Clinic at Sissu and Kaksur

I didn't get many pictures at the clinic site in Sissu, partially because it was the first day and things were kind of crazy and partially because I was assigned to the triage tent because of my experience as an EMT doing vitals. Me, Jenny, and Dustin did vitals that first clinic day. I ended up only doing a half day in the vitals tent because Anna was struggling to see all the patients that came in for eye exams. The eye exam area was cramped in next to the Med stations so there was really no room to work at all. Usually we had the patient sitting on the tripod stool that we brought from our camp and we would kneel, squat, or bend to do the eye exams. We saw 307 patients today!

The pictures here are from the clinic site the next day at Kaksur. This town is the first town you run into after coming over Rohtang Pass so we had to back track from our campsite to get to this village. I was stationed in the Med tent today with Emily, Stephanie (not in the group photo) Kelly, and Anuj. The way this would work is that we would have a couple translators per tent and we would do the history and physical exam pieces that we thought were necessary and then we would present that information to Mike (the ER doctor), Payul (don't think I spelled that right), or Rashmi (probably didn't spell that right either). At the beginning they would have us go back and ask more questions or do more tests and then we would decide what the plan would be.

Once again I worked in the Optho tent for the second part of the day to switch with Anna. Most of the eye problems that we saw were pterygiums (the patient usually complained of watering and itching), cataracts, and refractive errors. Unfortunately our pharmacy was only stocked with a select amount of glasses which were all for near vision problems so anyone that had distance vision problems we had to refer to another clinic, usually the eye clinic in Keylong. The pterygiums were very common and are a result of eye irritation. The conjuctiva begins to vasularize and it moves towards the limbus creating a triangle shaped growth that can grow to the point were it obstructs the pupil causing visual field loss.

One interesting case we saw today was a elderly man who had visual field loss and was unable to close his right eye. We did some cranial nerve testing and determined that he had a 7th nerve palsy. We talked this over with Mike and then went back to do another test to see if there was forehead sparing which would indicate a stroke. If the forehead did not wrinkle this meant there was a peripheral problem and was likely much less serious. He did have forehead sparing so we began to think stroke. It was at this point that the patient mentioned he had just had some dental work done and things began coming together. It the end we realized that his 7th nerve palsy was the result of a dental block and that once the anesthesia wore off he would regain function of the right side of his face. We did however still send him for further evaluation because of the visual field losses we noticed.
We saw about 170 patients at this clinic site.