Thursday, February 20, 2014

Physical Exams, Lomo Saltado

This morning I reported early to the clinic so that I could learn more before we had to do rounds with the babies.  Andy took me into the hospitalization room and demonstrated an exam for me on a baby, then had me do it.  In total I did 3 physical exams, although they weren’t in front of a doctor.  Wow, what a cool experience.  If the baby isn’t already crying (which is rare), you start by listening with a stethoscope to the lungs and heart.  The lungs should not have mucus or make a scratching noise.  The touching exam starts with the head, checking for the fontanels in the skull.  Several things can be gleaned from this test.  First, if the skull is fully closed that is a big problem because the skull won’t expand appropriately and brain problems are likely to develop.  Also, if the baby has hypertension you can feel swelling in the fontanels.  Hypotension will do the opposite, where the fontanels will be little depressions down into the head.  You then move onto the ears.  The ears have to be permeable to sound, and should look to have consistent development between the 2 of them.  The nose should be clear and not have any obstructions.  Next is the mouth, where we check visually for a continuous pallet.  The neck is then checked to make sure it doesn’t have any masses, and the clavicles are checked to be without fracture.  This can be common for babies as they exit their mom’s body, especially if the baby is particularly large.  For chest and thorax, palpation for abnormalities is enough.  I next would grab the hands of the baby, let it hold on for a few seconds, then let go to test the Moro reflex.  The arms should spread out as if going into a hug.  The legs must be free of clicks when we move them around.  Tomorrow the med students will teach me what to describe the exam with words, so maybe I can do it when we do rounds with the doctor!!

It was also a pretty cool day in the Sala de Partos.  Two ladies were groaning in the Sala de Dilatacion for much of the day, so it was only a matter of time.  Right around 1:00, it was obvious that she was close so I stuck around to watch.  And I was told I could help with the post-birth preparation.  Wilson was receiving this baby, so he was super excited.  As much as I am liking this rotation and as much as I’ve been becoming acclimated to the typical sights and sounds, I’m not sure that’s one I want to explore.  It might be the only time in my life I would have the chance to deliver a child, but I just fear the consequences of an error in that setting.  This was one of the more impressive births I’ve seen.  She got in position, and a minute later the head popped out.  Absurd.  She did seem like she was probably from a more rural region since she mainly spoke Quechua, and I’ve heard that their births tend to go faster because of the musculature of the women.  For some reason she stopped pushing at this point, although she clearly wasn’t done.  Fortunately this time there weren’t complications because of it, but an aspirator was required to get the baby healthy.  When things like that are happening I tend to just stand back and let the professionals handle it. 

For the sake of time I’ll skip to the evening when I hung out with Kevin.  I took a different bus on this trip for the fun of it, and I did eventually make my way to our meeting place.  He fetched me and took me to his dad’s restaurant.  It looks about like a typical Peruvian restaurant.  Not huge, not tiny, pretty clean but not sparkling.  He took me into the kitchen, where I first got to taste fried rice (this tastes very similar all around the world), then we started on Lomo Saltado.  Here are a few pictures of the experience:


How do you cut a whole chicken?  Knife and a hammer.


The finished product.



It was absolutely fantastic, I definitely want to make this again in the states.  Kevin will bring me a list of spices eventually, since I didn’t catch everything and I’m not sure what they are called in English.  His dad was very kind, he told me I could come back more if I wanted to learn more Peruvian dishes.  When he found out about mom’s restaurant and that I can cook, he said he could get ingredients for some dishes I knew and I could teach him.  I’d love to introduce them to mostaccioli, but I’m not sure they have all the ingredients I need.  

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