Clinic, Week 2

I meant to write this while at work on Friday, and then yesterday during my day of doing absolutely nothing (no, really--I woke up, went on a run, and then only got off my couch to get food. It was kinda glorious). But I didn't, so I'm writing on Sunday night.

So here's how this past week of clinic work went:

Monday: No clinic (my preceptor at Whitman-Walker was still on vacation from Thanksgiving). So I sat at WRAIR and worked on work. And went to a two hour long safety briefing, which was incredibly boring, even with the company of my two fellow residents.

Tuesday: Travel clinic at Ft. Myer. I actually had patients! It was a lot of fun (and actually fairly busy). I had a retiree who is now a consultant who will be going to Afghanistan for twelve months, so he got a couple of vaccines and a year's prescription of doxycycline, which is an antibiotic that is also used as an antimalarial. He'll have to get a two-week prescription for primaquine, another antimalarial, to take when he gets back. The next patient was another retiree, going to Ghana for his mother-in-law's funeral. He's been out of the service for almost twenty years, and despite still having family (well, family he married into) in Ghana, he has never been to Africa, so he got quite a few vaccines, and also a prescription for antimalarials (Malarone, in his case, which is a drug with very few side effects but a pretty high price tag), as well as all sorts of counseling about how to take care of himself while he's traveling. Patient number three is a dependent (meaning she was never in the military, but her husband was) who was born and raised in El Salvador and is going back for Christmas. El Salvador does have malaria, but not much, so I gave her some bottles of bug lotion with DEET and told her to be careful going out at night (which is when the malaria mosquitoes bite), but she didn't need any medications. She did need a couple of vaccines, though, which we were more than happy to provide. The final patients were a family (mother and three kids under 10) who were going to Bahrain to visit the husband/father, who is stationed there temporarily. Bahrain is a pretty safe place, when it comes to diseases, so all they needed were typhoid shots and prescriptions for antibiotics in case they get diarrhea, and they were good to go. No malaria there.

Moral of the story: whenever you're traveling to the developing world, go see a doctor. You're probably going to need a few shots and drugs before you go.

Wednesday: This was supposed to be prev med clinic at Bethesda (excuse me... Walter Reed National Military Medical Center), but instead, we had a talk about the embassy bombing in Nairobi in 1998, by the doctor who was in charge of the research lab then (she is now retired but still working for the Army). It was a really interesting talk, if for no other fact than to demonstrate how far we've come as a military when it comes to treating and evacuating casualties from big, traumatic events. And this bombing was a big, traumatic event--there were around 400 killed and 1200 injured.

Thursday: TB clinic at Montgomery County. This was, well, not what I expected. I pretty much just observed while the medical director saw patients. The first was an elderly woman who recently immigrated from China and had a positive TB skin test and x-rays that looked like she had TB in the past. She never had any sort of treatment, so she was given a prescription for four months of isoniazid and rifampin (two drugs that are used to treat latent, or inactive, TB), and then a whole bunch of counseling on why it was important. The next few patients were all follow-ups who have active TB and come into the clinic once a month to check on the symptoms, see how they're progressing, and so on and so forth.

Friday: No clinic (there's never clinic on Friday). I finalized my orders for attending the American Society of Tropical Medicine and Hygiene conference in Philadelphia (where I am right at this moment) and did some mandatory online training, and that was about it.

So now I'm in Philly, with one day of the ASTMH conference down and four to go (it's a pretty long conference). I'm not presenting anything, just going to the sessions and, I hope, learning stuff. We'll see how that goes.