The First Day.....

Wow the first day was a little trial by fire. I think Steve and I are both a little overwhelmed at this point. I know the Lord is looking out for us and will continue to give us wisdom and strength. We saw some clinic patients today including what I think was chickenpox with the worst case of impetigo I have ever seen. (that's a secondary bacterial infection from scratching....for those non-medical people) I saw plenty of people with generalized body pain and many with fever, headache, diarrhea, etc. The two most common infectious diagnoses here are malaria and typhoid fever. It is crazy to think we are now in charge of trying to diagnose these people. However, we have some other doctor friends here who are available to ask questions and get second opinions....and have no fear I exercised that today.
The hospital is limited in their formulary (which makes things easier in a way) and in their lab capabilities. We cannot check any electrolytes, BUN/Cr or any type of cultures. We can get a CBC, a blood smear for malaria, U/A, fingerstick blood sugars, AFB sputum (for TB), CXR and ultrasound. That is pretty much it. So diagnosis goes alot by physical exam and history. Getting the patient's story seems to be something that takes a lot of skill and a good helping of patience.
On last thing before I go to bed....We were rounding this evening on the inpatient service with Dr. Jim Adams (another short term volunteer from Canada) and they asked me to come and see a patient who was actively coughing up blood. He was breathing probably 40 times a minute, heart rate in the 120's, was sweating so much the bed was soaked and was coughing up a lot of bright red blood. His hemoglobin was 5.5 and his WBC was 24. I have no idea what his temp was but I know it was off the chart. He was very thin and was probably in his 30's. He said he had been coughing for about 6 months and that he started coughing up blood last night. He had already been started on penicillin by the medical officers who admitted him. I gave him a 2 liter NS bolus and 2 units of blood and started septra instead of the penicillin because Dr. Adams and I thought he most likely has HIV, which we also tested for. He did not look very good at all as you can tell from the description. I pray that he is still alive tomorrow...there really is a distinct possibility that he may not be. I will try to let you know. It was so crazy I didn't even catch his name. They will take care of him tonight and we will round tomorrow morning and I do pray I see him there.
I love you all and I will talk to you again soon hopefully.
Jeremy