High school mentorship journal entry No. 4, AILEEN BI

Today’s Date: Oct.  12, 2011

Total Mentorship Hours: 61.5 hours

Mentorship Research Journal #4

My fourth journal entry begins on Sept. 7, when I returned to shadow at the VCU School of Pharmacy.  Dr. Stevens was conducting a lab with the class, while Dr. Mawyer tested the students’ counseling skills. Dr. Mawyer was a pharmacy resident interested in clinical pharmacy, like that practiced in the Ambulatory Care Clinic, due to her desire to practice “clean medicine.” 

The second-year pharmacy students were required to be able to counsel on Warfarin, a blood thinner used to prevent the formation of blood clots in the blood vessels.  The drug works by blocking Vitamin K, which aids blood clotting.  The students must have had to memorize myriad facts about the drug in order to sufficiently answer questions the patient might have.  Their directions had to be very specific, or else they could be putting their patients at risk.  Most importantly, they must be able to communicate their directions sufficiently, in a manner that was more like a conversation than an order.  In this class activity, Dr. Mawyer played the role of the patient, while the students assumed the pharmacist role. 

In addition to Warfarin, students were also required to research the INR, or International Normalized Ratio, which determines a patient’s risk for bleeding.  The ideal ratio is between two and three; a high INR indicates risk of bleeding, while a low INR indicates the risk of painful clot formation.  If the patient’s INR was too high, then the dosage of Warfarin would be lowered.  Practicing counseling skills required that the students demonstrate their understanding of the medication while preparing them for their future careers.

I participated in another class activity on Sept. 14, which focused on genetic testing.  In this activity, students researched different kinds of genetic tests from different companies.  For example, the company Navigenics offered genetic analysis that could be conducted with a saliva sample.  DeCODE offered genetic tests that could be conducted with skin cells from the side of one’s cheek.  The students were responsible for reviewing these different means of genetic testing and determining which kinds of tests they would recommend to their hypothetical patients.  When making these recommendations, the students kept in mind patient convenience, counseling services provided, level of privacy and confidentiality, and possible test limitations, which are all very important factors for patients.  This activity served to allow students to practice their research skills, which are essential for pharmacists, who must frequently research drugs and pharmaceutical companies as more and more enter the market.

After observing several classes from the students’ perspectives, it was time that I explore pharmacy school education from the teacher’s perspective.  Over the next few Mondays, I mentored with Dr. Donohoe, an assistant professor at the School of Pharmacy.  My task was to help create PowerPoint presentations for her class, using the text “The 200 Most Common Drugs.”  During my time with her, I prepared presentations on cardiovascular agents and lipid-lowering agents.  I relied on the text as my guide– by looking up terms with which I was unfamiliar, I recognized them more easily over time. 

Dr. Donohoe gave me additional help by explaining the terms I did not understand.  Through this process, I came across a slew of new medical terms.  While working on the cardiovascular agent unit, I learned about ACE inhibitors, which treat hypertension and heart failure.  Drugs that fall under this drug group typically end with “–pril.”  ARBs also treat hypertension and heart failure and typically end with “–sartan.”  Amiadorone, which also treats the heart, is known for its many side effects. Clonidine is used to treat hypertension and has to be taken often.  Pertaining to lipid-lowering agents, cholestyramine binds with the gastrointestinal tract to block bile acid, which in turn helps lower cholesterol.  LDL and HDL are two of the main groups of lipoproteins: LDL is more commonly known as the “bad cholesterol” while HDL is the “good cholesterol.”  Myopathy is associated with intense muscle pain.  This experience gave me a small glimpse into the vast amount of vocabulary students must pick up over time in order to function as pharmacists in the work field.

I returned to the Ambulatory Care Clinic on Sept. 20. This time, I mentored with Dr. Mayer, who also works as an assistant professor at the School of Pharmacy.  While reviewing a patient’s medical history, she noticed that he had Oslo-Weber-Rendu Disease but was not familiar with that particular disorder.  I watched her put her researching skills to the task and find out that it is a genetic disorder that causes abnormal blood vessel formation.  On Sept. 28, a patient with hypothyroidism, a condition in which the thyroid gland fails to produce enough thyroid hormone, came into the clinic complaining of symptoms that she believed might have been caused by the medication she had been recently prescribed.  These symptoms included intense swelling of feet, dizziness, and headache. 

The pharmacist with whom I was shadowing at the time allowed me to check the patient’s medications, just like I had seen the residents do at my earlier visits.  I found many of the medications challenging to pronounce, but the patient was very patient and knowledgeable of her medical needs.  The resident suggested that the patient’s swelling might have been caused by amlodipine, which had been prescribed to help lower her blood pressure. 

While in the workroom, I overheard another resident discussing her latest successful motivation interview with one of the physicians.  She explained to me that sometimes motivation interviews are conducted to improve patient compliance.  The patient is asked open-ended questions about his perception of his health and other matters.  The pharmacist must give empathetic responses throughout the interview and focus on assessing the barriers preventing the patient from taking more responsibility for his health, then steer him in the right direction.  She explained that it was essential that the patient understand why he should take care of his health and the steps that will take him to that direction.  She seemed content with her recent achievement, as she expressed how much she liked “making a difference” in that patient’s life.  As someone who views pharmacy as a likely career path, I was encouraged by this reaction.

As my mentorship experience has drawn to a close, I would like to sincerely thank Dr. Ballentine for arranging the numerous shadowing opportunities I received in the Main Hospital, Ambulatory Care Clinic, and School of Pharmacy.  I had initially chosen to pursue a career in pharmacy because I felt that it fit well with my personality, according to the research I had conducted on this field. 

No amount of research, however, could have taught me as much as going directly to the professional scene, where I was able to observe many different types of careers in the pharmaceutical field, from education to ambulatory care.  The students and residents I met along the way were also extremely helpful in informing me about this career path.  Overall, this experience has painted a much clearer picture of the pharmaceutical field than the one with which I had began this mentorship experience.  Now I am much more confident in my decision to pursue a career in pharmacy, and I am very grateful to this experience for allowing me to enter college with this newfound sense of direction.

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

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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.

“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.

RxIMPACT: “As a future pharmacist …,” GEETIKA GHANDI, 3/10/11

As a future pharmacist I stepped into the Capitol Hill area, smelling the American aroma IMG_1789.JPGof advocacy, and was prepared to advocate for accessible and equitable pharmacy services for our future patients.

Prepared, we visited five legislators’ offices and spoke to their staff about two topics: expansion of National Health Service Corps, and one that I have witnessed the need for: Medication Therapy Management (MTM) for Medicare patients. I enjoyed the conversations with our legislators, especially with Rep. Bobby Scott’s staff since he shares my hometown of Newport News.

It is experiences such as RxIMPACT that remind me about the importance of advocating for our profession and more importantly for better health care for our patients. During my pharmacy career, I will come across situations that will make me ask questions, where within the question I would have identified a need for pharmacist-led services. Speaking to my legislators about these issues was rewarding, and I look forward to advocating for my future patients’ needs.      

School-supply project for India, Part 2 — GEETIKA GANDHI, 1/19/11

When I entered school, the first thing my mother did was buy me a bookbag. When Nikita with bookbags 2.jpgthe children in Yuva Parivartan enter school, their mother looks for the best plastic grocery bag.

I reached India two days later than expected, due to flight cancellations. With the rebooking, I was unable to meet Nupur to collect the bookbags and school supplies that the International Federation of Medical Students Association had donated. However, I did meet Nikita (a University of Durham student, pictured at right) and, in total, we purchased 100 bookbags. This is more than expected as the cost of the bookbag was less at the wholesale market. The wholesale market was your typical hustle-and-bustle marketplace filled with stores and street sellers. I browsed through different stores before I decided on one that had a collection of Hannah Montana and soccer bookbags.

Thumbnail image for Geetika's mom.jpgThis picture represents the team — my pharmacy peers and University of Durham students who donated the supplies — that allowed the school-supply project to be successful.  My mother (Usha), sister (Sabrina) and brother-in-law (Hemanth) assisted me in purchasing and distributing the supplies.

I visited the afternoon preschool batch; my mother, who is currently in India, was to distribute the school supplies to the children in the morning batch. The children were hysterical when they saw what I was going to distribute to them. I spoke to them about the importance of education. But looking at their expressions, I knew that they were too excited toClassroom.jpg comprehend what I was saying.

I asked them what they would like to be when they grow up. They answered: teacher …  doctor … and I inspired one young girl to say pharmacist. One boy answered that he wanted to be a “bhai” (gangster). I wonder what influenced his answer. I gave him encouragement and, hopefully, inspiration on considering other career options. Last year, when I volunteered with these children, one boy told me that he wants to be a “banana wala” (person who sells banana on the streets). Upon further inquiry, I found out that he helps his father sell bananas in the evenings and had not considered other career options.

Ankita 2.jpgBefore class started, I spoke to a student named Ankita (pictured at left). I asked her to show me her school bag. She passed me a tiny plastic bag that could barely contain her two notebooks. When I gave Anikita her new pink Hannah Montana bookbag, I could see that she was overwhelmed with excitement. She was smiling, and her eyes were glistening. She stared at her bookbag as she watched me place pencils, a pencil sharpener, eraser and a Cadbury chocolate bar in her bookbag. When I placed a pink pen around her neck, she looked up at me as though she was wearing a princess crown.

One particular boy worried me. It was evident that he was severely malnourished. Classroom 2.jpgHe flapped his arms down, just like a skeleton, and unlike the other children he was too weak to be excited. It was sad to see him, but it served as a reminder that as pharmacists, we have the ability to help and inspire children worldwide.

My hope is that through this project we have given 100 children the tools and inspiration they need to learn and succeed in school. Personally, it was rewarding to give the children their first bookbags. This project has inspired my next project, which is to help bring undernourished children to better health.  

School-supply project for India, Part 1 — GEETIKA GANDHI, 12/18/10

My medical mission in the Dominican Republic has changed the way I look at pharmacy as a profession. Adding on to the list of “why I want to be a pharmacist” is so that I can participate in medical missions and serve those in need internationally and within my community.

As a student pharmacist. I have seen how pharmacists play a vital role in international medical mission trips. I am proud of what we can do and am excited to participate in more medical missions as a pharmacist.   Participating in the medical mission last summer taught me how to fundraise. I applied that knowledge during the fall semester toward a school-supply fundraiser for underprivileged children in India.

 The idea to fundraise all started with a pen, while volunteering with an NGO (www.yuvaparivartan.org) in Kherwadi, Mumbai, India. The primary mission of this nongovernmental organization is to give a second chance to less educated, deprived youth (dropouts) through urban and rural livelihoods training, provided inThumbnail image for supplies 2.jpg partnership with stakeholders. Additionally, this site offers preschool classes to prepare students for kindergarten.

I volunteered with both the teenagers in the urban and rural training courses and with the preschool children. With the preschool children, I was surprised to see the lack of school supplies in the classrooms. They were no crayons or coloring books. Each child owned two notebooks that the NGO provided. They were also given pencils to use while in the classroom, but they had to return them upon leaving the class. What surprised me the most was that most of the children were using plastic grocery bags as book-bags.

There is a high percentage of elementary and high school dropouts in the Kherwadi area. I believe that this is due to the difference of the children’s social economic class when they enter the public school system. First, it is a struggle for their parents to allow kids to go to school (due to the loss of child labor income). Second, once they enter the public schools, they compare themselves to other children from better economic backgrounds and are discouraged by the lack of financial support for their education.

Going back to the pen story, while volunteering I met a girl named Gayatri. I was concerned about her since she was the only child who sat at the corner of the room Thumbnail image for Thumbnail image for Gayatri.jpgwhile the other children were excited about the classroom activities. I looked at her notebook and noticed that while the other children were up to the “Ms” for their alphabet, she was at “E,” followed by scribbles.

What surprised me the most about her is that she did not speak when I asked her questions. I inquired from the teacher if this was a disability or did she prefer not to speak to me. I was taken aback when she told me that Gayatri does not have a disability and that she does not talk to anyone. I spent time with Gayatri in hopes that she would speak to me.

 

When this did not work, I walked over to my purse and gave Gayatri a pen. It was  an orange light pen that I thought would be multipurpose for India (pen and a flashlight). I told her that she had to practice writing her alphabet with this pen.

You would not think that a pen could inspire a child, but it did. To my surprise, she immediately sat down and started writing the alphabet, and she started to talk to me. I do not remember what she told me, but I remember being excited that she was speaking.

At the end of the day, I waited with her for her mother to pick her up. Gayatri’sGayatri using her pen 2.jpg mother walked into the classroom wearing a sari (traditional Indian clothing). Her mother was sweating and looked as though she just came from work. The way her mother wore  the sari was typical of Indian women construction workers. I remember Gayatri running to her mother and showing her the pen, but what touched me even more was her mother’s expression. I could see the excitement in her eyes and her smile widen to see her daughter happy.

My experience with Gayatri and observing the lack of school supplies inspired me to do a school-supply fundraiser at my School of Pharmacy. I will be visiting the NGO this January and will be able to distribute the supplies. This project represents what student pharmacists value. We value education, hence we are in graduate school, and we want to serve others, hence our profession.

As student pharmacists at VCU, we are fortunate to be in a position where we are receiving a world-class education. I believe that we should motivate others who are less fortunate and help them realize their potential to become well-rounded, diverse and lifelong students.

Through slideshows and letters, I got my pharmacy peers involved in the project. Thumbnail image for Thumbnail image for The kids.jpgThey were interested and supportive, and for many of them it was an eye-opener. They were in disbelief that there are children out there who do not own their own pencils. 

I approached my fraternity, Phi Delta Chi, to get the support of my fraternity brothers in collecting school supplies: pencils, pencil sharpeners and erasers. My goal was to have enough supplies for 30 students. A suitcase full of school supplies later, I have achieved that goal.

My next goal was to collect funds to purchase 30 bookbags in India. For this, I asked the different pharmacy school organizations to donate funds for four bookbags. I was pleased to see the positive response from the organizations. Rho Chi, SNPHA, Phi Delta Chi, Kappa Epsilon, SACP, CPFI and Kappa Psi supported the project. SNPHA even rounded up to cover my costs to transport the supplies. In total, I collected $334.

 I love international collaboration, so I got two friends from two other countries involved: Nupur Ko and Nikita More. My friend from Netherlands arranged to have 10 bookbags filled with supplies, waiting for me at the Netherlands airport while I make my stopover to India. These supplies were donated by the International Federation of Medical Students’ Association in the Netherlands. Another friend from the University of Durham collected $134 from a fundraiser that she did in her university. The Durham friend will be joining me in India for this project.

I am now all packed and leaving for India tomorrow.

Here is a quote that my Dutch friend shared with me:

“All kids need is a little help, a little hope and somebody who believes in them.”

                                -Earvin Johnson