Power Outages, Scorpion Bites, Appendicitis... oh my!

What an incredible first day at the clinic!

Successful first day! 

We were picked up by Keith at 7:45AM for our first day of the clinic. When we arrived, we got a tour and met the doctors we will be working with for the next 4 weeks. We are so thankful to be working with such welcoming and friendly doctors who let us have a lot of freedom to interact with patients all day long. Not only is the entire staff at the clinic very relaxed and comforting to us, but the patients themselves are very patient with us as we do our physical exams (which are probably a little too textbook from what they are used to seeing) and ask lots of questions to find the root of their problem. Even when I missed drawing a patient's blood, he and the phlebotomist both laughed and said that is why he was given 2 arms! I have had many patients on previous rotations yell at me to go get someone older and more experienced after I miss a vein or have to readjust the needle to get it into the right location. It is refreshing to have this opportunity to practice amongst people will to let me learn and become more comfortable with everyday procedures.

While I was not surprised, I was still impressed to see that the clinic does not have all of the fancy diagnostic tools and equipment like most American hospitals. During the morning, the doctor and I were halfway through seeing a patient when suddenly the power completely shut off in the clinic. We learned that Belize gets all of its electrical power from Mexico, so when Belize looses the "electrical connection" from Mexico it creates a nationwide power outage! Instead of continuing on and finishing the patient's appointment, we instead all sat and talked about local cuisine and traveling to Cuba while waiting for the power to return so the patient's medications can be put into the computer to be printed. We waited approximately 25-30 minutes for power to return (the clinic does not have a back-up generator) and all of the patients waiting in the waiting room sensed no urgency to see the doctor and leave. How different from back home where waiting 15 minutes to see the doctor seems like a century.

I have also quickly realized that the best way to see and treat patients here is through a good history and physical. One of my first patients was an 18 year old boy presenting with right flank and back pain for the past 4 days with associated nausea and diarrhea. Based on the way he presented, I started to created a differential diagnosis based on an infection of the bladder or kidneys or perhaps a stomach bug. I began my examination by listening to his heart and lungs. Since he was already sitting, I gave his kidneys a light tap which produced a lot of pain. At this point, I thought, "well it looks like I'm done, this kid has pyelonephritis". However, I still wanted to complete my physical exam so I had the patient lay down so I could look at his abdomen. It was a good thing I did not take the lazy way out. I found the boy to have a severe amount of pain in his right lower quadrant, where the appendix is located. I preformed some more maneuvers traditionally used to diagnose appendicitis and like I suspected, these produced positive findings as well. The doctor and I then ordered a CBC with differential to look at his white blood cell count and a pan-abdominal ultrasound to be done at the local hospital to look at all his organs, including his appendix. Right before I left for the day, the patient came back with all of his results and the ultrasound revealed an inflamed appendix. I had just diagnosed my first appendicitis, and it was based on history and physical alone!

I believe that I am so proud of this moment because having just finishing my surgery rotation, I was very used to seeing everyone with any type of abdominal pain automatically getting a CT scan of the abdomen. Half of the time, the patient was not even examined and the clinician automatically jumped to imaging. In Belize, these sources of imaging are very expensive for patients and they must be used sparingly. We have been told a million times while in school that the patient's history and physical are the "bread and butter" of diagnosis and additional imaging is just extra. It has been hard to practice this since American medicine is so quick to jump to the next step and imaging seems to be replacing talking and examining a patient. I am thankful that I have this opportunity to realize that as a PA I cannot get caught up in the way society is heading and I still need to stick to the basics--a good history and physical.

Now onto the second exciting part of my day.... we finally got food!!

For lunch, one of the nurses traveled with us to a local Chinese restaurant where we ate our first real meal since before the New Year. I don't think I have ever been so excited to eat a good meal.

Karilyn eating chow mein

After returning from the clinic, our food adventures continued and we were finally able to shop at the local grocery store. We are now stocked up on local treats, PB&J material, and fruit for all our meals. We found that the local food and brands are quite cheap, but you have to splurge if you want an American brand of food. Thankfully we could care less and it now seems we are forced to try all local the cookies to determine the best ones.... we are not complaining. 

So many options...

I'm ending this incredible day sitting on the Easy Inn patio, watching the sun set while drinking a coca-cola (which is 10x better here and it may be because of the glass bottle) logging patients and blogging. Cheers to hoping each day is just as rewarding as today! 

PS... as the blog title suggested, Karilyn saw a patient today who was bit by a scorpion the night before while outside her home. It looks like we will be more cautious walking through through grassy areas and around town 🐍