Friday, February 17, 2012

Clinic Day 4

Thursday's news from down south:

I can't believe we only have one day of clinic left! I am definitely ready to be heading for home.

Thursday, our medical clinic was set up at a school for orphans here in town. It was similar to the other days — mostly gripe and dolor de cabeza — though I did have a couple of alarming pediatric patients.

A grandmother brought her three grandsons, ages 5 and younger, and pointed to the five year old and said, "he has seizures."

"Is he on any medicines?" I asked through my interpreter? "No," came the answer.

"Has he only had seizures with fever? How many seizures has he had?"

"Yes, with fever. He's had two, the last one was six months ago. Well, actually, the first one he ever had, he didn't have a fever."

"Have you taken him to the doctor?"

"We took him to the hospital when it happened but the doctors were asleep so no one saw him." (!!!!)

"Does he learn and understand the way that other kids do?"


I'm just about to launch into a speech about how kids outgrow febrile seizures, but if he has another seizure without fever, he really needs to see a doctor, when grandma adds, "and he has diabetes."

"Diabetes????" I want to make sure I'm understanding this correctly, so I make my interpreter ask again.

"Si, diabetes."

"On medicines?? Shots???" (The only way to treat juvenile diabetes is insulin.)


It's at this point I start looking for the camera, because it has to be a joke. I make my interpreter ask again, and then grab one of the older Rotary ladies who is completely fluent, because there has to be some sort of misunderstanding.

"When did you find out he has diabetes?"

"Two days ago. They did some blood tests and said he has diabetes and to bring him back tomorrow, but I heard that you were here and brought him here instead."

The kiddo looks way too healthy to be in diabetic ketoacidosis, which is usually the way that kids are diagnosed, and there's no way that a kid in DKA would have been sent away from the hospital, they usually have to be admitted for several days. So I still don't understand the sequence of events at all. Nonetheless, I am NOT a pediatric endocrinologist and there is no way I can start insulin on this kid, and I still think there must be some sort of misunderstanding anyway. I explained several times through the interpreter that childhood diabetes is VERY dangerous, that they absolutely need to follow up at the hospital tomorrow and will probably need to see the doctor very often while they are starting treatment, and that we do not have the ability at our mini-clinic to do this!


Then there was the mom with the 8 month old who said he was vomiting all the time and losing weight. The child was INCREDIBLY chubby, 20 pounds on our scale! (B, for example, didn't reach 20 pounds til around her 2nd b-day). Mom insisted that he used to weigh 28 pounds. (???) I explained that babies spit up a lot, some much more than others, and that it would gradually improve over the next few months—it's only concerning if the baby is losing weight. She said he seemed skinnier to her, so I wrote her a referral to see the pediatrician at the hospital here. Who knows?

We're off for our last day of clinic now.

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