Well today was just another day in the clinic. Nothing particularly outstanding or special. But I don't often write about what a typical day looks like. In many ways our walk-in clinic probably has some similarities to clinics in the USA.
There are the patients who you know will not take your advice unless it is in alignment with what they already had in mind. There are the patients who started self-medicating before they came to you. Because antibiotics can be purchased over-the-counter here that one can be a bit scary at times. Bactrim is the drug of choice for patients to take one or two doses and then come in a few days later because the medicine didn't work.
Today I was the only nurse in the treatment department. I have to say that my preference is to work alongside another nurse because I strongly believe that two brains are better than one. Especially with some of the crazy things we see. But thankfully I didn't see anything too scary today.
My first patient of the day didn't really want to be at the clinic. She had malaria and clearly felt horrible. I think she just wanted someone to pick up the medications and bring them home to her. She was refusing a physical exam, refusing lab tests, pretty much refusing everything but medicine. Fun stuff!
I made a referral this morning for a two-year-old who is severely developmentally delayed. The mom brought her in because she has a respiratory infection. But she hasn't walked yet, is cross-eyed and doesn't interact with people much.
My typhoid patient of the day was diagnosed at another clinic. The mother of the 10-year-old girl brought her lab results and the medicine they gave her a week ago. She hadn't improved so they wanted another opinion. Well sure enough she had typhoid, unfortunately they were giving her antibiotics for a skin infection. So we started her on a new medicine and hopefully she will turn around quickly.
I had a 19-year-old girl who is finishing HS at a boarding school. She has a menstrual problem and is really embarrassed about her teachers and peers knowing about what she is being treated for.
My toughest case so far today was the three-year old with the third-degree burns on her hand. They aren't fresh burns but she has to come regularly for wound care. I had to pull of some of the dead skin before putting on a fresh dressing. The sweetie is a little trooper. Trembling all over and tears rolling down her face she holds up her hand to me to begin debrieding. I was wishing I had stickers to put over the bandage when I was done.
And the funniest case of the day was the old-man (that is a respectful term here) with the chronic ulcer on his ankle. So the ulcer wasn't the funny part. The funny part was that he told me "I'm here to get my dressing changed from my snake bite." I asked him when he had the snake bite and he told me "1950, and it's doing much better now than it was then!"
Just another day in the clinic. Thank you Lord for giving me this opportunity to reach into people's lives when they are at their most vulnerable. Please use me to make a difference in the lives of each patient I encounter this week....
3 comments:
good to hear you trucking along! Drugs over the counter...wow.
So is malaria a clinical diagnosis, or do you actually look at blood under a microscope? It's so rare here that similar symptoms could be a billion other things, but I imagine it's pretty obvious there?
Malaria should be diagnosed using microscopy. However it is often diagnosed clinically here for a few reasons. The most common reason is unavailability of a blood smear. Either the clinic doesn't have a lab, it's a weekend and the lab is closed or the patient can't afford the lab test and still have enough money leftover for the treatment.
There is a conundrum of syndromes that 8-9 times out of 10 are malaria. At least that's how it works in our area.
However I do think that we over-treat at times. I was recently talking to a friend who works in a big government hospital. She explained that even there they have a very low threshold for treatment just because it is so common and takes such a toll on the body.
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