Primary Care

Please post any primary care questions, discussions etc. in this space.

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  • Hi Everyone, our volunteer team is heading out to Sierra Leone in April for the next round of Medical Mission Trip. Presently, we have few volunteer nurses. We need a doctor  to join us so we can get prescription medication from Americares.  Our medical stuff container is leaving on February.

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  • Question: In the field, how do you address and manage comorbidity and chronic conditions, when you see hundreds of patients a day? Would be interested in your feedback. Thanks!

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    • Valerie Colgate, MSGH, CCTSS  This is a great question and always a concern of mine and I hope it is something teams are always considering. I work more in disaster response and emergency work, but I am always worried about management of the chronic issues we see. I think this is so hard, especially for intermittent or short term projects/groups. I always encourage teams to have local referral pathways in place so in the event they need long-term management they can possibly have follow up. But obviously that can be very difficult in many areas. I also strongly urge people to use medications that can be found in country and have the least potential side effects or monitoring needs (ie if at all possible don’t choose a brand name drug or a drug that requires follow up labs). Have a plan in place for how a patient will check in regarding their meds effectiveness—maybe a local community health worker can recheck BP in 2 weeks and text you, for example.  I help with an organization that has a whole network of nurses in USA (and elsewhere) who respond to texts via WhatsApp from our community health workers who send vitals and send photos of the patients they visit so we can track them when we aren’t in country (these are TB and HIV patients so on high risk meds and some on home oxygen, etc). 

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    • Micaela Theisen Also, always remember to “do no harm”—sometimes it is safer to do nothing or do less than perhaps you ideally would, in certain situations.  sometimes you have to think of innovative interventions that work locally rather than putting someone on a high risk med or doing a procedure than could cause problems in the long term if not followed. It is imperative that one always consider what the long term implications of a treatment or med are in these situations.  

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  • This is a quick interesting article about inexpensive and simple innovations that have changed public health. I am wondering what inexpensive  innovative interventions you have seen in your settings that perhaps could be expanded elsewhere? 

    https://www.technologyreview.com/s/612952/ten-recent-low-tech-inventions-that-have-changed-the-world/?utm_campaign=site_visitor.unpaid.engagement&utm_source=facebook&utm_medium=add_this&utm_content=2019-02-28&fbclid=IwAR3KRw0Xm3IlfEaqw6Rvz-dFKdoEynZR9xjA3d_Pij785qWJ6oV49sP9HNM

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  • Micaela Theisen Thank you for your reply to my discussion post! I appreciate you sharing your field experience and knowledge in disaster response and emergency work. I'd like to summarize the ethical and sustainable pathways of care you discussed, in regards to addressing and managing comorbidity and chronic conditions in the field.

    1.  Establish local, referral pathways of care for follow up care i.e., community health workers (CHWs).

    2.  Use medications that can be found in-country with least potential side effects and/or monitoring needs.

    3. First and foremost do no harm. Agreed, very important! Sadly, short-term projects that do not partner with the local, health community and have no intention for long-term engagement, may cause more harm than good.  

    In closing, I'd love to hear more about the organization you aid with that responds and tracks CHW messages via WhatsApp. I'm very interested in innovative forms of virtual technology. Did you see the webinar I posted under 'Webinars, Conferences, Courses Etc.' topic about Using WhatsApp to connect, train, and empower health professionals in Sub-Saharan Africa? This presentation will be in May. 

    Also, thank you for sharing the article Ten recent low-tech inventions that have changed the world. I love learning about global health innovations. Please note the Global Health and Innovation Conference in April under 'Webinars, Conferences, Courses Etc.' topic too . Here's another great resource: Innovation Countdown 2030 Reimagining Global Health 30 High-Impact Innovations to Save LivesI too would be interested in hearing from members about any cost-effective, innovative interventions you have seen in the field that could be scaled. 

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  • Hello,

    Great summary, thank you!

    I am involved with Ti Kay, Inc in Haiti which is an organization that treats patients with TB, many are also co-infected with HIV. For several years after the 2010 earthquake they also ran an inpatient facility for these patients as there were very few places to go at that time if you were oxygen dependent, and there was (and still is) a huge stigma around these diseases.  The org has transitioned to more home-care visits due to lack of funding for an inpatient facility. They now have an incredible network of local CHWs that visit the patients daily. They monitor med compliance and some are on directly observed therapy (for HIV as well, for the less compliant ones).  They also monitor oxygen saturation, nutrition, lower ext edema, and general condition. They they send photos of the vitals and patient condition and med administration via Whatsapp to a team of nurse (and a few physician) volunteers who are each assigned to 1 or 2 patients. If there are changes, such as increase in oxygen need or weight loss or gain or other changes, or a patient misses doses or is missing (sometimes they leave to visit family or for other reasons disappear for awhile) then we work with local staff to make med changes (via the medical director/infectious disease physician) or obtain home oxygen (via concentrators) or advocate for whatever other interventions are needed.  It is a simple approach that has allowed us to care for a large number of people with a small team of local staff. Many of our CHWs are former patients themselves and they are really amazing at helping patients understand why they need to take meds daily. They also help them through many of the common side effects, encourage good nutrition (which we provide) and encourage physical activity because they know what is needed to get stronger. It is also a great system because these former patients now have a relatively well-paying job too, and many of them likely would not have been able to get a job before.  They have wanted to do some data collection to compare outcomes with other TB treatment programs but so far have not had the capacity to do this (it is a small org), but anecdotally I think they have done really well and on a very limited budget. 

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      • Ann Colbert
      • Physician
      • Ann_Colbert
      • 1 mth ago
      • Reported - view

      Micaela Theisen 

      Very interesting to read about Ti Kay.  Sounds like they are making good strides against TB.  I was curious how they use telemedicine- do they consult providers in Haiti or outside of the country?  Virtual medicine is a real positive for global health. 

      I volunteer for an organization The Addis Clinic which has a well developed system for providing telemedicine consults - the health care workers seeking help are mostly located in Africa and the consultants are from the US. The number of consults are growing fast - last month I believe there were 117 consults with 15 specialties being used. If any physician is interested in volunteering, go to https://www.addisclinic.org/ for information. The most consults one consultant will get in 1 month is 3 and the platform is very easy.

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    • Ann Colbert , yes Ti Kay is a fantastic organization working on a shoestring budget now. They previously provided some of the only inpatient TB care in Haiti but due to lack of funding and changes at HUEH (the national hospital in Port-au-Prince), they had to cut out the inpatient care. Luckily it sounds as though some other established programs have taken over some of the TB care needs in Haiti. In regards to telemedicine consults, they are primarily done by providers in USA, most of whom are able to speak Haitian Creole which is a huge asset.  

      I agree that telemedicine is a real positive for global health. It certainly improves access to specialty services which can be really hard to come by in some areas.  What we do at Ti Kay is relatively small scale for telemedicine, but I know at Bernard Mevs in Port-au-Prince and at HUM in Mirebalais, Haiti they were ramping up telemedicine efforts last time I was there. Both facilities are fortunate to have connections to training programs in the US and elsewhere which help facilitate their telemed programs. 

      Thank you for sharing about the Addis Clinic. I will share this with some of my physician colleagues who I think would be interested. I'd love to hear from others in the forum as well. Are you using telemedicine services or other platforms to help expand access at your sites? Would be interesting to hear what is done elsewhere especially in areas that may not have access to larger networks of telemedicine services (or the equipment such as video conferencing and such). 

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  • Micaela Theisen Thank you for sharing about Ti Kay, Inc. and your work with them in Haiti! 

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  • I'm not sure which topic this best goes under, but this is a great list of books that have been recommended by those interested in global health. I have only read a few of them, but now have many more on my to-read list.  Does anyone have any recommendations for books they have found helpful in their work? I especially like to try and read a local author or a book on the historical context of any place I am going because I think it helps me connect to an area and understand some of the potential challenges. 

    https://naturemicrobiologycommunity.nature.com/users/20892-madhukar-pai/posts/41300-if-you-had-to-read-one-book-on-global-health

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  • Micaela Theisen  Thank you for sharing! 

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  • The WHO released their top 10 biggest global health threats for 2019: https://www.who.int/emergencies/ten-threats-to-global-health-in-2019. Pollution and climate-change related issues and non-communicable diseases are at the forefront. I am interested to hear what problems or action points your teams or organizations are focusing on this year. What are your thoughts on this list? Does it seem to coincide with what you are seeing or hearing on the ground?

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  • Edx.org has a new course free open access course starting soon that may be of interest to those of you who work with/train local community health workers. Here is the link:

    https://www.edx.org/course/strengthening-community-health-worker-programs-to-deliver-primary-health-care

    As a reminder, there are also many great resources/links on the Americares Medical Outreach Exchange site: https://medicaloutreach.americares.org/en/resources/

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  • You may have seen the news release on this 27 year global diet analysis published by Lancet suggesting poor diet is responsible for more deaths worldwide than anything else https://www.cnn.com/2019/04/03/health/diet-global-deaths-study/index.html). The full article is attached here,  or it is open access on the Lancet website.   I'm curious if this is something you try to address when doing primary care in your global health settings? I have always found it difficult to address diet--especially in areas where food choice is highly limited by access or poverty.  I currently work on a remote part of the Navajo Nation and access to healthy food is an ongoing challenge here. There are some local initiatives through the IHS and through the Cope Program (https://www.copeprogram.org/), but it still remains a huge barrier, even here in the USA. 

    I'm curious what you have seen in the field...is this something that is being addressed? And what more can we do, especially knowing it is a huge contributor to deaths worldwide?

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  • There was an interesting article in the NYT today regarding antibiotic resistance as a growing concern among low and middle income countries and other places where there is less pharmaceutical regulation.  I am sure many of you have encountered this on prior trips, but certainly something to be aware of.  It is a tricky balance as increasing access to cheap antibiotics has also helped many, but lack of regulation (both in production and dispensing) is a huge concern. And, lack of access to trained providers and pharmacists for people to get properly prescribed antibiotics only fuels the problem.  Is anyone aware of global programs out there working to address this? I know there are initiatives within the US, but I am not sure about elsewhere. Is it something you try to address during your work in countries or communities where this is less regulated? Any success stories?

    https://www.nytimes.com/2019/04/07/health/antibiotic-resistance-kenya-drugs.html

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  • Hi all, 

    Please share what type of medical record/documentation you do when you are on outreach trips. I have almost solely done fairly basic paper documentation (on triplicate or duplicate paper) but not sure how useful this has been for the patients. I’m curious if there are any teams using EMR on outreach trips?  There are a number of open source platforms available and I have heard good feedback about OpenMRS (https://openmrs.org/) where you can create your own EMR specific to your program needs. Has anyone tried this? Or any other program? 

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    • Micaela Theisen  great question! Interested to hear what folks are using for your trips. 

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  • We’ve touched on this a bit before, but I would still be interested from other groups on how they are approaching NCD management (non-communicable disease) during short-term medical missions. It’s become a larger focal area in recent years, but in my experience, many times we are unprepared for proper management of NCDs on shorter-term medical outreach.  Even during my more recent trauma projects in Iraq and Syria, I’d say the majority of our patients actually were seeking care for chronic disease management and we (as a collective humanitarian response) weren’t well prepared for this. 

    http://www.thenewhumanitarian.org/analysis/2018/12/11/new-normal-humanitarian-aid-treating-middle-class-diseases

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