My first week has been pretty busy, but things are going relatively well in the clinic. Agnieszka was in clinic Monday and Tuesday with me, and then it was just Dr. Charles and I the rest of the week. Since neither of us really knows exactly how things are supposed to work or where anything is, we are sort of learning together. We've had 20-25 patients each day, and with only one doctor, we usually aren't done until 1-2pm. I am doing all the record keeping on the computer, updating and
organizing the charts, calling patients, doing weight/temp measurements, etc, and then helping Charles as necessary.
This is keeping me pretty busy, so I haven't gotten to do many surveys yet - maybe 15-20 total for the week. Perhaps once I am a bit more organized I'll have time to do more, and certainly the last week when Alissa comes that will be more possible with two of us. My Spanish is okay, but definitely still leaves something to be desired - I can do the surveys okay, and direct
the patients to where they need to go and answer basic questions, but I'm sure I'm missing a lot of the nuances of what they're saying sometimes and when they start talking to me really fast I get lost really quickly.
Otherwise, the only problem I've had is trying to keep the patient flow smooth and keep the clinic calm inside, when a lot of the patients want to wait inside or come in every five minutes and ask me how long it will be. Another problem is that follow-up patients (with test results, either from earlier the same day or previous clinic days) come back in and want to be seen right away. Charles usually sees them next (they're usually pretty fast consults, writing a prescription or giving meds and instructions usually), but this tends to make the other patients who have been waiting rather irritated. And then sometimes one of the nurses or another hospital worker will come by and demand that we see a certain patient first (for reasons that are
entirely unclear to me - as far as I understand, it's usually a patient they know personally or a relative or something like that), even when their file is at the end - again, other patients get irritated. But all of this said, I think things are running relatively smoothly given that Charles and I are both new, and I'm sure things will get better as we get used to the system more.
Dr. Eileen is returning tonight and will be here for a day or two before she returns home. We are hoping that she can see a follow-up patient, an 8 month old baby with AIDS, that she treated a while ago in clinic. The baby has a severe oral thrush infection, but the meds that other doctors have given her apparently don't agree with her. Her mother said that Eileen gave her something else that worked previously, so she is coming back to clinic tomorrow to see her.
I have been to Peggy's three times so far. She now has Dr. Raymond working with her, as well as a group of Irish dental students, and several other student helpers. Plus several family members are staying with her, so she has a very full house right now. She has been very helpful with the water survey, and I think I am going to drop the final version off to her tomorrow afternoon. She thought it would be better to at least start by having her student assistants administer the survey at her clinic instead of going up into the Colonia. I feel bad that I can't help with it then since her clinic is also only open in the morning, but I think we'll see how it goes the first few times and then probably have to revise anyway. Also, it looks
like my sister may be able to come out here for a few days so she can help me with the survey as well. I also talked a lot to the owners of the hotel where Peggy's clinic is - they are from CA and just came here four months ago, and the guy is a water treatment engineer. He put in a mixed oxidant chlorination system for the well there at the hotel, and got one donated for the Colonia, so as of two months ago, one third of the Colonia has completely purified water (for drinking, cooking, bathing, everything - at least every three days). So it will be interesting to see if there is a difference in the surveys between the people who now have purified water and those that don't. Peggy thinks that the owner of Anthony's Key, who is
running for Mayor, could also be convince to pay for a purification system for the rest of the Colonia in the near future. Interestingly though, people who are part of the purified system apparently don't like it - they think it smells funny (chlorine) and makes them itch, so they are constantly complaining to the system operator to turn down the chlorine levels - the
hotel owner keeps going up there to turn the chlorine back up to safe levels. In any case, I think it will be really interesting to see what we find with the surveys.
In the clinic surveys, every single person I have asked has said that they drink only purified store-bought water, all the time, and yet a really high percentage of the kids have bacterial or parasitic intestinal infections, so I'm not really sure how to reconcile those two facts. When I have more clinic surveys done and have more time, I will go back and cross-reference
the surveys to the kid's diagnosis in the computer spreadsheet, and then we can see if there's any correlation with survey answers and the types of medical problems they are coming in with. Someone mentioned that in addition to drinking water contamination, the other way that a lot of kids get parasites is by sleeping on the dirt floor - I don't know how true that
is, and I would imagine that applies more to skin parasite, not intestinal ones, but it would be interesting to look at that more too.
Otherwise, things are going really well - the apartment is great and I've got it all stocked for cooking. Agnieszka and Ben introduced me to a lot of good restaurants and fun places in West End, but while I'm here by myself for the next two weeks, I think it makes more sense to just cook for myself as much as possible. After Eileen leaves, I am going to try to clean out
the other apartment a little bit - it is quite a mess, especially the kitchen - filled with gross food, and the fridge desperately needs to be defrosted as the door currently doesn't shut because there's so much ice. Hopefully Eileen and I can also go through all the extra supplies that are over in that apartment and take what is useful to the clinic and get rid of the rest - I get the idea a lot of it is supplies for equipment we don't even have. In the clinic itself, what do you think we should do with the old computer and the printer, both of which are completely non-functional? Arup said he has another computer ready to go, but it's unclear when that is coming, and I don't think we have another printer yet. Any thoughts on whether we should try to get rid of this stuff or just keep it around for a while?
Also, Agnieszka left me with the cell phone that she bought, which works quite well here - the number is 504-368-6590 if anyone needs to get ahold of us at some point. I will just leave it with the next doctor or with Alissa when I leave. It works on a prepaid card systems that you can refill almost anywhere, and incoming calls are free - apparently its about 30 cents/min to call from the US, so Agnieszka was having her parents call on that, it seems to be a little bit better connection than at the clinic, plus it works in West End as well. Also, it is the best way to find Raymond, Charles, Peggy, and others with local phone numbers, who are otherwise difficult to track down. Arup called when we were in clinic on Thurs, and Charles and I talked with him for about an hour - he just wanted to be filled in on everything that was going on, how Charles and I were settling in, etc. It was good to talk to him and get his perspective on how the clinic should be run, what our roles should be, etc.
The computers are both a bit tempermental but generally working fine. I have just been taking the Global Healing laptop back and forth to clinic each day, but using Jenn's laptop for my personal use. I keep saving the patient files on a jump stick because I don't quite trust the computer. Jenn's laptop works fine for email (although internet at Casa Calico has been in and out), but doesn't do much else because the hard drive is completely full and "low disk space" errors come up all the time. So I have been keeping my survey files on the other computer and on my jumpstick just to be safe. But basically, for my purposes, everything is working just fine. Agnieszka and I took a bunch of pictures in clinic last week too, so now that she is back she'll probably send some of those to you guys for the website. I'll take the GH digital camera and take more photos at some point too.
