Seeing patients today was definitely a challenge. I heard an appropriate analogy yesterday that is very applicable to today's situation, it was like drinking water from a fire hose. It felt like the entire village came out to see us. I believe we saw about 3,000 patients. We expect to see the same number tomorrow. The CMA was actually suppose to be an Afghan National Army CMA. They were supposed to be running the show and we were suppose to just help out where ever we were needed.

There were 4 tents, 2 for women and Children and 2 for men. I worked in one of the women and children tents. There is a real delicate balance that you have to strike when seeing patients in these kind of conditions. We were seeing patients in a dirt floor tent, with no labs, no x-ray, and a limited supply of meds. There is not much that you can accomplish unfortunately. There is a mantra in medicine which is first do no harm. You really need to understand your limitations and not try and overstep your bounds. For instance, just about every older adult had blood pressure that was through the roof (yes this is an official medical term). You will not be helping them if you just give them just 3 days worth of blood pressure medicine because hypertension is a disease that needs to be managed over time. It would be harmful to give someone medicine to abruptly lower their blood pressure just to have it rise again 3 days later when they run out.

Unfortunately, a lot of what we saw today were chronic medical conditions that really needed to be managed in a clinic with regular close follow-up care over many months. My goal was to alert them of the problem and to encourage them to seek proper medical care.The only problem is when I suggested this their answer was always that they had no money and therefore did not have access to care.

I saw some children that I would have referred to an ER right away if I were in the states, but instead, they were left to walk back to their home barefoot. For instance, there were a couple of children with serious heart problems, probably ventral septal defects, this boy pictured below was one of them. He was as cute as could be. He had the classic "machinery mumur" on exam. I am going to try and make an effort to see if I can get in contact with a charitable organization to see what we can do to help him. He really needs to be seen by a peds cardiolothoracic surgeon. If anyone out there can help, ie., if you have any contacts, please let me know. You would be saving a life.

I saw a number of cases that I have never seen before. I saw a bad case of spina bifida. I also saw a young child that had the after effects of infantile polio. Obviously, there was not a lot we could do for them but we still tried our best to show our care and compassion. When we could we referred them to a local hospital out in town.

Another interesting thing I encountered was attempting to interview and examine a patient in a burka. There is a strict custom that dictates that all women wear a burka or atleast cover their head when they reach puberty. How strict this is followed depends on where you live. Usually the further you get from the city the more strict they are. It was strange peering outside the gate and just seeing the sea of burkas. I can specifically recall this one patient that the Afghan interpreter saw. She was being seen for arm pain, knee pain, and stomach pain. The interpreter said to me, you see, this is osteoarthritis, it is because she weighs too much. I looked at the patient who was completely covered with only her eyes showing and I thought to myself, "how can you tell?" But again, we were not there to cure any diseases we were mainly handing out over-the-counter medications along with antibiotics and it was not meant to be a comprehensive exam.

I expect more of the same tomorrow. Again, I wanted to thank everyone that has sent in meds, candy, and supplies especially the Zonta Club of Marathon (Marathon is a city in Florida). They must have sent about 20 boxes full of stuff. Some of the boxes cost $30.00 just for shipping.

Take care and thanks for reading.