Last Day

Disclaimer: The views and opinions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of Consultant360 or HMP Global, their employees, and affiliates. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, association, organization, company, individual, or anyone or anything.

This blog was originally posted on March 26, 2011 at Please note, Dr Robson is not accepting donations at this time. However, he would greatly appreciate your comments and suggestions in support of his efforts.


The final day started with the sickest patient for the entire week and ironically the patient was an American woman. The clinic physician asked if I would talk to her mostly because I could speak to her in English,  but also because she was frightened. Her anxiety was well founded. She had been sick for two weeks with fever and shortness of breath. She had received two courses of antibiotic, oral then IV, had been treated in both Managua and at the clinic, and she looked very tired. I examined her and thought she had an effusion in the right base. Turns out she has a past history of three episodes of pleurisy, which implies there is likely an underlying predisposition. 

They treated her with IV aminophylline, which I have not seen used since I was a young resident at sick kids. While she was at the clinic, she developed all the signs of aminophylline toxicity. She became agitated and talkative, her heart rate increased and eventually she vomited.  Her lungs did open up, so the intervention was successful.  

Notwithstanding two weeks of illness with multiple visits to various physicians and clinics, she had not had a chest x-ray.  After two weeks of shortness of breath and with no improvement, I suggested she seek out a more comprehensive care situation, at least in Managua, and preferably back home in Texas.  She was reluctant to return to Texas because she no longer has medical insurance in the states. 

We saw over a dozen children, only one of whom was moderately ill with pneumonia.  The homes are very poorly ventilated, some without a single window, and they sometimes cook outside the home over an open fire. The floors are often earthen and there are animals all around the home.  The air quality in the homes must be pretty awful.  On a positive note the parents do not usually smoke; they cannot afford to.

At the end of the clinic, we hugged and shook hands and then gathered for a group photo.  From left to right in the photo are Manuel, the clinic administrator, Dr. Flore the general physician, Martina, the lady who cleaned up in the clinic, an obstetrical nurse who arrived that morning, Marta the clinic nurse, the pharmacist, and me.  Louise took the photo.