Last day in infectología

Last day in infectologia – I am really going to miss it. We started off with rounds again. Most of the same kids were there. Miguel, the boy with diphtheria, looked a lot better. His eyes were animated and he interacted with the nurses who came in to attend to him. The baby of the HIV positive mother was still there. While we were in outpatient clinic that morning, Dr. Velasco received the news that the baby was indeed HIV positive. Everyone’s spirits fell in the room for a moment, as it dawned on us that another person (a baby) now has to live with HIV. In Bolivia, due to the stigma of HIV, whenever they talk about HIV, they say “known disease”. So when the doctor received the news, he was told that the baby was positive for an known disease (diagnostico conocido). Since privacy is hard to come by in hospitals, they use code words for sensitive news and illnesses. Josef, the boy who went into surgery to remove the cyst in his lung due to hidatodosis, came back from surgery, and I helped the nurses transfer him from the stretcher to the bed.

Then we went to the outpatient clinic on the first floor. Outpatient clinic consists of each doctor getting a small office in which to see patients while all the patients mingle about outside the doors, sometimes getting inpatient enough to barge into the office, demanding that their child be looked at. The hospital is also terribly cold, as only the inpatient rooms are heated. The minute you step out into the hallway or a waiting area, the temperature drops by at least 10 degrees (from 70 to 60). Many doctors and nurses have begun wearing vests and jackets on top of their white coats. In consultorio, there were 6 of us medical students, and we took turns doing the physical exam on the children. I had to examine the ears, the lungs, and the heart on the child. They are all so terribly cute and innocent. Mostly, we saw children with fevers, the flu, and middle ear infections.
At one point, I saw one of the medical students come in with a small bag and a 2 liter bottle of coca-cola. I assumed he had brought his lunch and thought nothing of it. Then, after a patient left, the doctor told the nurse to tell the patients waiting outside that “we are cleaning the bed, or something”. Then, once the door was closed, he mentioned to the medical students, and said “quick, lets eat fast”. The coca-cola was opened, plastic cups were filled, and the bag revealed a heap of tucumanas and salteñas. I opted for a tucumana, the other special Bolivian empanada, which is filled with potatoes and spices. We chatted for about 10 minutes, escaping from the world that awaited us outside the small office, where children were crying and mothers were agitated from waiting so long. Afterwards, we hid the coca-cola and saw more patients. Eventually, he said we can all go, and I went up to him to tell him how much he has taught me this week and how I was interested in infectious diseases. After hearing that, he told me I could stay to see more patients with him. It was great, but I also had plans to exchange phone numbers with one of the medical students, and since they left, I never got to do that. On the other hand, the next patient we saw was a 2 month old baby. The mother was carrying him on her back, tucked into one of the blankets that the indigenous women wrap around the shoulders. When we asked her to put the baby on the bed, she untied the blanket and swung it around to the front. A baby was in there! Then she unlayered him of the 4 blankets that he was wrapped up in. Dr. Velasco then told me what I should check for (lungs, heart, development such as holding up his head by himself and the grip reflex, and hip dysplasia) and then left the room. I did the physical exam and checked for hip dysplasia by trying to separate the hips to 90 degrees. After about 30 degrees, the hips resisted. That’s a sign that there is hip dysplasia. The baby was half sleeping while I was doing the exam, and his hands trembled. They looked like convulsions. I asked whether these convulsions happened anywhere else, and the mother said they also happened in the legs as well. For the past two weeks, they woke the baby up and he couldn’t sleep at night. I asked about the tongue, and she said she has seen that as well. She could tell that it wasn’t a good sign. “Doctora, él va a estar bien?” she asked me if the child would be alright, if the convulsions could be fixed. I told her that I was only a medical student and silently hoped Dr. Velasco would come back soon. When he did come back, we ordered an x-ray for the hip dysplasia as well as a neurology consult and an EEG. I hope the child does not have epilepsy and I wonder how epilepsy is treated in Bolivia – do they have access to the same medicines as in the states, and how is the quality of life for someone with epilepsy in Bolivia compared to someone in the US. The mother had a simple and honest look of worry on her face – I hope the child will be alright.