And when you learn to walk, wear shoes to avoid those nasty hookworms.

11/13/2010

Yesterday was a day of first steps.

In the morning, the CHOP and NPS teams in their entirety met up at the clinic for our first-ever joint academic conference. The electricity in the clinic was out, so we were a little delayed waiting for someone to go buy gasoline for the back-up generator, so we could power our projector. But once the generator roared to life, doctors, nurses, pharmacists, and interpreters crowded into white metal chairs in the conference room and we were on our way! First, the two current rotating RRC residents gave a well-timed presentation about cholera. There has never been, to date, a cholera outbreak in the Dominican Republic, according to the NPS doctors. But with the worsening epidemic in neighboring Haiti showing no signs of abating, here it's on everyone's mind. Then it was our turn. Barbara Picard, nurse practitioner from CHOP's Market Street clinic, and Eden and I gave a case presentation. Our talk was on a bread-and-butter general pediatrics topic -- a child presenting with a neck mass. Nothing fancy, but we wanted to discuss how we approach a common complaint, with a broad list of diagnostic possibilities that we then narrow down based on the particulars of the case. More importantly, we wanted to learn how our Dominican counterparts would approach the same kind of patient.

Because of our late start, we ran over the allotted time, but the NPS, RRC, and CHOP pediatricians clustered around a table exchanging ideas and stories well into the lunch hour, in a rapid mix of Spanish and English that seemed to get everyone's point across.  After a quick stop back at Casa Roja for a lunch of the clean-out-the-fridge, day-before-departure variety, it was time for the second half of the health promoter workshop, the first having passed successfully on Thursday afternoon.

The health promoters are a group of barrio residents (usually women, as it turns out), one from each neighborhood, who've been identified by the community as particularly capable. Neighbors come to them for advice, and they serve as a link to Ramona and NPS. The health promoter model is not unique to Consuelo or to the bateyes or barrios -- but it's hugely important here. Though these women have no formal medical training, sometimes they're the closest a barrio child will ever come to seeing a pediatrician.  On Thursday, we met five of them in a breezy, covered outdoor meeting room at the Asilo, a residence for elderly men without families, run by the same nuns who founded the Centro de Salud. Alicia Genisca, CHOP second-year resident, delivered a charla on breastfeeding myths and truths, leading to a spirited discussion about community beliefs about breastfeeding. Barb then gave a talk about the contents of the supplemental food packets received by the families of children in the clinic's malnutrition program, and she passed along some recipes from Martina for the nutrient-dense foods in the packets (oatmeal, rice, beans, sardines, cornmeal, peanut butter, powdered milk, and calcium granules).

For day two, Eden led off with an expanded version of the parasite charla we've been delivering in the barrios for the past two weeks, complete with new and disgusting close-up pictures of worms.  Beth Resweber, CHOP PACU nurse, followed up with a companion piece on hand-washing, ending with her 20-second hand-washing song, which is always a crowd-pleaser (to the tune of La Bamba, "yo voy a lavar los manos...yo voy a lavar los manos con jabon, y un poco de agua..." ). Then Kelly and Carine and I gave our talk about vaccine-preventable illnesses, how immunizations work, and how to manage common side effects. Ramona delivered the part about the Dominican vaccine schedule, sharing a clever piece of Dominican wisdom that always impresses me: at birth, babies get the BCG vaccine in the left arm and the hepatitis B vaccine in the left leg; at 2, 4, and 6 months, they get a combined DTP/hep B/HiB shot in the right leg; and at a year they get MMR in the right arm. This way, even if a family has lost a child's vaccine card (which you can imagine might happen often given the crowded, cramped conditions many of them live in), by asking where the last shot was given, you can get a sense of how up-to-date a child's immunizations are. (But make no mistake, Ramona is strict on this: if a family can't provide an immunization record, the child starts the series from the beginning, no exceptions.)

At dinner, Kelly updated us on the data-gathering part of our anti-parasite barrio efforts: in two weeks, over one thousand barrio residents de-wormed and educated.

And to cap off the day, we found out that Lara's little daughter walked for the first time! We sat back and thought about it a little. It's a good feeling, learning to walk, watching the scenery change as you feel the momentum growing.

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Posted at 12:00AM Nov 14, 2010 by Pamela Mazzeo MD in Health  |  Comments[4]