Burns and Kidneys

In the hospital, I have seen everything from gruesome injuries to interesting, yet terrifying infections (see Brain worm entry).   Etienne and I saw two armed guards standing outside of the room.  This guys were huge and were sporting some pretty serious guns.  (Note: I am not one who is well versed in guns, but  it looked like an AK47, but was an not an AR15).  We walk into the room and see 6 guys in different beds.  The closet has his ankle cuffed to the bed. The second is laying down and is in some pain. The others are similar.  MRSA is a big problem in these hospitals.  Just as in any hospital, really. We were presented a patient who had MRSA on his elbow.  It looked like his whole elbow was being chewed off.  The man in the ankle cuff was horribly burned.  He had a 1st thru 3rd degree burns that covered 25% of his body.  His neck and shoulder were the worst.  He was in prison when some other prisoner came at him with a very large container of boiling water. The water spilled all down his chest and entire back and splashed his face. The plastic surgeon came in to determine the damage.  She first had to clean the burn.  This guys is tough.  He had to stand up while she harshly rubbed soapy water and some other cleaning agent over and over his burns.  Skin was flaking off and blood started pouring from his neck area.  He grimaced, but did not scream, did not slap the surgeon in the face, and did not throw up.  It was painful to just watch. I don't know what he did, if anything, to deserve that.  But he took that cleaning like a boss. 

FYI: Burn percentages are measured in the Rule of 9's.  So your arm is a 9, leg is 9, so on. You add up all the part and percentages of those parts that are burned.  Here is a picture:

source

The other guy was having trouble moving his legs, arms and hands.  He had weakness in his muscles, due to super low potassium.  The docs were still trying to figure out the cause behind his low potassium.  One of the other men was in there for end stage renal disease which was causing pretty serious pleural effusion.  the attending physician recommended that he go on dialysis, but his family refused it.  I'm not sure what will happen to him, like if he will go home or if the hospital will offer palliative care.  Or why his family refused it.  Many patients have to travel a long way to get to the hospital.  Treatments, like dialysis, are necessary a few times a week or more.  I can understand how difficult a trek like that could be. 

Oh yeah, and we saw our ulcer patient. He was in a wheelchair, outside enjoying the sun, and accompanied by his sweet mother. Hope.

I am finished for now with shadowing in the Nicaraguan public hospital system.  I have learned many things from being here, and here are some important notions:  1)The resiliency of the human spirit is unbelievable  2) State-of-the-art medical institutions and universities aren't always necessary for training great doctors and nurses. These doctors and nurses work under a lot of pressure in hot hospitals that are in pretty bad conditions and with little resources. They don't have their iPads on hand to google search symptoms and medications. They have to know their stuff. I have a lot of respect for how the have chosen to live their lives.  Especially the ones who could have stayed in the states or Europe but chose to come back to their homes. 3) We have it really good in the US, especially in terms of health care, so quit your bitching and be more appreciative :)