First, a clinical recap: this week I went to the emergency room of the women's hospital. It's essentially a triage for pregnant women; most are walk-ins, very few arrived by ambulance. Most women were close to or beginning labor and had labor pains, sent in for being post-dates, or a few other common pregnancy problems like bleeding. As I had mentioned before, there were "internos" there (students in there last year of school, at a level like our 4th year students and interns/first year residents) and a few 4th and 5th year students. I accomplished most of my learning by trying to mirror them, and they were very nice and helpful! One of our main tasks was to perform the fetal heart rate monitoring or NST. I have gottenmuch better at the Leopold maneuvers, which is how you determine the position of the fetus inside the mother, thus allowing you to find the location of the heart and appropriately place the monitor! The 'internos' also take the clinical history from the patient before she goes into to see the attending physician. The internos were great at helping me nail down the correct vocabulary, both medical terms and lay vocabulary, and I even got to take the history a few times! Very helpful and useful!!! Other than that, I would sit in when the patients saw the attending physician, and would learn by listening and asking questions afterward.
Today: my precepting doctora from week 1 - a family doc - invited me to participate in today's activity. I'm not sure what best to call it - a health fair? a free clinic? It was an event put on by a church (I believe it is done yearly) for a basic physical and addressing of minor complaints for 200 niños (kids)! There were 6 of us doctors - yes, us doctors. I was in a room on my own examining and treating children! Fortunately one doctor there is an American expat, also a family doc and missionary, who has been here for almost 30 years. He was in the room next to mine and I would consult for things like drug doses (or even, do we have this drug here?), confirmation of a murmur, etc. I was even writing and signing prescriptions myself - crazy! Before arriving in my 'consultorio' all the children had vital signs, height/weight/BMI/growth chart, vision screen, and basic blood, urine, and stool tests. Here are some of the things I encountered:
-everyone got a stool test, because parasites (colloquially, "bichos") are very common. The test reported normal flora too, and since this test is rarely done and results like this are not reported in the US, I had to have some coaching on what to look for. The pathological ones were Entamoeba Histolytica and Giardia. And I wrote prescriptions (several) for Tinidazole 50mg/kg (up to 2g) after the biggest meal of the day (here, lunch) for 3 days.
-the blood test was just looking a hemoglobin and hematocrit (anemia tests), which is common here because the higher level of altitude requires more hemoglobin. However, no one today had anemia, but many had taken iron in the past
-I saw a classic case of first time oral herpes today, which i correctly (easily) diagnosed (I took a picture for those interested
-diagnosed migraines in a 13 year old (menstrual related, which is very common). They don't have the medication class "triptans" here, which is the most common and effective abortive therapy...too bad.
-a 7 year old with first time UTI
-a benign heart murmur
-lots of ear wax
-A LOT of short stature (flirting with or under 3rd percentile), howeve once their children there's not much to do other than ensure a healthy and plentiful diet...people are just short here. Thus, a lot of practice with my reassurance skills.
-a couple overweight kids, thus practice in my nutrition counseling
-two with poor vision, one on which I discovered nystagmus ---> referrals to ophthomologist
-enlarged adenoids --> ENT referral
The record I kept of my patients:
Me in action:
A prescription I wrote and signed:
What a great and varied day! I was a little scared the whole time with the undue responsibility of practicing on my own (even just the clinical judgment of when to ask for help and when I was confident in my conviction), but I loved that I was helping/volunteering, I loved speaking Spanish, I think I was quite successful, and I was energized and happy the whole time (830-3 in this clinc)...I really am meant to do primary care.
I will post about the rest of the week in another post!!!
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