Day 2.
First Day of Clinic: A record for the ages!
Following our 6 a.m. devotionals and breakfast, we head to the busses for the hour drive to our clinic. Lots of anticipation, energy, chatting, and even apprehension among our new folks about what to expect today. But it’s a great feeling for those returning: We know what the challenges and rewards will be.
Many of the 259 patients we will end up seeing today are complicated medical cases, since we are pre-selecting patients in the months leading up to the clinic that we feel we can help the most. Patients that were admitted to our clinic were encouraged to indicate their two main issues that we would try to address on their visit.
A successful clinic experience is not possible without or Triage team. Our four triage stations–each with a clinical evaluator (some from the States like Leilani Ferrer and Sylvia Alvarez as well as several from Guatemala who stepped in as needed) and local and US-based translators (including Fran Killelea and Kip Frautchi)—were situated outside, and along the shady edge of the community building’s wall. As soon as patients are registered and have their vitals gathered, they explain their situation to a triage staff member and their first or most important clinic assignment is made. Still, many of these patients will visit three or (in a few cases) four of our physicians in different clinics, including our lab and of course the pharmacy. A typical patient might move from Triage and start in General Medicine (where we had four health care providers and their translators), visit the Ultrasound Clinic, check in a second time with General Medicine, move on to the Mobility Clinic, and end with a visit to Pharmacy. Backlogs developed on Monday, and so some patients waited five hours and longer. If a patient came with their children to see the pediatrician, that round of appointments could add significant time as well. Humidity and heat were our constant companions. As the day progressed fans were turned on, and sweat trickled down our clinicians, and patients backs. But mutual gratitude was evident between clinicians, patients, translators, and the other staff working to keep the patient visits moving.
Our Pediatrics Clinic, which was ably staffed by Mark Ward and Joanne Reid (from the great states of Texas and California, respectively), saw children as young as three months and as old as eighteen years. For some, this was their first time being checked by a physician and diagnosed accurately of their condition. Some could be helped with medication. But many others required referral for a needed surgery. In some of the saddest and avoidable cases, patients were referred for further consultation and surgery for an earlier misdiagnosed problem or for an injury that may have been incorrectly treated months or years earlier.
The Ob/Gyn Clinic saw a wide variety of patients with gynecologic and obstetrical problems. Our staff saw minor surgical office procedures that significantly helped the quality life of patients, such as opening a Bartholin’s cyst which relieved a woman’s pain. Our village clinic included a specialized and dedicated VIAA-Thermo clinic which provided examination and treatment options for cervical cancer, which remains the leading cause of death in women in Guatemala. The only way to definitively diagnose any cancer is by biopsy, and at least for this week this little village has a clinic that can get that done for women at risk for cervical cancer.
One woman that we worked with today illustrated the challenges we will face, but also the resources that we can access for this village clinic. Our patient suffered from metastatic cancer but our basic village team doesn’t come equipped with the necessary scanning and other equipment to establish the primary site of such a cancer. Her gynecological exam showed she had intervaginal lesions, with suspected erosive cervical cancer, and it seemed to have spread to her bladder. We were able to give her an immediate referral to the National Cancer Hospital of Guatemala, a resource that was not always available in past years. These Faith in Practice clinics hold a special place for women in Guatemala. Women’s health needs are often underfunded and misunderstood.
The Ultrasound Clinic (buried in a dark corner room to keep out light, but with the added burden of being really hot and humid) saw about 130 patients during the week–from a one-month-old to folks in their 80’s. Phebe Chen has been the backbone of this clinic with the Delk/Zimbelman team for years, and she wowed us again with the number of patients she saw and the aid she provided in diagnosis. We were able to tell whether an alleged problem was minor or whether it might require referral for further examination or surgery based on her work.
The Mobility Clinic saw challenging and novel cases as well. The ten folks working here spent significant time assessing the nature of daily movements by patients and explored ways that this could be enhanced through medications or mobility equipment. Some patients had amputated legs, many suffered the ravages of diabetes, congenital deformities, arthritis, and joint pain that made movement unbearable. We provided injections and referrals for surgical interventions as well as for further assessments of their conditions
Wheelchairs were assembled outside the community building by local Guatemalan and three of our US volunteers, Pat Slaven, Scooter Goll and Louis Hoebel. Assembly of each of the ninety-six wheelchairs (and three state-of-the-art pediatric wheelchairs) provided over the four days of clinic required two people working together for ten-fifteen minutes with a real focus on accurate assembly. Patients receiving a wheelchair, walker, or cane were provided with a crash course on how to improve their movement and independence with the new equipment. Our wheelchairs completely change the quality of life of both the caretakers (who in some cases have been carrying their loved ones from room to room for many years prior to their visit) and our patients. Janice Smith working mobility today and Gayle Turner (our lead occupational and physical therapist) heard lots of “thank yous” for their work in that clinic on Monday, but none more heartfelt than the words from one struggling woman: “Doctor, thank you for your hands!” It was an exhausting day, but a very successful one.
Our clinicians and their translators in the General Medical Clinic probably had the highest patient load today. Linda Zimbelman, Carol Schobert, Janice Smith (who will move into this clinic tomorrow) and Ruth Granlund saw hundreds of patients over the whole week. Throughout the first day, these providers–along with their super local and US-based translators–listened to patients hoping to resolve a myriad of problems. As the day progressed and other clinics were winding down, General (as it became known) still had a backlog of a couple dozen patients, all of whom would be seen before we called it a day.
Pharmacy and our small lab seemed to get a visit by most patients whatever their individual problem. Shirley Ann Frautchi and Deb Unverferth checked urines and did finger sticks to help diagnose a range of issues. Their up and down schedule meant that we pulled in some of our mobility volunteers later in the week to keep the patients moving through the Lab. The Lab never seemed to rest, and the four pharmacists (including three from the States—Monica Morgan, Sarah Miller, and Carolyn Casia) and their local assistants and translators dispensed thousands of medications to address chronic diseases, diabetes, hypertension, and infections. They gave out multivitamins to younger and prenatal populations, and anti-inflammatories for those suffering a myriad of pains and aches. Since the pharmacy is typically the last stop for patients on their health care journey, the pharmacy was always the last clinic to close for the day, and became the focus at the end of the day as other clinicians would watch them diligently complete their work.
Behind the clinical encounters with patients that are our reason to be in this little town, there are other tasks that get done in a village clinic that are not always visible. Certainly our kitchen staff and chef who keep us healthy and well fed during the day are an important component of this endeavor. And patient education remains an important part of our work here, especially for patients who might benefit from physical therapy or who are preparing to move on to surgery through a referral. In a corner of the large community building we occupied for four days, Guatemalan volunteers were seen with anatomical models and photos explaining basic biological functions, healthy lifestyle habits, and preparations for upcoming surgery to an audience of women.
A clinic of this size has lots of logistical support for equipment, supplies, and daily operations. Organization is everything, and the Guatemalan staff on the ground is seasoned at this challenge. For the first time, our Zimbelman/Delk team utilized computer tablets to input patient information, history, treatment, scans, and prior conditions. This allowed patients to move without the hassle and responsibility of carrying basic paperwork between clinics. As we built a medical chart for each patient on admission this morning, our equipment and the technology support from the IT team allowed providers to see what their colleagues wrote and eased the referral process. In the pharmacy, the tablets and access to medical files made it much easier to access detailed physician notes and quickly fill needed prescriptions. The whole process was much more efficient than in some previous years, but it took time to get the system nailed down. And the IT folks—all seasoned Guatemalan professionals–made over 200 discreet visits to our clinics today to help get us on the right footing. From an Angelino’s perception, it was cool seeing the iPads in use. High-five, and surfs-up!
I was told FIP clinics are important occasions to Guatemalan families, so they dress-up in their best outfits for the occasion. Many saw their providers and wanted to take photos with them, seeing it as a cherished memory. As the day came to a close, we received grateful hugs, and goodbyes. Making this experience just as memorable.
It was the longest clinic day of our week. many were complicated cases And in fact one of the longest village days on record for any FIP clinic. We left the clinic at 7:30 pm, about three hours later than our scheduled departure time but with a real sense of accomplishment. So many patients seen, and over sixty referred on for life changing surgery in the coming weeks. An hour bus ride back to our hotel, a quick but filling dinner, and its off to bed to start our next day at about 5 a.m.
Eleanor, Team Blogger
