“Something really neat happened …” NATALIE NGUYEN, 7/25/11

Thumbnail image for Natalie Nguyen with Gov. Bob and Maureen McDonnell.JPG<<< Bob McDonnell, Natalie Nguyen, Maureen McDonnell

 

Something really neat happened this weekend at RAM.   Virginia Secretary of Health and Human Resources Bill Hazel and his wife Cindy, Mrs. George Allen, Mrs. Jerry Kilgore and Gov. Bob McDonnell and his wife Maureen visited RAM on Saturday.  

Mrs. Allen and Mrs. Kilgore met some of the VCU School of Pharmacy students working at the smoking cessation booth and, even further, P2 Shaema George and I were able to have a long dialogue with the former first ladies about medication adherence and health prevention strategies.  And so, it was such a great feeling being able to represent VCU SOP in this way!

Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Susan Allen, Natalie Nguyen, Marty Kilgore.JPGEditor’s note:  Natalie Nguyen worked as a Virginia Governor’s Fellow this summer with the Office of Health and Human Resources. She had been tapped for the RAM team before receiving the fellowship and was happy to find that Bill Hazel also would participate in RAM.

                                                                          ^^^ Susan Allen, Natalie Nguyen, Marty Kilgore (photos by Shaema George)

“Patient interventions when you least expect them,” CATHERINE FLOROFF, 7/29/11

DSCN0959.jpg

Catherine Floroff (center) had a rewarding patient intervention experience at RAM.

 

 

For many reasons, Remote Area Medical (RAM) is an experience I will never forget. Patients in triage, the medical tent and those receiving dental care all have significant stories that brought them to the fairgrounds to receive treatment. However, I quickly learned that patient interventions can happen where I least expected it — at the smoking cessation booth.

The first opportunity I had to sit at the smoking cessation booth was on Saturday. As soon as I walked up to the booth, I was met by a woman in her mid-40s who stopped by on her way to the pharmacy to retrieve her medications. I will call her Barbara.

Barbara’s eyes looked desperate, and her body language seemed very sluggish. From her demeanor, I could tell she needed to talk about a problem she was having. I asked her if she struggled with smoking. When Barbara replied yes, I then proceeded to put together some materials that could help provide tips on ways to quit.

Then she started to cry. I grabbed a chair and brought it to her. I asked Barbara if she had a few minutes to talk about her situation and I reassured her I was there to help. We spent the next 20 minutes or so talking about her situation. Barbara was the sole caregiver of her sister who was struggling with COPD. She smoked four packs a day and found that stressful situations made her want to smoke even more. Recently, Barbara explained that her fiancé had asked her to quit smoking. She also explained that praying helped during times of extreme cravings.

When she calmed down, we were able to go over the materials that would help her on the path to recovery. In the end, she thanked me for taking the time to listen and provide assistance because her doctor never did in the past.

Patients came and went by the booth throughout the course of the day. Moms, dads, brothers, sisters and friends spoke to me about their loved ones and how they wish they would quit smoking. A pregnant woman in her mid-20s stopped to grab some patient assistance materials and explained that she planned to quit once her baby was born. A 16-year-old boy sat down in the chair to tell me that his friend asked him to start smoking for no reason. I asked him if he planned to quit. He replied that his mom smoked and that made it OK for him to keep smoking. While his story and many others are difficult to recall, the reality is that they are true.

My experience at RAM was very humbling and one I will never forget. It reminded me of why I wanted to be a pharmacist. It also reassured me that patients will always need our help. I will never forget the raw emotion I felt during my four-day experience at RAM and how these patients helped me to better myself as a future pharmacist.

“This is the first time that I have done RAM …” SHAEMA GEORGE, 7/29/11

 

DSCN0997.jpg

Shae George (kneeling, left, in VCU Rams T-shirt) found Remote Area Medical a fulfilling experience.

 

This is the first year that I have done RAM, and I was very uncertain of what to expect initially. The scenery of the six-hour drive was absolutely breathtaking!

We stopped in Abingdon for lunch at Pop Elle’s. Ironically, this restaurant was once a pharmacy.  The first evening spent at RAM was just to help with setting up the pharmacy and getting an idea for where all the different teams will be. We then went back to our living quarters to find that the townhouses we were assigned to had no air conditioning and, to be totally honest, were not the cleanest, either.

The conversation at dinner that night was mostly about what we needed to get from the nearby Wal-mart to make living here for the next three days bearable.  Then, by showering with our flip-flops on, wrapping ourselves in our blankets, sleeping as far away from the walls as possible  and turning our fan (that we had decided to bring at the last minute, thank GOD!) on the highest setting, we made it through the night.

At 4:30 a.m., I was up and getting dressed for my first day here.  Even though it was dark outside still, I was surprisingly awake and excited to see what the day would bring. I started off at “Med Rec,” where it was my job to fill out a wallet-sized sheet that listed medications, allergies and other such personal information for each patient waiting to be seen by triage.

The Appalachia School of Pharmacy students were also doing this with us, so it was very interesting to see how the other schools had trained their students and to work with them on certain tasks. Shortly afterward, I was asked to help at triage, so that was where I was for the most of the morning.

I was with a nurse named Donna, who was such a delight to be partnered with. She and I had worked out a system where we’d raise our hands for a new patient, he/she would come over, we’d introduce ourselves,  then I’d ask all the questions to fill out their paperwork while she did their vitals. This was where I saw firsthand how critical a pharmacy background is for a task as simple as filling out the patient’s papers.

A few patients had been writing their own medication lists out or had someone write it who didn’t know the actual name of the medication. For example, one lady had “Prabapast 20mg for cholesterol” written down. Turns out the patient had meant to write “Pravastatin 20mg” but couldn’t spell it or pronounce it, and the person writing the list out had no idea, either. I was able to correct the patient’s list and paperwork because I was familiar with the drug name.

About three hours later, I was scheduled to go to the grandstands and play our educational trivia game with the patients who were in the waiting area. Unfortunately, by the time I had gotten to the game, the heat and humidity were taking the life out of the patients. A few volunteered to answer some trivia questions merely for the sake of having something to pass the time, but for the most part, there was not much interest. About an hour later, I was reassigned to triage, where I was able to put a little more of my skills into play.

The nurse I was with, Kathy, allowed me to take blood sugar and pulse while she filled out the sheet and took blood pressures. If there was a patient with multiple papers to fill, we’d both fill them out as one of us asked the questions. It felt good to finally have something more than my handwriting and talking skills to offer to the efforts of the whole RAM mission.

The day had started winding down four hours earlier than expected, so we were slowly running out of ways to help. After doing some cleaning and straightening up, we went back to the townhouses and relaxed. After my much-needed shower, I was able to watch a movie and rest for about two hours before dinner.

About dinner, Reno’s Roadhouse had THE BEST bread I’ve ever tasted! Plus, being at a higher location than the townhouses, I finally had cell phone service and caught up on five voicemails and six text messages I had received from the last 24 hours. Once we all went back to our rooms, there was a short team meeting to discuss what worked and what didn’t for the day, and some games. But the day had worn us all out, and we went to bed almost immediately.

The next day started at 5 a.m., and I was at triage for the first hour and then went to the pharmacy to take prescriptions. Another interesting experience was when a dentist had forgotten to sign a Vicodin prescription. I had to run to the dental side and try to locate the dentist to get the signature. The dental clinic is HUGE! While there are at least three different tented areas where dental procedures take place, everyone knew at the very least what general area I should go to search for this dentist. I was able to get the signature and come back to the pharmacy, and the script was filled and ready  before the promised 10 minutes were over.

That’s probably the biggest thing I have come to appreciate about RAM so far. Everyone works together to get everything done! No one team can perform their tasks without the help of the other teams, and so the overall morale of the RAM mission is always high.

People will drive golf carts all day to provide water and snacks, serve meals three times a day for hours at a time, escort patients throughout each step of their care — and all this with a smile! It is nothing like I’ve ever experienced.

I’ve also noticed that the mood of the patients is changed for the better because of it. They are all so thankful and cooperative towards the staff. That also speaks volumes for how much they need health care here. Patients as young as 12, needing root canals or diabetes medications — it’s very heartbreaking.

For the 10 minutes that I was sitting with Amanda and Courtney at the smoking cessation booth the first day, we were able to speak to a group of Girl Scouts who were doing community service at the clothes tent. They had a lot of good questions, and we were able to at least plant the thought in their heads of how treacherous cigarettes and dip are for their health. Hopefully they took enough away information to think twice before they do it, or to reach out to a friend or family member and pass on what they learned.

RAM has definitely been the most fulfilling time well-spent this summer, to date. I’ve grown to like this area, the people and this incredible mission. I hope to repeat this experience for as long as I possibly can.

 

“Coming to RAM for the first time …” LAUREN COPELAND, 7/23/11

Coming to RAM for the first time, I had no idea what to expect. I prepared myself for mass chaos, but what I found on the Wise County fairgrounds was nothing close to disarray.  What I found was a highly organized, highly efficient clinic with a heart as big as the Blue Ridge. 

From the doctors to the nurses to the patients who came through the tent doors, what I had the privilege to be a part of at RAM was humanity in its purest form.

The very first day I was here, I was assigned to the grandstands, where patients would wait to be called before going into triage.  My job was to sit down with patients as they were coming in to go through medication reconciliation with them, so they would have an accurate medication list before going into triage. 

A woman and her daughter in the back corner of the stands motioned me over to where they were seated, and I went to work, going through their extensive lists with them.  As I was about to get up to go to another group, the mother  grabbed my hand and said, “Thank y’all so much for being here.  Next year I’m going to volunteer to pass all this goodness on.”

I was struck by her sincerity, and I asked what their experience had been with RAM in the past.  The daughter said that last year she was in the dental clinic, and the dentist had told her that she had to have seven teeth pulled.  The daughter said she started to cry, and the dentist tried to comfort her by telling her it wouldn’t hurt at all and, after all, it was only seven teeth and she was fortunate to have the rest. 

The woman said that she wasn’t crying because she was going to lose her teeth.  She was crying because after a full year of being in pain, she would be able to eat again.  At that moment, as this middle-aged woman from Tennessee was telling me her story, I realized that RAM is all about the little things: about helping out your fellow human being through rough patches and empowering all of us to take care of ourselves and each other. 

Whether it’s pulling teeth, taking vitals, providing counseling or just making sure everyone has enough water and food, no act here was too small and no act went unnoticed.  And as the elderly mother said in the stadium, every act gets passed forward to somebody else. 

“Early mornings, little sleep, long lines …” JESSICA MILLS, 7/23/11

Early mornings, little sleep, long lines, painful procedures and extreme heat could test the patience of anyone.  But that’s what has surprised me most about both the patients and the volunteers here at RAM: Despite these conditions, everyone is excited, appreciative, friendly and generous. 

The RAM spirit is unbelievable and energizes everyone so they can complete the amazing amount of work that is done in the few days that services are provided.  I knew going into the trip that I would test my communication and clinical skills, but for me this has been more of a test of physical endurance. 

I have proven to myself that I am able to work harder and longer than I ever imagined simply by pushing through and feeding off the appreciation of the patients and the excitement of my classmates.  I am very happy that I was able to attend this event, and I hope to find other events like this to attend so I can help others realize how much their skills and knowledge can help those who need our services.

“Although this is my third year attending RAM …” ERIKA STIENE, 7/23/11

RAM.jpg

Erika Steine (left) helmed the RAM 2011 team for VCU School of Pharmacy.

 

Although this is my third year attending RAM, the strength and dedication of the volunteers continues to astound me. Volunteers from all different backgrounds from all over the state come together to work toward a greater cause.

Large groups from VCU School of Dentistry, U.Va. Medical Center and the Lions Club make up a large portion of the work force, but there are countless volunteers who have signed up and made the trip to Wise, all on their own, to volunteer.

With triage taking place in a barn, dentists working under tents and a pharmacy operating out of a shed, volunteers do everything they can to provide care in less than ideal conditions. Adaptability and dedication create an event where over 1,500 patients can be seen in one day.

It is important to note, however, that even though a large number of patients are served through this event, each one is given a great amount of attention and individualized care.

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

“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.