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CHIMPS BRIGADA APRIL 2012 EL CHAPERNO

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Trip Overview APRIL 9Arrival APRIL 10 Trip preparation and travel to El Chaperno APRIL 11 AM Meeting Hospital San Vicente PM Meeting Health Committee APRIL 12El Chaperno School Dental Charlas & Fluoride APRIL 13AM Meeting Unidad de Salud Santa Maria Ostuma PM Health Committee training APRIL 14Return to Santa Tecla, meeting with Sonia APRIL 15Beach day, inventory of supplies APRIL 16Departure

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Trip Objectives INFORMATION GATHERING - To gain a better understanding of the medical services available to the community of El Chaperno HEALTH COMMITTEE TRAINING - To learn more from the Health Committee about their desired training and community health care goals FLUORIDE APPLICATION - To apply fluoride varnish to school children in the community RENAL INSUFFICIENCY - To learn more about the current epidemic of renal insufficiency/failure in the region

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#1 INFORMATION GATHERING Medical Systems

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NATIONAL SYSTEM OF HEALTH SERVICES FOR PATIENTS WITHOUT INSURANCE OR PERSONAL MONETARY RESOURCES: Promotoras Unidades de Salud Regional hospitals Specialty hospitals in San Salvador: Adults Rosales Children Bloom

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NATIONAL HOSPITAL OF SANTA GERTRUDIS San Vicente 139 beds, 14000 sq meters New hospital building 2010 (old one destroyed in 2001 earthquake) 4 basic areas: Surgery, OB, Peds, IM Subspecialities: Cards, Pulmonary, Ortho, Plastics, Urology, Gyn

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HOSPITAL SAN VICENTE Part of the basic system of integrated health SIBASIS Many Ancillary services Formulary medications free; delivery system sporadic & unreliable Several Referred services Areas of concern for this hospital: - Maternal/Infant morbidity/mortality - Renal Insufficiency

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HOSPITAL SAN VICENTE Targeted to rural populations Space in the hospital building available; no supplies or equipment Unidad de Salud nurse refers to hospital when close to delivery

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Casa Materna

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San Vicente Staff

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ACCESS TO MEDICAL CARE BETWEEN EL CHAPERNO AND 20 kilometers from El Chaperno, 30-45 minutes by car Patients from El Chaperno are really supposed to go to Zacatecaluca for hospital care, but it is farther away (1 hour) due to poorer roads El Chaperno 5 minutes Guadalupe 45 minutes La Ceiba 45 minutes Santa Maria Ostuma 45 minutes Jerusalen 1 hour Hospital San VincenteUnidades de Salud

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EL CHAPERNO UNIDAD DE SALUD

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El Chaperno Unidad de Salud ECOS - F: Equipos Communitarios Familaria Open 5 days a week, M - F, 0730 -1730 30 - 35 patients a day Small clinic and waiting area outside Wired for electricity but none available when we visited Everyone is welcome, regardless of place of residence

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Staffing Unidad de Salud Team composed of physician medical director, lead nurse, auxiliary nurse, promotoras for El Chaperno, Concepcion, and San Antonio, and Polivalente Staffed daily with nurses and promotora MD hours vary: El Chaperno M,W, F Concepcion - Tuesday San Antonio - Thursday

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Unidad de Salud Staff

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MEDICAL DOCTOR MD changes every year; assigned by Systema Regional de Salud Currently a resident in last year of medical school, who cannot prescribe controlled medications. Can prescribe antibiotics, antihypertensives, diabetic meds, contraceptives.

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NURSING Has a university degree 3 years in high school & 5 years in university Performs vaccinations, pediatric & prenatal care Contract worker 3 years of high school, 3 additional years of training Adult chronic health care Employment through the government system more lucrative than if employed as a contract worker Enfermera LicensiadaAuxillary Nurse

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PROMOTORA No formal education 3 months of training Assigned to 200 households, sees 8-12/d Checks on immunization status, pregnant women, helps with health campaigns Last partera passed away, no new one; no formal training for this role

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MEDICATIONS Dispensario on same site as clinica Medications must be prescribed by MD to be dispensed. 55 medications on formulary

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LABS Able to draw blood; no equipment to analyze it Samples to private lab in Guadalupe and/or ECOS Verapaz lab FEES: $3 glucose or parasite $4 for hemoglobin $6 for cholesterol

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FUTURE. Hx of collaboration with Health Committee in San Antonio with dengue & cleaning campaigns Health Committee alerting promotoras to pregnant women in community Collaborating with health fairs Referral from health fairs

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#2 HEALTH COMMITTEE TRAINING

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Health Committee Training Attended by 10 members 3 stations: Hgb & Glucose Blood Pressure Peds triage education

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Health Committee - Highlights Have used first aid kits Replenished 1 st Aid supplies Keen interest in lab testing Supplies left: BP cuff, stethoscope & Donde no Hay Doctor

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EL CHAPERNO HEALTH COMMITTEE Next training. Bring thermometers to leave? Bring U-dips Plan ahead further for better attendance Always include brief orientation to first aid kits Involve Unidad de Salud in health fair

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DREAMS. Pastor Luis dreams of his own clinic. using Edgar as the nurse.

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WISHES Pastor John wants a MINILAB since lab tests are such a challenge for the Unidad

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FUTURE. Hoping for improved communication directly with committee. We could plan for November health fair to include large renal component in testing and education. Health committee could study chapters in Donde no hay doctor and email us their questions on a monthly basis to solidify our commitment to their community

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#3 FLUORIDE APPLICATION

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El Chaperno school 380 students, K-grade 9 Two teams: AM & PM Dental charlas to 9 classes 170 children treated

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Dental Charla in Action..

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FUTURE.. Update charlas to be more interactive & sophisticated Next time: - divide toothbrushes into adult and child ahead of time - have only small size toothpaste. NOTED DURING VISIT: School had overflowing toilets, no drinking water and no facilities to wash hands.

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#4 RENAL INSUFFICIENCY/FAILURE

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RENAL INSUFFICIENCY 1000 patients/year; 8-10 cases/day Incidence highest near rivers in agricultural communities Postulation causes: DM, HTN & pesticides Interest in BP, Hgb, Urine dip screenings Renal prevention unit Hemodialysis done in San Salvador, unclear if biopsies done there Staff aware of increased incidence of ARI Nursing staff observe lack of drinking water (coffee instead) in fields, pesticides, and concomitant hypertension and diabetes Hospital San VicenteEl Chaperno Unidad de Salud

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Renal Insuffiency Per Sonia: Inadequate patient education. Only advice drink 1 liter of water daily No dietary restrictions on salt, potassium, phosphorus

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Barriers to care for CRF Wait lists for dialysis classes Wait Lists for Specialist Consults Limited Dialysis Poor quality equipment Lack of medications Home dialysis available; limited to approved houses A law against organ donation in El Salvador

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FUTURE Awaiting results from panela Awaiting results from water samples Promotora role in education about primary & secondary prevention renal disease Promotora assisting with home peritoneal dialysis for patients

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REVIEW OF TRIP LOGISTICS

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WHAT WORKED Letter from Abrazo to present at airport Having end of day recap & entering into laptop while in El Chaperno Having a meeting prescheduled with San Vicente Hospital prior to our arrival Our interpretor Norma Great food no illness Serendipity - running into Unidad de Salud doctor & nurse out walking to be able to schedule a mtg with them.

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WHAT DIDNT WORK COMMUNICATION!!! ABRAZO & CHIMPS COMMUNITY & CHIMPS BUDGET

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SUGGESTIONS... TO IMPROVE PLANNING TO IMPROVE COMMUNICATION * Timeline developed for Abrazo & future CHIMPS leaders to follow in preparation for trip so each party knows expectations * BRAINSTORMING NEEDED * Health Committee, Pastor, Sonia and Raul all told by our group to expect another CHIMPS brigada in November. * Email address given to health committee member, Pastor Luis. * Would like to stay in regular monthly communication with them to nurture relationship

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Issue for Future Brigadas Expense Barriers Cost of airfare expensive Lack of Fund raising Dates confirmed earlier = more time to shop for more affordable prices or book airmiles. Airlines contacted for consideration of reduced airfare, baggage fees. Budget volunteers need to know cost prior to volunteering. Fundraising. Needs to become part of at home function to support volunteers

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Future Brigadas continued.. Recruitment Regalos Internet Recruitment consider adding on vacation destination after brigada (ie Argentina) Regalos report what was given most recently and also ideas for next incoming group to bring (ie leaking kettle) Internet access @ Abrazo WIFI. Could Hilda could get Sonia to update internet prior to future brigadas

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CHIMPS TEAM APRIL 2012