Coolness

Apologies times a million for my shameful lack of paintbrush skills. I do have an actual photo but can´t seem to get it to upload, I´ll edit it in later.

A 9 year old on the ward came in with a fractured femur. Lacking any equipment whatsoever, and the family lacking the money to buy splinting materials (in Peru patients are responsible for buying their own supplies if uninsured) the doctors quickly improvised a kick-butt traction splint using a two liter water bottle and some rope. Rendered (poorly) aqui:



So simple, just a loop around the ankle and the other end of the rope tied around the neck of the full water bottle. The water bottle was then hung over the footboard of the bed. Pretty awesome.

Signs in the ward: before and after

Yesterday: Please do not remove the sheets from the hospital.

Today:Please please return the sheets to the hospital.

another winning combination

One of my patients hospitalized for suspected hepatitis got his lab reports back this morning. He now has a new diagnosis of "multiparasitosis" (which should really just be imprinted in the charts, it´s that much of a given.)

His lucky draw?
-Ascaris
-Giardiasis
-Whipworm
-Amoebiasis
-Hookworm

I´m amazed the worms haven´t staged a massive death battle yet; instead they seem to be peacefully coexisting if not actually plotting together to take over this poor kid´s every organ system.

On a personal note, my own roundworm infection is going awesome. I´ve decided to imagine the worms as silent squiggly protecters of my digestive system. This has freed me to eat absolutely whatever I feel like. Street-corner ceviche? Sounds great!

Unwise? Perhaps. But it keeps things interesting.

uh oh?

This morning our hostess came into the kitchen wearing only a towel and filled a mug with sterilized water before heading in to shower. Catching our puzzled looks she explained that it is very very important to wash our lady parts (with a brief mime of how lady-part-washing should occur) with filtered or boiled water, and absolutely not, under any circumstances, with the shower water.

She offered no further explanation and cheerfully skipped off to the bathroom, vagina mug in tow.

So now we´re all wondering exactly what noony-invading parasites lurk in the shower water. And also, if this was so so important, why why why would she wait four weeks to share this it us? And does she use the yellow coffee mug every time?

It all just gets stranger and stranger. Well, I suppose I´m off to wikipedia water-borne loo-loo destroying parasites. . .

babel

Working on a survey of biosafety practices among Peruvian health care workers, I decided to ask google translate for some help. The first question: "have you ever had blood or bodily fluids splashed into your eye?"

Google of course translated this to "Do you always have the blood or body fluids splashing into your eyes?"

I'll be translating the rest by hand.

Typical breakfast conversation

Me: How´s your capuccino?
Roommate: (considering her questionably pasteurized beverage) Pretty good, you can hardly taste the brucellosis.

Not often seen in America

Results of a stool sample for a 2 year old boy with diarrhea:

Ascaris: +
Giardia: ++
Entaomeba: +

"Well, doctorita," that attending physican asked, "which do you feel like treating today?"

Now I get it/overseen in the ED x70

So I began my rotation down in the ED mid-last-week. Chatting with the physician one afternoon, I mentioned my interest in tropical medicine and infectious diseases. "Is there anything you're hoping to see while you're here?" he asked.

"Well, I've been here three weeks and I still haven't seen a case of Dengue yet."

The doctor laughed for what felt like 47 minutes, nearly fell out of his chair. Catching his breath, he glanced out the window at the non-stop drizzle (so apparently it rains a fair amount in the rainforest), glanced at his watch and said: "wait 40 seconds."

Sure enough in the next five days I would see literally over 200+ cases of Dengue. Luckily, few are hemorrhagic, and even those are much less dramatic than the textbooks and Discovery Health specials had led me to believe.

It's absolutely endless. I can spot them from a mile off now. The shuffle, the index finger and thumb squeezing the bridge of the nose, eyes covered with a towel or bandana. We do a brief workup: check the urine for blood, check hematocrit, listen the lungs, and take a blood smear for malaria. But most leave with just a painkiller and reassurance.

Many of the patients refuse a workup, simply marching into the triage area and announcing "I have Dengue again." We thank them for letting us know, tell them to take some tylenol, and off they go.

overseen in the ward: Peru

Yesterday a new (and long-awaited) sign was posted on the wall of the infectious disease/pulmonology wing stating: "No spitting on the walls. Thanks."

The sign did seem to have its intended effect.

Then this morning a new sign appeared. . .

"No spitting on the floors. Thanks."

overseen (smelled?) in the ward:Peru

Or. . . well, that´s one way to diagnose a vaginal infection.

Obstetrician sticks his (ungloved) fingers into a young woman´s vagina then holds his fingers in the air and dramatically yells for the "interno." The intern runs into the room, the fingers are thrust under his nose, he inhales deeply and announces "No, no infection." The OB smelled the fingers himself, seemed unsatisfied, and proceeded to obtain second opinions from everyone in the room, including me.

The conclusion was "no evidence of infection, evidence of poor hygiene."