Lots of Transitions

The Primeros Pasos Clinic is always bustling with change (forgive the cliche, but it's true). The medical director has generally been a one year post, and the administrative people are shifting in and out. International volunteers may come for as little as a week or a month, though few stay for longer. The most influential group of transitioning people is the medical students from the local university. They rotate about every 2 months, and each time they change we have to train a new group of people. The med students get this as their family medicine rotation, which comes before their pediatric rotation. Our clinic sees mostly pediatric patients, so this leaves them with a lot of catching up! This means that they have been spending the last week learning dosage calculations, and what ages you can start using certain medications. After getting used to the previous group of students, it feels like a difficult transition to start all over again teaching the same things. But it's exciting to see when they pick things up, and start to remember the things we have gone over before. Since there is little orientation for people coming into the clinic, there is a lot of peer-peer teaching.

Working with people through all of these transitions, and coming into what seems like a lot of abruptly finished projects, it seems like there is little continuity. Not just in terms of protocol and procedures, but in terms of knowledge. If I have learned what a particular rash is, or what medications are not well tolerated my the population, then I leave with that knowledge and leave others to figure it out. But if I find a way to transition out, leaving information for people who will come in the future, I can use some of that information for the grater good. This is one of the things that I have been working on.

I started a list of medications to share with foreigners, and all newcomers to the clinic. As healthcare providers, sometimes it doesn't matter to us what particular medication from a group we use, as long as it's from that group, and safe for the patient. If a patient goes to the pharmacy and can't find a particular medication, there is often some flexibility, but the decision must be made carefully. At home, CVS or whatever pharmacy may call the person who prescribed it, but that doesn't happen here. When there is no dialogue after the one-time visit, there's no way we can adapt our choice of medications. Needless to say, we have to be very careful about what we write on a prescription. So I am writing a list of meds that can be prescribed for some relatively common conditions that are rare enough that we don't stock the meds in the clinic. This includes certain allergy medications, antbiotics, laxatives, asthma meds, and eczema meds. When I first got here, I had to make guesses on EVERY one of these drugs, hoping they happened to stock that kind here. Now that I have scoped it out, I can share that with future volunteers, and even post it in the pharmacy for easy access!

I am also going to work on sharing my protocol information for children with malnutrition. I am starting to write up a curriculum to review with the students soon.

The clinic has some protocol in place to make these sorts of transitions easier, but there's always room for improvement. I think that the only way to keep this consistency going is to have strong leadership and communication between the people in the environment. That's what I'm trying to help out with!