It’s four years in the future, and you’re in your practice.
You are approached by some good friends, Doug and Sandy, who recently began serving as host parents for a twelve-year-old Haitian boy named Jean Baptiste, who was brought to your hospital for free heart surgery. They ask if you will help them with some pre-op and post-op medical issues, should any arise. You agree to provide this as a free service through your primary care office.
You review a clinic note from a pediatric cardiologist:
Thank you very much for the opportunity to evaluate Jean Baptiste in consultation. As you may recall, he is a 12-year-old boy who has been here in the United States for less than 12 hours (i.e., at the time of this evaluation). He is seen in the company of his host family representative (i.e., Sandy). Jean Baptiste speaks primarily a French-based Creole language. Consequently, there is no apparent information regarding any significant medical problems outside of his present cardiovascular concerns. His remaining review of systems and social history are non-contributory. He is receiving no medications.
- HR 81 and regular.
- BP 100 systolic/68 diastolic.
- SPO2 room air 99%.
In general, Jean Baptiste was somewhat tall for his age, a thin black male in no distress. He was acyanotic. There was no jugular venous distention. His lungs were clear to auscultation. On cardiac examination, S1 and S2 were present. There was a grade 2 to 3/6 blowing, long systolic murmur heard best at the apex. This murmur radiated to the anterior axillary line on the left, the left axilla, the left sternal border, and faintly into the left hemithorax. A prominent lift was present at the left lower sternal border. The PMI was displaced well into the lateral aspects of the left hemithorax. Peripheral pulses were of normal character and equal intensity. There were no palmar pulses. The liver edge was palpable at the right costal margin in the mid clavicular line. There was no abdominal bruit. The capillary refill was brisk. Maneuvers to elicit findings of mitral valve prolapse were nonproductive. The remainder of the cardiovascular examination was within normal limits.
- Normal sinus rhythm.
- Left atrial enlargement.
- Left ventricular hypertrophy.
questions
1. Probability per 1,000 that a newborn baby will die before reaching age 5.
2, 4, 5. Data from WHO, UNFPA, and World Bank.
3. Number of women per 100,000 live births who die from any cause related to or aggravated by pregnancy or mismanagement.
A note
This activity was adapted from: Fredrick NB. Exploring Health Systems Within the Context of Social Determinants of Health: A Global Health Case Study. MedEdPortal. 2016;12:10457. https://doi.org/10.15766/mep_2374-8265.10457