Rounds with Dr. Germa and July 4
I haven't been doing too much work in the dressing room in the last 3 days because of the sudden presence of ~5 british/french/european volunteers. They have kind of taken over the dressing room (we won't discuss the new level of patient care) and so the last two days have been an interesting departure from the routine. Yesterday, Jake, Zev, Mekais (an Ethiopian starting his 2nd year @ Harvard Med), and I followed Dr. Germa on his rounds through the mission. His cases aren't as complicated as Rick's but he sees the more severe cases of some of the more unique diseases. A short list of the things we saw yesterday:
~Parkinson's
~Leprosy - as with everything else here, a text book example.
~An Abdominal Cyst that dominated the lower half of her abdominal cavity - It was so large such that looked pregnant, but b/c it was so large they were unable to find where it originated from in the ultrasound, maybe the ovaries
~Scabies
~A Leopold exam on a lady who was 30+ weeks pregnant - it's a physical exam to make sure the fetus is oriented correctly and seems to be doing ok; the fetus can shift orientation in the uterus until the 34th week, after which it should be oriented correctly, head down; Dr. Germa ordered the lady's first ultrasound...how many women in the US go through 30 wks of pregnancy w/o an ultrasound?
~HIV+ Sero-converted patient who is one of the sickest individuals I have ever seen. I won't go into too much detail here, but I was worried she wouldn't last the brief physical exam. Dr. Germa ordered her bloodwork and depending on her CD4 count they will probably start treatment. Anti-retrovirals are dispensed based on WHO guidelines which suggest for anyone w/a CD4 count of below 300, at which point it is already too late for many patients (Dr. Germa has had patients come in w/a CD4 count of 1, who miraculously recovered). The WHO is in a tough spot b/c they would save many more people if they recommended anti-retrovirals for CD4's 500-200 or some other range of that nature, but they would catch too much political flak for abandoning those w/counts below 200; catch-22.
Before the rounds w/Dr. Germa, I spent a little bit of time in the microbiology lab and saw blood samples with the Borellia bacteria (causes relapsing fever, endemic during the winter/rainy season here) and "Chronic Malaria" (very common during the summer/dry season). Amazing how clearly you can see these things in a blood sample.
In the afternoon, I folded gauze and hung out with Abebe...nice and relaxing. For dinner, went out with Adam (Rick's former asst) and 3 of the GW med students to a good indian place and then to Rodeo Bar to celebrate the 4th of July. Rodeo Bar is the most garishly decorated, pseudo-american bar probably this side of the atlantic. The walls are covered with pictures from rodeos, sombreros, and random American paraphenalia and the drinks we ordered were so vile (I had 'Buffalo Sweat'....tasted like actual buffalo sweat) that the place should be shut down for poisoning customers. But an interesting attempt at a foreign celebration of july 4th.
~Parkinson's
~Leprosy - as with everything else here, a text book example.
~An Abdominal Cyst that dominated the lower half of her abdominal cavity - It was so large such that looked pregnant, but b/c it was so large they were unable to find where it originated from in the ultrasound, maybe the ovaries
~Scabies
~A Leopold exam on a lady who was 30+ weeks pregnant - it's a physical exam to make sure the fetus is oriented correctly and seems to be doing ok; the fetus can shift orientation in the uterus until the 34th week, after which it should be oriented correctly, head down; Dr. Germa ordered the lady's first ultrasound...how many women in the US go through 30 wks of pregnancy w/o an ultrasound?
~HIV+ Sero-converted patient who is one of the sickest individuals I have ever seen. I won't go into too much detail here, but I was worried she wouldn't last the brief physical exam. Dr. Germa ordered her bloodwork and depending on her CD4 count they will probably start treatment. Anti-retrovirals are dispensed based on WHO guidelines which suggest for anyone w/a CD4 count of below 300, at which point it is already too late for many patients (Dr. Germa has had patients come in w/a CD4 count of 1, who miraculously recovered). The WHO is in a tough spot b/c they would save many more people if they recommended anti-retrovirals for CD4's 500-200 or some other range of that nature, but they would catch too much political flak for abandoning those w/counts below 200; catch-22.
Before the rounds w/Dr. Germa, I spent a little bit of time in the microbiology lab and saw blood samples with the Borellia bacteria (causes relapsing fever, endemic during the winter/rainy season here) and "Chronic Malaria" (very common during the summer/dry season). Amazing how clearly you can see these things in a blood sample.
In the afternoon, I folded gauze and hung out with Abebe...nice and relaxing. For dinner, went out with Adam (Rick's former asst) and 3 of the GW med students to a good indian place and then to Rodeo Bar to celebrate the 4th of July. Rodeo Bar is the most garishly decorated, pseudo-american bar probably this side of the atlantic. The walls are covered with pictures from rodeos, sombreros, and random American paraphenalia and the drinks we ordered were so vile (I had 'Buffalo Sweat'....tasted like actual buffalo sweat) that the place should be shut down for poisoning customers. But an interesting attempt at a foreign celebration of july 4th.
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