Back in Bocas!

Natasha and me at Red Frog Beach

Day 7/April 3: After a great day off (we took the Panga to Red Frog Beach!) we were back to working hard today! The day started with our routine trip to Asilo, the nursing home-type establishment in Bocas town. We took the boat over from the marina around 10 o'clock and started with Rafael, our patient with the very bad pressure sores. Before we left last weekend, we taught one of the nurses how to care for and change his wound dressings. We even wrote out instructions and numbered the dressings in order of how to use them. After all that and making sure she understood, we  came back to find she had done nothing. The wounds were very bad yesterday, and he even had a fever. I learned in tropical medicine that they often use honey to debride and disinfect wounds, and this is what we did (no fancy Apligraf or muscle flap reconstructions out here!) Last week I had emailed my surgery preceptor, Dr. Halbreich to ask him for tips on caring for this mans wounds. He sent me instructions on how to make something called Dakin's solution, which is water, Clorox bleach and baking soda. This morning I cooked up some Dakin's solution and we tried it on the wounds today.  He looked better today, and he actually spoke to us for the first time (before I was unsure of his mental status) We will go back tomorrow and I am crossing my fingers that the wounds look a little better, even though no matter what they have a long way to go.

Bernardo from Asilo and me at the park

After the wound care, we took all the Asilo residents on our usual walk to the park where we bought them juice and cookies. It was very hot today, but there weren't many bugs! I pushed Venturio, at 82 year old man who used to live in Changuinola Panama where he worked on the banana plantation. He said he doesn't have kids or a wife, so I assume that is why he resides in Asilo.
After our walk with the Asilo residents, we went to start clinic, which we hold on Tuesdays and Thursdays from 3-6 in our warehouse. The most amazing thing about today's clinic is that I didn't have to speak any Spanish! My first patient was a 27 year old woman from Finland who was having terrible back pain. She had been to the hospital in Bocas, but because her Spanish isn't very good, she didn't understand what they told her. I checked out the X-rays she bought with her, which were essentially normal, and then performed an exam. To Hanily and me, it seemed like sciatic pain. Because my grandpa has recently had a lot of trouble with nerve pain, I remembered that a good drug is Neurontin. We prescribed that along with Tramadol and Tylenol.

Med/supplies shelves at la clinica (the warehouse)

My next patient was a 6 year old boy who, after a very long exam turned out to likely have mono. The frustrating part about practicing medicine down here is that we don't have a laboratory at our fingertips. In the states we are so dependent on blood tests because it makes our lives so much easier! Here in Bocas, even if went to the hospital he wouldn't be able to get mono titers, because apparently their lab here doesn't have the resources. Normally we would check for EBV and CMV antibodies, but we were forced today to make a clinical diagnosis and ask the mother to return if symptoms changed or got worse (we also had to ban the poor kid from surfing since his spleen was palpable.)
My last patient of the day was a 30 year old woman from Fort Lauderdale eo lives permanently in Panama. She had an abscess in her right axilla, which I got to drain (yay!) and I will see her back tomorrow to change the dressing and re-pack it.
After clinic we went to have dinner at Sky's new house! She has been living on the boat with random volunteers for the past three years, and finally decided since they are going to be in Bocas for a while, to rent a house. Halfway through cooking dinner the power went out in the whole town so we ate by candlelight, which was festive :). Tomorrow will be a long day at the warehouse. We are doing a clinic for a village named La Solucion starting at 9am. I'm in my bunk bed below on the ship and am ready to turn the lights out. Goodnight!
Lindsay

Honey for wound debridement: http://bio.waikato.ac.nz/honey/evidence.shtml