---
This morning there were no lazy clouds, only immediate blue skies and excitement. Everyone was down to breakfast and hour early and ready to go. I tried to prepare everyone (and above all myself) that it is likely to be a slow organizing day since the radio announced we were coming Thursday not Wednesday. We shouldnt be frustrated if it is as quiet as it was when we visited on Monday afternoon, we need the down time to prepare. I neednt have worried.
We were planning on getting organized in the morning, and starting to accept patients at 1:00pm. By 8:45am there was a line.
As we watched people trickle in steadily, it became obvious that the longer we waited to see people, the longer we would be at the clinic, and by 9:15 I was taking stitches out of a womans whose bull had impaled her. It was only her leg, but there was an entry wound and exit wound and it was infected and ulcerated of course, and why are the stitches still in three weeks later. Plus, do you have any idea of the kind of logistics necessary to treat even the smallest thing? First, just a place to sit. She sat in a spare dentistry chair. I squatted on the floor. Second, light. We left the door open for the hallway light, and I used my penlight to spot the stitches amongst the scab and the healing tissue. Third, water. That wasnt going to happen. Even if it was running somewhere in the clinic, its not clean anyway. Lots of iodine and alcohol. Then there is the issue of providing excellent treatment with limited medications and procedure options. Its really tough. There is always the "this is what the evidence says" and then the slightly different "but this is what we have in the medroom" talk. The woman took 45minutes. There were 10 people in the waiting room when I came out at 10am.
A local nurse was helping us organize, and at one point in the afternoon I commented to her, "this is really a lot of people" and she corrected what she thought was a Spanish error "you mean a FEW people." I looked at her, "no, a lot." She looked at me for a long moment and then decided to laugh, "Doctorita, espera." Just wait.
We had three people in triaje (triage) taking chief complaint, history of present illness, and vitals. Then passing them on 4th year students who filled in the gaps and did an exam, developing their assessments and plans and then staffing them with one of our three docs. Nearly every one requires the docs to consult each other. What did we see? Before we started there was a general question of whether we would see lots of common issues or many rare ones. The answer is both. We saw diarrhea and fever, lots and lots of back and leg pain (herniated discs, compression fractures, radiculopathy), depression and anxiety, hypertension. We saw brisk GI bleeds, severe gastric ulcers, corneal edema (possible slow cranial bleed), domestic violence, gaping sores on the mouth... maybe leishmaniasis. About 40-45 patients in all today, which means triagers and doctors saw about 15 each, examiners/students about 8 or 9 each. Remember that for each patient we do our own labs, we are our own pharmacists. No one stopped for lunch, everyone had to be pried one by one from their post to eat a banana and orange and drink some water.
We stopped taking new patients around 3pm and the waiting room was empty by 4:30pm. We were all shell-shocked and reeling, and got home after dark an hour later. Some went straight to eat, others straight to shower. Our nightly 1- hour debriefing session was delayed until 8pm (in fifteen minutes), while people collected themselves. There is so much to talk about tonight, it is wild. Tomorrow's goal is to be more streamlined, because Im afraid that really the masses will start pouring in.
No comments:
Post a Comment