Ambulancia

It is not uncommon here to have a patient in clinic who has organophosphate poisoning since it is a main ingredient in most insecticides. This is a rare thing to happen in the US but common in developing countries where its use is very prevalent in farming (we even have cropduster planes on our plantation that fly over every morning for a few hours spraying it around, I stay inside during this if possible!). We also happen to be a catchment area for a lot of people who work on farms. We’ve had many patients come in with neon red hands, which I initially thought was from painting, but found out was from working with insecticide without gloves—apparently they are provided with 1 pair of gloves for protection that they can swap out, but if they lose their first pair, then they can’t get more. I’m pretty sure masks aren’t common either.

Organophosphates can get into your system by ingestion, inhalation, and across your skin (gloves would help) and it makes every part of you leaky and also happens to be a medical emergency. In the US you often go straight to the ICU since there could be a need for intubation, cardiac monitoring, and even pressors to stabilize.

It’s pretty scary to get a patient like that in a rural clinic. In one of these situations, I got to ride in the back of the ambulance with the patient to the nearest hospital in Coatepeque (turns out when you’re pummeling across the road in the ambulance you can get there in closer to 30-45 minutes). I was in the back with the PA student, a nurse, and a nursing student. We only had a back board, oxygen tank, and were carrying atropine with us (we had not given it because if given before the hospital, the patient has to pay but couldn’t afford it (we had already paid for the ambulance ride to help out), but if the same med is given at the hospital , the global insurance should kick in). I was trying to visually monitor the patient to make sure they were breathing and their heart was beating all while trying to finagle a plan for what to do if any of those things changed en route. It was a little nerve wracking.

We dropped the patient off at the hospital and hoped they would treat them appropriately. We then looked around the hospital’s ED just to get a feel, it was pretty small but seemed to have a little bit of everything with different blue painted, open air rooms for maternity, pediatrics, and adults.

Of note, we had been bumping around and accelerating/decelerating suddenly while we were in the back of the ambulance on the way there and then we had to turn right around and head back, mostly with my head between my knees or poking out the little window.

Some random clinic musings:

--Everyone, including you and your patients kiss on the cheek to say hello. I’m not sure if handshakes or this style of greeting is worse for transmitting infections in the medical setting..

--“Fiebre adentro” (fever inside) is a very common complaint describing feeling generally unwell and trying to describe an infection or similar process moving into the body. I can’t totally wrap my mind around what it really means though.

--We take our porcelain toilets for granted when asking questions about stool changes, it’s a lot harder to determine if anything is different when your toilet is a dark hole in the ground.

Also, THIS is a cashew fruit:

And it's disgusting except for the little nut inside that top green shell part.