medical elective

sportswear

Hey im going on an elective to Haiti on wednesday for 8 weeks.
Im a 5th year med student.

Im going with a charity that has 35 other students going along too- im they only med student- they will be building, working in summercamps etc.
ill be taking care of them when they inevitably become sick.

the local hospital is very limited in what it can provide.

any suggestions on what drugs to bring?

I have a load of amoxicillin/augmentin, loperamide, motilium, rehydration sachets, abx cream, first aid kit with all the usuals in it.



any advice?

im going to empirically treat any symptoms of chest infections with abx due to the conditions in which we will be living and the need to remain healthy. - thoughts on this?

there is one person who is allergic to penicillin? any recommendations on an abx for them if they become ill with a cx infection?

do you think its necessary to get my hands on some metronidazole etc if anyone gets a very bad bout of diahorrea?


anything else i should bring/ be aware of?????


thanks!!!!

Vorsprung

I'm not sure what the situation is like out there, but maybe when you get out check other things like power supply - a few mates of mine were in Africa and bought a generator for the hospital out there, that meant they could power the fridge and meds lasted longer. Just a thought!

sportswear

hey jim yeah the charity supplis stuff for the hospital but i was just wondering about things specific to take care of the group that i'll be travelling with.

hope the finals went well.

Vorsprung

sorry, misread the question! might leave it to someone who knows something!

tallaght01

Most of the chest infections are still likely to be viral, no?

I very rarely give antibiotics for them.

Growing resistance is a very real problem. Amoxil is usually fine. Erythromycin/roxithromycin are the alternatives for those who are allergic (IN the paediatric population anyway).

I'd be more worried about the person's antibiotic allergy if they were to require IV antibiotics for something serious, like a meningitis. You can use ceftriaxone, but some people with penicillin allergies are allergic to that too (bout 15% I think).

Are you bringing IV meds for your group? Because they're what you might actually need to haul your arse out of the fire. Or will th ehospital have them if you get ill?

Maybe some clindamycin/ciprofloxacin/flucloxacillin too for other infections (eg wounds if you're doing any dangerous activities). careful of clindamycin colitis though!!!

DrIndy

for travellers diaorrhea - you need to have ciprofloxacin and metronidazole for amoebiasis. The difference between the two is one is bloody diaorrhea and the other is profuse messy non-bloody diaorrhea. You should have either Co-Amoxiclav for general infections and wound infections and as an alternative consider taking clarithromycin as well for allergy.

so for antibiotics bring:

Ciprofloxacin
Metronidazole
Co-Amoxiclav
Clarithromycin

You get other tropical ailments out there too which would not neccesarily be covered but most things are so by the above.

Remember vaccinations and malaria prophylaxis - if you are taking doxycycline as part of that you are well covered too for most infections. You could bring some penicillin and flucloxacillin for skin infections - but i would err on caution and probably use augmentin for those in case it was contaminated

Also be careful yourself - have a low threshold to getting people to hospital quickly if they are sick because the docs there are much more experienced than you are. Dehydration is a huge problem in hot climates and being sick makes it worse so they will almost certainly need IV fluids.

Tallaght - 5% crossreactivity between penicillins and cephalosporins and they usually only apply to anaphylactoid reactions.

Traumadoc

I would have thought maclorides would be more appropriate for the atypical pneumonias, It would be worth finding out how prevelent diseases such as HIV malaria or TB are.

http://www.paho.org/english/sha/prflhai.htm


PS mrs traumadoc (also a medic) advises cipro, and says "highest HIV outside Africa" lots of gloves dont forget eye protection and face masks. Also personal protection as kidnappings rife. http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/6346549.stm

sportswear

hey guys thats great stuff exactly what i was looking for .

The hospital will have IV stuff if its called for. by that stage ill be well out of depth!!


also jim theres some lovely pictures of you still lurking about the res room on the table. I can put a face to your name!! can you figure out who i am!?!

DrIndy

Traumadoc wrote: »

I would have thought maclorides would be more appropriate for the atypical pneumonias, It would be worth finding out how prevelent diseases such as HIV malaria or TB are.

http://www.paho.org/english/sha/prflhai.htm


PS mrs traumadoc (also a medic) advises cipro, and says "highest HIV outside Africa" lots of gloves dont forget eye protection and face masks. Also personal protection as kidnappings rife. http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/6346549.stm

Macrolides have good efficacy for many infections - but they tend to be bacteristatic rather than bactericidial.

they are a good alternative if required.