Saturday, July 08, 2006

A Typical Medical Mercy Team

Medical Mission teams can take on many different faces. Our typical team includes a Medical Team, a Dental Team in the near future (including extractions, restorative work and cleanings), and an Optical team to fit reading glasses. We will eventually establish special Cranio-facial teams that can be organized to work in local hospitals to provide cleft lip/palate repairs and General Surgical teams to help a community catch up on a backlog of hernia and gallbladder surgeries. We will evaluate those needs for each trip, and identify local hospitals that we can partner with to do the surgeries. We may consider bringing physical therapists to do work treating patients with musculoskeletal complaints. The Medical Missions teams are as diverse as the needs identify.

What follows is a very basic description of what a typical team would do, and how the clinics are set up.

To explain briefly, patients line up outside of the clinic usually quite early in the morning. The lines are then organized by specialty: medical, dental, optical. The patients are then registered with their name and address placed on the encounter card. They then proceed to the triage waiting line, followed by triage where a brief history and vitals are recorded. After triage patients are moved to the appropriate waiting line for the service they are presenting for. The patients then receive their exams and move to the spiritual counseling line, receive spiritual counseling and then wait for their medications at pharmacy. After pharmacy they are lead outside of the clinic to allow optimal flow.

The above schematic works great in a large sanctuary, school or hall utilizing string and curtains to make cubicles for the examiners or simply having enough space between examiners for a comfortable examination of the patients. We have conducted clinics in schools with classrooms and in villages in open and closed buildings and under huge tarps. Each of our clinics looks different, but all follow the flow pattern above. We have always been able to have a similar flow, regardless of the setting, though creativity is often required.

We limit patients to one service through the clinic at any given time as the lines waiting out front may not fairly get a chance at care if one patient is allowed to see medical, dental and optical in one pass. After a patient completes a pass through the clinic, they are welcome to join the line of their desired service if it’s not too long or return later on another day of clinic if we return there.

What we have found is that encounter cards that are numbered need to be given to registration little by little throughout the day or ideally before we arrive with careful attention paid to the flow of the clinic and any backlog in the pharmacy or counseling area. Numbers from 1-100 are used for a 2 hour block of time: 8am-10am, 10-noon, 1pm-3pm, 3pm-5pm. This limits the overwhelming numbers on the examiners, and keeps the crowds down. Depending on the number of examiners, we can either increase or decrease the numbers. 100 patients in 2 hours seem to work well with 3 examiners. We have asked local ministry helpers, the local pastors, and the missionaries to disperse the numbered cards so that they may follow up with those whom they have found to be in most need.

The triage nursing area provides a great function to supply a brief history and to check vitals signs on patients. Ideally there will be an automated blood pressure cuff to allow rapid assessments in a noisy environment. We find that two people staffing this area works best and one can be pulled aside to assist a physician in performing exams or checking a blood sugar, pregnancy or urine test. Documenting allergies and current medications greatly assists in the medical evaluation and enhances patient care safety. There are many times however when we have had to bypass the triage area and see patients directly due to the large numbers of people waiting to see the team.

Adequate seating areas should be arranged using chairs or benches to allow an orderly and comfortable flow for the patients who will be spending quite a while waiting for the various phases of the clinic. Adjustments may need to be made to add to or take away from the various lines of benches to accommodate the optimum flow. If at all possible, finding an area out of the elements for the usual long line of patients outside is ideal. The clinic should not be overrun, however, so in many locations it is just impossible to arrange this. In this area, we have found that local pastors and the missionaries can interact with the patients, introducing them to his word. Public health issues can be taught such as dental care, hygiene, and nutrition.

Since each examiner will move at a different pace, having one general waiting line is better than having individual lines for each examiner. This way, the next patient in line will be taken by the next available examiner.

Each examiner in an efficient medical mission clinic with minimal paperwork should be capable of seeing 50+ patients per day which is a pace of about 6+ patients per hour. That would be a minimum. There have been times when we have been able to see twice that number in an hour. A balance must be sought in the humanitarian need to examine as many people of the community as possible, with the need to provide quality care and an adequate presentation of Christian love and the Gospel message. If we are working in an area of large population we find that having the examiners stick to medical care and allowing the spiritual counselors to handle the Gospel presentation and counseling allows the greatest efficiency while still allowing the spiritual goal to be accomplished. In such a setting we would ask our examiner to pray that the Holy Spirit would guide them to knowing when they may be asked to initiate spiritual discussion as at times the examiner who touches the patient can provide the greatest witness for Christ. We pray that God would bring those to the clinic who need to be there as a mission clinic will always be a limited resource to a large population of needy people.

The dental clinic requires a location with good lighting. If a source of running water is available then situating the dentist near that area (if it allows for appropriate patient flow) is ideal. Also important is access to electricity if compressors are being used to allow drilling and cleanings. Portable generators may be necessary. Provision must be made to allow for sharps handling and disposal. A great system for sterilization can be made using a series of baths including soapy water, gluteraldehyde, clean rinse and then steam sterilization using a pressure cooker over a hot plate.

The optical clinic will also require an area with adequate lighting. Having tracts available or a Bible in the local language will allow the examiner to test the reading glasses on each patient. A small kit with needle and thread or similar can also allow testing for those who are illiterate.

Medical Mercy believes that spiritual counseling remains a number one priority. We would require a local church or group to commit to a follow up plan in order for us to agree to put on a clinic. Ideally the local church or churches participating will have their Pastor(s) present and actively counseling along with their best and most mature church leaders (deacon and deaconess type leaders). We would look to the missionaries for guidance on how best to proceed.

A pharmacist and assistants will set up, supply and distribute medications. It is imperative that traffic flow in and out of the pharmacy be kept to a minimum as this area tends to be a center of attraction and efficiency mandates the area be kept clear of extra non-essential staff or visitors.

In addition to the clinical staff, I would utilize a support staff utilizing local church volunteers and United States based volunteers. There are almost always more people who want to help than room to allow them. We would assign roles and possibly do so in shifts.

US based team:

Physicians: 2-4
Dentist: 1
Nurses: 2-4
Pharmacist: 1
Child Life Specialist: 1
Optometrist: 1
Support lay staff: 2-5
Total team members: 10- 18

Country support:

Interpreters: 6
Missionaries: 2
Pastors: dependent on location
Drivers: variable
Total team members: 8-10

Medications: enough to treat 1500 patients

Dental equipment:
Portable dental extraction and restoration equipment

Typical Medial Clinic setup:

Medical exams
Dental exams
Vision exams
Public health education
Pastoral counseling

These teams are specific for a particular country in terms of medical needs and are lead by an experienced phyiscian, nurse, and lay person. New team members are always welcomed, and become an important part of who we are.

In all things, give thanks.