Initial Whittling of NHCM W&W Manual

Nazarene Medical Organization

GUIDELINE ADDENDUM

Requirements for Medical C. Medical Instruments / Team Members Equipment *Name of item 1. List of medical personnel coming on *Use trip and their title (doctor, nurse, etc.) *Lot number 2. Photocopies of each team member’s: *Quantity *CV -for doctors only or faculty *Manufacture date members (if a student group) *Current license *If you are bringing equipment that you *Diploma (of your specialty if it will be taking back with you, please applies) put these items on a separate list (lab **Each document copy (except for equipment, glucometer, etc.) CV) needs to be a certified copy and needs to be notarized 3. Statement of donation with an Recommendations approximate value in dollars of the From the Field: entire donation (medications, medical supplies, etc.) It is suggested that each team member 4. Copies of receipts of items that are donate $200.00 for the purchase of bought (meds, instruments, etc.) supplies and medicines. This allows for 5. Flight information – dates, airline, someone on the team to buy basic meds in flight number, times bulk. It also allows money to be available 6. Complete list of items being donated: when the team is in the field. Contact the Field Coordinator to discuss whether these A. Medications funds are necessary and should be used to *Generic name (if combination med, purchase medicine in the sending country. need each ingredient name and It might be that these funds should be sent concentration of each) through the General Treasurer’s office as *Concentration, dosage, etc. W&W funds. If the Field Coordinator will *Quantity be purchasing the medicines in country *Expiration date prior to the arrival of the team, the funds *Needs to have at least 6 months or need to be sent through the General more expiration date from the date of Treasurer. the trip W&W team members need to have an B. Medical Supplies updated tetanus shot. Medical team * Name of item members additionally need to have *Manufacture date Hepatitis A and Hepatitis B. The other *Expiration date vaccines depend on the country. A good *Quantity place to look is www.cdc.gov, under *Lot number “travelers health.” This allows you to look up the specific country where you will go. The team leader in the US should check with the field coordinator to ask what is

Medical Addendum 1 required as well (the CDC suggests many Keep up with equipment/supplies at all things, but it may not always be practical times. Theft is sometimes a problem. nor required). Gather up and clean equipment/supplies at the end of the day. Don’t leave the clinic Each country has a different process to site until everything is cleaned up and put register the teams with the Ministry of away. Health and to get approval for the medications the group is bringing. Field personnel need to start this process months Medical Trip in advance. It is important to remind the “Typical Day” coordinator on the field about the potential process of approval right at the beginning There is no such thing as a “typical day.” of the conversation. Not every area is A typical day will vary depending upon required to register teams. your host country and living arrangements. This section is meant to give you a brief Most people think of recruiting nurses, idea of how a “typical day” is most likely physicians and dentists for medical trips. to occur. Don’t forget to recruit nurse practitioners, physician’s assistants, pharmacists (a Breakfast is usually served between 7:00 pharmacist is invaluable!), optometrists, and 8:00 a.m. This is also a good time to physical therapists, etc. have a short group devotional. The team leader may want to designate different Make sure that either you or the field ones to do the morning group devotionals. coordinator is recruiting translators for your group. Some fields do not have the Clinic usually begins around 9:00 a.m. ability to send or find many. It usually depending on where the team is lodging. takes one translator per doctor (if he or she By the time the team arrives at the clinic doesn’t speak the language of the country), site there will usually be a long line of one for triage (the station for taking vital patients or perhaps a crowd waiting to be signs), and in the pharmacy—the more the seen by the North American doctors and better. nurses. Sometimes the pressure and intensity of the waiting crowd is something Beyond offering a health clinic, another that cannot be expressed in words. It can need is teaching basic nutrition, personal only be experienced. It seems there is hygiene, etc. Depending on the location, always a constant struggle between this may be more of a need than the actual focusing on the needs of the individual clinic (this would require another patient while at the same time always translator). being aware of the pressing crowd. At Sometimes your luggage does not arrive times there seems to be no end to the with you. Try to carry a numbers of those seeking help. sphygmomanometer, stethoscope and ophthalmoscope in your carry-on, or Between 12 noon and 2:00 p. m. lunch is anything else you feel you need to function usually served. This is a good time to take in some extra liquids and put your feet up. in the clinic for a day or two.

Medical Addendum 2 The clinic will open around 2 o'clock and Patient Flow and continue until about 5 p.m. The time that you end clinic will be determined by how Records far you have to travel back to your lodging. It is sometimes dangerous to be out after Make it a practice to document on a card dark in some of the countries that the for each patient which doctor served them, teams visit. It is up to the group to their diagnosis and treatments and determine if there needs to be breaks taken medications prescribed and dispensed. The throughout the day. Usually there is a front desk is the “front line” of clinic cooler of drinks in the clinic area where where this Medical Record Card is created team members can go to rest and nourish for each person. A translator or the Team themselves. Please be aware and sensitive Missionary is usually assigned to this area. to eating and drinking in front of patients This is located just inside the main who do not have access to even a simple entrance to the clinic. glass of water. Towards the end of the clinic day it is up to the person who is Step by step patient flow: running the pharmacy to inventory the medications in order that there will be a sufficient supply for the next day. 1. Patients are admitted one family at a time through the front doors.. 2. A Medical Record Card is filled out Some evenings the local church will want on each patient, completing the top to have some special evangelistic services. portion of the form. Any team member with musical talent, etc. 3. The patient is given his card and is encouraged to participate. Even though proceeds to the appropriate we do not always understand the words, designated waiting area. the spirit is always understood. There will 4. When the doctor is ready to be some evenings that will be spent in just examine the patient, he is escorted sharing and playing games with other team to the appropriate table/chair and members. Some choose to update their the card is given to the doctor. journals; some spend time alone with the 5. Once the exam is finished the card Lord, or just vegetate to prepare for the is appropriately completed by the following day. doctor. An assistant in the pharmacy will pick up the card and There are always exceptions to the typical fill the prescription. day. Saturdays and Sundays are usually 6. The patient proceeds to the waiting reserved for sight- seeing and church. area while the prescription is filled. There will also need to be time before the 7. The prescriptions are filled from last day where team supplies are packed the information on the card. away and preparation is made for the 8. The translator or missionary return home. Remember that all of the dispenses the medicines and returns above is tentative, subject to sudden the card to the registration clerk. change. Be flexible and have a great time. 9. It is the privilege on many teams to be able to distribute Bible tracts and toothbrushes. These are to be

Medical Addendum 3 placed in a bag and given to each patient by the registration clerk. WE ARE CALLED TO BE The pharmacy is a busy place. Those JESUS TO A HURTING preparing the prescriptions for the patients WORLD… are often concentrating on “tasks” that must be done accurately. The registration AT ANYTIME, clerk is the one that focuses on “people.” IN ANYWAY, Smile and be encouraging to all those who are waiting! WITH ANYTHING THAT WE CAN!E ARE Disease Prevention CALLED TO BE JESUS

Adequate rest, a good diet, and an upbeat AIDS attitude are important ingredients to help keep you healthy. If you are working in a Acquired Immune Deficiency Syndrome warm climate you must also make sure that (AIDS) is a common disease. Certain you drink enough water (purified, of course) to prevent dehydration. If you are precautions should be taken with all not urinating at least three or four times medical and dental patients to minimize each day, then you are not taking adequate the possibility of spreading this fatal fluids. disease. AIDS is basically hard for us to get! The vast majority of cases are Depending upon the team destination you contracted through homosexual may start taking a drug called chloroquine encounters, through the sharing of “dirty” before departing. This medicine will needles during IV drug abuse, or by minimize the chance of getting malaria. receiving a blood transfusion contaminated Remember to take it according to the with HIV. It would appear that an instructions and on schedule. increasing number of cases are also developing after heterosexual intercourse Handwashing: outside of a mutually monogamous Always wash your hands between patients. relationship. Only very rarely has a health Liquid hand sanitizer is usually needed as care worker not involved in one of the running water is not available at the above activities contracted AIDS. In other clinics. words, we will not be at great risk while working with nationals from other countries.

Medical Addendum 4 Nonetheless, we recommend the following Examiner’s Cubicle: guidelines to minimize the danger to our Recommended Supplies team personnel: Additional information on supplies, with 1. Wear gloves when coming in specific lists and forms, are in this section. contact with any patient mucous The following list is based on the number membrane (mouth, nose, vagina, of examiners. The “X” means the amount and rectum), non-intact skin, or listed should be multiplied by the number moist body substances (i.e. blood, of examiners. If there is no “X” and just a urine, feces). quantity listed, then that number goes on every trip regardless of team 2. Wash hands before and after makeup/number. working with each patient. Doctors/nurses packing list: 3. Dentists and helpers will wear stethoscope (required) masks and goggles (or glasses). otoscope

4. Place all used sharps in a sharps General packing list: container (plastic jar, etc.) Do not Alcohol wipes 200 put needle cap back on needle prior Garbage Bags 4 to disposal. Cotton tipped applicators 100 Cotton balls 1 bag 5. Handle any laboratory specimens Bandage, ace (unspecified) 10 as if the patient were known to be Bandage, cling 20 infected. Tape, bandage (assorted) 1 bag Bandaid 200 6. Carefully cover any open sores or Gauze 3 X 3 50 cuts you may have, and do not Tongue depressors 100 allow them to come in contact with Basin 1 any patient fluids. Blood pressure cuff 1 each Stethoscope 1 each 7. Dispose of all patient waste fluids Thermometer 2 or tissue in double plastic bags. Ear Syringe 2 each Otoscope tips 1 bag If we follow these guidelines, the risk of K-Y jelly 1 tube getting AIDS will be negligible. Pen 1 Liquid hand sanitizer 1 Finally, by being careful, paying close Baby wipes 1 box attention to these guidelines, and by using Paper towels 2 bunches good common sense, the likelihood of Script pads 1 pad remaining healthy while working in your Trash bags 10 host country is excellent. Gloves, latex, exam 100 per examiner (appropriate sizes) Tongue depressors STERILE – a few Tape, Scotch transparent- 1

Medical Addendum 5 Skin closures (assorted)- 1 bag Ziploc bags (snack, sandwich, and Sponge/brush pre-op surgical scrub- 1 gallon size) Speculum, vaginal disposable plastic Pill bottles Visine and/or allergy eyedrops (small bottles) Over the Counter Medicines to Ear wax removal drops (Debrox or Bring Cerumenex) Thermometer covers (disposable) for oral and ear thermometer *These can all be found over the counter Tums, Gas-ex, Pepcid, Zantac, Mylanta (you may have to ask the pharmacist for (drops for infants) some) Immodium or other anti-diarrheal *Generic medications are fine and much medication cheaper too! Gauze (sterile 4x4 pads) and gauze wraps *Please do not bring or send expired Ace wraps mediations Small scissors and tweezers Medical tape Tylenol (Acetaminophen) Toothbrushes, sample size toothpaste Ibuprofen/Advil Travel soaps, shampoo, and toothpaste (the Aspirin kind from hotels) Vitamins (adult and children) Calcium tablets Vitamin E tablets Prescription Medications Vitamin C tablets Hydrocortisone cream *Please check with your medical field Antibacterial ointment (like Neosporin) contact before buying anything and ask Monistat cream (or generic) what other specific medications are needed Anti-fungal cream (Lotisone or generic) for that area. Sudafed Benadryl (liquid for kids and pills for Antibotics: Amoxicillin, Erythromycin, adults) Bactrim, Cephalexin, Metronidazole Any pills and liquid for cold/cough/sinus Scabies medication (Lindane) Childrens’ chewables and liquid – Prednisone Motrin and Tylenol Parasite medication (Mebendazole) Children’s cold/cough medication (in Asthma inhalers (Albuterol, etc.) chewables and liquid) Nix or Rid (for lice) Bandaids (small, regular, large) Instant cold packs one time use (the kind you squeeze for the cold) Alcohol pads Gloves (disposable) Purell hand sanitizer (small bottles)

Medical Addendum 6 crushed during transportation. Make sure Guidelines for Packing that they are put in a container that will Medicines and Supplies prevent them from being crushed. If you are transporting glass bottles, you might want to wrap them with bubble wrap to It is important to understand that no avoid breakage. If you are able to “press- expired medications may be taken in- in” on the sides of your suitcase, then you country. When your luggage is inspected, have not packed properly. You want to the medicines may be confiscated and you insure that you cannot “press-in,” therefore may be fined. Again, it is important that you can avoid any breakage in the you carry NO EXPIRED MEDICINES suitcases. Upon completing the packing of with you in your luggage. your suitcases, place a piece of two inch wide sealing tape over each suitcase buckle Each team member is allotted two and the strapping latches as well. This is to suitcases and one carry-on. Each suitcase avoid breakage of your suitcase or having cannot be more than 50 pounds. One items stolen. suitcase is for personal items. The second suitcase is for medical supplies and Once you are in-country, it is very helpful equipment. Try to make sure your personal if you have an inventory of the medicines items, the medical supplies and equipment that you have brought. It will assist the are in both bags. So that it looks like they person in charge of the pharmacy in are part of your personal items. The getting them in an orderly fashion. Also, it quantity you should be bringing is one will let the team know what medications suitcase of clothes and one suitcase of supplies. If you place two suitcases open have been brought and are available. beside each other on a table, you can split the medicines between them. Then if a If you find that you want to bring more suitcase is lost, you will not be completely than two suitcases, please be aware that out of a certain medication. For example, you may be charged for a third or fourth split the different kinds of antibiotics suitcase. To avoid additional charges, between the suitcases. Make sure that contact your travel agent and see if you can liquids are separated from other get a waiver of excess charges BEFORE medications and always check to make you leave. W&W does not have any sure that the tops are secure. Lotions and waivers that can be sent for the team liquids tend to leak. You may want to members. The waiver of excess charges place them in a sealed Zip-lock bag. The needs to be completed by your travel more tightly items are packed together, the agent. less breakage will occur in transit. Remember that the suitcases of medicines If you have a rubber stamp for a frequently may end up being opened on a dirt floor, given medication, it might be helpful to so you want to insure that items are packed bring that. It will save time in having to re- in plastic bags to avoid contamination. write instructions for the patients that are Ointments, inhalers, etc. can frequently be being seen.

Medical Addendum 7