Rotavirus and Bazar

After working for several mornings in the Clínico Médico Pedriátrica with Dr. Flavia Rojas, I feel as if my clinical skills in regards to working with children have greatly approved. I have learned so much watching him interview and exam, and then doing it myself. It is neat to use the newly learned viruses and parasites and their appropriate meds during clinic hours. I am beginning to understand that what we memorize on paper (i.e. the high prevalence of RSV in children) actually plays out with patients! Nice to know we are learning for future practice. Not only do I feel like I am using Stritch material taught in class, but I definitely am taking in a lot of new information too. I think the biggest thing that I am gaining is opportunity to do the physical exam on children that Dr. Flavia teaches. I am impressed that it can reveal so much about the child’s health. I consider this a great benefit to treating the little ones since there is no conversation that can take place to describe the pain characteristics, the scale, onset, duration, and so on. Although I have had limited to no experience working with kids in the U.S., I believe it is rare to see the signs of dehydration and malnutrition in so many of our little patients back in Chicago and so I want to use this time to really pick up on clinical exam skills.

Yesterday, a woman brought in a 2 year old to be examined by Dr. Flavia. We did a physical exam, sent for a serum test, and found the baby positive for rotavirus. We treated the baby accordingly, but I was unaware of the implications of this diagnosis.

After the two left, Dr. Flavia expressed his concerns that extended beyond the visit from the woman and the baby. He explained that the woman worked at a non-profit facility called Bazar, sponsored by Christian and Spanish rotaries. Bazar houses children and adolescents for a variety of reasons. For example, many of the children are orphans; while some of the kids are there because their parents are drug addicts and some because their parents couldn’t financially afford to care for them (which is a relative concept). Many of the children at Bazar are in poor health or are at high risk for poor health. Although the facilities provided for the children to the best of their abilities (really to their financial ability), most of the house was seriously malnourished, which leads to weak immunity against infections and sickness and growth retardation. Additionally, many of the kids have psychological disorders because of in-utero drug abuse, previously being in violent households, receiving little emotional and physical attention, and so on. Because of these factors, and the fact that 20-some children and young adults lived together, the community was at very high risk for serious infection if rotavirus was present in even one child.

I was struck by the implications of one case of rotavirus in a little one and the dangers that it carried for the rest of the house. Dr. Flavia ended up cancelling clinic for the next day. We went to Bazar and did well-child checkups on twenty-sum children. It was a remarkable experience to have patient after patient in this manner.

A quick note on two of the patients there: I met a 14-year-old girl who had lived in the house since she was two years old. The girl was pregnant. It was emotionally difficult to imagine the baby and young mom living in such an unstable environment with little options for their situation to improve. Another young girl around the age of 13 presented Dr. Flavia and I with a baby less than a year old (8 months?). The baby had a severe Tinea infection with some open sores all over his body. The mom reported the baby have diarrhea very frequently. The young mother didn’t know her HIV status. We made a referral to the capital for the baby to get HIV testing done as soon as the fourteen year old could take her baby to an appointment. Who knows how long it will take…