Posts tagged #Diabetes

Redefining "One Project Site, Two Countries"

Project Restauración's Fellow, Amy VanderStoep, discusses the experience of working on the border of the Dominican Republic and Haiti.

All of the FIMRC project sites are working towards a similar set of goals but each one has a unique personality that makes the experience of being there special. While the various projects and staff make a huge difference in the individuality of the site, the community and location define the FIMRC experience.

One of the definitive aspects of FIMRC-Dominican Republic is its location on the border of Haiti. Although the site is in the Dominican Republic, we have ample opportunity to visit and work in Haiti as well as to witness the problems experienced by locals living on either side of the border. As the FIMRC site continues to grow and expand, we have been able to work our way into Haiti in more and more ways.

Our latest expansion began on a hilly soccer field in Restauración when one of the players approached me and my fellow intern Rachael. He had heard that we worked for a non-profit organization and his request was for our help in funding a new soccer field in Tilori, Haiti. We explained to him that, while our foundation did not have the resources to just give money for a soccer field, we would be interested in working with him and the Youth Sports Association in Haiti that he runs. He came to meet with our Field Operations Manager who explained to him the educational programs we are able to offer and connections we could try to make with other organizations in the US to help with the field. He seemed really interested in trying to develop this relationship.

Since this meeting, we have been working with the sports organization and have been able to provide them with jerseys, other sports equipment, and some lectures in health, focusing on the girls in the Sports Association. Not only does this provide a new definition for the FIMRC website’s declaration that we are “one project site, two countries”, it also provides an expanded opportunity for volunteers to experience another aspect of Haiti.

While the language difference between Spanish in the DR and Haitian Creole in Haiti presents an interesting obstacle, we are still working to expand this program by incorporating various aspects of our existing educational programming and some new programming. Hopefully, as we continue to develop this relationship with the youth program, FIMRC will be able to have an even greater impact with this one project site, in two countries.

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!

Ambassador Spotlight : Matt Karr

FIMRC Ambassador Matt Karr has focused his efforts both in our offices in Philadelphia and currently at our site at Project Huancayo, Peru. Matt is working on a Diabetes campaign in a rural community outside of Huancayo to help diabetics manage the disease and to also help others prevent it. Below, you will find an interview with FIMRC Ambassador Matt Karr!

Why did you choose to do an intern experience with FIMRC?

During my undergraduate years at Emory, I was the president of Emory’s FIMRC chapter during my junior year, and during my tenure I led a mission trip to the Dominican Republic.  I thoroughly enjoyed that experience and was extremely impressed with the quality of FIMRC’s organization.  When I decided to take a gap year, my main goals were to improve my mastery of Spanish, gain more clinical exposure, and help improve the lives of others; FIMRC’s fellowship program was the perfect fit for me. 

How do you think a hybrid internship is beneficial to your work on site in Huancayo?

 My “hybrid” internship consisted of spending August-January in our headquarters  in Philadelphia, and then February-June at our project site in Huancayo.  I definitely think it helped prepare me for my time here in Peru.  While at our headquarters, I regularly corresponded via Skype with our Field Operations Manager in Peru, Danel Trisi, to help strategically plan for my time here. We devised a set of criteria by which we could evaluate future projects, and this allowed us to target specific areas to focus on upon my arrival.  Additionally, I prepared briefing documents that we now send to our volunteers pre-departure regarding the national and regional healthcare priorities in Peru.  By the time I arrived in Huancayo, this preparation allowed me to hit the ground running.

What did you see in the community that made you want to create a Diabetes campaign in Huancayo?

The diabetes group that I am currently overseeing  takes place an hour outside of Huancayo in a small rural community called Aco.  There are a couple of reasons why I decided to create this group: first, their diet is shockingly poor.  Almost every meal (even breakfast) involves rice and potatoes, and these two foods are extremely high on the glycemic index.  When rounding in the hospital, the majority of the patients’ complaints are GI in nature, and I frequently  encounter a patient waiting for a gallbladder removal.  As a doctor once joked to me here, Peruvians have “flacos exteriores, pero gorditos adentros”, which translates into “skinny on the outside, and fat on the inside.”  The second reason I chose to run the diabetic group is because of the lack of health education and resources available, particularly in the isolated community of Aco.  They have a health post in Aco with extremely scant resources.  Many of the people in the community have diabetes, but are completely unaware.  We recently ran a diabetes campaign, where a group consisting of myself, our volunteers, and Peruvian medical students measured blood pressure, blood sugar, height, weight, and waist circumference to screen for diabetics for my program.  Two of the six diabetics we diagnosed (out of 25 people) had astronomically high blood sugar levels (over 500!).  It was evident to me that this community needed assistance.

What steps did you take before the project to ensure the projects success?

The diabetes group simply would not have been possible without collaboration.  First, Jessica Southern, our FOM in Nicaragua, sent us the curriculum she created for a similar diabetes group she runs at her site, which has proved to be invaluable to us as we launch our program here in Aco.  Additionally, we wanted to establish a synergistic relationship with not only the health post in Aco, but also the municipality, and both the mayor and Dr. Andrea Cosme have been extremely supportive of our efforts.  In particular, Dr. Cosme has been of tremendous assistance; when we presented our diabetics group to the municipality, she helped us prepare, and through her own presentation to the municipality she highlighted strategies to establish general wellness in the community. This perspective was eye-opening, as it helped me learn what the local leadership prioritized as areas that needed improvement.  Additionally, Dr. Cosme publicized the diabetes program within the community of Aco (this has proven to be difficult, as many do not have phones), and we now meet weekly to discuss the current week’s lesson plan.

What are you doing to make sure that the program will be a success after you leave Huancayo? 

Sustainability was one of my chief concerns when designing our diabetes program in Aco; too often, NGO’s will stage a one-time intervention and then things return to the norm.  To combat this problem, we took a two-pronged approach:  first, we wanted to collaborate closely with the health post (essentially a primary care facility with limited resources), and even invited their collaboration in lesson planning and administration of the lessons.  This way, once I return to the United States, the local population has the resources to continue the program for new groups.  Second, we aim to empower the diabetics in the group to take ownership of their group, and ultimately  of their disease.  If the participants take the initiative to continue meeting and holding each other accountable, then we will know that we have created a sustainable program.

How do you think this experience will help you in your future career in the medical field?

My experience in Huancayo will prove to be a tremendous help to my future career in the medical field.  My ability to speak Spanish has rapidly improved since I have been here, but particularly so in a medical setting.  Additionally, my experiences here, especially with the diabetes group, have strengthened my ability to work in a team environment with people who have backgrounds quite different from mine.  My experiences in Huancayo have made me more adaptable, as I have had to accustom myself to life in an unfamiliar culture, and have also had to improvise at times. I have become far more comfortable in a clinical setting, as I regularly scrub into surgery and round at the hospital.  I have observed procedures as remarkable as craniotomies, gallbladder resections, and Caesareans, and witnessed patients with tuberculosis, Legionnaire’s Disease, and meningitis.  Finally, my time here has improved my ability as a leader.  With the assistance of Danel, I am in charge of FIMRC’s diabetes group, and along with our other ambassador Mitchell Yeary, I design and administer medical English lessons for both Peruvian medical students and doctors.

What is the funniest thing that's happened on site?

For me, the funniest thing has been how literally every Peruvian thinks I look like a famous celebrity, largely because I am one of the only “gringos” in Huancayo.  Some common names that I am often likened to are Chris Martin, Calvin Harris, and Mark Zuckerberg.  One of Carlos’ (my host) friends even juxtaposed a picture of Mark and I next to each other to make her point!

What is the biggest challenge you've faced on site?

The biggest challenge that I have faced thus far is adjusting to certain cultural aspects of life in Peru.  For example, we always joke about how things here run on “Huancayo time”; instead of meetings at set times, they are more like rough estimations, as people here are chronically late.  When I presented my diabetes group to the municipality of Aco, we were scheduled to present at 9:30 a.m., yet did not begin until 11:15 a.m.!

Posted on March 25, 2015 and filed under Internship Program, Internship, Peru, Project Peru, Huancayo.