Island time : take 2

SO, today I was supposed to meet my attending, er, consultant at 8am for orientation before the clinic on Ward 12. No show. A doctor tells me to go to a lecture. I find my way to the lecture with no one there. Slowly people show up and the lecture ends about an hour late.

It was a very interesting lecture. Approach to the Transgendered Patient.

I still have no idea how to meet up with my attending so the resident (who says she is doing gyn clinic) says come back to the ward with her and then we will go over. When back on the ward I get dropped off to the medical student who is in my year and we have no idea what to do either because now rumor is circulating there is no consultant in gyn clinic. We call down and lo and behold no consultant. Thus we join the high risk rounding on wards.

"Dr. Mullings is in the gyn clinic" the resident hissed as she walked by the group of students surrounding the bed. With that we scampered down to the clinic. And then were hollered at for being late. Which was lovely to have to introduce myself as the visiting American student right after and then get hollered at personally by a doctor I never met before. I almost cried but I had my big girl panties on today.

Then we saw two gyn patients which took us to 1pm and then we were released for the day. Since exams are approaching for the other medical students they have afternoon review sessions. I came home and relayed my story to my roommates and they laughed saying not to take it personally. Apparently this is status quo here in Jamaica. Students wander helplessly, consultants holler. Oh well. He was perfectly lovely after that and taught quite a bit.

Wards.It is so very different here in so many ways. I will try to post more pictures of the wards and such as I become more comfortable. It did not seem appropriate on my first day to snap a million pictures. I just snagged a few when no one was looking.

The women on Ward 12 are high risk pregnancies that are admitted to the hospital. The stay in these sections with four beds a piece seperated by curtains. There is no air conditioning. They have no admission bracelet on their wrist. They are not hooked up to any sort of fetal monitering. If fact, they use some sort of stethascope to listen to the baby's heart beat. There is no electronic system here of any kind. Everything is done on paper.


When they round they have the student who 'clerked' the patient present the whole H&P by the beside. The consultant then goes on to have the others critique the student, discuss the case, and come up with the plan all in front of the patient! There is no discussing anything with the patient. Everyone pretends that she is not even there! It is really quite a different way. I cannot imagine saying some of the things the consultant was saying in front of the patient back in the US. People would be so offended! (The spoke openly and causally about her weight gain (to much) her previous STIs, the possibility of the baby having a different father then her other children). So oThere is a general lack of supplies everywhere you look. In the gyn clinic they re-steralize rubber gloves to re-use. There was no exam table or stirrups to put the patient in--not even a door to close! Just a curtain. In the gyn clinic the doctor asked this 45 year old woman if she ever had a Pap smear done. She said no and then he said that she would need to pay for it (1500 Jamaican dollars) She said she could not pay so no Pap smear was preformed. The doctor asked on of the patients if she wanted one while being examined--not the pelvic yet--told her how much it would cost. She agreed and he went and got a wooden spatula and a slide to preform the Pap smear. Again, so different from the US sytem.

This is the room where patients get triaged. Tomorrow I have antenatal clinic. The student I was with Kamali took me through this afternoon to ensure I knew where it was. Culture shock for sure! I can't wait to see what tomorrow brings! It should be very interesting!