CLINIC

Each day at Community Concern Society the medical center has a clinic with a special emphasis. Friday was "elder" clinic. I walked out of the office morning meeting to find about 70 gray haired angles, mingling about gossiping in Sinhala. I was told that they are mostly homeless, or live in shacks on the beach and have nothing to do. So, on Fridays, they come as early as they can and socialize. Friday at CCS is the highlight of the week for many of them. A physiotherapist from the "States" living in Sri Lanka conducted a morning presentation on stretching to alleviate aches and pains. A donation from the Center for Oral and Maxillofacial Surgery (based in Belleview, Washington) gave the money needed to start these programs and give sleeping mats to the elderly people so they don't have to sleep on the ground.

I've learned about many new afflictions from these patients. Pain usually involves an entire half of the body - and is exquisitely painful. I call it "half-body-pain" syndrome... very common. Looking through the scibles of doctors past, most of the time they have received paracetamol or B vitamins and sent on their way. For most of them, they feel this works miracles and would be happy with it again. One man complained of chest pressure and shortness of breath with walking. He had a blood pressure of 180 systolic, and complained of constantly being thirst and peeing a lot. We were able to take a blood sugar - 320. I was concerned about cardiovascular disease in the setting of likely diabetes. The arcus around his eyes didn't bode well for his cholesterol either. I was able to talk with one of the CCS managers and arrange financing for an ECG, cholesterol level, and chem 7. He is supposed to return next week with his lab results. I envision that we will start him on an ace and statin - fortunate things we were able to buy in stock from India at a fraction of the price compared to the "states."

Monday was "women's clinic." I was warned ahead of time that I would be asked to present a health education topic before clinic, so I decided to choose a culturally taboo topic that they might not have heard a lot about - breast cancer. I started by diagramming the anatomy of the breast to provide a little context. We then talked about what cancer is (in a nutshell), what the risk factors are, and what they should know about breast cancer screening. I then pulled a special T-shirt out of my bag. My translator and nursing student, Ruth, translated in Sinhala what I was about to do and ask for permission as to not offend anyone. In perfect unison the group of about 50 women replied, "we R nut shii - yoo con tich us anythiing." They had been taught well to receive useful information about keeping their bodies healthy.

I prepared the T-shirt the night before by drawing an outline of breasts on the front with a magic marker. When I pulled it out of my back and put it on for my health-lecture, the crowd erupted in laughter and smiles. I commented that because I was a man, a demonstration on myself would be of little use. The shirt might help to get the point across. It was well received.

I demonstrated the 5 steps to self breast examination and further educated them on the current recommendations of clinical breast exam and mammography. I also briefly explained what breast ultrasound, MRI, and FNA were in case they came across it. At the end, we had women come up front and demonstrate the steps of self exam; the rest of the group was to help them when they forgot a step. By the end of the talk, all the women knew how to do the exam, the basic information every woman should know about breast cancer, and they all felt that they could teach this skill to someone else. I felt like it was a success and great use of time. I made a simple handout describing how to teach the lesson along with the T-shirt so others could do it after I am gone.

I am continuously amazed by the medical culture here in Sri Lanka. When my host got otitis media/externa, I simply wrote on a piece of paper the antibiotics he needed, and he got it filled at the pharmacy - no problems. When our driver was hit by a car and had knee pain, I wrote the views he needed on a paper and he went to the radiologist and had the x-rays taken. This cost him 850 Rp (about 8 dollars!). He brought the films home in a plastic bag and I read them using the sun coming though the window as a light box. No fracture. Both are now doing much better.

Tuesday is a Sri Lankan holiday - a day where Buddhists visit the temple. I was sure to avoid the temples, as just this morning there was a suicide bomber in the deep south. Apparently there was a political demonstration or speech of some sorts. Although at times a little edgy, things still feel very safe here in Colombo. We took advantage of the holiday to catch up on a few things on the to do list. I took an inventory of the entire medication supply and put it on an excel sheet. Now we can see exactly what we have and know when to order more. I also created a well child visit form and method for keeping track of vital statistics and disease trends in our school-aged children so we can address current issues. Lots of work, but also very rewarding.