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.