Great Day in the Clinic

   A truckload of children were at the clinic when we arrived at 9:30 AM. The families were all from Gigante, a small community about 20 km away.   Bo Fox, who is a worker with Project Wave of Optimism, an organization with a mission to foster community development, was advised that a pediatrician would be available at the clinic, and he went door-to-door to identify families who might benefit.  Eighteen mothers and their children arrived and 7 hours later, after we saw the last patient at 4:30 PM, they left together.  Incredible to think that 18 mothers each spent an entire day away from their homes to spend about half an hour with a pediatrician.  

                                        Imagine 35 people in this truck!!!

   Two final-year medical students from Bristol, England were at the clinic. Their university arranged for them to volunteer at the clinic and also in the hospital in Rivas for two weeks.  Both of the students were fluent in Spanish and for the first time, I obtained a precise history from each mother.  The students translated for me and in return I served as a pediatric professor as well as a clinician.

   I designed a history and examination form, a two-page checklist, and I used this for the first time. The form definitely improved the data record and saved time. I used Google Translate only to document the diagnoses and the treatment recommendations.  The checklist and the Google Translate document, together with a growth chart, were stapled together at the end of the assessment and will become part of the permanent medical record for that child. 

   Karen assisted with record keeping, gave out toys, took photos, and arranged play activities for the children who patiently waited their turn. 

   The first patient of the day was the sickest. A 6 year-old boy presented with a two-day history of high fever. A week prior, he had a runny nose and cough without fever and someone had treated him with six days of amoxicillin. The day after he finished the antibiotic he developed the high fever. Today was the second day of fever and in the clinic his temperature was 39 degrees. He looked a bit toxic. He had very very red throat and he only coughed once but there was mild inspiratory stridor.  He had a small lymph node in the neck. The trachea did not feel tender.  His air entry was normal.  His exam was otherwise normal. I worried that this might be the start of a bacterial tracheitis or even epiglottitis. I do not think these children are immunized for H flu.  I had clavulinic acid available and I treated him with this antibiotic and with acetomenophen for fever. I made sure Mom knew to bring him back the next day if he was not improved and for Mom to take him straight to the hospital in Rivas, about 30 km away, if he developed difficult breathing or drooling. I will inquire about the boy today.