Day Two: Las Mercedes Clinic Day 1
This morning we woke up between 4 and 6 am, depending on whether our mattress deflated, how loud the roosters crowed, and whether or not we were motivated to shower before everyone else. Our shower is a three wall cement box with a pvc pipe delivering water, its amazing.
During breakfast we franticly brushed up on our Spanish and reviewed the clinic process. We were separated into groups of 3-4, 4 groups would see patients in Clinic rooms 1-4 and the 5th group ran the Pharmacia.
We began clinic promptly at 8 am, as a bus of patients had arrived from EL Rosario and were waiting outside. In the morning our patients were mostly women and children, often about 5-6 per family, including grandma, aunts, mothers, nephews, nieces, and cousins. During the afternoon clinic we saw more men individually and their pathologies were vastly different from the morning. The morning presentation was a variety of dermatitis, mostly scabies. In the afternoon the men presented with more musculoskeletal trauma and chronic repercussions from labor in the fields.
During the afternoon I was able to see one of the CO-OP leaders, he presented with radiating pain from a rash in his axilla, a reddened eye from cement trauma, a fungal infection on both feet, he also had parasites. We found his rash to be Varicella Zoster and thankfully and were able to provide him with Acyclovir and Ibuprofen, we treated the eye infection with eye drops to irrigate and relieve some of the irritation, we provided Ketoconazole for his fungal infection, and Mebendazole for the parasites. This was one my favorite cases because I felt like we could help him with every concern he had, otherwise the Zoster could be diffuse and he would be without relief.
One challenge that we all voiced at some point throughout the day reminded us of home: How do we ensure that the patient follows through with our recommendations?? It is the classic problem of health promotion that we have all addressed in the US. We recommend that someone stops smoking, that they lose weight, eat less salt, exercise differently—and yet America’s most preventable health concerns persist. Hondurans are no different. While there was probably only one patient with a BMI over 23, their BP is incredible, we still found that a few preventable conditions persist.
Multiple times we found ourselves emphasizes that drinking water would help with headaches, nausea, and vertigo- really, it will! But nonetheless their personal barriers persist. One group had an “ah ha” moment with a woman who had been admitted to the Hospital in La Esperanza last week with severe dehydration, she received IV fluids and realized that her headache went away, one of our classmates explained the connection between the fluids and headache and the patient responded with “ohhh.” Breakthrough moments with prevention are the best feeling, because parasite meds will run out, but patient understanding is invaluable.