Reflections on the January MST

by Anne Brewer, MD

Dr Anne seeing patientsThis was my fourth trip with HHI, and I’m delighted to see the evolution and growth of the program.  We do so much with modest resources, and it’s gratifying to see how well our patients are doing with control of their chronic illnesses.  In fact, I think that as a whole, the HHI Chronic Care patients are under better control than most of the patients we see in our Family Medicine Center in Stamford, where many of our patients also contend with issues of poverty.  I suspect that the Cooperadores (HHI’s Community Health Workers) are the key—when you know that your Cooperador/a will be checking your Blood Pressure or sugar and hounding you if you don’t take your meds, you’re more likely to take them regularly.  And to have continuity of care and see patients for return visits and celebrate their achievements is a different experience from the medical “hit-and-run” of most international service trips.  Despite the challenges of our mobile clinics, it’s a joy to practice medicine in its purest form—just us and the patients, with minimal technology intruding.

The Cooperadores are emerging as leaders in their communities and are more and more confident in their care of their patients. They can have a major impact on the health of their communities.

I have so much respect for the people in the communities that we serve.  Anne at MST
They are resourceful and cope with challenges that would undo many of us “first-worlders.”  Their generosity and support for each other are inspiring.

What makes the trip the most fun is the team that develops over the course of the week.  The physicians and students all pitch in to care for our patients, and we develop a quick camaraderie that gets us through the challenges.

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Amazon Smile

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Long-Lasting Impact

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Liz on local transport

One of the things that I struggled with during my first trip with HHI in 2009 was the lack of a lasting impact in the communities we were working with. At that time, there were only one or two medical service trips planned each year. There was no real structure to the clinics except that there were 3 sections: triage, MD evaluation, and a pharmacy. We saw as many patients as we could at each community. It was heartbreaking to turn people away. We would bring common medications on each trip: Tylenol, ibuprofen, multivitamins, prenatal vitamins, Pepcid for GERD, common antibiotics for UTIs or skin infections, etc.

Part of me felt proud of having done SOMETHING, but I was saddened at the end of the trip when these communities would be left behind waiting for the next medical group to help them (hopefully soon). What good was a month’s supply of vitamins? What could be done about the sugar spilling into this patient’s urine obviously indicating diabetes or kidney disease? What could be done about a severe burn on a man’s leg obtained a week ago, now infected?

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Learning how to make healthy meal choices

By 2010, there was work being done toward implementing more trips yearly, organizing a Chronic Care Program, and then finally it was accomplished. Going back this year to see the fruition of the Chronic Care Program (and more!) has been absolutely amazing and truly warms my heart at the AMAZING things being done. There are charts documenting follow-up visits for each patient in the Chronic Care Program, which treats serious chronic diseases such as diabetes, high blood pressure, epilepsy, and asthma.  Reading these charts, I was able to see there is now great structure to the operatives, making them more efficient and successful.

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Liz helps at a Sano y Feliz meeting

There is now a Referral program helping the most critical and ill patients found at each of the operativos and connecting them with the specialist care they need. Cooperadores (community healthcare workers in each community) are HHI’s eyes, ears and mouth 24/7 in each community and each patient’s link to the doctors when they are in medical need. This is a great, great thing! Monthly educational workshops prepare these Cooperadores with more and more medical and patient support knowledge so that HHI can continue meeting the goal of quality care. The program “Sano y Feliz” for healthy eating and living is a great educational tool for educating individuals in the community that want to take more control over their health. The medication supply has expanded from “Band-aid meds” to medications that actually treat conditions the Chronic Care Program was created for.

As I met patients 2 weeks after the operativo, I no longer only offered a look of sympathy – I was finally able to say, “let’s see what HHI can do for you,” knowing full well something could be done. I am proud to say I’ve been able to witness how far HHI has come and I am so proud of everyone involved in helping HHI grow as much as it has.

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