Jailolo - Day 3

Day 3 – We stayed on site at the hospital for the second day of clinical. Unfortunately it was hotter at this site and there was absolutely no air circulation in our exam rooms. Also, some of the local workers smoke in some of the rooms (in the hospital). There was a long line of people waiting early in the morning. One of my early cases was a woman who came in stating she was diabetic, had run out of medication two weeks ago, and wasn’t feeling well the past few days (and she didn’t look well either). Luckily we had a glucometer so we checked her blood glucose (fasting since she hadn’t eaten since the previous evening). The result was above 500, beyond the detection level of the machine and was the same when repeated. For those non-med folks, normal would be less than 100! I wanted her to get insulin, fluids, etc. but we only had glyburide in our formulary (again, our formulary was what the government here would allow us to get from them) so I asked if there was a possibility of admitting her to the hospital and them giving her insulin. Well, they didn’t have insulin either and if they did, she would have had to buy it. I was feeling pressure to see more patients but I couldn’t just give her some tablets and send her on her way so I had her take two tablets and had her sit outside and told her to drink plenty of water and that we would recheck her blood sugar in an hour. After an hours of seeing other patients we rechecked it and it was still in the high 400s. I asked to remain for another check in an hour and then went back to more patients. The local “ER” doc came over for another reason and I thought maybe he could take her and have her observed for awhile and check her blood sugar. After explaining the situation I showed him the patient and he smiled and said”Oh, that’s one of my patients.” He then waved at her then promptly left, not to be seen again. I was dumbfounded but now think it was probably a matter of him not really understanding what I was saying. Like many cultures, people say yes they understand when they really do not. So I kept her there until her blood sugar was in the low 300s then sent her off with meds and a promise to get more before running out and to never run out. Then I crossed my fingers. Next was the patient with partial paralysis from a recent stroke who had run out of blood pressure meds. So I checked the BP and it was 215/110, another stroke waiting to happen. I gave him a combo of BP meds and had him promise to take it now then also to never miss a dose or run out of meds (again I crossed my fingers). Another woman with apparent metastatic breast cancer. Not as dramatic as yesterday but just another sad situation. Then a man covered in dirt came in emanating a rather foul smell. He lifted his foot to show me a gaping, smelly hole that went to the bone (this wasn’t apparent until after it was cleaned). He said he had the wound for 20 years but that it got worse lately. Not sure how that could be but anyway I had him with high doses of oral antibiotics, topical antibiotics, and a good cleaning with a dressing by the wonderful med techs. They showed him how to do it himself but again, crossed my fingers. Of course, most cases were not like these four. Again, many vague complaints. However, this is actually fine as major goal of our mission is to build relationships and establish goodwill in this country so despite the limited ability medically, this latter mission was achievable.