New Doors Open to KCE in Lima, Peru

There was a certain air of excitement as the Kids Care Everywhere team walked through the historic gates of Hospital Nacional del Dos de Mayo in Lima, Peru on the first day of software training. Although I was not part of the original team that brought PEMSoft here in 2016, I could feel an exuberant warmth and congeniality as staff greeted us in the administrative offices on our first day. As this year’s global health fellow, I had the opportunity to introduce something new to familiar faces - DynaMed Plus, a mobile application that incorporates all of the on-demand pediatric clinical decision tools that PEMSoft offered with an encyclopedic medical database that covers all of adult clinical care. On this visit, we would not only be reaching pediatricians, but also supporting providers caring for patients of all ages by giving them a handheld medical library.

What struck me immediately about Hospital Nacional Dos de Mayo is its history steeped in public service and medical education. Central to the hospital grounds is a beautiful courtyard with wooden benches and manicured paths lined with multi-colored lantanas and bright geraniums, a park where a community of patients, their loved ones, and hospital workers enjoy sunshine and fresh air. In an octagonal pattern long patient wards extend out like spokes of a wheel in every direction, each with raised box skylights to let natural light flood inside. In the middle of the gardens beneath a statue of Jesus Christ sits a mausoleum that houses the remains of an honored medical student, Daniel A. Carrion, who died in 1885. This national hero injected himself with contents from the wart of a patient with a common warty illness to study the disease’s natural history and establish the link between the chronic form and its initial deadly febrile course. Carrion died as a result of his experiment, and infection with Bartonella bacilliformus now carries his name. The disease, also known as Oroya fever or verruga peruana, is endemic to the region and often fatal in the acute phase if left untreated. To think of the advances in scientific research and the summation of medical knowledge since Carrion’s time is truly mind-boggling and further underscores modern medicine’s need for facile, searchable clinical databases to deliver the best patient care.

This visit to Lima opened new doors to KCE. Despite some initial hiccups in publicizing our arrival, we quickly learned that word spreads like wildfire here and we were soon being asked to present DynaMed Plus and all of its features at other hospitals. In addition to training physicians at Dos de Mayo, we also trained medical personnel at el Hospital Nacional Arzobispo Loayza, el Instituto Nacional de Salud del Niño (the nation’s single quaternary pediatric referral center), and Peru’s future physicians studying medicine at la Universidad Nacional Mayor de San Marcos. This diverse group of attendings, residents, medical students, and nurses from services spanning Neonatology to Geriatrics were not only impressed with DynaMed’s ease of access to the most current guidelines and recommendations, but also excited about the direct links to primary sources for further reading and investigation.

The highlight of each training session has been fielding clinical questions from trainees to demonstrate the search function of DynaMed Plus. The search and find from each problem raised led to a well of information and features that I glimpsed along with attendees. An internist’s dilemma in managing a patient whose self-treatment of genital warts with trichloroacetic acid had gone too far prompted a discussion on chemical burns and appropriate wound dressings, including consideration of silver impregnated agents since the patient’s wound appeared quite deep. A resident whose patient had both cytomegalovirus infection and kidney dysfunction was able to quickly find the therapeutic renally-adjusted dose for intravenous ganciclovir. A hematologist was thrilled to discover a body surface area based dosing calculator for methotrexate, and how simple it was to bookmark this page for her frequent use.

On a return visit to el Hospital Nacional Arzobispo Loayza, a second-year resident in Geriatric Medicine was delighted to tell me how he had been using DynaMed Plus in the week since we last met. In his practice, he cares for many hospitalized elderly patients, many of whom have become bedbound after a fall, fracture or progressive frailty. He has used DynaMed Plus to read up on prevention of sarcopenia and pressure ulcers for these patients. Using the Norton scale calculator, easily found in the Calculators section of the mobile app, he is able to assess a patient’s risk for developing pressure ulcers, and modifies his plan of care accordingly. What he enjoys most is the fact that DynaMed acts as a diving board to delve further into the literature on geriatric dysmobility, which has become a particular area of interest for him. Having DynaMed Plus at his fingertips not only allows him to answer clinical questions during moments of decision-making, but also opens up opportunity for further research and advancement of patient care. In this way, KCE continues to brighten the future and influence medical care across generations throughout Lima.

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