Working in the clinic

I am writing while at clinic, as the afternoons tend to be pretty slow. I spent the morning doing paps with Dolores. Here, we do the pap, then we do VIA as well. Every Wednesday is pap day.

This is a Centro de Salud, a clinic run by the government. The population we see is generally very poor, with a lot of Mayan patients. Yesterday we saw a 71yo woman with crushing chest pain- she also had cachexia, decreased breath sounds in one pulm lobe and crackles in another, and at times an irregular heartbeat, and possibly a productive cough for over 15 days. (Here, if anyone has a productive cough for more than 15 days, they get three sputum samples tested for TB.)

For her, we gave her atenolol (no aspirin or nitro in the pharmacy, only a very small tank of oxygen), and sent her to a nearby town to get an EKG and CXR done and then to come back.

She came back today with her EKG, which just showed bradycardia- the EKG costs about Q50 (about $7), and the CXR (one view because that is cheaper) would have cost Q125 (about $16). She did not get the x-ray done due to cost.

Here, the medicines that we prescribe (that the pharmacy has) are free; if the pharmacy does not have the medication, we write a prescription to be filled (and paid for) at another pharmacy.

After the paps, I worked with another nurse, and we diagnosed clinically hepatitis, Dengue, allergic reaction, and pneumonia. It is kind of nice to rely less on expensive tests, and more on clinical judgement.

There are several labs available here, in fact, but the person who works in the lab is on vacation (I think until November, unless something has been lost in translation!).