Pediatrics Day 3 & 4 Outpatient Clinic and Shenkeng District Public Health Center 29-June-2011 to 1-July 2011

Sorry all, for the delayed update everything these last three days has been like a whirlwind. Now that I am in Hong Kong time to reflect back on the final days I spent in Taiwan.

29-June-2011
Another day in the outpatient clinic today with Dr. Wu, Wen-Chiu in the morning and Dr. Wang, Yi-Jen (Dr. 王怡人) in the afternoon. I am starting to like the relaxing pace of the outpatient clinic. Dr. Wu is a dedicated teacher and always goes over each patient with us. The most valuable experiences were when Dr. Wu would let us listen in on lung sounds on the peds patients; I would have never imagined that the wheezing in the doctoring labs recordings. In the afternoon with Dr. Wang, Sandy and I had more time to talk about the current affairs in pediatrics in Taiwan including the declining birthrate, clouding agent problems and more. In particular Dr. Wang’s research on the clouding agent problem seems to be in full swing, she collected about 50 urine samples last week and has a total about 6000 or so samples and is ready to be analyzed. With previous urine analysis samples as controls I am sure something interesting will come out from her efforts. On our side Karen and Bor-Han will be helping her on Friday to tabulate the latest samples and I am looking forward to seeing the results when they are available.

30-June-2011
We all had a wonderful time, in Yeliu for the beginning of the day. Got to see some natural land and rock formations that seem to be ever changing due to different effects of corrosion. After which we all went to the Shenkeng District Public Health Center for a tour and information session. It is comforting to see that Taiwan seems to have a good amount of money put into public health, judging be the size the number of people that they have on staff, in many offices in the United States it seems there are too many budget cuts in this area. The center has integrated health screenings for different age groups during different set times, a mobile unit and many other services such as tobacco cessation. As expected there is an extensive screening program for TB there is an increased incidence of cases in Taiwan. Overall I felt the presentation the center gave was a good review of all the basics I learned from the MPH program at Touro and it was great to learn about some of the issues that Taiwan has in the public health arena.

1-July-2011
Today was the final day in Taiwan. I can’t believe how fast time has flown by. In the morning after the meeting we ended up following Dr. Wu around the ward, it was good to see that the scarlet fever patient that we saw at the beginning of the week was much improved due to his treatment with Penicillin G. After a quick run the rest of the morning we spent in the outpatient clinic with Dr. Kuo, I-Ting (Dr. 郭怡廷). Dr. Kuo always seemed to spent extra time to talk about every case and gave us lengthy detailed answers to every question that we asked. One of the most fascinating discussions with Dr. Kuo was about a condition known as horseshoe kidney, a congenital disorder that, where the patient has their two kidneys fused resulting in one super kidney. Being a rather rare condition I feel that we were very lucky to be able to see a patient with this condition that was here for a return check-up. In the afternoon we finished our rotation with Dr. Wu. The most interesting highlights included more breath sounds including more wheezing and ronchi both of which are very much like the recordings from lab and a visit to the wards to see a premature baby (30 weeks). Overall I am very happy with the experience I have had in Taiwan and hope that one day I will get to return for some more exchange. It was a pleasure and I will cherish everything I learned.

Pediatrics Day 2 Outpatient Clinic 28-June-2011

I was not sure what to expect as this was the first full day at the outpatient clinic. In the morning we followed Dr. Wu, Yu-Nien (Dr. 吳俞哖), who is a pediatric cardiologist. The whole experience was very different from all the other outpatient clinics that I have been at in Taipei Hospital, the most contrasting difference was that the pace was much slower. It almost seemed to run at the pace most clinics do in the United States. A lot of the time was spent conversing with the parents of the peds patient, building a relationship, reassuring them that everything is going to be okay and patient education. Another interesting difference is the speed that lab results are done, often Dr. Wu would order CBCs, WBCs, X-rays, EKGs and have the patient return in about 20-30 minutes to discuss about the results. Dr. Wu being the only pediatric cardiologist on staff (actually she just retired and works once a week part-time now) get all of the suspected cardiac cases in addition to all the regular general clinic patients. Dr. Wu commented that she gets a lot of the chest pain cases, 60% of which are osteochondritis cases opposed to something more serous involving the heart or lungs. Other than a few cases of sinus arrhythmia Dr. Wu did not have any out of the regular cases. On the other hand Dr. Tsai, Ya-Hui (Dr. 蔡雅慧) next door walked over at one point to tell us about an interesting case of suspected Marfan’s syndrome and also get Dr. Wu’s opinion on the case. It turns out that the patient did not have enough of the criteria for Marfan’s he only had the wrist sign (the thumb and index finger overlap excessively pass the distal phalanx when the wrist is gripped with the opposite hand). His X-rays did show that he had a pneumothorax which was interesting in that Dr. Wu had just mentioned that for patients that are tall and thin we should look out for spontaneous pneumothorax if the patient complains of chest pain. Any case I seem to be having trouble sleeping tonight so I thought I catch up with some of the blog.

Pediatrics Day 1 27-June-2011

8:10 am started the day on the 5^th Floor meeting room situated behind the nursing station at the pediatrics meeting. Over the course about 30 minutes many cases were discussed, the major concerns seemed varied from otitis media, unknown skin rashes to asthma and infant jaundice. The most interesting discussion at the meeting was about a patient with a strawberry tongue, as it sparked a talk about Kawasaki disease and scarlet fever. After the meeting Sandy and I followed Dr. Wu, Wen-Chiu (Dr. 吳文秋), he showed us around the ward including the neonate-infant room and the empty new born room. Dr. Wu commented on the low birth rate in Taiwan (the lowest in the world currently) explained that there had only been two deliveries in the hospital for the entire month which occurred last week. As we continued through the ward I was able to see a real strawberry tongue, I don’t think I will ever forget what a text book strawberry tongue after that experience. At 9:30 Dr. Wu gave Sandy and I a lecture on common Airway problems in pediatrics. There was some review in the lecture including common pathogens that will be encountered, how different seasons and school affects transmissions of infectious diseases. Also the mechanism, treatment, screening and testing for asthma. Dr. Wu had a series of different inhalers and peak flow meters that are used for patient education which he ran us through. The time seemed to fly by in pediatrics for some reason or another as it the end of the day before I noticed.