“The final days … ” SEEMA BANGER, 6/16/10

The final days were exhausting as well as exhilarating!

Our second site was so much different than El Paraiso. It was called Fundacion Sol Naciente, which translates into “The Rising Sun Foundation.” The type of population we saw here varied a little bit by their socioeconomic status, but had similar health conditions.

The rundown in the clinic was the same as El Paraiso. For example, the different stations included registration, vitals, consultation and pharmacy. We all rotated through each of the stations to gain a little out of everything. As we were getting to the end, things started getting a little crazy. More people wanted to be seen, but we kept reaching our limit for the day.

The workers at the Fundacion were trying to get their families and friends in for visits before other individuals in the community. There were times where we had to simply say no to a patient, although we wished we could do more.

However, in the end the community did appreciate our hard work. Many of the elderly gave us their blessings as they were leaving the clinic and acknowledged the great work that we were doing. When I heard them express their emotions, it made me realize that all the exhaustion, heat  and long days of work were worth it for them.

Our last day at the Fundacion was Friday, and it was a half day. The second half of the day was spent shopping/touring Santo Domingo, which we ladies thoroughly enjoyed. Later that day, we went out for dinner at a nice restaurant by the ocean and had some authentic Dominican food, which was delicious. And of course, how could we leave the DR without taking part in their music and dances? We ended the night dancing to merengue, bachata and salsa … could you ask for more out of this trip? Certainly not … .

“Mission accomplished!” GEETIKA GANDHI, 6/15/10

Diagnostic.JPGMission accomplished! We have served about a thousand underserved patients. As I sit at home reflecting on my first international medical mission trip, I am sipping my fifth glass of iced tap water. The past two weeks have been sweaty, muddy and exhausting but nonetheless rewarding.

Preparing for the trip was tedious, but was worth every ounce of effort. Since October we have been fundraising for medical supplies and taking global outreach and medical IMG_0916.JPGSpanish classes. These classes were in addition to my pharmacy course work and were held monthly on Monday evenings and Saturday mornings.

My team experienced two different settings: the school-based clinic and a medical foundation for the underserved. I performed different diagnostic tests, such as auscultation of the chest and heart, range of motion exams for musculoskeletal problems, palpation and inspection of the skin and abdominal cavity and use of many portable tools, such as an otoscope. In addition, I was aIMG_0877.JPG part of a variety of diagnoses from asthma (a lot of wheezing of the lungs), allergic rhinitis (we saw a lot of this), hypertension and edema to fistulas, heart murmur, goiter (a huge one) and UTIs.

Hiking in Esfuerzo (near the school-based clinic) strengthened my connection with the community. You could notice a sign of relief as we were welcomed into patients’ houses and were offered the best chairs in the house to sit on. We got to see firsthand the living conditions of those we were serving. Walking barefoot indoors and outdoors DSCN0273.JPGand the lack of hygiene made it clear why they were constantly infected by hookworms or other infections. 

The hypertensive cases were interesting since their blood pressure would be skyrocket high (around 220/110), yet many of these patients were not aware that they have hypertension. We also saw patients who could not afford their medications, so they simply stopped taking them. One of my patients knew that he had progressing diabetic neuropathy and glaucoma, but he could not afford his medications. Situations like this were a IMG_0912.JPGreminder of why it is important for HOMBRE to continue its medical mission trips to the DR and to continue to fundraise for medications.

Through this mission I have grown as a person and a student pharmacist and have bonded with seven medical students, one physician and two civilians. I have learned new diagnostic skills and how to be creative with supplies, such as using a plastic cup that I calibrated to a measuring cup for the pharmacy.

Thumbnail image for Hand made measuring cup by me.JPGLooking back, I am proud of my small effect in the Dominican Republic with HOMBRE. As I think of the future, I look forward to serving more communities as a pharmacist.

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“We saved a life today!” GEETIKA GANDHI, 6/9/10

“We saved a life today!” Sravi exclaimed as I walked back into our clinic room.

We had just consulted a 69-year-old male who had a blood pressure of 252/112. He is diabetic, hypertensive, has diabetic neuropathy and glaucoma. He has no left-eye vision due to retinopathy and had stopped taking his Captopril since he couldn’t afford his medications.

We spoke to him about the importance of his medications and replaced Captopril with a 90-day supply of medications that we had at the clinic: Enalapril and Amlodipine. When he left, it felt relieving and rejuvenating to know that he had the medications that he needed to keep his heart beating.

“Fundacion Sol Naciente, a medical foundation …” GEETIKA GANDHI, 6/8/10

IMG_0347.JPGFundacion Sol Naciente, a medical foundation for the underserved, is our new clinic site. It looks like the CrossOver clinic [in Richmond] where you have consultation rooms, patient examination beds and waiting areas. However, there is no pharmacy.

So we found a small space in a room and placed medications separately in grocery plastic bags and spread them alphabetically on the floor. For the laptop, where we need to register the medications, we stacked up a couple of suitcases and a box and — ta-da! —  we have our table. It sounds like a mess, but it worked out pretty well.

I was at consultation today with one other medical student, where I got to see patients and write prescriptions. I love working with them since they teach me diagnostic techniques and, in return, I educate them on the medications we prescribe. Once we finished diagnosing and coming up with a treatment plan, Dr. Ryan would come into the room and allow us to present the case and the proposed treatment. The whole set-up was educational, and it allowed me to apply what I have learned from pharmacy school.

Pharmacy computer.JPGWe had a daughter and mother who we separately consulted with. The mother came in to see if her blood pressure was controlled, and luckily it was. However, it was sad to see that she had recently lost 15 pounds since she could not afford to eat enough food for dinner and that she took Simvastatin only occasionally since she could not afford it. Her daughter was our next patient, and Dr. Ryan had to prioritize which medication she “has to” take since we didn’t have them in our pharmacy and she could not afford them. I look forward to the next few days here and hope to help as many patients as we can.

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“We’re halfway through our trip.” SEEMA BANGER, 6/7/10

We’re halfway through our trip. It is unbelievable!!

Yesterday was our last day in Paraiso. The clinic ran as usual, and we were able to serve about 70 individuals. I was assigned to do the vitals yesterday, which I thoroughly enjoyed.

After the house-call team returned, we had more hands to help around so I joined the consultation room for the first time. The role of a student in the consultation room is to go over the symptoms described during the registration period and perform any other exams needed (lung sounds, heart sounds, etc). It was intriguing to be a part of consultation, being a pharmacy student, while the medical students got a perspective of the pharmacy world.

This trip is definitely a learning experience, and some things will stay with me forever. We had an interesting patient yesterday who was about 12 years old and had kidney problems and thus had high blood pressure as well. She was on four different types of blood-pressure medications, which is obviously not common for a 12-year-old.

The patient population in Paraiso is very different, and each patient presents a unique problem. We were upset that it was our last day, but we were also looking forward to having the entire day off today. So on our day off today, we went to a beach called Boca Chica. We had fun, we bonded, we relaxed. It was a vacation day for us and very well spent.

Tomorrow, we are setting up our next clinic — so keep checking back to hear some more stories!

“The school-based clinic …” GEETIKA GANDHI, 6/7/10

The school-based clinic is located in El Paraiso, and the house calls are done on a Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for IMG_0269.JPGneighboring hill that is 40 minutes away called Esfuerso. During house calls, we visit those who are elderly or disabled and are unable to walk down the hill to the school-based clinic.

A couple of days ago, I did house calls with two medical students and Dr. Ryan. It felt like an adventure as we hiked with our backpacks full of medications and medical equipment and walked through the dirt pathways, tall plants, cow manure and barbed wires.

One visit that we made was for a 13-year-old girl who had a genetic condition Thumbnail image for Taking blood pressure at a house call.JPGcalled Klippel-Trenaunay-Weber. She was sitting a small room in her wheelchair when we examined her. Later Dr. Ryan told me that when she was younger her grandmother would carry her around the house, but now someone had donated the wheelchair to her. Visiting her reminded me of the importance of house calls since her unpaved neighborhood would make it impossible for her to visit a clinician.

I spent my last day at the El Paraiso clinic varnishing children’s teeth. I have a IMG_0281.JPGwhole new respect for dental hygienists since as a pharmacist I would be advising children, but dental hygienists have to work in the mouths of kids who come to their clinics crying. As I walked around the community yesterday, I realized that the locals here depend on HOMBRE for their medical needs. I am glad to be part of a team that is helping those who are medically underserved. In El Paraiso alone, we have served around 500 patients. Tomorrow we will be starting clinic at a new site in Los Mina.

Thumbnail image for Thumbnail image for IMG_0295.JPGMy roommate Sravi summed up our day:

“Work yourself to exhaustion, crash, wake up with the roosters and do it all over again. So worth it. :)”

“Wow is my word for today.” SEEMA BANGER, 6/4/10

Wow is my word for today. I went on house calls and visited a various individuals in their homes. Although, we only covered about eight to 10 houses, these houses had multiple individuals and we attended all of them. Since my Spanish is not up to par, it was a little difficult to take a leadership role and be interactive with the patients.

However, we as students were able to gather some basic medical history information from the patients, perform blood pressure check-ups, quick eye exams, and even check heart and lung sounds.  I was very surprised by the diversity of illnesses in this community. We saw individuals from some common disease states such as diabetes and hypertension to a person with sickle cell anemia and a 26-year-old with hypertension-induced renal failure who is now on dialysis.

It was also striking to me that these individuals were very involved with their own medical care. As needed, they would go to the public hospitals for sonograms, mammograms, dialysis, etc. As far as our visit, we were able to provide them with medications for their chronic illnesses, but not for all conditions. Almost every individual we visited received vitamins (adults and children) and parasite medication (Albendazole… parasites are very common in this community).

We were welcomed into the houses with great modesty and generosity. The community of Paraiso looks forward to HOMBRE’s visit every six months. Although our days start at 6 a.m. and don’t end till 6 p.m., it is truly a wonderful feeling to being doing such a good deed. This is definitely a lifetime experience for me.

“When we arrived at the clinic …” GEETIKA GANDHI, 6/4/10

When we arrived at the clinic today, we had a row of patients already waiting for us. At 8am, there were 50 people waiting for us. At a certain time of the day we just could not see any more people. The clinic could take additional patients if we had more health professionals, so it was disappointing to turn patients away.

I rotated in the pharmacy today with one other medical student and another civilian. I was nervous before since this put me in the pharmacist role for the first time. But once I was in the pharmacy, it felt amazing since not only was I able to help the underserved but was running a pharmacy and counseling my patients in another language.

The pharmacy was a bit slow in the morning, so I stepped out to help other medical students varnish kids’ teeth. The first boy that I sat down with had no teeth to varnish. You are not supposed to varnish teeth that have cavities, but all of his teeth looked infected. Back home, I am so used to seeing bright clean teeth and had not thought before of kids who cannot afford to buy toothpaste and toothbrushes. It was quite a disappointment to see that most of the kids had cavities and were clearly not brushing.

I am now comfortable speaking Spanish with my future patients. There is only so much that you can learn from Medical Spanish courses; the true learning lies in communicating with Spanish locals. I am slowly getting accustomed to the slang and pace of the local people in the DR.

The top three drugs dispensed today were Albendazole, vitamins (of course) and ferrous sulfate.

“I am in Paraiso, Dominican Republic …” GEETIKA GANDHI, 6/3/10

IMG_0188.JPGI am in Paraiso, Dominican Republic (DR), with one other pharmacy student, seven medical students, one pre-med student and our group leader, Dr. Mark Ryan. We landed here a couple days ago and prepared for our medical mission, which started today. It feels rejuvenating to be a part of a group that is also committed to helping the underserved.

We brought vitamins with us from the U.S. In the DR it is culturally preferred to take vitamins since the are the “cure-all drug” IMG_0215.JPGand are fairly expensive here since they are in high demand.

In our school-based clinic today, I was at triage … mainly measuring blood pressure, body temperature, weight and heart rate. Last year, I volunteered at a rural area medical project in Virginia and also was stationed at triage. In comparison, I agree that people in rural areas in the U.S. do need more medical attention, especially in dental and vision care. However, the level of medical attention needed in the areas that I am currently in far exceed anything that I IMG_0208.JPGsaw last year. The three prominent diagnoses that I saw today were fungal infections, parasites and hypertension, which are all conditions that can be treated or managed.

During the rural Virginia project, I noticed that the majority of the patients had primary care doctors through their Medicaid plan. But the people here don’t have that government-sponsored option. With my half-spoken Spanish I found that most of them are choosing between food or medical care. This IMG_0212.JPGis something that I have heard of before, but seeing it in real life was a different experience. Another reason for the lack of medical care is that the community does not have clinics available. It was also interesting to see patients bring prescriptions to the clinic since they can afford the doctor’s visit but not the prescription.

With the word of mouth, the citizens here were waiting for us to arrive at the clinic. They are in need of our basic human right, “healthcare.” I am fortunate to be in a position where I could care for them.IMG_0200.JPG Over the next few days, I am looking forward to understanding the community better. More importantly I am excited to serve those in need. It is trips like this that makes me realize how blessed I am to live in a country that is so resourceful.

This quote shows one reason why I chose to volunteer for this medical mission.

“I believe that serving and being served are reciprocal and that one cannot really be one without the other.”

— Robert Greenleaf, educator and writer

 

“Today was our first day of clinic …” SEEMA BANGER, 6/3/10

Today was our first day of clinic in El Paraiso. We left our hotel around 7:15 a.m. and drove through floods of water. Since it was our first day, we had to set up the pharmacy and all of the other stations for the clinic.

My main role today was to run the pharmacy as smoothly as possible. I presumed there would be a lot of difficulties on our first day, but we had a very productive day. Language was definitely a barrier; however, after a few hours, we immersed in it with the people of the community. It was truly a pleasure to serve the natives of this community.

Tomorrow, I am set to go on house calls, where we actually visit the natives in their houses if they cannot make it up the hill to the community. I look forward to a very informative/interactive day tomorrow.