Outreach at Simit

After a team breakfast we were off to the clinic to do clinic rounds and prepare for the outreach.

First and foremost, update on the mother who was to deliver yesterday.   When we arrived at the clinic she still had not delivered.  So we were all hoping she would give birth before we left not only because we were desperate to see the new baby but more importantly in order for the clinic staff to benefit from feedback from Dr. Michael (our paediatrician) on the post birth protocol.  We’ve found the combination of classroom training with real time patient treatment is the best strategy for training and education.  The clinic here will do about 10 deliveries a month and recently most unfortunately had a death of a baby at birth due to a cord being wrapped around its neck.  This incident was in fact why Dr. Michael did the classroom training with the staff on neonatal resuscitation.  Although rare, these types of incidents happen and our goal is to give them strategies on how to improve the outcomes.   Luckily this mother delivered her baby uneventfully (it was a girl), but unluckily we had left for the outreach before she gave birth!

Before we left for the outreach we needed to prepare the drug supply we took to the site.  One of our goals is to reduce the unnecessary usage of antibiotics that are prescribed by the staff.  The two reasons being, in order to reduce costs and to educate the staff on the negative impact of overprescribing.  For example, when a child arrives with a cough and cold the nurse automatically gives antibiotic.   In fact if there are no signs of respiratory distress or fast breathing then the child likely has a viral infection and does not require antibiotics.  But the challenge is the mother may have travelled a few hours to get to the clinic or the outreach and if she isn’t given something she is not happy.  Rightfully so!!  Therefore, instead of giving the child antibiotics our doctors are encouraging the nurses to give them micronutrient supplementation for health promotion.  

Dr. Hawkes in the Fluorspar pharmacy

Dr. Hawkes in the Fluorspar pharmacy

After a 40 minute ride from Fluorspar on let’s just say less than hospitable roads, we arrive at Simit, a remote mountain village.  The doctors are separated into different locations inside and out of one of the houses in the village.  The patients then stand in line to see the appropriate doctor.  It is an amazing sight to see what seems like the entire village encroach on this small house.  They will see a couple hundred patients in about 5 hours.

Dr. Michael saw 50 children and was able to immunize many of them.  The most important case involved a 10 year old boy who was carried in with an abscessed foot caused by him stepping on something (unclear what).  Dr. Ed with the clinic nurse needed to lacerate the foot to drain the infection.  A procedure that anyone of us would be sedated for, this young boy endured lying awake on a table.  He was incredibly brave given the enormous pain I know he felt.   I’m not sure if he very much likes doctors from Canada given what he went through but I’m sure he’ll be thankful tomorrow when his foot finally feels better.  We gave him candy and a pack of gum in a last ditch attempt to win him over before he left with his family.

Boy with  abscessed foot

Boy with abscessed foot

We were able to begin our community healthcare workers program by meeting with Helen, the healthcare worker in Simit.  She has agreed to collect data on members of her community who are age 40+ and submit that data via her cell phone back to the database at the clinic.  She collected data on 10 patients, input the data in her phone, sent the data to the central database at the clinic.  Based on the data she submitted she received via automatic text from the database a risk score.  Basically  simply either green yellow orange red.  We are very hopeful this will result in very good intel which will use to build a more robust chronic disease program.

Jennifer with the community health worker

Jennifer with the community health worker

Dr. Ed examined a patient and after hearing her history and testing her blood sugar she was diagnosed with diabetes. Our hypothesis is that many people in the community are also undiagnosed for diabetes and hypertension.  Through training of the Fluorspar staff we believe that more people will be diagnosed and treated, thereby reduce the incidence of chronic disease.

Tomorrow we’ll begin with rounds and then continue on to the outreach. Looking forward to another productive day with our Fluorspar team!

- Stacy Fracis