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Common Problems Eloise Harman Common Problems Eloise Harman

Common Problems Eloise Harman - PowerPoint Presentation

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Common Problems Eloise Harman - PPT Presentation

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

treatment scabies pain common scabies treatment common pain infection conditions areas provide haiti medication skin people itching avoid sick

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Slide1

Common Problems

Eloise Harman

Based on 16 years with PH

Slide2

Slide3

Project 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”

Slide4

PH 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

Slide5

Project Haiti was the pioneer for international service projects at UF

Slide6

Common Problems

Organizational

Medical

Behavioral

Slide7

Slide8

Crowds 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

Slide9

At 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

Slide10

Medications

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

Slide11

Werner, Where There is No Doctor, 1992

Medication Label for Non-Readers

Slide12

Common Complaints

Fever

Itching/rash

Cough/wheeze

Malaise

Joint pain

Epigastric

pain

Headache

Dysuria

/discharge

Slide13

Who’s Really Sick?

Change in level of consciousness

Unable to walk unassisted

Breathing fast/using accessory muscles

High fever

Bleeding/injury

Slide14

Common Conditions

Skin rashes

Asthma/bronchitis/URIs

UTI/

Vaginitis

/STDs

PUD/parasites/H

. Pylori

DJD/muscle strain

Pregnancy

Hypertension

CHF

Malnutrition

Slide15

Skin Conditions

Cutaneous

fungal infections

Impetigo

Scabies

Atopic dermatitis

Slide16

Impetigo

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

Slide17

Slide18

Impetigo treatment

Treatment is usually topical (

mupirocin-Bactroban

)

Oral antibiotics are recommended in more severe cases (

macrolides

,

cephalosporins

, amoxicillin/

clavulanate

)

Slide19

Cutaneous Fungal Infection

Tinea

versicolor

(caused by yeast

melassezia

furfur

)

“Ringworm” (caused by

dermatophytes

)

Monilial

(Candida infections)

Slide20

Slide21

Slide22

Tinea

Capitis

Tinea

faciei

Slide23

Treatment

Topical

clotrimazole

Avoid using topical corticosteroids

Oral therapy:

Fluconazole

6 mg/kg for 2 weeks

Griseofulvin

20 mg/kg for 6 weeks

Slide24

Scabies

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.

Slide25

Signs/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

Slide26

Slide27

Norweigan 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

Slide28

Treatment 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.

Slide29

Permethrine (

Elimite

)

Applied from the neck down and washed off the next morning

Safe for children over 2 months of age

Slide30

Treatment 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.

Slide31

Asthma

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

Slide32

Slide33

Dysuria

UTI/

vaginitis

(

candida

, bacterial

vaginosis

,

trichomoniasis

)

Urine dipstick

Exam if conditions allow

Avoid empiric treatment without some indication of infection

Slide34

Vaginal 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

Slide35

Slide36

Epigastric 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

Slide37

Joint/muscle pain

Hard labor

Muscle strain and DJD are common

Usually treat with ibuprofen

Use acetaminophen if older

or has

epigastric

pain

Slide38

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

Slide39

These 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

Slide40

Educational 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

Slide41

Final 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