VCU SOP team completes ninth Remote Area Medical

Ram 2015-0175Fourteen VCU School of Pharmacy students along with faculty members and residents were chosen for the experience of a lifetime: the 2015 Remote Area Medical event targeting underserved patients in Wise County, Va.

The trek to RAM, helmed for the ninth year in a row by SOP associate professor and alumnus Evan Sisson, allows participants to join thousands of other volunteer health-care professionals and students to provide hands-on services for people with little or no insurance.

Last fall, the School of Pharmacy won the Association of Public and Land-grant Universities’ C. Peter Magrath University Community Engagement Award. This summer, it won the American Association of Colleges of Pharmacy’s Lawrence C. Weaver Transformative Community Service Award. In each case, RAM was one of the many community partnerships and outreach programs cited for having earned the school these notable recognitions.

Here, now, are the students’ stories from RAM ’15.

Photos by Thuy Tran and Serena Barden

Serena Barden, class of 2016 (2015 RAM student leader)

There have been several defining moments in my life where I had to make hard decisions. Which undergraduate college should I attend? Easy, James Madison University, the friendliest college in the nation. What should I major in? Chemistry because of my love for science and the ability to explore in-depth the natural world. Should I continue doing research or should I try to focus on a whole different career path? Research was proving to be more monotonous and had less opportunities to interact with people, something I love to do.

Serena Barden (left) and co-leader Irene Lee preparing for a smoking cessation class on nicotine replacement therapy

Serena Barden (left) and co-leader Irene Lee preparing for a smoking cessation class on nicotine replacement therapy

Naturally, I was drawn to a career in pharmacy because it allowed me to pursue my passion for science and to make a tangible difference in the lives of others. However, after the reality of tests, grades, networking and the general stress of adjusting to a professional program set in, I quickly lost sight of why I came to pharmacy school in the first place. I began questioning whether I made the right choice. Then, I made a single decision that reignited my passion for pharmacy.

In 2013, as a first-year pharmacy student, I applied to volunteer at Remote Area Medical (RAM) with a team of pharmacy students in Wise, Va. I was delighted to learn that I had been selected to volunteer and I was looking forward to helping Wise’s underserved community.

As a first-year student, I was afforded many opportunities to help patients. I helped patients fill out medication history forms, triaged patients and helped dispense medications at the pharmacy. This was the first time I experienced how my pharmacy education could make a real difference in the lives of others. I was truly blown away by the gratitude each patient expressed to me for volunteering. and I was eager to use this experience to push forward in my professional career.

Plotting out the Wise County Fairgrounds for volunteers

Plotting out the Wise County Fairgrounds for volunteers

Returning to Richmond, I remember hoping that I’d be able to return to Wise next summer. Luckily, I was selected to participate in RAM 2014 as a pharmacy student co-leader. RAM 2014 was a whole new, yet equally, rewarding experience. As a student co-leader, I was able to take a more involved role. Not only did I have the opportunity to directly work with patients, but I was able to assist the student leader organize the event and prepare our team of student volunteers for the event.

The experience I had in my second year of RAM helped me find a new, greater appreciation and understanding of the medically underserved. Working more directly with patients, I was able to hear firsthand the stories and troubles of these patients. I remember one patient, in particular, who told me her husband had been laid off his job at the local coal mine. Consequently, she and her children were unable to afford health insurance. She explained to me that she had the debilitating diagnosis of rheumatoid arthritis and she no longer could afford her expensive medications to help treat the disease.

I could tell she was in a considerable amount of pain, but she continued to smile throughout the whole time I was talking with her. At the end of our conversation, she hugged and thanked me for what I was doing. It was amazing to see the resolve and optimism she had despite her circumstance.

This past year at RAM 2015, I had the privilege of serving as the RAM pharmacy student leader. My role encompassed leading our team of pharmacy and nursing students and residents to provide quality care to the underserved of Wise. The responsibilities of this new role taught me what it means to be a leader. I learned how important effective communication, patience and flexibility are in a strong leader.

Admittedly, serving as RAM student leader was daunting and stressful at times, but if asked to do the job again, I wouldn’t hesitate to say yes. I felt as though I was passing on the tradition to others. Using my experiences to help them shape theirs, all the while knowing that this could be a transformative event in the lives of both the patients and the students.

I will be forever grateful to have been part of RAM for the past three years and forever humbled by the experience. The lessons I’ve learned, the people I’ve met and the visible impacts my team and I have made at RAM are immeasurable. Volunteering at RAM solidified my passion for pharmacy, ignited my desire to help the underserved and taught me what it means to be a strong service leader. It is my hope that opportunities like this one will be continually made available to pharmacy students in the future.

Serena Barden (back row, left) and fellow RAM participants

Serena Barden (back row, left) and fellow RAM participants

Irene Lee, class of 2017 (2015 RAM student co-leader)

Irene Lee discussing nicotine replacement therapy

Irene Lee discussing nicotine replacement therapy

RAM is a one-of-a-kind experience that many people wait all year for, myself included. As a returning volunteer of RAM, I could not have had a better experience. This time around, I was able to grasp just how valuable our services are in this underserved area of Wise, Va.

Most people cannot afford health care and therefore put off seeking the necessary care they need. In particular, one gentleman I spoke with was newly diagnosed with diabetes in its late stages, experiencing diabetic neuropathy, and could not afford physician visits, along with his diabetic medications and testing supplies.

I was able to have an in-depth conversation with him about his medications and the importance of being aware of the complications that can occur with diabetes. But more importantly, I was able to give a lending ear to someone who wanted someone to talk to. The very next day, that same gentleman waved to get my attention to say hi. I was surprised he was able to recognize me from a distance but was reminded that simply listening to someone’s story can make a significant impact on his or her life.

We, as students, are not only there to volunteer our time and services to provide the utmost care to a population in need, but we are there to learn from the people around us. Everyone has a unique story to tell, and taking the time to listen shows that you truly care.

VCU School of Pharmacy student RAM leaders Irene Lee (left) and Serena Barden with School of Nursing RAM participants

VCU School of Pharmacy student RAM leaders Irene Lee (left) and Serena Barden with School of Nursing RAM participants

 

 

Thuy Tran, class of 2016

RAM may have lasted for only three days, but the impressions and lessons learned from this short experience have certainly impacted my personal and professional development.

My initial impression of the campground was its resemblance to a military base.  Each tent on the ground was assigned a task force to address a specific agenda.  The attending personnel operated with the objective to deliver the best care possible with a limited supply of resources.

Thuy Tran (left) and family medicine physician Roxanne Reynolds

Thuy Tran (left) and family medicine physician Roxanne Reynolds

From day one, I quickly learned that flexibility is the key to successful adaptation to this operation.  While my primary responsibilities involved providing pharmacy services to the patient and being a supportive member of the interprofessional team, I learned that the execution of these responsibilities took many forms.

I had the opportunity to provide cholesterol, blood glucose  and blood pressure screenings, discuss the implications of the screening results with the patient and family members, and figure out lifestyle and behavioral changes that the patients could integrate into their daily routines in order to meet their blood pressure or cholesterol “goals.”   Through the conversations with these individuals, I gained a newfound respect for their perseverance to manage their health care to their best abilities, developed empathy for their life challenges, and accepted those challenges as motivation to find a solution.  I learned to become a better listener and advocate for the patient.

One of my most rewarding experiences at RAM was the opportunity to work as a scribe for the medical tent.  Physicians, nurse practitioners and social workers from all specialties came together in one “tent” to provide medical care.  Individual patient “rooms” were partitioned, using shower curtains.

It was a unique environment to be surrounded by a urologist, nephrologist, gynecologist  and family medicine physician in one setting.  I was surprised by the physicians’  enthusiasm to have pharmacy as a part of the team.  As the scribe, I was able to serve as a liaison between pharmacy and medicine, discuss clinical guidelines affecting a patient’s medical treatment plan and counsel the patient on new medication therapy, non-pharmacological treatment options and lifestyle changes.

In addition, the physicians took me under their wings and taught me how to perform a proper ear exam, auscultate the patient’s lungs and abdomen, and other clinical techniques that supplemented my clinical knowledge.  I valued the interprofessional team approach used to assess the patient’s case and develop the treatment plan.

As a soon-to-be-practitioner, my experience at RAM provided me with a soft and hard skill set to become a better pharmacist.  I was able to interact with a diverse group of patients and practitioners and learned about ways to approach providing health care in a limited resource environment.   This was truly a rewarding experience that further solidifies my decision to pursue a career as a pharmacist serving the underserved community.

Thuy Tran (second from left) with family medicine physician Paul Evans

Thuy Tran (second from left) with family medicine physician Paul Evans

Mimi Baker, class of 2016

School of Pharmacy and School of Nursing RAM participants

School of Pharmacy and School of Nursing RAM participants

This may be my last year at RAM as a pharmacy student, but next year will be the beginning of my volunteering efforts there as a licensed pharmacist. The past three years at RAM have taught me more about clinical skills, empathy and life than I could have ever imagined as a P1 when I first applied.

Then, I wouldn’t have known how much disparity still exists within our own state. Then, I wouldn’t have gained the confidence to take blood pressures while squatted uncomfortably in front of the patient amid all the noise. Then, I wouldn’t have known how to effectively counsel — no, motivate — patients for five minutes while they sit, anxiously awaiting their A1C and cholesterol readings. Then, I wouldn’t have been touched by each of their personal stories. Because ultimately, the care we provide must revolve around what our patients want, and if we don’t take the time to listen, we fail as health care providers.

Every year, I speak of the strong rapport between the pharmacy and nursing students at VCU, and this year was no different. The nursing students were invaluable to our team for their expertise in taking vitals as well as their willingness to step out of their comfort zone to help out with dispensing at the pharmacy. We enjoy interacting with them, and I hope that we continue to cultivate our interprofessional relationship in the years to come. University at Buffalo School of Pharmacy students also made a 10-hour trek down to Wise this year, and we loved collaborating with them along with Appalachian College of Pharmacy students.

Mimi Baker (left) and Irene Lee

Mimi Baker (left) and Irene Lee

The pharmacy influence at RAM is ubiquitous; we are heavily involved with patient care from its infancy to the very end. We are at every station where patient and interprofessional interactions are crucial: at the Grand Stands doing medication reconciliation and educating patients with a wellness quiz called “The Game” while they wait for their ticket to be called; at triage taking vitals alongside nurses and paramedics; at the A1C/cholesterol booth helping manage diabetes and cholesterol with Dr. [Evan] Sisson; at pre-med taking vitals and premedicating patients with the current Bon Secours and McGuire VA residents; at Becky’s Place encouraging people to stop smoking; at the pharmacy where mostly U.Va. and ACP pharmacists oversaw filling, counseling and immunizations; at the medicine tent where a few of our P4s were serving as formulary checkers for physicians.

The list above may seem extensive, but that’s just the tip of the iceberg; there is still so much more that pharmacists and pharmacy students can do at RAM. I am so proud of how our profession doesn’t hesitate filling in where there is a need. Sometimes this phrase is exhausted in academia in every class we are taught, but it really is true: Pharmacists are the most accessible health care professionals. And truly, that is a huge privilege.

Till next year, RAM!

 

Amy Liu, class of 2016

Amy Liu (back row, left) and the rest of the 2015 School of Pharmacy RAM team

Amy Liu (back row, left) and the rest of the 2015 School of Pharmacy RAM team

I had the privilege to attend RAM for my second time this summer. It is amazing how much you can learn when you work with other health care providers, students and patients in three days. I had the opportunity to work with different professionals at each station. In triage I worked with nurses and nursing students; at pre-med, I worked with dentists, dental hygienists and dental students; then in pharmacy I worked with pharmacists and pharmacy students from multiple different schools.

Dental procedures being performed

Dental procedures being performed

What stood out for me this year was that I helped multiple patients get dental care as well as a medical check-up. One of my interactions was with a man who was waiting in pre-med to get a few teeth extracted. I sat down next to him and reviewed his medical history and noticed that his A1C was 12 percent. I asked him if he knew what an A1C was, and he responded, “Does that mean sugar?”

I explained that it was important for him also to get a medical checkup. The patient originally thought that he could only choose to see dental or medical but was misinformed. I went to register him for medical as he waited in line for hours for his dental procedure. At the end of the day, I saw him in pharmacy getting antibiotics for his teeth extractions as well as diabetic medications. I was very glad that he was able to get started on medications for diabetes when his main incentive for RAM was for his teeth extractions.

Sally Ahn, class of 2016

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Sally Ahn (back row, right) with classmates

Even before pharmacy school, attending RAM was always on my bucket list of things to do, so I was very eager to participate.  At this year’s RAM, a thousand volunteers served over 2,700 patients seeking health care that they needed. It was truly rewarding in that we pharmacy students could play a variety of roles to promote health in underserved communities.

We were involved in medication reconciliation, took vital signs at triage, premedicated before dental procedures, and helped with immunization and counseling at pharmacy pickup. I was particularly impressed to see how RAM expanded the availability of immunization vaccines. Countless number of patients expressed their gratitude in receiving vaccines because they can be costly or simply because they are not aware of their immunization status or risk.

I encountered most patient interaction at the A1C triage and the premedicating session. I learned how to effectively communicate with patients about their A1C or blood pressure results. Instead of just telling them the numbers and their goals, asking questions like “What do you think this number means?” or “What do you think your sugar control is at?” triggered the patients’ reflection on how much they are taking care of their health,   which increased their involvement in our conversations.

Showing patients how much their ASCVD [atherosclerotic cardiovascular disease] risk value can decrease by quitting smoking seemed more powerful of an education tool than providing a smoking cessation.

Area heading into triage

Area heading into triage

Especially since patients reside in remote areas with limited access to health care, I firmly believe they need to be reinforced to change their health lifestyles. Whenever I encouraged patients to consume more vegetables on daily meal, they complained they couldn’t afford healthy ingredients because of the high cost.  Seeing patients eating McDonald’s while waiting at premedication area or smoking all over the grounds frustrated me as we struggle to improve their health.

COPD exacerbation will continue if a patient does not quit smoking. Hypertension will remain if a patient continues eating high-sodium food. Engaging with these patients showed me that lifestyle modification should serve as the initial treatment even before giving blood pressure medication. Pharmacists can intervene to prevent common risk factors, such as inappropriate diet, physical inactivity and smoking.

With our motivational interviewing skill and disease state background knowledge, we can deliver impactful conversation to patients to avoid these risks in the first place, then we can prevent the deadly diseases.

Armeen Hassan, class of 2016

Since RAM at Wise 2015 was my first outreach trip, I was a little nervous Friday morning for the patients to start coming through. By 9 a.m. that day, however, it became apparent that the patients we were serving here were just like my patients that walk in to the pharmacy where I work, with the main difference being a lack of health insurance.

Armeen Hassan (left) with nephrologist Nancy Allison

Armeen Hassan (left) with nephrologist Nancy Allison

My favorite station was the A1C and cholesterol checks where, with some great tips from the pharmacy preceptors, I was able to master efficiently getting enough blood from a single finger stick for both point of care tests. I also got to spend some time getting to know the patients and assessing their needs here while waiting for my turn with the A1C machine.

One thing that I was fascinated by from the beginning was the medical tent. Walking through on the first day while taking a tour, I had to stop and take pictures of the tiny spaces being used as patient rooms, each one having a bedsheet attached with clothespins at the front for privacy. Although pharmacy wasn’t assigned to the medical tents this trip, I was able to get a chance to shadow there Saturday afternoon. It was a once-in-a-lifetime experience to see a functional clinic with almost no resources outside of human volunteers.

Many patients were extremely thankful for our help, and I was thankful to them for the learning experience. One patient who stood out to me had ridden his motorcycle with his girlfriend for eight hours to get to RAM. He had just been hired for a good job and was required to have his bipolar disorder controlled on medications to keep the position. Unfortunately, we were able to provide only one out of three medications since the other two were controlled substances. This encounter exemplified a vicious cycle of a patient who was without health care because of unemployment but was unemployed due to lack of health care.

Overall, I had a very positive trip, and every hour spent with patients at RAM had value to me in some way. Seeing patients in the setting where the patients had all traveled far and waited in the heat for health care and had little to no opportunity for follow-up really uncovers the true value of the health care system that we often take for granted. In my opinion, the reason why so many volunteers come back year after year is because this experience can really help remind a person why they went into the health care field as a profession in the first place.

School of Pharmacy RAM team receiving initial instruction from faculty leader Evan Sisson

School of Pharmacy RAM team receiving initial instruction from faculty leader Evan Sisson

 

Meredith Weakley Crumb, class of 2016

I was extremely fortunate to be able to return to RAM for the second year this past July.  As a fourth-year student, it can be difficult to take time off of rotations, and as luck would have it my off rotation coincided with the RAM event.  I am equally as fortunate that the team agreed to take me again as there is limited space and many interested and qualified students who apply to be a part of the VCU Pharmacy team.

Page 15RAM has given me the opportunity to use my love of pharmacy in combination with my need to serve others.  I am very happy that the VCU School of Pharmacy continues to support student involvement in community outreach.  Our group of students, residents, and faculty associated with VCU worked as a cohesive team to deliver compassionate, patient-centered care to the truly deserving people in Southwest Virginia.

I am continually amazed at the number and variety of health professionals and volunteers who join together at the RAM event.  It is an organizational feat that I am sure is only possible because each and every person involved in RAM acts selflessly in order to further the vision and mission of RAM.

The nature of remote area medical missions gives students the opportunity to learn hands-on skills that they will take with them long after school.  In addition to gaining pharmacy-related knowledge, participation in service events teaches students about themselves and the kind of pharmacist they want to be.  Pharmacy practice is and should always be firmly rooted in service to others regardless of the setting. By ensuring the opportunity for pharmacy students to participate in service to others, we are furthering the practice and scope of the profession of pharmacy.

As always, I was personally moved by my interactions with people of Southwest Virginia.  Every single individual I spoke with was kind and appreciative, even if they were exhausted by the “hurry up and wait” pace that is unavoidable when there are more patients than providers.

One encounter with a mother of two and grandmother to three especially touched my heart.  I was testing her A1C while we discussed her concern over not seeing a doctor for over four years.  I told her that she had made the right decision to come to RAM and, no matter the results, it’s best to know so we can take action.

After she found out she was pre-diabetic, she became emotional, but we spoke about her motivation to make changes and take care of herself.  She spoke of her grandchildren and how she was ultimately glad that she came so that she can overcome the health issues she had been avoiding for so long.

When our conversation came to an end, I walked her out of the station and she turned to me with tears in her eyes and gave me a warm, sincere hug.  There aren’t words to describe the feeling of truly helping another.

Meredith Weakley Crumb (front row, yellow dress) with fellow School of Pharmacy and School of Nursing RAM participants

Meredith Weakley Crumb (front row, yellow dress) with fellow School of Pharmacy and School of Nursing RAM participants

 

Erin Hickey, class of 2017

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Erin Hickey

I left beautiful Wise, Va., after RAM overwhelmed with gratitude: for Remote Area Medical and the volunteers, for my pharmacy education and mostly for the inspiring patients who let us into their lives for a weekend to take care of them.

Before RAM, I was nervous that I wouldn’t be able to make a difference. As with many experiences in pharmacy school and in life, I learned that all I needed was an open mind and an outward focus (and, of course, a top-notch HbA1C measurement technique).

As a future professional and as a person, I grew every day at RAM by being with the patients. There were a few who are especially memorable.

Working at the cholesterol and A1C station, we often saw patients with varying states of cardiovascular disease. There was one patient, a widowed man with severely uncontrolled diabetes, who was directed to my station. With cardiovascular and endocrine therapeutics modules under my belt, I felt prepared to collect his lab values, calculate his ASCVD [atherosclerotic cardiovascular disease] risk and counsel him on ways to improve his health. However, nothing can prepare you for the first time you tell a patient that there is a greater than 50 percent chance that they’ll have a heart attack or stroke in the next 10 years.

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Erin Hickey at the smoking cessation booth

The ASCVD Risk Estimator tool was once just a handy calculator to use on hypothetical patient cases in class, and suddenly it became a powerful counseling tool that struck emotion in my patient and myself. After we shared a tearful moment, realizing the path his health was taking, we were able to talk about what he could do to take control and reduce his risk, like regularly taking his insulin and quitting chewing tobacco. I’ll never again worry that I can’t make a difference in someone’s life.

Another unexpected moment occurred while volunteering at Becky’s Place, an organization that offers educational programs on cancer and smoking cessation, when a patient who had just had dental extractions suddenly passed out. Being the nearest health care professional, a nurse called me over to assist in taking his vitals. I realized what a great responsibility it is to be a health care professional and what an honor it is to have patients trusting us with their lives, especially when they are most vulnerable.

Through participating in RAM, I learned how to find a connection with people and let them know that they are not alone in their health problems. I will always carry these patients and this approach with me in my future as a pharmacist.