Saturday, July 14, 2012

Conquering Blood Pressure...

July 6, 2012
In spite of lack of blog posts we didn't decide to stay in Roatan the rest of the trip...After a fantastic time in Roatan, a long travel day back to the hospital on Tuesday--taxi, ferry, taxi, bus, taxi, other bus with 12 adults and 6 kids--14 total hours of travel was quite the experience in itself. Covered in record # of mosquito/bug "picadores" bites. Overall, quite epic fun/adventure. We hit the ground running with a health expo on Wednesday morning, a brigada/clinic in Tegus on Thursday. Over 80 people came to the health expo on Wednesday. I worked on the computer making calculations of people's "biological age" and giving them their print-out based on age, body fat %, exercise and eating habits and other parameters. Thursday I tackled my fear of taking blood pressures.

Taking blood pressures is indeed an important basic tool, and yet being basic does not make the technique trivial (and this is confirmed by other first year medical students). Every time one takes blood pressure (in my experience) there is a small adrenaline surge and inner sigh of relief upon completion when everything goes as planned. Though with increased practice (especially thanks to OSCE exams) one grows less and less concerned about complete silence in the room and all the stars aligning at the exact time you are taking blood pressure measurements in order for you to be holding all the equipment in the correct position and hear the Korotkoff sounds. Then coming to Honduras, a different type of sphymanomometer used by the hospital added a whole new element (and added apprehension) to the blood pressure taking equation. In spite of the times Dr. L or Dr. M had asked us to take BP on a patient going fairly well even in the face of apprehension, every request for BP felt like a new adventure.

In our brigadas, health expos, or even taking vitals Sundays in clinic we always have one or two people taking blood pressures. Thus far when the topic of choosing stations came up, I've avoided the BP/vitals station, and K stepped up to BP like it was nothing (like she possibly even liked blood pressure taking). I readily acknowledged my terror of taking BPs to myself, but the argument in my head went something like this. Realizing my terror, I also realized the most obvious solution to overcome my fear would be to volunteer to take upwards of 50 people's blood pressures at one of our events. The terrible downside of this I feared, would be to either would leave someone with "hipertension" and its terrible consequences walking the streets of Honduras undiagnosed, or (more likely) we would have a giant backup of people at the blood pressure station as I made someone wait another 5 minutes to retake their blood pressure after unsuccessful attempts on two arms already.

This line of thought had been going in my head for a while, and I knew that it would only be a matter of time until my time came and I could no longer avoid the blood pressure station (in fact it became sort of a trip goal to volunteer for the BP station, conquer my fears, and possibly even be a BP expert). Finally, a week ago Thursday, we were discussion station posts on our way to a brigada clinic and K didn't jump to volunteer for BP taking, and I knew, it was my time to conquer the beast. So I squeaked out an, "I'll take blood pressure." And that was that. Thankfully, I had a compadre--S was joining me as my ally in BP taking.

Surprisingly, after quickly making friends with a sticky sphymanomometer valve, the things I most feared--taking way too much time and holding up the entire line or pure and simple, utter failure--did not materialize. In fact, taking our time, plus some, at the blood pressure station helped to spread out the line and somewhat improve the backup in the line that inevitably occurred before the "talk to the doctor" station. There were, however, unanticipated challenges. Primarily, the noise differential between a doctors office and a brigada is notable, to say the least. In contrast to the quiet doctors office, at the brigada there are people mulling around, loud excited talking, people tapping the table while waiting in line, babies grabbing stethoscopes, and plenty of wind blowing. Realizing these elements the first blood pressure I started, I had a moment of total respect for K, who totally uncomplaining, had never even hinted at the additional challenges of BP taking at brigadas. Yet, in spite of these added elements with supreme focus I could hear the steady, rhythmic tick, tick, tick of Korotkoff sounds stand out from the background cacophony of sounds. Worst case scenario (which were not so bad) when suspecting a higher than normal BP or sounds were indistinguishable from the background noise, the second arm would be requested, "Necesito su otro brazo, por favor," for BP confirmation. 

In fact my original fear of not having enough time was so far from realized that we had time to make friends with precocious 9 year old little Paula and her 12 year old brother Christian, who were really curious and excited to talk to us. We exchanging important details like our favorite colors and classes in school. Sadly, they left while we were in the middle of blood pressure taking, and we didn't have a chance take a picture with our new Honduran friends. When we were leaving the brigada, driving on our way out of the neighborhood we saw them and got to wave goodbye, and their curious smiling faces will remain with me.

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