We had our first day of clinic today! We’re still in Nako and had a very busy clinic day. We saw a wide variety of patients from ages 5 to 95-years-old, all with different complaints. Probably one of the most insightful things I learned today is to always inquire if a patient is taking medication at the start of the visit.

A 45-year-old gentleman came in to see us, complaining of diarrhea and abdominal pain. My medical student and I were halfway through his visit when we got to his medication history and learned he’d been diagnosed with abdominal tuberculosis just last week!

This crucial nugget of information, of course, changed our entire visit.

It also illustrates how exponentially difficult the language barrier makes clinical care abroad, especially when we ask patients if they have any “medical conditions.” So many English words just cannot be easily translated and vice versa.

We had two pregnant patients in our tents who we referred for OB ultrasounds using the Lumify system. Thankfully both ultrasounds were normal. We also got to use the iStat machine (provided by Abbott) for the first time today and it worked beautifully! We had a patient who was jaundiced and we checked his hemoglobin to decide if he needed to go to the hospital.

It turned out his hemoglobin was 10.5, so we didn’t feel compelled to send him to the nearest hospital, which was four to five hours away. His father, unfortunately, had severe sepsis from severe pneumonia. He was very ill, so we sent him on a public bus to the nearest hospital after giving him a course of oral antibiotics.

We also suffered through a sandstorm this morning that left everything in its path covered in a nice thick layer of Himalayan dust, including ourselves! Nevertheless, we persevered and completed a busy clinic day.

In the evening, I reviewed performing a cardiac physical exam with our students. My first echo teaching session with them also went very well. They were excited to learn about ultrasound mechanics and physics and are looking forward to performing their first exams.

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