My decision to hire interpreters for this trip to Nicaragua was a good one. I feel more confident that the mothers understand my recommendations.
The interpreter this week is Jessica Southern. Jessica is not only bilingual, but she is an American paediatric nurse. Wow! What a great combination for my work! Jessica works for FIMRC, a US charity, at the Las Salinas community clinic, but the clinic is closed this week, so she kindly agreed to help me. Jessica is terrific.
We saw 9 patients today and we saw them in 5 hours, which is fast compared to past visits. I typed out the basics of the treatment plan and Jessica communicated the recommendations to the mothers. After two days, we are a good team. This was my best clinic day yet!
The sickest child was a boy with a history that suggested urinary retention. He had past history of treatment for urine infection and kidney stone. I hear these diagnoses a lot and the histories do not usually fit with these diagnoses. My sense is that any urine problem in Nicaragua is diagnosed as infection or stone or both. The boy was 12 years old and had pain severe enough to make him cry. During the episodes of pain he felt as if he needed to pee but he could only pass small amounts. His urine today did not show infection or blood, and he had an episode last night, which makes infection and stone unlikely. He had a very narrow pee hole at the end of his penis. Jessica arranged for him to have an ultrasound at the Las Salinas clinic and to see the pediatric surgeon who comes up from Rivas once a week.
A fourteen-month old boy was brought in for recurrent hives, which Mom was convinced was due to beans, beef, and shrimp. From the age of 8 months he has experienced itchy bumps. He had typical papular urticaria, which is usually an allergic or immunological response to insect bites and not usually to food. The clinic pharmacy had an anti-histamine, which I asked Mom to give him at bedtime on the real itchy days.
A 12 year-old boy came in with typical migraine. He told me the headaches were much worse when he was walking on really sunny days. The sunlight in Nicaragua is very bright and I have no doubt this would aggravate the headache in any person with migraine. Poor hydration likely also plays a role in his headaches. I treated him with Naproxen and Jessica reviewed the migraine- teaching handout I prepared with Mom.
The days whiz by in the clinic. This is no different than at home. One child after another until the waiting room is empty.
Most of the children today did not have a chart at the clinic, which means this was their first visit. They came to see the Canadian Doctor.
This immature Tri-colored Heron was fishing in the late afternoon.
The sun was very bright and the bird opened up the wings to create a shadow so the fish in the small pools would be easier to see.