Haitian Child

Haitian Child

Wednesday, December 28, 2011

The Interpreter is Making a Difference

Another kidney clinic day. When Dr. Flores found out that I was a paediatric kidney specialist he asked if I would see the chronic kidney patients in the community.

"Of course," I replied. I asked that he designate kidney patient days and general paediatric patient days. My reasoning was that chronic kidney patients would take more time than general paediatric patients. I asked to spend an hour with a kidney patient and to see 6 children a day, and to spend half an hour with a general paediatric patient and to see 12 children a day.

Yesterday and today I saw only kidney patients and all but one had recurrent urinary tract infection, which is a very common problem, but when I asked Dr. Flores if there were other kidney problem patients, such as nephrotic syndrome, nephritis, kidney failure, high blood pressure, etc, he replied, "No, all urinary tract infection." This sounded strange to me. 

The solitary patient that did not have recurrent urinary tract infection had hemolytic anemia with dark urine during infectious events. The mother was told the dark urine was infection but the dark colour is really due to the chemicals in urine from broken down red blood cells.

I have learned this is a common situation. On prior visits I realized that "dark urine" was interpreted as urinary tract infection. Dark urine can mean dehydration, kidney stone, nephritis, hemolysis, and other problems, but is not usually a sign of urinary tract infection, except it appears, in Nicaragua. In Nicaragua, dark urine or blood in the urine is interpreted to mean urinary tract infection and the child is treated with antibiotics. My sense is that every kidney problem is urinary tract infection. Gosh, I wish it were that simple.

Sheyla, the interpreter, is getting better at explaining the ins and outs of how to prevent urinary tract infection and I can see that mothers are happy with her explanations, so I presume the patient teaching is happening. How can I know for sure?  I can't. Only time and experience with Sheyla, and follow up visits with the same child, will clarify if we are connecting properly. I really need to learn Spanish.

Today I learned that Dr. Flores and Marta, the clinic nurse, were informed that I only wanted to see kidney patients. This is not true. There is a communication problem with the Director of the Clinic. I definitely asked to see both kidney and general paediatric patients. Sadly, this sort of communication problem is routine. The Executive Director of the clinic speaks English, is originally from Rivas, now lives in the US, and he helps manage and raise money for the clinic, and he means well, but communication problems like this are the rule. Today I asked Marta to cancel some kidney patient days and to arrange general paediatric patient days. 

Communication. Communication. Communication.

Whimbrel with Crab, Dawn, Surfside. 


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