Good day!

Let me get this out of my system:
I am loving it here! I would highly recommend you come and visit Jamaica! It has been fantastic so far! Great people! Great weather! Great learning experience!

Ahem. Moving on.

Today I took a quick dip in the pool for some exercise in the morning. And then headed off for antenatal clinic (pre-natal care clinic for all the non medical people who might be reading). Maurilee had a major exam (good luck Maurilee!) so headed right off to her class and I found my way (with confidence!) to the clinic. I think I have figured out how they teach here. Instead of the consultants teaching off of every patient to the students they divide the labor. One sees the patients with the residents and other is teaching. Basically, we went into the patent's area and began to take the history and physical with the consultant present. He interjects, teaches, instructs, and quizzes throughout this process. I found it to be highly educational and really enjoyed the experience. Granted, he is not quizzing me as hard as he is the UWI student but I am learning a lot nonetheless.

The physical exam is really taught well here. There is very limited resources for the physicians to use so they have highly honed physical exam skills and know a lot of pathology. I am really excited to expand my physical exam skill set. The attending asked the student to preform the PE in front of him. The student moves to the foot of the bed and begins to inspect the patient commenting on her position(supine), skin (no pallor, striae), abdomen, (gravid, hair that is more then expected for a female but not yet pathological) and then moved to examine her taking the fundal height, Leopold's maneuvers, and the depth of engagement of the baby's head in the pelvis. It was pretty impressive. After that we discussed all the different options for her assessment and plan. And after that we discussed various issues in her case for an hour. All in all a great learning experience!

Also of note is again, the lack of resources. This mother was Rh - and is at risk for complications to her baby. To prevent these complications RhoGam is given to the mother at 28 weeks and after delivery. However, in the chart it is noted that "Patient saving up for Rhogam." The mother was 39 weeks along and Rhogam costs about 15,000 Jamaican dollars ($150 USD) and the average minimum wage is 4000 per week ($50). So, she cannot afford both doses and is saving up for the one after delivery. Again, so different from the US. I hope to write a post soon about their entire health care system but I am still not familiar enough with it.

This is the hallway in back of the exam rooms that the doctors have access for the clinic.

This is the hallway in front of the exam rooms that the patients have access to. The exam room is sandwiched in between these two hallways.


Typical exam room. Behind the blue curtain is a doorway to the patient hallway. The other is just changing area.

No Dopplers here. This is how we auscultate the fetal heart rate. I will get an action shot for sure!
Equipment. The wooden spatulas are for Pap smears. They actually gather the specimen and make the slide in the room.
Where orders and notes are written. Also, no intercom system--just a call out for the nurse if you need anything
Order set for labs


Triage area
Urine sample station.

After the morning in the clinic I got a tour of the hospital from Kamali.
Here is casualty. This is the equivalent of our fast track. Bumps, bruises and minor issues are treated here.
This is A&E or Accident and Emergency. This is like our typical ER. The above photo is their ER bay.
The entire ER. After the tour and FINALLY getting my UWI school ID (third time is the charm) and eating my first Jamaican beef patty. (sandwiched between coco bread--yummy!) I headed out with Alicia to her grandparent's house.
Half way tree. I think it means halfway through Kingston.
"Big Ben" the British left this.

At Alicia's grandparent's place I had the much talked about and anticipated BUN AND CHEESE. Easter celebrations include eating massive quantities of this it seems and I got to try some. The Bun is bread that is pretty sweet and spicy (flavorful, not hot) and you eat it with the cheese on top or in the middle like a sandwich. The cheese is Jamaican cheese and comes in the can.
It is really good!
Alicia's grandfather. He cannot remember how old he is or his birthday because he does not have a birth certificate. He has lived in the area since 1951 and figures he is about 100. He was quite charming and pretty witty. He wished Jon and I a happy, clean and beautiful life together. Alicia's grandmother gave us Jamaican apples. Which is pictured below.

I can't really describe the taste or consistency as it is nothing like I have ever felt or tasted before. It is much softer and 'mushier' then I expected. I liked it.

Tonight we are going out to dinner to celebrate Maurilee being done with exams. Tomorrow I have a lecture, ward rounding, and then hopefully off to Portland for some beach time and sightseeing. The hiking will take place the last weekend I am here. I am pretty excited about it!!