Brain worms

There is this super cool organization called Free Wheel Chairs.  And it is exactly that.  This non-profit hand-assembles wheelchairs and donates them to hospitals.  Etienne and I saw a pack of young, pregnant Nica woman being wheeled to delivery in these really creative wheel chairs. 

Source

Here is how they are made... pretty nifty!

One of the ladies who we saw on our first visit was initally diagnosed with having a stroke.  When we visited her, she was drooling and could barely communicate.  Etienne was asked to give her an eye exam, because she had hypertensive retinopathy and retinal edema (note: may have just been retinal edema, I can't remember). He looked into her right eye with his left eye, which is slightly incorrect.  It looked like he was going in for a beso :)  Her smile was priceless.  He said in a French accent, "I can't see anything".  Then went in for another look, their noses almost touching. I tried to hold in giggles so hard, I started choking. I wanted to take a picture of her face, and her daughter's face.. It was priceless.  Finally, the resident told him he needed to look with his other eye to avoid giving any besos (kisses).  Our second visit with her, we learned that after further examination, she had a worm in her brain called taenia solium, which a tapeworm you can get from pork.  This causes Neurocysticerosis.  This leads to increased intracranial pressure, which is the reason why the residents initially thought she was having a stroke. She was acting funny, because her brain was under pressure.  

The residents are incredibly smart and very good at what they do.  I feel very spoiled witht he shiny, brand new toys we have at MUSC and in the states in general.  These kids have literally barley anything to work with.  Their CT scan machine is ancient, and the images are poor quality. Yet they still manage to make correct diagnosis, based on back up from nicer hospitals in Managua.  We bitch and moan about healthcare in the states, but it could be worse.  I honestly think every health care practitioner should take some time, even if it's a week, to see and learn how health care is in other places.

The clinic has been pretty steady.  We have started to see a lot more dengue fever.  Today, I thought I have a touch of it,but med students have everything they read about or encounter in someone else.  It starts out like the flu.  You get a really temp, pain in your body, pain behind your eyes, nausea, vomiting. Then once the fever drops a weird rash.  I have something on my back and stomach but it might be surfboard burn or heat rash. Dr. Villarreal had me as her patient today and got me hooked up with a ton of meds that cover multiple bugs. I am probably just sick with something normal like a flu or sinusitis. I feel better now, and no high fever :) so no worries family...

No hemorrhagic dengue as of yet in the clinic, which is good.  There may be some cases in the hospital.  One of the attendings who I follow specializes in infectious diseases. 

I have seen many patients with gout, infectious intestinal diseases, diabetes type 2, and, breast masses, possible cervical cancer, and lots of anemia. These are all apparently very common conditions here. Many of these patients are unable to manage these diseases on their own.  This clinic does a great service.  Almost every day we catch someone with a systolic blood pressure over 200 or a blood sugar level over 300 and 400.  

Don't get me started on women's care.  There is a very good ObGyn clinic similar to this one down the road.  They provide care for anyone who is a female. We sometimes get their overflow. These docs do everything they can to provide care.  All they can really do is look and if its looks infectious, prescribe a drug. Prenatal visits are pretty standard as is the counseling: eat well, don't drink coke, take the vitamins, don't drink alcohol, stay away from sugary sodas, and stop consuming sugar.  Coca Cola has a large presence here. Gestational diabetes is an issue.    

I have one more week left as of today, and I am very sad.  I am somewhat ready to come home.  Really just to see my family, bf, and friends.  But I am really going to miss Nica.  I already started looking at plane prices for December.  

This is a really inappropriate picture of pig's kahunas....
sorry it just had to be posted :)