Practice Medicine Around the World

Transcription

1 Practice Medicine Around the World David Bryman, D.O Volunteer Physician Disclosures None 1

2 Why volunteer Make a huge difference in peoples lives You have knowledge and ability that only very few people have Travel to places few people ever see Practice medicine like never before Be part of team Understand and respect cultural differences Remotologist Mexico Cambodia India Africa Kenya, Nigeria, Tanzania, South Africa Remote America Alaska Kotzebue, Bethel,Wrangell, Navajo Nation Kayenta, 2

3 Todays Talk Mexico Cambodia Kenya Mexico Flying Samaritans Group started over 40 years ago What would you do if you lived over 100 miles from the nearest medical or dental care and had no money for treatment? You would hope a good Samaritan would come and help you! 3

4 Baja Flying Sams Mission is to provide medical and dental care to remote areas of Mexico Lopez Mateo approximately 600 miles south of San Diego To teach the first year graduates in the village Cooperative effort with the medical community clinic is licensed as well as all providers for the day of the clinic 4

5 Clinic day Providers start out in PHX or Tucson fly to Mulege or Loreto, then on to Lopez Saturday AM Weather check on the sea of cortez side then coordinate with Pacific side for marine layer Airplanes fly in a group Clinic day Patients sign in way before the providers arrive One patient came 2 days by horse back Given a number for the clinic they request Dental, Pediatrics, GYN, Skin surgery, Chiropractor, General Medicine, occasional specialty care Triaged by RNs or Medical students Providers have interpreters available to them 5

6 Clinic Patients carry their own medical chart and bring it to the clinic when they are seen Specialty care is available in certain circumstances Most out of clinic expenses are paid for by the group We provide medication bought in MX Treat a variety of common problems, DM, HTN, CAD, Clinic Services Triage Medical Pediatric Dental Psychology at times Cardiology at times Neurology at times Eye doc/glasses Skin surgery 3 5 times per yesr 6

7 The Chicken El Pollo Loco 7

8 Dental 8

9 Hurricane 2009 Mulege Challenges Travel in a small aircraft sometimes issues Runways flooded Weather Hurricanes, Marine layer Medical system difficulties X rays, lab, specialists 9

10 Some Cases Umberto Jaw guy Teenager abuela Cataracts 10

11 Umberto 11

12 10/27/2016 Jaw guy teenager Medical Students (D.O) 12

13 Cambodia Cambodia Slightly smaller than Oklahoma 14.5 million people Borders Thailand, Vietnam and Laos Southeast Asia Weather 2 seasons dry and monsoon 13

14 Cambodia Horrific past War, Famine Drought, natural disasters One of the worlds poorest countries The countries hope is with its children over 50% of the population is under 15 many of the parents lost to the horrors of the killing fields The killing fields refer to almost a 4 th of the country systematically killed and burried by Khmer Rouge a communist movement in the 70s Motto To keep you is of no benefit, to destroy you is of no loss Cambodia After the Vietnam war, in 1975 Khmer Rough took control and Cambodia entered the dark ages entire cities were emptied and people forced into the rural area. Over 1.5 million people died. In 1978 Vietnam invaded Cambodia and occupied it for 10 years, this also started a civil war that lasted 13 years 40% of Cambodians live on a dollar or less per day Physicians earn less than 300 dollars per month 14

15 Cambodia Pediatric Mission Children affected by disease, hunger and poor sanitation Ignorance to proper hygiene Cambodia Mission Children are examined Educated on how to care for their bodies Nutritional supplements Immunizations Head to toe exam 15

16 Acute Respiratory Infection Is the leading cause of mortality in young children ARI kills nearly 2 million children under the age of 5 in developing countries Diarrhea Frequent cause of death in children under 5 years old 19% of children under 5 suffer from diarrhea and 5% have bloody diarrhea Diarrhea and Acute upper respiratory infections account for 80 90% of all deaths of children under 5 years old 16

17 Fever Malaria Causes over 300 million episodes of acute illness and at least 1 million deaths of people of all ages Maternal Nutrition 60% of pregnant women in Cambodia are anemic Babies born to malnourished mothers are more likely to be underweight Underweight babies are at high risk for infection, disabilities including hearing, vision and learning Underweight babies in Cambodia and 2 and a half times more likely to die under 1 month old 17

18 Infant mortality Highest in rural areas 170 deaths per 1,000 live births VS 38 deaths per 1000 in Phenom Penh Rural children born to mothers without education and those who had no assistance with their delivery have a much higher mortality Cambodia In Cambodia, 1 in 8 children will die before his/her 5 th birthday They may suffer from diseases easily preventable through nutrition, immunization, and sanitation 18

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20 Eye Kid 20

21 Lunch? 21

22 Kenya Kenya borders Ethiopia (north), Somalia (northeast), Tanzania (south), Uganda (west), and South Sudan (northwest). The Indian Ocean is on the eastern side. The coastline houses the port of Mombasa, which enables Kenya and several other countries, including Uganda, Rwanda, and South Sudan, to engage in global trade. Kenya 22

23 Kenya The majority (64 percent) of households in Kenya do not have electricity Almost half (46 percent) of households live in dwellings with cement floors. More than half (53 percent) of households use one room for sleeping. More than half (56 percent) of households use wood as their main source of cooking fuel. 23

24 Kenyan Children The infant mortality rate is 39 deaths per 1,000 live births, and under 5 mortality is 52 deaths per 1,000 live births. At these levels, about one in every 26 Kenyan children dies before reaching age 1, and about one in every 19 does not survive to his or her fifth birthday. Male children are more likely than female children to die during their first year of life (44 deaths versus 37 deaths per 1,000 live births). Once past infancy, male and female children one to four years of age experience the same level of mortality (16 deaths per 1,000 live births). USA 24

25 Childhood illnesses Acute respiratory infection Diarrhea parasites Nutrition Fever/Malaria HIV Female genital mutilation Childhood Illness and Treatment URI 63% of children with severe infection are taken to a healthcare facility for advise 9% of children are taken to a healthcare facility under age 5 for fever 25

26 Education in the bush contry The proportion of children with diarrhea taken to a health provider for advice or treatment increased from 49 percent in the KDHS to 58 percent in the 2014 KDHS. Education The proportion of children with diarrhea given fluid from ORS packets has increased over the past five years, from 39 percent in to 54 percent in

27 Education The percentage of women who know that ORS can be used to treat diarrhea in children has increased from 78 percent in to 93 percent in The percentage of children whose stools are disposed of safely has increased from 78 percent in to 83 percent in Nutrition Nutritional Status of Children Twenty six percent of children under age 5 are stunted, 4 percent are wasted, and 11 percent are underweight. 27

28 Malaria Net Ownership and Use Six in 10 households (59 percent) own at least one insecticidetreated mosquito net (ITN), while 34 percent of households have at least one net for every two people. Forty eight percent of Kenyans have access to an ITN. Two fifths of the household population (42 percent) sleep under an approved mosquito net Fifty four percent of children under age 5 mostly city 28

29 Fifty one percent of pregnant women overall sleep under net Seventeen percent of women received intermittent preventive treatment (IPTp) for malaria Twenty three percent of children under age 5 who had a fever took treatment for malaria and 13 percent took treatment within 24 hours of fever onset. HIV/AIDS Awareness of and Knowledge about AIDS Awareness of AIDS is universal in Kenya. However, only 56 percent of women and 66 percent of men have comprehensive knowledge about HIV and AIDS prevention and transmission; that is, they know that both condom use and limiting sexual intercourse to one uninfected partner can prevent HIV, they are aware that a healthy looking person can have HIV, and they reject the two most common local misconceptions about HIV: that HIV can be transmitted by mosquitoes and by sharing food. 29

30 Female Genital Cutting Twenty one percent of women age have been circumcised. There is some evidence of a trend over time to circumcise girls at younger ages. Kenya Volunteer Clinics Set up in villages part of a network of support by cooperative efforts between USA based groups, churches, medical associations, charities All children in each village are examined Triage area, pharmacy, deworming area, vitamin area, nutrition area, specialty area for complicated cases All children given vitamins and dewormed Malnourished children put in nutrition program All fever is treated as malaria Team will see and treat about 3000 children in a week 30

31 Healthcare workers Jambo 31

32 Kayenta Arizona 32