Clinica

So it was pointed out to me that by reading my blog, you may get the impression that all I’ve done in Ecuador is party and go on vacation trips. Be assured that I definitely have done those things and they are the most interesting things for me to write about, but I would also like to let everyone know what I’ve been doing in clinic. It’s not as eventful or as entertaining, but here it is….

So for the first week and a half I was taking Spanish classes with the intermediate class. We reviewed grammar and worked on our conversational skills. I would say my speaking skills have definitely increased and gotten better over these past couple of weeks. I’ve learned so much more medical Spanish and just vocabulary in general by listening to the doctors speak and working on it in Spanish classes. I still make lots of mistakes, but I’m definitely learning new things and I’m much more capable of holding a conversation with someone. I’ve finished with my classes by now, but I still practice the language daily and listen to the doctors in the hospital etc.

I’ve also learned a lot about Ecuadorian culture just by traveling around and living here. I’ve definitely talked about that but its interspersed among my other stories.

As far as my clinical rotations go…last week I was at a clinic for kids and maternal health. I was working with Dra. Paredes and for the most part I just observed her talking to the patients and examining the kids. Dra. Definitely did things the nurse would normally do in the states (height, weight, head circumference). I did a couple of the height and weights and listened to some lung and heart sounds but that was about it. I feel like I was unable to demonstrate my knowledge base and skills with the language barrier. I’m not really sure what the nurses did in that clinic other than bring pt. charts into the doctor’s office. For the most part there were lots of kids with colds, UTIs, or the flu. Other kids/infants came in for well child checks. I noticed a trend of Ecuatorian babies generally being within the norm for height and weight, but in the lower percentages of that norm. Dra was always like “I would like it to be higher.” Another thing you notice in Ecuador is the number of young mothers. It’s not uncommon to see a 15 or 16 year old with a kid. In fact, they have a special ward at the maternity hospital dedicated to adolescent mothers. Anyway, Dra.did a lot of pt. education on proper nutrition and development for the parents.

Getting to listen to the medical Spanish was great, but from a medical standpoint it was kind of boring for me, especially because I mostly just observed.

This week I’m at the Hospital Militar. It’s for those in the military and rich people. It’s also a big teaching hospital. There were tons of interns and residents going with us during patient rounds. I know I talked about these things a little but I want to say more.

Today was a good day, but I want to tell you about one case in particular. I’m not sure if this is a doctor vs. nurse thing, or an Ecuador vs U.S. thing… Anyway, we went down to the ICU to see a pt. that they had operated on over the weekend. She was old, morbidly obese and has problems with her colon. The surgery involved taking out part of the colon and creating an ostomy. When I saw her, she was on a ventilator, unconscious, with monitors, drains, a catheter, a fem line and pretty much naked. I’m not sure if we came during the middle of her bath, but she was just laying their naked and the nurses were cleaning her. The doctors gathered around to just talk about the patient while she was just in front of them naked. It’s not even about an aversion to nakedness, its much more about keeping the dignity of the patient. Even though she was unconscious, I feel as though they should have had the parts of her covered up that were not being washed. I mean I wouldn’t like it if I was having my bath and a group of doctors comes in to just stare at me and talk about me in front of me.

The second thing that happened when we were down there was the nurses went to change her diaper and found a lot of blood that soaked through the diaper and through the sheets. They were saying that they though it was a thrombosis from necrosis of the part of the colon going to the rectum which was detached from the rest using the ostomy. They also discovered digestive liquid in the Jackson-Pratt drain. They though it was due to a possible fistula leaking out into the peritoneum. The patient also had systemic inflammatory response syndrome. I’m not sure exactly but I believe that was what resulted in her needing the ventilator. We talked with the Dr. about her case later and this is what he explained to us. He said they would used a blue liquid to see if the fistula had indeed broken and that is what resulted in the digestive juices in the drain. If that was the case, she would begin receiving TPN.  This is what I ascertained from trying to translate everything.

In general, I can get the gist of things in a Spanish conversation, but its much easier for me to understand things when I am in the conversation and I can ask for clarification rather that trying to figure out what topic someone is talking about.

The second interesting case was a man who had appendicitis, had surgery and developed complications. They thought he had internal bleeding because his BP dropped to 90/70 and he looked pale combined with the lower ab pain he had.  Another thing about the doctors here, they don’t seem to really care about patients being in pain. This one doctor was examining his abdomen and he kept pushing on the areas that hurt and asking him 2 or 3 times if it hurt. I feel like he could have done it in a way that wasn’t so painful to the patient. He also didn’t even apologize or really tell him what he was going to do before he did. The bedside manner here just kind of sucks; there were three patients I saw that happen to.

The doctor we shadow is a great teacher though. I got to hear him lecture his students and grill them about things. He’s pretty enthusiastic. In conclusion for today, I have one more day at hospital military, so I will tell you how it goes later.

I’m starting to miss Home.