Download Student Orientation Manual - Hillside Health Care International

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Hillside'Health'Care'International'
Hillside'Student'
Orientation'Manual'
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Revised 3/2015
! CH & MR
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Dear%Student,!
Welcome!to!Hillside!Health!Care!International!!!We!are!so!excited!to!have!you!with!us!for!this!unique!
learning!opportunity.!!In!preparation!for!your!rotation,!we!ask!that!you!carefully!reflect!on!a!few!key!
concepts!related!to!the!provision!of!services!in!Toledo!District!before!reading!the!remainder!of!this!
manual.!!First,!the!nature!of!our!program!requires!a!great!deal!of!flexibility.!!It!will!be!important!to!
accept!that!things!might!change!at!the!last!minute,!with!the!need!to!develop!new!strategies!at!a!
moment’s!notice!(don’t!worry,!we’ll!help!you!with!this!)!!Second,!in!order!to!maintain!consistency!amidst!
the!frequent!turnover!of!students!and!volunteers!here!at!Hillside,!it!is!of!utmost!importance!that!you!
work!respectfully!with!the!longHterm!staff,!and!avoid!the!pitfall!of!trying!to!change!our!system!without!
fully!understanding!its!complexities.!!Positive,!sustainable!change!often!requires!the!perspective!that!
comes!with!months!or!even!years!of!experience!in!the!region,!and!an!understanding!of!the!available!
resources!and!limitations!of!the!current!system.!!Many!wellHintentioned!changes!have!been!attempted!by!
shortHterm!volunteers!and!students,!to!the!ultimate!detriment!of!the!Hillside!organization,!its!programs,!
and!permanent!staff.!!If!you!have!ideas!on!quality!improvement,!please!pass!these!along!to!the!Medical!
and/or!Clinic!Director(s).!!They!will!be!happy!to!discuss!what!strategies!have!been!attempted!in!the!past,!
which!succeeded,!which!failed,!and!whether!your!idea!might!be!worth!pursuing.!!Finally,!we!encourage!
you!to!ask!questions!of!all!staff!at!Hillside.!!Open!and!honest!communication!is!essential!as!we!strive!to!
support!our!students,!patients,!and!the!community.!
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TABLE!OF!CONTENTS!
Overview!of!health!care!delivery!in!Belize!
Page!4?6!
Curriculum!
6?8!
Overview!of!rotation!activities!
8?9!
Campus,!dorm!and!Punta!Gorda!area!
9?10!
Transportation!
10?11!
Making!the!most!of!your!experience!
11!
Other!resources!and!information!
12?13!
Global!health!and!Bezlie!travel!websites!
13!
Appendix!1?Medical!and!PA!students!
14?15!
Appendix!2?Physical!Therapy!and!rehab!students!
16?22!
Appendix!3?Pharmacy!students!
23?24!
Appendix!4?Common!diagnosis!and!medications!
25?27!
Appendix!5?Required!readings!
28!
Appendix!6?Staff!list!
29!
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HILLSIDE!MISSION!STATEMENT:'
Hillside'Health'Care'International'(HHCI)'is'a'faith'based,'non9profit'organization'dedicated'to'serving'
God'by'providing'health'care'and'disease'prevention'to'the'people'of'Southern'Belize.'HHCI'is'devoted'to'
improving'the'Belizean'quality'of'life'through'medical'care,'health'education,'and'community'outreach.'
HHCI'promotes'healthy'global'attitudes'by'offering'a'culturally9rich'educational'program'for'medical'
volunteers'that'challenges'them'to'better'understand'their'role'in'international'health'care.!
HILLSIDE!VISION!STATEMENT:!
To'ensure'HHCI'dynamically'fulfills'its'mission'by'striving'to'build'bridges—to'the'medically'
underserved,'to'the'people'living'in'our'service'areas,'to'our'volunteers'(medical'and'non9medical)'who'
serve'others'through'our'program,'to'our'partners,'to'our'staff,'and'to'long'term'financial'sustainability!
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There'are'three'main'programs'through'which'we'try'to'achieve'our'goals:'
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• CLINICAL'9'Direct'patient'care'including'acute'illnesses,'disease'prevention,'and'referrals.'
• COMMUNITY'9'Outreach'and'education'in'Punta'Gorda,'neighboring'villages'and'mobile'villages'as'
well.''
• EDUCATION'–'Teach'our'students'and'volunteers'how'to'practice'in'a'resource'challenged,'culturally'
diverse'setting.'
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I.
OVERVIEW OF HEALTH CARE DELIVERY IN BELIZE
A. Health'Care'Delivery'in'Belize
1. 'Ministry!of!Health!(www.health.gov.bz)!The'Ministry'of'Health'(MOH)'manages'a'
country9wide'system'of'hospitals'and'clinics.'The'MOH'divides'Belize'into'4'
regions'with'each'region'possessing'a'lead'hospital'(Northern,'Southern,'Eastern,'
and'Western). The'hospital'for'the'Southern'Region'(including'Toledo'and'Stann'
Creek'Districts)'is'located'in'Dangriga,'Stann'Creek'District,'and'is'the'main'
referral'site'within'the'region. Most'specialties'are'located'in'Belize'City,'with'the'
exception'of'Orthopedics,'which'is'located'in'Belmopan.'Critical'cases'are'referred'
directly'to'Karl'Heusner'Memorial'Hospital'in'Belize'City,'the'country’s'only'
tertiary'care'hospital. Hillside'works'in'a'close'partnership'with'the'Belizean'
Ministry'of'Health'(MoH)'and'Ministry'of'Education'(MoE)'and'attempts'to'
provide'services'that'will'augment'those'already'available'through'the'MoH.
2. National!Health!Insurance: Belize'has'a'developing'National'Health'Insurance'
program'that'provides'care'to'all'registered'citizens.''Patients'must'be'registered'
with'the'Social'Security'Board'to'receive'free'care'at'most'clinics.'Patients'receive'
free'or'low'cost'care'at'MOH'facilities'throughout'the'country,'and'may'opt'for'
more'expensive'care'through'private'facilities'(e.g.,'Universal'Health'Services,'or'
Belize'Medical'Associates).
B. Health'Care'Delivery'in'the'Toledo'District'
1. Punta!Gorda!(PG)!Hospital
a. Basic'inpatient'services'and'maternity'care.
b. Staffed'by'primary'care'physicians'(many'come'from'Cuba).
c. Many'births'are'performed'in'the'home,'particularly'in'the'villages.'The'MOH'
encourages'woman'to'have'their'first'child'at'the'PG'Hospital,'where'
deliveries'are'typically'performed'by'midwives.
d. Surgical'services'are'not'offered,'though'a'surgical'team'form'the'US'will'
perform'elective'surgeries'at'least'once'per'year'over'the'span'of'one'week.
2. Polyclinics
a. There'are'two'in'the'District'(PG'and'San'Antonio)'that'coordinate'out9
patient'care.
b. Maternal'and'Child'Health'public'health'nurses'are'responsible'for'
immunizations,'prenatal'clinics,'and'well'child'exams.
c. Each'polyclinic'oversees'293'rural'health'clinics/centers'staffed'by'rural'
health'nurses'(similar'to'family'nurse'practitioners),'and'community'health'
workers.''Physicians'rotate'though'these'clinics'on'certain'days'of'the'week.''
PGs'clinics'are'located'in'Santa'Ana'and'Big'Falls,'and'San'Antonio’s'clinics'
are'located'in'Columbia,'Pueblo'Viejo,'and'Santa'Teresa.
d. Services/clinics'at'PGs'Polyclinic:'TB;'Hypertension;'Diabetes;'Vector'Control'
(malaria,'dengue,'etc.);'Public'Health'Inspector'(water'standards,'restaurant'
inspections,'etc.);'District'Health'Education'Office'(HECOPAB);'Psychiatric'
nursing'(under'the'supervision'of'a'psychiatrist'in'Belize'City).''The'Medical'
Director'for'PG’s'clinic'is'Dr.'Eduardo'Garcia.
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3. Village!Outreach
a. Each'village'in'Toledo'is'intended'to'have'a'Certified'Nursing'Assistant'
(CNA),'also'called'a'Community'Health'Worker'(CHW).'The'CHWs'work'out'
of'a'village'Health'Post,'which'frequently'is'a'small,'one9room'structure.'
CNAs'have'varying'levels'of'training,'but'are'generally'limited'to'very'basic'
medical'care.'They'are'provided'with'Tylenol,'benadryl,'chloroquine'and'may'
perform'malaria'smears,'wound'dressing,'etc.'The'CNAs'provide'the'first'line'
of'care'to'the'villagers;'they'refer'patients'to'a'higher'level'of'care'when'
necessary.'Some'villages'also'have'volunteer'Traditional'Birth'Attendants'
(TBAs).
b. At'present,'Hillside'is'the'only'primary'care'provider'other'than'the'MOH'in'
the'Toledo'District.''Hillside'works'in'areas'that'the'MOH'is'unable'to'
adequately'cover'with'the'aforementioned'system.'We'work'closely'with'the'
MOH'to'determine'our'mobile'sites'and'schedules,'and'coordinate'referrals'
and'services.
c. “Bush'Doctors”'are'utilized'by'some'villagers,'particularly'in'the'more'rural'
areas.''Much'of'the'Toledo'population'will'try'home'herbal'remedies'prior'to'
visiting'a'health'care'provider.
4. Other
a. The'Belize'Family'Life'Association'(BFLA)'is'a'countrywide'NGO'which'has'
an'office'in'every'district.'The'Toledo'district'office'is'in'Punta'Gorda.'BFLA'
provides'reproductive'and'sexual'health'services.
b. Belize'Council'for'the'Visually'Impaired'(BCVI)'is'a'countrywide'NGO'which'
has'an'office'in'Punta'Gorda'next'to'the'hospital.
c. Short9term'volunteer'health'care'providers'(missionary'teams,'US'military'
teams,'individual'providers,'etc)'often'visit'the'Toledo'District'to'conduct'
clinics.'These'visits'are'to'be'coordinated'through'the'MOH.''They'may'visit'
villages'without'our'knowledge.'Any'concerns'about'these'medical'
missionary'teams'should'be'brought'to'the'attention'of'the'Clinic'
Administrator.
C. Hillside'Clinic
1. History:
Hillside'opened'in'1999'as'a'collaboration'between'the'Jericho'Road''''''''''''''''
Foundation'International'(JFRI)'based'in'the'Chicago'area,'and'the'Medical'College'
of'Wisconsin'(MCW).'The'Sisters'of'Mercy'(SOM)'subsequently'became'a'third'
partner. The'organization'underwent'reorganization'in'early'2005'and'is'now'
called'Hillside'Healthcare'International'(though'the'clinic'continues'to'be'known'
as'Jericho'Road'by'the'local'population).'
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2. Structure:
3. Funding:'
The'clinic'is'supported'entirely'through'student'tuition'and'private'individual'and'
organizational'donors.'In'order'to'maintain'good'standing'with'the'MOH'as'an'
NGO,'the'clinic'currently'provides'all'services'at'no'cost;'however,'we'do'ask'all'
non9Belizeans'to'donate'for'the'care'received.''In'addition,'we'ask'for'individuals'
to'pay'at'least'the'cost'of'acquisition'for'any'durable'medical'equipment'(DME)'
provided.'
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'
4. Staff!and!volunteers!
The'Hillside'Clinic'team'consists'of'salaried'local'employees'and'volunteer'health'
personnel'from'abroad.'A'current'list'of'Hillside'staff'and'volunteers'can'be'found'
in'the'appendix.'
!
5. Students!!
Students'and'have'been'performing'electives'at'Hillside'since'its'inception'and'are'
an'integral'component'of'the'Hillside'Health'care'team.'Participants'are'primarily'
from'the'US,'though'more'recently'there'have'been'participants'from'several'
other'countries,'including'the'UK,'Germany,'Australia,'and'Canada,'among'others.!
II.
CURRICULUM!
A. General'Description:'!
Hillside'Health'Care'International'(HHCI)'offers'a'49week'international'rotation'for'
students'of'multiple'disciplines.'We'provide'primary'care,'physical'therapy/rehab,'home'
visits,'and'community'outreach'and'education.''Our'teams'are'made'up'of'medical,'
physician'assistant,'nurse'practitioner,'physical'therapy,'and'pharmacy'students'from'
multiple'countries'as'well'as'supervising'licensed'providers.''In'addition'to'clinical'
activities,'students'are'expected'to'fully'engage'in'the'following'learning'activities:'core'
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lectures'given'by'faculty,'student9led'lectures'and'case'presentations,'community'health'
projects'and'teaching,'and'self9directed'learning.'!
!
B. Core'topic'areas:'The'HHCI'International'Health'Curriculum'is'comprised'of'four'topic'
areas:!
1. The!Belizean!Culture!and!Health!System:'The'aim'of'the'Belizean'Culture/Culture'of'
Medicine'topic'area'is'to'provide'education'on'both'the'present'culture'of'
medicine'and'health'system'of'Belize.'Students'will'learn'about'the'Belizean'
medical'system'and'the'political'and'cultural'forces'which'shape'it.'Students'will'
learn'about'how'historical'and'present'day'political'and'cultural'forces'shape'
health'care'resources'and'delivery'in'Belize.'!
2. Global/Public!Health!and!the!Social!Determinants:'The'Global,'Public'Health'and'
Social'Determinants'topic'area'is'intended'to'provide'a'brief'overview'of'
international'and'public'health'for'students'who'have'not'had'a'formal'course'in'
these'subjects.'Students'will'get'population'health'data'for'Belize'and'the'Toledo'
District,'and'learn'of'health'disparities'found'in'Belize'relative'to'the'region'and'
more'developed'countries.'Ultimately,'students'will'learn'to'consider'what'forces'
impact'health'beyond'the'health'system,'and'the'context'of'an'individual’s'life'on'
his/her'health'and'wellbeing.'!
3. Clinical!Medicine!in!ResourceHLimited!Region:'The'Clinical'and'Tropical'Medicine'
topic'area'is'intended'to'provide'participants'with'first9hand'experience'in'
delivering'health'care'to'a'medically'underserved'and'mostly'impoverished,'rural'
population'in'a'developing'country.''They'will'be'challenged'to'consider'these'
complicating'factors'in'making'treatment'and'management'decisions,'which'might'
differ'in'other'settings.''Emphasis'will'be'placed'on'common'diagnoses,'
reproductive'health,'dermatologic'conditions,'and'evaluating'severity'of'illness'
and'appropriate'follow'up.'!
4. Interdisciplinary!Learning:'The'Interdisciplinary'Learning'topic'area'is'intended'to'
provide'a'lifelong'foundation'from'which'to'build'on'the'benefits'of'cross9
professional'collaboration'and'teamwork'in'the'provision'of'health'and'
community'services.'Students'will'have'the'opportunity'to'learn'from'a'variety'of'
health'professionals'through'placements'in'the'Toledo'District.'In'addition,'
students'from'a'variety'of'backgrounds'(physical'therapy,'medicine,'physician'
assistant,'pharmacy)'will'work'in'multi9disciplinary'teams'throughout'their'
rotation'to'provide'care'and'education'while'on'mobiles,'at'the'home'clinic,'and'
through'community'outreach'efforts.''
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C. Core'Components:'We'aim'to'reach'our'curricular'objectives'through'participation'in'
several'activities:'
a. Clinical!Care!(in!main!clinic,!mobile!clinics,!and!home!visits)!
b. Faculty!&!Staff!Presentations!
c. Cultural!Immersion!Field!Trips!
d. Self!Study/Required!reading*!
e. Didactic,!Discussion!and!Reflection!Sessions!
f. Student!Topic!and!Case!Presentations!
g. Public!and!Community!Health!Projects!
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*Please'note:'To'compliment'your'in9rotation'activities,'you'are'expected'to'read'and'review'several'
required'readings.'A'list'of'these'and'a'more'comprehensive'suggested'reading'list'have'been'sent'to'you'
before'your'arrival'and'are'included'in'Appendix'5.'
!
III.
OVERVIEW!OF!ROTATION!ACTIVITIES!
A. Clinical'activities:'Currently'our'clinic9related'activities'include'time'at'our'onsite'clinic,'mobile'
clinics,'and'our'home'visiting'program.'Students'participate'in'all'of'these'activities.'
Additionally,'there'is'opportunity'to'observe'the'rehab'program,'participate'in'home'visits,'and'
visit'the'hospital/MoH'programs.'Each'month'students'are'divided'into'two'teams'that'work'
together'for'the'whole'rotation.'Each'day'one'team'works'at'the'Hillside'Clinic'and'the'other'
team'goes'out'on'a'mobile'clinic.'
1. Home!clinic!
a. !Onsite'clinic'is'conducted'Monday'thru'Friday,'8'AM'–'Noon.'Villagers'from'
throughout'Toledo'District'bus'into'PG'early'in'the'morning'and'return'to'their'
villages'on'buses'that'depart'PG'at'11:30'or'noon.'!
b. Hillside'provides'a'shuttle'service'to'and'from'PG'central'square'twice'a'week'
for'patients.'The'shuttle'departs'Central'Square'for'clinic'at'9am'and'returns'to'
Central'Square'once'all'the'patients'shuttled'in'have'been'seen.'Because'patients'
from'rural'and'urban'areas'attend'the'onsite'clinic'the'patient'mix'(and'
therefore'the'conditions'encountered)'tends'to'be'diverse.!!
c. Afternoons'the'team'working'at'the'clinic'participates'in'community'outreach'
programs'or'home'visits.'!
!
2. Mobile!clinics!!'
a. Mobile'clinics'to'villages'are'conducted'Monday'thru'Thursday'(Fridays'
some'weeks).'The'mobile'vehicle'leaves'at'8'AM'and'returns'about'
3:00pm.'The'villages'serviced'are'determined'by'the'MoH'and'presently'
include'17'villages'from'the'Punta'Gorda'and'San'Antonio'catchment'
areas.'Each'village'is'visited'at'least'every'4'to'6'weeks.'Overnights'to'the'
most'remote'villages'are'held'twice'a'month,'and'each'student'is'
scheduled'for'1'overnight.''
'
B. Public'health'&'community'outreach:'
1. Health!education!&!community!presentations:!
a. As'part'of'your'experience'you'will'be'expected'to'give'presentations'on'certain'
health'related'subjects.'This'may'be'to'your'fellow'students,'to'an'organization'
in'the'Toledo'area,'or'in'one'of'the'schools'or'villages.'It'is'important'to'express'
yourself'in'terms'appropriate'to'the'group'and'be'aware'that'certain'items'are'
not'found'here'(e.g.'recommending'that'diabetics'eat'more'of'a'certain'vegetable'
that'is'not'available'locally'or'get'exercise'at'the'gym!).'Do'your'research'as'to'
what'is'culturally'and'age9appropriate'and'think'creatively'about'games'and'
activities'that'can'be'used'to'education'on'various'health'topics.'It!will!be!to!
your!benefit!to!have!reviewed!the!presentations!for!your!rotation!and!
come!prepared!as!you!will!have!limited!access!to!internet!onsite.!!
!
2. OffHsite!Clinical!Experiences:!During'your'rotation'at'Hillside,'you'may'be'assigned'to'
other'health'care'facilities.'This'is'to'give'you'a'better'idea'of'health'care'in'the'Toledo'
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District.'Some'of'these'facilities'include'Belize'Council'for'the'Visually'Impaired,'which'
does'eye'exams'and'provides'corrective'lenses,'and'the'Punta'Gorda'Poly'Clinic,'that'
serves'the'entire'Toledo'District'with'primary'health'care.'You'may'have'the'
opportunity'to'go'on'home'visits'with'the'RN'in'charge'of'home'care,'as'well.'Make'the'
most'of'these'by'interacting'with'the'staff,'doing'research'beforehand'and'asking'
appropriate'questions'when'there'are'slow'times.'You'can'learn'much'about'the'health'
system'in'Belize'by'these'exposures.'
'
C. Home'visiting/nursing'program:'Home'visits'are'provided'for'people'in'the'PG'area'who'are'
unable'to'easily'access'a'medical'facility.'Currently'there'are'approximately'50'patients;'these'
include'the'elderly'and'disabled'children'and'adults.'Home'visits'are'conducted'by'a'Hillside'
nurse/preceptor'under'the'oversight'of'the'medical'staff.'An'attempt'will'be'made'to'give'all'
students'the'opportunity'to'assist'in'these'visits.'''
'
D. Rehab/physical'therapy'program:'In'2011'Hillside'instituted'a'physical'rehabilitation'program'
with'a'director'of'rehab'and'DPT'students'providing'physical'therapy'services'to'patients'and'
community'outreach'programs.'The'medical,'pharmacy'and'physical'therapy'education'
programs'are'integrated'so'that'students'from'the'different'disciplines'live'and'learn'together.'
Read'more'in'Appendix'2.'
'
E. Curriculum'&'faculty/student'presentations'on'campus:!Medical'presentations'by'students'
and'preceptors'take'place'in'the'afternoons.'Friday'lunches'are'reserved'for'case'presentations'
by'students'and'evaluation'from'preceptors.'
!
'
!
IV.
CAMPUS,!DORM!AND!PUNTA!GORDA!AREA'
A. Security''
1. Please'be'mindful'of'your'security'at'all'times.''Although'Toledo'is'a'relatively'safe'
environment,'it'is'easy'to'fall'into'a'relaxed'mode'and'allow'for'unfortunate'things'to'
happen'to'you'and'your'belongings.''
'
2. We'have'a'night'watchman'on'duty'from'6'PM'to'6'AM.''Please'check'in'with'him'when'
leaving'and'returning'to'the'grounds.'No'one'is'allowed'on'the'grounds'except'students,'
volunteers'and'staff,'other'than'patients'during'clinical'hours.'Keep'your'room'locked'
when'you'are'out'and'secure'your'belongings.''
3. Hitchhiking'is'not'recommended.'Use'the'bus'system'or'taxis'when'traveling'or'going'into'
PG.'Whether'on'clinical'or'touring,'be'sure'to'keep'your'belongings'safe.'When'traveling'
either'before,'after'or'during'your'rotation'at'Hillside'please'use'licensed'guides'for'trips.'A'
list'of'guides'is'available'in'the'student'dorm.''
B. Housekeeping'
1. Bedding'and'towels'are'supplied'and'are'laundered'every'Friday.'Please'keep'your'rooms'
tidy.''The'housekeeper'cleans'the'rooms'once/week.'Keep'the'kitchen'area'clean.'Any'food'
or'scraps'will'immediately'draw'ants'and'flies.'Keep'the'refrigerator'clean'as'well.'
Leftovers'are'encouraged,'but'should'be'thrown'out'after'394'days'if'not'used.''All'wet'
garbage/food'stuffs'should'be'thrown'into'the'compost'bin'for'disposal'or'in'the'compost'
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'
pile'in'the'southwest'corner'of'the'compound.'If'mixed'with'thrash'it'will'give'a'rotten'
smell'within'a'day.'
'
2. There'is'a'washing'machine'in'the'dorm.'Clothes'hanging'areas'are'under'the'tree'house'
and'under'the'dorm.'No'drying'of'clothes'inside'or'on'furniture'please.'The'housekeeper'
will'launder'the'linens'and'towels'once'a'week.'
C. Meals'&'water'on'campus:'
1. Early'Monday'and'Wednesday'mornings'are'scheduled'times'for'marketing.'We'
encourage'you'to'work'together'to'figure'out'a'cooking'and'cleaning'routine.'
Transportation'is'provided'to'market'before'clinic'on'these'days.'Drinking'water'is'
provided.'If'the'container'is'low,'please'advise'one'of'the'staff.'
'
2. Certain'meals'are'provided'by'Hillside.'Otherwise'you'and'your'group'are'on'your'own.'
Check'the'weekly'schedule'to'find'which'meals'are'provided.'For'some'mobile'clinics'or'
activities'you'will'be'able'to'purchase'food'at'the'village.'This'will'be'noted'on'the'
weekly'schedule'with'the'amount'to'bring.''
!
D. Dress'Code:''
Dress'appropriately'when'out'in'public.'You'reflect'Hillside'whether'on'or'off'campus.'If'you'
are'in'a'professional'setting'long'pants'or'skirts'that'come'to'the'knee'and'sleeved'shirts'are'
necessary.'In'church'or'school'settings'this'is'also'true.'When'working'in'clinic'or'on'mobile'
most'students'wear'scrubs'which'are'available'from'our'housekeeper'if'you'did'not'bring'any.'
'
E. Phones'and'Internet''
1. We'do'not'have'wifi'internet'on'campus.'We'do'have'a'system'in'place'whereby'
students'can'pool'money'together'and'purchase'internet'credit.'It'is'based'on'MB'usage'
and'is'very'slow.'Please'do'not'count'on'being'able'to'Skype'or'watch'videos'from'
campus.'
'
2. The'phone'system'here'is'also'very'expensive.'Even'local'calls'are'.25/minute.'If'you'
want'to'make'calls,'please'buy'a'phone'card'in'PG'and'follow'the'directions.'''
'
V.
F. Substance'use'on'campus!
There'is'no'smoking,'alcohol,'or'drugs'allowed'anywhere'on'the'Hillside'campus'including'in'
the'clinic,'the'Abby'House'dorm,'the'Tree'House,'the'upstairs'apartment,'or'on'the'grounds,'at'
any'time.'The'same'policy'goes'for'mobiles,'vehicles'and'overnights.'What'you'choose'to'do'
off9campus'is'your'choice,'we'are'not'here'to'babysit.'That'being'said,'how'you'hold'yourself'
reflects'on'Hillside'as'an'organization'and'use'or'presence'of'any'alcohol,'tobacco'or'drugs'will'
mean'immediate'evaluation'and'probable'dismissal'from'the'program.'
'
TRANSPORTATION'
A. Fleet'vehicles:'Our'fleet'vehicles'are'essential'to'getting'our'staff'and'patients'around.'The'
main'transport'vehicles'are'not'to'be'used'for'non9clinic'activities.'Students'are'not'
allowed'to'drive'Hillside'vehicles.'Transportation'to'and'from'Hillside'activities'is'provided'
by'the'clinic,'as'is'transportation'to'and'from'the'airport,'for'market'days'twice'a'week'and'
Revised 3/2015 CH & MR
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occasionally'for'evening'activities.'Hillside'has'bicycles'for'student'use,'public'buses'run'
between'Eldridgeville,'Punta'Gorda'and'the'rest'of'Belize'and'private'taxis'are'available.!
!
B. Buses:'There'are'a'variety'of'bus'lines'to'common'destinations'in'Toledo'and'Belize.''One'of'
them'is'James'Bus'Line:'http://www.pgbelize.com/jamesbusline.'Other'local'buses'also'
travel'up'and'down'the'highway'near'clinic'with'different'hours,'but'are'often'not'reliable'
or'on'a'schedule.''Please'be'aware'of'this'and'prepare'to'be'flexible'and'plan'in'advance.'
More'information'posted'in'the'dorm'upon'your'arrival.!
'
VI.
MAKING!THE!MOST!OF!YOUR!EXPERIENCE!
A. Cultural'Awareness:'It'is'important'to'remember'that'you'are'spending'time'in'a'foreign'
cultural'environment.'Just'because'most'people'here'speak'English'does'not'mean'that'
they'have'the'same'values,'the'same'ways'at'looking'at'the'world,'or'the'same'ways'of'
dealing'with'the'problems'of'life.'There'are'also'differences'between'the'various'ethnic'
groups'within'Belize.'Please'do'not'make'judgments'or'comments'that'only'reflect'your'
world'outlook.'It'is'much'better'to'observe'and'process'what'you'see'and'then'discuss'
these'in'our'evaluation'times.'If'you'are'not'certain'what'is'appropriate,'ask'one'of'our'
Belizean'staff'members.'They'are'used'to'foreigners'and'better'understand'your'confusion.!
!
B. Interdisciplinary'team9work:!You'will'work'as'a'team'in'almost'all'activities.'This'means'
that'you'may'ask'and'give'advice'to'the'other'students,'preceptors,'and'staff.'You'should'
never'feel'that'you'are'not'practicing'safely!''Most'patients'are'seen'by'two'to'three'
providers'at'each'visit'and'this'makes'for'good'learning'and'care.''If'you'have'an'interesting'
patient'that'everyone'can'learn'from'be'sure'to'notify'not'only'other'medical'providers'but'
the'pharmacy'and/or'Rehab'students'as'well.!
!
C. Self9directed'learning:!Several'times'during'the'rotation'you'will'have'presentations'on'the'
local'culture,'local'health'care'system,'and'local'development'projects'and'programs.'These'
are'scheduled'to'help'give'you'some'insight'into'where'you'are'working'and'who'you'are'
working'with.'This'is'a'good'time'to'ask'questions'about'what'you'see'in'clinic'and'outside'
to'clarify'what'may'be'confusing'and'to'learn'as'much'as'you'can'from'those'around'you.'!
!
D. Flexibility:'!
1. Health!care!resources:'You'will'quickly'find'that'you'do'not'have'all'the'resources'that'
you'are'used'to.''That'means'you'will'have'to'be'resourceful'and'innovative'with'your'
care.'Generally'speaking'we'have'the'basic'equipment'necessary'for'most'exams.'If'you'
do'not'find'something,'ask'one'of'the'staff.'If'you'need'lab'tests'or'diagnostic'
procedures'refer'to'the'staff'for'what'is'available'at'Hillside,'in'PG'or'elsewhere.'
Remember'that'the'patient'may'have'to'pay'for'these'and'may'not'be'able'to'afford'it.'
As'part'of'the'new'National'Health'Insurance'Plan'each'patient'must'have'a'Social'
Security'card'and'number.'They'will'need'this'to'access'any'care'outside'Hillside'and'be'
covered'by'the'government.'The'intake'personnel'will'usually'take'care'of'this'for'you.!
!
2. Scheduling:!There'are'a'lot'of'moving'parts'at'Hillside.!Weekly'schedules'are'posted'in'
the'dorm'library'area,'in'the'Education'Building,'and'in'the'clinic'office'area.'It'is'
important'that'you'stay'FLEXIBLE'since'schedules'change'daily'due'to'circumstances'
beyond'our'control.'Please'check'with'regularity!!
Revised 3/2015 CH & MR
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'
Be!flexible,!learn!from!those!around!you,!ask!questions,!and!thoroughly!enjoy!your!Hillside!
experience!!!
!
VII. OTHER!RESOURCES!AND!INFORMATION!
A. Embassy'(United'States)!
Address:'4'Floral'Park'Road,'Belmopan,'Belize'
Phone:'+(501)'82294011'
Email:'[email protected]'
!
B. Weekend'Activities:'There'are'many'interesting'places'to'visit'and'things'to'do'in'the'Toledo'
District.''It'is'encouraged'that'you'work'with'your'group'to'plan'these,'since'it'is'a'good'time'to'
get'to'know'each'other'and'the'group'rates'for'tourist'activities'is'generally'cheaper.''It'is'
generally'better'to'try'to'make'your'plans'early'in'your'rotation,'since'some'activities'need'
prior'notice'and'planning'to'make'them'happen.''Be'mindful'of'your'safety'at'all'times'and'if'
you'are'questioning'the'reputation'of'your'guide'or'the'agency'ask'one'of'the'staff.''
Occasionally'the'schedule'will'ask'you'to'participate'in'a'weekend'fair'or'activity,'and'in'that'
event,'compensatory'time'off'will'be'allowed'at'a'future'weekend.''There'is'a'binder'in'Abby'
House'with'information'from'activities'students'have'enjoyed'in'the'past.!
!
C. Infectious'Disease'
1. Recommended!Vaccinations'(per'US'State'Department'August,'2014)'
Hepatitis'A'
Typhoid'
Traveler’s'tetanus'
Diphtheria'
'
Note:'We'recommend'you'visit'the'WHO'and'CDC'websites,'as'well'as'your'local'travel'clinic'for'
additional'up9to9date'information.'
'
2. Belize!Malaria!Protocol:!All'patients'with'temperature'of'99.6'or'greater'automatically'
get'a'malaria'smear'done'regardless'of'their'chief'complaint.'If'you'see'a'temperature'at'
or'above'this'value,'please'refer'the'patient'to'the'clinic.'In'addition'to'a'malaria'smear,'
they'will'be'treated'with'a'dose'of'chloroquine'based'on'their'age.'The'slide'is'evaluated'
in'the'lab'for'a'diagnosis'of'malaria.'If'the'patient'has'malaria,'the'department'of'vector'
control'will'send'someone'to'the'patient’s'home'to'treat'the'patient'for'malaria,'and'
also'to'spray'their'home.!
!
3. DeHWorming:'Do'it'before'you'leave'or'upon'return'to'the'states.''It'is'just'a'good'idea.!
!
4. Oral!Rehydration!Solution'–'home'remedy!
Recipe'(yields'5'cups)'
1/2'tsp'salt'
6'tsp'sugar'
1'Liter'clean'drinking'water'(or'boiled'water'that'has'been'cooled)'
Revised 3/2015 CH & MR
13
Directions:'Wash'hands'prior'to'preparation,'and'use'a'clean'pot.''Stir'until'salt'and'sugar'
completely'dissolve.''Solution'should'taste'no'saltier'than'tears.''Preferably'store'in'a'
cool,'dry'location.'
VIII.
IX.
!
GLOBAL!HEALTH!WEBSITES!
A. American'Medical'Student'Association:'Global'Health:'
http://www.amsa.org/AMSA/Homepage/About/Committees/Global.aspx'!
B. Centers'for'Disease'Control:'Global'Health:'http://www.cdc.gov/globalhealth/index.html''!
C. Consortium'of'Universities'for'Global'Health:'http://www.cugh.org/''!
D. Global'Health'Ethics'from'Stanford'and'Johns'Hopkins:'
http://ethicsandglobalhealth.org/index.shtml'''''!
E. United'Nations:'Millenium'Development'Goals:'http://www.un.org/millenniumgoals/!
F. Unite'for'Sight:'http://www.uniteforsight.org/about9us!
G. World'Health'Organization:'Social'Determinants'of'Health:'
http://www.who.int/social_determinants/en/'!
!
TRAVEL!AND!BELIZE?FOCUSED!WEBSITES!
A. http://www.travelbelize.org/'!
B. http://www.belize.com/'!
C. http://www.lonelyplanet.com/belize'!
D. US'State'Department'information'on'Belize:'
http://travel.state.gov/travel/cis_pa_tw/cis/cis_1055.html'!
E. CDC'information'about'travelling'to'Belize:'
http://wwwnc.cdc.gov/travel/destinations/belize.htm'!
!
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Revised 3/2015 CH & MR
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!
APPENDIX!1—MEDICAL!AND!PHYSICIAN!ASSISTANT!STUDENTS!
I. CLINIC!FLOW:!!Staff'will'check'in'patients'and'get'basic'vitals'including'a'malaria'smear'if'
indicated'per'Belize'MoH'guidelines'(Temp'>99.6F).'Charts'will'then'be'placed'in'an'inbox'in'the'
order'that'they'should'be'seen.'Students'are'to'pick'up'charts'in'order'(sometimes'families'are'
seen'together).'You'will'be'expected'to'get'additional'vitals'if'indicated'by'the'reason'the'patient'is'
coming'to'clinic,'for'example'a'respiratory'rate,'a'pulse,'or'pulse'ox.''!!!
II. CHARTING:!!All'charting'is'done'the'American'way'using'the'SOAP'(Subjective,'Objective,'
Assessment,'and'Plan)'note'format.'This'is'important'for'good'consistent'patient'care.'In'addition,'
on'the'left'hand'side'of'the'chart'is'a'patient'data'base/problem'list.'Please'update'and'confirm'
this'with'the'information'that'you'gather'during'your'patient'interview.'Note'that'the'MoH'and'
Hillside'use'different'forms.''
The!SOAP!NOTE!
S:!!Stands!for!subjective.'This'is'the'reason'the'patient'has'come.'This'should'include'historical'
information'about'the'problem,'aggravating'and'alleviating'factors,'pertinent'positive'and'negative'
review'of'systems'as'well'as'relevant'past'medical,'surgical,'social'or'family'history.'Please'document'
this'at'the'top'of'the'paper'under'where'the'intake'staff'member'has'written'a'one'line'chief'
complaint.'
'
O:!Stands!for!objective.'This'is'your'“objective”'observations'that'lead'you'to'your'diagnosis'and'
plan.'This'should'be'written'with'AMERICAN'abbreviations.'If'you'don’t'know'ask…''We'recommend'
that'in'the'beginning'you'gather'your'data'in'the'form'you'are'most'comfortable'with'on'scrap'paper'
and'then'work'with'your'attending'to'apply'it'to'the'soap'note'for'that'clinic'visit.'Remember,'the'
charting'needs'to'be'legible'and'make'sense'for'the'next'person.''
Other'objective'things'besides'your'clinic'exam'are'labs'and'x9rays.''Please'note'them'here.'
'
A:!!Stands!for!assessment.''This'is'your'problem'list,'diagnosis,'or'differential'diagnosis.''Your'verbal'
argument'for'the'treatment'you'are'going'to'give.'Your'subject'and'objective'sections'should'support'
your'assessment'and'plan.'When'you'present'the'subjective'and'objective'data'to'your'preceptor'you'
will'together'arrive'at'an'assessment'and'plan.'See'following'examples'for'more'explanation.'
'
P:!!Stands!for!plan.'This'is'where'you'list'succinctly'how'you'are'going'to'address'each'problem,'
including'medications,'labs,'x9rays,'and'patient'education'points/precautions,'as'well'as'follow9up'
recommendations.'''
'
SOAP'NOTE'EXAMPLE'
'
S:''COUGH.'22'year'old'male'complains'of'cough'that'is'worse'at'night'and'early'morning,'no'fever,'no'
chills,'no'sputum'production,'no'rigors.'Brother'and'sister'also'have'same'symptoms.'No'shortness'of'
breath,'no'chest'pain,'no'orthopnea'or'paroxysmal'nocturnal'dyspnea.'Has'not'tried'any'medication'at'
home.'Denies'any'past'medical'history,'no'weight'loss.'Had'pneumonia'3'weeks'ago'and'wonders'why'
he'is'still'coughing.'(Also'note'past'medical'history'that'might'be'pertinent,'for'example'history'of'
CHF'or'Diabetes).'
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O:''Review'vitals'at'top'of'the'sheet'and'add'to'them'if'need'be'based'on'the'chief'complaint'of'the'
individual.'A'focused'exam'is'fine,'but'you'must'include'positive'and'negative'pertinent'findings.''
'
Revised 3/2015 CH & MR
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''''''General:'''AXO'to'person,'place,'location.'Appears'well'and'stated'age,'no'tachypnea'or'dyspnea,'no'
accessory'muscle'use.'
' HEENT:''NC/AT,'PERRL,'EOMI,'no'scleral'icterus,'MMM,'OP'without'exudates'or'erythema,'
bilateral'TMs'with'good'light'reflex'and'landmarks.'No'rhinorrhea,'neck'supple'without'LAD.'''
''''''Lungs:''CTA'''reflexive'coughing'with'deep'inspiration.'
' CV:''RRR'nl'S1'S2,'no'm,'r,'g'
' Abd.''+BS,'soft'NT/ND'
' Ext:'CR'<2'sec,'no'clubbing,'no'cyanosis,'no'edema'
'
LABS'and'XRAY'results'would'be'included'here.''
'
A/P:''(please'note'that'while'you'can'split'these'up'it'is'often'better'to'include'them'together'as'in'this'
example).'
'
A/P:''22'year'old'male'with'
1. Post'infectious'bronchospasm/cough!
'''''''''''''''Reassurance'given'that'this'often'happens'after'pneumonia.''Pt'instructed'to'return'
if'fever,'chills'or'shortness'of'breath'continues,'or'if'cough'has'not'resolved'in'the'next'7914'
days.'
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OTHER!IMPORTANT!THINGS!TO!INCLUDE!ON!THE!NOTE!
• Allergies,'this'should'be'on'every'chart,'and'should'be'asked'if'you'are'dispensing'any'medications'
• Your!signature!and!title'
• Medications'dispensed,'including'name,'how'to'take'it,'and'number'of'pills'dispensed'
• FollowHup!
• All%notes%and%prescriptions%must%be%signed%by%a%licensed%provider%as%well%as%by%the%student.%!
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III. REFERENCES:''There'are'drug'reference'books'and'other'reference'books'located'in'the'clinic.'
Please'return'these'to'where'you'got'them'at'the'end'of'the'clinic.'Others'depend'on'these'long'
after'you'are'gone.'Internet'access'is'usually'available'in'the'clinic.'
IV. TO!BRING!FOR!CLINIC:'A'pocket'drug'or'other'clinical'reference'books'for'both'pediatric'and'
adult'patients.'A'calculator'is'needed'to'calculate'pediatric'drug'dosages.'Purell'(difficult'to'find'in'
Punta'Gorda)'or'other'instant'hand'sanitizer.'Stethoscope'and'pens.'Previous'students'have'felt'
that'a'personal'torch'is'useful'to'bring'as'well.'The'clinic'has'otoscopes'and'ophthalmoscopes'but'
feel'free'to'bring'your'own'if'you'wish.'!
V. CLEANING!BETWEEN!PATIENTS:!!There'should'be'a'spray'bottle'with'a'bleach'solution'at'each'
clinic'station.'Please'clean'the'beds'between'each'patient'and'at'the'end'of'the'day.''You'should'
always'wash'your'hands'or'use'an'instant'hand'sanitizer'between'patients!
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I.
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II.
APPENDIX!2—PHYSICAL!THERAPY/REHAB!STUDENTS!
!
HISTORY!OF!PROGRAM:'The'Rehabilitation'Program'maintains'mutually'beneficial'relationships'
with'DPT'schools'throughout'the'US,'including'Elon'University,'Winston'Salem'University,'Saint'Louis'
University,'the'University'of'Evansville,'Northwestern'University,'Emory'University,'and'the'
University'of'Wisconsin.'In'2011'Hillside'instituted'a'physical'rehabilitation'program'with'a'director'
of'rehab'and'DPT'students'providing'physical'therapy'services'to'patients'and'community'outreach'
programs.'The'medical,'pharmacy'and'physical'therapy'education'programs'are'integrated'so'that'
students'from'the'different'disciplines'live'and'learn'together.'
COMMUNITY!BASED!REHABILITATION'–'Hillside'Rehab'uses'a'Community9Based'Rehabilitation'
(CBR)'model'which'has'been'recommended'by'the'World'Health'Organization'(WHO),'the'
International'Labor'Union'(ILO),'and'the'United'Nations'Educational,'Scientific,'and'Cultural'
Organization'(UNESCO)'as'a'proposed'method'for'effectively'reaching'the'needs'of'people'with'
disabilities'in'resource9limited'settings.''CBR'promotes'the'health,'education,'livelihood,'social'
inclusion,'and'rights'of'persons'with'disabilities'with'the'ultimate'goal'of'enhancing'their'quality'of'
life.''Students'will'receive'a'reading'list'with'articles'to'further'their'understanding'of'CBR.'
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III.
PRIMARY!COMPONENTS'
A. Community'Awareness'and'Collaboration:'Hillside'Rehabilitation'is'partnering'with'local'
governmental'and'non9governmental'organizations'to'increase'disability'awareness'and'
fundamentally'alter'negative'perceptions'and'attitudes'towards'people'living'with'a'disability.'
By'doing'this,'we'strive'to'enhance'quality'of'life'by'ensuring'inclusion'and'participation.'With'
our'partners,'we'hope'to'improve'access'and'opportunity'to'education,'employment,'and'
social'services'so'that'people'of'all'ages'who'live'with'disability'can'be'active'contributors'
within'their'communities'and'society.'Disability'awareness'programs'are'carried'out'in'school'
and'community'settings'throughout'Toledo'District.'Initial'participant'feedback'has'been'very'
encouraging,'and'more'of'these'activities'are'planned'for'the'future.''Relatedly,'we'have'
partnered'with'local'craftspeople'to'build'low9cost'medical'equipment'made'with'local'
materials'in'an'effort'to'provide'necessary'medical'equipment'and'support'the'local'economy.'
B. Patient'Care'and'Work'Force'Development:'The'World'Health'Organization'estimates'that'at'
least'15%'of'the'population'of'the'Toledo'district'has'some'kind'of'disability.'The'Hillside'
rehabilitation'program'is'committed'to'full9time'staffing'of'at'least'one'licensed'physical'
therapist'to'help'address'the'therapeutic'needs'of'this'population.'However,'with'a'district'
population'of'over'30,000,'the'efforts'of'one'person'are'not'enough.'We'need'empowered'and'
educated'people'throughout'the'entire'district'who'are'able'to'address'the'basic'ongoing'
needs'of'those'who'live'with'disability.'In'order'to'achieve'this,'Hillside'Rehab'plans'to'do'
training'with'the'Ministry'of'Health,'Ministry'of'Education,'and'other'local'organizations'to'
share'knowledge'and'to'eventually'teach'basic'technical'skills'to'the'community'health'
workers'and'other'community'leaders.'Hillside'Rehab'is'also'partnering'with'various'academic'
institutions'in'the'United'States'to'bring'Doctor'of'Physical'Therapy'students'to'Belize'for'
clinical'rotations'in'an'effort'to'increase'the'work9force'and'to'promote'healthy'global'
attitudes'by'offering'a'culturally9rich'educational'program'that'challenges'them'to'better'
understand'their'role'in'the'global'arena.'
C. Wellness'and'Quality'of'Life:'The'average'life'expectancy'for'Belizeans'is'68'years,'and'chronic'
health'conditions'are'becoming'more'prevalent.'Chronic'physical'disability'can'lead'to'many'
health'and'emotional'problems'and'can'present'many'challenges'for'the'family.'Hillside'
Revised 3/2015 CH & MR
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IV.
V.
Rehabilitation'provides'a'restorative'mobility'program'in'which'people'living'with'chronic'
physical'disabilities'can'improve'their'quality'of'life'and'maintain'their'abilities'through'
guided'wellness'and'exercise.'
D. Clinical'Education:'Students'will'perform'direct'patient'care'via'mobile'and'outpatient'clinics,'
as'well'as'home'health'visits.''In'addition,'students'will'assist'in'supervising'a'restorative'
program'for'patients'with'chronic'disabilities/diagnoses'who'benefit'from'physical'activity'but'
do'not'require'ongoing'skilled'care.''Hillside'seeks'to'teach'students'and'volunteers'how'to'
practice'as'both'individuals'and'as'an'interdisciplinary'team'in'a'resource'challenged,'
culturally'diverse'setting.''In'addition,'students'are'expected'to'invest'in'the'communities'they'
serve.''Hillside'Rehab'has'various'education'programs'that'are'presented'to'communities,'
schools,'and'organizations.''Topics'have'included'education'on'physical'therapy'as'a'health'
service'(PT'is'not'a'licensed'profession'in'Belize),'disability'awareness,'body'mechanics,'and'
postural're9training'for'individuals'who'use'machetes'or'carry'loads'in'the'local'traditional'
manner.'
'
COMMUNITY!PARTNERSHIPS!
A. Ministry'of'Health'(MOH)!
B. Ministry'of'Education'and'NARCIE!
C. Inspiration'Center!
D. Additional'Organizations'and'Institutions!
E. Peace'Corps,'the'Special'Olympics'Committee,'and'various'other'organizations'in'the'region'to'
raise'awareness'about'the'issues'affecting'people'with'disabilities.!
F. Local'Craftspeople:!As'part'of'the'CBR'model,'Hillside'Rehab'seeks'to'partner'with'local'
craftspeople'for'the'construction'of'durable'medical'equipment'(DME).''This'creates'a'culture'
of'collaboration,'promotes'a'sustainable'supply'of'DME'by'using'locally'available'resources,'
and'invests'in'the'local'economy'rather'than'promoting'a'charity'model'which'often'fosters'
dependency'in'target'populations.!
!
GETTING!STARTED!
A. Orientation'–'Clinical'rotations'involve'a'variety'of'activities'throughout'the'Hillside'campus'
and'surrounding'communities.''The'following'orientations'will'help'guide'you'through'your'
time'in'Belize:!
1. Hillside!Clinic:'Purpose'–'to'familiarize'you'with'the'Hillside'Clinic'and'Abby'House!
2. Rehabilitation!Department.!Purpose'–'to'introduce'you'to'the'rehab'program'staff,'
review'requirements,'and'discuss'the'curriculum.!!
B. Core'Learning'Objectives:!To'optimize'your'experience,'the'Hillside'Board'and'the'Rehab'
Committee'have'put'together'the'following'core'learning'objectives:!
1. Recognize'prevalent'cross9cultural'and'underserved'issues'in'primary'care,'and'gain'an'
understanding'of'how'this'knowledge'can'be'applied'to'a'practice'in'your'home'
country.!
2. Identify'cost9effective'approaches'to'medical'care'in'a'resource'constrained'setting.'!
3. Demonstrate'effective'team9building'skills'with'colleagues'from'multiple'medical'
disciplines,'and'with'local'health'care'providers.!
4. Recognize'and'treat'diagnoses'common'to'those'seen'in'the'student’s'home'country'as'
well'as'those'that'are'more'common'in'the'tropics,'such'as'lateral'epicondylalgia'from'
machete'use'and'cervical'impingement'from'excessive'carrying'force'through'the'c9
spine.!
Revised 3/2015 CH & MR
18
5. Understand'and'appreciate'the'uniqueness'of'the'many'cultures'of'southern'Belize'
including'the'Maya,'Garifuna,'East'Indian'and'Creole'cultures.!
6. Recognize'how'diverse'political,'cultural,'and'historical'perspectives'influence'the'
receipt'of'health'care.''!
7. Appreciate'how'psychological,'economic,'spiritual,'social'and'biological'factors'inter9
relate'to'affect'one’s'health.!
8. Understand'the'benefits'and'challenges'of'working'with'communities,'and'recognize'
strategies'to'overcome'perceived'challenges.!
9. Develop'the'skills,'knowledge'and'attitudes'necessary'to'effectively'work'with'
communities,'and'identify'appropriate/sustainable'ways'access'community9based'
resources.!
C. Requirements!
In'addition'to'engaging'in'direct'patient'care,'all'students'are'required'to'complete'the'following'
activities'as'they'strive'to'meet'the'core'learning'objectives:'
Activity'
Description/Purpose'
Reading'List'
Students'are'expected'to'read'and'reflect'on'a'list'of'required'readings'that'
they'will'receive'either'prior'to'or'during'their'rotation.''Topics'include:'
global'health;'community'based'rehabilitation;'cultural'humility;'etc.'
Interdisciplinary'
Presentations'by'students'and'preceptors'(of'all'disciplines)'take'place'in'
Presentations'
the'evening'after'those'on'mobile'have'returned.''Students'will'present'at'
least'one'topic'to'the'interdisciplinary'team,'and'will'receive'an'academic'
schedule'with'the'date'and'time'of'all'presentations'during'the'rotation.'
Interdisciplinary'Health' Hillside'provides'an'interdisciplinary'approach'to'care'in'which'various'
Care'
health'care'practitioners'interact'to'maximize'the'efficiency'and'quality'of'
patient'care'in'a'learning'environment.'This'is'an'opportunity'to'promote'
our'profession'and'demonstrate'our'unique'role'in'rural'health'care'and'
development.''It'is'the'PT'student’s'responsibility'to'engage'other'students'
and'professionals'in'discussions'and'it'is'strongly'encouraged'that'you'
facilitate'discussions'regarding'treatment'and'outcomes'when'the'patient'is'
referred'by'another'practitioner.''Take'initiative'and'communicate,'as'many'
other'medical'providers'have'not'been'exposed'to'the'practice'of'physical'
therapy.''In'addition,'practitioners'from'other'disciplines'are'often'unaware'
of'the'rigorous'didactic'education'involved'in'physical'therapy'education'
including'pathophysiology,'pharmacology,'and'radiology.'
Cultural'Competency'
Friday'lunches'consist'of'cultural'presentations,'brown'bag'discussions,'and'
Luncheons'
guest'lectures'from'area'clinicians.''These'are'intended'to'increase'
awareness'of'basic'cultural'tenets'within'the'diverse'Belizean'population,'
and'provide'you'with'an'opportunity'to'ask'questions'about'what'you'have'
observed'in'and'out'of'clinic.'
Culture'Day'
Students'will'participate'in'a'monthly'Culture'Day'activity'to'familiarize'
themselves'with'the'diverse'cultures'that'comprise'Belize’s'patient'
population.'
Weekly'evaluation'and'
Students'and'preceptors'will'meet'weekly'to'review'the'schedule'for'the'
schedule'review'
upcoming'week'(though'this'could'change'by'the'next'day!),'and'discuss'
learning'objectives.''This'is'also'a'time'to'ask'questions'and'raise'concerns.'''
Community'Outreach'
Students'will'engage'in'at'least'community'outreach'project'(eg.'health'
literacy,'quality'improvement,'patient'education,'etc.)'
Revised 3/2015 CH & MR
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Note'–'these'requirements'may'change'as'the'result'of'current'needs'on'the'ground,'and/or'at'the'
discretion'of'the'Rehab'Director'or'visiting'preceptor'(flexibility'is'so'important'at'Hillside!)'
!
D. Cultural'Humility:''
Students'of'Hillside’s'Rehab'Program'are!held'to'a'high'standard'of'cultural'humility'and'sensitivity.''The'
CBR'reading'list'contains'information'that'will'enhance'the'your'ability'to'provide'care'in'the'appropriate'
cultural'context.''We'ask'that'you'also'reflect'on'the'following:'
a. Students'are'expected'to'demonstrate'respect'for'the'diverse'culture,'religions,'
practices,'and'beliefs'that'they'will'encounter'during'their'time'in'Toledo'
District.''It'is'important'for'students'to'remember'and'respect'the'fact'that'they'
are'spending'time'in'a'different'cultural'environment.'Just'because'some'people'
speak'English'does'not'mean'they'have'the'same'values,'the'same'perspectives,'
or'the'same'coping'strategies.''Remember'to'think'before'you'speak'(even'if'you'
think'no'one'is'listening'or'able'to'understand'you).'
b. We'also'ask'that'students'refrain'from'judging'or'attempting'to'alter'Belizean'
cultural'practices.''It'is'easy'to'pass'judgment'on'things'we'don’t'understand,'
believing'our'knowledge'and'expertise'to'be'superior.''Please'take'the'time'to'
reflect'on'cultural'differences,'and'discuss'your'thoughts'during'weekly'
meetings'with'the'Rehab'Director.''You'may'also'consider!respectfully'asking'
our'Belizean'staff'members,'who'are'very'knowledgeable'and'willing'to'answer'
any'questions'you'may'have.'
c. Relatedly,'when'working'in'villages'and/or'in'patient’s'homes,'students'and'
clinicians'may'encounter'living'situations'that'fall'outside'of'their'prior'
experience'or'comfort'level.''Students'and'clinicians'will'nonetheless'conduct'
themselves'with'respect'and'appropriateness,'and'should'refrain'from'any'
outward'expressions'that'may'be'construed'as'judgmental'or'condescending.'
d. Keep'in'mind'that'you'are'here'to'both'share'and'receive'knowledge.''Avoid'
viewing'your'rotation'as'an'opportunity'to'“help'those'in'need”.''Rather,'view'it'
as'an'opportunity'to'build'on'the'strengths'of'the'community,'and'work'in'
partnership'to'develop'programs'and'policies'that'support'people'with'
disabilities.'
e. Students'should'receive'a'Que’Chi'key'phrase'list'prior'to'the'start'of'their'clinic'
visits.''The'words'are'type'phonetically'with'the'English'alphabet'according'to'
how'the'Que’chi'phrase'sounds.'Students'are'encouraged'to'review'and'begin'
practicing'these'phrases'before'arriving'in'Belize.''Learning'these'phrases'is'
helpful'in'the'evaluation'process'as'well'as'in'developing'relationships'with'
individuals'who'speak'this'language.'In'addition,'making'a'good'faith'effort'to'
learn'the'local'language'helps'to'demonstrate'intercultural'respect'and'humility.'
f. Students'are'required'to'develop'any'assigned'educational'materials'in'a'
manner'that'is'culturally'appropriate,'using'images'that'depict'people'with'
similar'ethnic'backgrounds'to'people'in'Toledo'and'jargon9free'language'(3rd'
grade'reading'level).'
E. Dress'Code:'Dress'appropriately'when'out'in'public.''Students'reflect'Hillside'whether'on'or'off'
campus.'If'in'a'professional'setting,'long'pants'and'sleeved'shirts'are'necessary.''For'females,'
skirts'should'be'worn'for'school'presentations'and'church'settings.'When'working'in'clinic'or'
mobile,'most'students'wear'scrubs,'which'are'available'from'the'Housekeeper'if'needed.'
'
Revised 3/2015 CH & MR
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VI.
CLINICAL!PRACTICE'
A. Settings'
1. Outpatient!Clinic:!Outpatient'clinic'is'held'twice'per'week'from'8:00'AM'to'12:00'PM'in'
the'Rehab'Department.''Services'are'provided'by'appointment,'with'additional'walk9in'
or'day9of9referrals'accepted'at'the'discretion'of'the'Rehab'Director.'Villagers'from'
throughout'Toledo'District'bus'into'PG'early'in'the'morning'and'return'to'their'villages'
on'buses'that'depart'PG'at'11:30'AM'or'noon.'Hillside'attempts'to'make'itself'available'
to'these'villagers.'Additionally,'Hillside'provides'a'shuttle'service'to'and'from'PG'
central'square'on'Tuesdays'and'Thursdays.'The'shuttle'departs'Central'Square'for'clinic'
at'9:00'AM'and'returns'to'Central'Square'once'all'the'patients'shuttled'in'have'been'
seen.'Because'patients'from'both'rural'and'urban'areas'attend'the'onsite'clinic,'the'
patient'demographics'and'diagnoses'encountered'tend'to'be'diverse.'
2. Cleaning!between!patient!visits:!!There'is'a'spray'bottle'with'a'bleach'solution'in'the'
rehab'department.''Treatment'areas'should'be'cleaned'upon'arrival,'between'each'
patient,'and'again'at'the'end'of'the'day.''Students'should'either'wash'their'hands'or'use'
an'instant'hand'sanitizer'between'patient'visits.'
3. Clinic!Flow:!!The'rehab'technician'will'check'patients'in,'obtain'basic'demographic'
information'and'history'as'well'as'check'basic'vitals.'Students'will'be'expected'to'get'
additional'history'and'vitals'if'indicated'by'the'reason'the'patient'is'coming'to'clinic,'for'
example'respiratory'rate,'pulse,'or'SaO2'reading.'
4. Mobile!Clinic:'The'rehab'program'has'fewer'staff'and'students'than'the'medical'
program'and'currently'accompanies'the'medical'mobile'to'each'village'on'a'quarterly'
basis.'This'frequency'optimizes'equitable'distribution'of'rehab'services'throughout'the'
district'and'affords'the'opportunity'to'continue'other'aspects'of'the'community9based'
program.'The'mobile'clinic'vehicle'leaves'at'8'AM'and'generally'returns'by'4:30'PM,'
though'return'time'varies'with'road'conditions'and'distance'between'villages.''Given'
the'distance'needed'to'travel'to'some'remote'villages,'the'mobile'clinic'may'stay'
overnight,'and'attend'to'patients'in'a'neighboring'village'before'returning'to'Hillside.'
Be'ready'to'help'load'the'mobile'by'7:45'AM'on'days'you'are'scheduled'to'go.''
NO'EXCEPTIONS.'DPT!students!are!responsible!for!bringing!their!examination!and!
documentation!supplies,!ICD?9!sheets,!and!village!folder(s).!It%is%the%responsibility%
of%the%student%to%ensure%that%the%village%folder%(which%contains%all%of%the%rehab%
documentation%for%patients%seen%on%mobile%to%that%village)%is%brought%back%to%
Hillside.'Students'are'responsible'for'typing'up'the'mobile'recap'and're9organizing'the'
village'folder'upon'returning'to'Hillside.'See'“Documentation”'below'for'details.'
5. Home!Health:'In'order'to'meet'the'needs'of'as'many'Toledo'District'individuals'as'
possible,'Hillside'Rehab'has'a'limited'home'health'and'restorative'caseload'comprised'
of'patients'in'the'PG'area'currently'under'the'care'of'Hillside’s'Home'Health'nurse.'
Patients'must'be'truly'unable'to'leave'their'home'in'order'to'qualify'for'physical'
therapy'home'visits.'The'rehab'director'reviews'consults'requested'by'nursing'and'
medical'providers'to'determine'if'patients'are'appropriate'for'these'services.'Hillside’s'
rehab'technician'performs'restorative'home'visits'every'two'weeks,'providing'
maintenance'mobility'and'exercise'programs'under'the'supervision'of'a'licensed'
physical'therapist.'
'
B. Documentation'
Revised 3/2015 CH & MR
21
1. General:'An'ICD99'sheet'must'be'completed'for'each'day,'regardless'of'the'setting'in'
which'care'was'provided,'and'should'be'submitted'to'office'staff'no'later'than'3:30pm'
on'the'day'in'which'care'was'provided.'On'the'left'hand'side'of'the'chart/folder'is'a'
patient'history'and'personal'information'form.''Please'update'and'confirm'this'with'the'
information'gathered'during'the'patient'interview.'Students'are'expected'to'document'
evaluations'on'the'evaluation'form,'and'follow9up'visits'on'a'progress'note'using'
standard'SOAP'note'format.'
2. OutHpatient!versus!Mobile:'Physical'therapy'is'not'yet'a'formally'recognized'profession'
in'Belize'(though'we'are'working'on'this!).''As'such,'rehab'documentation'is'stored'in'
the'medical'files'for'Hillside’s'patients,'but'kept'separate'from'the'MOH’s'files'that'are'
picked'up'and'returned'for'mobile'clinics.'Any'rehab'documentation'performed'on'
mobile'is'placed'in'the'village'folder.'Following'mobile'clinic,'students'are'responsible'
for'typing'up'mobile'recaps'and'saving'them'to'the'desktop'of'the'Rehab'Computer'in'
the'appropriate'village'file.''A'second'copy'should'be'printed'and'placed'(with'the'hand9
written'documentation)'in'the'village'folder.'
3. “Rehab!Only”!and!Home!Health:'There'are'a'select'number'of'patients'only'receiving'
rehab'services'or'home'health'services.''These'charts'are'kept'in'the'rehab'filing'
cabinet.'
4. Consultations!and!Referrals:'Mobile'Consult'Forms—Located'in'orange'folder'in'“mobile'
box.”'Consults'to'be'completed'by'medical'providers'during'mobiles'when'PT'does'not'
accompany'the'mobile.'Completed'consults'are'placed'back'in'the'orange'folder.''The'
Rehab'Technician'checks'this'folder'weekly'and'places'new'consults'in'the'appropriate'
village'folder'to'ensure'that'PT'can'follow'up'with'the'individual'the'next'time'rehab'
goes'on'mobile'to'that'village.'Please'educate'fellow'students'and'guest'preceptors'in'
the'interdisciplinary'team'on'how'these'forms'are'used'and'which'patients'are'
appropriate'for'a'physiotherapy'consult.'Communication'with'outside'health'care'
providers:'
a. Must'be'legible,'preferably'typed'and'printed'on'Hillside'letterhead'(found'on'
rehab'computer)'and'use'simple/clear'language'
b. Addressed'respectfully'
c. Clearly'states'problem/issue'and'reason'for'communication'
d. Signed'by'medical'director'and'rehab'director'
e. Delivered'by'rehab'staff'or'by'Hillside’s'drivers'when'they'are'en'route'on'
mobile'visits.''
Abbreviations'are'for'charting'only'–'not'for'home'exercise'programs'or'professional'communication!'
'
C. Common'Diagnoses'
1. Musculoskeletal'
Arthritis9related'pain'
Back'pain'of'various'origins'
Foot'pain'(ankle'sprains,'calcaneal'bursitis/plantar'fasciitis)'
Cervicogenic'headache'
Cervical'radiculopathy''
Rotator'cuff'pathology'
Other!
CAD'
CHF'
Revised 3/2015 CH & MR
22
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
COPD'and'other'respiratory'disorders'
CVA'
Developmental'disorders'
DM'
HTN'
Scabies'
GI'
'
D. Equipment:'You'will'quickly'find'that'you'do'not'have'all'the'resources'that'you'are'used'to.''
That'means'you'will'have'to'be'resourceful'and'innovative'with'your'care,'exercise'
prescriptions'and'procurement'or'construction'of'DME.''Generally'speaking,'we'have'the'basic'
equipment'necessary'for'most'exams.''If'you'do'not'find'something,'ask'one'of'the'staff.''
Remember'that'the'patient'may'have'to'pay'for'diagnostic'tests'you'recommend'and'may'not'
be'able'to'afford'it.'
'
E. Reference'materials:'There'are'orthopedic'and'pediatric'examination/intervention'books'and'
other'reference'materials'available'for'student'use'located'in'the'rehab'department.''Please'
return'these'to'their'appropriate'location'at'the'end'of'the'week.''Others'students'and'
clinicians'will'use'these'resources'for'years'to'come.'In'addition,'there'are'e9books'and'
reference'materials'saved'on'the'rehab'computer.''Students'are'encouraged'to'bring'additional'
resources'to'use'during'their'rotation,'and'to'consider'what'they'can'create'or'share'to'
enhance'the'rehabilitation'library.'
Revised 3/2015 CH & MR
23
APPENDIX!3!
PHARMACY!STUDENTS!
!
I.
!
II.
III.
OVERVIEW:!First'and'foremost'the'pharmacy'student'should'review'the'“Common'Medications”'
lecture'prior'to'their'arrival'at'Hillside.'This'lecture'outlines'some'of'the'key'points'that'will'be'
essential'in'making'sure'that'the'student’s'first'week'at'Hillside'is'a'smooth'one'and'that'
pharmacy'students'are'able'to'assist'students'of'other'disciplines'in'understanding'proper'
pharmacy'policies'and'procedures.'Please'also'refer'to'the'pharmacy'Dropbox'for'additional'
resources.'
SITES:!Pharmacy'students'will'be'practicing'at'several'main'sites:!
A. Main'Hillside'Clinic'–'Here'the'student'will'collaborate'with'other'Hillside'staff'members'
and'students'to'coordinate'proper'prescription'writing,'appropriateness'of'prescribed'
medication,'verification'of'dose'and'frequency,'screen'for'drug'interactions'and'provide'
patient'counseling.'The'student'will'also'be'responsible'for'performing'a'“Drug'
Reconciliation”'by'utilizing'Hillside’s'paper'based'prescription'recording'system.''
B. Mobile'Clinic'–'At'this'location'the'student'will'once'again'work'with'Hillside'staff'
members'and'students'to'provide'safe'and'appropriate'medication'dispensing'and'
counseling.'In'addition'to'the'responsibilities'above,'the'student'will'have'the'opportunity'
for'cultural'awareness'as'these'clinics'are'performed'in'local'villages.'The'student'will'also'
have'ample'opportunity'to'work'with'translators'in'order'to'ensure'sufficient'
understanding'during'counseling'sessions.''
C. Punta'Gorda'Polyclinic'–'The'Belize'Ministry'of'Health'provides'an'opportunity'for'
pharmacy'students'to'learn'under'the'direct'supervision'of'Belizean'licensed'pharmacists'
at'its'Punta'Gorda'Polyclinic.'The'students'will'have'the'opportunity'to'counsel'patients'
and'dispense'medications'in'a'formal'clinical'setting'at'the'local'hospital.'This'experience'
allows'the'students'to'also'differentiate'between'the'Ministry’s'formulary'for'Belizean'
citizens'and'medications'that'make'up'the'majority'of'dispensing'standards'in'their'home'
country.''
D. Home'Visits'–'Students'will'accompany'medical'and'nursing'staff'to'attend'to'patients'in'
the'Punta'Gorda'area'who'are'homebound'and'unable'to'come'to'the'clinic'to'be'seen'on'
their'own.'Home'visits'give'the'students'a'unique'experience'to'see'how'many'elderly'
patients'in'Punta'Gorda'live'and'how'they'are'cared'for'by'the'community.'Opportunities'
for'compliance'pill'counts'and'counseling'exist'in'this'environment.'
E. Public'Health'Opportunities'–'Pharmacy'students'will'participate'in'Public'Health'activities'
and'educational'sessions'with'other'students.'Examples'include'but'are'not'limited'to:'Lice'
and'Scabies'Eradication'Programs,'Women’s'Health'Initiatives,'Dental'Health'and'Fluoride'
applications,'Fitness'and'Exercise'Education'as'well'as'Screening'and'Health'Fairs.'''
!
TIPS!FOR!COUNSELING!PATIENTS!
A. Introduce'yourself'to'patients'prior'to'counseling'and'let'them'know'you'are'a'pharmacy'
student.'
B. Counseling'is'to'be'done'at'the'pharmacy'window'or'off'to'the'side'at'the'clinic'or'a'semi9
private'location'at'mobiles.'This'may'be'difficult'but'patients'deserve'and'require'
confidentiality.''
C. Ask'if'it'is'okay'to'speak'English.'The'population'Hillside'serves'is'very'diverse.'Not'all'
patients'speak'English.'Use'a'translator'when'necessary.'Talk'to'the'patient'directly'and'let'
Revised 3/2015 CH & MR
24
D.
E.
F.
G.
H.
I.
the'translator'fill'in'the'gaps.'Often'the'translator'will'not'translate'back'what'the'patient'
has'said.'Don’t'be'afraid'to'check'for'understanding'though.'Be'persistent.''
While'showing'the'patient'the'medication'package,'counsel'them'on'the'name'of'the'
medication,'what'it'is'being'used'for,'how'to'take'it,'and'key'counseling'points'about'the'
medications.''
Patient'often'don’t'ask'questions'and'will'indicate'they'understand'by'saying'yes.'Check'for'
understanding.'Utilize'the'teach9back9method,'especially'for'inhalers'and'oral'liquids.'Try'
not'to'overwhelm'the'patient'with'too'much'information,'stick'to'basics,'and'explain'things'
clearly'and'make'it'as'simple'as'can'be.''
To”'drink”'a'medication'means'the'same'as'swallowing'the'medication.''
Remember'to'counsel'patients'about'protecting'their'skin'from'the'sun'if'on'medications'
that'can'cause'sun'sensitivity,'especially'because'a'lot'of'patients'work'outdoors.'Even'
though'they'have'darker'skin,'they'still'may'burn.'
Remember'to'be'courteous.'Smile'when'you'are'talking'to'them,'make'eye'contact'and'ask'
if'they'have'any'questions'or'if'there'is'anything'else'you'can'do'for'them.'
If'a'patient'has'a'liquid'antibiotic'that'needs'to'be'kept'cold'but'does'not'have'a'
refrigerator,'tell'the'patient'to'keep'the'bottle'in'a'cool,'dry'place'out'of'the'direct'sun.'
!
IV.
V.
!
'
ABBREVIATIONS!FOR!CHARTING!ONLY:!!DO!NOT!PUT!ON!PRESCRIPTIONS'
A. QD'or'Q'day'is'once'daily'
B. BID'is'twice'daily'
C. TID'is'three'times'daily'
D. QHS'is'at'bedtime'
E. PRN'is'as'needed'
F. PO'is'by'mouth'
G. IM'intramuscular'injection'
H. SC'is'subcutaneous'injection'
I. Gtt'is'drop'
J. OD'and'OS'are'right'eye'and'left'eye,'respectively'
K. Q'496'hrs'is'every'496'hours'
'
PRESCRIPTIONS'
A. Must'be'legible,'and'instructions'must'be'in'simple'English'as'this'is'what'the'patient'will'
use'at'home'as'a'reference'for'how'to'take'the'medication.'
B. Sign'all'scripts'so'that'if'there'are'problems'or'questions'the'person'dispensing'
medications'knows'whom'to'ask.'
C. Write'the'number'of'pills/tubes'to'be'dispensed.'You'will'decide'this'together'with'your'
attending.'
D. It'is'helpful'to'be'clear'about'what'class'of'medication'the'patient'should'be'on'in'the'plan,'
that'way'if'that'medication'is'not'available,'a'substitution'within'the'same'class'might'be'
made.'
E. REMEMBER'TO'CHECK'ALLERGIES'if'writing'prescriptions.'
F. A'hand'written'prescription'is'written'for'every'item'that'leaves'the'pharmacy'in'order'to'
maintain'an'accurate'inventory.'All'prescriptions'are'in'duplicate.'
!
Revised 3/2015 CH & MR
25
APPENDIX!4!
COMMON!DIAGNOSES!AND!MEDICATIONS!
'
Belize'Malaria'Protocol'
Oral'Rehydration'Solution'
Clinical'Evaluation'of'Diabetics'on'Oral'Hypoglycemics'
Clinical'Evaluation'of'Chronic'Hypertension'
Asthma'Classifications'and'Therapy'
'
I. BELIZE!MALARIA!PROTOCOL!
All'patients'with'temperature'of'99.6'or'greater'automatically'get'a'malaria'smear'done'regardless'of'
their'chief'complaint.'In'addition'they'will'be'treated'with'a'dose'of'chloroquine'based'on'their'age.'The'
slide'is'evaluated'in'the'MoH'vector'control'lab'for'a'diagnosis'of'malaria.'If'the'patient'has'malaria'the'
department'of'vector'control'will'send'someone'to'the'patient’s'home'to'treat'the'patient'for'malaria,'to'
test'family'members'and'to'spray'their'home.'
'
Presumptive!Treatment!Protocol!for!Vivax!and!Falciparum!Malaria!!
All!dosing!is!in!portions!of!a!250mg!chloroquine!tablet!
AGE' '
'
DOSE'OF'CHLOROQUINE'
3mo'or'less' '
1/8th'of'a'tablet'
4911mo'
'
¼'of'a'tablet'
12923mo'
'
½'tablet'
294yrs''
'
½'+'1/8th'of'a'tablet'
596yrs''
'
1'tablet'
7910yrs'
'
1'+'¼'of'a'tablet'
11912yrs'
'
2'tablets'
13yrs'and'older'
2'+'¼'of'a'tablet'
'
II. ORAL!REHYDRATION!SOLUTION!
1. 1/2'level'teaspoon'of'salt'
2. Six'level'teaspoons'of'sugar'
3. One'liter'or'five'cups'(each'cup'about'200'ml.)of'clean'drinking'or'boiled'water'and'then'
cooled'
Preparation:'
Stir'until'salt'and'sugar'is'completely'dissolved.'
Do'not'use'too'much'salt.'Taste'solution,'should'taste'no'saltier'than'tears.'
Wash'hands'prior'to'preparing.'
Use'clean'pot.'
Water'should'be'bottled,'or'boiled'and'cooled,'or'other'clean'drinking'water.'
If'the'child'still'needs'solution'in'24'hours,'must'make'a'fresh'batch.'
Store'in'cool'location.'Chilling'may'be'helpful'if'available.'
!
III. DOSING!
Give'ill'child'as'much'of'solution'as'needs,'in'small'amounts'frequently.'
Give'to'child'alternately'with'other'fluids'such'as'Breast'milk'
Continue'to'give'solids'if'child'is'over'4'months'of'age,'again'small'amounts'frequently.'
Revised 3/2015 CH & MR
26
THIS'WILL'NOT'STOP'THE'DIARRHEA,'just'protect'against'dehydration.'THE'DIARRHEA'WILL'GO'AWAY'
ON'ITS'OWN.'If'the'child'vomits,'wait'10'minutes'and'then'give'solution'again.'Vomiting'usually'resolves.'
The'body'will'retain'some'salts'despite'vomiting.'If'vomiting'give'the'child'small'spoonfuls'of'solution'
every'few'minutes.'
Continue'rehydration'solution'for'the'duration'of'the'diarrhea,'usually'395'days.'
If'diarrhea'or'vomiting'increases'or'lasts'more'than'3'to'5'days,'see'a'doctor.'
'
Adults!and!large!children!should!drink!at!least!3!liters!of!solution!a!day!until!well.!
Sip'from'cups,'small'sips'frequently.'
Drink'some'after'every'loose'stool.'
Children!under!the!age!of!2!
Each'feeding'should'be'between'a'quarter'to'a'half'of'a'large'cup'–'small'frequent'sips!'
Older!children!
Each'feeding'should'be'between'a'half'to'one'large'cup'–'frequent'small'sips!'
'
Wash!cup!well!!!
!
IV. CLINICAL!EVALUATION!OF!DIABETICS!ON!ORAL!HYPOGLYCEMICS!
Subjective:!
1. Screen'for'hypoglycemic'episodes'
2. Are'they'taking'their'medications'as'prescribed?'
3. Screen'for'cardiovascular'symptoms'
4. Screen'for'wounds,'especially'on'feet.'Does'the'patient'do'daily'foot'exams?'
Objective:!
1. Check'that'BP'is'less'than'140/90'(goal)'
2. Goal'is'to'have'all'blood'sugars'less'than'150'with'no'hypoglycemic'episodes'
3. Yearly'diabetic'foot'exam'
4. Good'cardiovascular'and'lung'exam,'including'peripheral'pulses'
5. Check'when'they'last'had'labs'done'as'they'may'be'due''
6. Labs:'At'least'yearly'Hbg'A1C'tests,'yearly'BUN,'Creatinine,'Lipid'panel'
7. Yearly'eye'exam'
!
V. CLINICAL!EVALUATION!OF!CHRONIC!HYPERTENSION!
History:'
1. Are'they'taking'their'medications'as'prescribed?'
2. Screen'for'angina'symptoms,'CHF,'palpitations,'dizziness,'syncope,'SOB'
3. Do'they'have'a'past'medical'history'of'coronary'artery'disease'(CAD),'diabetes,'hypertension,'
or'tobacco'abuse?'Family'history'of'CAD'or'cerebrovascular'accident'(CVA)?'
Objective:'
1. Check'a'pulse.'If'history'of'CHF,'check'weight.'
2. Screen'for'JVD,'carotid'bruits,'and'peripheral'pulses.'Perform'good'cardiac'and'lung'exam.'
3. Check'to'see'when'patient'last'had'lab'work'done'and'if'they'have'been'screened'for'other'
cardiovascular'risk'factors.'They'may'be'due.''
4. Labs:'At'least'yearly'BUN,'Creatinine,'Lipid'panel,'make'sure'they'have'had'their'glucose'
checked'
5. Goal'BP'is'<140/90'
Revised 3/2015 CH & MR
27
6. SBP'>200'with'symptoms'or'diastolic'BP'>110'with'symptoms'requires'referral'to'the'hospital'
now.'Pulse'>120'should'be'worked'up'and'evaluated'for'cause.'
!
VI.
ASTHMA!CLASSIFICATIONS!AND!THERAPY!
Mild!intermittent!
!
!
!
!
!
Treatment/Step!one!
'
Symptoms'less'than'or'equal'to'2'times'per'week.''
Short'acting'beta'2'agonist'(albuterol)''
'
Nighttime'symptoms'less'than'or'equal'to'2'times'
'
'
per'month.'
'
Brief'exacerbations,'can'vary'in'intensity.'
'
Mild!persistent!
!
!
!
!
!
Treatment/Step!two!
'
Symptoms'>'twice'per'week,'and'less'than'once' Low'dose'inhaled'steroid'
'
'
per'day.'
'
'
'
'
Albuterol'as'needed'
'
Night'symptoms'>'twice'a'month.' '
'
Alternatives:'Cromolyn,'leukotriene''
'
Exacerbations'may'affect'activity.' '
'
'
modifier,'nedocromil'
'
Moderate!persistent! !
!
!
!
Treatment/Step!three!
'
Daily'symptoms.'Daily'use'of'albuterol'inhaler.' Low'to'medium'dose'inhaled'steroid'plus''
'
Night'symptoms'>'once'a'week.' '
'
Long'acting'beta'2'agonist'
'
Exacerbations'affect'activity,'and'occur'>'2'times'Alternatives:'low'to'med'dose''
'
'
per'week.'
'
'
'
'
steroid'plus'leukotriene'inhibitor'or'
'
'
'
'
'
'
'
'
Theophylline''
'
Severe!persistent!
!
!
!
!
!
Treatment/Step!four!
'
Continual'symptoms''
'
'
High'dose'inhaled'steroid'plus'long'acting'
'
Physical'activity'limited,'and'frequent'exacerbations.' '
beta'2'agonists,'plus'leukotriene'
'
Frequent'night'symptoms.' '
'
'
'
inhibitor.'Consider'oral'
steroids/theophylline'
'
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
Revised 3/2015 CH & MR
28
APPENDIX!5!
REQUIRED!READINGS!!
(Reading!list!and!folder!sent!prior!to!arrival!and!available!in!Abby!House)!
!
Curriculum area
Required reading
Topic 1
Health in the Americas, 2012 Edition: Country Profile for Belize. Pan
The Belizean Culture & Health
American Health Organization.
System
Topic 2
Belluz, J et al. 4 Global Health Issues You’ve Been Ignoring
Global/Public Health and the Social
Because of Ebola. Vox News.
Determinants
Swain G et al. Health Care Professionals: Opportunities to Address the
Social Determinants. Wisconsin Medical Journal. Dec 2014
Topic 3
Pasricha SR et al. Control of iron deficiency anemia in low- and
Clinical Medicine in Resourcemiddle-income countries. Blood Journal: 121 (14). April 2013.
Limited Region
Topic 4
Fries K et al. Service learning in Guatemala: Using Qualitative
Interdisciplinary Learning
Content Analysis to Explore an Interdisciplinary Learning
Experience Among Students in Health Care Professional
Programs. Journal of Multidisciplinary Healthcare 6:
45–52. 2013
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
Revised 3/2015 CH & MR
29
APPENDIX!6!
HILLSIDE!STAFF!(AS!OF!FEBRUARY!2015)!
'
'
Management'Team:'
Mischa'Ronick,'MD,'Medical'Director'
Carly'Hood,'MPH,'MPA'Clinic'&'Public'Health'Director'
John'Kelly,'PT,'MSPT'Rehab'Director''
Loretta'Charles,'FNP,'Associate'Medical'Director'
Anastacia'Coc:'Office'Manager'
Alfia'Pau:'Clinic'Supervisor'
Alva'Cucul:'Head'of'Pharmacy'
Evert'Mangar:'Maintenance'Manager'
'
Staff:''
Britt'Fontana,'NP:'Lead'Nurse'
Clarita'Kib:'Clinic'Intake'
Jennifer'Tzui:'Clinic'Assistant'
Amira'Ack:'Rehab'Tech'
Emelita'Coc:'Clinic'Intake'
Alva'Cucul:'Assistant'Clinic'Manager''
Rudy'Jacobs:'Driver,'Community'Liaison''
Allen'Mangar:'Security'Guard''
Randolph'Parham:'Security'Guard'
Omar'Parham:'Maintenance'
Frank'Bahadur:'Security'Guard'
Amelia'Ramclam:'Housekeeping''
Jamie'Tamsley:'Maintenance'
Chad'Ryan:'Student'Liaison'
Steve'Fontana:'Non9medical'volunteer'
Jacob'Wasag:'Non9medical'volunteer'
'''''''James'Finney:'Non9medical'volunteer'
'
!
!
!
Revised 3/2015 CH & MR
'