Thursday, July 5, 2012

12 hours + 90 women = First day of Clinic! (Monday Post)

·      --  The power is out on the mountain, and has been for a few days, and could be for the majority of the week.
·      --  Because the power is out, our clinic had no electricity.
·      --   Because the clinic had no electricity, six young medical students learned how to do full pelvic exams and pap smears using only headlamps for light.
·      --   The HHA team performed headlamp-exams and pap smears on nearly NINETY women on the first day!! (That’s three times the normal amount!)

So yes, the first clinic day was a success.  We were serving the Espaveles community, and we knew that there would be a good amount of people due to the great turnout at their charlas.  But I don’t think anything prepared us for turning the corner in our chicken-truck and seeing a line of at least fifty women at 7:30AM waiting to be checked in… some of whom had been lined up since 5AM.

The line never seemed to get shorter throughout the day.  We hit the ground running, beginning exams before 8AM and didn’t get back to El Corpus until well after sunset.  There has never been a first day that took this long in the history of HHA!  We told the women at the beginning of the day that we would stay until every single woman had been seen, and we kept our promise. 

We were split into pairs again – one MS2 with one MS4 – and each pair took one patient at a time.  Together they would do a full history, take vitals, listen to the heart and lung, isolate the chief complaint, determine which tests were needed, and prep the patient for a pelvic exam in one of our four clinic rooms.  The pair would then find an available resident and formally present their case.  If the resident signed off on their plan, she would then enter the clinic room and oversee the students as they performed a pelvic exam, bimanual exam, pap smear, and/or wet prep.  When they were through, they would assess the results of the exam and wet prep and come up with a treatment plan.  One student would run to our make-shift pharmacy, while the other cleaned and prepped the clinic room for another patient.  Pap smears were secured (with hairspray) on slides and logged to be sent to ASHONPLAFA in Choluteca to be read.  The student pair would then have a final meeting with the patient to tell them the results and advise them on any medication or follow up they might need.  Pap smear results will be expedited and then we will personally deliver the results to our villages next week—meeting individually with each woman.    

For a first day, in the dark, with three times as many patients as expected, we fared surprisingly well.  Every patient was seen, all supplies were restocked for tomorrow, all patients were properly examined and counseled, and all slides for Pap smears were documented and recorded.  Our leaders spent the day sterilizing speculums and restocking the rooms with instruments when needed.  KUDOS to Megan and Rachel for taking the tough jobs and keeping everything super organized and flowing smoothly.  The public health students worked “Intake” and logged (and placated) every single patient that walked through our door—keeping everything in order and being incredibly patient and upbeat and resourceful.  We also have three wonderful residents/attendings who got into town under the cover of darkness (literally) on Sunday, and spent all day today overseeing the rising second and fourth year medical students and answering all of our questions.  I’m sure it was an extremely long day for them as well, but a MAJOR shout-out goes to Rupal, Ingwe, and Stacy who were such professionals all day, and absolutely amazing leaders and role models to all of us.  THANK YOU.

And last but not least, all of the medical students that had been waiting to get their hands dirty for quite a while – we certainly jumped right into it.  And we definitely are impressed with the amount that we learned in a single day, but I think the best part about it was the amazing energy put forth.  It was a crazy day, and everybody had a fantastic attitude throughout. 

Go heels.

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