Saturday, November 29, 2014

Albendazole After All

As the patient glared at me with an utterly concerned look, I couldn’t help but feel slightly out of place. ​I had just thanked her for her time and after an uncomfortable ten minutes of fumbling through a series of medical questions in Spanish, I had finally obtained all the information necessary for the patient’s diagnosis. I was working in a medical clinic in Masaya, Nicaragua and this was the third patient of the day. My job seemed quite simple, to collect information and take patients’ vital signs. However, since the doctors had twice before asked me what medicine I would prescribe, I knew I should start thinking about treatment as well. I quickly glanced over at the pharmacy table where a scattered multitude of medicine bottles seemed to loom before me like misplaced stones in a boulder field. They each were labeled with strange names, most of which were alien to me only the day before. This made me realize that, despite the short training lecture, I definitely was not qualified for this job. I was, to say the least, quite surprised that the doctors would even ask me what medicine I think they should prescribe.

For this particular patient, a kind and elderly woman, the presented symptoms of diarrhea, intense itching and decreased appetite seemed to indicate a clear diagnosis: parasitic helminthic infection.  However, which medicine would it be? That was the question.
An ever-persistent feeling of uncertainty engulfed me as I struggled to remember which medicine should be used in this situation. The vital bits of information that I could recall from the guide booklet given to me the day before flashed through my head. Although I very well knew that the array of medicines present could treat a wide variety of medical conditions from gastritis to fungal infections, the specific uses of each proved to be difficult to remember. At the time, the diagnosis and symptoms seemed to form an almost-complete puzzle that only the correct medicine could fully complete. As I awaited the doctor, I continued to think about this and fortunately a few medicines came to mind. Would it be Albendazole? Metronidazole? Ivermectin?​

As one of the Nicaraguan doctors approached, I realized it was time to decide on a treatment. I quickly selected one based solely on instinct and the little information I could remember. Albendazole it would be.
The doctor sat next to the patient and, after hearing my report and talking to the patient, turned to me to ask the ever-anticipated question. “How would you treat her parasites,” he asked. I responded with my last-second choice and his answer honestly surprised me. Despite my uncertainty, the medicine I chose was what the doctor would prescribe. Upon hearing this, I felt truly accomplished. I realized that I was learning quite a bit through such an incredible clinical experience. It was Albendazole after all.

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