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
Slide 3
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
Slide 4
#1 INFORMATION GATHERING Medical Systems
Slide 5
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
Slide 6
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
Slide 7
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
Slide 8
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
Slide 9
Casa Materna
Slide 10
San Vicente Staff
Slide 11
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
Slide 12
EL CHAPERNO UNIDAD DE SALUD
Slide 13
Slide 14
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
Slide 15
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
Slide 16
Unidad de Salud Staff
Slide 17
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.
Slide 18
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
Slide 19
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
Slide 20
MEDICATIONS Dispensario on same site as clinica Medications
must be prescribed by MD to be dispensed. 55 medications on
formulary
Slide 21
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
Slide 22
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
Slide 23
#2 HEALTH COMMITTEE TRAINING
Slide 24
Health Committee Training Attended by 10 members 3 stations:
Hgb & Glucose Blood Pressure Peds triage education
Slide 25
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
Slide 26
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
Slide 27
DREAMS. Pastor Luis dreams of his own clinic. using Edgar as
the nurse.
Slide 28
WISHES Pastor John wants a MINILAB since lab tests are such a
challenge for the Unidad
Slide 29
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
Slide 30
#3 FLUORIDE APPLICATION
Slide 31
El Chaperno school 380 students, K-grade 9 Two teams: AM &
PM Dental charlas to 9 classes 170 children treated
Slide 32
Dental Charla in Action..
Slide 33
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.
Slide 34
#4 RENAL INSUFFICIENCY/FAILURE
Slide 35
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
Slide 36
Renal Insuffiency Per Sonia: Inadequate patient education. Only
advice drink 1 liter of water daily No dietary restrictions on
salt, potassium, phosphorus
Slide 37
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
Slide 38
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
Slide 39
REVIEW OF TRIP LOGISTICS
Slide 40
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.
Slide 41
WHAT DIDNT WORK COMMUNICATION!!! ABRAZO & CHIMPS COMMUNITY
& CHIMPS BUDGET
Slide 42
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
Slide 43
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
Slide 44
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