A great day with a great Pediatrician

So, I know that writing 2x at once and then not writing again for a while (my habit with this blog) isn’t the best way to keep an audience, but we have sporadic internet access so I got to get them in, when I can…and after today’s work in the clinic, I really wanted to share with you a really exciting day I had.

A little background on the clinic I am at first: I have been working at La Fuente Health Clinic in Cusco for the past 2 weeks. It was a clinic started 10+ years ago by the Mennonite Church. The doctors we connected with via Dr. Mayes (my favorite/best professor from UR) are Mennonites and have been working at the clinic for the past 6 years. About 2 years ago, a team of 5 families came to Cusco to join in the work here at the clinic. 1 ophthalmologist, 1 pediatrician, 1 dentist, 1 pharmacist, 1 Nurse Practioner, 2 physical therapists and 1 physician assistant. They all went to the same Presbyterian church in Augusta, Georgia and all signed up to be a missions team together. Combined they have 15 kids under 10 yrs old, and their connection back in Augusta had been with a ministry called “Medical Campus Outreach”, where doctors/dentists reach out to med students. They came to Cusco with the goal of replicating this ministry with medical and dental students here in Cusco.

Ok….back to my awesome day…today was the first day I got to work with Dr. Nathan Wilson, the pediatrician from the Georgia team. I’d met him a lot of times, but working with him was one of the more inspiring days I’ve had in med school. I was equally challenged today to strive to excel academically in the practice of medicine as much as I was challenged to really love my patients and their families like God does. It is rare that these seemingly different (by no means opposite) roles of a doctor are so well exemplified in one person. I will try to elaborate on this…

-Today we saw a little boy named Saul, Saul is 4.5 yrs old, but is the height/weight of a 2 yr old, most of his specific health issues are related to the fact that he has Down’s Syndrome. Saul and his mom live in the one of the towns we visited with PROSIM (8 hrs away), they were able to get a free ride back with us on Sunday so that he could be seen by a doctor, and they came all the way to Cusco for a “check-up”. It was his first actual doctors visit in his life (despite the fact that he has a major medical condition!) We did a very thorough exam, as children with Downs are prone to tons of other health problems (congenital heart defects, thyroid issues, intestinal issues, failure to thrive, leukemia, early-onset Alzheimers)…but what Dr. Nathan spent even more time doing was encouraging Saul’s Mom. He shared with her a story from John 9, when Jesus is asked, “Who sinned, this man or his parents, that he was born blind?” and Jesus replies “neither..this happened so that the work of God might be displayed in his life”. Dr. Nathan told me that he spends a great deal of time talking to all parents with kids with severe disabilities because they need to know that the world promotes a lie, the lie is that their child is worthless. Instead, he tells them that their child, and whatever problem their child has (cerebral palsy, MR, downs, etc) is also a gift from God, and that their child and the way they care for that child is an opportunity to bring glory to God. I think here the idea that the parents must have done something wrong, and now they are punished with a child with Downs is very pervasive and this encouraging message can be life-changing for these families.

-Before we even saw Saul, I saw a 18 yr boy with the complaint of “abdominal pain”. Gastritis is extremely common here in Cusco and we diagnose 2-3 people with it every single day. I took the boys history (I worked up to 3 patient visits in Spanish today!) and came back to Dr. Nathan to present the patient to him. Over the past 2 years of medical school, the number 1 thing I've been graded for has been my ability to “present a patient”, no one expects the med student to know exactly what is wrong or to know exactly what meds/tests the person needs…but they do expect the med student to “present the patient well” so that the objective information is clearly communicated. When I went to present this boy with abdominal pain to Dr. Nathan I totally botched the entire thing. I was rushing, I was skipping around the presentation telling him random things “out of order”, and basically failing to follow the standard format of presenting a patient. Over the past 1.5 wks as I’ve been working with the other doctors here, no one has commented on my “sloppy presentations”, in fact, as Dr. Nathan later stated, “I've probably stooped to the level of organization/professionalism that has been expected of me”, but he said that he expects much more from me and will not accept a disorganized presentation. At first I felt embarrassed and dumb…(I know what to do, I know the right way to present), yet I was talking to him like a 2^nd yr student who doesn’t know any better! And in 2 months I am going to be a “doctor”! How could I be presenting so haphazardly? My gut reaction was to tell him I am good at presenting, I know what to do, but instead I resolved to do better next time, to prove to him (and myself, more) that I am capable to “talking/presenting” like a doctor. My next few patients were a bit better, but overall it was a very humbling “failure” and a good reminder to do my best even if I am only being asked to do “good enough”.

Finally, Dr. Nathan shared with me two “pearls of pediatrics”

1) “Continuity is a powerful tool”. He contrasted primary care with the emergency room, and reminded me that we can see the patient the next day if we are worried about sending them home. We can try something, and if it doesn’t get better, try something else in 2 weeks. We have the benefit of not having to waste money, or order extra tests, with the fear we’ll never see the patient again.

2) “Always listen to the parents”. He said that when a parents tells you there is really something wrong with their child, you need to believe them. They know that child a ton better than you do. He said almost every story he knows of a pediatrician being sued or a child dying unexpectedly/suddenly starts with the parent saying something is seriously wrong and an arrogant doctor saying everything’s fine. Not that it isn’t commonplace to calm worried parents by explaining the relatively benign nature of a viral infection…but that you should still trust a parents judgment when they are seriously concerned

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Now for 5 "old" pictures that should have been in the previous post about PROSIM, but these are more "health related" pictures so I split them up and put them here

This is what the nurse drives to work...about a 1 hr trip on a dirt road...hardcore!

This is the clinic/ health post in the small village...and in the picture is the ROCKSTAR public health nurse, Huana

I found this picture to be terrifying/awesome...its a vaccine schedule, but then they show these horrific pictures of kids with the diseases that could be prevented: measles, mumps, rubella, TB, diptheria, tetanus, etc...a bit gory for most moms, but maybe it works?

I just really liked this sign instructing women to eat 3 meals a day while pregnant. Isn't 3 meals standard always?

This is the view from the clinic, not a bad view from "work"