Day 11

Blog Entry day 11: 10/01/08

Today was the first day of my rotations, and it turned out to be great. Nick (housemate) and I, took the bus to the municipality of Volcanes, which is where our centro de salud (center of health) was. We arrived at about 7:30 AM, but were notified that Dra. Consuelo, the doctor we had to meet with, was going to arrive at 10:30. So instead we chose to be reassigned to another doctor who already there. The first doctor, me and Nick were with, was Dr. Victor Lopez; he was a really easy going and fun doctor, something that I really liked. The first case of the day was a boy, about 5 yrs., old came in with trouble breathing. After, checking his chest with a stethoscope the doctor concluded it was bronchitis, an infection I would find out later in the day that is all too common with kids around the area. After the patient, I was transferred to another doctor, Dra. Ana Maria, to keep the ratio more one to one. The transfer turned out to really benefit my learning experience, both in medicine and in Spanish.
Throughout the 4 hours I was there, we went through a least 12 patients. I honestly don't know where she gets the energy to keep examining patients and diagnosing problems one after the other, I suppose you get used to it after doing it so much. Due to the fact that she didn't know english, my main challenge was trying to understand what she was saying. When I started to pay more attention to names of diseases, while looking at the parts of the body she spend most of her attention on, as well as the types of medications she was prescribing, I started picking up where the problems most likely occurred and what types of sicknesses the patients had. I really liked my rotation because she let me do stuff during the examination. I was able to look for inflammation and infection in peoples throat and ears, as well as listening to what wheezing sounds like when someone has a respiratory infection. I'll go over a few interesting cases that came in.
The most interesting case that I saw was this 1 year old girl with a secondary secretory bacterial infection (after doing some research might have been fungal). She had these strange green secretions on her skin, in different parts of the body. The girl had a primary infection that she probably caught from her older brother, who was 3 years of age. The doctor said that because the girl would scratch and itch herself after wiping her nose with her hand, the infection spread to places where she scratched, causing a secondary bacterial infection. She was prescribed an oral antibiotics (Dicloxacilina suspension, Lortadina Jarabe) as well what I assume to be an antibiotic topical creme (clioquinol creme, which turns our to be an antifungal).
I was also able to look at pictures of an endoscopy of a woman who came in with tuberculosis. She had many lesions and granulosa in her respiratory tract. I felt really bad because she was in a lot pain and was on the verge of crying. It seemed like the T.B. was really accelerated, possibly due to late assessment and treatment. I derived that it was bad, based on the expression and tone the doctor; in this case, she seemed really disturbed and had a really grim expression on her face.
I think the most common types of cases, are those relating to chronic diseases such as hypertension and diabetes. There were a few men we saw who's ages ranged from 50-75, who didn't exhibit any infections, but instead we paid close attention to blood glucose levels and blood pressure; which, luckily, were pretty well under control.
Most of the kids who came in exhibited bronchitis or rhinopharyngitis, which seem to be the common infections in the area. For most bacterial infections Dra. Ana Maria prescribed Amoxycilin, in other oral tablet or liquid form. The way I learned to identitfy infections was to look at the back of the throat, color of phlegm, secretions in the ear, and the presence of a fever.
Due to the lack of technology in these clinics, doctors rely much more on their senses and intuition. For instance, Dra. Ana Maria would feel the abdominal area of her patients to check for where there was pain, and what types of pain the patients felt. For pregnant patients who came in she felt the abdomen and listened with her stethoscope to get information on the timing of contractions and information on the baby, rarely was there a sonogram included in the chart. What was pretty cool was that she let me listen to the baby and contractions through the stethoscope, which was something I've never done before, and to be honest I don't know how she was able to get information on the baby from that, but she did. It was a bunch of random sounds to me, and I had trouble distinguishing the sounds from the ambient noise.
Being at this clinic has shown me a little bit about primary care, and I know I'l learn a lot more in the next two weeks of this rotation. From what I could see from my first day, primary care is really exciting because you never know what's coming through your door next. People could have any variety of problems, ranging from any field of medicine, and the primary care physician must be ever vigilant in diagnosing these issues, which any times can reveal greater hidden problems. The job seems to be mostly based on finding and diagnosing problems based on any current symptoms supplemented with information you can get the patient's medical history. You never know what your going to see next, you have to have knowledge of all fields, and nothing is repetitive because every patient is unique in the problems and issues they bring to the clinic, which is what I think keeps primary care interesting and fresh.
Reflecting back on the first day, I really liked the experience. There is an immense amount of joy in helping people increase their quality of life, there's no doubt in my mind about that. One aspect of being a doctor, which in my opinion makes it completely worth it, is that people literally trust the doctor with everything that's really important to them, which is their quality of life, life itself, and their trust. The way I think about it is, if someone trusted me with their life, which is their one of if their most important assets, then it would become my responsibility to help that person save or improve the quality of that asset with everything that I can, due to the fact that it's entrusting it to me and no one else, which is a great honor in itself. Likewise, if I were to go to a doctor, I'm trusting him/her with the my ability function and enjoy life, which aside from my religion and family is my most important asset. I would expect that doctor to guard and take care of my life with the utmost care and compassion. I truly believe that I can be a great doctor because I care about people and I would to improve their quality of life and make that difference by taking caring the things most important to them. Today, I was able to feel the joy of seeing patients feel relief when the doctor found out what was wrong with their either themselves, or their kids. Knowing that the doctor was able to provide a solution really brought satisfaction to a lot of these patients, which makes the entire profession worth it. It's a very good feeling, a sense of fulfillment hard to describe.
However, I realize that its not all a walk in the park, and that there are unsatisfied patients and unsolvable problems, but that's how life goes, and we can only do the best we can.