Wednesday, January 29, 2014

Crazy Clinic Week

I’m going to stop including my training in the blog posts, but you can trust that it’s happening.  I officially signed up for the 25k river bank run today.  I think my goal will tentatively be to enter the 2 hour club.  This is approximately 7:45 miles throughout the whole race.  That’s pretty quick, but I do have altitude training on my side and that will help tremendously.  I plan to run very seriously for my entire time here.  Once I print off a training schedule I’ll be all set.

I went to the local oven where all the bread is baked.  When we arrived they’d already sold their bread, so we’d have had to wait for more to come out.  I wasn’t able to get far into the building to see what this place all about.  I could not differentiate what I saw from an unfinished construction site.  Random piles of things, not super clean looking, etc.

The clinic was not tame today.  Around 9 a man came in with a huge gash in his head.  It must have been at least ¼ in. deep, which is very intense for a wound on the top of the head.  The hole probably had a diameter of ¾ of an inch.  Julia was off today, so they had to call in a pinch hitter; Neilida, my supervisor from my time in radiografia.  I guess she can do anything.  I doubt suturing is a regular procedure for her, but it was certainly necessary for this patient.  Doctors seem like they would be more qualified to do this kind of task, but I have yet to see them do work in emergency.  They seem to direct what procedures occur, but they don’t tend to get their hands involved in those procedures.  Neilida injected him with anesthetic, put a covering on the bed under his head to catch the blood, and went to work.  No amount of anesthetic could entirely block the pain, so this patient’s wailing filled the room for most of the procedure, which took about an hour.  A relative of the patient filmed most of the procedure with his phone.  I’m not sure why, and I don’t think that would be ok in the US, but it was interesting to be sure.  Neilida cleaned and sutured the wound, though the skin was pulled very tight to make that suture work.  Every time the suturing needle went in, his moans increased.  The chaos in the room increased as time went on, since more and more people were waiting for procedures.  There were some typical injections going on at the same time as this man’s surgery.  Try to imagine a small room with a groaning man on the only bed and other people rushing about to prepare and administer injections or check the work schedule.  Maybe you can imagine why I was thrown off balance a bit.  By 10:30 I was tired and about ready to go home.

The second interesting case today was a young boy, who came in with a bandage wrapped around his left thumb.  I wasn’t asked if I wanted to help with this one, but I would have said no.  The bandage was wrapped very large and blood was still obvious all over it, showing the significance of the injury below.  The bandage took a very long time to get off, since the whole tip of his finger was gone.  He was using some type of machine and the tip of his thumb got caught in it, ripping off the nail, skin, and even the tip of the bone.  It looked like an astoundingly painful wound.  He started crying when the bandage was still being removed, so I tried to comfort him by rubbing his back and keeping him from looking at everything going on with his finger.  When his cries grew loud enough his dad came in and took my place.  Eventually the wound was cleaned and gauze was put back on; no suturing here, since there’s no skin left to work with.  Very sad.  The kid has to keep coming back every 2 days to get it cleaned and the bandages changed.  I’m sure this will continue to be a source of agony to the kid and everyone near him during the procedures. 

The other highlight of my day was meeting another med student, Nadin.  She seems more interested in actually helping me get involved in a hospital than Maribel was.  Unfortunately I don’t understand her Spanish quite as well, but it still functions.  And when we struggle to communicate she writes things down on a little notepad she carries around.  We didn’t get to talk too much since it was a busy morning, but I did learn that she either wants to do endocrinology or oncology, and her goal is to do her specialization in Spain.  I also got her phone number so if I have questions I don’t have to hunt for her like I did Maribel.  She also likes to go to the hospital to practice suturing and whatnot.  As makes sense, many of the accidents requiring attention are the result of drunkenness in the evenings.  I know it would be nuts, but I do want to see what it’s like.  Nadin said this evening that she has already started asking around about where I could be a volunteer and will have more information for me tomorrow.  Having connections with med students is great.  I do think I can count on ProWorld to help me find a good hospital to work in too.  I like Belenpampa, but it is small and I’d love to become familiar with a more wide variety of Peruvian medicine.

Because I am finally becoming accustomed to everything, I am starting to think about my honors senior project.  Rodolfo and I discussed the Peruvian health system today during class.  Public sector is cheap, but the doctors don’t tend to be as good because they are paid less.  Also, the general system tends to be too simple and therefore less effective.  For example, our ER is one bed and we don’t have the sterilizing capabilities that we should have.  Also, rural towns typically have one tiny clinic (maybe one room total) that is run by a nurse with no other supervision.  For simple sicknesses or injuries that works fine, but if anything serious happens the patient often dies on the way to a city for better treatment.  The private sector is better, but you have to be very careful that they don’t do extra tests just to make more money.  That can be common, especially among foreigners.  In terms of preventative medicine, the government has tried to host programs in that area but they typically fail because the general population is uninterested.  That’s a decent summary of what I learned during my Spanish lesson.  There is a lot more there, and I’m excited to dive into it and learn more.  My Spanish teacher agreed to help translate my survey that I’ll give to people involved in my study.  I hope to get input from people in many different areas; public doctors, private doctors, administrators, nurses, etc.  We’ll see how successful I am in that endeavor, but I am excited thinking about planning that study.  

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