Experiancing El Salvador- Clinic Day #1

Monday, January 30th, 2012 – Clinic in Izalco

Our first clinic of the week was in the Village of Izalco. Our clinic this day was set up in the church, and two of the nearby buildings. A variety of patients were seen at this clinic, varying both by age and medical condition. Although we saw only adults at this particular clinic, each of our patient’s came with a unique concern.

A variety of health conditions were seen at this clinic, ranging from a middle aged female complaining of headaches, GERD, and a yeast infection, to a 65 year old female with new onset hypertension and a new cataract. We also saw a patient with severe Glaucoma, who appeared to be nearly blind. Both of these patient’s seen with ophthalmic conditions were transferred to the vision center for evaluation. Another patient seen had severe deformities of the right hand and foot from a burn as a child, however had adapted very well and had no residual issues.

One of the male patient’s seen at this clinic was in his mid-thirties, and came with concerns about a history of a seizure disorder, as well as increasing issues with insomnia, anxiety, and anger. This patient was being followed by a neurologist for his seizure disorder. However, he was noticing an increase in the psych issues in his own life, and knew he needed help. He also noted they were starting to have issues at home with his family. We referred this patient to talk to the psychiatric nurse practitioners. Later, we were told that this man was the president of the community, and had been open to a very effective session by himself, and with his young daughter. While we were glad that this man had been given help and hope for the issues he was experiencing, we were also excited to know that he had set an example for the community by opening up about his issues, and accepting help from foreigners.

One of our most memorable patient’s from this particular clinic was a 40 year old male, who presented with concerns about a rash. I did not initially notice the rash on his arms, but as I approached this patient to obtain his blood pressure, the large open lesions on his arms were impossible to miss. Although the patient was wearing long pants, and a dark colored t-shirt, it was apparent that this patient had a serious skin condition, as the exposed portion of his arms was extensively affected.
Initially, the lesions on his skin looked like Ringworm, as they were generally circular in shape, with raw, open interior areas. However, as we talked to the patient and obtained a history my differential diagnosis began to change. The patient told us he had had this condition for about five years, but over that time the severity had varied. At one point, about a year ago, the condition was almost completely resolved, with only small lesions on his forearm and in the crease of his elbow. He told us that over the past few months the condition had been gradually getting worse and covering more of his body. When we asked what other areas of his body were affected, he told us that his back, abdomen, and lower extremities were all covered with the lesions.
As we continued to ask questions, the patient told us he had seen a specialist several years ago, who had diagnosed him with Psoriasis and given him a cream for the lesions. After this diagnosis, the patient had changed his occupation to avoid exposing his skin to the direct sunlight on a daily basis. This change in occupation, as well as the use of the topical cream, had significantly improved his condition. However, ever since the death of his son six months ago, the condition had been getting progressively worse. He had used all of the topical cream he had been given in the past, and therefore was not treating the condition or symptoms in anyway.
Further exam revealed that his entire torso, both anteriorly and posteriorly, was extensively affected, as well as his bilateral lower extremities. The only body areas not affected were his neck and face; however, faint scars were visible on the patient’s head, indicating that in the past, these areas had also been affected.
Due to the limitations of the medications and services we could offer in this clinic setting, we strongly encouraged this patient to be seen by a dermatologist as soon as he could. Additionally, we prescribed him topical steroid cream, as well as Benadryl to help reduce the itching and discomfort. Lastly, we encouraged him to meet with our psychiatric nurse practitioner to address the stress component of the condition.