Tuesday, November 29, 2011

Using Data to Plan Trip Four

During past trips I kept an electronic copy of the written summary of patient visits. I typed out a short summary with the name, age, gender, symptoms, physical exam, assessment, and recommendations.  I used Google Translate to convert the text to Spanish, and the printed version was placed in the clinic chart and a copy was given to the mother. Until I got into the routine I did not save every patient, and when the clinic was hectic, I forgot to save some patients, but I managed to save all but one or two a day, so my records are pretty good.  

I reconverted the files one by one to English, and then made a spreadsheet of age, presenting complaints, diagnoses, and medications prescribed.  

The children ranged from 1 month to 11 years of age and I saw 12 to 24 children a day.

The graph below shows the most common diagnoses and the percent of patients with these diagnoses. 

I expect to see about a hundred patients during the next trip and based on this data I can predict how many of each diagnoses I will likely see and I will bring enough medications in each class to cover the common problems without dipping into the clinic pharmacy stores.  As well, I will bring my preferred medication for each problem, which obviates the need to choose a second or third line medication from the clinic stores.  

The most common prescribed medication was an anti-pyretic followed by an antibiotic.  

I'm sure that I did not diagnose all the cases of scabies, ringworm, and tinea versicolor. Many children had these skin infestations but the mother often didn't point the rash out as a problem. As well, the clinic did not have supplies of medications for these skin infestations. With the next visit I will bring enough medications to treat these problems.  

I am also sure that I did not diagnose all the cases of abdominal parasites.  A case might be made that any child who drinks well water, that is to say probably every child, likely has an abdominal parasite.  Perhaps I should bring enough to treat every child.  But, if they continue to drink the well water, the parasites will return.  

Over the next month I will prepare a teaching handout in Spanish for the common problems such as fever, cold, ear infection, rehydration with gastro, nutrition, abdominal parasites, scabies, ringworm, tinea, and impetigo. Having the handouts will save me time when I see children with these problems.  

Friday, November 25, 2011

Planning the Fourth Trip in 14 Months

Orange-fronted Parakeets
During the last week of December I will fly to Nicaragua for my fourth visit in fourteen months.   

Illness doesn't take a holiday, and my presence, I hope, will allow clinic staff in Limon to spend more family time during the Christmas festivities. All good.  

Daniel Ortega, the president of Nicaragua, recently re-elected for another five year term, stated that he expected to continue to govern on a path that is "Christian, Socialist, and in Solidarity."  The church figures prominently in his government and in the country generally.  Christmas is an important religious holiday in Nicaragua. The predominantly Catholic population celebrates the birth of Jesus with festivals, pageants, and traditional church activities.  

My goals for this trip are to provide Spanish teaching sheets for the common problems that I will see, to bring along the majority of the medications that I expect to personally use, and to establish a long term relationship with an interpreter. 

On prior visits I kept a computer file on almost all of the children that I assessed.  I prepared the files as a permanent record for the clinic chart and the recommendations portion was given to the mother as a written reminder of the instructions.  I am tabulating these records and in due course I should be able to estimate the medication needs.  

I am hopeful that some of my Calgary colleagues will again donate medical supplies for me to take to Nicaragua, and I will purchase the deficiencies between my estimate and the donations. 

The records will also serve to identify the basic problems for which Spanish teaching sheets need to be prepared.  

Finding an excellent translator is an important project.  I will pay the translator very well by Nicaraguan standards but a modest amount by ours.  An excellent physician translator relationship can make a huge difference with quality of care.  

I expect to post a blog every week or so until I leave and then daily while in Nicaragua so that the friends of Help Nicaragua Children can keep in touch.