Wednesday, September 19, 2007

Miriam Katarina Dolores was born August 18 to Hospitalito Atitlán’s social worker Chonita Mendoza. Lucky for Miriam and her family Guatemalan law gives her mother 3 months paid maternity leave. HA’s pharmacist Rosalia has experience working alongside Chonita, and is filing her shoes and very soon a second social worker will join the staff, giving Chonita the opportunity to work full time with the growing Maternal Infant Sponsorship program and other community outreach projects.

Wednesday, September 12, 2007

A typical day at the hospitalito turned more than strange when eleven year-old Jose David Ajcot Botan arrived at Hospitalito Atitlán last Friday afternoon. He was pointing at his throat and gagging. “Un Quetzal,” (the Guatemalan coin) he was trying to say.

Dr. Rudy Salvador, a recent graduate of medical school from Guatemala, was the physician on-call that day. He ordered an X-ray immediately, and then called on the other physicians in the Hospitalito, including the Medical Director, Dr. Juan Manuel Chuc, as well as the Chief of Staff, Dr. Mark Lepore, to help remove the coin from what was presumed to be the child’s esophagus. Rob Jones, paramedic from Seattle, was also on-call that day in the Emergency Department.

What to do with Jose David?
Much discussion about what to do ensued. Should we send Jose David elsewhere by ambulance where a surgeon could operate to get it out? Our experienced paramedic, Rob, felt that the coin could get dislodged in bumpy transport and might put the child at greater risk of having it completely obstruct his airway.

Looking at the child
gagging, unable to swallow, and drooling, with occasional retractions and apparent increasing difficulty breathing, Rob was indeed correct. That left us with 2 options: push the Quetzal down or try to grab it back up. Suggestions about pushing the coin down were also voted down for the concern of either rupturing his esophagus or having the coin get stuck in his intestines even if it were able to pass.

It was Dr.
Rudy who saved the day by suggesting the use of a Foley catheter to pull the coin back up. The catheter usually meant for urinary bladder drainage has an inflatable balloon on the end that could be blown up after passage down the child’s esophagus and used to pull the Quetzal back up. In a truly collaborative effort, Dr. Lepore administered Ketamine anesthesia with the child sitting up at the side of the bed.

He was
quickly placed supine, then administered 100% oxygen via bag valve mask and paralyzed. Rob intubated the child with a small tube (a normal size for that child was unable to pass either secondary to airway swelling or because of the coin itself). Julie Burdakin, a physician’s assistant from Idaho, bagged Jose David while Rob held the tube. Dr. Chuc placed the foley, inflated it, pulled back … and no luck. He tried again … and this time, felt something give, reached into Jose David’s mouth, grabbed the Quetzal, and flipped it up into the air onto the floor with a big “Hooray!”

Jose David had a very sore throat, but a very uneventful recovery
overnight in the hospitalito. This picture was taken on his day of discharge the next day.