December 20th: Week 8
Compared to normal standards, the hospital lobby was nearly empty today. Mario said this was typical for Fridays pretty much up until the time I arrived. Fridays are cruise ship days. Also the wind had picked up and the skies seemed threatening to unleash a tropical storm. This “rainy season” has been surprisingly full of sun and blue skies, so the stormy days keep people at home.
All patients were seen by10:15am after which Dr. Robert and I dug into the nebulizer/respiratory treatments/miscellaneous junk shelf. We found tons of expired inhalers and other meds. It was a shame to throw bags full of medications, but they say the clinic could really get in trouble if caught by the ministry of health. So away they went, only a few months expired. The rest of the shelves contained 8 different organizational systems left by the rapidly changing succession volunteers and employees. There were probably 200 pulse-ox electrodes stashed in various boxes and corners. We also found 4 more nebulizers although we’re yet to find out if they work. We got some organization in the jumble of supplies. Yesterday Dr. Robert threw out shelves full of expired meds in the cupboard of one consolation room. I think it needs to be decided what the plan of action is for the donated meds. If the doctors only write pharmacy prescriptions and never give them away, then we end up with shelves full of expired meds. It’s such a shame these meds aren’t helping kids who could really benefit from them, not to mention the wasted packaging and product.
This week I switched from growth charts by the CDC to ones by WHO. Dr. Bob brought print outs of these and explained how the CDC’s measurements are based on fat American kids, where as the WHO takes into account the less nourished 3rd world countries. The measurements don’t appear to be too different but this hopefully will be more relevant for the population. While I have seen a good deal of quite plump children and parents, there are also the occasional chronically mal nourished kids from the households of 10 children and bad hygiene.
This week I had a great proportion of terrified or angry children. 3 years of age seems to be the time when kids become skeptical, temperamental, and mistrusting. I had quite a few temper tantrums, which normally start before they even walk through the door. But some kids take one look at the scale I am asking them to get on and start screaming. I don’t know why they find it better to scream and fight than just to sand in a particular place. I have learned a few tactics for dealing with the screamers:
1. If the kid won’t stand on the scale, put a chair on it (it weighs 1 pound), sometimes they will sit
2. Give stickers to make a friend or bribe them with stickers if making friends is not a possibility
3. Weigh the mom with and with out the child then subtract the difference
4. Explaining everything before it happens
On Wednesday we had the first supposedly weekly conference since I’ve been here. Louis, a social service doctor presented on nephrotic syndrome. Most of it was straight over my head because it was not only technical medical terminology and in Spanish. Still, it was interesting to learn about this kidney disorder. We are going to try now to have a presentation luncheon each Wednesday.
