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.