Returning to Casa Maria

Today I returned to Casa Maria to see more patients in the Elderly Care home. We started very much in the same way that we begun the previous week – meeting the team and setting up a clinic area with one of the nursing staff. It turns out that the nursing staff are not trained nurses but carry out work that nurses would normally be expected to carry out.

The patients who I had seen the previous Friday had mostly not received the treatment that I had prescribed – the reason given being that they did not have much of the medication left and so they didn’t give any.

This was confusing and disheartening as the risk of complications greatly increases with delay in treatment. One patient, for example, had a skin abscess which had been draining pus. As incision and drainage seemed like an unsuitable option (due to likelihood of poor aftercare and so repeated superimposed infection) I prescribed some antibiotics to hopefully reduce the infection and aid healing. The patient had not been given any antibiotics and the abscess remained with a small blind ending tract.

Numerous other patients required a treatment of antibiotics but these were not readily available. Fortunately, my field manager suggested that we may be able to retrieve some of these from Maximo Nivel as they receive medicines as donations from doctors which can be used. 

One patient had been admitted a few weeks earlier with peeling of his skin. They had placed him in an isolation room – although it was unclear why. I assume it was because they thought he may have leprosy? I could not think of any other reason. He was very skinny and his bones were clearly visible. He had associated dry hair and the skin that was peeling was over many parts of his body. He didn’t have any signs of anaesthesia and the lesions were not hypopigmented. There were also no discernible thickened nerves. To me it seemed most likely that he was very malnourished which was leading to these  signs and his isolation did not seem necessary.

Having seen many patients, we gave instructions to the staff regarding the treatment plans for the patients and returned back to Antigua.

I went home for lunch and then went to the school where I spent an hour and a half talking to Helga. After this, I met my field manager again and we sorted through the bags of medication that they had received. It was a complete mixture of lots of medication and we put some aside that we thought would be useful for Casa Maria.

I spent the evening talking to the volunteers at the house and went for a walk into town.