​ This patient had been in a prior accident and was being treated for an ankle wound. I was chart checking the medics and saw he had fevers for 6 days despite being on antibiotics (Cloxacillin is their gram positive med and they had him on IV Metronidazole too). He would be a Sepsis Alert in a bigger hospital. Yesterday was my second clinical day this week and he had been admitted last Friday after I left. I saw all medical patients 2 days ago and then saw all the trauma patients yesterday, along with the sicker medical patients again. So I went to examine him for the first time, already intending to tweak his antibiotics with some I bought from India. His ankle was warm and tender but not swollen or oozy. He said it felt a lot better but his ipsilateral thigh was hurting a lot. I noted a warm, swollen, and tender thigh. He had a healed surgical scar there. I grabbed the ultrasound and discovered a big fluid collection all along the top 2/3 of his femur. One portion was encapsulated. S

Got potassium?

​Today we had a young lady with Type I diabetes who presented with blood glucose in the 300s, diffuse weakness or and 3 ketones in her urine. She also had diffuse abdominal tenderness but no distention or guarding or bleeding anywhere. Vitals rather stable.  She had been off of her diabetes medication for a few months. She actually had received care at the local Thai hospital in the past and had been an oral medication only.  There was some concern for DKA.  Interestingly, the head medic pulled out their guidelines for chronic disease, and I peered over her shoulder while I worked on a quality measures project I’m doing. The DKA guidelines said to give 1 liter IVF per hour. That is all. Their only clue to potential acidosis was ketones in the urine.  They can’t test metabolic panel, pH; don’t have insulin drip or potassium infusions. We have subQ insulin leftover from patients who have expired, and a bottle of insulin I bought at the local pharmacy just in case. We have potassium tabl

Big Head Baby: "Snow Falling Down"

 Back in August, before I arrived here, a Burmese mother arrived at the hospital in labor. She had not wanted another pregnancy, so she took some medicines to try to abort the baby. The medicines didn't take, though, and she remained pregnant. She did not have any prenatal care, so did not know to take vitamins or alter her nutrition. It is also possible she just wasn't able to obtain any of those things.  When she was in the prenatal area, a cursory ultrasound showed that the fetus had an abnormally large head, so the mother was transferred to the bigger hospital for a c-section. The baby girl was born with severe congenital defects, including cleft lip and palate, microphthalmia of her right eye, one shortened arm that never developed a forearm and had a vestigial non-bony finger at the end, abnormal fingers of her other hand and toes of both feet, and of course hydrocephaly. I have not been able to procure the early imaging of the baby's head, but another volunteer here

Bombs for Christmas

On Christmas Eve, we received news that the land just across the Thai-Burma border from us would be bombed by the Burmese military government.  The military used RPG’s, air strikes, tanks and other heavy artillery to decimate the area, forcing thousands of the nation’s own people to flee into the forest or to the edge of Burma for safety. Reports said the military government had killed women and children, and many bodies were found burnt to crisps inside vehicles. Just cruelty and fear everywhere.  We have had an influx of the post-bombing casualty patients, from sniper bullets to the skull to paralysis to amputations to extensive wounds and broken bones, lost eye sight and more. We currently have 3 patients with tracheotomies and 3 amputees. After they stay on the unit awhile, they get moved to Patient Housing which is basically an roofed outdoor facility similar to a rest area you might stop at on a long road trip. They sleep on wooden benches in there and have no home you go to anym

We Use What We Have

​ Sometimes I get frustrated because we just don’t have basic equipment we need for patients.  For example, here is the baby incubator I saw when I first got here. Yikes. I was planning to scrub it down with bleach myself.  Then I saw we had a better one, but it still made me nervous: And then 2 weeks ago we got this amazing one: I was very excited we got a donation of state-of-the-art medical equipment.  There are a lot of other things I hope for here. The thing is, sometimes the hospital isn’t ready for new tech. I’ve been on a bit of a soapbox about us getting more lab test capability. We have CBC, POC Glucose and urine pregnancy, Total bili, malaria smear, and urinalysis without micro.  We have a TON of cirrhosis, alcohol withdrawal and altered mental status patients. I’m working on a sepsis protocol because we have so many deaths from sepsis. But we can’t check lactate, sodium, potassium, calculate anion gap, creatinine, LFTs or anything else for critical patients. We had an alcoh

GoFundMe is finally set up! Please join!

​ Most of my Global Health Fellowship year is spent here on the Thailand-Burma border helping a 30-year old refugee clinic to develop emergency medicine and acute care focused care. The patients are escapees from one of the world's longest civil wars and have become stateless refugees. The mission of the clinic I am helping is to provide Healthcare as a Human Right. I have seen that many of the displaced people are very poor and often cannot afford even simple life-saving diagnostics and treatments such as chest X-rays, antibiotics, immunosuppressants for diseases that are ravaging their vital organs or transfer to the bigger hospital for severe hypoxia or sepsis. Others need simple things like walkers, crutches, physiotherapy equipment or nutrition (generally that consists most basically of formula for malnourished babies and rice and oil for adults). Healthcare providers in Burma have been targeted and forced out of the country, so many Burmese come acr
Curriculum meeting nwe ni: no emergency care here (GIB, AUB, DKA) no IV potassium here. No IV insulin.  Concern should we bother teaching the treatment if we don’t have the resources? I think yes. When in doubt, train up and look to the future. Don’t train down because as we grow, medics will need to know the right way to treat patients. We don’t have to go into excruciating detail. But we can mention the ideal treatment and why it’s important