Cases of the week and records

This week I gave some more training sessions for the nurses. I was prepared to give more talks but patient care was more urgent and two sessions were canced. Through consultations with nurses about individual patients I am able to do some teaching and they have taught me about malaria and other subjects. There were three cases of probable TB this week. The reason I say probable is due to lack of diagnostic tests and resources. The first was TB of the spine and the other two lymph node involvement. The latter two cases I referred the patient back to the regular clinic physician who was at a conference this week. I want his opinion before starting treatment.
Another 28 year old man came in with knee pain. Seven years ago he had an infection in the knee and now has severe osteoarthritis and walks with crutches. We started the process of referring him to a specialist for knee replacement. This is a long process and he may not qualify or the United Nations Health Care for Refugees may not have funding. Another 62 year old patient was found to have inoperable cervical cancer. She probably will have no treatment. Cervical cancer is the most common cancer to cause death in women in much of Africa.
Today while seeing a child in the hospital with pneumonia his mother told us about fever, headache and backache. She immediately became a patient to be treated without registration or pulling a chart. After her temperature was measured and found to be normal and a brief exam, I ordered a malaria smear and acetaminophen. This order and prescription were written on a blank piece of paper which will be taken to the lab and pharmacy. One of the nurses will follow up on the smear when it is completed later today.
Out patient records either are totally absent or consist of a pocket sized note pad that has brief descriptions of previous visits for that patient and other family members. Lab information from the past may be listed in the pad or on loose pieces of paper. X-rays are rolled and carried by the patients. One from a year ago was totally useless as it was bleached out and covered by smudges.
We have been discussing improving the records system, particularly since in the next year the clinic expects to start treating people with AIDS who are now being referred to a local clinic.