It’s a wrap! School of Pharmacy hits RAM seventh time running

IMG_0609Fourteen VCU School of Pharmacy students, four residents and three faculty members traveled to southwest Virginia in mid-July as part of the 2013 Remote Area Medical experience in Wise County.

The 2013 School of Pharmacy RAM crew consisted of team leader Natalie Nguyen, team co-leader Erika Lambert and students Sara Ayele, Mimi Baker, Sarena Barden, Melinda Ellis, Nellie Jafari, MaryBeth Jones, Kelly Miller, Jenna St. Pierre, Margaret Robinson, Rebecca Saunders, Allison Smith and Keshia Ward, as well as pharmacy residents  John Bucheit, Stephanie Culbertson, Bethany Helton and Rose Salzberg  and faculty members Evan Sisson and Jennifer Neal and clinical faculty Rebeccah Collins.

Since associate professor Sisson led the first pharmacy team to RAM in 2007, the event has provided an excellent interprofessional experience for pharmacy students who work with dental students, dental hygienists, nurses and other health-care professionals. Among their other duties, pharmacy students obtain  medical histories from patients, help with patient counseling, distribute  preoperative medications and work with smoking cessation.

This year, more than 1,400 volunteers worked the two-and-a-half day event at Wise County Fairgrounds, providing free medical, dental and vision care services to more than 2,000 uninsured and underinsured patients. Some patients — entire families, in fact — waited as long as 24 hours and more to see health care professionals.

The School of Pharmacy has a long tradition of serving patients both at home and abroad. Nearly 70 students applied this year to work with Remote Area Medical and Mission of Mercy teams.

To learn more about the School of Pharmacy’s participation in RAM, contact Evan Sisson at emsisson@vcu.edu. For more information about Remote Area Medical, click here.

“In one of the wealthiest countries in the world …,” SERENA BARDEN

Serena Barden (second from right) left RAM with a new appreciation for what she has learned in pharmacy school and how it can benefit patients.

Serena Barden (second from right) left RAM with a new appreciation for what she has learned in pharmacy school and how it can benefit patients.

In one of the wealthiest countries of the world, there are still millions of people who do not have access to health care.

To have been a part of an event that provided free, professional health care to those in need was an incredibly humbling experience. Each encounter I had with patients was a positive one, and I could see how thankful they were for the work that everyone was doing.

I loved being able to give back to my community by providing health care services that I’ve been taught during my time in pharmacy school.

“While at RAM, I had many memorable experiences …,” MARYBETH JONES

Working with RAM patients gave Marybeth Jones (right) a glimpse into the lives of people who don't have easy access to health care.

Working with RAM patients gave Marybeth Jones (right) a glimpse into the lives of people who don’t have easy access to health care.

While at RAM, I had many memorable experiences. I worked closely with a nurse, Aimee, over the course of the weekend. At first it seemed she was hesitant to let students work with her. She was unsure of what pharmacy students were capable of doing.

However, as the weekend progressed, her confidence in the knowledge that a pharmacist and a pharmacy student had seemed to be more clear. Over the weekend, I was comfortable asking her questions about what different blood pressure readings meant. Aimee also asked me many questions. I shared with her a new drug interaction I had learned the past week, and the next day she was asking me questions about it in order to implement her knowledge when she returned to practice.

She was very confident in my drug knowledge as a pharmacy student, but she also learned that pharmacy students and pharmacists are capable of doing clinical work such as blood pressure, blood sugar and pulse. Aimee taught me how to take a forearm blood pressure, which I had not been previously exposed to or asked to do. We both learned from each other in a short period of time spent together. It was very interesting to me to have an interprofessional experience with open minded health professionals and use each profession’s knowledge to achieve a goal of the best health care we could provide at RAM in Wise, Va.

Personally, the most important thing I took from this experience was seeing how caring the nurse, Aimee, that I worked with was with each and every patient. Topics like depression, anxiety and smoking have always been subjects that are hard for me to approach and address with patients. However, even with our limited time working with each patient, Aimee would make it a point to stop and ask them if they were OK, and if they were seeking help. I am definitely more comfortable approaching sensitive subjects with patients just from seeing how easy she made it by staying calm and not seeming judgmental. You never know what someone may be struggling through and how you can make a difference in their life.

While I had great interprofessional experiences, overall the patients were what mattered. It was heartbreaking to see these people waiting hours in the heat to receive basic health care that they could not afford. I felt like I got a small glimpse into life problems that these people deal with daily. The patient that truly caught my attention did not even know she had done so. While working with Aimee, who was in her mid-30s — after working with the patient to get her vitals and health history — when she walked away, Aimee looked at me and said that they were the same age. The patient looked almost 20 years older than Aimee.

Also during this experience I was asked to check blood pressures closer to the time the patient would be seen. Spending one-on-one time with these patients while they were nervously waiting really opened my eyes to the extremes these people were going to just to receive the health services that may seem simple to someone who has these things done annually, such as cleaning or restorative fillings. While checking these patients’ blood pressure, a few of the patients had readings that were too high to go in for their procedure. The nurse I was working under at this time was grateful for pharmacy students catching these blood pressures that may have put the patient in danger during a procedure, as they were receiving drugs that would further increase their blood pressure.

“I had a great experience at RAM overall …,” JENNA ST. PIERRE

Jenna St. Pierre (left) appreciated the opportunities to talk to patients up-close and personal at RAM.

Jenna St. Pierre (left) appreciated the opportunities to talk to patients up-close and personal at RAM.

I had a great experience at Remote Area Medical overall, but what I enjoyed the most was the many opportunities to interact with the patients.

I’ve spent my summer working in a very busy and very corporate community pharmacy where I haven’t felt a strong connection with any of our patients, so I really enjoyed being able to have a real conversation with many of the patients at RAM. I felt that most everyone I talked to was genuinely interested in and appreciative of talking with me. It was a nice contrast to the busy setting I have been working in to feel like I could sit and talk with a patient for several minutes about whatever issues they wanted to bring up.

While helping out at the smoking cessation booth, I was surprised and inspired by the number of people who were seriously interested in quitting smoking or helping a family member to quit. I had not expected so many people to have such openness to the idea.

I felt that many patients I worked with at RAM seemed to be very open to the idea of making positive changes in their life to improve their health, which was a great thing to see.

“RAM was a life-changing experience …,” MIMI BAKER

Mimi Baker (left) found that getting up early was worth it at RAM!

Mimi Baker (left) found that getting up early was worth it at RAM!

Remote Area Medical was a life-changing experience, one that I will keep a special place for in my heart. The patients were all so grateful and appreciative of everything that we did for them. They were in high spirits throughout the whole day, even though most of them had been camping outside all night just to secure a decent spot in line. This put things into perspective while working in the community setting; usually I have patients that are easily perturbed when we don’t crank out their prescriptions in under 15 minutes on a busy day.

There were so many different interactions with patients and health care providers alike that I had while I was at RAM, but most of them revolve around providing the optimum patient care. One instance was when I was at the pre-med station, where pharmacy was playing a major role in pre-medicating patients with amoxicillin and ibuprofen before dental extraction/surgery. I was making rounds with my ibuprofen when I happened upon one gentleman who had a yellowish cast to his skin and eyes. He did not seem to be responding as well as the other patients. I immediately thought that he had hepatitis, but his triage papers did not say so. I asked him if he had hepatitis, and he finally admitted that he had A and B. I alerted our residents, Rose and Bethany, and they were able to relay this information to the dentists who were responsible for pre-checking all the patients. The gentleman was then sent to the medical tent for further check-up on his condition.

Another time was when I was at the smoking cessation booth and I had lured some foot traffic our way by standing in front of our booth, holding the face mold of the chewing tobacco cancer victim. A gentleman walked right up to me and started asking me about the face mold. I showed him the progression of cancer for the victim and the toll it took on his facial features. I gave the back story to the face mold, letting him know that the victim was a world class athlete who had a bad habit of chewing snuff. I guess it hit home because he started asking me about smoking cessation, and I happily provided him with all the information that he needed. He looked me right in the eye at the very end of our conversation and said, “It won’t be easy, but I’ll try.” I thought that was awesome.

I’m not a morning person, but waking up at 4:45 every morning to be on site by 5:15 wasn’t even bothering me by the second morning we were at Wise. I was running like a well-oiled machine by 6 a.m., going around and doing everything from health testings to counseling patients when they picked up their medications.

I have already thought about coming back to RAM every year I can spare as a pharmacist when I graduate in 2016. I know that all of our patients were extremely thankful for our work, but they didn’t know that they were also rewarding me with the pleasure of working with them. I enjoyed every single moment that I helped them and I’m thankful that I got to be part of such a great team assembled by Natalie (Nguyen), Erika (Lambert) and Dr. Sisson.

“RAM is a great thing for any pharmacy student …,” REBECCA SAUNDERS

Participating in RAM taught Rebecca Saunders (second from left) that there are people in need both here and abroad.

Participating in RAM taught Rebecca Saunders (second from left) that there are people in need both here and abroad.

Remote Area Medical is a great thing for any pharmacy student to experience, no matter where they want to practice after pharmacy school.  To be a pharmacist, one needs to have a serving attitude and that is just what you do at RAM in Wise, Va.  You serve the people of the area and surrounding states.

I took many blood pressures and blood glucoses in triage and pre-op, but when I felt most helpful to people is when they were lost and I could point them in the right direction.  Most of them not knowing which long line to wait in next, where the pharmacy was or that there was even a pharmacy to get their prescriptions filled at.

RAM makes you feel how fortunate you are and that in the United States, not just third-world countries, there are people who need help desperately.

 

“RAM was truly one of the most wonderful experiences …,” MARGARET ROBINSON

Margaret Robinson (front row, third from left) found joy in helping RAM patients both medically and otherwise.

Margaret Robinson (front row, third from left) found joy in helping RAM patients both medically and otherwise.

Remote Area Medical was truly one of the most wonderful experiences I have had since being in pharmacy school. I thoroughly enjoyed helping each patient and assisting volunteers throughout our time at the site. I had several interactions with patients while at RAM — assisting with premed, taking prescriptions, filling out medication cards, taking A1Cs and so on.

Some of the most meaningful times for me, though, were ones where I wasn’t serving the patients as a pharmacist but rather helping them carrying their belongings to their next destination or running to find a plastic grocery bag for a woman whose bag of things was leaking. I had the opportunity to talk to one gentleman at the smoking cessation for an extended period one afternoon. He told me about his experience with trying to stop smoking and how he had cut down from 2½ packs per day to ½ a pack. He told me about his reasons for wanting to quit — so he could enjoy more time with his nieces and nephews and put the money he saved towards a house while becoming healthier. It was nice to have him open up and be so honest about something that I have not personally experienced.

Several of the people at the booth were funny, and I really enjoyed educating them about smoking cessation and breast cancer awareness. I loved talking to some patients who told me as soon as they were done being cared for they were going to volunteer for the remaining time. One of the most touching experiences was a father telling me that he wanted his daughter to have braces, so that’s why he was coming to receive free care for himself.

While there were tons of positive experiences, there were also those interactions — like an 8-year-old boy telling me he’d only gotten 10 minutes of sleep the night before as they waited for the gates to open, or a woman telling me she’d lost her mother just two days before — that made me so thankful for all that I have and reminded me of how fortunate I really am. There was no hierarchy at RAM — no one was better or worse — everyone deserved the best care they could receive whether they had a million dollars or barely anything.

The interprofessional experiences were fantastic as well. I learned so much from Liz at the smoking cessation booth and from another woman who was well-educated in breast cancer awareness. Both of them showed such great joy in sharing what they knew with patients and students. They seemed to love having us there, and I was even able to get contact information for the woman who taught me about breast cancer so that we can possibly meet with her in Richmond and she can educate others.

I had a great talk with a nursing student, as we explained to each other the different types of pharmacy and nursing and the education required for each. It was so interesting because I know so many nurses but so little about the different levels of nursing. She was surprised to hear that there wasn’t necessarily a hierarchy in pharmacy like in nursing.

I would love to go back to RAM next year and then again when I’m out of school. The people we served were those who were in such great need and were so appreciative of us. While I wasn’t always doing “pharmacy” things, I had a great time helping out in any way that I could —  and sometimes those were more important ways. I felt like I was making a difference — even if it was just sharing a smile with a patient or trying to ease a concern for a minute or two.

A few of us on the team discussed one night the types of occupations patients reported on their triage sheet. There were many of the expected unemployed, disabled, or retired, but I was surprised to find there were also so many people who were employed as clerks, receptionists and even teachers and nurses who came to receive care.

I am so fortunate to be able to receive health care immediately and not worry about not being able to see a doctor if I get sick. If I have any mouth problems, I know I can call my dentist and be seen within the week. There are too many others who do not share this luxury. Many of these people work harder than I do and they deserve great care. I’d like to help give back.

 

“The best way to find yourself …,” MELINDA ELLIS

At Remote Area Medical, Melinda Ellis (left) discovered that people her own age were as much in need as older people.

At Remote Area Medical, Melinda Ellis (left) discovered that people her own age were as much in need as older people.

“The best way to find yourself is to lose yourself in the service of others.”                       — Mahatma Gandhi

As a student pharmacist who eats, sleeps and breathes every day within a mile of a major medical center, it’s hard to believe that someone in today’s society wouldn’t have access to appropriate medical care. Sadly enough, there are people all over the state for whom this is true — and especially for the people of Wise County, Va.

The days leading up to Remote Area Medical were filled with excitement, both to experience something new and to be able to work alongside my fellow classmates helping people who were less fortunate than us, but also apprehensive. I’ve learned all of this information in class, but could I apply it to real-life situations? Either way, I was headed to Wise, and I couldn’t have been more excited for what this journey had in store for me.

The first day came early — 4:30 p.m., to be exact — and people were already lined up at the gates waiting to get in. As we triaged patients, took vitals and medical histories, it dawned on me that the people we were serving weren’t just older — there were patients my age, as well. Young adults who had chronic medical conditions who weren’t getting appropriate care — people who could have further complications prevented.

It was one patient that I helped that particularly hit home with me — a teenage girl with Type 1 diabetes who had lost her mother due to complications of the same condition. As we talked, she told me about her struggles with not being able to afford insurance, insulin and sometimes — healthy food. She hadn’t slept in over 24 hours in order to keep her spot in line to be seen because she had seen her mom suffer and didn’t want to be faced with the same problems in the future.

I couldn’t help but admire her for being so proactive despite the struggles she seemed to face.

Volunteering at RAM has been one of the most rewarding things I’ve done thus far in my pharmacy career. It afforded me the opportunity to strengthen my clinical skills and knowledge, teach patients and help them understand more about their medical conditions and medications, learn about other professions, make new friends and, most importantly, provide care to patients who were overwhelmingly appreciative of what we were doing.

“RAM has truly been a remarkable experience. …,” NELLIE JAFARI

Nellie Jafari (front row, yellow dress) found value in the interprofessional aspects of Remote Area Medical.

Nellie Jafari (front row, yellow dress) found value in the interprofessional aspects of Remote Area Medical.

Remote Area Medical has truly been a remarkable experience. Not only did I get to learn from the pharmacy students from my school, I also got a chance to meet pharmacy students from Appalachian College of Pharmacy. It was really interesting to compare curriculum and hear their perspective on pharmacy. In addition, I got to meet medical students, dental students and nursing students. Having the opportunity to work in an interprofessional environment was a great way to foster lasting relationships that could lead to future collaboration.

Another aspect of the trip that I enjoyed was practicing my clinical skills in the areas of triage, medication reconciliation, the pre-med area and in the pharmacy. I learned so much from the nurses, residents and pharmacists. They were able to provide me valuable feedback to improve my skills. I am very grateful that they took the time to supervise the students because their input is very beneficial to us.

Not only did I learn from the health practitioners, I also learned a lot from the patients. They were so amazingly grateful for the service we were providing. Most of them had slept overnight in their cars just to receive medical care, but they did not let it show in their interaction with us. They were so positive and thankful for the advice we would give them.

Although it was rewarding helping the patients, my favorite part of the trip was simply interacting and talking with the patients. Learning about their life and their view on health care really made me understand the health disparities that pervade in the Wise community. It is evident that their daily routine is not ideal for their health. Although we cannot directly change their socioeconomic situation, I am appreciative for the opportunity to have been able to help with their health care. 

“Wherever the art of medicine is loved …,” SARA AYELE

A defining moment for Sara Ayele (second from right) came when she met a father and daughter who had defied the odds to get to RAM.

A defining moment for Sara Ayele (second from right) came when she met a father and daughter who had defied the odds to get to RAM.

“Wherever the art of medicine is loved, there is also a love of humanity.”

When I got to Remote Area Medical, I saw a sea of T-shirts with the above Hippocrates quote. Upon my arrival to RAM, I had no idea that the short four days that I would spend in Wise, Va., would rock my perspective.  Before my arrival to Wise, I hoped to gain a greater understanding of how to help patients with limited resources navigate the health system. Little did I know that I would walk away from Wise having gained much more than I would have given.

We always learn in our pharmacy classes how important it is for us as pharmacists to work in rural, underserved areas. But I never quite understood how much of an impact a pharmacist could make in a rural area until I came to Wise.

A defining moment for me at RAM was when I was in the medication reconciliation station. Here I met a father and daughter who traveled three hours to get to Wise. As I sat down in the bleachers side by side with them, slowly they unraveled their story to me. As I interviewed the daughter on what medications she took, she explained to me that her primary concern was to get her teeth examined. She knew she had at least four cavities and feared having to get extractions. She also wore glasses and needed an updated pair of lenses. Her mother was raised on a tobacco farm, causing her to have COPD from the second-hand smoke she inhaled. As a result, her mother was bed-ridden, jobless and dependent on an oxygen tank to breathe. Her father bounced from job to job, and the jobs he took didn’t include insurance benefits, leaving his family uninsured. Worst of all, her father suffered from a stroke just days before RAM and was confined to his bed for three days without being admitted to the hospital because he couldn’t afford it.

I tried to weave in some advice to the daughter and father about the hallmark signs of having a stroke and the importance of getting to the hospital as soon as possible. The only one who knew that the father had a stroke was the family dog. The father claims that the only thing that kept him alive was the constant licking from his dog as the dog tried to keep his face from going numb and drooping.  Although today, the aftermath of her father’s stroke are undeniable. When speaking to the father, I noticed he would often lose consciousness and would have difficulty coming up with words to express himself.

The father put his daughter’s health needs above his own in coming to Wise. He got a lottery number only for his daughter to be seen because he knew that he couldn’t sacrifice missing two days of work if health care providers saw both him and his daughter. For him it was a simple decision, but to me it was a selfless decision. To them their story was an ordinary one, but to me it was anything but that.

Having walked away from Wise on Sunday, I learned much more than just how to provide patient-centered care for patients with limited resources. Above all, I saw with my own eyes the best of humanity. At RAM, I saw the Hippocrates quote I read on the DO’s shirts come to life. It is the essence of what tied us all together not only as RAM volunteers but also as patients.

I learned each patient had a story. As health care providers, it is our responsibility to hear their stories. For us, as pharmacists, that translates into providing care to make sure that our patients are around to live quality, healthy lives. We are all a part of the same tribe of humanity because their stories are our stories and our stories are their stories.