Well its Friday night and 2 days before i have to go home and back to the reality that is residency... the good news is i only have 3 mo and 2 weeks of that...
Monday I found myself at Port Maria A&E, seeing a lot of URIs and fungal infections, big bites, AGE, ect. There was a 12 y/o male whom i was told that he had been diagnosed with Pneumonia about a week ago but the fevers have not gone away.. I began asking the mother a little more history and find out that he was given a 10 day course of amoxil, and she has been using paracetamol for fevers...on further questioning I was told that he had completed all 10 days... ( he didn't look half bad today), but some how mom pulls out this bag of pills to show me the exact name.. WHY where there 24 pills in the little baggie of 30.... SO i counted the pills infront of the mother and said there is no way he could have taken all the pills there are only 6 missing.. I turn to the young man and he starts mumbling.. LOL.. So i politely told them he needed to finish the meds completely to get cured... and explained ABX resistance... I hope it sunk in.. LOL.. this scenario is not unlike some i have run across in New Orleans... All in all i saw about 19 pt that day...Not bad.. NOT bad at all..
Tuesday clinic was off to a slow start, I got there at 830 , and despite my heading to the front a few times to ask about pts, didn't get my first pt until 11 am... BUT then it was PT diarrhea.. LOL.. they just kept bringing me 5-6 charts at a time... YIKES.. I saw a total of 27 pts this day... and I Was EXHAUSTED by the end of it.. Cases included the again many colds, a couple of scabies, some MS pain, need for deworming and the such.. notable case was a little girl with dysuria ( pain with urination). Whom, after a thorough history and physical, I had decided that she needed a UA/UCX... Now in the clinic there are no immediate access to labs, so i needed to send her to the hospital lab.. Mother came back in 10 min saying that the machine was down and she didn't have any money to go to an outside lab to run the test (this is sometimes needed for certain labs, or xrays).. I ended up treating for UTI but giving firm instructions to return to the clinic if it wasn't better in 2-3days..
Wednesday I went to Annotto Bay A&E, and saw quite a few gastro enteritis.. it seems that this is the season for it.. I think that i was told that the outbreak at Port Antonio had a few rota virus positive cases.. I hope that's not whats here as well... It seemed like every one was on ORS ( oral rehydration salts).. They do almost the same thing we do.. I put quite a few kids on PO challenge..I didn't have to admit anyone thank God. I think that their ( GPs) threshold for admitting these kids is quite low, so that they don't get behind the 8 ball. Again anti emetics are not an option.
I did have a teacher bring in a student with the complaint that he has asthma and he has a fever. So i asked if he was wheezing (NO), but has a little cough, How high was the fever (he just felt hot). HE looks very comfortable now..why r u here today? well I called his father and he said that every time he gets a fever his asthma acts up.. I had her call dad and try and get some more history from him.. he stated that he has had a slight cough but has been using his inhalers as prescribed but there was no wheezing or SOB at home and has maintained his activity level. After a complete exam showing normal Sat's, no fever, normal respiratory rate, and basically a lil boy siting there and just talking like he didn't have a care in the world.. I let them go.. I did give the teacher a talk on what to look for that would signify emergency, as I didn't want her to feel that she could not come back if there was a real problem... I think that is important.
We got off to a late start on Thursday due to a flat tire.... but made it to clinic in time to help out with a few of the pts.. saw quite a few asthma follow up visits, and then well baby visits... I gave all my new mothers the BACK TO SLEEP talk and again discouraged co bedding, reprimanded a mother who was giving her 2 week old glucose water?, and explained y this was inappropriate.... I have also noticed in the month I have been here, thermometers are not a household appliance.. ( maybe two people were able to tell me how high the fever was). I did try and encourage , especially new mothers, to buy one if they could afford it, as well as bulb suctions.. ( I did not however discourage them coming in if they felt like the child was febrile and sick...
Well our last week was likely the most fruitful.... we were able to say our goodbyes to all the docs we worked with, It was kinda sad...;-(. Its been a great experience and I would really love to do it again.... I Leave for NOLA on Sunday morning...there is not escaping that.
I'll see if i can pull out one more blog to give the new people some pointers and the I wish I had known tidbits...
off to bed I go...
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