El Ayudante

Fever, cough, diarrhea, gastrointestinal pain/burning, bone/joint pain, arthritis, muscle pain, stomach pain, back pain, stress, headache, dizziness, infection (urinary tract, respiratory, kidney), chronic dehydration, high blood pressure, allergy, itching skin, burning/itching eyes, rash, scabies, lice, white spots, inflammation, fungus, parasites, anemia, asthma, diabetes, STD’s, excessive ear wax, pink eye

Logistics/Flow

Order of stages is 1. Registration, 2. Vital signs, 3. Medical exam, 4. Pharmacy
Important to have order. Have a numbering system (small pieces of paper with numbers) to determine the order of people in line. Good to have a local Nicaraguan do this, preferably someone who might have information as to who could benefit being early. Have this done before the team shows up.
There needs to be room for lines to be formed before each stage
There needs to be someone to control entrance to the medical exam and to the pharmacy (gatekeepers). Depending on the physical space available, you may want to have someone directing/leading patients from one step to the next.
When there is a lunch break, there needs to be a way to identify those in line at the medical exam and pharmacy so they can regain their places when the process resumes after lunch
At lunch you need to secure the medical exam and pharmacy rooms
Throughput estimate: 3 provider stations able to see 125-200 patients in 6 hrs (including lunch break)
Locations could be a school building, community center, church property or medical clinic building

Registration

Record name, age, sex, and symptoms person is experiencing. A non-medical person can be trained quickly to do this work if they are bilingual in the vocabulary of medical symptoms.
Most difficult part is understanding the patient’s name. Have local Nicaraguan fill out names on cards to speed up the process.
If you have a number of physicians (specialty), you can triage patients to direct them to the appropriate specialty.
Need 1-2 stations.

Vital Signs

Record blood pressure, pulse, weight, temperature
If you use an automatic blood pressure cuff, a non-medical person can be trained to do this work.
Need 1-2 stations

Medical Exam

Patients arrive alone or with their family, so be prepared to see the mother and her children at the same time
Need to have sufficient chairs for doctor (provider), 2-3 patients and translator (if required), plus one small table for each exam station. May want to include space for a nurse if anticipating wound care or other work that would use a nurse for.
Need to have an area with some privacy for some exams (can be set aside from other exam areas) – for example ultrasounds, gynecological or whenever someone needs to drop their trousers or remove their blouse. Use a separate room or hang some sheets or tarp around a table.
Need 2-3 stations for volume seen

Pharmacy

Having a trained pharmacist improves efficiency and flexibility to make substitutions and changes as the inventory changes or is limited.
Bring tried and true medicines, not ones that have been out for only a short time. See attached list for medicines typically brought by medical teams.
Helps to have liquid medicines in inventory for children that can’t take pills
Need to dispense into small containers (bags or bottles)
Bring parasite tablets for everyone (except expectant mothers and children under 3).
Bring vitamins for everyone, including some with Calcium and Iron
Need tables or shelf to store bulk quantities of medicines (sometimes can just leave suitcases on the floor)
Need 2 tables/work bench to fill orders and affix labels
Need table and chair for each station to dispense/explain medicines
Prepackaging medicines in frequently prescribed dosages improves throughput

Forms

Preprinted information cards (5x7) are necessary for efficiency and quality control/documentation
Questions that are asked at registration should be written in Spanish, everything else in English
Preprinted labels for medicine bottles/bags with directions for taking medication should be written in Spanish. Blanks can be filled in at time of dispensing
Information cards should be numbered sequentially as they are filled out, and should include the date and location.
Helps to have preprinted directions (Spanish) for how to use lice shampoo.

Transportation

Many communities are 30-40min drive from El Ayudante property. Anticipate 30min to set-up. Anticipate 20 min to take down. Pharmacy is last area to finish.

Standard Equipment to be provided by El Ayudante

Tables
Chairs
Table for patient to lie down on
Sheets or tarps with ropes and/or clothespins for privacy rooms
Portable tents in case need to set up stations outside of a building
Drinking water (in a cooler or bottles) and cups
Fans if electricity available (bring generator when not)
Lunch
Baggies and/or small bottles for prescriptions (small inventory available)
Standard blank labels for prescriptions (small inventory available)
Sanitary wipes for tables

If need to buy medicines, buy in U.S. or Nicaragua?

See attached for recent Nicaraguan prices of medicines commonly used by medical teams

How to integrate local doctors/nurses into brigade

It is important to invite a local provider(s) to participate with the medical brigade. Doctors are to be compensated for their time. $50/day is recommended.

Interpreters

El Ayudante will provide interpreters as needed. Normally an interpreter is used at each medical provider’s table, at registration, and at the pharmacy.