By Kate Taylor
With a few unpredictable elements at each outreach station – weather, number of people waiting upon arrival, number of people expected throughout the day, demand for certain medications, and the physical space we are given – it is difficult to strategically plan the flow of each clinic to be as efficient as possible. However, as the think-on-your feet approach of the first few missions gave way to a more established understanding of how to maximize effectiveness, our team began to function like a well-oiled machine.
Patients wait to be registered.
As soon as the individual stations and supplies are set up each morning, the doors are opened for patients to register. This tends to be a chaotic process as often hundreds of people are waiting for us upon our arrival and the sign-in booths are quickly congested with people vying to establish who was first in line.
Once registered, each patient’s basic information including name, age, sex and location of residence is recorded and they are given a form to take as a record, and for our staff to refer to as they make their way through the necessary stages of the clinic.
From there, patients wait to see volunteers from local health clinics who mark down their weight, blood pressure and chief complaint, and then they are directed to the nurse triage stations.
Patients wait with their registration forms to see the next available triage nurse
On top of doing a head-to-toe assessment, specifically zoning in on their chief complaint, a pivotal role – and perhaps an unexpected one – of the triage nurses is to provide health education. Many of the benefits of proper dietary, lifestyle and hygiene choices that are obvious to us aren’t well understood or even known. For example, a child came in complaining of burning in their belly but after further assessment, the nurse discovered that they had six bottles of Coke that day and eaten only fried, or heavily sweetened or salted food for days prior. Many patients don’t have a choice but to eat what’s affordable and available.
Sugar is the number one export in the Philippines, and it is consumed at an exorbitant rate. Triage nurses say that there seems to be a disconnect in patient’s knowledge of the adverse effects of excessive sugar intake, with most people drinking Coke multiple-times a day, often with every meal, even at breakfast. Coupled with the fact that there is no fluoride in the water and many of the patients we saw could not afford toothbrushes or toothpaste, this explains the alarmingly common cases of poor dental hygiene.
Unfortunately, it is not an exaggeration to say that the vast majority of the patients we saw had extreme dental decay. Most of the adults and a lot of children had some, if not all of their teeth fall out and there were many visible cavities.
When Jasmine Errett, an ER nurse at St. Michael’s explained the importance of dental hygiene, her patient said that it simply was not a necessity. Buying a toothbrush would mean choosing it over buying food – a choice with an obvious answer.
Triage nurses then send patients either to the eyeglasses station or to our doctors at the clinic based not only on their symptoms, but sometimes unfortunately, on our available treatment options. Given the mobility of our clinic and the limited resources we have to offer, patients who need a biopsy for example are referred to local social workers who often have a station set up at our clinics. Gynecological problems, although relatively common, can also not be treated as we simply do not have the resources to examine patients.
A man waits to be seen at the social welfare desk
What the doctors have been able to successfully assess or prescribe medication for is high blood pressure (common because of the excess salt consumed), bad and chronic coughs, worms, infected wounds, asthma and high fevers to name a few.
After seeing the doctor, patients needing to fill a prescription head to the pharmacy. In reflecting the types of cases the doctors are seeing, the most commonly prescribed medications are anti-hypertensives, inhalers, antibiotics, Tylenol and Advil.
The pharmacy team hard at work
We call it a kind of “organized chaos”, but at the end of a long day, once we have funneled thousands of people through our carefully crafted system, we realize how well it works.