Monday, January 19, 2009

Juggling patients...

I am sure you can imagine that the conditions seen in the clinic are diverse; some of the children being much sicker than others, ranging from a child with a runny nose to a child gasping for breath or a child running around in the clinic to a child too sick to walk. Seeing the sickest children first, means triaging. As you can guess, this totally mixes up the order of the patients which can cause some commotion since they just spent 10-15 minutes trying to get in a line outside the gate in the order of arrival (as early as 4am)!

As soon as the clinic opens, the patients come in, and we prioritize using a color scheme. RED = very sick child needing urgent attention ORANGE = mild to moderately sick which needs to be seen fairly quickly (very pale, some respiratory distress, high fever, dehydration) GREEN = stable child needing no immediate attention, which will be seen in order of arrival. With 2 doctors you can work through the red/orange patients relatively quickly and at least get the REDs to referral centers as quickly as possible. When you’re on your own it gets a little tricky and often it feels like your juggling patients.

Today’s juggling act: a set of 3 week old twins, a staggering 9 year old, a dehydrated looking 5 year old and a very hot and pale 1 year old. And throw in an older sibling to the mix half way through the act.

The older two I took straight to the lab, sending the 5 year old in first. While she was inside, we checked the 9 year olds glucose outside the lab, then he waited to go in for other tests. Meanwhile I the nurse took vital signs for the twins and 1 year old. When the 5 year old was out of the lab she came to my office for history and examination. Meanwhile the 9 year old went into the lab. I then sent the 5 year old for ORS and to wait for results. Meanwhile the twins were ready to be seen. That took longer than expected so meanwhile the 9 year old was back in the waiting room, asleep on the ground. While busy with the twins, I was shown the 1 year olds paper- high fever so I gave paracetamol and sent her directly to the lab for a malaria test. Back to the twins; low birth weight, hypothermic and not feeding well so got lab tech to take some blood and carried on. When I was just about through with them I hear that family came with an older sibling so I started seeing her, so that I would have her results by the time the twins were ready to be referred. Time to stop juggling. I wrote referral letters for the twins and prescribed meds for the sibling. Off they went. 3 left. The 5 year old drinking her ORS, the 9 year old on the floor and the 1 year old on the bench waiting for me. The 9 year old couldn’t even walk so really needed to be seen. While examining him the 1 year olds result showed up- malaria positive. So I wrote up the first dose of malaria treatment. Then finished with the 9 year old, whose results I also received but unfortunately the referral center was not answering the phone, so he would have to wait a little longer. So, onto the 1 year old who looked alright besides being pale and having malaria. I would see her again in an hour. By this time the 5 year old finished her ORS and looked better so went home with medication. Finally at 11am I got a hold of the referral hospital and was able to send the 9 year old who was so weakened by malaria he had to be carried out. And the 1 year old ended up going home with medicine to be seen back tomorrow. Of course, towards the end of the juggling act, other patients made their way into my office and by the end of the day 40 patients were seen. At least after the intial reds and oranges it's not as hectic...

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~ Act Justly. Love Mercy. Walk Humbly. micah 6:8 ~