Tingriti: Day 2

We woke up in the rain this morning. It was a much lighter rain than the rain storm that had flooded our pharmacy tent the day before. I was stationed in the Med Clinic today and I got to work with a new doctor that just got into town to help the team. Her name was Sarah and she was a internal medicine resident. The other people working in the clinic with me today were Chalini, Josh and Bavana. The first patient I saw turned out to be one of the most interesting cases of the day. The patient was complaining of epigastric pain and I first thought that this was going to be another case of acid reflux. However, on visual examination of the abdomen I saw a small bulge in the area he had complained about. With palpation I noticed a nodule that was about 3-4 centimeters long and was tender. The patient also had rebound tenderness. We ended up sending this patient to get a CT scan. We think that he might have had a piece of incarcerated bowel which can be quite bad if it loses blood supply and becomes ischemic. Throughout the rest of the day were many more cases of arthritis and acid reflux and a few cases where we were concerned about Tb so we all had our masks on. Another case that stands out in my memory was a young guy who had repeated left shoulder anterior dislocations of his shoulder, many times while playing cricket. Even though he was right handed something about the throw in cricket caused his left shoulder to come out of socket. He also had an interesting medical history because he was taking medication for epilepsy. This case was one of several where people wanted us to do more than we really could. He was trying to get more epilepsy medication from us and he wanted us to make his shoulder stay in place. Of course we couldn't do either. We recommended that if his shoulder dislocations got to the point where he couldn't do normal activities than he could have surgery. Near the end of the day I had a lady who was having pain in her left ear and difficulty hearing from the same ear. It turned out that she had a pile of ear wax that was completely covering her tempanic membrane so I got to do a warm water flush of her ear. I was able to clear most of it and she said that she could hear better so I had a nice sense of immediate satisfaction.

I am beginning to feel much more comfortable with my histories and physical exam skills. With most of the pts I have been seeing I really feel like I am able to adequately assess them and figure out what they need. Even if I can't figure out exactly what they need, I feel confident in sending them to someone who will know what to do.

I have no real sense of time here. I would not easily be able to tell someone how long I have been here or even how much longer I plan to stay. All that has really mattered is the rising and falling of the sun. This combined with the busy schedule of this trip has made it seem that I only left home a couple days ago.

A group of us took a hike up the mountain beside us after clinic today. We made it up pretty high and had a great view of the town and the campsite.