Tuesday, August 28, 2007

Practicing Medicine without a License

More and more often we now receive requests for help with medical problems, from the very poor of our area. This is challenging for us, because, except for the knowledge acquired from having kept our own six children reasonably healthy, we have no training for this.

We can help, fairly often, with just this parental level of knowledge. Passing out bandaids, antibiotic ointment, children's tylenol, vitamins, etc isn't beyond us. Recently, however, we have had some more challenging problems brought to us. We appreciate your prayers, as we try to help those who come to us for medical assistance, in spite of our limitations!

A few weeks ago, a young nursing mother, her husband, and their month old baby knocked on our door (an unidentified young girl was with them - sister of the mother, I think). The mother had developed an infection in one of her breasts. She had opened the pockets of infection herself, and the infection had worsened, so that she could no longer nurse the baby on that side, because of the pain and the open wounds. She visited the government health center, and from them she received Tylenol. She visited another health facility, and was told they didn't have any medical workers there to help her. I don't know who sent her our way, but there she was, in dreadful condition, still needing help for her raging infection.

We contacted health workers in the US and Canada, using the internet, and were able to start her on antibiotics (which are available over the counter here), and advise her on how to care for her wounds, keep the baby healthy, and hopefully retain the ability to breast feed her child through the treatment and after.

Very frequently, when people come to us for help, we ask them to return at a later date, to check on their progress, or for other reasons. In many cases these people do not return, but happily this little family has returned three times now, and we have been able to oversee this woman's recuperation. She is due to check in again later this week, and we hope to see her well enough to restart nursing on that breast. So many many situations arise here, which we cannot help. It is exhilarating to see that we have been able to make a difference for this family.

Today, the mother of one of the children in our Special Needs Program approached us about an ongoing medical problem she has been dealing with. Two years ago, after giving birth at the local hospital, she was given three injections of penicillin, 'in case she should get an infection.' About a month later, welts and wounds began to appear at and around the sites of the injections. She complains of much itchiness and pain at these locations. I am posting a very small picture here, in case anyone has a delicate stomach for such sights. You can click on the image, if you'd like to see a larger version. We imagine that perhaps she is allergic to penicillin, but we haven't ever heard of an allergic reaction like this - so localized and yet ongoing (for two years?). Thus begins another romp through medical sites on the internet, and emails to medical professionals. I'll let you know how this progresses.


Brenda said...

I forwarded your blog and the photo of the woman to a doctor I work for and these were his suggestions:
Some thoughts would be
1. Staph infection - can be treated with a sulfa med like bactrim or septra
2. Cutaneous Larva Migrans
3. Tinea corporis (unlikely - no central clearing)
4. Next would be inflammatory conditions - doesn't really matter what kind - most respond to topical steroids.
5. Could be shingles (Herpes zoster) - there would be vesicles and the area would be painful.
6. Are the scabbed areas from the rash or from the patient scratching the areas?
7. Does it itch? What makes it better?? What makes it worse?
They could experiment with a few treatment options. If it does not respond a biopsy and pathological study should answer the questions.

Brenda said...

I meant to say this too: Go to Google on the internet, and search under just the images portion for the terms he mentions. It should bring up photos of these conditions and you can kind of compare the photos to her arm and see if any looks identical. If you click on the image, it will also direct you to where it is found on the internet and it may include an article from which you can draw more information about the condition. Hope this helps! We know a great nurse missionary who has a free clinic in Honduras, but I'm not sure of her location in relation to where you are. She is stateside at the moment anyway, but I will ask her for future reference if you are any where near each other.

Trish said...

Thanks so much for this info, Brenda. It will certainly help me on this research. In answer to your questions, the site does itch, and I don't know if she is scratching it open, but I expect that she is. I don't have access to any kind of lab work, so we're going to have to try some things, and see what this responds to.

La Gringa said...

Dr. Trish, you are incredible.

Those stories are so bad. Tylenol for an infection? Penicillan just in case? Shame on them. The average person in the street knows better than that.

Trish said...

Thanks LG. It's sad, isn't it?

The whole situation makes me wish I had studied nursing in college, instead of (ahem) Fine Arts. I haven't noticed a lot of demand for my musical abilities here.

I'm fortunate to be building a network of health care people who are willing to help me through this stuff!

Patty said...

Trish, I forwarded this to a friend of mine who is one of the best triage nurses I know. As soon as she answers me,I will get in touch with you. That offer I made in an e-mail to come and give you a crash course in nursing still stands, when we ever get to Honduras

Patty in Ft. Lauderdale - Trujillo

Honduras Sprout said...

I hope you find the answers you are looking for, for your "patients". You may already know this, but I tried this when I was working through reoccurring breast infections so I'd thought I pass the tidbit on. My midwife recommended this:
An ancient and effective treatment is to apply a chilled bruised cabbage leaf to the breast inside the bra, replacing as necessary for up to 24 hours. (Warning: may stain clothes.) Cabbage leaves have an anti-inflammatory effect.