A Day at the OPD!

Well I hope this doesn't bore everyone to tears, but I decided to write a blog about a typical busy day at the OPD(outpatient department) here at Karanda Hospital(by the way it was April 12). If nothing else its just a good way for me to look back and see what kind of things we see on a usual OPD day. This will probably be more interesting to those of you in medicine or just those of you who find medicine interesting. To the rest of you read on at your own risk. I'll be just listing the majority of the patients I saw, but for your reading pleasure I might just throw in some interesting side commentary.


Anyway, as always the day starts out for Shea, Paul and I rounding on the wards. This month Shea and I have been in the Female Ward. Female ward is generally the busiest. Usually we have anywhere from 25-30 patients that need to be seen. Luckily for me on this particular day we only had 18 patients....so as you can imagine it made rounds quite a bit faster. On this day the female ward had 9 post-operative patients(ranging from hysterectomies(5), ovarian tumor removal, scalp tumor removal, thyroidectomy, and vesico-vaginal fistula repair). We had 9 other patients with diagnosis's ranging from: HIV, TB, pneumonia, vaginal bleeding with severe anemia, heart failure, and intractable Headache. After rounds is when the fun began!

Now to give you some background OPD is not just a normal outpatient clinic. We don't have an ER here at Karanda so from 9-5 everyone goes straight to the OPD....so there is always an interesting mix of the worried well, and critically ill. Basically, the clinic takes place in a fairly small room surrounded by benches. We are all quite packed together in a poorly circulated, warm room. I will sit at a table with a translator next to me, and a long line of people sit crowed around us on benches waiting for there turn to be seen(Its actually a bit unnerving because they just sit and stare why you talk to and examine the other patients). The nurses triage the patients and actually 25-40% of the patients are actually seen by nurses. Its the lucky ones who actually get to see a doctor (Well I guess that depends which doctor it is :)) Many of these people live within a 5-10 KM area, but the majority live quite far away, and many had to get up as early as 4 am to wait to be seen.

On this particular day I saw 68 patients (which is probably quite typical). Now to put this into perspective most family medicine clinics see about 20-30 patients a day(and this doesn't account for all the other patients that the nurses saw). So its quite different than what we are used to back home, and I can tell you I'm learning a lot. OK,OK,OK, now for the list you have all been waiting for. Many of them are fairly routine things, but many were quite interesting. I will just list them in the chronological order I saw them.

I saw crytococcal meningitis(brain infection in HIV patient), drug reaction to HIV medicine(quite common since the HIV meds have many side effects), HIV wasting syndrome(this is usually the last stage before death for these patients), olecranon fracture(fracture of the elbow), foot fracture, fracture of the tibia/fibula(the fracture was a bit old and probably difficult to fix), ascaris infection in a toddler (worms that crawl around your bowels.....think about that tonight when you eat some pasta), Tertiary syphilis,( This was actually quite interesting. This man came in with paralysis from the waste down for 5 days. He had large painless ulcer on his privates (gotta put that for the kids).....usually diagnostic for syphilis. Of course he was HIV positive..so this always complicates everything.....I started him on antibiotics, and when our X-ray machine is working again we'll take a picture of his spine, but for now we'll see how he does), Conjunctivitis (infection of the eye), Kaposi Sarcoma (tumor caused by HIV), Benign prostatic hypertrophy (we see a lot of these around here, since we are one of the only hospitals in the country that removes prostates), new diagnosis of tuberculosis, tension headache, hypertension/backache (fairly typical US stuff), radial/ulnar fracture in a kid, hydrocephalus, osteoarthritis in both knees in an older lady, large ear keloid (enlarged scar), otitis media, tuberculosis, pneumonia in pregnant lady, child with multiple skin abscesses (probably HIV positive), heart failure, abscess of left foot, hepatitis, DVT (blood clot in your leg) , tuberculosis, pneumonia (this was a very sick older man), HIV diarrhea, gastroenteritis, conjunctivitis, impetigo (skin infection in a child), a mother that couldn't lactate, phimosis (a good reason circumcised), 3rd trimester pregnancy with complications, ruptured otitis media, CVA(stroke), malunion of radius and ulnar fracture( 3 month old fracture that wasn't set properly).................OK, OK I'll take a break and put a period. Next I saw post herpatic neuralgia (bad headache and someone who has had a herpes infection), malnutrition, tuberculosis(there seems to be a bit of a TB pattern here), cellulitis(another type of skin infection), conjunctivitis vs glaucoma(sent that one to theater for a proper eye exam), DVT, large lipoma (benign fatty tumor), TB (x2 more), infected VP shunt(shunt for kids with hydrocephalus), pregnancy with poor dating, fungal infection of the scalp, severe eczema, parotid gland abscess, femur fracture, urinary tract infection, pneumonia, atopic dermatitis (allergic rash), cataracts in both eyes (one is totally blind so to late for surgery), hemorrhoids, severe ascites (lots of fluid in the abdomen that shouldn't be there probably from liver failure or heart failure), osteomyelitis of the tibia(infection in the bone), severe vaginal bleeding(had a hemoglobin of 3(should be 12-14 in a normal women), hematuria x 2 years(probably bladder cancer), miscarriage, prostatitis, sinusitis with large reactive lympadenitis(large swollen lymph nodes), tuberculosis(what kind of day would it be without at least one more TB patient...this was on death's doorstep by the way), severe heart failure, and to finish it off one large fibroid uterus (a uterus with large benign tumors).

So that was a mouthful! I think my fingers are beginning to cramp a bit. It was a long, but very fun day for me. I would still prefer to be in the operating room, but the OPD has really grown on me over the last couple of months. I hope you enjoyed the tour through a day at the OPD here at Karanda Hospital. Many, many interesting patients for one day, and there is always more where that came from. I'll be back there to do it again tomorrow.