My usual source of inspiration for blog material, my journal, had been decidedly uninspiring these past few days. So today the blog material is coming from my charting. That’s right; as much as I hate it, for the past 6 or 7 months now I charting a little when I go out to see the kids. Mostly it’s because I can’t remember who needs me to bring meds when, who had malaria last and when I need to follow up, that sort of thing. I have absolutely no fear of a HIPPA violation so here are two kids from the past week:
3/1/2011 Routine check. Angelia along to translate. Job and his mother sitting outside when we arrived. Job looking well. Responsive to his mother. Per mother seizures fewer. Tolerating meds well but needs both phenobarbital and phenytoin for March. Discussed giving shillings for transport but mother requesting that I pick it up and bring. Reports that pharmacy won’t give more than a month at a time. Will attempt to get three months. States no other needs at this time.
3/3 Meds obtained without difficulty (Awoja Rx) for March/ April/ May. Delivered. Mother away at market. Child being care for by aunt. Phenytoin 50mg BID, Phenobarbital 30 mg in AM. Asked to see old meds to confirm dose. Pt's aunt brought me an unlabeled bag of small while pills cut in half, a bottle of ARVs and a bottle of Tylenol Arthritis. Asked for any others- she states there are none. Asked to see record from hospital- states that she doesn't know where it is. Asked when Job's mother is coming back- also unknown. Left sugar and soap and promised to return.
3/4 Angelia along to translate. Job sitting outside in chair with his mother. Tolerating chair well. Looks like strength is improving. Asked mother about meds and to see hospital record. (Hospitals, clinics and offices here don't keep a patients' record. It is the responsibility of the family to keep all papers. Most have a 50 cent note book that they keep that medical personal write in- lab results, prescriptions, receipts- everything. Sometimes helpful, most often indiscernible.) The book confirmed the doses. Asked the mother where the meds were. She states the dilantin comes as 100's so she breaks them and puts them in in the ARV bottle. States that she is HIV positive with a CD4 count less than 400 so the bottle was hers. The unmarked bag is phenobarbital. Confirmed doses and times of medications with her. States no other needs at this time.
Lazaro
3/1/2011 Routine check. Angelia along to translate. Arrived to find no one home. (No one under the age of 7 at least.) He is not looking good. Pale and losing weight. Found in the hut, wet in urine and old stool caked on his legs. Sores on his backside, open wounds on his legs. Large puss filled ulcer on left side of his head. Wound on head looks bad. Gave him a bath and debrieded the sore on his head. Cleaned legs, backside and head with iodine. Packed head wound with abx ointment and dressing applied. (I’d like to start abx but no one to give directions to). Neighbor arrived. Reports that Lazaro’s mother is “away” looking after her husband. Has been gone since Sunday. Young boys caring for Lazaro. Lazaro fed with glucose/protein biscuits. Clearly hungry and thirsty. Ate well and attempted to feed himself. Considered admission to Amecet. Called Else (director) and she said without an adult to sign she can’t admit him but willing to come out in the afternoon to follow up.
3/3 Arrived to find an older sister around the home. Lazaro alone in hut. Dirty bandage still on head. Wounds draining. Dressing removed. Wounds cleaned and re-applied. Pt appearsnto have been fed and bathed. Attempted to explain abx but no one around who spoke English. Pt remains afebrile. Given beans for children.
3/4 Angela along to translate. Lazaro outside with his mother when we arrived. Wounds again cleaned and redressed. Wounds on buttox and legs looking better. Head ulcers still open and draining. Started on Bactim. 8mg/kg/day q 12 hrs for 7 days. Discussed with his mother to clean twice a day and keep flies off. Also attempted to discuss leaving him alone for days at a time. Pt’s mother says she doesn’t have anyone who will care for him and she can’t tie him on her back. Asked if there is a neighbor or anyone she could ask. She says she will try next time.
*Pt’s father also present. Looking good considering he was demon possessed two days ago. (This is the reason that they told me the mother was not around.) Complaining of right sided back pain, pain with urination. He was able to produce a urine sample. No frank hematuria but cloudy and foul smelling. Given course of cipro. Instructed not to let children take it and go to a clinic if doesn't improve.
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| Lazaro, Angela and I. Not a picture from these visits but a visit a few months back. |
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