Tuesday, February 14, 2012

First Clinic Day

No valentine's day in the Moose household. From our foreign correspondent:

We had quite the introduction to Honduran medical treatment yesterday. We went to a newly built hospital about half an hour away. The six people on our provider team (three physicians, two NPs, and a nurse partway through her NP training) saw upwards of 200 people and were there for about eight hours. The dental team (a dentist plus a few helpers) saw 20 patients and pulled 35 teeth.

The majority of what I saw was cough (toz) both acute and chronic, headache (dolor de cabeza)--of which I was able to identify several migraines and give Excedrin--and gastritis/reflux (dolor de estomago)--we were handing out Tums like candy. People drink lots of coffee and soda, which is NOT good for the stomach. Also many skin and nail fungal infections.

Our first patient of the day was a woman with a chronic leg ulcer that had been there for fourteen years! She was keeping it meticulously clean, but it was huge. All we could do was give her a referral to see a specialist at the hospital here in Danli, but it's hard for me to imagine what they are going to be able to do. I think we'd have her in a hyperbaric chamber in the States.

We also saw a girl with the most horrendous case of head lice—all of us were having psychosomatic itching for hours afterwards.

And I saw a woman with pelvic pain and discharge, but without the space and supplies to do a pelvic exam I wanted to treat all the possibilities, so she ended up with meds for bacterial vaginitis, yeast infection, and chlamydia (we didn't have the right antibiotic to treat gonorrhea, but we looked through our pharmacy stores this morning and now we do have something that should serve). It was a bit frustrating, because with a pelvic exam and maybe I microscope I could have narrowed my differential diagnosis a bit!

Usually, talking to patients is my very favorite thing, but it took so much effort and mental intensity to try to understand the Spanish, and then formulate a response (though I did have an interpreter to help), that it was SO lovely to just put a stethoscope on a chest and listen to heart and lungs, which is a language I feel pretty comfortable with!

We had a few patients who I knew EXACTLY what to do with, and we even had the meds to help, and it was such a relief: a teenage girl with bad menstrual cramps (high-dose ibuprofen, and then go find a clinic for birth control if that doesn't work), and the migraine folks (yay for whoever donated that Excedrin!). We're also giving out a few month's worth of blood pressure and diabetes medications when indicated.

It was overall quite exhausting. My Spanish got a bit better through the day and peaked around 2 or 3 PM, then collapsed for the last few hours as I got tired. I still can't use the subjunctive at all, and was too tired last night to do much grammar review! Thank goodness for the translators.

Today we're off to hold a clinic in Las Robles, where part of our larger Rotary team is building a school.

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