10 September 2009

Hello! A lot of time has passed since our last entry! We will do our best to explain what we are doing now, and also want to let all of our readers know that we miss you!

As you know, there was a coup in Honduras, and the country was put on the US State Department´s Travel Alert until October 20th. The University of Rochester does not fund students to go to countries on the list, and so we made other plans in the meantime. Thanks to another classmate, Jenny, we were able to apply for a position to volunteer in the community of Estancia in the Department of Morazan in El Salvador with the organization Doctors for Global Health (http://www.dghonline.org/). We were accepted by the organization to volunteer pending a commitment until the end of the December, and we accepted the position.

Bela traveled to the capitol city, San Salvador, for language school, and I met him in the capitol later. We traveled together to the community, and have been working and living here for a month. We are working under the direction of an amazing health promoter, Etelvina Umana, seeing patients alongside her and accompanying patients to specialist appointments and to the hospital. Additionally, we have been able to participate in home visits to members of the community who are too sick to walk to the clinic. It has been an intimidating and gratifying experience. It is a hard transition to go from being a medical student with lots of direction to being in charge of making decisions (albeit with a lot of support and guidance from Etelvina, doctors who we can call within El Salvador, and doctors in the US. My dad has been a wonderful resource and is on call for me twenty four hours day if I have questions about a patient). I feel as though my history taking and physical skills are improving rapidly. Furthermore, it is so wonderful to be living in the same community in which we work, as it is an opportunity to get to know the families of the patients that we see.

The clinic where we are working—Clinica CAIPES

---Calla

I am writing an addendum to Calla´s introduction. In an attempt to better illustrate our work here, I want to describe my experience with a single patient over the past two weeks. Jorge (not his real name) is a 22 year old resident of Naranjera, a part of Estancia that is a 50 minute walk from the clinic. He came to the clinic on August 27 with a chief complaint of a swollen finger. His finger was swollen to three times its normal size and was draining pus from its distal aspect. Calla and I saw him and decided that he needed to get to a hospital.
Jorge and I immediately departed for the hospital, while Calla called a surgeon and alerted him to our impending arrival. The trip to the hospital begins with a 40 minute walk, mostly uphill, to the main road. We then waited for the noon bus to pass. It was only thirty minutes late. We then took our first 20 minute bus ride to Cacaopera, then caught a second bus for another 20 minute ride to San Fransisco Gotera, the closest city and the location of the nearest hospital. Two and a half hours after our departure, we had arrived.
The general surgeon met us and saw us as soon as possible. He adeptly anesthetised Jorge´s finger and subsequently debrided and cleansed the wound. Jorge then received a radiograph of his finger, which looked suspicious for osteomyelitis. The surgeon sent us home with orders to wash his finger every day, take antibiotics and return in two weeks.
These instructions were not easy to follow because it meant 80 minutes of walking every day for Jorge to gets his finger washed in a somewhat sterile environment. Very much to his credit, he has done whatever has been asked of him and has come every day. Three days after our initial hospital visit, Jorge´s finger failed to improve. I was becoming more and more distressed by this lack of improvement. Fortunately, Calla´s father is an expert in infectious disease medicine and has bent over backwards to help us. I discussed Jorge´s case with him. He recommended changing the antibiotic. We followed his advice, and Jorge´s finger has continued to improve ever since.
Every day for 13 days Jorge has made the trip to the clinic. He and I wash his finger and pack his wound with sterile gauze. Tomorrow, we will make our return visit to the surgeon in Gotera. I believe he will be pleased with the progress, and we will continue our current course. While I had initially been worried that Jorge might loose part of his finger to infection, I am now confident that this will not happen.
I believe my experience with Jorge demonstrates our project here at the clinica CAIPES. Through consultation with doctors, both locally and in the United States, medical students are helping administer decent health care to patients in rural El Salvador, a place where there is no doctor. In addition, I am learning a tremendous amount regarding osteomyelitis and general wound care. I have also found a new friend in Jorge. I will be a better doctor because of my experience with Jorge.

--- Bela Denes