Mobile Health
Unfortunately, I put this project on hold in July to be able to do the other projects. I revised the surveys to fix some of the wording, but was not collecting data or investigating the logistics of implementing an SMS-based mHealth program. I returned to my project last week (7/30), beginning with talking to the phone companies to figure out the cheapest text message package to put on a SIM. It was incredibly frustrating to visit each of the three major phone companies in the country (Claro, Orange and Viva), and wait on lines at each one, only to be told that the very simple thing that we want (text messages to add to a SIM card, no phone or data package) isn’t simple to get. Orange and Viva had nothing for us, and at Claro we found one man who said he would look into the available packages but hasn’t gotten back to us or returned our follow-up email. Back at the clinic I’ve resumed administering my surveys, with the help of Evy one day and a new volunteer (Cindy) yesterday, since both of them are bilingual. Today I began digitizing the data so we can analyze it, and Cindy emailed several online text messaging companies for price quotes. So far, the lowest is still Clickatell, though I thought 3.5 cents a pop was still rather high, given the quantity of messages we want to send…
Storeroom Efficiency
Our ofertas are selling well, and are definitely priced to move. Yajaira has continued making the announcement signs (listing each oferta’s contents and price) and taping them to the pharmacy window, and she and Don Teo seem to have worked out a functional system for making sure she doesn’t run out. Similarly, the storeroom has remained orderly, following the sections we set up, even as more supplies and medications have been delivered. The fact that Don Teo has received new deliveries and has been actively maintaining the set organization soothes my fear that our multi-week project was a one-time affair that would slowly deteriorate over time because it was mostly made by visitors, rather than by the person who actually runs the storeroom. However, though Don Teo was not very involved in planning the reorganization—aside from answering our questions whether the plans sounded good/more useable for him—he has told us on multiple occasions that everything is going well and he will continue to use the new organization, oferta routine, etc. Since I’m here until the end of August, and there are two new pharmacy students here with me until then, I will be able to continue to monitor and tweak (with their help and expertise) so that when we leave it runs smoothly and is flexible enough to be able to adapt to anything that might happen in the future.
Medication Guide
Derek, Jillian and I worked on the medication guide in our spare time over the course of their month here. Originally, the guide was just meant to translate the medications that didn’t have instructions/information included in Spanish. After completing a chart that listed the brand name, generic name, strength, indications, dosing and side effects for each of the donated medications, Teresa told us that it would be better if it included all of the medications used by the clinic. We thought about it, and decided that the guide could be a really great resource for the “pharmacist” (Yajaira isn’t trained in pharmacy, and the pharmacy is really more of a dispensary), community health staff, nurses, new staff, and anyone who might have the opportunity to counsel a patient on his or her medication.
So we went through the clinic inventory list for June, as well as the shelves of the storeroom, and added each of those drugs to the guide. Derek and Jillian would add the information in English, and I would proofread (and get rid of any pharmacy jargon) and translate everything to Spanish. After it seemed complete, we printed one copy each for Yajaira and Reyna/Rosi/community health (Miguel was moved to archives and then let go, so the community health office is staffed by a hodgepodge of different people over the course of each day). Jillian worked with Yajaira to find out which medications currently or usually in the pharmacy were missing from the list, and the new volunteers (Evy and Sarah) have added those. They will print a few copies of the second beta edition tomorrow (Wednesday). So far, Yajaira loves the guide, which she wants to use to study the medicines. She plans to get a license of some sort in pharmacy (not to be a pharmacist, but I suppose the equivalent of a technician), which will give her somewhat more job security than she currently has. We also printed a copy in the Santo Domingo clinic and emailed the file along with the materials from the Teach Back workshop, and we heard from Orlando that it is being used by multiple people in that clinic. The next step is to find one person in each clinic to assume responsibility for adding to the guide when new medicines come in. In Monte Plata, I hope that Yajaira will do this (and can ask Berkys to translate anything that’s in English). In Santo Domingo, I am thinking that Wilson, the storeroom manager, might be a good choice. He takes great pride in his work, always knows exactly what he has in stock, and would like to take on additional responsibilities, even on a volunteer basis. If his computer skills are adequate I know that in his care that clinic’s guide will be well-maintained and a useful link between the storeroom, pharmacy, and community health office.
Teach Back
I translated Derek’s PowerPoint slides and served as his and Jillian’s interpreter/partner in the staff meetings we called to walk with the clinics’ staff about the Teach Back method. The first meeting, at the Monte Plata clinic, was difficult to call a success because my translation was mediocre at best (I REALLY should have practiced beforehand, at least a dry run with them before presenting) and it wasn’t clear that everyone fully understood the method. Pedro Pablo gave an impassioned response during the question and comment period, in which he basically said that there are just some patients who don’t understand things, who don’t listen, and who rush out of the clinic without going to the community health office. Reyna also made a point during this period that community health is already stretched too thin; where there used to be three people there is now one, and one person really cannot do everything that the community health program should be doing. In Santo Domingo, we gave the presentation twice and it seemed to go over much better. Of great help was one of the medical student volunteers, Huascar, who understands and speaks English quite well. In the first presentation he helped with translating a few sentences, actively participating and voicing support for the method, and so we asked that he join the next day’s presentation as well. Again he helped with a bit of translation and explanation, and was an amazing advocate for the method, even though he had just learned about it the day before. We wish he was a more permanent staff member, but will soon be returning to school. Otherwise, he would be an ideal person to have in charge of actually implementing Teach Back (amongst all the doctors, nurses, techs, etc.) and monitoring its usage.
