Another Triple Digit Day

Class was so intense today I forgot to take photos of the COVID information from the department of health site. But I did read the news article about the 3rd consecutive day of record new COVID-19 case.


Today was the first day of PUBA 446 Contemporary Issues in Health Care. This is the 2nd class necessary for the Community Contact Tracing Training. The instructor is Dr. Ricardo Custodio, aka Dr. Ric.

This illustration was done by Dr. Ricʻs wife.

This is what we were in for this morning.

Class can extend up to 30 minutes after these times.

The Quote of the Day is related to the subject of the session.


Because this is a contact tracing training for COVID-19, the COVID News of the Day will be presented. For today's session, Dr. Ric compared the statistics he presented on the day Cohort #1 started this class, which was 6 weeks ago. The 2nd set of numbers are the statistics for today; the difference highlights the severity of the outbreak and why contact tracing has become so necessary. If people practiced physical distancing, mask wearing, good hand hygiene, and not going out when they were sick it would reduce the need for so many contact tracers.

World-wide on June 25th.

World-wide today.

United States on June 25th.

United States today.

United States daily new cases.

United States daily deaths; yesterday it was at a rate of almost 1 death per minute.

Hawaiʻi on June 24th.

Hawaiʻi yesterday; they have changed the way they report the statistics to  more meaningful metric.

The primary risk factor was travel in the beginning; now it is community spread.

In each session Dr. Ric will give us a Medical Term of the Day as he trains us to become clinicians. We have to try and figure out what it means before he gives us the answer.




We will also be shown a Medical Image of the Day. We have to figure out what is happening with the image. What do you think happened to the person in this x-ray? Answer below.



Dr. Ric followed the medical image with a happy image of his dog Rosie.


We all had to answer this question. It was interesting to hear what each of us has had to cancel or not do because of COVID-19.


But before we started sharing we had to take an oath to be respectful to the speaker.


Dr. Ric said this class is Pass/Fail because Life is Pass/Fail. There is also no Final but there is a group Hoʻike presentation.

Guess I need to get some clothes.

Track 1 is the Professional Clinical Contact Tracing Training Course for medical professionals with a clinical background; that training was 1&1/2 days long. According to Dr. Ric, over 300 medical professionals have completed the training under Track 1. Track 2 is the Community Contact Tracer Training that I am in; 50 people were trained in Cohort #1. There are 35 people in Cohort #2; there will be 5 more 6-week trainings with about 30 people each. The Community Health Worker training is a professional degree program within the UH system.

The program is 6 weeks long to provide the clinical skills necessary for contact tracing; it's not just asking people who they came in contact with or where they went. You also have to determine how much of a risk factor they have.

I think a lot of people don't realize it is more than just asking people who they came in to contact with.

I actually describe myself as running towards the fire.

The afternoon session was focused on Values. We did our first graded presentation on what one of our values were; either Personal, Family, or Emerging. It counts for 15% of our grade. After class a 500-word paper on all 3 is due; it is 10% of our grade.

These are Dr. Ric's values.

Here's the homework.

Each session will include at least one clinical case study. Here's what we got today.


Dr. Ric introduced the class to SOAP notes. I learned about this in massage class.

 We ask questions based on the Chief Complaint. Some questions were, When did the pain start? (this morning) Is the pain sharp or dull? (both) Is there a fever? (no) Is it affecting balance? (no)

Diagram of human ear.

The patient was diagnosed with otitis externa. To confirm the diagnosis, tug on the earlobe; if it hurts it is otitis externa. If it doesn't hurt it is otitis media. (There is a smelly discharge so you know something is going on.)

Inflammation in the external ear.

Discharge from the external ear.

This patient was actually Dr. Ric's son! He had stuck a dried corn kernal up his nose at school.

Sometimes adults do this, too.

The questions asked for this case included, What is the child's clothes washed in? (Tide detergent with Bounce dryer sheets) Has there been a new food introduced? (no) Does the child have a fever? (not now, but earlier) What does the rash look like? (little roses)





After the clinical cases, we were released for the morning. We needed to be back by 1 pm.


In the break between the morning and afternoon sessions I contacted a few friends to find out about scrubs. When Marcus got back to me and he handed me over to his wife Nora; I told them about the contact tracer training and needing to look professional for my Zoom classes. I also told her I only needed a top since that was all that would show in the Zoom class. They were out shopping and would let me know when they returned; they live about 4 blocks away.

While on break I picked some papayas; I would always give Marcus & Nora papayas when the trees were producing well. I got 3 today but 1 turned out to be bird-eaten on the side I couldn't see until I picked it. I also checked out the ground orchid that was blooming! It was in a pot with the 'uala; I did not know there was anything else in that pot. I will have to check with The Potential Most Favorite Roommate to see if he planted it.

Theyʻre way up there at the very end of the extension ladder.

I think this is Bletilla striata.

The afternoon session was focused on our first graded presentation on what one of our values were; either Personal, Family, or Emerging. It counts for 15% of our grade. After class a 500-word paper on all 3 is due; it is 10% of our grade. We were also placed in teams based on where we lived; I indicated both Hawaiʻi Island as well as Oʻahu.

The agenda was similar to the morning session.

Our homework for tonight. Along the Values paper.

I always wondered what these things were called; now I know!

Philtrums come in all shapes and sizes.

The philtrum can indicate an underlying condition.

There are several frenulums (frenula ?) in the mouth.

When the frenulum extends all the way to the end of the tongue it makes clear speech difficult.

WARNING!!! If you are squeamish, skip this part of the post! Some photos below are not easy to look at.

For the unsqueamish, what do you think happened here?

Vaping can be hazardous to your health!

Dr. Ric followed that with a photo of Bean, the feral cat that came to stay with his family. We had seen Bean earlier in the day, jumping around in the background as Dr, Ric was talking.


The team we were assigned to before class ended will be working on an "of the Day" presentation as well as a final presentation together. I am in Team #1 which is representing the Big Island. Team members are Jean, Malia, Michael, Bill, and Justin Y. Tonight we need to come up with our team name and motto. This team building exercise is because the contact tracers will be working in teams.

After class I called Marcus; he said Nora had gone to work but left something for me. When I went to pick up the top I was surprised; Nora gave me 3 full sets of scrubs! Iʻm really glad I had at least a couple of papayas for them! They're such nice people.


In the evening there was a series of emails going back and forth between Team #1 members. Malia suggested a Zoom meeting about 15 minutes before class tomorrow to decide on our team name and motto from the ones suggested this evening. I'm glad someone on our team knows how to set up Zoom meetings!

Hauʻoli lā Hānau e Dustin!