Download Brigade Report - Timmy Global Health

Brigade
Report
Public Trip - Guatemala
July 2010
Timmy Foundation
Building Healthy Futures
Brigade Report – Public Trip Guatemala, July 17-24, 2010
The following report summarizes the Timmy Foundation’s July 2010 brigade to Quetzaltenango,
Guatemala with general volunteers and medical professionals. A special thanks to all of the
volunteers—both students and medical professionals—that made the brigade possible.
Volunteer Specifics
10 general volunteers travelled on the brigade—six men, and four women. Five total medical professionals were
recruited by Timmy staff, including one physician assistant, two RNs, and one pharmacists. The former Timmy
Foundation’s International Programs Coordinator, the current Programs Coordinator, the Timmy LAMP intern and
medicine coordinator were also present on the trip. The Medical Programs Director in Guatemala also participated
in the trip. The total number of trip participants totaled 19. For a complete brigade roster, please refer to Appendix
I.
Though facets of the trip are summarized below, please refer to Appendix II for a complete hourly schedule,
revised according to the group’s actual movement.
Travel
Flights
All participants arrived according to schedule and met Timmy’s Medical Programs Director and driver at the
airport. The first groups to arrive were transported to Antigua where they got lunch and waited for the remaining
flights to arrive. Everyone but the two on flights arriving after 8:00 PM had dinner together at Las Palmas in
Antigua.
Ground Transportation
Transportation was organized throughout the week by Juan Antonio Loarca, a private transportation contractor
that works principally with non-profit organizations in Quetzaltenango, Guatemala. He, along with partner driver
Francisco, ensured that all luggage/baggage was secured on the roofs of the “microbuses”—15 passenger, diesel
powered vans—and that there was ample space for all 19 trip participants. Though space was tight in the vans
throughout the week, drivers were very safe and competent.
Clinic
Clinic was scheduled for all work days this week. Full days of clinic were scheduled for Monday-Thursday; half day
on Friday. In total, the Timmy team attended to over 400 patients during the clinic week.
Pop-Wuj sent around 12 medical students to assist with clinics in the morning each day. These students travelled
with the Timmy team to clinics each morning and left around lunch time each day. The students were extremely
helpful, particularly in triage where they took patient histories and assisted general volunteers with Spanish
translation.
Monday – Buena Vista
The Timmy team visited Buena Vista twice on this brigade, on Monday and again Thursday. In total, the team saw
178 patients there including: 37 males, 141 females; 20 young children (ages 0-5); 31 children/adolescents (ages 617); and 125 adults (ages 18 and older).
The group easily adjusted to the three-way translating necessary in Buena Vista, a Maya-Ma’m village 30 minutes
northwest of Quetzaltenango. Many patients spoke Spanish in addition to Ma’m, making communication fairly
easy and requiring only a few Ma’m translators. The brigade clinic was hosted at the home of a local midwife, Doña
Ana, where a child was birthed during the day.
Tuesday – CEIPA in Salcajá
On Tuesday, the Timmy team attended to 100 patients: 36 males, 64 females; 19 young children (ages 0-5); 30
children/adolescents (ages 6-17); and 51 adults (ages 18 and older). The clinic was hosted at one of CEIPA’s schools
in Salcajá. CEIPA—Centro de Educación Integral Pastoral (Pastoral Center for Comprehensive Education)—is a
program for children and adolescents largely affected by social issues such as abuse, domestic violence, rape,
single parents, etc. The school requested the help of Pop Wuj, Timmy’s partner in Guatemala, to see the students
during one of its school days.
While previous Timmy clinics at CEIPA schools have resulted in a high percentage of well-checks, this particular
clinic seemed to consist mostly of sick patients with several instances of pediatric malnutrition and/or stunting
identified. The patients seen during the day have very limited access to healthcare and few resources to seek
medical care if it is needed. For this reason, periodic visits to CEIPA are recommended. Because the patient profile
at other locations was generally healthy, it might be useful for Timmy to send clinics to different CEIPA locations
throughout the year in order to provide care to different communities while Pop-Wuj provides treatment and
medications (particularly for any chronic patients) in between brigades.
Unfortunately, the leaders at CEIPA told most of the patients to come to the clinic at noon, so the morning went
very slowly. Only having to translate from Spanish to English did make the day go faster, though, and the team was
still able to finish with the clinic in plenty of time to return to Los Olivos for dinner. In the future, Pop-Wuj and
Timmy should emphasize the need to have patients arrive on time in order for Timmy to be able to provide the
best quality of care for each patient.
Wednesday – Xeabaj
On Wednesday, volunteers, medical professionals and Pop-Wuj medical students attended to 73 patients in
Xeabaj, a community displaced and rebuilt following Hurricane Stan in 2005. Of the 73 patients, 17 were males, 56
females; 13 were young children (ages 0-5); 17 were children/adolescents (ages 6-17); and 43 were adults (ages 18
and older). For more specific information regarding the morbidity statistics in Xeabaj (and all other communities
and age-groups), please refer to the brigade data in subsequent pages.
Translation in Xeabaj, a Maya-Quiché village, can be quite difficult. The majority of doctors and patients required
translation support from Spanish to Quiché to properly understand the patients’ histories and treatment options.
Because of the three-way translation (English>Spanish>Quiché and vice versa) and because of the shortage of
designated Quiché translators, communication throughout the day was delayed and frustrating for many
participants. Nonetheless, all patients were seen during the day and community leaders were very grateful for the
team’s presence.
Thursday – Buena Vista
Doña Ana distributed tickets for the day in advance and advised patients to be lined up for the clinic to begin at
8:00 AM. By 9:00 AM, very few patients with tickets had arrived and several community members without tickets
were patiently waiting. Timmy and Pop-Wuj staff consulted with Doña Ana and determined it was best to
distribute tickets to those who had been waiting in line all morning without tickets in order to provide care to as
many patients as possible, particularly given the absence of many ticket holders.
By 2:30, Timmy and Pop-Wuj staff agreed to close intake as no more patients were in line. By 3:00, a few additional
patients arrived with tickets. Since intake and triage had already completed for the day, these patients were
provided with directions to the Pop-Wuj clinic as well as hours of operation. One woman was given medication per
the direction of Doña Ana despite not being seen by the doctor since she was illiterate and could not understand
the directions to Pop-Wuj. She only needed medication for gastritis, and the pharmacists were comfortable
dispensing vitamins and ranitidine to her per Doña Ana’s request.
Friday – Pop Wuj
On Friday, the Timmy team attended to 43 patients in the half-day clinic that began at 9:30am and commenced at
12:00pm. Of the 43 patients, 16 were males, 23 females; 6 were young children (ages 0-5); 3 were
children/adolescents (ages 6-17); and 34 were adults (ages 18 and older).
Following clinic, all medicines were categorized and set out to be inventoried into the Pop Wuj pharmacy. Because
very few team participants travelled from Indianapolis, meaning we transported fewer medical supply bags to
Guatemala, the Timmy clinics had to tap into Pop-Wuj’s supply of certain medications. This should be taken into
consideration in planning the medications for the October brigade to ensure that Pop-Wuj has adequate supply for
the coming months.
Activities
There were several planned cultural activities throughout the week beginning on the IU participants’ first full day
in Guatemala.
Chocolate Tasting at Doña Pancha’s
On Monday evening, the Timmy team walked to Doña Pancha’s in Xela to sample locally produced chocolate and
hear the history of chocolate in Mayan culture. The team sampled chocolate covered fruits, strawberry yogurt with
a chocolate sauce on top and hot chocolate. Afterwards the team was welcome to purchase chocolates from the
shop. The team really enjoyed the talk and the samples, but would have preferred to not watch the video that
followed. In the future, Timmy should continue to go to Doña Pancha’s but request the explanation without the
video.
Cultural Competency Lecture – Roney Alvarado
As is custom on each Timmy Foundation medical brigade, Roney Alvarado, Pop Wuj’s director of health programs
and the foundation’s main contact at Pop Wuj, gave the group a brief yet important overview of Guatemalan
culture. Roney, an anthropologist by training, framed our clinic week with a bit of a rhetorical question—“why are
you here?”
Among the topics covered in the cultural competency lesson were: the differences among cultural perceptions and
reality; the difference between western and traditional medicine; the necessity to learn throughout the week; the
importance of self-evaluation and reflection throughout the week, specifically in regard to individual’s motivation
for attending the medical brigade; and the responsibility one has for the work during the week and follow-up
thereafter.
Fair Trade Shops
On Wednesday afternoon, the group visited TRAMA, a fair trade textile cooperative in Quetzaltenango. The store
offers high-quality, hand-made goods at very reasonable prices, while also offering patrons additional information
relative to where products were made, who makes them, how they are reimbursed for their work, etc.
Antigua
To make transportation to the airport quick and efficient on Saturday morning, the group departed from
Quetzaltenango shortly after finishing clinic on Friday afternoon to stay the night in Antigua, Guatemala, a colonial
town 45 minutes outside of Guatemala City. Known for its beautiful colonial architecture, old churches and
cathedrals, gardens, and cobblestone streets, Antigua is always a favorite of Timmy medical teams.
After checking in at Hotel Santa Lucia IV, the group spent a brief amount of time shopping near the hotel before
gathering to walk to dinner at La Peña del Sol Latino where participants were treated to great food and live music.
A short reflection session followed dinner at the hotel where trip participants were invited to share their thoughts
with the group.
Wellness
About half of the group reported feeling ill during the brigade. Most team members suffered only mild symptoms
such as very mild headaches and sore throats. Only two trip participants became more significantly ill with more
severe nausea, vomiting, and diarrhea. The majority of those feeling ill affirmed that symptoms disappeared in 2448 hours.
The cause of these health issues has not been pinpointed, but there are a number of factors that may contribute,
including: the altitude in Quetzaltenango (roughly 7,500 ft.), patient contact, lack of proper hand washing
throughout the week, consumption of raw vegetables, and travelers’ GI tracts adjusting to different food.
Feedback
Debrief with team members each night
Would like to have team member profiles and bios prior to trip
Update the trip booklet with greater emphasis on bringing warm clothes
Forewarn participants that there is little time to spend at internet cafés (may want to get international
cell phone coverage)
Delete the recommendation that participants not bring iPods or laptops for public trips
Desire for more traditional Guatemalan cuisine—accommodations otherwise found to be very pleasant
Would like to have an evening free to eat in downtown Xela
Interest in mid-week free day like the Quito trip
Would like to stop along the road to take photos of some of the scenery
Don’t schedule first day at Buena Vista because it can be overwhelming
Take time Sunday night to examine our equipment such as BP cuffs, thermometers and make sure they
are all working after the trip (could also use this time to train people who don’t know how to use them)
Be more realistic about the time schedule for the itinerary – make sure people realize the limited number
of opportunities they will have to shop
Basic Spanish introduction
More interpreters be made available
More advanced communication from Timmy needed
Would like email confirmation when trip documents are received
Be sure to translate when community leaders (such as Doña Ana) give talks
If possible, have community leaders give an introduction to their community before the clinic begins
Appendix I
Trip Participant Roster
Public Trip – Guatemala – July 17-24, 2010
Last Name
First Name
Specialty/ Occupation
Kulon
Amy
PA
Shepherd
Susan
General Volunteer
Tischbein
Sara
General Volunteer
Tischbein
Phillip
General Volunteer
Lomax
Becky
Medicine Woman
Carmichael
Tanya
RN
Cairns
Catherine
Public Health
Howes
Laura
Accountant
Morrow
Andrew
LAMP Intern
Belden
Zachary
Undergrad
Schneider Bego
John
High School
Zanko
Michael
High School
Portman
Thomas
General Volunteer
Portman
Mark
Pantalone
Janine
Lienert
Josephine
Pharmacist
Morris
Kathleen
TF Staff
Shultz
Paul
TF Staff
Sullivan
Meg
TF Staff
Undergrad
RN
Appendix II
Revised Hourly Itinerary
th
Saturday, 17 of July
8:00 AM-9:00
GROUP Arrivals
PM
Last Name
12:00-3:00
7:00 PM
Sunday, 18 July
8:30 AM
First Name
Flight No.
From/To
Arrival Time
Cairns
Catherine
TA 7979
FLORES
9:10am
Howes
Laura
TA 7979
FLORES
9:10am
Carmichael
Tanya
AA 981
MIA
10:30am
Pantalone
Janine
AA 981
MIA
10:30am
Morrow
Andrew
Delta 461
ATLANTA
11:25am
Shepherd
Sue
AA 983
MIA
1:10pm
Kulon
Amy
AA 983
MIA
1:10pm
Zanko
Michael
AA 983
MIA
1:10pm
Schneider Bego
Henry
AA 983
MIA
1:10pm
Tischbein
Sara
CO443
IAH
1:13pm
Tischbein
Phillip
CO443
IAH
1:13pm
Morris
Kathy
CO443
IAH
1:13pm
Lienert
Joey
CO 443
IAH
1:13pm
Lomax
Becky
CO 443
IAH
1:13pm
Portman
Thomas
CO 443
IAH
1:13pm
Portman
Mark
CO 443
IAH
1:13pm
Belden
Zachary
COPA 390
PANAMA
8:12pm
Shultz
Paul
AA2195
DALLAS
8:40pm
Lunch/shopping/touring Antigua (while waiting for others to arrive)
Dinner in Antigua –Las Palmas & Welcome by Kathy
6a Ave. Norte # 14,
between 4a & 5a Calles
Tel.: (502) 7832-9734
Breakfast – Kaffee Fernando
9:30 AM
9:30 AM
Check out of Hotel Santa Lucia
Exchanged money, hiked to Cross in the Hill, shopping
1:00 PM
2:00 PM
6:00 PM
6:30 PM
Lunch in Antigua – Doña Luisa’s
Leave for Quetzaltenango
Arrive in Quetzaltenango, check in at Hotel Los Olivos
Dinner at Los Olivos
7:30 PM
Monday, 19 July
7:30 AM
8:00 AM
12:30 PM
6:00 PM
7:00 PM
Tuesday, 16 Mar
7:30 AM
8:00 AM
12:30 PM
4:30 PM
6:00 PM
7:00 PM
7:30 PM
Orientation, Overview of Medical Clinics (Paul, Kathy, Dr. Sullivan)
Organize Medicines (Med Professionals, Volunteers)
Breakfast at Los Olivos
CLINIC: Buena Vista
Lunch
Dinner at Los Olivos
Chocolate Tasting – Doña Pancha
Breakfast at Los Olivos
CLINIC: Salcajá (CEIPA)
Lunch
Free time to explore downtown Quetzaltenango
Dinner at Los Olivos
Organize medicines
Cultural Competency with Roney
Wednesday, 17 Mar
7:00 AM Breakfast at Los Olivos
7:30 AM
12:30 PM
6:00 PM
CLINIC: Xeabaj
Lunch
Dinner at LO
7:00 PM
Organize medicines
8:30 PM
Drinks at local bar
Thursday, 18 Mar
7:30 AM
8:00 AM
12:30 PM
Breakfast at LO
CLINIC: Buena Vista
Lunch
5:00 PM
Free time to explore downtown Quetzaltenango
6:00 PM
Organize medicines
6:50 PM
7:00 PM
Leave for Pop Wuj
Goodbye dinner at Pop Wuj – Mingle with Medical Students, etc.
Friday, 19 Mar
7:30 AM
Breakfast at LO
8:00 AM
8:15 AM
Check out of Hotel LO
Leave for Pop Wuj
8:30 AM
CLINIC: Pop Wuj
1:30 PM
Lunch: Pollo Campero
2:00 PM
Leave for Antigua, Guatemala
5:30 PM
Check in at Hotel Santa Lucia #3
6:00 PM
7:00 PM
Free time to shop/explore Antigua
Dinner at La Peña del Sol Latino
Saturday, 20 Mar
7:15 AM – 3:10
PM
DEPARTING FLIGHTS
Shultz
Paul
7/23/2010
AA 2196
DALLAS
8:40am
Lomax
Becky
7/24/2010
CO 457
IAH
7:15am
Kulon
Amy
7/24/2010
AA 2196
MIA
8:40am
Shepherd
Schneider
Bego
Sue
7/24/2010
AA 2196
MIA
8:40am
Henry
7/24/2010
AA 2196
MIA
8:40am
Zanko
Michael
7/24/2010
AA 2196
MIA
8:40am
Belden
Zachary
7/24/2010
AA982
MIA
11:40am
Cairns
Catherine
7/24/2010
CO 867
IAH
11:45am
Howes
Laura
7/24/2010
CO 867
IAH
11:45am
Tischbein
Sara
7/24/2010
CO500
IAH
11:50am
Tischbein
Phillip
7/24/2010
CO500
IAH
11:50am
Morris
Kathy
7/24/2010
CO500
IAH
11:50am
Morrow
Andrew
7/24/2010
Delta 596
ATLANTA
12:35pm
Carmichael
Tanya
7/24/2010
AA 2132
MIA
2:25pm
Pantalone
Janine
7/24/2010
AA 2132
MIA
2:25pm
Lienert
Joey
7/24/2010
CO 436
IAH
3:10pm
Portman
Thomas
7/24/2010
CO 436
IAH
3:10pm
Portman
Mark
7/24/2010
CO 436
IAH
3:10pm
Brigade Report – Public Trip Guatemala, July 17-24, 2010
The following report summarizes the Timmy Foundation’s July 2010 brigade to Quetzaltenango, Guatemala with general
volunteers and medical professionals. Patient and referral data was collected during the brigade and clinics and is summarized
below.
PATIENT PROFILE
TOTAL Patients
394
Under 5 (age 0-5)
School-aged Children (age 6-11)
Adolescents (age 12-17)
Adults (age 18 and older)
58
43
38
253
Males
Females
106
284
Schoolaged
Children
(age 6-11)
11%
Under 5
(age 0-5)
15%
Adults (age
18 and older)
64%
Adolescents
(age 12-17)
10%
Males
27%
Females
73%
OVERALL MORBIDITY
Stunting
Gastritis/GERD
Other musculoskeletal
General Pain
Malnutrition
Headache (non-…
Urinary Tract…
Abdominal Pain
Cold/Cough
Allergy
Other
Well Check
Anxiety/Depression
Parasites
Diarrhea
URI Non-specific
Other derm.
Diabetes Mellitus
Anemia
Prenatal visit/pregnant
Vaginitis
Menstrual/Menopause
Dermatitis
Scabies
Hypertension
Osteoarthritis
Other neuro.
Other laryngo/pulm.
Ear Infection
Other ophth.
Conjunctivitis
Bronchitis
Other gyn.
Yeast Infection
Fungus
Strep Throat
Tonsilitis
Impetigo
Exema
Other Cardiac
Injury/Lesion
Dry Eyes
Caries
Pneumonia
Lice
Abscess
Osteoporosis
Other gastro.
Murmur
Other psych.
Cataracts
Migraine
Asthma
74
73
56
47
38
32
28
26
25
24
22
21
21
17
15
14
14
13
13
13
12
12
12
11
11
10
9
9
8
7
7
7
7
7
7
6
5
4
4
4
3
3
3
3
3
2
2
2
2
1
1
1
1
0
10
20
30
40
50
60
70
80
INFANT MORBIDITY (age 0-5)
Stunting
Malnutrition
Well Check
URI Non-specific
Cold/Cough
Diarrhea
Scabies
Vaginitis
Parasites
Other musculoskeletal
Other derm.
Fungus
Allergy
Other neuro.
General Pain
Tonsilitis
Abdominal Pain
Dermatitis
Murmur
Other
Anemia
Other psych.
Caries
Other laryngo/pulm.
Bronchitis
Asthma
Impetigo
29
12
9
9
5
5
5
4
4
3
3
3
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
0
5
10
15
20
25
30
35
CHILD MORBIDITY (age 6-17)
Stunting
45
Malnutrition
26
Well Check
11
Gastritis/GERD
10
Other
6
Allergy
6
Other musculoskeletal
6
General Pain
6
Dermatitis
6
Headache (non-specific)
5
Menstrual/Menopause
5
Abdominal Pain
5
Other derm.
5
Ear Infection
4
Cold/Cough
4
URI Non-specific
3
Strep Throat
3
Diarrhea
3
Scabies
3
Exema
3
Abscess
2
Caries
2
Pneumonia
2
Prenatal visit/pregnant
2
Fungus
2
Impetigo
2
Other Cardiac
2
Anemia
1
Dry Eyes
1
Conjunctivitis
1
Other laryngo/pulm.
1
Tonsilitis
1
Other gyn.
1
Yeast Infection
1
Other gastro.
1
Lice
1
0
10
20
30
40
50
ADULT MORBIDITY (age 18 and older)
63
Gastritis/GERD
47
Other musculoskeletal
39
General Pain
28
27
Urinary Tract Infection (UTI)
Headache (non-specific)
21
19
Anxiety/Depression
Abdominal Pain
16
16
15
13
13
11
11
11
10
Allergy
Cold/Cough
Other
Diabetes Mellitus
Parasites
Anemia
Prenatal visit/pregnant
Hypertension
Osteoarthritis
8
7
7
7
7
7
6
6
6
6
6
Vaginitis
Other ophth.
Other neuro.
Other laryngo/pulm.
Menstrual/Menopause
Diarrhea
Conjunctivitis
Bronchitis
Other gyn.
Yeast Infection
Other derm.
4
4
3
3
3
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
Ear Infection
Dermatitis
Injury/Lesion
Strep Throat
Scabies
Dry Eyes
Osteoporosis
URI Non-specific
Tonsilitis
Lice
Fungus
Other Cardiac
Well Check
Cataracts
Migraine
Pneumonia
Other gastro.
Malnutrition
Impetigo
Exema
0
10
20
30
40
50
60
70
MORBIDITY TOP TEN
Infants (age 0-5)
Other
musculoskeletal
Other derm.
3%
3%
Stunting
33%
Parasites
4% Vaginitis
5%
Scabies
6%
Diarrhea
6%
Cold/Cough
6%
Malnutrition
14%
Well Check
10%
URI Non-specific
10%
Children (age 6-17)
Menstrual
7%
Stunting
34%
Headache
Dermatitis General Pain
4%
4%
4%
Other
musculoskeletal
4%
Allergy
5%
Other
5%
Well Check
8%
Malnutrition
20%
Gastritis/GERD
8%
Adults (age 18 and older)
Other
5%
Gastritis/GERD
22%
Other
musculoskeletal
16%
General Pain
13%
Cold/Cough
Allergy
6%
5%
Abdominal Pain
7%
Anxiety/
Depression
7%
Headache (nonspecific)
9%
Urinary Tract
Infection (UTI)
10%
TOP TEN MORBIDITY PER COMMUNITY
Buena Vista
39
Stunting
Gastritis/GERD
General Pain
Other musculoskeletal
Urinary Tract Infection (UTI)
Headache (non-specific)
Anxiety/Depression
Abdominal Pain
Malnutrition
Allergy
34
32
22
19
17
14
14
11
10
0
10
20
30
40
50
Xeabaj
22
Other musculoskeletal
Gastritis/GERD
Stunting
Cold/Cough
Malnutrition
Headache (non-specific)
URI Non-specific
General Pain
Dermatitis
Ear Infection
14
14
12
12
8
7
6
5
4
0
5
10
15
20
25
Ceipa – Salcajá
15
Stunting
Well Check
Other musculoskeletal
Gastritis/GERD
Malnutrition
Allergy
Cold/Cough
Hypertension
Anxiety/Depression
Other laryngo/pulm.
14
13
11
11
10
7
6
5
5
0
5
10
15
Xela
14
Stunting
Other
Gastritis/GERD
Other musculoskeletal
Diabetes Mellitus
Urinary Tract Infection (UTI)
Abdominal Pain
Hypertension
Malnutrition
Other neuro.
9
7
5
5
4
4
4
4
3
0
2
4
6
8
10
12
14
16
20