Wednesday June 27, 2012
After a fantastic week in Urubamba and Sacred Valley, and an enjoyable weekend in Cusco and Lima, I joined the Chincha team on week 3 of the Peru trip. Chincha was different in that it was more urban, we were stationed at one Health Clinic site the entire week, and we also had access to some specialists.
After a fantastic week in Urubamba and Sacred Valley, and an enjoyable weekend in Cusco and Lima, I joined the Chincha team on week 3 of the Peru trip. Chincha was different in that it was more urban, we were stationed at one Health Clinic site the entire week, and we also had access to some specialists.
At the Chincha Clinic I had my own office and cadre of
translators and sharp medical students assigned to work with me. However, I also had 35
patients on my schedule on day 1. As an internist in training who barely speaks
a lick of Spanish, I knew it would be a challenge. We made it through the day,
and each day after felt a little bit easier despite what seemed to be a
continued increase in patients. At times, buses of patients would show up at my
door despite an already full schedule. Turning patients away wasn’t an option,
so I’d recruit some help and get down to work.
Along the way we saw a ton! End stage rheumatoid arthritis,
esophageal cancers, gastric cancers, severe Vitamin B12 deficiency, hip
fractures, self-inflicted severe testicular ischemia (yes, you read
that right), severe hyponatremia, septic knees, congenital hypothyroidism, and
much more. Our tools were limited, so reliance on a good physical exam was crucial.
Knowing we had access to basic tests and procedures, on day one I ordered an
EKG and pulmonary function tests on one patient. A few minutes later a medical
student came back with a conveyed message from Dr. Zambrano (the fantastic
Peruvian cardiologist who spearheaded the Chincha mission) stating the tests
weren’t currently available and that I should “treat them like we’re at war”.
Yes there was limited access to procedures, but it was a reminder that history
and physical would be our primary weapons. There was an ultrasound, but an
ultrasound tech was usually not there, so at times I would just do my own
ECHO’s or perform my own abdominal ultrasounds.
Many Chincha moments will forever remain etched in my memory.
I remember sending patients to the hospital emergently. Transport is different
there as ambulance is not all that common. Instead we put the patients in a cab
and send them stat to the hospital. I remember feeling great after treating an
incredibly kind elderly gentleman with ataxia who was found to be severely
vitamin B12 deficient, but then feeling hopeless when I realized he was
deficient because he simply could not afford food. I remember David Xu our
medical student taking an astute history on a patient and discovered she had
black stools. We referred her immediately to our wonderful GI specialist from
St. Louis Dr. Walden who did an EGD and found a gastric mass. I don’t know what
treatment options are available and what the outcome will be, but at least she
now has a fighting chance. The next day she came in and thanked the team with 2
cans of homemade chocolate bean dip!
From a professional standpoint this was a growing experience
for me, as I gained confidence in my ability to handle a high patient volume
and also my ability to diagnose without all the fancy lab tests and procedures
we have available to us back home. It also made me appreciate the training I
had received at Cleveland Clinic as I felt my instincts I developed in training
served me well. Can’t wait to go back in the future!
Vipan Nikore MD, MBA, PGY-2 CCF Internal Medicine
No comments:
Post a Comment