Thank you so much for taking time to look at our blog! We are a group of edical students who are passionate about training and in underserved areas. This January and February, we are in Peru, the Dominican Republic and Costa Rica internationally as well as locally in Flint and Lansing completing volunteer service, rotating in hospitals and clinics, and learning about international medicine and local underserved health care. We appreciate any time you take to read our reflections and any donations you might offer.
Please click the “Donate” link on the side for more details on how to give directly to these communities.
Saturday, February 22
Tuesday, February 11
Carolina and I had the fortune of observing surgeries yesterday and today. We saw ETVs, traditional shunt placements, as well as a spina bifida procedure today. This last procedure was really remarkable.
Picture a 7 day old child, tiny lungs receiving air through a tube in her mouth, little monitors all over her body, laying on her stomach as she is draped with sterile sheets for surgery. The myelomeningocele is the mass protruding from her lower back, the sign that her spinal cord did not correctly form and is bulging out. It means she may be at risk for paralysis, absent bladder control, chronic constipation, and other problems.
Everyone in the room closed their eyes to say words of protection for the child, then scalpel is handed to the surgeon, and to the tune of gospel music, he makes the first cut. We watched in awe as the a small fountain of fluid splashed out, and was quickly sucked up by the scrub tech's syringe. The mass that had looked so solid quickly deflated before our eyes, and skin was further opened up to tackle the damaged spinal cord, that quarter-sized piece of nervous tissue that would dictate so much of this child's future.
Over the next 45 minutes, he separated out the cord, all the while explaining the procedure to us. He expertly wrapped it in the dura, as if swaddling it, and sutured it closed, after which he finished up by closing the skin.
It's true that these problems are rare, far less common than malnutrition, malaria, or diarrhea in a child. However, there was something so profound in seeing this procedure, in seeing a small child get a chance she may have otherwise not have received. My experience at Cure really stimulated my thoughts regarding access to medical care in low resource settings. I have no answers, but only thoughts on more questions. Where should resources be funneled? Does every child have a right to a cure, if it exists? If so, what impact does this have on low-resource, high-need care?
Sunday, February 9
Welcome to Huaytapallana, a nearby mountain and glacier. Last Saturday, we reached a altitude of 17,400 feet and all experienced dyspnea first-hand. We enjoyed hiking together with our faithful guides to help us along the way.
|Laurie was the first to go|
We even got to go sledding with trash bags at the top! Since there was an edge leading to rocks below, we caught each other with a rope to avoid injuries.
|Chris and Phil keeping Laurie alive|
This was not exactly fail-safe, but it worked!
|Phil, Laurie, Danielle, and Chris (not pictured: John and Jared)|
During last week, we resumed our individual work at doctors offices. Please read Phil's great verbal account of the many things we have been able to experience here in Huancayo.
Another great experience has been going to an orphanage for children with HIV/AIDS, or who have been physically abused. We spent our first visit playing games like Red Light Green Light, Duck-Duck-Goose, and Simon Says. These children were a pleasure to meet.
|Chris helping a child with Red-Light Green-Light; Laurie tries to cheat with her child for the win|
|Phil and Danielle are fantastic at all they do|
A visting lecturer from the USA spoke to the Medical Society in Huancayo about hand washing. I think it was a good topic for the doctors here as hand-washing seems to be sparsely observed.
Education and provisions of alcohol-sanitizer, soap, running water in clinics, and hand dryers might be a good use of energy in our future endeavors.
Wednesday, February 5
Last Friday our group did a hypertension education and screening campaign in a smaller pueblo in the hills outside of Huancayo. It took us about 30 mins in bus to arrive, through dusty roads that wound enough that one of our girls got car sick. When we arrived I realized we had been there the previous Saturday on one of our tourist excursions with our family. In the center of town is a cathedral loaded with religious icons. And outside the church is a huge stone cross that my señora told me is 500 years old. It has four sides, of the two large sizes, one depicts the crucifixion (very defaced making it the most difficult image to appreciate) and the other side has the Virgin with baby Jesus. The two smaller sizes have images of two monks, I don't know if they are particular ones or not. Around this cross on all sides people come and burn candles to ask God for something. And they wait until the candles burn entirely down. Different colors and arrangements signify different types of requests I was told. The aura of devotion of the faithful that are gathered is impressive. Chris took good pictures when we were there the first time. This time, our work was across the street from the cathedral in a convent. On arrival there were maybe 20 mostly old people that were seated in a big open room that had a few tables and chairs where we would do our visits. Laurie introduced us and gave an overview of blood pressure, hypertension, and preventative measures. Then we split up into teams. The really old people gravitated to one corner of the room where Danielle checked their BP and talked to them about various health concerns. Like in the States, the old folks took longer than the other patients. I laughed when I was done checking my patients' pressures and I saw that Danielle had a lot of old folks seated around her table waiting their turn for a SECOND consult to discuss more issues.
|Peruvian medical student Freddy was working with Danielle|
After the intro, I went to one corner of the room and started "seeing patients." I asked their name, age, medical history, social history and wrote this all down on a paper and then took their BP twice and and then their pulse and respiratory rate. Then I listened to their lungs and heart with my stethoscope (mostly just to oblige them bc they saw the other students in our group auscultating patients at their stations). This town and this population was distinctly different than Huancayo, I could tell as soon as I started to be near the people. This was truly the Andean pueblo. The women I thought were 50 were in their mid 30's. Most women wore the dress of the campo (five layers of skirts of worn fabric and straw hats). When I inquired about occupation, 90% told me they worked in the "chacra," which means intense manual labor farming. And their worn leathered hands proved their response. Their speech was markedly more difficult for me to distinguish than my Huancayo host family members and physician friends. More than one was illiterate. More than these pieces of evidence though, is just the palpablility of poverty that was present, I've seen it in patients I've met in the Hurley ED, and it was the same here. Part of it is a smell, but a bigger part of it is a deeper feeling from your soul that tells you that this fellow human lives at a lower standard of living than you do.
Most of my "patients" had systolic blood pressure below 100. Probably because they physically exerted themselves for long hours each day and nobody smoked and nobody drank alcohol and nobody had diabetes and nobody had a family history of heart disease or hypertension and nobody was overweight. But everybody wanted to talk about a health issue. And like I've experienced already once or twice in Peru, they all gave my medical opinion great deference, and showed me that they cared deeply about their health, and said "thank you doctor" and "bless you doctor" about 1000 times.
|Photo by Danielle Chang|
Among these events though, stands out a particular encounter. After a few hours of sitting at the same table and having conversations, I was feeling ready for a break. Then she came and sat down after another patient vacated the chair at my table. I'd be lying if I didn't admit I wanted just to be done with talking to her before we even started. She smelled liked poverty. She had only a few teeth. I couldn't understand her hardly at all. She had food crumbs all over her lap and her dress was tattered. I knew it was going to be hard for me, practically and emotionally and I didn't want it at that moment. Finally after a few minutes I decided that I would seek a translator, which I hadn't needed to do yet. I decided this because I thought she was telling me that her son was punching her. And also I thought she was telling me that she was having bloody nipple discharge. Then Natalia, our Peruvian FIMRC director, came over and translated. The patient told that her husband had beat her for years and now her sons were following suit. She told that her husband forced her to work by begging on buses. She told that she had no family in the area, except her husband's extended family, who all hated her. I had to get this story later because I could understand neither her nor Natalia's Spanish through their sobs. Also because I had to maneuver her husband to another area of the room when he approached the table and accused her of lying and dementia.
I didn't talk to her after I guided her husband away. The sisters and someone Natalia talked to them for about 1-2 more hours. Now I don't know what will happen to her. The experience was another lesson for me about the assumptions I make without realizing or intending to and how easy it is for me to misjudge a person and a situation. Easily she was the patient that had the most at stake that morning.
All in all, it was a demanding morning, both mentally and emotionally. It really covered a lot of of the primary care roles: health screening, education, patient reassurance, and unplanned psychosocial troubleshooting (of the utmost importance).
|Lunch with Nuns and Community Volunteers after the campaign - Delicious!|
Sunday, February 2
|At the Rivas hospital in the ER|
|One of the homes in the pilot micro-health insurance program|
|Cooking over a wood fire in proximity or |
within the home is very common in this community
Quality Improvement Project
Having worked at the community health post for the last few weeks, we have noticed a few aspects of the clinic that desperately need some improvement. The most glaring problem is the absolute MOUNTAIN of unorganized charts that piles a large bookshelf. The health post where we work is the largest in the area-with over 3,000 patients. And with over 600 new children born per year-the volume of patients is always growing.
Documentation of health records in Nicaragua is an absolute mess. When someone is born, the government issues that person one health card with a number on it. If they lose the card, it's gone forever. So when someone enters the clinic for a visit-it's really a toss up of if they still have their health card or not. Because the charts are organized by this issued number-it is impossible to find someone's chart without the number. The doctor then sees the patient without a past medical history and simply writes about the encounter on a piece of paper. All around the health post, piles of these loose papers sit without knowing which chart they belong to. In talking to Domingo, the current physician at the health post, he says that it is one of his greatest challenges. He sees patients who present with new complaints but do not know why they were hospitalized a month ago. He is continually making decisions without an adequate view of the patient. Then without this documentation, it is very difficult for him to follow up on a patient.
Our goal for the next few weeks is to create a system that the nurses are able to easily use to find patients. We have made a notecard look-up system where the patient can be looked up alphabetically by first name (everyone has a few last names and prefers to go by a different one). The notecard has name, issued number, and birthdate on it. Then we bought new folders for all of the charts (the old ones were falling apart) and organized them by a brightly labeled patient's number. This way, if a patient comes in and does not know their number (most patients), they can be looked up by first name, then using their number, their file can be found Hopefully this will then allow Domingo to have a full picture of the patient and also practice better follow-up.
|Jenny and one of our prenatal patients giving a talk|
|Checking blood pressure at prenatal visit|
|Las Salinas, one of our communities|