One thing at a time

A lot happened this past week. We closed the clinic for three days in order to do a complete inventory. We stayed open only for emergencies of which there weren't many. A boy with a swollen and infected toe the size of a water balloon, a child with a gaping head wound, another with his ear cut in half and an 8-year-old with a 14-inch razor blade cut down his arm that needed 22 stitches. I spent most of the week sorting out expired meds and emptying a 20-foot trailer filled to capacity with hundreds of boxes full of ethyl alcohol, and pill & syrup containers of all sizes. It took all morning and part of the afternoon to sort and count everything. A donation totaling more than 9,000 bottles of alcohol, 2,700 pill containers and nearly 10,000 syrup bottles. A bit much for our small clinic, but a perfect opportunity to build relationships with nearby clinics and NGOs by offering them some of our extra supplies.

Since we are in the middle of nowhere, it is difficult to get and keep electricity. It's been better these last few days because we've installed some car batteries that can give us juice when the electric company shuts off electricity. They pretty much get to decide when they want to give us electricity and sometimes it's only for an hour or so in the middle of the day or randomly at 3am. The batteries are working great. We've had electricity 24/7 for the last two days. We don't have a fridge in the clinic yet (I'm hoping to raise the $2,000 to get a propane fridge that would be best for storing the vaccines). I currently have no place to store any vaccines so I've just been putting the PPD vials in a cooler with ice packs for now. We need a fridge asap, especially to be able to give out tetanus shots which the children desperately need.

Their are 640 children here and while the 150 who are either orphans or homeless, stay all year round, the others go back to their desperately poor families for two months of the summer and return for school in Sept. The way we have the TB treatment set up ensures that the 9 month regimen is complete before summer break starts. We identify all of the positive cases (what I'm doing now) and when the other docs come down in Sept., we will start treatment for the people who need it, that way their regimen is over by mid-May-early-June. The regimen is one pill everyday for 9 months. People in the US can't even adhere to such a regimen. For this reason, the house monitors (house mothers in charge of each of the 20 children homes) are responsible for distributing the meds every week to make sure the children take them. The older children and adults that don't live in the same area as all of the other children have no one to monitor their adherence to the regimen. The plan is to start DOT for those older people receiving treatment in order ensure adherence and prevent multi-drug resistant TB (MDRTB).

Most of the children have serious cases of scabies and ringworm of the scalp (tinea capitis). It is an enormous burden that can only be lessened by treating all of the children at once. The problem is that we only have enough meds to treat a few dozen of the children at most. Currently, we've been treating the children individually as they come into the clinic with scabies or tinea but this has proven to be ineffective at controling the outbreaks. Both of these infections are highly contagious and are difficult to prevent when only some of the children are being treated and all are sharing 3 or 4 to one bed. This isn't to say that there is nothing to be done if we can't get the meds. I'm drafting a plan for the control and prevention of the two infections and believe that we can drastically reduce the incidence of both by taking a few simple preventative measures. There's a lot to do. I'll post the abstract for the plan when I'm finished.