Sacred Valley - Day 18

June 22, 2012

I am not sure if it’s the remembrance that makes certain moments stand out in my memory, or if they were truly singular when they occurred. Either way, I will always remember the moment that the cries of a girl from the waiting room of the Lamay Puesta de Salud (health center) caught my attention as I was finishing updating another patient’s chart. Finding myself without a patient, I went looking for the source of the sound and received the intake form from the PHOP members working triage. This three year old girl presented to the clinic because of a new onset of nocturnal nosebleeds for the past month. Clinging to the limited knowledge of a first year medical student, I determined that I would examine her lymph nodes in the physical exam. By the time I met my young patient she had been crying for ten consecutive minute. Like many of our patients, she was dressed up to see the doctors in the clinic. Her eyes were full of tears and deeply brown-green. She was inconsolable, so I lead her and her mother into an unused room in the clinic to see if she would calm down away from the busy clinic. It took me a few minutes of playing and telling her that she had “los ojos bonito” to calm her to the point where I could begin addressing her medical problems. I learned through patient questioning that she also had a 1mo history of anemia and had had a “gripe” (flu) the week before. My physical examination revealed bilateral lymphadenopathy (swollen lymph nodes) but otherwise was uneventful. Upon presenting the case to Dr. Chris Stryker, our pediatrician for the week, we agreed that the combination of swollen lymph nodes, anemia, and new-onset bleeding was probably just a reaction of tiny nostrils to the dry mountain air. However, we also both knew that this triad of symptoms could be the harbingers of a much more serious ailment; childhood leukemia.

Dr. Stryker examining a patient

In the United States, the process from this point would be elementary. A complete blood count (CBC) would be ordered to address the possibility of an over-proliferation of a specific lineage of white blood cell and a normal result would rule out the possibility of a liquid tumor. Sophisticated machines would line blood cells up and force them single-file past a laser, which would help us identify their individual characters and rule out the devastating diagnosis of childhood cancer. However, here in the Sacred Valley of Peru, this kind of CBC is not available without traveling several hours to the nearest large hospital in Cusco. In any of the other clinics we’d seen this week, we would have been unable to do anything but refer this patient to the clinic in Cusco.

Luckily for my tiny friend, the Puesta de Salud in Lamay has been working with our organization for several years at this point. Before we were called the Peru Health Outreach Project, we were known as the Lamay Clinic because our medical outreach focused on this town within the Sacred Valley. Our relationship with the Puesta has been fruitful for both parties, and has allowed our group to grow as well as nurturing the growth of the Puesta. One of our larger donations was that of a laboratory microscope capable of assessing hematological samples. Twenty minutes after walking my patient to the laboratory, the technician who works full time on the microscope was able to draw her blood, prepare a simple blood smear, and manually count the blood cells on the slide to acquire a basic CBC. Having worked with hematologic histology in the past, I asked to also assess the slide and was able to confirm that my patient's blood was normal.  I instructed her on how to safely make a saline nasal wash from sterilized water and table salt and our pharmacy gave her mother a rubber nasal rinse bulb to help solve her issue with nosebleeds. Finally, we gave her vitamins to last the next month.

Will with his 3 year old patient

If our organization did not have a presence in the Sacred Valley, my tiny patient would have had to spend a whole day traveling to and from Cusco to be assessed for a disorder which she luckily did not have. Our efforts have made it possible for the Lamay Puesta to provide essential laboratory services to the people of our beloved region year round. This patient stands out in my mind because she shows how much of an impact we can have on the lives of these patients, because I felt that I contributed to her care in a concrete and meaningful way, and because she would only stop crying for a strange medical student from far away. My time here in Peru has been filled with patients who have made an impact on me for many reasons, but I wanted to share this patient with our community because her story exemplifies the impact of our Project and the connection which we feel with the people of Peru.

Will Tierney

Second Year Medical Student

Cleveland Clinic Lerner College of Medicine

Financial Coordinator - PHOP 2012MS2,