VCU School of Pharmacy’s eighth RAM event: mission trip accomplished!


School of Pharmacy associate professor Evan Sisson (first row, left) initiated and has helmed the school’s participation in Remote Area Medical for eight years. Sisson is also an alumnus of the school.

About two dozen VCU School of Pharmacy students, faculty and residents made the journey to Wise County, Va., in July 2014 for the eighth year running. Why? To participate in RAM — Remote Area Medical — and to be among more than a thousand volunteer health-care professionals and students helping thousands of unserved and underserved patients in two and a half days. Here are the students’ stories.

As an aside — but important to know in recognizing the program’s ongoing success — the School of Pharmacy’s ongoing participation in RAM earned it an American Association of Colleges of Pharmacy 2013-14 Student Community Engaged Service Award. Read more about it!

“Although this was my third year attending RAM …,” ERIKA LAMBERT, class of 2015

Erika Lambert, with SOP associate professor and alumnus Evan Sisson, plans to return to RAM once she's a practicing pharmacist. She was student leader for the school's participation in RAM 2014.

Erika Lambert, with SOP associate professor and alumnus Evan Sisson, plans to return to RAM once she’s a practicing pharmacist. She was student leader for the school’s participation in RAM 2014.

Although this was my third year attending RAM, it was a very different experience RAM from the perspective of the student leader compared to a student participant.  This year, my focus was to ensure that students and preceptors had the tools and support to provide quality care for the thousands of patients we saw over the three-day clinic.

While the uncharacteristic cold and rain added some unique obstacles, it was a pleasure to lead such a dedicated and compassionate team.

This year, we provided an additional service of measuring cholesterol levels with CardioCheks to patients with diabetes or identified as pre-diabetes.  This service was possible through the award money received from the AACP Student Community Engaged Service Award, which recognized the commitment that VCU School of Pharmacy has made to Wise, Va., over the past seven years.  The cholesterol levels, in addition to the A1C values, provided patients with greater insight into their diabetes management and cardiovascular health.

Utilizing these values and pertinent medical and social history, students calculated and educated patients on their individual 10-year and lifetime risks of atherosclerotic cardiovascular disease (stroke, heart attack, etc.). Through these calculations, we were able to show patients how their modifiable risk factors (blood pressure, total cholesterol/HDL, smoking status, etc.) impacted their risk of having an ASCVD event.  These calculations were an incredible teaching tool as it was evident how much patients were impacted by seeing their risk scores and how their risk can decrease with lifestyle and medication management .

A duty of the student leader is to teach smoking cessation classes with members of Becky’s Place, an outreach organization with the Virginia Breast Cancer Foundation.  In collaboration with nurses and other health care professionals, we taught four smoking cessation classes with a focus on nicotine replacement therapy options.  The interactive classes allowed us to understand just how important is to educate patients on the proper use of the products, especially the nicotine gum.

The smoking cessation tent

The smoking cessation tent

Many people expressed that they had tried and failed using nicotine gum, but we came to find that they had been using it inappropriately, which greatly hindered the affect and made the therapy very expensive.  We also had great group discussions about e-cigarettes and provided the most recent safety information to help patients make the decision whether or not to use this option.  Several patients came back for multiple classes and were excited at the prospect of quitting smoking.

It was an honor to serve as the student leader as my last trip to RAM before graduating.  Without a doubt, I will return to RAM.  It may not be next year or the year after, but I will one day return as a practicing pharmacist to serve not only the patients, but students as well.

My experiences at RAM over the last three years have been invaluable to my education and have made a large impact on where I see myself as a professional.  Because of RAM, I want to continue to work with underserved patients and apply my years of schooling and practical experience to providing them with the highest quality care possible.

“After three years of volunteering …,” LAUREN GRECHECK, class of 2015

Lauren Grecheck (right), with nursing student Anna Young, feels medical outreach trips are critical to the student experience.

Lauren Grecheck (right), with nursing student Anna Young, feels medical outreach trips are critical to the student experience.

After three years of volunteering at medical outreach events, I have witnessed my role at these events change. During my first year, I was soaking in all the knowledge that upperclassmen, practicing pharmacists  and patients were able to share with me. I was utilizing the practical skills from lab by taking blood pressures, checking point-of-care blood glucose  and counseling patients on their medications and smoking cessation.

Now, in my last year of pharmacy school, I still found myself using these skills, but my role as a volunteer changed to include teaching as well. With the roles reversed from my first year, I was now the one able to teach younger students, patients and even practicing pharmacists.

Many underserved populations have undiagnosed or uncontrolled disease states, such as diabetes. As part of this year’s Remote Area Medical (RAM) trip in Southwest Virginia, VCU School of Pharmacy was able to perform A1C tests and cholesterol checks on patients who had a history of diabetes or had a high point-of-care blood glucose result during triage.

At this station, students were charged with checking these values and then counseling the patients on what their numbers mean and ways of improving these numbers to decrease risks and complications. Because the pharmacy volunteers are from across the four years of pharmacy school, this was a perfect place for students to learn. I was teaching pharmacy and nursing students how to use the devices for testing and proper counseling points based on the results. I was also able to counsel the patients on their values, explaining to them what their goal values mean, why we aim for these numbers and lifestyle changes that can be adopted to improve their values.

What I loved the most about these interactions was how, as the teacher, I was also a learner. Younger students who had volunteered at events such as these were able to provide pointers on how to obtain a better sample of blood with the pipettes for the cholesterol machine. Additionally, working closely with other students in this environment allows one to observe others’ counseling techniques, which enables students to refine their own counseling skills.

However, it is not just the students and preceptors teaching each other at these events; the patients teach all of us. The patients we help at these events are living with these diseases every day. They teach us the reality of how hard it is to pay for medications, such as insulin, and the experiences they have had with certain medications. Hearing about these experiences firsthand allows me and other students to better care for future patients because we will have a greater understanding of what living with these conditions entails.

Lauren Grecheck (right) and Erika Lambert

Lauren Grecheck (right) and Erika Lambert

While my role and experiences at these outreach trips has evolved from mostly learner to more informed teacher over the last three years, the thing that remains the same is the appreciation for these patients for allowing us into their homes to provide care for them. Without these experiences, students would be unable to apply what they learn in school to real-life scenarios.

I am so touched when I see patients receiving the care they deserve, but I feel empowered in my profession when I see younger students expanding their confidence in taking blood pressures or counseling on discharge medications at these events. Medical outreach trips are critical experiences for students, an experience that I wish more students were able to have.

Many people think of these events as medical professionals serving patients, but the reality is that we are all serving each other. Patients invest their time and trust in us, and in return we are able to learn and grow so we can provide optimal health care to more patients in the future, as well as teach future students to provide this level of care.

“When I look back on my time at RAM …,” SERENA BARDEN, class of 2016

Serena Barden found RAM to be a good reminder of why she chose pharmacy as a career.

Serena Barden found RAM to be a good reminder of why she chose pharmacy as a career. She was the school’s 2014 RAM student co-leader.

When I look back on my time at RAM this year, I remember the encounters I had with the people of Wise, Va., I think about the many patients I was able to talk with and hear their stories of why they were at this event.

Many patients had spouses who lost their jobs, some had recently been laid off from the local coal-mine and others had never been able to afford adequate health care. The majority of patients that were seen received dental care such as extractions, fillings and cleanings. Other patients were able to see an optometrist and receive new glasses.  Some patients were seen by medical doctors and were assessed for certain disease states.

I remember one patient specifically because of the impact he had on me while I was at RAM this year. It was 5 a.m. on Friday morning, and I was helping with triage. The nurse that I was working with was someone I had just met 15 minutes prior to starting to triage patients. He explained to me that he worked as an RN at a free clinic in the town where he lived.

I was excited to work with a health care professional that I hadn’t known prior to this event and, with my cup of coffee, was ready to see patients. One of the first patients of the morning was a man who explained to me that he was here strictly to see a dentist and get a few of his teeth pulled. After taking the patient’s vital signs and discussing the patient’s medical history, I asked him if his blood pressure normally ran high. He explained that yes, it did, but when he measured his blood pressure and the reading was high, he would just take one of his mom’s blood pressure pills.

I quickly explained to him that it was not beneficial to sporadically take blood pressure medication, that it was a maintenance medication intended to be taken every day. The nurse and I then counseled the patient on the importance of lowering his blood pressure and the implications down the road if he chose to continue not to do anything about it. I then asked him if I could get him a medical sheet that I would fill out for him, and he responded that he would, yes, like to see a doctor about his blood pressure.

Serena Barden (right), with Erika Lambert, discussing risks for cancer.

Serena Barden (right), with Erika Lambert, discussing risks for cancer.

I made sure he had two people with him when he left triage; one to hold his place in the line for extractions and one to walk him to the medical tent. I then returned to my station at triage and continued to work throughout the day at various places on the fairground. Around 4 p.m., I was walking to the A1C station where VCU pharmacy students were conducting A1C and cholesterol screenings. I turned around when I heard someone yelling “Miss, miss.”

To my surprise, it was the same patient I saw earlier that morning. He told me that he wanted to find me and thank me personally for what I had done for him that morning. He said he was able to see the doctor and was prescribed blood pressure medication, which I jokingly reminded him to take every day. He gave me a hug and said that my presence at RAM was a true blessing and thanked me again for helping him.

In my opinion, it is often hard as a pharmacy student to fully grasp the importance of why we are doing what we have chosen to do as a career. It is easy to get caught up in making good grades, impressing future employers and getting involved in organizations as we complete our four years of doctoral work. I came to pharmacy school in hopes that I would be able to give back to my community and help people who needed our services.

RAM has allowed me to see that what truly matters after my four years in pharmacy school is the positive impact we make on the world through our profession and the people we help along the way.

“Although I am a fourth-year pharmacy student …,” LAUREN FLYNT, class of 2015

Lauren Flynt found working with underserved patients in Virginia, rather than abroad, was an eye-opening experience.

Lauren Flynt found working with underserved patients in Virginia, rather than abroad, was an eye-opening experience.

Although I am a fourth-year pharmacy student, this was my first year volunteering for the Remote Area Medical outreach trip.  I had been on an outreach trip outside of the country, but working with underserved individuals in my own state was a completely different and very eye-opening experience.

One of my favorite parts of the trip was working in the pre-medication station where the patients were waiting to have dental procedures done.  Here we were able to talk to the patients and assess which antibiotic and pain reliever they should receive prior to their dental work.

Often patients were very nervous and scared of what they were about to have done.  I took this time to talk to the patients, answer any questions and try to get them to relax.  I really enjoyed getting to know some of the things they like to do, and I think it helped them too!

Another great thing about these trips for pharmacy students is the ability to practice our clinical skills. We were all able to practice taking blood pressures in a loud room and to perform blood glucose, A1C and cholesterol screenings.  Being able to counsel the patients on what their A1C and cholesterol numbers meant for their overall health was another important learning opportunity. By using the ASCVD risk calculator, it was very easy to show patients how much their risk would go down if they were able to quit smoking.

The last thing that stands out in my mind was enthusiasm from all of the volunteers. Both Friday and Saturday were very cold and rainy days, but it did not discourage anyone.  Some volunteers were there at 2 a.m. to make sure we all had breakfast and coffee when we arrived at 5 a.m.  The energy from all of the volunteers is what kept me going during the early mornings and long days!

Interacting with the patients and working together with the other volunteers was by far the best part of the trip.

“RAM 2014 was filled with rain …,” REBECCA SAUNDERS, class of 2015

Rebecca Saunders (second from left), with Lauren Flynt, "smoking cessation guy," Mimi Baker and Erika Lambert, appreciated the fact that she got to interact with patients throughout RAM.

Rebecca Saunders (second from left), with Lauren Flynt, “smoking cessation guy,” Mimi Baker and Erika Lambert, appreciated the fact that she got to interact with patients throughout RAM.

RAM 2014 was filled with rain, lots of puddles and a need for warm clothes, as temperatures didn’t make it out of the 60s. Despite the weather, RAM volunteers were still able to come together to serve over 2,000 patients seeking health care.  Many of those patients waited a majority of the year for Remote Area Medical to make it to Wise, Va.

Pharmacy students are involved in many roles at RAM including: medication reconciliation, triage, A1C, pre-medicating before dental procedures, smoking cessation  and working in the pharmacy.  In all of these roles, patient interaction is present.

My favorite part of RAM is getting to interact with patients. Through interacting with patients, I learn about the barriers patients face in caring for their own health and recognize areas in which I can educate the patient.  Patient education seems small, but can make a big impact in the way a patient manages his or her health.

RAM is truly a rewarding experience because the patients are so appreciative of what you are doing for them all, while we are learning more about pharmacy practice.

“Despite the pouring rain …,” MIMI BAKER, class of 2016

Mimi Baker (right), with Irene Lee, especially enjoyed developing a rapport with VCU School of Nursing students at RAM.

Mimi Baker (right), with Irene Lee, especially enjoyed developing an interprofessional rapport with VCU School of Nursing students at RAM.

Despite the pouring rain and surprisingly chilly weather in late July, RAM was the highlight of my entire year thus far. I was fortunate enough to have been given another opportunity to serve the people of southwest Virginia in Wise County with my fellow pharmacy contemporaries.

This year’s experience only enhanced and furthered my zeal to help our state’s own underserved population. It also helped me grow and become more comfortable with the responsibilities that come with becoming a part of the esteemed profession of pharmacy.

Coming to RAM with a year of therapy under my belt allowed me to participate in certain areas that I wasn’t able to as a rising P2 last year. Counseling patients at the A1C/cholesterol area in triage was definitely one of my new favorite parts. The amount of time it takes for the A1C testing to occur allowed us a fantastic window of opportunity to talk to the patient about how they can augment their therapy and what steps they can take to better adhere to their medications. We were always under the watchful eye of Dr. Sisson or one of our residents, so I never felt like I was lost during this critical time in the patient’s care.

My other favorite part was bonding and developing an interprofessional rapport with other health care professionals at RAM, specifically with our very own VCU nursing students. We worked side by side with nursing to help pre-medicate and triage our patients before dental surgery.

P1020486Our relationship with VCU nursing now transcends RAM; we have already invited nursing to come participate in service projects headed by pharmacy school organizations and vice versa. I am excited to continue to cultivate a positive relationship with our various professions because our patients deserve the best care in the world, and that can only happen if all of us work together.

To me, RAM is not just a service project. It is a place to evolve, to look introspectively and learn how to empathize. That is simply something that you cannot learn in a classroom. I am truly blessed to have gone to RAM and look forward to serving my community even more in the upcoming future.

“You have no idea what you’re capable of till you try.” ASHLEY SIMPSON, class of 2017

Ashley Simpson felt her RAM experience began and ended similarly: with the opportunity to try her best.

Ashley Simpson felt her RAM experience began and ended similarly: with the opportunity to try her best.

“You have no idea what you’re capable of until you try.” This was the hallmark of my experience at Remote Area Medical. In the beginning, I was anxious as to whether I had the capability to contribute to such an awesome group of volunteers and such a deserving group of patients, but I learned quickly that nothing prepared me more than the hands-on experience I received while volunteering.

We drove six hours to the edge of Virginia to serve the rural area of Wise; however, when we got there, the first patient I met drove from states away to be able to access free health care that weekend.

It was a very humbling experience, right from the start, that made me realize the importance of what we were set out to do that weekend. My time consisted of filling out medical reconciliation cards in the morning, taking vitals and determining medical history at triage, medicating patients before their procedures, and spending time filling and counseling at the pharmacy.

My initial worries were quickly alleviated when I realized how willing the rest of the pharmacy and nursing team were in answering questions and helping me when patients had additional concerns. I was impressed by the flexibility that our team had in working different stations and providing excellent clinical care.

Aside from our tasks, what really made the trip for me was the patient interaction. Everyone was so positive despite the lengthy waits and the less than ideal weather.

Out to dinner after a full day with patients

Heading out to dinner after a full day with patients.

With such a large volume of people, you don’t always know what impact you leave, but when I was in town and saw a patient who recognized me from taking the medical history and who had received new glasses that day as a result, I felt like I made a positive impression just by serving and by being a friendly conversation amidst the day.

The very last interaction I had before departing Wise was with a nurse who approached me because a patient did not have his vitals checked at triage before a dental procedure. The dentist wanted me to check his blood pressure to make sure he was eligible.

I could see how anxious and afraid this young man was that there was a possibility he wouldn’t receive his extractions. His arm was completely tense, and he seemed to be almost on the verge of tears. Being able to help him relax, and to report optimal vitals so he could continue through the day, was a great last interaction for me because I felt like I started with a purpose and ended with a purpose, to try my best and provide great patient care.

“I find it very difficult to isolate a specific event …,” MEREDITH WEAKLEY, class of 2016

Meredith Weakley (left) had a rewarding experience finding out that a few questions can go a long way.

Meredith Weakley (left) had a rewarding experience finding out that a few questions can go a long way.

I find it very difficult to isolate a specific event that stands out in my mind more than another because the entire Remote Area Medical weekend was filled with truly amazing opportunities and experiences.

Some of the things I enjoyed most weren’t even pharmacy-related: Passing out donated jackets to frigid patients awaiting dental procedures and ensuring all had snacks and water brought me sense of purpose and comfort.

My most memorable pharmacy related moment occurred by happenstance:

The pharmacy at RAM received a great deal of Auvi-Q devices, and naturally I had to play with the demonstrator device (those of you who know me completely understand this compulsion).  So there I was, standing at the outpatient pharmacy tent playing with an Auvi-Q, pretending to inject myself, and I notice that a man sitting with his mother waiting for her prescription takes an interest in my actions.

I ask him if he wants to see the device, too (because it really is awesome), and he asks if it is an Epi-Pen.  He then says, “I need one of those, I’m deathly allergic to bees.”  I immediately ask why he doesn’t have one, and he replies that when he was in the hospital for the allergic reaction, he started to feel better so he just walked out.  “I guess they would have given me a prescription for one if I waited… .”

I decide right then and there that somehow this man is going to leave today with an Auvi-Q.  I ask my preceptor what to do, and she sends us to medical to ask if he can get a script without being seen — of course, the answer is no.  At this point, this gentleman has been at the fairgrounds for several hours and he is really ready to take his mom home.

P1020532I somehow convince him that it’s worth going through medical, and I’ll even go with him so he won’t be bored. His mother agreed wholeheartedly with the plan.  So on the walk to registration, I ask if he has any other issues to get checked out while he is here, and he tells me that he is “completely healthy, well … except I have high blood pressure, but I haven’t been taking my medications, oh, and I was in the hospital for a blood sugar of 17 last month.”  That’s right, 17.

So we make it through registration and triage (the whole time he is giving me a hard time about making him go get his finger pricked and get his blood pressure taken (but really, he is enjoying the attention), and we make it to medical where he gets seen right away!

I told him I had to get back to the pharmacy but made sure he was comfortable.  A few hours later, I’m running an errand around the grounds, and I hear this guy shout out, “HEY! HEY!! LOOK!!!” It was my buddy of the day, and he was grinning from ear to ear, holding up a brown bag full of Auvi-Qs.

He was so appreciative, and I am so glad I took the time to ask a few more questions when I could very easily missed or ignored his interest in the Auvi-Q.   Going the extra mile for someone besides yourself often results in an unexpected sense of personal reward, as well.

Editor’s note: It’s a small world! Just for the record, VCU School of Pharmacy alumnus Eric Edward (Ph.D. ’11) and his twin brother, Evan, invented the Auvi-Q. To learn more, click here. Since this article ran, their company has been renamed Kaléo.

“Although I have participated in numerous education and outreach efforts …,” DIEN TU, class of 2017

Dien Tu, with Serena Barden, found that RAM validated his passion for pharmacy and commitment to serving others.

Dien Tu, with Serena Barden, found that RAM validated his passion for pharmacy and commitment to serving others.

Although I have participated in numerous education and outreach efforts during my time in pharmacy school, my experiences as a member of the Remote Area Medical (RAM) program team were distinctly different.

Prior to engaging in the Honduras Outreach Medical Brigada Relief Effort (HOMBRE) program in the Dominican Republic in January, I had read about the lasting impact that poverty and social circumstances have on health.  I felt prepared, and ready to provide assistance and support to others, in an effort to improve their lives.  Yet Wise, Va., was a mere six hours away and certainly couldn’t be much different than those volunteer experiences I’d had in and around Richmond.

I couldn’t have been more wrong.

We arrived at the fairgrounds at Wise on early Friday morning to a line of persons who had been waiting patiently for services.  I had heard the term “organized chaos” before, and assumed that, given the number of patients and providers, it would be a chaotic experience.

Once the gates opened, I was moved to see smiles on the faces of patients, despite long lines and heavy rains.  For some, it was one of limited opportunities to receive care, and accessing that care superseded any other circumstances.  Their determination motivated me to not only provide superior care, but also make their time an enjoyable experience for both of us.

While attending to hundreds of patients over the course of three days, I was mindful of the uniqueness of each case and the value of providing individualized consultation and care.  I wasn’t merely treating a woman with diabetes.  Rather, I was treating a 42-year- old wife and mother of two whose income limited her access to healthy foods.

P1020479I began to realize that the circumstances that led many of our clients to be in need were not of their own doing, and that a simple smile, conversation or personalized approach affirmed our commitment to making their lives better.  Those conversations weren’t merely about their health conditions but provided me with a glimpse of their lives.

I returned home Sunday evening feeling both exhausted and fulfilled.  Three long, tiring days, as well as short, sleep-limited nights, validated once again my passion for pharmacy and commitment to serving others.  Providing patient-centered care to persons in need was a simple task — yet providing hope, compassion and a sense of integrity was invaluable.

Similarly, working alongside doctors, dentists, nurses and other specialists reinforced the critical importance of an interdisciplinary approach to health promotion and disease prevention and fed my passion for providing quality, professional and respectful care to my patients.  While my time in Wise was only three days, my reflection of the experiences will impact my practice as a pharmacist for years to come.