Thursday

Today has been a busy day. I arrived at the clinic at 8am to get my scripts ready to distribute to my home visits. Our clinc pharmacy is located on the second floor of the clinic. It is small and narrow. Every inch of space is used! The long term MD volunteer has worked hard to bring order to the pharmacy. She has also created an inventory. Hopefully, this inventory will help us monitor par levels and give us adequate time to order meds.

I left the clinic with Patricia around 8:30am. Shortly down the road, is a family of 9, waiting in the rain for a bus. We stop, pile them in. Not a peep heard from the kids. Some of them were sick, others had mouth sores. We dropped them off at the hospital.

Our first stop was to a 41 year old female who has had more loss and suffering than I could even imagine. Last year, she was pregnant and her daughter, husband and mother in law died in a tragic car accident on the way to Belize City. She wanted to go with them on the trip, but due to complications with the pregnancy, she stayed home. Several weeks after losing her husband, daughter and mother in law, she miscarried. Shortly after that, she became completely blind in both eyes.

Today, when we arrived at her home and she greeted us with a warm smile and hug. She had a friend visiting her. Her spirits were good and so was her fasting blood glucose. Patricia was pleased. We added an afternoon dose of Metformin, prayed together and then left.

Stopped by my patient home with PVD (Peripheral Vascular Disease)to let her and her daughter know we would be picking her up at 1230pm for a trip to the hospital. I saw her two days ago and she just cried out in pain. No position was making her comfortable. She wasn't eating. Toes: black. Little to no trace of pulses. From the knee down, her leg was cold. Two weeks ago, her second toe toenail fell off. He foot was dying. She had her left leg amputated a bit over a year ago. Six years ago, a stroke left her paralyzed in the right arm. She knows that the only thing that will help alleviate the pain is to have to right leg amputated as well. She agreed to the hospital visit. I asked the daughter to give her two tylenol at 12pm.

Our 82 year old CHF patient was next. She had an CHF exacerbation last week. Edema down, breathing better. There were two young boys outside working in the yard. As we entered into the home, the two boys looked and then slowly walked behind us and waited in the doorway. They didn't say anything, just watched. Moments later, one of the construction workers from across the street, became curious and stood in the doorway for a few moments. Once he saw Patricia taking her patient's blood pressure, a dialog in spanish began between the patient and the worker. The worker wanted his pressure checked as well. It was a bit high and I provided some patient education regarding his diet.

Next, we went across town towards Indianville (that's the community I live in). My patient with COPD was waiting for us on his front porch. As I entered, I could hear his labored breathing. I did vitals and a quick assessment on him. When I asked him if he has been using his nebulizer, he sent me in to talk with his wife. She returned to me with the nebulizer still in the box. "We haven't used it since the last visit" "We were not quite sure how it worked". I walked -the patient thru the setup process and gave him a neb treatment. His O2 went from 85-86%RA up to 93% after the treatment. I encouraged the patient and wife to leave the nebulizer out of the box. I will return tomorrow and have them show me the set up process.

It's 12:10pm, we have 20 minutes for lunch. Marian's it is for some Conch soup. Tried coconut water and I don't like it. It's suppose to be really healthy for you. Exactly why I don't like it!!! The taste reminded me of colonoscopy prep. Nasty!

1:01 pm. "Patricia, we"re late", I exclaimed. We both took one last sip of our Folger's instant coffee, paid and left.

Our patient was ready to go to the hospital. We lifted her into the trooper. Her daughter came with us. Our little patient cried the whole way. "First the arm, then this leg (pointing to her left leg) and now this one. Three gone". The MD took one look and said "this is not good". He will meet with the specialist in the morning. Blood work was done and she was admitted. I think she is alone tonight and she is heavy on my mind. Will she get pain meds? Will the MOH pay for her transportation to Belize City to have the procedue? Tommorrow seems like such a long way off. I'm sure for my patient it seems like an eternity. I pray there is pain medication to keep her comfortable for the night.

My last two patients of the day were new patients to me. Patricia introduced me to each of them and she was able to see her patients while I was assessing. One diabetic and one 95 y.o. HTN, s/p CVA. Both were females and so precious.

4:15pm. I leave my last patient and remind myself to drop off vitamins I promised to a pt. yesterday. "I didn't forget about you" "I know", she replied, "I've seen you going back and forth and knew you would be by".

4:25pm Met Patricia at the internet. We both checked our email. Left at 5pm and outside, a patient's granddaughter was waiting for us. "Granny isn't doing too well today. She feels a bit shaky. She's being treated for parasites and is probably dehydrated. We pass by the clinic to see if we can get some oral rehydration solution. The pharmacist won't give it to use with out a order. WHAT?!?!?!!! This comes free to the MOH. We leave and stop at a local store. We get gatorade and a few other groceries and bring it back to our patient. Vitals are stable. Blood glucose high at 247. She's a diabetic and only eating 2x/day. Most patient's don't have money to buy foods to have a well balanced diet. More education and follow up.

535pm, Patricia and I head back toward my house "what about our friend who had the recent stroke", I asked". We both looked at each other and simultaneously said "first thing tomorrow morning".

PG has had heavy rain since yesterday afternoon. Thankfully, we had a vehicle to get around today. I love my new bike, but was thankful I didn't have to bike in the rain today.

As I reflect on today, I am thankful for my experience here in PG. After seeing some of the patient's today, and listen to their stories and see how they truly live day to day, relying on God's provision, I ask myself "Am I really trusting in Him with my whole heart?"