Wednesday, March 18, 2009

Chrissy Journal 8

The nurses were promised a raise, so Monday we were in the clinic again, I thought we would be busier, but we saw about 25 kids. Dr. Howard came down for a week and a half. He is busy arranging and meeting with people. Dr. Hott is still in the ER, and still enjoying it, he sees much different things than we do. He has made some nice improvements to the ER, by improvising a handwashing station. He also did a meeting with them about HAZMAT. He’s pretty cool.

Wednesday, another resident arrived, Dr. Tamy, the clinic was pretty crowded with five doctors and an intern, but we made the space work and were able to see lots of patients. Not to many interesting cases, lots of upper respiratory infections and scabies. It seemed like every chart said ‘cough and cold’ as the chief complaint, and if it didn’t, they would say they did as soon as you asked. Friday looke like the nebulizer special, as we had three kids in one corner all on nebulizers at the same time.

Dr. Mario and Dr. Howard were pretty busy arranging meeting and had a great meeting about setting up a tooth varnish program through the vaccination clinic, getting it set up across Roatan, and using it as a model to have it set up across Honduras. It sounds like Mario should be spearheading the project, and I think he’s excited about it. It was a good week, with a good team.

Wednesday, March 04, 2009

Chrissy Journal 7

Dr. Andrew, Dr. Preetha and Dr. Hott arrived over the weekend. Dr. Andrew is the attending, Dr. Preetha is the resident and Dr. Hott is an ER doctor who is going to be working with the ER here in the hospital. Dr. Stephanie is going to go over to Ms. Peggy’s clinic, but she came in this Monday morning to make sure all was going well. There was a little boy who had been mauled by three dogs, and Dr. Dennys was going to operate, so Stephanie went to that. It was quite an experience when his heart rate fell to 33 and the doctor looked up, then reached over and turned the monitor off. He turned it back on and his heart rate was ok.

We arrived Monday morning to find the gate to the hospital closed and no patients inside. Apparently, the nurses were on strike. I’m not sure exactly why, because they didn’t get a promised raise or because they want a raise. So, they wouldn’t let us see patients, it was especially disappointing to patients that were coming from far away places like Oak Ridge, that had to get up early and pay a lot to get here and then they couldn’t see a doctor, unless they went to the ER.

I showed the new doctors the hospital and they saw the newborns, then I took Dr. Andrew and Dr. Preetha over to Ms. Peggy’s to help. Dr. Hott stayed in the ER. Tuesday the clinic was open and we had quite a few patients. Then Wednesday the nurses were on strike again, they were all outside the hospital protesting. One of the Social Service Doctors, gave a presentation over lunch on Hyperglycemic Shock, so we all sat in on that. It was a nice conversation between the doctors and a nice opportunity to get all of them together, many of the doctors, and all the social service doctors came.

Chrissy Journal 6

This week was busy. The other two doctors/clinics that see patients were gone and so we were getting a lot of patients. It wasn’t too much, though, just busy. The cases were about the same as what we usually see.

There was one boy who came in that had been on the ward the week before for a broken arm. Dr. Jackie was giving him a little ibuprofen for the pain and thought that the reason his blood pressure was so high was because he was anxious, and so they put him on blood pressure medication. He came into the clinic and Dr. Stephanie took him off of it, and his blood pressure is doing fine now. Dr. Aditi heard a few heart murmurs, so she filled out the referral to mainland hospitals, then we found out that Ms. Peggy will have someone doing Echos in a couple weeks. We need to figure out a way to have better communication on the resources she has. She is an amazing asset to healthcare on the island.

Dr. Stephanie and Dr. Aditi stopped going on rounds in the morning, because they felt that Dr. Jackie and Dr. Lemos were patronizing them, and they couldn’t see eye to eye with the medicine they were practicing here.

Chrissy Journal 5

Dr. Stephanie and Dr. Aditi arrived last weekend, and will be in the clinic for two weeks. Dr. Dennys, one of the social service doctors came in to help as Dr. Mario had to go to Tegucigalpa.

Dr. Stephanie had been here before, so she got adjusted fairly quickly, and they were on rounds and seeing newborns right away. There were a lot of kids in the ward, so clinic got started a little late. Dr. Dennys saw a kid with an abscess on his head and tried to drain it with a syringe, but it didn’t work out very well and he tried to squeeze out the pus and that didn’t get enough out so the poor child had to be admitted to the hospital, so the surgeon could use some anesthetic and lacerate it. He did fine. We had a boy come in with malaria p. falciparum, he actually didn’t even look or act as sick as one would expect. There was another boy that came in with a head lesion that was a parasitic infection. It looked like an abscess on his scalp, but there was a worm living in it. The surgeon came in for a consult and they set up an appointment for the surgeon to remove the worm the next day. Other than that, there were lots of scabies cases this week, in addition to the intestinal parasites and respiratory problems.

Dr. Stephanie did an ultrasound course at Ms. Peggy’s clinic with Dr. Laleh. I somehow was coerced into being the model for all the ultrasounds, but it was very interesting. A couple of doctors from Anthony’s Key were there and all the doctors Clinica Esperanza and a few nurses too. I think they are using the ultrasound machine more already.

There was one baby on the ward that Stephanie and Aditi were worried about and the hospital discharged with a distended abdomen, and abnormal hematocrit and platelet counts. Aditi talked to Sarah, another social service doctor that was in peds, and they arranged to have the mother come by our clinic after she was discharged so we could take her to Ms. Peggy’s. She ended up getting discharged an hour earlier than we expected and she left. We tracked her name down from the chart and that she lived in Sandy Bay, so we had people asking around for her. Somebody foung her and she came into Ms. Peggy’s the next day. Dr. Laleh did an ultrasound and found free fluid around the liver. The clinic bought her a ferry ticket and gave her money to take the baby to the mainland. She ended up going to the hospital in La Ceiba because she had family there, I don’t know what the diagnosis is.

Chrissy Journal 4

Week 5

This week started out pretty busy on Monday we saw 19 patients, whereas we usually only see 15 with one doctor and then got really slow to no patients on Friday. We can only assume the island was healthy. The most interesting case to me was a baby girl that Dr. Gross had seen a few weeks earlier in the newborn exam and thought she had Down’s Syndrome. She came in this week for her ten day check up and had lost weight, she only weighed 5.5 pounds, littlest baby I’ve ever held. Dr. Mario suggested that she take some high calorie protein formula too.

Since the clinic slowed down, I spent some time cleaning and dusting and organizing before Dr. Stephanie and Dr. Aditi arrive next week. Dr. Mario made arrangements for one of the social service doctors, Dr. Dennis, to come into the clinic next week as well, since he will be in Tegucigalpa taking tests next week.

One of the doctors gave a presentation over lunch on Monday, I think, but I didn’t realize it until after it happened, so I wasn’t there.

I did ask Dr. Mario about Miss Valerie, but he hasn’t heard of her, so I will have to ask around some more.

Chrissy 3

This was Dr. Jessie’s last week in the clinic. The baby is still not breathing normally, and the mother has lost any trust she had in Dr. Jessie. They painted the hospital really nice, most likely in an effort to placate the problems of this hospital and delay building the ‘new’ hospital that has been promised for so many years.

The clinic was steady all week. The most interesting case was a 20 month old with Icthyosis. Dr. Jessie nor I had seen it before, but Dr. Mario knew what it was instantly and said he had seen other cases of it in Tegucigalpa. Keith, a friend of Dr. Gary’s, came into the clinic a few days and took pictures of the kids and moms and he brought a little printer and gave everyone pictures, everyone really enjoyed that.

I had family visiting all week, so I didn’t make it to Peggy’s clinic at all. I did hear that there is an American woman here in Coxen Hole working with people living with HIV and AIDS. Miss Valerie, is what I heard her name is, so I might try to touch base with her and see what she has going on.