This Thursday some of us got to go the clinic in Francia and help out. In the morning I was with Dr. Linares in the exam room helping out. He showed me lots of physical exam techniques that are essential here in the absence of advanced imaging equipment and lab tests. One technique I found especially interesting was a way to measure the size of the liver by percussion. You begin percussing on the rib cage just above the liver and as you move down the sound changes when you reach the liver. By knowing when the sound changes you can estimate the liver's size. We saw twelve patients before lunch; one woman was exhibiting malaria symptoms, a boy had likely pneumonia, and a 3 month old had a hyperchromatic dermatosis in the diaper area. There was a girl with a congenital eye defect called strabismus where one of here pupils was higher than the other. Apparently it is a common problem among the Miskito. Dr. Linares let me do some of the physical exams and interview the patients in my limited Spanish. Some of the patients only spoke Miskito so we had to rely on the aid of a translator for some of the day. After lunch we went back to the clinic but nobody showed up so we sat around in the lobby read text books in the intense heat.
This morning before class Matt, Dan and I went with the doctor to do some house calls in Francia. We visited one boy who had had surgery to repair a broken elbow several months ago. Unfortunately by the time the surgery was performed there had been too much scar tissue and he would never regain full range of motion in that arm. We also talked to a lady who described having stroke symptoms including temporary loss of vision and weakness in one arm. Dr. Linares did some stroke tests but decided that she had likely had a transient ischemic attack or a mini-stroke. While at this woman's house we also looked at 3 year old girl who was complaining of stomach pain and not eating well. During her examination the doctor found a green stick fracture in the radius of her right arm. A green stick fracture, which is common among children, is when only the outer segment of the bone is broken. He told the mother of the girl to meet us back at the clinic right away so we could splint it. When we got there he told us that one of us could do the splinting and since I had already gotten to give someone a shot in the butt Matt got this job. The doctor ran through all the procedures of measuring the splint material, getting it wet and forming it to the girl's arm. After about 15 minutes we had a very grateful mother and daughter and a satisfied medical team.
Today was also a class day with Public Health in the morning and Travel and Tropical Medicine in the afternoon. So after getting done with the splinting we raced back to the compound and barely made it in time for class. The lectures mainly covered the reading which was pretty basic and introductory. I'm not a big fan of lectures back at Union, but I am now adamantly opposed to them in this climate. It is almost impossible to focus on anything other than keeping as still as possible. In the middle of Travel Med we had to switch sides of the porch to follow the breeze. Jeff mainly covers what is in the reading and the quizzes haven't been to difficult yet so I think it won't be that bad.
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