Infectious diseases...probably one of my favorite topics in medicine. Luckily, for me, last week I was able to do a rotation in the infectious disease unit at Hospital del Niño. I worked with Dr. Velasco, who is one of the top doctors that runs the hospital.
As I walked into the infectious disease unit on my first day of this rotation, I was greeted by an entirely white ward that contained small rooms. Each room had windows in which one could look into. This ward was certainly different from the general pediatrics ward that I had visited the previous week. In addition to being greeted by the whiteness of the ward, I was also warmly greeted by Dr. Velasco who introduced Lila (the other CFHI intern) and me to an American pediatrician who was visiting Bolivia.
After being introduced to the American doctor, Lila and I followed Dr. Velasco to his office. I was a little shocked that we were not doing rounds because the previous week in general pediatrics, we always started each day with rounds. Nevertheless, once in Dr. Velasco’s office, he introduced Lila and me to three Bolivian medical students that were working with him.
After the brief introduction to the medical students, Dr. Velasco began to teach us the basics of a physical exam in pediatrics. Although the medical students already knew how to complete one, Dr. Velasco found it important for Lila and I to know because later in the week he was going to expect us to do some exams all by ourselves and report back to him with our results. He reviewed how to listen to the heart and lungs and what to expect in a healthy child and also how to check testicular dissension in baby boys. In addition, he went over developmental stages. For development, he went over the physical, cognitive, language and motor development stages from newborn to age five because as interns we were also going to have to check the child’s development. In addition, Dr. Velasco said that the 5 most common infectious diseases in Bolivia are leishmaniasis, malaria, chagas, dengue, and yellow fever so we should expect to see these cases presented most often in the infectious disease unit, especially TB.
Following Dr. Velasco’s lecture, I saw my first patient who was a young boy suffering from a fever, has asthma, and possibly TB. I must admit that I was nervous because, after all, I had just learned everything that I would need to know to complete an exam. In addition, not only was Dr. Velasco watching but also so were the medical students. Luckily, as I completed the exam, Dr. Velasco walked me through ever step. For the rest of the week, I was paired with one of the medical students, Juan Jose, and together we completed several exams.
Overall, I felt that Dr. Velasco’s consults were weighted more towards general medicine than infectious diseases. Because it is somewhat the start of flu season here, I saw cases in which Dr. Velasco had to differentiate between the common cold and the flu. Because of the large volume of these types of cases, Dr. Velasco went over how to differentiate between the two. For example, with the flu, one can expect high fever, body aches, headaches, weakness for a couple of weeks, coughing that can become severe, and some other symptoms. While with the common cold, fevers and headaches are not that common, some body aches, mild weakness, sore throat, stuffy nose, and coughing.
Although I felt that the consults were more heavily weighted towards general medicine, I did see a case of whooping cough and several cases of TB and probable TB. Dr. Velasco told us that when a child has probable TB or is TB positive, they most likely contracted it from an infected adult. He also stated that it is difficult to diagnose TB in children b/c of the difficulty in obtaining a good sputum sample and even interpreting a chest x-ray. Nevertheless, there are often good indicators that a child has TB (ex. contact with an infected adult, coughing, malnutrition, etc.). During the consults, Dr. Velasco often went over the patient’s chest x-rays and I must say that it was difficult to see if the child had TB.
Also during the week, I did get to do rounds with Dr. Velasco. One case that I saw involved a boy who was about 6 years old. He had a staphylococcal infection and an abscess. In addition, the boy had pneumonia and was suffering from paralysis in which he couldn’t move his jaw. Another interesting thing was that because the boy was receiving insufficient amounts of calories, he had cold arms. The doc was going to give him antibiotics and increase the boy’s calorie intake.
Furthermore, most of the cases in the infectious disease unit involved some pulmonary problem or TB.
Most days after finishing the rotation, Lila and I would stop and visit the children in the burn unit. I must say that even though these kids were in severe pain, they were the happiest children that I had seen in the hospital thus far. The kids absolutely loved to play with Lila and I, and they always wanted us to return the next day. I personally enjoyed just hanging out and playing with these kids.
Overall, I enjoyed the infectious disease rotation. Besides the medical part, this week I was more aware of the interaction between the doctor and the patient. Not only does the physician have to be able to connect with the kids by being theatrical and playful but the physician also has to connect with the parents. I remember one particular consult in which the mother just walked in and as soon as she sat down began to cry. She hadn’t even said anything to the doctor yet. Dr. Velasco, who at first was standing, sat down so that he could be at her level. In this world, doctors (and the medical profession itself) are often viewed as some of the most powerful people in the world with everyone else beneath the doctor. I have certainly witnessed some doctors that are very cocky and not humble. By taking his seat, Dr. Velasco made himself equal to this mother and showed empathy. To me, this situation highlighted one of the reasons why I want to go into the medical profession. To me, medicine is not just about human biology and science but includes humanism.
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