Today was day two
in the hospital, and things went pretty similar to day one. I talked to the DRC
physician I’m working with before the first patient this morning, and said that
I’m okay doing physical exams, but what I wanted to do was discuss what he thought
the diagnosis would be and differences between symptoms in DRC and the US.
However, what ended up happening was pretty much the same as yesterday. He
would pretty much do a full history, full lab work, and physical exam on every
patient, which is not standard operating procedures in my clinic. If I do a
physical exam (which our veterinarian will tell you is hit or miss), I only
examine the areas in question—if you’re complaining of shoulder pain, I’ll look
at your shoulder, but don’t expect me to press on your abdomen. If you’re
complaining of shoulder pain, I’ll ask you about your shoulder, what the pain
is like, and how long it has been hurting. And I’ll only order labs if you look
like you have an infection or if you need your cholesterol checked.
I did have some
opportunity for teaching, or training, or whatever you want to call it: there
was a man around 70 years old who came in for difficulty rising from a chair
and inability to see out of one eye, and I pulled out my ophthalmoscope (to
look in the eyes) and showed the DRC physician and the doctor-in-training
(graduated medical school and here for additional training before he goes out
into independent practice) how to use an ophthalmoscope to look into the eye.
Anyway, he was completely blind out of that eye, and the pupil didn’t even
change with light, which is a bad sign. I’m pretty sure he had a stroke, and
possibly has Parkinson’s, but neither of which is treatable in DRC, so there
really wasn’t much to do.
The second case
where I got to be an expert was the last case of the morning, an obese women
(yes, they do exist in Africa) with abdominal pain. I’m pretty sure she has
gallbladder problems, and talked the doctor into sending her for an abdominal
ultrasound to look at her liver and gallbladder. I also identified that her
skin was darker in her skin folds (neck, armpits, stomach rolls) and pointed
out that that is usually a sign of diabetes in the States, and maybe we should
check her blood sugar. So they did. I don’t know the results yet.
Over lunch, our
team conferred about things we had seen over the morning and what we wanted to
do for academics. We have a pediatrics infectious disease physician, adult ID
physician, me, a public health nurse, and a lab officer. The peds ID doc saw
clinic and then rounded in the pediatrics ward, but both the adult ID doc and I
just saw clinic, and would both be interested in seeing rounds. Hopefully
tomorrow. Honestly, I think the public health nurse is having the best time and
seeing the most things. Yesterday she went over the tuberculosis surveillance
program and other surveillance programs, and today she rounded with the nurses
on the internal medicine wards. The lab officer, who was requested to help them
with the blood bank program and with SOPs in the lab, today tried to talk to
them about quality control and calibrating equipment, but didn’t really get
far. The idea of having quality control is fairly foreign to them.
After lunch was
academics, and today was the first real day of academics. We got an overview of
the hospital, which I had heard in March but the rest of the team hadn’t. The
hospital commander ended up giving more of an explanation of the health zone
and the six included health areas, which was good, because that was stuff that
I hadn’t heard before. After that, I gave an overview of prevention of cholera,
and then the academics concluded with the hospital commander with discussing
the cholera epidemic that happened from January 2012-February 2013. In the 12
months of the outbreak, there were 226 cholera patients in the Kitona Health
Zone area, with 4 deaths, and no cases among health care workers. Everything
they had done was textbook; in the lecture I gave about preventing cholera
during an outbreak, there were ten points that I had mentioned, and they did
all ten of them during that outbreak. There were questions from both the DRC
physicians and our team asking if we had coordinated the lectures, but we
hadn’t. They had done everything that well.
 |
| Setting up for academics |
 |
| COL Amisi Okito, the hospital commander, speaking about the 2012 cholera outbreak |
I’m hoping to
round with the internal medicine team tomorrow, which I think will be more
interesting than clinic, and possibly have more opportunities for teaching. We
shall see how things develop.
No comments:
Post a Comment