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Letters
to the Editor
Dear Editor,
I am from Kaiser Permanente Woodland Hills, Department of Quality Improvement.
I have worked for KP for 18 years in this field. I just wanted to share
with you that I have just had the opportunity to read The Permanente
Journal (Winter 2005) and wanted to say it is "AWESOME."
I enjoyed "Soul of the Healer" and the various quotes while
reading some very informative articles. I am looking forward to future
Journals.
Jacqueline
Johnson, RN
Quality Management Coordinator
Woodland Hills Medical Center
Woodland Hills, CA
Dear
Editor,
I want to praise you for your issue of The Permanente Journal
(Winter 2005) dedicated to the topic of women's care. I would like to
suggest that you follow it with an issue dedicated to pediatric care.
As studies are showing, the care of children is being transformed from
what was previously primarily care of acute problems, such as infectious
diseases, to care of more chronic conditions, asthma, obesity, depression
and other behavioral conditions ... the list goes on and on. I think
an issue dedicated to highlighting these issues and the need for more
research in diagnosis and therapy specifically dedicated to kids would
go far to highlight the needs of children and the jobs that pediatricians
do for their patients and families every day. I would be happy to assist
you with this in any way possible.
Sincerely,
Rahul
K Parikh, MD, FAAP
Department of Pediatrics and Adolescent Medicine
Walnut Creek Medical Center
Walnut Creek, CA
--
Reply
Dear Dr Parikh, The
Winter 2002 issue was dedicated to Pediatrics but, with your comments
in mind, it is perhaps time for us to consider looking at this topic
again.
Thank you for your praise, your suggestion, and your offer.
Editor
Dr Jacobs,
Thank you for your article (Disaster relief: What can I do to help?
Winter 2005: p 99)--I found it to be complete and well written. I just
returned from a trip to Banda Aceh, and your article really hit on a
number of important points, including footwear (I had only brought boots
and found myself pulling them on and off quite a bit when visiting in
people's homes--on the other hand, it made a rather dramatic impression
on the local people of the lengths I would go toward showing respect).
I
used an Extream water bottle and was pleased with its performance (at
least so far--I'll be more certain after the incubation period passes).
Regarding
prophylaxis--I had one member of another team have a psychotic break
that was probably induced by mefloquine and triggered by the stressful
conditions in Banda Aceh. It ate up a lot of time and resources and
was frightening for many of the people involved. Thankfully, it resolved
well for the man afflicted. However, many of the long-term relief workers
gave anecdotal reports of similar problems linked to mefloquine. KP
Travel Service prescribed Malarone, which many of us took without incident.
One
point I would add is in regard to clothing: Most of the team were in
scrubs, but I wore "technical" clothing designed for hot weather,
and I was much more comfortable and less limited than they were. It
is tempting to wear scrubs in a hot climate, but they actually tend
to be a bit heavy and don't provide enough protection from sun and insects.
Long sleeves and pants were better suited to the terrain as well as
the culture.
Record
keeping was another matter that would have been better to work out ahead
of time--paper was in short supply, and there had been the expectation
that a record-keeping system was already in place. The nonmedical Field
Coordinator didn't have a comprehensive understanding of the needs of
medical caregivers. Printing up new forms was not impossible two months
after the tsunami, but it wasn't a simple matter either.
Your
article will help all involved in such missions be better prepared for
what will actually happen. Can I get a copy in digital format so that
I can share this information with future medical teams going out through
my church?
Thanks
again,
Tom
Leighton, MD
Chief of Emergency Medicine
South Bay Medical Center
Harbor City, CA
--Reply
Dr Leighton: Thank
you for your letter. You have provided some excellent embellishments
to my paper. Your comments on the best clothing in hot climates were
especially helpful.
Thank
you for commenting on the Extream water filter. Such water filters
are invaluable. I'm always amazed how many travelers trust the bottled
water in the field, and I am never too surprised when they incur significant
waterborne infections.
Malaria
prophylaxis is always a challenge. Very necessary, but never without
the risk of bothersome side effects. While most people actually tolerate
Lariam (mefloquine), many do get significant gastrointestinal and
psychotic problems. Although daily Malarone (atovaquone/proguanil)
is promoted as a better-tolerated option, I have not found the incidence
of side effects to be much less than with weekly Lariam. The recommendation
for Banda Aceh is daily doxycycline--100 mg daily. However, I have
heard from a few individuals who took doxycycline for prophylaxis
in Banda Aceh that they developed persistent light-headedness, and
one got severe vertigo. Again, no real easy answer, but when you see
how rapidly falciparum malaria kills, as we did in Banda Aceh, there
is no doubt that the value of prophylaxis far outweighs the risks
of side effects. I have found the CDC Malaria Web page to be the best
reference (www.cdc.gov/malaria/).
A
pdf version of my article may be accessed on the TPJ Web site: http://xnet.kp.org/permanentejournal/winter05/relief.pdf.
Thanks
again for your comments.
Lee
D Jacobs, MD
Health Systems Editor
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