August 4, 2011:Yesterday I went out for the first time in Costa Rica to a MEDCAP at Fray Casiano, a school in Puntarenas. I worked with one of the lieutenants and a corpsman from the pharmacy.The site set-up was fairly well organized and there was a giant fan secured in the pharmacy that made the heat more tolerable. Overall, the day was very slow compared to those in El Salvador. We saw a total of 237 patients in contrast to the 500s we were seeing previously.
However, throughout the day we learned that many more patients were being referred for more severe problems than in other countries. It seems that because the general health of the population is better as a whole when compared to other countries, perhaps fewer people are seeking our services. The population even looks more “well”. Additionally, those that have presented to the clinic have more severe issues.
We have come to find that at each site there is nearly always an opportunity to try the local food, although this is all assumed, “at your own risk,” as many people have subsequently ended up in Sickbay on the ship. I tried a potato empanada, which was delicious! The other main dish that I saw being eaten, as well as enjoyed earlier in Costa Rica, was a typical plate or Casadas, which most often has chicken or fish, rice, beans, salad, and fried plantains.
Today I was out again on MEDCAP, but a different site, Baranca Gymnasium. The set up is very different between the school and gym, but these are both the major venues for this type of operation. The schools allow each area or discipline to have its own room, whereas the gyms are set up in a big circle with patients in the middle. Today the pharmacy was stationed right next to the physical therapy area, which was interesting to observe. Many disabled people were outfitted with new wheelchairs, others taught exercises, etc.
August 5, 2011
Today I had the opportunity to specifically observe anesthesiology in the operating rooms for the whole morning. I was with the plastic surgery OR and saw a double gynecomasectomy and an abdominal scar revision, as well as portions of a severe inguinal hernia, cataract, and axillary lypoma removal surgery in other rooms. I was able to observe two different anesthesiologists as well as meet and talk to a local Costa Rican anesthesiologist. She mentioned that the practice in Costa Rica is not much different from what she sees at her hospital. The differences in the drugs are minimal; however the equipment is not as advanced, and finally she mentioned that the system is generally less organized in her hospital. The anesthesiologists discussed the effects of different drugs in combination on respiratory depression. I was very unfamiliar with the volatilized agents, which I learned decrease tidal volume but increase respiratory rate, thus maintaining minute volume. However, when you compound three or four drugs for different effects: analgesia, amnesia, akinesia, etc., they may act synergistically (or not), but he explained that he always titrates to effect.
No comments:
Post a Comment