Me Mato

2/17/09

Well the substitute doctor finally made it last night. He brought along with him a patient with pre-eclampsia. When I arrived in the morning I went to see if there were patients to round on and he was trying to convince her to be transferred to the bigger hospital in Otuzco for further care and likely a C-section. The patient was a young girl in her late teens whose bag of water broke yesterday (over 24 hours ago) …they were going to induce her in her village, but when the midwife checked her blood pressure she noted that it was in the 150’s. So she recommended she be transferred and apparently it took them hours to convince them to even come down to Julcan. So then when they got here and she continued to have high blood pressures and protein in her urine…they could not convince her to go to Otuzco. When I got there the patient and her parents said well if she dies that is God’s will…they both felt they knew better and that they would rather take her home than transfer her to Otuzco. So why not just keep her in Julcan? Well, one there is no C-section ability in Julcan and not much emergency equipment and secondly no one really wanted to take responsibility if something went wrong. The family refused to sign any kind of form that said they would release the center of any responsibility since they weren’t following medical advice and b/c they wouldn’t sign the doctors didn’t want to try and doing anything that could potentially help, but has it’s risks. I recommended she be put on continuous magnesium sulfate and be induced with oxytocin, but no one wanted to take the risk…so we prayed and tried to find their pastor. Somehow about 4 hours later after almost everyone in the health center talked to them they decided to go to Otuzco with one of the midwives. But she went w/o any Mag….definitely some stuff to go over here. And definitely an area to target in outreach is churches…ridiculous what we heard today.

The other patient on rounds was a 17 week pregnant patient that was admitted two days ago with pyelonephritis. She was clinically doing well…no pain, no fever, eating well, but as we reviewed her chart we noticed she’d had 4 UTIS during this pregnancy already. Anyway, so we decided to keep her for one more day of IV antibiotics and then she’ll go home one oral antibiotics. Per our guidelines this patient should be on antibiotic prophylaxis for the rest of her pregnancy. The doc says that it’s not covered by the insurance and most patients can’t afford it so she’s essentially out of luck and at risk for more UTIs.

I spent the rest of my morning with the nutritionist trying to bone up on that…I think I’m starting to get a better idea and hopefully by Thursday we can be out seeing patients.

So the rest of the day proved to be an adventure…after lunch I went back and did some reading and had fun talking to a little girl named Ana, who said she’d like to be a Pediatrician one day. Then I was lucky enough to have the pleasure of sowing up a 3 year olds gaping forehead. He was hit lightly by a motorcycle and came in with a pretty big gash on his forehead…so fun to stitch him up while he screamed “me mato” (literally I am killing myself) over and over. Anyway, at least I got to use my doctor skills.

Then I sat in a 3.5 hour staff meeting. I will never complain about another PCC meeting…I mean this was so long and at such an awful time, 5pm – 8:30pm. I’ll have to say that since the head honcho was there they talked about every single thing under the sun and they’ve got a lot of management issues…it was painful, but interesting. I really think they could use a fulltime management person, that is at the center all the time just to deal with all the management issues so the staff can really focus on taking care of patients. Anyway, tomorrow is a big community meeting…so should be interesting.