When I arrived at the clinic this morning there was a five year-old girl with abdominal pain and vomiting in the exam room and Dr. Flores was talking to her Mom. For three days she had experienced episodes of acute central abdominal pain. The episodes lasted up to an hour, sometimes she cried, she was doubled over with the pain, and occasionally she vomited during the episodes. She had up to seven episodes a day. Between the episodes she wasn’t eating as well but she otherwise felt fine. Her last poop was three days ago and described as stickly black. Her exam was normal.
The pattern of the pain and the vomiting was suspicious for intestinal obstruction. I could feel a lump on the right lower side of her abdomen. I obtained a poop specimen. The clinic can test for parasite cysts, worm eggs, and blood. She had all three. The child developed an episode of abdominal pain while she was at the clinic and I examined her again. She was not distressed and the lump as no longer palpable. I treated her for parasites and for worms. I did a quick Google Scholar search of worms and intestinal obstruction and learned that this is possible. I’m not sure she had obstruction due to worms, but that is how I treated her. The 3 day mebendazole treatment will get rid of the worms and Mom knows she must come back if the pain and vomiting continue.
The two week-old baby came in with the results of the ultrasound. Amazing! Mom obtained an ultrasound in Rivas for $20 and the films with the report were available to me in 48 hours. Wow! Outpatient results that fast would be difficult to obtain in most Canadian centers. The Mom and Dr. Flores made this happen and this shows that the system can function.
I checked poop for parasites and worms twice today and both tests came back positive for both. Both families used well water. I'm sure most of the children are "colonized" or infected with worms and parasites. I reviewed how to disinfect water with the SODIS system and the need to wash hands and fresh produce to minimize ingestion of worm eggs. My Spanish teaching handouts on these preventative measures came in real handy.
A Dad brought in a three year-old boy with typical nephrotic syndrome. These children develop generalized edema (swelling) after common colds. An abnormality in the immune system is the likely cause. The Dad was told (or he understood) that the edema was due to infection and that antibiotics were the treatment for nephrotic syndrome. I had a hard time clearing up this misconception, but the distinction is important. Nephrotic syndrome requires treatment with a steroid medication and the problem is usually recurrent. I was not convinced that the Dad really understood but Sheyla felt confident that he did.