Daycare #5

I've come up with a theory (okay, okay, hundreds of other people have had this theory before, but I'm jumping on the bandwagon...). The more rural the place, the more health problems we are seeing. I'm sure when you get into the extremes of urban areas you see these things, too, but in general from the daycares and schools we have been to this seems to be pretty true.

The water supply is different in the rural areas. People get their water from big basins in common areas, and carry it back to the house in jugs and big containers in wheelbarrows, hands, or on top of their heads.

Today we went to two new daycares, and I got to see this theory in action. As we got off the bus, we saw a water area like the one above. Once we got closer to daycare #5, the water area looked like this. Daycare #6 was located pretty close to the first water area.

Once again, we were walking along a beautiful country road. The volcanoes and mountains loomed above the valley. Dust was going crazy every time someone drove by. And cows stared at us as we walked.

We even caught sight of a man spraying his fields with pesticides. No boots, no protective gear. Just the spray.

When we got to the daycare, we were greeted by a few overly-excited kids, who shouted friendly "buenos dias" good morning greetings to us. The rest of the kids were lined up waiting for us.

As for the theory, we saw some pneumonia, impetigo, malnutrition, coughs, and what was probably a heart defect. My first patient was a 5 year old girl who was a little small for her age (just on the border of what we'd diagnose as Grade 1 malnutrition). She didn't want to talk to me, so I just went on with my exam, and figured I'd have to find out for myself if there was anything going on. First thing I did was I had her stand in front of me (as I sat in my little toddler-sized chair) and I put my stethoscope to her chest. WOW! It was a grade V/VI murmur. It made all the other murmurs I've ever heard seem like a joke! It was so loud I couldn't hear her lungs well. It radiated to her back and both axillae. There was a strong thrill, strongest on the right side. The murmur was audible everywhere, but strongest at the aortic and pulmonic points. It didn't take me long to go get some help. I went and talked to the clinic's doctor who by chance was with us, and we noticed that she had strong peripheral pulses but had some clubbing and peripheral cyanosis. Her liver edge was palpable about 4 cm from her ribs. We got a little bit of history from the teacher, and it seems that she had fainted once. I'm not sure what else was in her medical history because her parents weren't around to answer.

We tried to refer the girl to the hospital, but the teacher told us that her parents wouldn't take her, even though we explained that it was important. The teacher, sadly, said something like "her mother wouldn't care if she died." So we wrote her a note to go to the clinic tomorrow, and we'll do more tests and try to get them into the hospital from there if need be. I'm working at the clinic tomorrow, and I really hope they make it in to see us!

As we said goodbye, not only did we get heartfelt thanks from the teacher, but we had a little follower who ran out after us. :)