Based on 16 years with PH Project Haiti Started by Serge Geffrard then a second year medical student in 1996in Serges words Having grown up in Haiti I have always had a passionate desire to be part of a medical trip to my native country ID: 784609
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Slide1
Common Problems
Eloise Harman
Based on 16 years with PH
Slide2Slide3Project Haiti
Started by Serge Geffrard, then a second year medical student in 1996-in Serge’s words
“Having grown up in Haiti, I have always had a passionate desire to be part of a medical trip to my native country”
Without Serge’s passion and ingenuity, there would not be a “Project Haiti”
Slide4PH History
In Fall 1995, Serge, recruited several other students and a physician in private practice to go to Haiti during Spring break 1996
They stayed at an orphanage
The physician couldn’t tolerate the conditions (and the gastroenteritis) and left after 3 days
Serge persisted and with the help of Dr Parker Small, went back with a better organized group and 2 faculty in 1997. Serge also asked Dr Art Fournier of Project
Medishare
(U Miami) to accompany the group
Slide5Project Haiti was the pioneer for international service projects at UF
Slide6Common Problems
Organizational
Medical
Behavioral
Slide7Slide8Crowds and Organization
Develop organizational plan including triage and crowd control
Use the help of local people to maintain the organization
In advance, pack and label commonly used drugs like NSAIDs, Acetaminophen, vitamins
Limit the number of medicines that you give to an individual
Develop a system to mark people (
eg
children already given worming medicine)already seen to avoid repeaters
Slide9At each location take a few minutes to scout out the available sites for exams and figure out where the people will wait and the location of the pharmacy
One entrance and one exit
Triage
Obtaining a detailed history of a complaint may be difficult. Try to think of key questions.
Use observation, vital signs, common sense to determine who is really sick
Slide10Medications
Use caution and avoid giving multiple medications
Ask if they are already taking medication
Childproof containers may be desirable but teaching how to open them may be problematic
Ask women if they are pregnant or nursing
Label every drug clearly with name and strength and write directions in the local language or with pictorial labels
Slide11Werner, Where There is No Doctor, 1992
Medication Label for Non-Readers
Slide12Common Complaints
Fever
Itching/rash
Cough/wheeze
Malaise
Joint pain
Epigastric
pain
Headache
Dysuria
/discharge
Slide13Who’s Really Sick?
Change in level of consciousness
Unable to walk unassisted
Breathing fast/using accessory muscles
High fever
Bleeding/injury
Slide14Common Conditions
Skin rashes
Asthma/bronchitis/URIs
UTI/
Vaginitis
/STDs
PUD/parasites/H
. Pylori
DJD/muscle strain
Pregnancy
Hypertension
CHF
Malnutrition
Slide15Skin Conditions
Cutaneous
fungal infections
Impetigo
Scabies
Atopic dermatitis
Slide16Impetigo
A bacterial skin infection (staph
aureus
, strep
pyogenes
or combination
A red
macule
or papule progresses to a vesicle which ruptures easily to form an erosion, with characteristic honey-colored crusts that may be
pruritic
.
Often is spread to surrounding areas by autoinoculation. This infection tends to affect areas subject to environmental trauma, such as the extremities or the face.
Spontaneous resolution without scarring typically occurs in several weeks if the infection is left untreated
Slide17Slide18Impetigo treatment
Treatment is usually topical (
mupirocin-Bactroban
)
Oral antibiotics are recommended in more severe cases (
macrolides
,
cephalosporins
, amoxicillin/
clavulanate
)
Slide19Cutaneous Fungal Infection
Tinea
versicolor
(caused by yeast
melassezia
furfur
)
“Ringworm” (caused by
dermatophytes
)
Monilial
(Candida infections)
Slide20Slide21Slide22Tinea
Capitis
Tinea
faciei
Slide23Treatment
Topical
clotrimazole
Avoid using topical corticosteroids
Oral therapy:
Fluconazole
6 mg/kg for 2 weeks
Griseofulvin
20 mg/kg for 6 weeks
Slide24Scabies
Scabies is an infestation by the itch mite,
Sarcoptes
scabiei
. Mites are small eight-legged parasites . They are tiny, just 1/3 millimeter long, and burrow into the skin to produce intense itching, which tends to be worse at night. The mites which cause scabies are not visible with the naked eye but can be seen with a magnifying glass or microscope.
Slide25Signs/Symptoms
Small red papules and vesicles
Scabies may involve the webs of fingers, the wrists and the backs of the elbows, the knees, areas around the waist and umbilicus, the
axillary
folds, the areas around the nipples, the sides and backs of the feet, the genital area, and the buttocks.
Often there are erosions and crusting because of scratching
Slide26Slide27Norweigan Scabies
A severe form of scabies
occuring
in the context of
immunosuppression
The lesions are extensive and generalized
Skin may become thickened and wart-like
Itching may be minimal or absent
Slide28Treatment of scabies
Topical Treatment:
Permethrine
Oral treatment:
Ivermectin
: Dose is 200 micrograms/kg. May give a repeat dose in 2 weeks.
Antihistamines,
eg
diphenhydramine
(Benadryl), may help provide relief from itching.
Slide29Permethrine (
Elimite
)
Applied from the neck down and washed off the next morning
Safe for children over 2 months of age
Slide30Treatment of scabies
Wash linens and bedclothes in hot water. Since mites don't live long away from the body, not necessary to wash all of ones clothing.
Treat sexual contacts or relevant family members (who either have symptoms or have the kind of relationship that makes transmission likely).
Cut nails, and clean under them thoroughly to remove any mites or eggs that may be present.
Slide31Asthma
Sx
/signs:
Dyspnea
, cough, use of accessory muscles, wheezing
Acute management: Inhaled bronchodilator (
albuterol
) either by nebulizer or inhaler with a spacer
Short course of oral steroids if available
If you provide an inhaler teach technique and use spacer
Slide32Slide33Dysuria
UTI/
vaginitis
(
candida
, bacterial
vaginosis
,
trichomoniasis
)
Urine dipstick
Exam if conditions allow
Avoid empiric treatment without some indication of infection
Slide34Vaginal Discharge
Common complaint
A scant clear
or white
odorless discharge is normal
Itching, burning, irritation, redness, erosions, friability are associated with infection
Character, odor of discharge may be clue to
dx
Slide35Slide36Epigastric Pain
In patients with chronic abdominal pain H Pylori is common (62% in rural Haiti)
Treatment of H Pylori is complex and involves multiple medications-not practical
Generally we use PPIs (
prilosec
,
nexium,etc
) or H2 blockers (
pepcid
) or antacids in pregnant women
Slide37Joint/muscle pain
Hard labor
Muscle strain and DJD are common
Usually treat with ibuprofen
Use acetaminophen if older
or has
epigastric
pain
Hypertension and Other Chronic Conditions
If you are at a clinic that can provide
longterm
follow-up and medication, provide medication per their formulary
If already on a medication and has run out try to match this drug as closely as possible
Do not give medications for chronic conditions if there is no f/u
For hypertension, CHF can advise low Na diet
Slide39These Global Missions are Mutually Beneficial
Provide care for people in medically underserved areas
Interact with local health professionals and students
We gain better understanding of pressures faced by people in less privileged circumstances
Often this ignites an interest in service
Slide40Educational Gains
See a lot of patients
Observe physical findings and diseases that you may never see at home
You use powers of observation, physical exam and common sense rather than testing to make decisions.
Learn basic pharmacology
Interact with students from other disciplines
Slide41Final Word of Caution
Be careful in the country
Critical care for trauma or serious illness will be limited and it will take hours to evacuate a seriously sick or injured student
If you get seriously injured or sick in the country-this can jeopardize all future trips
Consider a “ no alcohol” pledge
Slide42