Sharpening your jungle assessment skills and treatment plans!

Here is an informative video on a basic otoscopic examination. If you don't have an otoscope they are a great investment and can be purchased for under $20. It will save you many times from guessing if your patient has an ear infection or not. Often it is just a case of swimmers ear. That is when the canal is red (verses the ear drum) and can be treated with simple antibiotic drops.

This video reviews techniques for obtaining a respiratory rate. I know that this seems basic; however, often it is really important to know. The normal respiratory rate for an adult is 12-20 breaths per minute. Note that the wrist was held while the breaths were counted, this is because a patient can control how fast they are breathing if they know you are watching.

Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians. This video is an incredible tool. Some of the terminology is for doctors, but if you can grasp the big picture it will really sharpen your assessment of the pediatric in respiratory distress.

Another clinical video showing the actual ear infection. Learning to look inside the ear and know what is normal and what is not is a great skill to begin working on (I'm still working on it). This skill is not taught in nursing school, but is so helpful to learn in any basic clinic setting. Start by noting what a "normal" ear drum looks like.

What does a normal ear drum look like? Here is a gorgeous video showing you that. Unfortunately there is no talking, but still helpful. If only we could see with our cheap otoscopes this clearly.

Abdominal examination assessment for nursing students that will demonstration bowel and vascular sounds, inspection, and palpation of the abdomen. These are excellent assessment videos of the abdomen. Obviously, many things we don't deal with in the jungle like "ostomies". However, the general principles are great.

Learning how to listen to different lung sounds takes time and experience. Your whole village is your classroom. Pull out your stethoscope often and listen.

What I like about this video is the assessment skills that you will witness including the questions. Questions are so vital to obtain a solid history that will impact your diagnosis and treatment plan. Including things like a pain level. Pain is very subjective. We cannot guess how bad our patient is hurting by just looking at them.

I just wanted you to see this picture of a classic spider bite. The venom is creating the center lesion. Often as long as the patient keeps it clean it will not get infected. However, in the jungle that is much more challenging. Then the center will turn black. This is different from Ringworm. Ringworm has a clear center with a distinct out circle.

As you already know: rashes are tricky. This one we are guessing is a post measles rash and should clear up on its own. Sometimes you just have to go with trial and error. Often if you can shooting a picture and sending it to a medical staff member is a great option.

Yaws is still present in Papua. Know how to recognize it from tropical ulcers.

I can't emphasize enough the importance of taking a temperature. One cannot tell a patients temperature by just feeling the skin. Invest in this simple tool for accurate knowledge on how hot or cold your patient is. It will impact your treatment plan greatly.

A remote disaster training course is helping Australian medical teams save lives in the wilderness. The eight-day course, taught on an island off the coast of Australia. I think we should all sign up??!?!!! What do you think? Honestly, you guys are the BEST at thinking outside of the box. Including running your Jungle clinics. After all you live outside of the box. So in reality we could learn many things from you. I thought you would find some of their equipment, insightful and perhaps a bit humorous when you compare it to what you have to work with.

No matter what your skill level and previous training plus experience is: WE ALL NEED HELP when it comes to patient care and treatment plans. I want to encourage you to not be shy. Reach out to the team of medical people you know when you are feeling stuck, in over your head, or unsure. Be looking for those resource people when you are in town or when you are on furlough. Have them in your contact list to reach out to. More than likely they will feel honored to help and give advice and it will take a weight off of your shoulders.

This web site looked like a fun place to study on a furlough. I know many of you have expressed the desire for more training. Under time constraints, this may be a good option.
Do you know of more? If so, share them here.

Most of you are quite savvy in your clinical assessments of malaria. Cycling fever and we are all reaching for rapid malaria tests. Please don't hesitate to consult with us on tricky cases. Please do use rapid tests whenever possible and don't treat malaria blindly unless you have no other choice. When a rapid test is positive they are 98% right. When a rapid test is negative they are 20% of the time wrong. So if you get a negative on a patient that seems to have malaria we ask that you repeat the test in 24 hours. Again, if in doubt feel free to ask for outside help.

I know that many of you battle tropical ulcers. This resource, written by an Australian physician, should provide great insight for many of you.

You will not want to miss reviewing these amazing slides and set of information on how to recognize the most common venomous snakes in Papua. Also how to care for snake bite victims. The steps are simple, but very different from first aid that you may have learned in different parts of the world. A special thanks to one of our clinic nurses for putting together this amazing presentation.

This is a very brief video explaining the signs of dehydration. I cannot overstate the importance of being aware of the hydration status of your patients. Especially young children. Irritability, little or no urination, NO TEARS, sunken eyes and rapid heart rate and breathing are all signs that need to be addressed. You will want to ask how often this child has had diarrhea or vomited in the last 24 hours, then you can narrow the window to see how acute the loss is. Consider fever also. Treat the causes and Re-hydrate.

This is a valuable resource that you want accessible to you often as you treat your patients in Papua. We update it frequently.

You don't want to miss this great document on how to treat malaria. It will also advice on how to treat if the patient is already taking a malaria preventative. This is a MUST tool for your Papua Jungle clinic library.

I would love to see this as a place to share ideas for your jungle clinics. I know a common problem is patient non compliance. How do you get a patient to finish their antibiotic coarse even after they feel all better?

One suggestion that I learned from one of you all (and I thought it was brilliant, plus it worked): If a patient did not take their medicine then their name was written on a board on the clinic porch. Everyone then new that this patient was on the "bad" list. So village peer pressure. What this meant is that they could not receive further treatment at the clinic without paying. Payment for next treatment might be leaving their machete. Once the treatment was completed they could get their machete back AND their name erased off the board.

Do you have ideas that other jungle clinics could benefit from?

This is a very short video on wounds that need debridement. It is a great insight into why a wound sometimes needs surgical care. I probably could provide a whole list on wound care only. Perhaps later, I can do that if indicated.

OK my jungle hero's.....I worry about burnout with you all. No one to relieve you. Patients that can show up on your doorstep at any time of the day or night. I don't need to list your stress, but you do need to recognize yours and create room and space to prevent burnout. Feel free to share your how not to burn out tips with us here.

Comprehensive overview covers treatment and warning signs of this potentially life-threatening situation.