Down to Business

The long journey, expense and hassles endured seemed to evaporate as hundreds of children surrounded and mobbed us with hugs and hello's as soon as we stepped out of the truck. After 24 hours of flying, and sitting in airports, we arrived at the Akha training center, and the reason we were here was clear. Scores of kids grabbed our luggage and took us to our rooms. They all love to practice their english on us and they have soul melting smiles. I immediately noticed their teeth and skin were vastly improved over my first visit here.
The students and I were introduced to them and we are all making friends by the minute. We held the first day of clinic and saw over 260 children. The mission is to install a medical record database so we can document and follow the health of the children. Many of them are small for age and most have not been fully immunized. The problem is there are no records of most of the care they receive from various volunteer agencies. The myriad questions about their health will remain difficult to answer and manage without medical records. Since many of them are orphans we have little information on their family and past history. We are focusing on ROS and drilling down on issues found and documenting exams. While most are healthy kids with usual childhood issues we found several with significant issues, including cardiac arrhythmias, a mitral regurg murmur and several wheezers. Due to the smoke from the farmers clearing fields with slash & burn methods it is not clear if there is an underlying pulmonary problem. By having a chart to follow them we will hopefully be able to tease this out.
I am extremely proud of our students, they did absolutely yoeman work yesterday. Because of that we should be able to work at a bit more leisurely pace. One of the students is a dietician and will discuss ways of improving the calorie and protein in their diet. With that and growth charts we can begin to evaluate the questions about their size. I believe they are constitutionally small people and some also have superimposed malnutrition.
We will teach the older children the basic metrics and normal exam to continue updating the medical records. With it being web-based I hope to be able to continue to evaluate them from home. Perhaps the residency program directors will be interested in making this available to their docs. There is much to learn and give.
Time to teach more English. Today, "Whatsuuuuuuuuuuuuuuuup!"
KLF