The past week I’ve been treating a little girl with cystic fibrosis. Before coming to Peru, I had never seen a patient with this condition (basically all my experience has been in outpatient orthopedics). She came to the hospital about 2 weeks ago from Cusco with difficulty breathing, fever, etc. and was quickly admitted to the ICU. She was found to also have pneumonia. I first saw her in the ICU about a week ago. She had a drainage tube coming from the right side of her chest and had labored breathing. I was asked to do some chest physical therapy to help with drainage in her lungs. The treatment was a bit limited due to her pain and decreased mobility from the chest tube, however we got through the first treatment.
This week she has been doing much better and has been moved to the floor. The chest tube has been taken out and she is visibly more comfortable and less scared. We have been able to complete almost all of the different postural drainage positions while doing some percussion and vibration techniques. The first time we were able to go through the full series I was amazed at how much mucus/flem was expelled, probably about 1/2 cup.
The last two days I’ve been trying to teach the family how to do the treatments at home, since the postural drainage techniques will need to become part of their daily routine. For those who don’t know, cystic fibrosis causes abnormal amounts of mucus to be produced which causes bronchial obstruction and predisposes the lungs to infection. Often the extremely viscous mucus is difficult to cough up. Thus the family needs to stay consistent with a regimen of drugs, breathing treatments, chest therapy, and adequate hydration and nutrition to minimize risk of infections and chronic problems. Within the last 30 years, many advances had been made with regards to CF, however most patients still do not live past their mid-30’s.
The past two days I’ve seen Mariela* walking around the hospital. She’s been much more up-beat, and seems to have less mucus production during her chest treatments. Hopefully the family will be consistent with all forms of her treatment, which is vital for the future of this little girl. However, in this part of poverty stricken Peru, those are things which are often quite difficult to maintain.
*Name has been changed