Tomorrow I'm taking off for Democratic Republic of Congo again, so why I even bothered to go to work is beyond me. Especially because I was on the only one there.
It didn't take me long to finish the few things I needed to do for travel before I went (printing off my official orders, attempting to check-in for my flight only to be told that I have to check-in in person because I'm flying internationally), and then I moved onto the things I knew I needed to do before heading out for two weeks (putting in medication refills, making sure orders were in the computer, etc). All in all, most of the work day was pretty boring, but at least it was quiet, since I had the office to myself.
The one point I had today where I actually got to feel productive was when one of the medics for A Co came in to ask me to look over his medical threat brief for Lesotho. He's not going to Lesotho, but two of his team members are, and it's always the responsibility of the medic to put together a "okay, here's what this country has and here's how you can avoid getting sick" brief. We have a template of the brief that they should give on the medical section website, so they just fill in/delete as needed for the country (for example, Lesotho doesn't have yellow fever or malaria, so you don't need slides for either of those). Unfortunately, he didn't remember that we had a template, so he tried to reinvent the wheel.
For the most part, it wasn't too bad. There were a few things he went into too much detail about--he had a slide about the symptoms and treatment of hepatitis A, when all he really needed to say is 'hepatitis A is transmitted by food and water, and you're vaccinated against it--and a few things he didn't go into enough detail about--what to do about jet lag, how to be safe while traveling, etc. So we went through the template presentation and filled it out for Lesotho, discussing things along the way, such as which vaccines they needed and which they didn't. The medics are all pretty sharp, and this one was no exemption, so he picked up on the stuff pretty quickly. It's still hard for me to remember that they don't have the same training in travel medicine as I do, however, so sometimes I have to stop myself in midst of technical explanations about proper dosing of malaria medications and remind myself to stick to the things they need to know.
Anyway, so that was my bit of excitement for the day. Once we were done discussing Lesotho (and discussing his future career plans), I called it a day (because there was nobody around to tell me I couldn't), put a message on my white board saying that I'm out until 17 June, and headed home to pack/procrastinate about packing. Because honestly, I hate packing and I wish I could pay someone to do it for me.
Showing posts with label travel clinic. Show all posts
Showing posts with label travel clinic. Show all posts
Friday, May 31, 2013
Tuesday, April 24, 2012
Travel Clinic
Today for travel clinic, we seemed to be having a special on people getting ready for permanent change of station (PCS) moves. There are some things that are nice about these--for one, they're going somewhere with a military base or embassy, so they have access to American healthcare overseas--but there are things that are more difficult, mainly that they're going to be gone for three years.
The first patient of the day was a 23-year-old wife of a Marine moving to Okinawa, Japan. This is normally a pretty easy appointment (I had a similar one last week), but was made more interesting by the fact that she recently found out she was pregnant. Normally, I order vaccines for typhoid (not because they need it in Japan, but because most people who live in Japan do a lot of travel in Asia) and Japanese encephalitis (which we don't even have in clinic, currently). Since she's not planning on doing any travel outside Japan while pregnant, we deferred the typhoid vaccine until some time she's ready to travel, and Japanese encephalitis vaccine until after she's no longer pregnant. I did remind her that it's important that she protect herself against mosquitoes in the meantime.
The second family (husband, wife, four-year-old son) is going to be moving to New Delhi, India for three years. This is a map of where malaria is in India, which, as you can see, is almost everywhere. There's no malaria in New Delhi itself, but there is in the surrounding areas. We discussed the risks and benefits of malaria prophylaxis for all three years, and ultimately decided that they'd be spending most of their time in the city and wouldn't need it. I did remind them that anytime they're going to travel around or outside India, that they need to see their physician for malaria prophylaxis. They also needed typhoid vaccine and Japanese encephalitis vaccine, which presented another problem (in addition to the fact that our clinic didn't have it). The current JE vaccine in the US is only licensed for adults. That's not because it's unsafe for children, but because it hasn't been studied (we don't do studies in kids in the US, usually). It can be ordered off-label by a physician, so after discussing risks and benefits with the parents, that's what I did (and gave them phone numbers of the other military immunization clinics in the area so they could make sure they have it in stock before driving across DC). The son also got rabies vaccine, because there's a lot of rabies in India, and you can't trust four-year-olds to tell you when they've been bitten by a dog (or cat or monkey, etc, etc).
The final family of the day (mom, dad, eight- and five-year-old boys) is going to be moving to Morocco. This was probably the easiest appointment of the day, not because of the location (although, being a desert country, there's really not a lot of tropical risk), but because the family has done a lot of traveling and is pretty savvy about things. In fact, the mom grew up in Egypt, so the Sahara is not a new location to them. They actually did get a lot of vaccines, though, because they're planning on doing some traveling to sub-Saharan Africa in the three years that they'll be in Morocco. Everyone got yellow fever vaccine (except dad, who just got it three years before), meningococcal vaccine (except dad, who already had it), typhoid, and rabies. I also prescribed a few courses of azithromycin and loperamide for traveler's diarrhea, but after that, they'll have to go the embassy clinic for more. They'll also have to go to the embassy clinic for malaria medications before any of that travel to sub-Saharan Africa.
In all, not a bad day at travel clinic. A lot of notes had to be written (each person has to have his or her own note, even if the family was all seen together), but everyone was friendly and excited about traveling, so that was okay. That's the best part of travel clinic--everyone is happy, relatively healthy, and the only thing they complain about is the number of shots they have to get.
The first patient of the day was a 23-year-old wife of a Marine moving to Okinawa, Japan. This is normally a pretty easy appointment (I had a similar one last week), but was made more interesting by the fact that she recently found out she was pregnant. Normally, I order vaccines for typhoid (not because they need it in Japan, but because most people who live in Japan do a lot of travel in Asia) and Japanese encephalitis (which we don't even have in clinic, currently). Since she's not planning on doing any travel outside Japan while pregnant, we deferred the typhoid vaccine until some time she's ready to travel, and Japanese encephalitis vaccine until after she's no longer pregnant. I did remind her that it's important that she protect herself against mosquitoes in the meantime.
The second family (husband, wife, four-year-old son) is going to be moving to New Delhi, India for three years. This is a map of where malaria is in India, which, as you can see, is almost everywhere. There's no malaria in New Delhi itself, but there is in the surrounding areas. We discussed the risks and benefits of malaria prophylaxis for all three years, and ultimately decided that they'd be spending most of their time in the city and wouldn't need it. I did remind them that anytime they're going to travel around or outside India, that they need to see their physician for malaria prophylaxis. They also needed typhoid vaccine and Japanese encephalitis vaccine, which presented another problem (in addition to the fact that our clinic didn't have it). The current JE vaccine in the US is only licensed for adults. That's not because it's unsafe for children, but because it hasn't been studied (we don't do studies in kids in the US, usually). It can be ordered off-label by a physician, so after discussing risks and benefits with the parents, that's what I did (and gave them phone numbers of the other military immunization clinics in the area so they could make sure they have it in stock before driving across DC). The son also got rabies vaccine, because there's a lot of rabies in India, and you can't trust four-year-olds to tell you when they've been bitten by a dog (or cat or monkey, etc, etc).
The final family of the day (mom, dad, eight- and five-year-old boys) is going to be moving to Morocco. This was probably the easiest appointment of the day, not because of the location (although, being a desert country, there's really not a lot of tropical risk), but because the family has done a lot of traveling and is pretty savvy about things. In fact, the mom grew up in Egypt, so the Sahara is not a new location to them. They actually did get a lot of vaccines, though, because they're planning on doing some traveling to sub-Saharan Africa in the three years that they'll be in Morocco. Everyone got yellow fever vaccine (except dad, who just got it three years before), meningococcal vaccine (except dad, who already had it), typhoid, and rabies. I also prescribed a few courses of azithromycin and loperamide for traveler's diarrhea, but after that, they'll have to go the embassy clinic for more. They'll also have to go to the embassy clinic for malaria medications before any of that travel to sub-Saharan Africa.
In all, not a bad day at travel clinic. A lot of notes had to be written (each person has to have his or her own note, even if the family was all seen together), but everyone was friendly and excited about traveling, so that was okay. That's the best part of travel clinic--everyone is happy, relatively healthy, and the only thing they complain about is the number of shots they have to get.
Tuesday, December 13, 2011
Whitman-Walker and Travel Clinics
In trying to stay up to date on the blogging, I'm writing about yesterday's and today's clinics. I was going to write yesterday, but I decided to go out to dinner with friends instead.
Yesterday I was at Whitman-Walker Clinic, which started as a HIV/AIDS clinic in DC and is now mostly primary care for HIV-positive patients (among other things, but the primary care in HIV patients is what we do). Every three months, the patients come in for blood work, including a full chemistry panel, blood count, HIV viral lode, and CD4 count (the white blood cells that HIV attacks). Twice a year they also get blood work for hepatitis B and C and syphilis.
All the patients I saw yesterday are doing very well, as far as their HIV. In fact, for all of them, that was the least of their complaints. One recently had a heart attack, one was recently diagnosed with diabetes and colon cancer, and one fell and hurt his shoulder (there were others, too, but I don't remember if they had any complaints). I wonder if the people who started HIV care thirty years ago imagined that the disease would be so manageable that chronic diseases would be more of a concern than the HIV.
That was yesterday. Today was travel clinic at Ft. Myer. I had four patients, three different trips (the middle two patients were a husband and wife traveling together). Here's where they're going and what I did:
Tanzania:
The first patient is going on a two-week safari in Tanzania. She got a yellow fever vaccine (there's no yellow fever in Tanzania, but there is in Kenya and she has a connecting flight. Tanzania requires official WHO documentation of a yellow fever vaccine for everyone coming from Kenya) and a bunch of other vaccines, including typhoid, meningococcus, hepatitis A and B, polio, and flu. She also got a prescription for doxycycline for malaria prophylaxis (the map above is the malaria map, so you can see that it's everywhere) and prescriptions for Immodium and ciprofloxacin for traveler's diarrhea. I also discussed with her safe food and water, insect avoidance (wear DEET, sleep under mosquito nets, etc), avoiding animals (because they all have rabies), and standard safety information and how to register her trip with the State Department (so they know she's there if anything happens).
Southeast Asia:
The couple traveling together is a retired lieutenant colonel and his wife, going on a two week cruise to Southeast Asia. They needed surprisingly little for their trip. Both needed two shots--typhoid for both, influenza for him and pneumococcal for her--and I gave them prescriptions for traveler's diarrhea, but there's no malaria in any of the cities where they're stopping, so they didn't need anything for that. I did give them some DEET, because there is dengue, and the mosquitoes that carry dengue bite during the day, which is when they're going to be off the ship.
Eritrea:
My final patient was born in Eritrea and lived there until she was 13. This is her first time going back; she's going to visit friends and family for two months. She's mostly going to be in the capital, Asmara, where there is no malaria (the white spot in the middle of the map). Since she is planning on visiting people outside (in the giant red areas), we discussed malaria prophylaxis. There were a few choices: no prophylaxis, a few short courses of prophylaxis just for when she's outside Asmara, or prophylaxis the whole time. She decided on prophylaxis the whole time, so I prescribed mefloquine, since it's only once a week. She also needed a couple of shots--typhoid, flu, and polio. There's no yellow fever in Eritrea, so she didn't need that. I also gave her a few courses of Immodium and cipro in case of diarrhea, and we discussed the standard safety things and travel insurance and whatnot.
Not a bad two days. In other news, I have a couple of presents under my tree, so that makes me happy :)
Yesterday I was at Whitman-Walker Clinic, which started as a HIV/AIDS clinic in DC and is now mostly primary care for HIV-positive patients (among other things, but the primary care in HIV patients is what we do). Every three months, the patients come in for blood work, including a full chemistry panel, blood count, HIV viral lode, and CD4 count (the white blood cells that HIV attacks). Twice a year they also get blood work for hepatitis B and C and syphilis.
All the patients I saw yesterday are doing very well, as far as their HIV. In fact, for all of them, that was the least of their complaints. One recently had a heart attack, one was recently diagnosed with diabetes and colon cancer, and one fell and hurt his shoulder (there were others, too, but I don't remember if they had any complaints). I wonder if the people who started HIV care thirty years ago imagined that the disease would be so manageable that chronic diseases would be more of a concern than the HIV.
That was yesterday. Today was travel clinic at Ft. Myer. I had four patients, three different trips (the middle two patients were a husband and wife traveling together). Here's where they're going and what I did:
Tanzania:
The first patient is going on a two-week safari in Tanzania. She got a yellow fever vaccine (there's no yellow fever in Tanzania, but there is in Kenya and she has a connecting flight. Tanzania requires official WHO documentation of a yellow fever vaccine for everyone coming from Kenya) and a bunch of other vaccines, including typhoid, meningococcus, hepatitis A and B, polio, and flu. She also got a prescription for doxycycline for malaria prophylaxis (the map above is the malaria map, so you can see that it's everywhere) and prescriptions for Immodium and ciprofloxacin for traveler's diarrhea. I also discussed with her safe food and water, insect avoidance (wear DEET, sleep under mosquito nets, etc), avoiding animals (because they all have rabies), and standard safety information and how to register her trip with the State Department (so they know she's there if anything happens).
Southeast Asia:
The couple traveling together is a retired lieutenant colonel and his wife, going on a two week cruise to Southeast Asia. They needed surprisingly little for their trip. Both needed two shots--typhoid for both, influenza for him and pneumococcal for her--and I gave them prescriptions for traveler's diarrhea, but there's no malaria in any of the cities where they're stopping, so they didn't need anything for that. I did give them some DEET, because there is dengue, and the mosquitoes that carry dengue bite during the day, which is when they're going to be off the ship.
Eritrea:
My final patient was born in Eritrea and lived there until she was 13. This is her first time going back; she's going to visit friends and family for two months. She's mostly going to be in the capital, Asmara, where there is no malaria (the white spot in the middle of the map). Since she is planning on visiting people outside (in the giant red areas), we discussed malaria prophylaxis. There were a few choices: no prophylaxis, a few short courses of prophylaxis just for when she's outside Asmara, or prophylaxis the whole time. She decided on prophylaxis the whole time, so I prescribed mefloquine, since it's only once a week. She also needed a couple of shots--typhoid, flu, and polio. There's no yellow fever in Eritrea, so she didn't need that. I also gave her a few courses of Immodium and cipro in case of diarrhea, and we discussed the standard safety things and travel insurance and whatnot.
Not a bad two days. In other news, I have a couple of presents under my tree, so that makes me happy :)
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