THE PATIENTS

Little girl with snake bite being taken from Rumi Tumi to

Clinica Santa Clotilde

By Dr. Baldoceda:

You see everything here! My bread and butter: diabetes, hypertension, arthritis, chronic kidney disease...it's all here, but there are few of those patients. The most common things they see here are Malaria (both Vivax and Falciparum), infectious diseases...all kinds of GI parasites, TB, upper respiratory infections, and chronic malnutrition. Everyone that comes in to the center complaining of a fever gets tested for Malaria...it's basically a vital sign. There are some patients that have been treated for Malaria 19 or 20 times. We have diagnosed Dengue Fever, although this is much more commom in Iquitos than the Napo. Needless to say, I'm pretty much soaked in bug repellent.

It's been an interesting week in the hospital...
We had two infants with 2nd degree burns. One walked right into the flame that her his mom used to cook and the other was a hot water scald... it was awful. It was her whole face and part of her back. They both got antibiotics, IV fluids, and dressing changes and are both now home. The team asked me, how we managed serious burns...ha, um...I'm don't...thank god for ERs and burn centers.

Then there is little Vlademir who is a 7 year old boy who came in with osteomyelitis of his L elbow and R leg. There is no imaging technology here, so it's pretty much a clinical diagnosis. The day I arrived they had peformed an osteotomy under sedation w/Atropine and Ketamine. Ketamine is their anesthetic of choice here...it's the only anesthetic used. 2 days later, Padre Jack went back in to extend the incision a bit for better drainage and I saw the opening into the bone. I've never seen this procedure before, probably b/c we don't see a ton of osteomyelitis in the US that gets to this point, apparently pus oozed out of this kids bone. Anyway, he's doing great...fever free for the last 3 days and now he's with us for the next 4 weeks for IV antibiotics.

Lastly, I'll mention Ms. Luz...a little girl who has Pertussis, otherwise known as whooping cough. She's got the classic whoop at the end of these awful coughing fits. It's impressive to see the classic presentation of a disease, but at the same time it sucks b/c although she's on the right antibiotic it just takes time to get through the worst of it and even though her whole family should get prophylaxis they won't b/c there is no way to prove it's pertussis and the insurance won't pay for the medicines without proof. Sounds familiar...

January 10, 2009 Santa Clotilde