Ordinarily Extraordinary
- Zachary Self
- May 31
- 4 min read
Updated: Jun 1
It occured to me that readers may enjoy seeing a sampling of an "average" day at our center. I picked a random Thursday from a few weeks ago.
Below is a list of presenting problems, per review of our Electronic Medical Record (EMR), which is an iPad based system, drChrono.
(we don't necessarily have a strong preference for the particular system... they happened to have a free version when we opened the clinic and we do tend to have a strong preference for "free" :)
Total Patient Count for Day: 45
List of Presenting Problems (i.e. "chief complaint")
follow-up cough
drainage from leg
burning pain to right calf
pain with urination
diabetes
history of schizophrenia... deported and now out of meds*
back pain
cough and wheeze
tearing from eye
fell from a tree*
finger pain
nausea and vomiting
mouth pain
pain to feet
abdominal pain
itchy feet
abdominal pain and headache
rash on arms
abdominal pain
diarrhea
throat pain
follow-up on electrolytes*
abdominal pain
altered mental status*
swelling to feet
decreased appetite
diarrhea
shortness of breath*
diarrhea
joint pain
dizzy
pregnant
left foot pain
diabetes
diarrhea
left breast pain
foot pain
leg pain
cough
abdominal pain
cough
diarrhea and vomiting
The astute reader may note that roughly 1 out of every 4 visits was for a gastrointestinal issue (abdominal pain, diarrhea, nausea/vomiting). This underscores the importance of our ongoing efforts- in collaboration with CLEAN international- to provide our patients with point-of-use water filters to ensure access to clean water.
I highlighted a handful of cases in the list above as they are particularly interesting.
*The gentleman who presented requesting medications for schizophrenia had recently been deported from the United States. While in the U.S., he had experienced auditory and visual hallucinations and ultimately been started on antipsychotic medication. He noted marked improvement while on his medication. He presented to our site with an empty medicine bottle with a label indicating it was from the "Arizona Processing Center." He had sought a refill of the medication (risperidone) at various local pharmacies, but had been unsuccessful (not too surprising as medications to assist with treating mental health pathology are frequently challenging to procure in Guatemala). We did have medication in stock at our on-site pharmacy (thanks to Direct Relief) that would be appropriate for his ongoing treatment. He was exceedingly grateful. His case shines light on an under appreciated facet of the immigration issues that seem to be ever-present in the news. When an individual with a grave, potentially life-threatening, medical condition is deported to their home country, what happens? This case had, if not exactly a happy ending, at least an acceptable resolution. I suspect many individuals may not be as fortunate.
*The patient with chief complaint of "fell from a tree" had indeed done just that. I included his visit in the list of highlighted cases as it is representative of hidden costs associated with ensuring delightfully delicious Guatemalan coffee arrives in your cup. Our patient was a 51 year old man who had fallen from a tree while trimming the tree to ensure appropriate shade canopy for the coffee plants growing below. His work-up was negative for any significant abnormality aside from soft tissue injuries. But, you (and I) can keep him in mind the next time we take a sip of shade-grown Guatemalan coffee. We can also pause before complaining about the cost of said coffee as there are additional costs in its cultivation (e.g. falling from trees) that may not be readily apparent to the consumer.
*The patient who presented for "follow-up on electrolytes" had been seen a few days prior for a diarrheal illness and was noted to have electrolyte derangements. Specifically, his sodium and potassium were dangerously low (121 and "<2" respectively). His case highlights the impact of point-of-care laboratory studies in providing patient care. Without immediate access to our iSTAT analyzer, the patient's critically low electrolyte levels would have gone undiagnosed (and thus, untreated). With access to iSTAT, our patient was able to receive appropriate repletion of electrolytes. Upon follow-up, his levels had largely normalized.
The final two highlighted cases (and arguably the severe hyponatremia case above?) would have likely been admitted to the ICU had they presented to a hospital in the U.S.
The patient with "altered mental status" was quite tachypneic and had fruity smelling breath (due to acetone). She was quickly diagnosed with severe diabetic ketoacidosis. She received IV hydration, an insulin drip, electrolyte repletion, close monitoring, and frequent lab checks. She spent the night at our facility. The following day her mental status had returned to baseline and her diabetic ketoacidosis had resolved. She was discharged home with follow-up as part of our Diabetes Program. *The patient with "shortness of breath" displayed obvious increased work of breathing and was profoundly hypoxic (oxygen saturation in the 70s initially). She was diagnosed with COPD exacerbation and received supplemental oxygen, steroids, antibiotics, and nebulizer therapy. She also spent the night at our facility. The following day she had improved sufficiently to be stable for discharge. She went home with ongoing supplemental oxygen via a small oxygen concentrator (similar to the one pictured below; one of several that we received from Direct Relief during COVID times) and had close outpatient follow-up arranged.
In summary, the above represents an "average" clinic day with 40+ patients presenting with diverse pathology- some of whom were critically ill.
World-class healthcare is delivered to our neighbors in rural Guatemala on a daily basis thanks to your generous support. On behalf of our local team, our patients and their families, "THANK YOU!" You make our "average" days exceptional.
Ordinarily Extraordinary.
Top Photo by Alexas_Fotos on Unsplash
