Day 2 of the CMA and Happy Halloween!

"One of the first duties of the physician is to educate the masses not to take medicine."

-Sir William Osler, Aphorisms from his Bedside Teachings (1961) p. 105British (Canadian-born) physician (1849 - 1919)

If yesterday was like drinking water from a fire hose then today was like drinking water from a fire hose that was connected to the Hoover Dam. I think everyone we saw yesterday told all of their family and friends to come today to be seen. It was like nothing I had ever seen. Around noon, after a very tiresome morning, I turned to the interpreter and asked how many more patients needed to be seen. The interpreter replied causally, "About 500." I smiled and shook my head. The people that we were seeing were the poorest of the poor. It did not matter if they were sick or not, they were going to be seen by a doctor because this was their one and only chance.

I actually treated some sick people today. One child was having a respiratory illness along with an asthma attack so we treated her with an inhaler, antibiotics, and prednisone. Another child had an abscess that needed to be lanced and drained. An older lady came in crying saying that she was very weak because she had not eaten for 5 days. I gave her IV fluids and one of our MREs. I saw more cases of Leishmaniasis. This one girl had it over a large portion of her cheek. I provided her with a referral to be seen at a specialty Leishmaniasis clinic. Usually if you give them a U.S. referral slip they are able to be seen because if they don't then we will stop donating supplies to the hospital.

I am going to reiterate the challenge of examining someone in a burka again. A very common complaint among middle aged women was pain- back pain, leg pain, neck pain. Initially, I would respectfully ask if I could interview them with the burka over their head. They would occasionally decline or act very uncomfortable at which point I would insist that they keep it on (they are always fully clothed underneath). I then would ask if I could examine the area that hurt. They would of course decline. So I literally had no idea what they looked like and, more importantly, what their area of pain looked like. Also, most people did not know their age either so I did not even know how old they were. For the most part, I gave them Motrin then recommended that they be seen at a local clinic for further care. What else could I do?

It was heart breaking examining some of the children. The huts that that they live in do not even have running water and they rarely bathe. I can recall this one child that was having leg pain. When I examined the leg he was bare feet and his legs were caked in dirt. It was very sad. I started to see a number of the children with similar problems- back and leg pain. I asked the interpreter, "Are these children pulling my leg? Why do they all have the same problem." He said, "Yes, they all just want some medicine."

A mother brought in her 7 year-old child who she said wet his bed every night. I asked if he had stomach pains, fever, pain with urination, etc. I did an exam and it was normal. I then proceeded to counsel her on limiting fluid intake and along with other conservative treatment measures. After I was done her story changed, the boy was having fever, pain with urination, and abdominal pain. Again, I just smiled and shook my head. I did not have any labs to help me out. I treated him as if he had a urinary tract infection and then I referred them to a local clinic for follow-up care.

Another problem I had was I wanted to hand out out a bunch of the toys and candy that was donated from people back home. It was very tricky because there were literally thousands of people waiting in line so, for one thing, I did not have enough for everyone and, second, if I were to start handing them out it would have created a riot. I waited until the very end right before we left to hand them out. It still created a mini riot but it quickly abated after all of the children with toys ran away. I learned a lesson that day, I will only give away donations to much smaller groups next time.

I almost forgot that it was Halloween. There is a comedian performing in the gym. It has been a long 2 days and I am feeling under the weather so I am going to go to bed early.

Happy Halloween and thanks for reading.