Tuesday, January 21, 2014

Transferring to Emergency Department

Today I went for my longest run of the trip, probably about 3.5 miles.  I’m still going slow, following the schedule that I remember from cross country in high school.  By the end of the 4 months I’m going to have to get up really early if I want to do the kinds of runs I hope to be doing.  I’m finding that it’s really not very easy to do everything I want here.  I get up before 6 to run every day.  Work (including transportation) takes about 6 hours of the day.  I then eat lunch and typically spend a little time with the family.  In order to do everything I need to with the precious proworld internet, I typically arrive to the office by 3 or 3:30.  Spanish class from 5-6:30 or 5:30-7 depending on the night.  Then I go home, tired from a long day of speaking a foreign language.  I eat dinner, hang out with the kids a little bit, then go to my room to write this.  Usually I go to bed after writing this since I like getting at least 7 hours here to make sure that my body is able to recover from adjusting to altitude and running.  I don’t have nearly the time I thought I was going to before I arrived.  Typical Michael Dykstra.

Today I transferred from X-ray to emergency.  When I arrived I told Neilida my plans, and she helped me look for Dr. Jorge, but he wasn't there.  So she put me with her friend Julia in emergency.  This lady seems very nice, although I get very confused when she switches to Quechua.  Now, allow me to describe this emergency room.  There is one bed.  It has no sheets or covering to change, and there aren’t an abundance of sanitary wipes between patients.  A rag is used to wipe it down after each patient, and that’s about it.  Don’t worry though; they have a little metal bowl they put under the area being worked on, so most of the chemicals (water, alcohol, iodine) and blood fall in there.  Most.  That’s wiped out between patients in a little sink.  The extent of the privacy is a curtain that covers part of the space between the doorway and the patient bed.  Patients are always walking in trying to get care, so it is common for them to see procedures being performed on other patients.  I am almost glad I have very little formal medical training, because I think this place would cause me more discomfort if I fully understood all the differences.  I was also happy to meet another US volunteer; she’s also here for 4 months!  And she likes hiking, so I’ll have someone to do that with!  I’m still going to look for more Peruvian friends, but I was very happy to meet another friend who I won’t have to go dancing with to get to know. 

The first case wasn't a big deal, a lady had some kind of object in a small hole in her leg (puncture wound) and Julia was cleaning it and trying to remove the object.  She cleaned it well, but it looked quite painful.  They started with the next patient, a little boy with a wound on his head, when all of a sudden a girl no more than 3 was rushed in with blood all over her face, and she was of course bawling her eyes out.  The wound didn’t end up being very bad, and didn’t even require stitches, but that was a dramatic start to the morning.  I did help some settling the girl down when she got upset again partway through the treatment.  It all happened so fast, I was watching then all of a sudden I was commanded to help out with the toddler.  This is good training for med school even if all techniques aren’t the same.  I was extremely surprised at the method of treatment for this little patient.  Julia broke open an egg, put the part we’d eat in a cup and set it on the windowsill.  With the remaining egg shell, she peeled off the pliable inner layer and placed it over the cut.  The gauze was put above the thin shell and taped to the skin.  I never got a chance to ask why this is done, but I hope to do that.  We had many other patients throughout the day.  Several head wounds that were cleaned and stitched or had stitches removed.  Syringe preparation was part of my task today, and I’m pretty sure that I’ll be allowed to do some intramuscular injections as well.  It’s really not all that spectacular, but I’m excited to get a bit of hands on clinical experience.  There weren’t any other super shocking events today, but I can tell that I’m going to learn a lot during my time on this rotation.

Another side note is that I’m learning that this clinic is largely run by students.  Especially nursing students, but med students as well.  Many of them just started in a rotation the same day I did, so they seemed to feel just as out of place as I did.  It was comforting to me that I could identify with my peers in that way. 

The evening was quite normal, although another systemic difference between the US and Peru became very clear in my mind.  Today I went to the bank to take out some soles, the currency of Peru.  As you can only take out $20 bills in US ATM’s, you can only take out soles by the 50 here.  In the US, it’s usually fine because I use my card for almost everything.  And if I did need cash, every place would take $20 bills anyway.  But in Peru, I have a problem.  This is a cash based society instead of a card based one.  Everything I want to buy requires cash.  Not any cash, but typically small cash.  I only know of 2 places nearby that willingly give large amounts of change when paying with a large bill; the mall and La Canasta (a grocery store).  For everything else, I need to have small bills or coins.  I love that the buses are so cheap, but every single day I need to plan how I’m going to get the coins to pay for the bus out of the large bills that I have.  Maybe I’ll put more minutes on my phone and get cash back for that.  Maybe I’ll buy an ice cream bar.  But it is on my mind all the time.  In the US, I never would think about acquiring the right cash for something except for a large purchase off of Craig’s List or something.  Cash based societies are really quite different than the credit card based one of the US.  Maybe everyone else has figured it out and I’m the only one who hasn’t, but it is proving to be an interesting difference. 

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