Working With the Local Physician

Lumber delivery from local "Home Depot,"
that "drove" by the clinic. 

At the last visit I identified four children who I requested be seen by the local physician, Dr. Mariana Jarquin. Dr. Jarquin works at the MINSA clinic in El Coyol, about 20 minutes away. As of next week, she will be the designated physician for the Gigante Community Health Centre.

Today Dr. Mariana and I followed up on those four children and also several others who she identified in the interim to be assessed by me. Patient follow-up was better than I expected, and better than might have happened in Canada!!

During the last visit I saw an infant, who on routine exam had an inguinal hernia. I asked Dr. Mariana to direct the family to an appropriate surgeon, and this morning I learned that the child has already had the repair! Wow! The waiting list for a routine hernia repair in Calgary would have been much longer. Just to see the surgeon would likely have taken longer.

Also on the last visit, I saw a child with a complex cyanotic congenital heart problem. The problem was diagnosed by echocardiography in Managua. Sophisticated surgery is necessary for correction. The mother had missed an appointment to discuss whether the surgery could be done locally and she had no money to travel to Managua for reassessment. The frequent hypoxic cyanotic squatting spells the Mom described were a serious concern. I supported her travel costs and asked Dr. Mariana to help direct the mother to the appropriate place. This morning I was pleased to learn that the child was seen and will have the correction within a few months when an American Paediatric Heart Surgery Brigade arrives in Managua! I hope all goes well for her. 

Dr. Mariana asked me to assess several other children. One toddler had bilateral pneumonia and asthma and we sorted out the anti-inflammatory and bronchodilator medications for the child. Another had an abnormal urinalysis and the history and exam suggested vulvitis, which was treated with instructions on genital cleansing and an antibiotic to cover the usual organisms.

Good outcomes can happen when health care providers care enough to communicate and cooperate.