Wednesday, May 21, 2014

Hospital Closed: On Strike

Kinda crazy, but true.  The government hospitals in Cusco and Abancay (the two nearest cities) are on strike. Probably related to wages or work hours or something along those lines.  It complicates our jobs because when we need specialists or CAT/MRI that’s where we send our patients.  Technically the hospitals are still seeing “emergencies.” (whatever that means).
    I have a patient, Policarpo, who arrived at our hospital Friday with his brother and family friend.  He’s in his 40’s, maybe has some sort of baseline metal delay, but presented almost completely unresponsive.  He’d been admitted at the hospital in Abancay for 3 days with “preseptal celulitis.” (Infection of the superficial area of the eye socket).  His family reported that prior to this illness he was working in the field, but since the onset of this illness he’s been bedbound and incontinent of urine and stool.  According to the discharge papers he was clinically improving so he was sent home on oral antibiotics.  No CT scan was ever done, supposedly.  (Most of our history comes from the family, so culturally you have to ask questions at least 3 times, and sometimes even then they won’t tell you everything or the truth).
  His family says he was throwing up to antibiotic, bedbound and barely responsive so they brought him to us.  He laid on the stretcher nearly dead looking, but if I yelled “What’s your name?” in Quechua, he’d open his eyes a crack and move his mouth as if he was going to answer, but nothing would come out.  His GCS was 9 (a way of measuring neurological responsiveness.  15 is normal. 0 is dead. 8 or less you should probably intubate to protect them against aspirating.)  His labs weren’t super impressive, WBC 8, CRP 10.  But clinically he looked bad.  He still had a red swollen perioribal area on the left with a fluid collection on ultrasound. He needed a CT, but our new one is still stuck in customs in Lima, and we weren’t confidant he’d make it Cusco, especially since they’d spent most of all of their money on their 3 days in the hospital in Abancay. 
                So I admitted him for Orbital Cellulitis on Cetriaxone, Vancomycin (which was a debate, because its expensive and I’m not sure of the prevalence of community acquired MRSA in Peru, though its recommended for patients in the USA), and Metronidazole.  By the next morning his GSC was up to 12. By Sunday he was consistently at 14.  Yesterday he was consistently 15.  But he still continues with profound debility and incontinence.  Since he’s been alert enough to talk, in Quechua he complains of pain when he moves his eye (I say “in quechua”, because once you go through 2 language barriers, I start doubting whether or not we’re talking about the same thing anymore).  He still really needs a CT to rule out abscess or any sort of intracranial process.  We never performed a spinal tap, because we didn’t have a CT first.  He’d received 5 days of IV antibiotics today and the plan was to send him to Cusco for a CT, but after talking it over with Martina, we’re really afraid he’ll get lost in the system because the hospital is still on strike and the family doesn’t have any money.  So we kept him on for a couple more days of IV antibiotics, ambulation and physiotherapy.
                Please pray for Policarpo and his recovery.  Pray for wisdom on when to send him for a CT.  Pray for our CT to be released from customs.  Pray for our X-ray machine which broke 2 weeks ago (we were without x-rays for a week, and now were using old schools films [thank the Lord for them] until the digital machine is fixed).

1 comment:

  1. Ari! That is crazy . Im glad Policarpo has you there though. Miss you friend and praying for you!