Today was our first day working in the clinic. I forgot to mention the region that we are working in, which is pretty much as far south as you can get, just about on the border of Nicaragua. Because of that, there are a lot of guarded checkpoints along the road and several armed guards who accompany us everywhere we go. So, check that out on a map if you are interested. Back to the clinic.
We arrived about 7:45am and got set up to start seeing patients around 8:15am. Dr. Pilch and I set up at different tables in the back of the room, nearby enough so I could ask her questions about patients as they arose. I had two college students with me, one that was fluent/nearly fluent in Spanish to help translate, and one to scribe and hand out Albendazole (de-worming medication that all patients receive). The patients came streaming in from triage pretty quickly, and the line quickly grew around the building. The students filled out the triage sheets with the vitals and chief complaint, and we were able to focus on figuring out the problem and formulating a treatment plan for the patients. Usually they were mothers with their 2, 3, or 4 children that came to the table, and you tried to go through a pretty full physical exam while addressing their complaints.
Most patients present with complaints about headaches, which are due to dehydration mostly.....some have migraine type headaches, but most are because they don't really drink a lot of water, they drink a ton of coca cola. One guy tried to assure me that he drinks 17 bottles of water while working in the fields all day and that his cramping and muscle aches had nothing to do with dehydration. On one girls prescription I wrote "MAS AGUA!" to which all of the students had a good laugh when it rolled into the pharmacy. She was very clearly dehydrated, and her mother was trying to assure me otherwise.
There are a lot of pterygiums as well, which I just recommend googling, but all we can do for them her is hand out sunglasses to help prevent them from worsening, or from getting them at all if they didn't already. Thanks to my parents for donating a bunch of sunglasses to bring down, especially because they are safety glasses, which for a bunch of the guys are really helpful.
Most of it is primary care type stuff, and we try to manage blood pressures (as long as we can give them a 3 month supply and know someone is coming back), refill medications that were filled 3 months ago, try to control blood sugars, and so forth. A lot of the kids have ear infections, upper respiratory infections, etc. and we give Amoxillicin. We did have one woman come in with a blood pressure of 240/128, and luckily we had some IV blood pressure medications. I placed an 18 gauge needle in her hand and started pushing the meds right away, to which I seem to have earned some respect from the nurse because she was surprised I got an 18 gauge into a hand so quickly. Thank you Africa for all that practice! We monitored her for a couple hours until it was relatively safe and told her to come back tomorrow to recheck how things were.
Another kid had "swimmer's ear," or otitis externa, with a really bad pseudomonas infection. It has a very distinct smell, to which we made all the students in the vicinity come and smell it. Pretty easy to diagnose, and glad we the meds to treat it.
We saw patients up until around 12:30 I think, took a short break for lunch, and resumed fairly quickly. I think we saw patients until around 4:30pm then. A total we saw 327 patients for the day, which was pretty good. 3 of us doctors saw them for primary care, 1 saw the gyne patients, and 2 dentists did extractions/cavities/etc. I think about all of the patients came through us first, so it was a lot.
It was good to start practicing medicine "on my own," though I had Dr. Pilch close by. But in general being able to diagnose and treat was a good feeling. Some of the skin conditions that I'm not as familiar with or certain medication dosing questions I still ran by her to clarify. I'm still learning a lot and teaching the students along the way makes me really think about things too. Thank God for having apps that work on the phone too without internet, because I can still consult it for certain dosing questions and diagnosing a few things that have slipped my mind over the last 4 years. But honestly, that's half of medicine, just knowing how to use resources, recognizing things and being able to figure out what it is. So today was a smashing success. Looking forward to tomorrow and I feel a bit more confident going into it, so that's a plus. I think it'll help me feel confident going into residency too, just from the standpoint of it won't be my "first" time prescribing medications. It's awesome working with Dr. Pilch in this capacity too. She has been my mentor for years, but now working alongside her, it's a good feeling. She's a great teacher and also pushes me. A few times I asked a question and she just said, "up to you." So that was good.
Our lady with the broken arm was not picked up today by the way, so they are going to get her first thing in the morning. We will be reducing the fracture and setting the arm, and I expect it will be a humerus experience (pun intended hahahahaha). I'll let you know tomorrow how it goes.
Having a team meeting tonight to discuss the day, but seems like everything went well. Dr. Erica (pharmacist) did a fabulous job and didn't have any complaints, so it's great to have a pharmacist who can handle things and keep everything running smoothly. Overall everyone is pretty pleasant to work with, and no complaints. It's good to see how they run things and I'll "take the meat and spit out the bones," as I do in every situation.
Thanks again for reading. Definitely consider supporting us in a future trip, and also consider sharing this post and our website with a few friends! We can use all the support we can get and I definitely know these people would appreciate it. Thanks everyone!
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