With a diagnosis comes a treatment plan. A couple weeks ago, I completed the chagas diagnostic rotation. To complement the diagnostic rotation, my ninth week of rotations was chagas treatment. My ninth week of rotation was a bit short because on Thursday I left for Argentina. Nevertheless, for the days that I was present for the rotation, I worked with Dr. Soledad and Nurse Selima.
With the chagas treatment program here, Dr. Soledad explained to me that there are two main categories: 1) treating patients for chagas and 2) treating patients for adverse reactions to chagas medication (usually benznidazol).
On the first day of this rotation, we drove out to a local school to meet with a couple of students that were positive for chagas. At the school, we met with two young female students; both girls had received benznidazol. The first girl that we saw had been experiencing adverse reactions to the medication. Because of the reaction, rashes began to develop on the girl’s arms and legs. To treat the reaction, Dr. Soledad gave the girl three different anti-allergic medications- loratadina, betametasona, and dexametasonar. The second girl was not taking her medication as the doctor had prescribed. She had missed several doses. When Dr. Soledad heard this, I could see that she was upset with the girl. As Dr. Soledad tried to explain to the girl the severity of chagas and the effects it has on the body, I noticed that the demeanor of the girl and the way she communicated with the doctor was as if she didn’t care that she had chagas. I had a hard time comprehending why this girl wasn’t following her treatment plan. After all, all the medicine that she was receiving was free. I guess I realize that even though you provide someone with resources it’s up to them to ultimately decide if they use that resource to bring about change and there is nothing more that the helper can do.
In addition to visiting the schools in Tarija, we also went to the countryside to treat chagas positive children under the age of 15. In my opinion, treating kids in the countryside is more difficult than treating kids in the city because it is difficult to deliver medicine to the countryside kids due to location. In order to make the process simpler, we went to schools and hand out prescriptions there. If possible, we tried to have parents present but most often the parents weren’t there. Most parents were absent because their houses are far from the school and they are often out working. To put distance into perspective, for the school located in Chaupicancha, on average it takes a student about 2.5 hours just to walk to school. This means that a student spends about 5 hours commuting to and from school! Most students have to leave their houses by 6 am in order to arrive at school on time. So, I can understand why some parents weren’t present. By not having a parent present this did create a problem because most kids didn’t understand the amount of medicine that they need to take each day and the time of day that the medicine needed to be taken. In order to provide a solution to this problem, we sent each kid home with an instruction letter to give his or her parents. The downside to this is that some parents in the countryside are illiterate. In addition, we also sent each kid home with a medicine-tracking card. The medicine-tracking card is a piece of paper that is divided into dates and the two different times of day that the kid needs to take the medicine. The card also has a picture of how the kid needs to divide the pills. Under each time column and day, the kid is supposed to record whether or not he or she has taken his or her medicine at that specific time.
Furthermore, for the chagas treatment program, we also made house calls. House calls are when we went to the houses of chagas positive children, who are currently taking chagas medication. At the child’s home, the doctor reviewed the child’s medicine tracking card and counted the remaining pills that the child had in order to make sure that the child was following the correct treatment plan. Also, while at the house, Dr. Soledad did a physical examination of the child to make sure that he/she wasn’t experiencing any adverse reactions.
In my opinion, I really enjoyed the house calls, and there definitely were a few interesting house calls that we made. At several house calls, we encountered patients in which the medicine-tracking card didn’t match up with the number of pills that the patient had remaining. When we encountered situations like these, I could see the frustration sweep across the doctor’s face. She would then begin her long explanation to the child’s parent(s) on the importance of diligently filling out the medicine-tracking card. Furthermore, during some house calls we had a feeling that the kid would be re-infected because of the environment that the child lived in. There was one house in particular that I remember in which there were huge piles of trash and debris inside and outside the house. Of course, the best way to prevent chagas is through vector control and one way to do that is to keep a very clean environment so that the vinchuchas can’t hide.
Furthermore, at one house call, we encountered a girl who had been taking benznidazol. However, she was having a very bad reaction to the medicine. She had edema all throughout her body and a rash that covered the entirety of her body. The doctor said that if we had not shown up and begun the treatment for her adverse reaction, she would have most likely developed Stevens-Johnson syndrome. I had never heard of Stevens-Johnson syndrome so I asked the doctor what exactly it was. She told me that Stevens-Johnson syndrome is a severe condition that affects the skin and mucous membranes. With this syndrome comes ulceration and the person’s skin begins to fall off. The cause is due to adverse reactions with drugs and all drugs have the potential of causing it. Unfortunately, for this girl, she can never again take any of the chagas medicines or else she’ll experience the same severe adverse reactions again. Moreover, because she can’t take chagas medication, she will never be cured of chagas and will have it for the rest of her life, which I find to be quite sad.
For this rotation, my job was quite simple. Besides observing the doctor work, I helped to calculate the amount of medicine that the patient would need based upon body weight and then counted the pills and put them in medication containers that the kid could take home.
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