For the week of Valentine's Day, Hansel took Jeff and I to the Amazon jungle to the town where he performed his year of rural service after graduating from medical school. We were able to take care of patients directly for the first time since we arrived in Peru, which brought up some discomfort about my rusty medical abilities, but it was a good challenge that I'd been hoping for when I came here. In brief, it was a thought-provoking and inspiring experience, and my respect for Hansel grew as I imagined myself in his shoes, freshly graduated, trying to learn on the fly how to be a primary care provider in a tropical setting.
The time in Santa Clotilde (the jungle town) helped me gain confidence in interacting with doctors and patients in the Lima hospitals. While attending rounds in the infectious disease department, I've found myself following the discussion more than I have in the past, and I sometimes am able to contribute something I've gleaned from the patient's chart or at least ask a clarifying question for my own learning purposes. Related to patient charts, my oh my are they a mess here. While in the US there often seems to be too much information in the electronic medical record, here there often seems to be some crucial data missing, for example the result of an important test during a previous hospitalization or, more generally, the patient's story, which can be nearly impossible to discern from some of the doctors' handwriting. I've gotten better at guessing what the notes say, but overall it makes me miss legible, typed notes!
When Jeff and I returned from the jungle, we started our research activities for a study about neurological syndromes in HIV patients. We arrived early at the hospital to ask nurses and residents in the emergency department if there were any new patients that might fit the study criteria, which was a little nerve-wracking because we're inexperienced in this setting and didn't want to unwittingly break any rules. In fact, on our first attempt, we were quickly kicked out of the ED when the head of the department walked by, disapprovingly looked us up and down, curtly asked us who we were, and then showed us the door. We hadn't realized that we weren't supposed to wear our backpacks in the ED, and we'd also broken the dress code by not wearing our white coats. We adjusted and sported the white coats the following days, despite how toasty it gets with them on, until we finally found a patient in the infectious disease unit. We spent some time introducing ourselves and explaining the study, but when we tagged along during rounds that morning we realized we'd made a mistake by not introducing ourselves fully to the attending doctor who didn't know what the study was about. When we stepped out of the unit to find out how much a CT scan for the study would cost, the patient asked a nurse about one of the procedures involved in the study, and since she didn't know she asked a doctor who also didn't know, and when we got back to the unit the chief of the service wanted to chat with us. It was a little embarrassing, but we had indeed committed an error in assuming that since we had obtained the hospital's permission to conduct the study, and had the head of infectious disease's support, we could begin the research activities. It turned out the ID service wasn't totally comfortable with that since they don't know us all that well other than our mostly-quiet presence at weekly case discussions that we usually go to. In the end, the chief of the service decided we should start a more official rotation so that the doctors would become more familiar with us. This was, on one hand, disappointing because we were ready to get to work, collect data, and feel useful. On the other hand, it is definitely a good opportunity to learn in greater depth about infectious diseases in Peru and how they are managed with somewhat limited resources (for example, doctors often can order a confirmatory test for a given infection so they just treat on their best guess).
So that's a little glimpse into my activities of late. I'm a little pooped from the rotation and working on a report for Socios, but overall it feels good to be productive :) Since it's still pretty hot during the day, Jeff and I will likely meet up with friends at a nearby pebbly beach to swim and cool off while trying not to get sunburned.
The time in Santa Clotilde (the jungle town) helped me gain confidence in interacting with doctors and patients in the Lima hospitals. While attending rounds in the infectious disease department, I've found myself following the discussion more than I have in the past, and I sometimes am able to contribute something I've gleaned from the patient's chart or at least ask a clarifying question for my own learning purposes. Related to patient charts, my oh my are they a mess here. While in the US there often seems to be too much information in the electronic medical record, here there often seems to be some crucial data missing, for example the result of an important test during a previous hospitalization or, more generally, the patient's story, which can be nearly impossible to discern from some of the doctors' handwriting. I've gotten better at guessing what the notes say, but overall it makes me miss legible, typed notes!
When Jeff and I returned from the jungle, we started our research activities for a study about neurological syndromes in HIV patients. We arrived early at the hospital to ask nurses and residents in the emergency department if there were any new patients that might fit the study criteria, which was a little nerve-wracking because we're inexperienced in this setting and didn't want to unwittingly break any rules. In fact, on our first attempt, we were quickly kicked out of the ED when the head of the department walked by, disapprovingly looked us up and down, curtly asked us who we were, and then showed us the door. We hadn't realized that we weren't supposed to wear our backpacks in the ED, and we'd also broken the dress code by not wearing our white coats. We adjusted and sported the white coats the following days, despite how toasty it gets with them on, until we finally found a patient in the infectious disease unit. We spent some time introducing ourselves and explaining the study, but when we tagged along during rounds that morning we realized we'd made a mistake by not introducing ourselves fully to the attending doctor who didn't know what the study was about. When we stepped out of the unit to find out how much a CT scan for the study would cost, the patient asked a nurse about one of the procedures involved in the study, and since she didn't know she asked a doctor who also didn't know, and when we got back to the unit the chief of the service wanted to chat with us. It was a little embarrassing, but we had indeed committed an error in assuming that since we had obtained the hospital's permission to conduct the study, and had the head of infectious disease's support, we could begin the research activities. It turned out the ID service wasn't totally comfortable with that since they don't know us all that well other than our mostly-quiet presence at weekly case discussions that we usually go to. In the end, the chief of the service decided we should start a more official rotation so that the doctors would become more familiar with us. This was, on one hand, disappointing because we were ready to get to work, collect data, and feel useful. On the other hand, it is definitely a good opportunity to learn in greater depth about infectious diseases in Peru and how they are managed with somewhat limited resources (for example, doctors often can order a confirmatory test for a given infection so they just treat on their best guess).
So that's a little glimpse into my activities of late. I'm a little pooped from the rotation and working on a report for Socios, but overall it feels good to be productive :) Since it's still pretty hot during the day, Jeff and I will likely meet up with friends at a nearby pebbly beach to swim and cool off while trying not to get sunburned.
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