Summer International Health Fellowship - Project Restauración

June 2015 was the first session of the SIHF summer fellowship at Project Restauración in the Dominican Republic. Six fellows attended, and each of the six stayed with a host family for the month while they worked on individual projects that will be continued in Session II and continue to improve the health of communities long after the fellows return home. The fellows were Devon Hughes, Michaiah Hughes, Sushmita Banerjee, Alan Tang, David Wu, and Lizaremi Luna-Sousa .

FIMRC staff identified the projects to work on in April, and assigned them in the first few days. FOM Diana worked together with each intern to set goals and determine what to achieve by the end of the month. Diana checked in on the progress of each intern several times, and scheduled specific afternoons during the month to work on them. The time spent working on the projects increased through the month. At the end of the month, each fellow had a written deliverable that followed the goals of their project.

Projects - Below are the descriptions of each Fellow's Project and the processes of creating and implementing each project

Health Promoter Training: Heavily revise materials and create new multi-day training sessions to combine and streamline the First Aid and Health Promoter Training projects. Elements include: designing and developing materials, writing classes, making first aid guides, designing and implementing restocking processes.

This project was picked up by Devon and Michaiah in Session 1, in which the project was divided into two parts. The first part, Devon’s, involves the development of a basic first aid training course that centers on using the first aid kits and recognizing emergencies that should be brought to a clinic. This will be the primary phase of the project, and should be developed into day-long (or two-day) training courses with emphasis on practice, and with a practical evaluation.

The second part was developed by Michaiah as a hybrid EMT/Wilderness First Aid course. This training course will focus on stabilizing emergencies that occur far from the clinic for transport. This will also be a one- or two-day training course.

Both Devon and Michaiah have outlined curricula for their upcoming training courses and a way to evaluate the progress of participants in the course. The projects are being continued in SIHF session 2 by Devon, Alexis, and Ariel.

Diabetes Database: Update and analyze health statistics of our diabetic patients in the Access Database to assess if program if helping patients reach their health goals. Adjust classes accordingly.  

This project was addressed by Sushmita in Session 1, who wrote recommendations to shift the focus for program evaluation from blood pressures and blood sugars in the Access Database to an analysis of HBA1C levels, which do a better job of evaluating adherence to treatment over time. 

Diclofenac + Complejo B injections: Literature review and possible analysis of a local combined injection of diclofenac (an NSAID like Tylenol) and B complex vitamin. Separately, the solutions are clear, but when mixed in a syringe, they turn opaque. I believe one or more of the ingredients is precipitating and may affect biological uptake.  

Alan investigated this issue in Session 1 and wrote a detailed report. The introduction of acidic B Complex is causing the Diclofenac (aqueous) to undergo a phase separation into diclofenac free acid. Additional investigation remains to see if diclofenac free acid can be safely and effectively injected; so far, it seems to be only commercially available to be turned into aqueous solution prior to administration.

Restauración Hospital data analysis: Acquire and analyze patient data from Restauracion Hospital. Topics include: maternal care, most common cases, types of emergencies.

In Session 1, David compiled the hospital data on emergencies for the month of January 2015, deciphered it, and broke down the emergencies by age, gender, nationality, and type.

Much more data remains to be analyzed, including more emergencies, data on births and women who schedule C-sections, and referrals. The referral records appear to be particularly messy. The project has been carried on into Session II by Brigitte and Bethany.

Infection control: Sterile technique in the hospital, particularly in emergencies, has many lapses. Work with nursing staff to review sterile procedures, identify a checklist of good technique, and evaluate progress. Design needed materials and conduct confidential evaluation (share only results, not names).

This project was heavily adapted by Lizaremi. Original goals were to station Lizaremi at the front of the hospital to take vitals and patient information for each patient in an attempt to improve quality of care in outpatient administration. Due to time constraints and diversity of areas in which the quality of care provision can be improved, Lizaremi instead wrote a brief set of recommendations on how FIMRC can approach this issue in a broader way, concentrating on vitals. Alexandra is continuing this project in SIHF Session II. 

Check back soon for updates on how the projects have progressed in Session II!