’s just another of the many frustrating things I’ve seen here in Jamaica, and I truly wish there was more we could do to help. Nutrition they may not remember, but if I start talking about sex I’m sure they’d remember. It’s a sticky situation, but one the volunteers were talking about after our presentations.

Thursday it was back in the maternity ward, to lots of jokes about how I must have extended my vacation and “hello, stranger!” I set the record straight and they’re all shocked and sympathetic about our weekend in Negril, but we quickly get down to business. It was a good day of phlebotomy and giving IV medications. I almost put in an IV but we got distracted by hanging blood for the anemic patients.

Josephine left on Friday, so Thursday evening we learned how to make fried dumplings. Very different from the dumplings I’ve had in the US and I’m very excited to know how to make both fried and boiled dumplings when I’m back home.

Things started to take a little tumble downhill on Friday—I woke up not feeling well. It was mild, slightly like I was hungover but I wasn’t. With my food allergies, this isn’t exactly an unexpected reaction because that can be how I feel if I ate something I’m mildly allergic to. In Jamaica, the foods and thus the proteins can be different than what I’ve been exposed to in the US, so I just figured something from dinner was bothering me and that was that. I sat out on the patio with Josephine for a bit and then came inside. She left and I fell asleep.

That’s when I started to figure things were more serious because I don’t sleep during the day, and I woke up feeling quite nauseated. That continued through the night until I eventually fell asleep and woke up this morning feverish and with a headache, but no nausea. It’s a bit scary to consider a differential diagnosis in the Caribbean that includes fever, headache, and nausea. But common things are common, so I’ll forget about the dengue and leptospirosis for now…

At least I got sick on a weekend where I didn’t have firm plans and I have until Tuesday to get better. This time next week, I'll be in Dulles waiting to get to Richmond to be home sweet home!

we made it to negril!

A lot has happened this week, and I will do my best to detail it well.

The time in the hospital has continued to be fabulous, and I appreciate all that I have. It’s interesting to consider some of the questions that the residents ask amongst themselves and also me by extension. It concerns me a little because some of it is very basic step 2 or even step 1 information, and many of them are professing the want to come to the US and thus have taken USMLE.

That all aside, I love going to work and drawing blood and mixing and administering medications. It makes me feel useful, and I’m helping the residents with their work as well as helping the patients. It’s still amazing to me what’s considering doctor’s work here is basic nursing care in the US, but as long as someone’s doing it, it doesn’t really matter.

On Friday, we actually ended up sewing up an episiotomy on a woman who has just delivered. It was critical we sew her up quickly because she was anemic and had been transfused before the delivery and was bleeding a lot. I held an iPhone for a flashlight (as I had the day before on a speculum exam—no lights around here). The intern did it, the midwife showed him where the tear was and then left. I ended up helping him a little (one sterile glove, the other hand holding the phone). The woman was given no pain medication, just a little numbing.  During this process, I realized how little some of these women are told. I don’t think any of these physicians could pass a physical exam board in the US because of the humanistic domain—they tell the patients to hush and behave themselves when they reach out or cry out in pain.

Me and Josephine--the moment of 'we made it to Negril!'

So it was nice to get out of the hospital on Friday and head to Negril. There were four of us going, and after driving on the absolute worst road I’ve been on in Jamaica (and that’s saying a lot!), we made it. It was so fabulous! One of the volunteers who went with us is a millionaire in his home country, and that made for a lot of perks over the weekend—including flaming shots of rum, because if the power’s out, we should light alcohol on fire. It was a very Jamaican experience though. As was swimming in the Caribbean Sea at night—the water’s definitely still warm enough to do that.

Me, Josephine, Debbie, and Mattias

 Saturday was a light day, just enjoying the gorgeous Seven Mile Beach.

We headed to the world famous Rick's Cafe that evening, a bar famous for its cliff diving. No cliff jumping for us, but it was fun to watch. We made friends with the Jamaican staff at our hotel and played cards with them when we returned from Rick’s, learning games from my fellow volunteers and their native countries as well as a Jamaican game.

 

Sunday was a rather unfortunate morning. I had gone back to the room slightly before the other two girls, and I also ended up waking up before them. Josephine and I were sharing a double bed, and she rolled over at 7:30 and asked me what time it was. Promptly getting out of bed, she went to get her phone from the charger and found it was missing. Looking for her handbag, she saw it was also missing. Debbie and I got out of bed to look for it, and Josephine declared that it had been stolen when it was clearly not in the room. I went out to the patio where we’d been playing cards to see if she’d left it there by chance, and alerted the staff there. They checked with security, and as security walked back to the cottage, they spotted her bag in the dirt between our cottage and the next.

There were no signs of breaking and entering, and the girls couldn’t remember locking the door. It’s such a habit, no one could remember; and I had already been in the room when they came in, so I can’t say one way or another.

The very difficult part about some of this is how hard it can be to make international calls on some cell phones. Luckily, Josephine and Mattias are both from Sweden and Mattias had a good working cell to call Sweden—and deactivate the credit cards as well as the SIM card on the phone.

This was being done and security called the police, but we could see Josephine’s wallet on the ground and carefully flipped it over. Her driver’s license and credit card were still intact, though about US$50 had been taken. So some worries abated.

Interlude to comment on the lovely staff—since we had been socializing with them since we’d gotten to Negril on Friday evening, they were so exceptionally friendly with us. They brought coffee and water and let us order breakfast while we’re all hovering around the little cottage of our room. It was amazing of them, and they were also very concerned about us. As we repeated frequently to them and to others, none of us had been assaulted or raped or anything horrific like that so we could get through a robbery.

Before leaving for court, we got a photo with the staff of Roots Bamboo

The police came (in jeans and t-shirts! Good thing for the constabulary vest, otherwise I wouldn’t have believed they were police!) and Josephine described the morning and her phone to them. Something rather miraculous happened then—they said they thought they had ‘something for her.’ They left for a bit (to go back to the station) and brought in a Samsung Galaxy S4, estimated at US$748 we later calculated, which was hers. We clearly identified it.

So at this point, all worries were relieved. Yes, the cash was gone but we will all take a loss of US$50 for everything else!

Josephine and I are wonderful friends for all that we’ve known each other for two weeks, and she and I share a host family. The police had assured us that they would try for a Tuesday trial date, since we were only in Negril for a short period of time. The others would go back to Mandeville, but she and I would stay in Negril until Tuesday (It was too far to go back on Sunday and come back for court on Tuesday). We alerted Projects Abroad and headed to the police station to make a statement. We also let our host mom know and it was so sweet, her reaction. I called her because Josephine’s English was deteriorating by this point and Ingrid was so outraged for us and so concerned. Neither Josephine nor I could talk to our real mothers, but Ingrid is a lovely substitute.

I’ve commented about the lack of computers in the hospital—the same holds true for the police station! I did at least spot one there. But the statement took about three hours to give because of the details required, the handwritten nature of it, and also the struggles with Josephine’s English. She speaks excellent English with very little accent, but under pressure, she deteriorated slightly. I helped, and we eventually made it out of there. The police were so nice (especially after the taxi that dropped us tried to charge us astronomical prices—too bad we’re savvy Jamaican travelers and didn’t fall for it!), taking us back to our hotel via an ATM so Josephine could replace the missing cash.

We moved cottages but stayed at Roots Bamboo (they did offer us a nice discount). The funny thing is the new cottage had a door that was swollen in the door frame, so it made a lot of noise to open it. No breaking and entering without us waking up anymore!

The very nice thing was that Mattias and Debbie had organized us to go snorkeling while Josephine and I were at the police station. It was a lovely change of pace and took all of our minds off the robbery. In fact, I got quite excited because there was an anchor and cannon from the 18^th century along the coral reef. The fish were gorgeous, but the history major in me came out. I dove to the ocean floor to touch the canon, which was clearly oxidizing on the ocean floor. The anchor had coral and algae growing along it, but when you stood on the end of the shaft, you could keep your head over water. It was so cool! I laughed in a carefree manner I can’t remember having done in a long time, it was so awesome a feeling.

On one of the small islands off Negril, near Bloody Bay

We headed back in to pirate stories, and Debbie and Mattias took off for Mandeville. Josephine and I really just calmed down and slept in a little for our day of relaxation on Monday—it felt like playing hooky from work to be there, but court on Tuesday was not easy. We waited around to be the last thing, since they usually don’t try cases on Tuesdays but were making an exception for us.

It was mostly like it was on TV, which was the extent of our previous knowledge of court between me and Josephine. It was almost heartbreaking to watch her on the stand and the pressure of the defense attorney and her English not always being exactly on. However, we were able to retrieve ‘exhibit A,’ the cell phone, and the judge very kindly apologized for the inconveniences of our trip and hoped we would continue to enjoy Jamaica.

The two hour wait for the bus didn’t help, but we made it home to Mandeville and our fabulous host mom, complete with hugs and homemade food (and showers!).

Okay a lot happened today too but I'm so exhausted I can't write anything else besides here's a comment on other things: I signed my contract today for my residency!

medical commentary on the maternity ward

I still can’t get over the blood-drawing differences. In fact, one of the residents commented that she’s never seen a tourniquet. I have trouble tying the glove in the right conformation to form a tourniquet, but they’re experts at it. I’m getting pretty good at phlebotomy, even though drawing up blood into the syringe while holding the needle steady is still something I’m struggling with on occasion. I miss the technology we have in the states.

Speaking of technology, have we ever considered the convenience of the tube system for blood delivery to the lab? And to continue with the general lack of resources, the pleasant use of biohazard bags in which to put the tubes of blood?

Behold the box for blood samples! After drawing up a tube of blood, you fill out the paper slip to order the labs, wrap it around the tube, fold down the ends, and put it in the box. Hope you mixed the preservatives in the tube well with the blood—it could sit there ALL day. If you really want something ‘stat,’ be prepared to walk it to the lab yourself and you still might not get the results in a timely fashion.

The lack of resources extends beyond the lack of tourniquets and tube systems. There are no op-sites to tape down IVs with, but just tape. Even that can be in short supply (in fact, we ran out of tape and purple top tubes for CBCs today!). There is no sharps box, but just a cardboard box. Which then adds to the fun because to put a needle in it, you have to recap it—and that puts you at risk for a needlestick injury. (For those of you who aren't aware, health care workers are NOT supposed to recap needles AT ALL. EVER. It's drilled into you. We still do it. Not so much in America, but situations do arise. Regardless, it's the time you're most likely to stick yourself with a used needle and thus, get a needlestick injury.)

Also lacking is a Pyxis system (the fancy term we have for the computerized system on every floor in every hospital in America, where the meds are locked in drawers and only the med drawer you key in for one particular patient opens when you key in your password and the patient's information), or any kind of secured medicine container. 

We have a cabinet.

It doesn’t even close all the way. It doesn’t really matter too much because there are no narcotics or anything particularly frightening in there, there is a small box with more dangerous medicines locked up (misoprostol is about it, though, no morphine here!).

Here’s another of my favorites.

This could be harder to figure out, but there’s a stack of notebooks on the counter. Those would be the booking diaries. You need a c-section? Open the calendar to the day you want to book it! Someone need to be induced? Check the diary to see if we have room! I went down to the OT (it’s a theatre here, not a room!) today to book someone for an emergency c-section; all I needed was her name, age, registration number, ward, and why we’re doing surgery. No signatures, no phone calls, nothing else. The orderlies came and got her later in the day.

There are no computers on the maternity ward (or anywhere else). You generally ask the patient their name while you’re doing rounds, then you go find their ‘docket,’ or chart. In fact, the patient brings their own supplies—receiving blankets and hats for the baby (West Wing aside--babies apparently do NOT come with hats!), pillows, sheet, rags, clothes, etc. There is a refrigerator where they can come to the nurses to buy juice or soda. Food delivery is common, though they do get food trays—not nearly so well stocked as American hospital trays.

This may be my favorite thing that happened today (besides getting all my blood draws)—finding the fetal heart rate with this thing.

I believe it’s called a pinhole, but I’m not sure. The resident actually handed it to me and I just had to say that I had no idea what to do with it. She kindly demonstrated while shaking her head at the thought of dopplers. (Her reaction when I told her that EVERY hospital has electronic medical records was priceless). I will tell you—it works. It belongs in a museum, to me, but it works.

new start in maternity

New week, new placement—this time on the maternity ward. It’s supposed to be OB/gyn, but there’s a separate ward for gynecology stuff, and I don’t think I’ll really end up there much but we’ll see.

It’s rather awkward here starting a new placement because the culture is different than what I’m used to in America. I’m trying so hard to not offend anyone that it makes me nervous to go somewhere new where I may inadvertently do something wrong, sit in someone’s seat, etc.

So the day didn’t get off to an auspicious start. Going into the hospital, your bags are searched by security guards. Mine are not, because I am clearly not Jamaican and also because I wear a Projects Abroad ID badge protecting me. Some of the guards like to talk to me and ask about America, but most just wave me through. To get to maternity, there were different guards who weren’t as friendly, but I found the ward and told the charge nurse why I was there and was directed to wait. Multiple nurses asked me if I needed help, which is always nice. Overall, these nurses are nicer than the surgical nurses. A lot of what is considering nursing care in the US is doctor-level care here, so I never really saw the surgical nurses doing much business nursing, but the maternity nurses visibly do work. I watched them while I waited around for my doctor for about an hour, which isn’t too bad in Jamaica. In fact, the maternity ward has a TV locked away in its small waiting area, so I was entertained. Even more so entertained considering it was a program on food allergies, something I know a lot about (I have charmed Ingrid with the idea of cooking without eggs—she was exclaiming to her friends in the grocery store about it yesterday!).

Collette, from Projects Abroad, came to check on me this morning and how things were going and she started to agitate more to find me something to do besides waiting around. As she is more au courant with the Jamaican culture, I went along with this. We tracked down the doctor to which I was assigned, who happened to be in clinic that day so it’s a good thing I didn’t wait around, and they sent me back to the wards with the doctor who was on wards today. I ended up being introduced to the residents and from there, things went swimmingly!

First off was watching one of the residents write her progress notes. It was fascinating, not only because OB notes are generally different than the traditional SOAP note, but because they use different abbreviation and phrasing here! NAD in America is no acute distress, a general observation or something put next to respiratory findings. Here is means no abnormality detected and can be written next to any system. For respiratory, we would write “CTAB,” clear to auscultation bilaterally, here there’s commentary on the vesicular air flow and something else I didn’t quite catch.

Ward rounds came next, and they’re not that exciting, although I enjoyed the attending playing a joke on the resident regarding the recently delivered mother—she’s not G2P1 anymore, she’s G2P2. They didn’t think it all the way through. (G=gravida, or pregnant, P=parity, or how many children--so she was pregnant twice and had one child, but now that she delivered she's been pregnant twice and has two children).

Then the going got interesting. I mentioned earlier about how some nursing care in the US is doctor-level care here. As such, I got to play phlebotomist and drew blood on four different patients. Never done on a real patient in America and in fact, I haven’t drawn blood since the lab where we had to learn it during second year, practicing on each other. They also do it differently here—in the US, we have rubber tourniquets, and the needles we place in the vein have a place where you put the blood tubes right onto the catheter drawing up the blood. Here there’s a latex glove tied for a tourniquet, and a beveled needle attached to a 10cc syringe to draw up the blood. I wear gloves, but the residents do not. You wipe the site down with alcohol swabs drawn out a jar that the orderly prepared earlier, and the same swab will be place on the site after you draw the blood—no band-aids here. Also, I’m used to my easily visible veins in my pale white skin, and it’s more difficult to see the veins in some of the very dark skinned Jamaicans. But I was proud of myself, I only struggled on the radial draw on a woman for whom we couldn’t find anything in the antecubital fossa. (in English, wrist...elbow crease)

The main part of the day was preoccupied with general admissions and notes and boring things like that, but then the resident asked me give the post-surgical patients their IV Augmentin. There is no such thing as locked up medicines/Pyxis, but you go over to the cabinet and take out what you need. I had to be shown how to mix up the medicine, but that was interesting. Also, there’s no sterile water like I’m used to, in jars or containers. I was drawing sterile water out of an IV bag, adding it to the powdered Augmentin in the vials, and pulling it back up into syringes and administering it to the patients. No IV flush afterwards, and apparently it burned a lot and I wished I could have flushed the lines.

There were then two emergency c-sections, which was interesting. It’s actually the first time I haven’t scrubbed in on c-sections, and it’s a surgery I had seen five times previously, so one with which I’m rather familiar. They suture the uterus together differently here and I was rather fascinated by the suture technique, which apparently doesn’t really have a name and is one of those things that is passed from surgeon to surgeon.

All in all, it was a long day by Jamaican standards, but a standard American one. I left some of the residents on the 24 hour shift, which I’m so glad we don’t do in America anymore.

big week in Jamaica

It’s been a long week in the Projects Abroad world, and the end of my time in surgery. So there’s a lot to recount. I’ll tackle it chronologically.

Monday was a visit to the custos rotulorum, an official here in Jamaica. I had to look up what it meant, but it boils down to the fact that is similar to the concept of a local magistrate. In Mandeville, or the parish of St. Elizabeth, it’s a post held by the Hon. Sally Porteous. She’s a very nice lady, engaging and fun to talk to. It was an interesting visit from start to finish. We weren’t really sure where her office was located, so we were wandering around the plaza looking for no. 14. In Jamaica, number 14 may be near 13 and 15, or could be randomly somewhere else. We were peeking around a corner and found 14 and the custos sitting at her desk; we were spotted. She was sitting at this desk that was totally bare of anything—no computer, no papers, nothing!

Regardless of how she spotted us trying to find her office, we got off to a good start. The Projects Abroad staff members who had come with us had spent the walk over practicing the German names and as always, the pure Englishness of mine was appreciated. I also confessed to the Germans that there are certain sounds English speakers will never be able to make and they think this is funny—no, I cannot reach back in my pharynx and produce those glottal noises!

Lucas, me, and Fabio--an American sandwiched between two tall Germans

It was a productive conversation, sharing with her what PA does in Mandeville in particular, and the future roles being planned. As always, she liked hearing why we’re here and it’s a rather awkward conversation because I know I don’t need any praise for saying that I wanted to experience medicine in another country. It gives me perspective on what I have and how blessed we are in the US, so no thanks are necessary.

The Jamaicans also like to hear the differences in our cultures, and somehow we ended up on how everyone you walk past will say hello or good morning. The custos mentioned that she had been watching Piers Morgan the night before, and he had a feature on about how lonely many people in developed countries are because we lack human connection—things as simple as saying hello and making eye contact with your fellow human beings. How many of us have stood in an elevator with other people and not said anything to them? That kind of thing would never happen here (not that I’ve seen an elevator).

On a somewhat unrelated sidenote, it wasn’t until I was taking photos with the Germans that I realized how tall everyone around here it! Obviously Lucas and Fabio are tall, but many of the Jamaicans are too. I did have a pair in clinic the other day that could not have topped 5 foot, but I’ve been finding myself classified as the shorter person in photos!

The visit and some PA paperwork took up most of my Monday morning, but then I got to come home and do laundry. This is notable and worth writing about because I want to point out how lucky I am here to not only have hot water, but to have a washing machine. Hot water isn’t essential around here because of the heat and cold showers can be nice, but it can get chilly here in the mountains so the warm water is nice. Interestingly, it is warmed via a solar panel mechanism! (We spend a lot of time pondering why Jamaica hasn’t spent more time benefited from their major natural resource—sunlight!) But so I didn’t have to hand wash my clothes, hooray! I did still have to hang them out on the line and it was a little eye opening—I’ve spent a lot of time in Jamaica considering the impact that American dollars have, and trying to spend a lot of money in local places. I ended up considering the fortune in clothing I was hanging on the line…like so many things in Jamaica, it puts things in perspective.

Tuesday was April 1^st, International Day. It was Projects Abroad’s six year anniversary in Jamaica. So we had a festival in the park where each country’s volunteers set up a booth and got to share bits about our culture with the Jamaicans. I knew about this before I left, and I’ve previously commented on this—how am I supposed to represent the entire US?! Funnily enough, there are four Americans here right now—all from the East Coast or Midwest. We put together a poster highlighting the Hollywood sign, the Grand Canyon, the White House and President Obama, and then Times Square and the Statue of Liberty.

I spent a good amount of time describing the flag also, with its fifty stars representing fifty states and thirteen stripes representing the original thirteen colonies.

Me and Matt, representing America

I really just stood around and waved my flag and used it as a pointer to gesture to the map. At one point, a huge group of schoolchildren ran up and had notebooks out to take notes on what we had to share. Thank goodness for a history degree, and a childhood in Virginia! I also was interviewed on the radio, and PA took a clip of me talking about America to put in some sort of promotional video. So basically I almost lost my voice, but it was all in good fun.

Wednesday I managed to get back into the hospital for surgical clinic. Clinic…oh my clinic. Fun for me, but also so affecting. First off, you start with a bunch of referrals. The patients are sitting outside waiting to see if they’re going to been seen that day! So you go through that and say yes, no, two weeks, two months. One lucky person got to be scheduled for that day. One man got lucky to get an ultrasound order and an appointment for next week. Then we start in on our queue.

First off, they get an appointment block—for example, 8am or 11am. You show up as early as you can, because they’ll put you in first come first serve. Clinics may not start until much later…in fact, last week the doctor didn’t get there until 10. We started on time this week, and it was just me and Dr. Lloyd. I had one room and he had the other, and we managed very quickly. He didn’t even go in and double check my patients for the most part, which was fine because they were a lot of inguinal hernias—order labs and see them back in the next available appointment (which was June, by the way).

There were two that I will always remember. The first was a 31 year old lady who had fallen out of care six years ago after a breast biopsy. The biopsy was cancer, but she never returned for follow up…until now. Her story is maybe going to turn out okay…her CT scans don’t show any metastases, and her bone scan results are still pending but they didn’t tell her anything scary immediately afterwards. Her breast is unbelievably full of tumor, but good margins should be obtainable. That alone is an affecting story and I will always remember her, but she is also notable because Dr. Lloyd asked me if there was anything I could do for her with osteopathy, and there was! I know from working with my mom’s lymphedema post-mastectomy that I can help this lady. She had lymphedema from enlarged lymph nodes, not post-mastectomy, but the treatment is the same. I was able to teach Dr. Lloyd a little OMT releasing the thoracic inlet and doing some enfleurage. Pretty cool!

Insert medical comment here—I had made a comment about trying to get a PET scan to check for mets and asked if it was available in Kingston and Dr. Lloyd just says, “No, Miami.” Think on that!

The second patient was a lot like a patient I had the week prior. Perfect healthy ladies suddenly having abdominal pain—last week was a likely gastric cancer. This one had already had an ERCP and signs are pointing to cholangiocarcinoma. It’s a type of cancer of the biliary tree (draining bile from the liver into the gallbladder and intestines); it’s incredibly rare and generally fatal. I’d never seen one and I hope to never have to consider that on a patient again.

Cancer awareness is so low here, and it makes me wonder about public health initiatives and just general health awareness. We (PA) try to do outreach and do what we can to supplement in the St. Elizabeth region, but we aren’t miracle workers.

My day on Wednesday did get a little brighter because we were continuing our mission with PA in getting the word out there with what we do in the local community and we took that mission right into Kingston, to the Minister of Local Government and Community.

This was a big deal, and they took some of the heavy hitter volunteers—the two medical students (there’s another one here from the UK), two of the teachers who have been here for three months, and one of the very well spoken journalism volunteers. I even put makeup on—the first time I have since being in Jamaica, other than sunscreen!

L-R: Me, Fabio, Lucas, Leeann, Bridgette

This is Bridgette, the country director for Jamaica, trying to identify for us all the VIPs in the pictures on the wall. She got most of them for us, but we were all trying to figure out—what do we address him as? (Minister) What does he look like?

So his advisor showed up first, and he was fun to talk to. Then the Minister showed up, and the advisor stood up so the rest of us did this awkward oh-we-have-to-stand move a few seconds later. Even funnier, Fabio couldn’t get his chair out so his standing was delayed a few more seconds.

We settled in to a good conversation, talking about the role of PA in the local community and all the different things that we achieve. He was astonished at the idea that we pay to come here, and we had to convey to him that we get a lovely experience—staying in a host family, experiencing route taxis, eating the Jamaican dishes, etc.

Once he got over that and we were once again commended for our ‘big hearts,’ we got down to how PA and the Ministry’s work can align. I think it will be a fruitful partnership in the future, as he asked for some specifics that we could do in Mandeville and if they work, implement all over Jamaica! In fact, the meeting last an hour and a half! Who would have ever though a politician would want to meet with US for 1.5 hours?!

Lucas, Sanikia, Leeann, Minister Noel Arscott, Me, Matt, Bridgette, Fabio

Then we paused for pictures. And he got his phone out to make sure he had a picture with all of us! It was funny because I could see the screen, and I could see all the missed calls and texts he had, and I thought that was why he pulled his phone out at the end of the meeting. He’s an important man and has a lot of business to do. No, just wanted to memorialize this himself!

Best of all, after the meeting was over, they took us to Juici Patties. It’s a Jamaican chain restaurant and a patti is the perfect melding of a Hot Pocket and Toaster Strudel. Real fillings and the flaky pastry crust. They have both vegetable and soy fillings for those of us who don’t eat the beef and chicken/cheese filling.

On the trip back to Mandeville, Matt (one of the other Americans) and I spent a lot of time comparing our cultures and how much work we could be doing here and how some little things could make a huge difference here (like actually making the kids attend school, or how important trash cans in public areas could be). It was interesting for me, since we both come from the same American culture and have a lot of the same views on how so very little things could make huge differences here—but it all takes money, and that’s something Jamaica doesn’t have.

It’s the same thing in the hospital, where I finally spotted some computers in the registration area. I did ward rounds on Thursday, and I encountered far more pathology that I was unfamiliar with in this one set of rounds than I have in awhile. It was also interesting because Dr. Lloyd was on a ‘how do they do this in America?’ kick, so I kept getting thrust front and center. I had to admit that the approach to trauma patients, as I described it, could be summed up by Dr. Lloyd as, “So really like they do it in the movies?” I suppose so. I also discovered that in the lack of privacy they have in the wards, there is still some privacy—there’s a code word for HIV. Instead of saying that the patient is positive for HIV, they say that they’re positive for ---- (I’m not giving it away!). It was rather decent, as the six men in the little room all know exactly what is going on with every other man and all the other intimate details of the life they share in that cramped room.

Dr. Lloyd and I have spent a great deal of time talking about American medicine, because he loves it. He dug out an antique central line the other day and made me guess what it was (it took me about thirty seconds of examining a guidewire in a catheter it before I exclaimed, “Is this a central line?”) He is amused by the fact that I hold the camera in laparascopic surgeries in the US, and shows me the lap equipment in Jamaica, complete with an old, glass TV monitor. I tell him we have hi-def monitors back home. The idea of up to date labs and carrying iPads with medical records is beyond his belief. Even physician salaries are incomprehensible to him (even just my poor resident’s salary!). But he assures me he’ll be in the US someday and I hope so because he is oh so smart—they have to be, to get by with the resources that they do have. But he wished me well, and I have to say I thoroughly enjoyed my time in surgery, even though I’ve no desire to go into surgery.

Thursday was a fun evening too, as Ingrid wanted to make a banana bread but didn’t want to bake. She literally caught me coming out of the shower and asked if I would make it, which was fine (but I could I get dressed first?). We had a fun conversation about baking without eggs, I made a banana bread without a recipe, she made dumplings to go with ackee and saltfish, and Josephine (the newest addition to our household—she’s here for three weeks, from Sweden) quizzed me on what I know about Sweden. It was a lovely evening, exactly the family experience we’re supposed to be getting in Jamaica.

Friday (today) was the end of the PA grand week of festivities, capped with a ‘dirty day’ where we went out into the community and cleaned up a school. We painted, freshened their murals of Mickey Mouse and Big Bird, hung fencing, and cut the grass. The guy who brought the lawnmower didn’t want to cut the grass, and I thought to myself, “I did NOT come to Jamaica just to cut grass!” though the push mower was reminiscent of the one I’ve used at home for years. He buckled down and cut the grass, we cleaned it up, and it was the end of a beautiful Jamaican morning as we got back to Mandeville to head home in the pouring rain.

Taxis do not want to take you home when you’re soaking wet.

I am home, however, listening to the rain, wearing a sweatshirt and smelling of sunscreen, waiting for the odd bits of sunburn to show me where I missed the sunscreen this morning. It has been a long week, and I am grateful for the weekend. Time flies here, even in this relaxed country.