“Today was amazing. …” ELEANOR PRESTON BITUIN, 7/23/11

IMG_0854.jpg<<< Eleanor Preston Bituin (seated), at the smoking cessation booth, was logistics coordinator for VCU School of Pharmacy’s trek to RAM 2011.


Today was amazing. Not only was RAM more efficient this year, but there was more volunteers and more optimism among the patients. It was also a great learning experience, despite having gone the year prior.

There was plenty of on-the-spot problem solving and making do with what you had. I got to not only work with nurses and doctors, but dentists and other pharmacy students from Appalachia, as well.

The dentists were interested in our profession and took time to get to know us and show us what they were doing and how it could relate to pharmacy. In addition, the nurses saw that we could adequately take vitals and counsel patients on their medications and disease states.

As always, smoking cessation was a great place for pharmacy students to get to know patients and really make a difference in patient lives. Although we are not official experts in smoking cessation, the pharmacy students had a great ability to effectively communicate with individuals of all walks of life.

The best part of the afternoon was when Dan Wrinkle, who is part of the RAM health wagon, asked if VCU Pharmacy was into helping RAM in Petersburg and the underserved population there. Of course we were very excited to be part of this opportunity, and we hope that this actually gets to be pushed through next year.

“This is my second time attending RAM …” DAVID ALLEN, 7/23/11

This is my second time attending RAM at Wise, and it has proven just as rewarding as before. It is a great learning experience, but more than that it has allowed me to give back to a community in obvious need. The duties I have been able to fulfill have ranged from keeping the patients company to clinical things like taking vitals and A1C.

Overall, it is the camaraderie of our group and all of the 1,300-plus volunteers that has impressed me the most. RAM is a great example of how all the health care professionals can work together to achieve great things.

An example of pharmacy and dental working together was when I was shadowing with the oral surgeons. During my time with them, I was able to stop a Vicodin prescription that was written for a patient with a codeine allergy. He then used me as a resource for what options the pharmacy had for someone with an opioid allergy. Once we had that cleared up, I was able to drop off the prescription to the pharmacy while the patient was being prepped for surgery. Once he was done, I walked him down to the pharmacy where his meds were ready and we were able to counsel him and send him on his way.

What I’ve said is just a small cross-section of my time at RAM. The experience will be something that I will remember and that will help me during my rotations in the future.

“Although I am originally from Wise County, …” COURTNEY HERRON, 7/24/11

Although I am originally from Wise County, this has been my first year attending RAM, and I have to say that it has been an incredible experience. In many ways, I really identify with these patients because I understand how difficult it is to get insurance and find a good job in this area.  It is extremely beautiful and peaceful here, and many people who have lived here their entire lives would never consider leaving. 

However, the remoteness of the area makes it extremely difficult to recruit new businesses, and people here really struggle to find well-paying jobs that offer benefits.  As a result, many are unable to afford going to the dentist or doctor, even if they have been diagnosed with conditions that need to be monitored on a regular basis. Because of this, RAM is extremely helpful in allowing patients to get at least a yearly check-up and have their medications added or adjusted as needed.

My favorite part of this weekend has been getting an opportunity to interact with patients and  apply many of the things that I have learned in the classroom.  I have particularly enjoyed measuring A1C levels in patients with elevated blood glucose readings and counseling patients about medications and disease states. I especially enjoyed counseling patients about diabetes and the A1C test because my grandmother has struggled with the disease for many years. 

While volunteering in this section, I found that several of the patients I encountered did not initially understand why their levels were so high.  However, as I began the conversation about diabetes by asking them questions about their diet, how they were taking their medications and how they often they were testing their blood sugar, the answers soon became obvious. 

One patient I encountered worked as a phlebotomist at a local hospital, but had been without a meter for over a year and so had been unable to accurately adjust her insulin.  Another patient stated that he only ate one meal a day and just “felt bad” when his glucose levels got below 200.  However, once I explained many of the micro- and macrovascular complications of poorly managed diabetes, he was much more receptive to considering a change in diet and working harder to lower his levels.

A second area that I loved working in this weekend was the pharmacy. Again, I enjoyed interacting with patients and counseling them on how to take the medications they had been prescribed and also about the side effects they might experience.  All of the patients I encountered there were so receptive and expressed a level of interest that I rarely encounter at my job in community pharmacy.  In fact, I would go as far to say that I consider those I met to be my ideal patients, and it really drove home the point that sometimes those most interested in their health are unhealthy solely because of lack of education, money and/or opportunity.

All in all, this experience has truly made me appreciate my heritage, and I am so thankful that I got the opportunity to help people that I feel I know and understand and who were so genuinely appreciative of all we did.

“RAM is one of those experiences that define you … ” ANDREW CARMICHAEL, 7/24/11

RAM is one of those experiences that define you as a professional. I think this is because you engage a population of people that usually have nowhere else to go, but typically have the most complex disease state management. More often or not, as pharmacy students we live in a bubble of lectures, homework, studying  and day-to-day decompression. We forget that the patients who need us most often do not have the resources to come to our workplace’s doorstep. We also forget, trying to get through our schooling, that the most important lecture we can ever have is patient engagement.

It’s very different to study disease states and how to treat people without a face or life’s complicating problems. It’s also completely different to develop therapy plans when you realize that your hesitations, your nonverbal communication  and your empathy directly impact how a patient receives the information or recommendations you propose. You can have the best therapy plan on the planet, but if you are callous, cold, unconfident or unsure, your patients will pick up on these things just like we do without any other social interaction.

We become excellent practitioners not because we are expansive in breadth in knowledge alone, but because we learn to be empathetic, relaxed, confident and sensitive to our patient’s needs. Often these qualities become more important. RAM is one of the places I have developed these traits, and I try to hone as sharply as possible. It’s worth every mile, hour of lost sleep and uncomfortable night of hot, sticky sleep. If anything, it gives you an appreciation for everything you have and how lucky we are to be the givers and not the receivers.  I also feel like it’s a sad excuse to not spend a little time in such a setting because most of us spend more time watching television, texting/calling/facebooking each other, and doing other nonessential activities than we devote to helping others.

 So many more things crash into focus when you treat patients who often cannot afford their medications, have social and cultural barriers that make counseling difficult, and whose situations are almost never ideal. Things are never as simple in practice as they are outlined in a classroom or a book. You almost never run across best-case scenarios or clearcut answers. RAM helps you make sense of this. It is also is one of the most rewarding things I’ve undertaken. I feel it is our duty not just as community members, but as professionals, to take a couple days out of our schedule to go to those who cannot come to us. We cannot have good health care without engaging in free health care.

There will always be economic divides, but we can help close them a bit, even if only for a couple days, if we go outside ourselves and give our time freely. We also talk constantly about team-based therapy in school and how medicine is going to this model. There is no place where this is truer than at community outreach events such as RAM.

At RAM, you have all the health-care professional specialties working together, instead of in bubbles, to form an integrated form of care, because there are no issues of who gets paid what or whose plan is more important. We come together to give the patient as much as possible. We also learn each other’s strengths and weaknesses and rush to fill in those cracks to form a more seamless plan of care. You also hear the gratitude, the tears of happiness and humility from your patients. I even often hear the phrase, “Thank you for everything you do. This is the best care I’ve ever received.” I also hear, unfortunately, “Thank you for actually spending time with me. My doctor, nurse, pharmacist, etc., does not spend this kind of time with me, and they charge so much money.”

This is my second time at RAM, and my role is much different this year. This year I’m learning to lead my peers to this same great opportunity and trying to develop ways to expand our presence at this event. I try and focus on what things went well, what needs work and which things not to continue or repeat so that next year, when I lead RAM, I can make it a little bit better than the year before and leave another scaffold on which my successor can build and make better after me, as well.

I’m incredibly excited by this prospect, but also very nervous. I want this experience to be as rewarding to others as it has been to me over the last two years. I want my peers to become better professionals. I want to show our communities that pharmacists are willing to go outside of their 9-to-5 work schedules to make sure that their health needs are met. So many of these things will worry me, but they will also focus me to ensure that I put everything I can into making RAM more successful. RAM has been one of the biggest honors I have been given because it has given me the chance to take care of my fellow man without the restrictions of insurance, prestige or management.

Thank you, RAM, for making me a stronger practitioner and a better human being.

Editor’s note: Andrew Carmichael was assistant team leader for VCU School of Pharmacy’s trek to Remote Area Medical 2011 in Wise County, Va.

“After the amazing experience I had last year …” AMANDA KROLL, 7/23/11

After the amazing experience I had last year at RAM, I couldn’t wait to come back again this year.  I have been eagerly awaiting the opportunity for me to get to know more patients, pharmacists, nurses, doctors and other students as we all work together to serve a common cause.  I was truly humbled last year as I went through the different stations that pharmacy was involved in and got to see how we impact the health of the patients we serve.  

This year, my experience at RAM has been just as wonderful as last year.  So far, the best experiences I have had were while I was using the point of care A1C test.  While getting to use the machine was a great hands-on opportunity, it was also a great time for me to talk to and get to know the patients as well as work on my diabetes counseling skills.  During the five minutes it takes to run the A1C test, I was able to educate patients on how to better manage their diabetes, talk to them about what an A1C test is, how to take their diabetes medications and what to do if their blood sugar gets too low. 

One patient didn’t understand why her blood glucose reading on Friday was in the 300s because when she takes it at home it’s always less than 100.  During the counseling session with her, I discovered that she stores her test strips in the refrigerator.  I was able to talk to her about the importance of storing her test strips at room temperature and how this could cause her to get an error in her glucose readings.  She expressed understanding, and I hope that this will have an impact on the management of her diabetes and insulin. 

While the clinical side of the point-of-care testing was a great learning opportunity, the best part was sitting and listening to the patients.  So many of the patients really enjoy being able to share their story and express their gratitude for the services we provide here at RAM.  To me, this is the most rewarding aspect of RAM.  Knowing that I have in some way made an impact on even just a few patients’ health care is an extremely gratifying feeling.

Reflecting back on these two years I have spent at RAM, I feel really lucky to have been able to be a part of the health care provided.  I am really fortunate to be able to sit with the nurses and learn from them, to be able to listen to the pharmacists and better my counseling skills, and to be able to give back to the community and surrounding areas.  I hope to share my experience with other students and encourage them to come in the future, because I know I will!