Clinics servicing the Lives of refugees

So I thought the best way to relay all that I've seen in the clinic this week is just to type out the notes I took while I was there. First, a little background. The clinic I was in this week was an UNRWA clinic, servicing the Bethlehem and Beit Jala area. It provides primary care free of charge to any registered Palestinian refugee that comes through the door. Medications are also free, unless of course the clinic runs out, at which point the patient must buy it from another pharmacy. This particular UNRWA clinic had an "ante-natal" or pre-natal clinic, a non-communicable disease clinic for diabetes and hypertension, a vaccination clinic, and a general "I'm sick, help me" clinic.

My notes are typed out exactly as I've written them, in case you're into that kind of thing (you can imagine it scribbled onto a half-sheet yellow notepad). Therefore, it'll all be in weird orders and may not make any sense, but you'll deal. I'll try to explain things that are confusing in italics, also bearing in mind that many of you reading this don't have a medical background. Enjoy!

Vaccine Clinic

• use cotton doused c alcohol as "wipe" (c = with)
  
• no gloves (hardly)
• hardly any handwashing
• BCG/Hep B given at birth (vaccines; BCG = TB vaccine)
• Mom's not tested for HIV/STIs during pregnancy
  
• All boys are circumcised
• IUDs = #1 family planning (IUD = intrauterine device; implantable contraceptive)
  
• Nursing shortage (& only 3 doctors)
• 300/400 pts/day (pt = patient)
  
• avg 6 kids/family for refugees
• clinic = free (for refugees)

"Ante-natal" (Prenatal)

• "You are very nice. We love Indian style!" - nurse
• To get age of baby, measure from symphisis to fundus (rather than using ultrasound)
  
• Use sonogram to find fetal heartbeat - placental sound is like ocean waves
  
• 3 forms --> family planning, preconception, and ante-natal
• IUDs/condoms = most common
• Women deliver @ Holy Family HOspital c a referral - UNRWA pays 50%
• There are nuns who supervise the midwives --> from the Franciscan church
• Currently a non-smoking debate - 10 yr old kids smoing, "All bad things come from America"
• Just felt the head of the baby in a 35wk preg mom!
• Intercourse is good for contractions because of prostaglandins
• Cleaned the tape measure/sonogram c hand sanitizer on gauze - after like 7 pts
• Woman c warts/fingernail fungus - started crying as hey spoke to her
• Avg 18 yrs @ marriage, 19/20 for g1 (g = gravida = # of pregnancies)
  
• More women study/work now bc occupation caused men to be jailed/have less opps for jobs bc cant go past wall
• Just saw a baby c Downs - pretty young woman (20 yrs) - Mom got progesterone shot, stops preg for 3 mo.
• JUST SAW AN IUD PLACED! 14 yr IUD for woman c 5 children
• Most common problems c pregnancy: Anemia (give ferrous sulfate --> compliance issues taking c milk; also shortage for past 6 mo.). Also have UTIs, gest. diab., HT, etc.
• C-sxns --> doesn't know the # but thinks sometimes docs do more to get $ from UNRWA, or to get practice. "Doctors think about $ more than human life"
  

GP (General Physician/Practitioner)

• Literally people are flying through this lady's office! Pts are in & out in 5 min (they've already had vitals/labs elsewhere). GP = dx-ing machine (dx = diagnosis)
  
• Doesn't change spec when checking ears bc wax is not patho? Says its sterile, so no need to change out (observed nose s it) (s = without)
• So far seen: pharyngitis, tonsilitis, vag. candida, otitis media, well baby checks for vaccines, allergies, etc.
  
• Def no hand hygiene here.
• Brief note about doc: female Palestinian, studied in Ukraine, can speak Hindi. Super helpful, despite the hectic sched, she explains everything to me.
  
• And now we have 2 docs @ 1 desk c 2 pts. Still going a mile/min.
• "1 x 3 x 7" = 1 tablet, 3x a day, 7 days
• Pts line up @ door (more or less) - Try to keep privacy by having people stand in doorway behind bookshelf.
• "drop foot" --> SX = urinary incontinence, areflexia, and one more Sx
• Also seen: atrophied tonsils, taken BPs of preg. women, slip disc, SNHL, fractured trochanter, chest x-ray of slightly enlarged aorta
• Doc's got a pocket Bates'

That's all for now. More later about our first few days at the Lajee Center with the kids.