“During spring break, I have journeyed to El Salvador …” WILL COLEMAN, 4/5/12

Thumbnail image for Pharmacy Students at volcano1.jpgDuring spring break, I have journeyed to El Salvador as part of a medical mission team each of the last three years. Words cannot adequately describe how much of a blessing these experiences have been in my life, but I will try to give a glimpse of some aspects of the mission journey that are very special to me. I will provide details of my experiences by responding to a series of questions.

·         How did you have the opportunity to go?

I was granted the opportunity to be a part of a mission team to El Salvador throughThumbnail image for Will with Salvadorian children at clinic.jpg my involvement with the Richmond area Christian Medical & Dental Associations. They offer a Bible study/discussion session and dinner each week. One of the leaders of this group who is a doctor in the area, in partnership with My Father’s House International, has been taking students to El Salvador for a number of years to participate in medical missions. My Father’s House International is a Roanoke, Va.- based nonprofit organization that serves as the financial backbone for a children’s home in El Salvador called La Casa de Mi Padre.

·         What did you do while you were there?

Over the course of our time there this year, we spent four days providing medical Thumbnail image for church in suchitoto.jpgcare to Salvadorians in rural settings that lack adequate access to health care. We even partner with Salvadorian doctors and dentists who join us in our efforts to help the medically underserved in their country. Every patient at least receives multi-vitamins, and some patients receive upward of five or six different medications. More importantly, each patient is prayed for, if they so desire, and we together acknowledge that God is in control of their health and is truly the Great Physician. We also spend time with the children of La Casa de Mi Padre eachSalvadorian sunrise amongst volcanoes.jpg year, which is truly a blessing. In addition, on nonclinic days, we have gotten to travel to various places over the course of my three trips, including Suchitoto, which is home to a beautiful church built in 1853; the Pacific Ocean; an artisans market where you can barter for local trinkets; and a phenomenal dormant volcano.

·         What did you learn?

Once again, words cannot describe what all I have learned during my experiences in El Salvador, but I will share some things that stand out the most to me. From my experiences in the makeshift pharmacy setting, I was able to strengthen my Will, Kristin, Mi Jung.jpgmedication therapy knowledge while also learning valuable life lessons. During our clinic days, I was provided the opportunity to spend time with individuals who are truly impoverished according to American standards. However, these individuals seem to be far more satisfied than most of us. They are actually content with life and take life as it comes, in comparison to many of us, who are on the go all the time, striving to obtain more worldly possessions and financial gains. It is quite evident that such material possessions cannot provide true happiness. Accordingly, while they may be poor in a material sense, they are rich in the sense of community and relationships, which are eternal in nature.

In addition, I witnessed firsthand a vast amount of broken relationships during my experiences in El Salvador. I learned about how many of the children of La Casa de Mi Padre were removed from their natural home environments by the government because of abuse, mainly sexual abuse. In addition, there is an extensive amount of gang activity in El Salvador. Last year alone, two fathers of children at La Casa lost their lives due to gang-related incidences. While these are obvious incidences of broken relationships, there are others that are not so evident and warrant careful consideration on behalf of everyone.

According to the book “When Helping Hurts,” we all suffer from broken relationships in four fundamental areas, whether it be with God, self, others or the rest of creation. The importance of this brokenness has really become evident in my life as a result of my experiences in El Salvador. While the examples described above are obvious cases of broken relationships between the individuals themselves and others, I have challenged myself, and would like to challenge all readers, to consider all the relationships in our lives. When relationships go haywire in one area, it will negatively impact other areas of our life as well. I hope that we can help each other to make right the relationships in all four fundamentalThumbnail image for Thumbnail image for pacific ocean.jpg areas of our lives.

I also learned about the significance of looking outward instead of inward. What does this mean? Well, society teaches us to look out for number one, ourselves, as we strive for worldly success. However, no matter what material things we gain here on earth, we cannot take them with us when we leave. However, the relationships we build through helping others are potentially everlasting and far outweigh any material gain.    

Finally, life is a journey, just as I would like to describe my trip to El Salvador as instead a journey. I have learned valuable lessons during my experiences in El Salvador, and these lessons are part of an evolving process of me becoming a better human being. The lessons I learned come up daily as I walk along the journey of life. I hope that I will embrace these experiences as opportunities to mold me into the person God would have me to be instead of viewing each day as a discombobulated trip without connections to previous or future days.

·         What is the most special moment you can remember?

During the third clinic day, our first patient in line was a 17-year-old boy who came for a dental visit, a simple tooth extraction, to be exact. As the triage nurses beganThumbnail image for Thumbnail image for Juan, 17 years old.jpg obtaining a medication history on this boy, it became evident that he had some serious health conditions. He had suffered from a heart defect from birth that made him unable to run or play as normal kids do. In fact, he actually looked to be more like 12 or 13 instead of 17 years old. Upon much physical exertion, his lips would turn blue from lack of adequate oxygenation. He had been told by Salvadorian physicians that there was nothing they could do for him; his life was destined to be cut short. Yet, I believe that God sent him to us that day to get him access to the necessary treatments for his condition.

The medical doctor he saw had previously worked with an international organization called Samaritan’s Purse that helps to coordinate visas and other requirements to get individuals to the United States for medical procedures. In addition, Samaritan’s Purse actually has an ongoing relationship with La Casa de Mi Padre because it constructed a chapel on the land that is the future home site of La Casa. Once these existing relationships were realized, the coordination efforts commenced to get the young man the help he needs. As of right now, contact has been made between the organization and the boy’s family, and he is scheduled to undergo testing that would qualify him to come to the States for surgery. Please pray for Juan and the outcomes of this ongoing process.

In addition to third-year School of Pharmacy student Will Coleman, Kristin Bell (P2), Jessica Libuit (P2), Mi Jung Lim (P1) and Rebecca Saunders (P1) participated in the 2012 medical mission to El Salvador.

 

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.

High school mentorship journal entry No. 3, AILEEN BI

Today’s Date: Sept. 3, 2011

Total Hours to Date:  45 hours

Mentorship Research Journal #3

On Aug. 25, patient rounds with Dr. Gravatt began in the Main Hospital’s prison area, located beneath the main floor.  The inmates housed here had been moved from the local jail in order to receive the kind of medical treatment given to the other patients in the hospital.  Although I did not have the chance to pass the main gate and go on rounds with the rest of the team, it was interesting to watch the team conduct business as usual from behind the gates.  With added distance between me and the team, I could see just how this large group of 10 would appear to the patients and visitors.  Afterward, we moved above ground to the emergency room and checked up on a man who suffered from shortness of breath and had initially been thought to have pneumonia.  The results of a CT scan on his chest had recently arrived, though, confirming that he did not have pneumonia.  The team then ordered a nebulizer for the patient’s asthma, hoping to prevent possible airway inflammation.  When used, the nebulizer would release a mist comprising a mixture of oxygen and other compressed gasses, which would be inhaled by the patient and travel into the lungs. 

Another patient had come out of a surgery for her heart failure, in which a small metal rod had been inserted into her heart to compensate for her useless right atrium.  Dr. Gravatt had to order anticoagulant medication for her.  The medication would serve as a blood thinner, decreasing the probability of blood clotting.  During our lunch break in the workroom, Dr. Gravatt conducted a short lesson with her two accompanying pharmacy students, discussing the differences between PPN and TPN, two types of nutrition that can be given to a patient with an IV.  PPN stands for Peripheral Parenteral Nutrition and is administered in a peripheral IV site in the patient’s arm.  TPN stands for Total Parenteral Nutrition and is administered through a central line, which goes through the patient’s chest.  This difference in IV placement is due to the fact that PPN, compared to TPN, has a lower osmolarity, or concentration of particles.    

On Aug. 26, I was able to observe a dialysis treatment for the first time.  This procedure was administered on a patient whose kidneys could not properly filter out the toxins in his body. Dialysis serves as an artificial kidney for the patient, taking out waste and fluid from the bloodstream and replacing them with dialysis fluid, which consists of potassium, sodium, and calcium in concentrations similar to levels that would be found in healthy blood.  Dialysis is based on the principles of diffusion — because solutes tend to move from high to low concentrations, dialysis fluid can move across a semi-permeable membrane into the patient’s bloodstream, while blood diffuses into a machine. 

The patient’s wife had come to the hospital that day with complaints about the care her husband had been receiving.  The atmosphere became quite tense and awkward at this point because of the manner in which she expressed her complaints, coupled with the fact that she directed all of her complaints toward one specific member of the team, insisting that she failed to treat the patient “as a patient” and ultimately disagreeing with all of the treatments given to her husband.  She was adamant about moving him to a different hospital.  I imagine that these kinds of complaints arise in the hospital from time to time.  Furthermore, I was not surprised that these complaints were delivered in such an antagonistic manner, as patients and their families have to deal with a lot of stress while in the hospital. 

However, my shadowing with the team allowed me to look at this situation from the physician’s viewpoint rather than the patient’s.  I was aware of the amount of time and energy that particular physician had given to the patient, as well as all of the other patients under her care.  After getting to know her personality, I truly believed that the physician had a genuine intention to help the patient get better, despite his wife’s opinion.  Thus, it was disappointing to watch her work get criticized in this manner.  The head physician in the team, however, took responsibility and responded to the woman’s claims with a calm tone as she explained that she would be more than willing to discuss these matters with her, one-on-one, after patient rounds were completed. 

When dealing with patients and their families, medical professionals will come across many different kinds of attitudes and personalities, and it is their job to accommodate those differences and stay calm and professional in order to reach an agreement.

I left the hospital and spent the afternoon in VCU’s Ambulatory Care Clinic for the first time, shadowing a pharmacy resident counseling patients in a clinical setting.  Both of the patients who came to the Ambulatory Care Clinic that day were diabetic which, I was told, was commonly seen at the clinic.  The resident informed me that the first patient of the afternoon was one of her most memorable patients because, at his last visit, she was able to convince him to try injecting insulin to lower his blood sugar.  She explained that he had refused at first, but she eventually changed his mind by gradually building trust between the two of them and convincing him that it might be worth trying for the sake of his health. 

She stressed the importance of allowing the patient to decide for himself; it was not the pharmacist’s place to force medical treatments on his or her patients.  She also described the process of teaching the patient how to inject insulin, underscoring the practice of “back-teaching.”  In other words, to ensure that the patient retained the new information, he should be asked to repeat the steps he had learned back to the pharmacist.  This way, it will be clear to the pharmacist whether or not the patient truly understands his instructions.

When the first patient arrived, the resident showed me how she checked blood sugar levels by pricking the patient’s finger and reading the result on the meter.  The monitor read 417, much higher than his ideal blood sugar level, which would have been around 180.  The patient was quite frustrated about not being able to lower his blood sugar despite his insulin injections.  After reviewing all of the patient’s medications, a process that required asking the patient how much and how often each of his medications was taken and checking his responses with his records, the resident determined that all of his medication had been taken correctly.  She then asked the patient to explain to her how he had been injecting his insulin.  After going through the process of “back-teaching” again, she finally determined that the patient had been following the correct procedures.  She ultimately decided to increase the patient’s dosage of insulin.  She asked the patient to describe to her his daily routines, and she suggested a few small lifestyle changes that could be made to help lower his blood sugar, such as adjustments to diet. 

The second patient was not as severely diabetic, so he did not require insulin.  He had come because he wanted to know what each of his medications was treating.  Thus, this visit mostly comprised going over the patient’s medications and explaining their purposes, as well as updating his prescription.  This patient was significantly more knowledgeable in medicine than the first patient, so it was interesting to observe the resident’s change in vocabulary; her explanations became much more thorough and specific.  Afterward, she asked the patient to explain the purpose of each of his medications to her to show that he understood.  That afternoon, I learned that the clinical setting certainly allowed the pharmacist to form a closer relationship with the patient than the busy, fast-paced hospital setting.  Clinics were also less chaotic than hospitals, but the cases seen in the clinic were much tamer than those seen in the hospital.

I returned to the Main Hospital for patient rounds on Sept. 2.  I was no longer shadowing Dr. Gravatt, but I did have the opportunity to go on rounds with another pharmacy resident and a couple of pharmacy students.  I joined a different medical team and spent the first half of the morning conducting “sitting” rounds, as opposed to the “walking” rounds I had previously been doing with Dr. Gravatt.  During sitting rounds, the team congregated in one room and stayed there for the entirety.  The medical students reviewed patient cases while the physicians asked questions and made adjustments as necessary.  Although sitting rounds was much less tiring than walking rounds, which required me to stay on my feet, I felt that it was a comparatively more tedious, and perhaps less thorough, process because it did not provide the team members with direct access of each patient they were reviewing. 

Afterward, the pharmacy resident and the pharmacy students left the other members of the team in order to conduct bedside counseling.  A patient required diabetes training and needed to be taught how to inject insulin, a topic with which I had gained familiarity at the Ambulatory Care Clinic a few days before.  I found that bedside counseling was very similar to the counseling process in the clinic; the only difference was that the pharmacists had to come to the patient instead of the other way around.  Before entering the patient’s room, the resident quickly described the patient’s loquacious nature and affinity to cats so that the students would not begin counseling without some background knowledge of the patient.  With this knowledge, the students were more easily able to connect with the patient, build trust between them, and begin counseling.

High school mentorship program 2011: Introduction, RON BALLENTINE

We’d like to share four journal entries Aileen Bi wrote during her time with us. Aileen, a student at Maggie Walker High School in Richmond, was part of the high school mentorship program.

It is obvious from reading her journal entries that she benefited greatly from the time that she spent with pharmacy faculty, clinicians and residents. She has a much better understanding of what pharmacists can (and should) do.  

PDC members attend 68th Grand Council Meeting … LAUREN LAKDAWALA, 8/11/11

PDC Late Night.JPGLauren Lakdawala, Hillary Hudgins, Melissa Rees and Tyler Stevens — and all those beautiful Grand Council awards!

 

The brothers of the Phi Delta Chi pharmacy fraternity, Alpha Delta chapter at VCU School of Pharmacy, attended their 68th Grand Council meeting in Buffalo, N.Y., the first week of August.

Brothers Hillary Hudgins, Lauren Lakdawala, Melissa Rees and Tyler Stevens (chapter advisor) attended the national meeting, which occurs every other year. The Grand official attendee Name Badge.jpgCouncil brings together collegiate and alumni brothers from 72 different chapters at pharmacy schools and colleges across the country. More than 300-plus brothers attended the five-day meeting, which focused on developing leadership skills, networking with other chapters and conducting business fraternity.

In addition to electing our national officers, Brother Melissa Rees was elected as the Mid-Atlantic Regional Correspondent for the upcoming year. The regional correspondent serves as a liaison between the national office and 12 regional chapters to promote achievement and foster brotherhood among chapters in the mid-Atlantic region (Virginia, Tennessee, Maryland and North Carolina).

To offset business meetings, numerous social outings around Buffalo took place, including a Niagara Falls trip, fraternity bar crawl and, of course, visits to Anchor Bar, the birthplace of the buffalo wing.

Current PDC President (Worthy Chief Counselor) Lauren Lakdawala reflected on her Grand Council experience as “nothing less than awesome! Meeting brothers from Delegate Seat occupied by pres. plus voting placard.JPGacross the country only solidified the meaning of brotherhood upheld by Phi Delta Chi. I made connections both professionally and personally that will last a lifetime. I am truly honored to be a part of this fraternity, one that fosters future leaders in the pharmacy profession.”

The awards banquet culminated the weeklong fun, honoring chapters for upholding the mission and values of Phi Delta Chi. Alpha Delta received The Dale W. Doerr 100% Achievement Award for the third consecutive year, which recognizes chapters for upholding the framework of the fraternity. For the second year in a row, the chapter received first place for the John D. Grabenstein Leadership Award, recognizing our individual and collective accomplishments that demonstrate leadership qualities.

These accomplishments, along with recognition for our chapter publication, scholastic development, brotherhood and professional projects, garnered Alpha Delta sixth place overall in The Emory W. Thurston Grand President’s Award. Lastly, Tyler Stevens received the Chapter Advisor of the Year Award for his exemplary role in guiding collegiate brothers in their development of organizational skills, leadership ability and personal competence.

On receiving his award, Stevens said he found himself to be “very humbled and honored to be recognized.  During my tenure as PDC advisor, I have been blessed with having excellent students, friends and leadership within the organization.”

The Phi Delta Chi brothers are very excited to be recognized for their contributions and are looking forward to another successful year!

Leadership Award.jpg

“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

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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.

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

 

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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.

 

“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.