The past month taking care of patients, teaching, and learning from my colleagues in the A&E at GPHC has been a wonderful experience as always. I have learned a great deal and I have also had the opportunity to teach in a variety of settings, which has been very gratifying. I never leave here not in awe at the great work these physicians do with the limited resources they have available. I also rarely leave without a memory of some patient that we were not able to help as much as I would have liked due to these limitations. This month in particular it was a lack of streptokinase (the medicine they usually give here to break up the blood clots that cause heart attacks as they do not have a Cardiac Catheterization option available at GPHC). Over the month we unfortunately saw many patients with heart attacks and there was little we could do for them. Still, the physicians here push on and do the best they can with what they have. I am looking forward to my next trip back in a few weeks so I can continue to work alongside these excellent physicians providing the best care possible to the people of Guyana.