Some things are just different here and it requires some thought to do a procedure that you do without thinking in the States. For example, when I prepared the birth control medication for injection, I pulled back on the syringe to test it prior to use. Well, unbeknowst to me, the syringe had a safety "lock" on it to prevent re-use of the syringe (a very common thing to do here). So when I tested it, I activated the lock and was unable to use the syringe for the actual injection. Fortunately (for me), the clinic carries syringes without this safety feature, so I was able to use another syringe to draw up and administer the injection.
Doing a bladder catherization also involves a little extra thought. In the US, everything comes in a kit; you open the kit and everything you need is there. Here, everything is packaged separately, so you need to pull the bowl for the iodine and open the package so that you have a sterile field. You then pull the catheter, the sterile gauzes, the catheter bag, and the syringe with solution to anchor the catheter and place these on the sterile field. Then you pour the betadine and place a little lubricant on the field. Now you are actually ready to put on gloves and start the procedure. Add to this the fact that I don't yet know where anything is stored, and you can see why anchoring a foley catheter is a big production for me!
I am working in order that Maribel can have a much needed vacation. Fortunately for me, Maribel didn't know that I was scheduled and showed up for the day shift. She helped me over the hump at the beginning of the shift then left around 0800. After that Mirna (the receptionist) was there to help with the language and with obtaining any needed supplies (she knows where everything is!)
The picture I have is of Mirna in the pharmacy area. Mirna is in Saturday School in order to finsh hgh school. She would like to study to be a Lab Tech when she finishes high school.
Admitted patients:
- 1 maternity patient who pushed x 2 hours yet was still unable to deliver. We sent her to Santa Barbara for a c-section.
- 1 mother who delivered this morning at 5:00 am, her third child a 8#-8 oz. girl
- 1 adult: a 71 yo female with respiratory difficulties/asthma, here for IV antibiotics, steroids and prn respiratory treatments.
Because the clinic is open 24 hours a day, we get just about every body who has an ailment or needs medication. We usually sell medication by the single dose or in smaller doses (enough for a week) because that is was the people can afford. I have the most trouble with these walk-in patients because I usually cannot understand what they want. This is where Mirna is of great help.
Although we may use a general over-the-counter medication (for example Mortin) for general pain, they often feel that they need a different pain medication for each different ailment. They are so convinced of this that they swear that one medication works much better than the other, even though both medications are exactly the same, just a different brand. But because they have a different name, they feel that they are different medications. So I am trying to learn what their preferences are for the different aches-and-pains. They also have some medications here that are not in use in the US.
The other problem with walk-in patients is they will often come for suturing. Any injured patient is usually brought to the clinic (not the doctor’s office). So the machete wounds, the farm accidents, all of them come to the clinic. I am comfortable with suturing a simple wound, but I know very little about more involved repairs of the tendons. Today a man was brought to the clinic as a walk-in for repair of a machete wound to his wrist. Dr. Maldonado wouldn’t even attempt to repair it because of the damage to the tendons.
An example of some of the Walk-in services provided today:
- 1 student to buy 50 cents worth of cough lozenges for a sore throat
- 1 man to buy 1 dose of pain medicine for tooth pain
- 1 man to buy 1 dose of cough syrup
- 1 young women for an injection of monthly birth control medication
- 1 older man for an injection of Vit B mixture (a very common injection, thought to calm "the nerves", also needed due to poor nutrition and/or alcoholism)
- 1 elderly man with a h/o BPH who was unable to void, with an attempt to place a urinary catheter which would not pass due to an enlarged prostate.
- 1 man with a wound to the wrist which severed the tendons. His co-workers said that he had bleed for about 45 minutes before they put a tourniquet on his arm in order to stop the bleeding. We called Dr Maldonado to repair the wound, but when he saw that he man could not move his fingers, he felt that the patient needed to have surgery at the hospital. So we wrapped the wound and sent him out.
Doing a bladder catherization also involves a little extra thought. In the US, everything comes in a kit; you open the kit and everything you need is there. Here, everything is packaged separately, so you need to pull the bowl for the iodine and open the package so that you have a sterile field. You then pull the catheter, the sterile gauzes, the catheter bag, and the syringe with solution to anchor the catheter and place these on the sterile field. Then you pour the betadine and place a little lubricant on the field. Now you are actually ready to put on gloves and start the procedure. Add to this the fact that I don't yet know where anything is stored, and you can see why anchoring a foley catheter is a big production for me!
I am working in order that Maribel can have a much needed vacation. Fortunately for me, Maribel didn't know that I was scheduled and showed up for the day shift. She helped me over the hump at the beginning of the shift then left around 0800. After that Mirna (the receptionist) was there to help with the language and with obtaining any needed supplies (she knows where everything is!)
The picture I have is of Mirna in the pharmacy area. Mirna is in Saturday School in order to finsh hgh school. She would like to study to be a Lab Tech when she finishes high school.Admitted patients:
- 1 maternity patient who pushed x 2 hours yet was still unable to deliver. We sent her to Santa Barbara for a c-section.
- 1 mother who delivered this morning at 5:00 am, her third child a 8#-8 oz. girl
- 1 adult: a 71 yo female with respiratory difficulties/asthma, here for IV antibiotics, steroids and prn respiratory treatments.
Because the clinic is open 24 hours a day, we get just about every body who has an ailment or needs medication. We usually sell medication by the single dose or in smaller doses (enough for a week) because that is was the people can afford. I have the most trouble with these walk-in patients because I usually cannot understand what they want. This is where Mirna is of great help.
Although we may use a general over-the-counter medication (for example Mortin) for general pain, they often feel that they need a different pain medication for each different ailment. They are so convinced of this that they swear that one medication works much better than the other, even though both medications are exactly the same, just a different brand. But because they have a different name, they feel that they are different medications. So I am trying to learn what their preferences are for the different aches-and-pains. They also have some medications here that are not in use in the US.
The other problem with walk-in patients is they will often come for suturing. Any injured patient is usually brought to the clinic (not the doctor’s office). So the machete wounds, the farm accidents, all of them come to the clinic. I am comfortable with suturing a simple wound, but I know very little about more involved repairs of the tendons. Today a man was brought to the clinic as a walk-in for repair of a machete wound to his wrist. Dr. Maldonado wouldn’t even attempt to repair it because of the damage to the tendons.
An example of some of the Walk-in services provided today:
- 1 student to buy 50 cents worth of cough lozenges for a sore throat
- 1 man to buy 1 dose of pain medicine for tooth pain
- 1 man to buy 1 dose of cough syrup
- 1 young women for an injection of monthly birth control medication
- 1 older man for an injection of Vit B mixture (a very common injection, thought to calm "the nerves", also needed due to poor nutrition and/or alcoholism)
- 1 elderly man with a h/o BPH who was unable to void, with an attempt to place a urinary catheter which would not pass due to an enlarged prostate.
- 1 man with a wound to the wrist which severed the tendons. His co-workers said that he had bleed for about 45 minutes before they put a tourniquet on his arm in order to stop the bleeding. We called Dr Maldonado to repair the wound, but when he saw that he man could not move his fingers, he felt that the patient needed to have surgery at the hospital. So we wrapped the wound and sent him out.
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