Who is the patient the mother or the baby..oh both!

We are a mixed bag of physicians here, an Electophysiologist (cardiologist who specializes in abnormal heart rhythms), family Medicine practitioners, hospitalists, intensivists, some of us see children on a regular basis and others (like me) do not. However today we are all pediatricians, we all dug deep into the forgotten vault of baby knowledge. Today I remembered Weight-based formulas and standard rashes that I tucked away in a file in my brain titled “Save for the apocalypse”. Ahh yes THAT is tinea corporis..oh right that is what an infected ear looks like..the list goes on of forgotten disease entities being unlocked from what seems like another life. There’s a line I always say—which most people think is a joke—that children and pregnant women scare me. The response is usually “you’re an ICU doctor nothing scares you”, oh how untrue that is. But thankfully, and not surprisingly given the amount of support staff and thanks to the handy MSF clinical guidelines App, everything went fantastic today.

Less patients than the previous day meant the ability to really spend some time chatting. Learning of the trials and tribulations of arriving to this country, those who are lucky made it with the entire family intact. Not uncommonly are the patients I saw who did not make it to Bangladesh with their full families intact, or hearing about those who arrived as the sole survivor of their family. 

Some of the interesting observations today: The 70 year old woman who had not had a BM in over a week, who was urinating frequently and constantly thirsty, we checked her blood sugar and it was 564.  She had ketones in her urine (in the US that may provide cause to consider diabetic ketoacidosis (DKA)however here starvation alone can do that). She probably does have DKA with that sugar and those symptoms..we gave her some iv fluids and oral medications for diabetes knowing full well this would likely be much less effective than subcutaneous insulin. But, imagine how that would work..would she come to the clinic every day, walking an hour there and an hour back, to receive her medication? No hut has a refrigerator, there’s no way to properly store this medication at home. And in fact she is unable to ambulate and was carried home in a basket tied to a pole held at either end by two young men. 

Then there was the gentleman with the frequent urination and occasional blood in his urine. While certainly his age lends to a diagnosis of an enlarged prostrate I was worried about a kidney stone or even worse cancer in the bladder. While performing a CT scan is impossible I could at least perform an ultrasound of his abdomen, looking for a bladder mass or any obvious masses on the kidney. 

Indeed his prostate was enlarged, however I did not see any other abnormalities. While that doesn’t guarantee anything it is at least some added information. I was able to perform another ultrasound exam on a woman who was short of breath and had a little bit of fluid in her legs and could definitively diagnose her with heart failure. In another patient who had a severe fall I was able to rule out any bleeding in the abdomen saving her a long trek to a hospital that could provide further imaging.  I brought this handheld ultrasound with me and it has been a tremendously useful tool and I hope that over time funds will be available to provide similar tools here.