Redline Doc

Sep 24, 2010 - 4 minute read - AccessMedcineNY in Guatemala Medicine Sometimes it works

Xela and the clinic the 21st

Sorry for the long delay out there but there have  been some connection problems as well as difficulties uploading photos to FLICKR so that they won’t take up all the room in the world.  Tuesday was clinic day at Pop-Wuj in the city.  The line up for clinic is not unlike that at CHS.

As a clinician I tail around one of the local doctors, Dr. Christian.  He works Tuesday, Wednesday and Thursday’s at the clinic and does a small wound clinic on Tuesday and Friday mornings.  Although there are many out-clinics, helping in the pueblos, the clinic here is run regularly and the out clinics when there are volunteers or students to help with managing the ‘stuff’ of setting up a clinic away from a home base.

The most surprising and yet elemental thing for me is the similarity of the patients here and at home.  Our first wound care was an ulcer caused by a hot water burn. She has a fluid load and some swelling as well as some mild but growing venous stasis.  Wound care here is much the same, debridement, support.

Our next, came without her support hose.  ”I left them at home today”, she said. When challenged about wearing the stockings regularly – she doesn’t. They itch in the late day when the sun is up and out. I gave her a strategy to wear them only in the morning.  She laughs, the way my patients in the states do.  Dr. Christian and I exchange a knowing glance. She might.  She gives us both kisses and warm handshakes.  Its all the same.

More patients. There are a lot of musculoskeletal complaints here. People use their bodies as handcarts. From the women who cary 20-30kg loads on their heads to the men who carry 100kg sacks of dirt or stone or concrete on their backs using a headband, the difficulties are related to a harsh life here. None of that is evidenced in the clinic – they are all grateful to have care. No one pushes. No one shoves. There are children everywhere and most of them a bit bashful.  Being nearly 13 taller than most I look rather giant to most of them.

The line trickles in and in two rooms with some seen on the cuff, we see 63 patients in about 5 hours. The care? First rate given some of the limitations.  There is no EKG.  Blood pressure monitoring is done in a clinic where you can scarcely hear yourself let alone small variations in sound. Medicine is, for the most part donated and solves many of the problems.  There isn’t much polypharmacy here. Even older folks walk nearly everywhere.

We are trying to install FreeMED but the problems not forseen are overwhelming.  Although there are three pronged outlets in the clinic, none are really grounded.  Wiring to light fixtures appears as if done with bell wire. The WIFI unit in the school isn’t readily accessible (a minor problem). The clinic too needs some reorganization. A lot of donated stuff has been in boxes awaiting trained and eager hands to triage (yup triage) the medications. Overall it gets done.  Our primary server got mis directed in baggage and we’re waiting for it to be delivered. The secondary waits.

Jeff and I are staying at a Bed&Breakfast called Casa Manen, about a mile (all uphill) from the clinic. We’re getting used to the altitude, about 8500 ft here in Xela.

Tomorrow we go to an outlying clinic about 13 of the way to Guatemala City to deliver health care to a small pueblo. We’ll be mounting the entire team plus medical students who are here to learn Spanish at Pop-Wuj. There’s a lot of preparation and Jeff is going to look at the organization from a systems perspective to get better grounded to bring the records out side the clinic.