Manual for

United Methodist Volunteers in Mission (UMVIM)

Health Care Volunteers: Honduras

This Manual:

This manual has been prepared with the goals of being in a website format, to be “information dense” yet concise, and to be user friendly with multiple links to both critical, need-to-know and supplemental information for health care teams.  At its initial posting, it has a strong emphasis on primary medical and dental care but it is the hope of the United Methodist Volunteers in Mission (UMVIM) Health Care Team in Honduras that it will quickly expand to encompass the vital health care disciplines of a variety of medical specialties, nursing, optometry, preventive medicine, and health care education. Health care leadership in the United Methodist Mission Church in Honduras is excited about potential partnering with Honduran public health agencies and the development of Community Based Primary Health Care in conjunction with a progressive program of Community Health Needs Assessment.

Acknowledgements:

          This posting is the combined work of Cindy Ceballos, BSN, UMVIM Health Care Coordinator, her short-term volunteer in mission assistant, Laura Thompson, RN, Litterman, and Dr. Roger Boe who has written the UMVIM Manual for Health Care Volunteers.  We are indebted to Dr. Boe for much of the form, format, and content that comes from his manual. That manual includes the following Acknowledgements.

“Notable earlier efforts in producing a Health Care Manual include Nuts and Bolts of Short-term Medical Missions, by Jim and Linda Fields of the SEJ, The Texas Annual Conference Partners-In-Mission Medical Training Manual, written by Kathie Mann, and the section on Health Care Teams in the UMVIM Training Manual for Mission Volunteers, 2005, ably edited by Jeanie Blankenbaker.  Destination Manuals have also been written for a number of sites served by UMVIM Health Care Teams.  It is designed to supplement, not replace the Revised Training Manual for Mission Volunteers, 2005, which provides general information vitally important for all UMVIM teams.  The information contained in that manual will not be duplicated here.  It is recommended that both manuals be used as resources for forming and training your health care team.

Also thanked are all of those who read over the drafts of this manual, and provided invaluable constructive criticism and feedback.  They include:

TABLE OF CONTENTS

1. Introduction and Philosophy  

2. Sites                                                                                                    

3. Putting Together Your Health Care Team

a.       Team Size

b.       Team Composition

c.       Translators

d.       Dental Teams (INCLUDING DENTAL MANUAL)

4.       Differences between US Experience and Honduran UMVIM Clinics

5.       Evaluation of Typical Complaints of Honduran Patients

6.       Supplies, Equipment, and Pharmaceuticals

a.       Supplies and Equipment

b.       Pharmaceuticals (with links to Formulary and Honduran Med Price List)

7.       Other Important Medical Considerations and Preparation Issues

a.       Commonly Seen Illness in Honduras

b.       Physician and Dentist Credentials

c.       Getting Through Customs

d.       Liability Issues

e.       Charging a Fee

f.        Gift Giving

g.       HIV/AIDS

h.       Birth Control

i.         Left-over Meds

j.         Security Considerations

8.       Setting Up a Health Clinic: the Nuts and Bolts

a.       Intake

b.       Triage

c.       Waiting Area

d.       Exam Room

e.       Pharmacy

f.        Record Keeping

g.       Health Education

8.   Treatment Protocols – Honduras

9.   Community Based Primary Health Care

10. Site Evaluation and Community Health Assessment

11. Other Logistical Concerns for Health Care Teams

a.       Abbreviated Checklist for Health Care Teams

b.       Health Care Team Immunizations

c.       Flexibility and Packing Suggestions

d.       Honduras Travel Tips for Health Care Teams

e.       UMVIM Policies Specific to Health Care Teams

f.        Emergency Phone Numbers and Internet Access

12.  Other Helpful Links

INTRODUCTION AND PHILOSOPHY

The United Methodist Mission Church in Honduras has identified health care as a major priority for the communities served by its component churches to serve both members of the congregations and the people of the surrounding community.  A focus of that priority includes the welcoming and logistical support of UMVIM health care teams and individual health care volunteers, including but certainly not limited to medical, dental, optical and health education areas of expertise.  The long term health care focus of the church is the development of sustainable, day-to-day health care availability for these communities to provide a continuity of patient care.

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SITES

 Health care teams are currently received at the following sites that have developed or are developing a measure of local support.  See Honduras Map of Sites. http://www.gbgm-umc.org/hondurasini/mission%20teams/preparing/mappage.htm

1. La Ceibita- Centro de Salud (Public Health Center)- Serves 3 communities, approx. 3,000 people Clinic averages around 50 patients per day and is staffed by one licensed nurse and an assistant. Has limited access to medications

2. Talanga- Centro de Salud - Serves approx. 35,000 people, has 4 several physicians who rotate work through the clinic.  There are a number of pharmacies (privately owned) within the area.  Teams would be hosted at the church house/parsonage and stay at La Fuente Hotel

3. Escuapa- Centro de Salud- Serves 8 rural communities, provides services for approx. 800 people.  Clinic has no access to a pharmacy. Provides general exams and vaccinations by local nurse

4. Subirana- Centro de Salud- Serves 8 rural communities, approx 4,000 people.  Has one physician that is available in the clinic during limited hours. This clinic also has a small pharmacy associated with it.

5. Cuidad Espana- Centro de Salud- Provides services for approximately 9,000 people, Clinic is currently open only during part of the week on limited hours with a maximum of 15 patients a day seen by the local nurse.  There is currently no Dr. or Pharmacy.  A Dentist is available at the clinic until August of 09.

6. Danli Central Church-Danli- Provides services for approx 5,000 people, 8 communities with limited medical care and prescriptive assistance Health Care Teams to be located within the church

7. La Cofradia Church- Danli- Provides services for approx 5,000 people, 8 communities with limited medical care and prescriptive assistance. Health Care Teams to be located within the church

8. San Jose de la Vega-Tegucigalpa-Provides services for approx. 7,000 people. There is a “Centro de Salud” within the neighborhood 5 blocks from the church. People in the community have access to both private and public health here as church is located within Tegucigalpa proper.

9. Fuerzas Unidas-Tegucigalpa-Serves approx 3,000 people, Has a private clinic within the church itself with pharmacy and physician, who is available on Thursdays. Clinic staffed for basic fundamentals otherwise. 2 additional private clinics within area

10. El Paraiso-Serves 8 communities, approx 10,000 people has a “Centro de Salud” where 5 medical doctors cover on a rotating basis and one licensed nurse. Church is considering the building of a clinic within the church (status incomplete) that will have pharmacy as well. As of April,2009, those plans are on hold.

11. Siquatepeque-Rural area. Serves approx 1500 people, No pharmacy, Has a “Centro de Salud” building that is not in service, Health Care Clinics to be held in clinic building

12. Quisqualagua-serves approx 500-600 people, currently no medical services available. Health Care Clinics would be hosted in the school.

For specifics on any site, contact the UMVIM Health Care Coordinator. 

Public Health Centers—Centro de Salud

At several sites (Escuapa, Ciudad España, La Ceibita, and Subirana), visiting Health Care Teams are hosted by the local government-run public health clinic. UMVIM is working to collaborate and maintain an ongoing relationship with these sites and will work along side of the staff that are in these clinics.

Visiting Health Care Teams generally do not have access to the pharmacy of the Public Health Center.  Teams need to supply all medicines they will use. This is mandated by the government because of the constant shortage of medicines at Centro de Salud.

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PUTTING TOGETHER YOUR MEDICAL TEAM

Careful planning, starting, ideally, at least a year to 15 months prior to your initial trip, is the most important key to a successful experience.  See the Abbreviated Checklist.  Click Here.  The expanded Checklist for Health Care Teams provides a step-by-step plan outline that will guide you through the process.

CONTACTS

Your first and most important contact will be the Honduras UMVIM Health Care Team Coordinator, Cindy Ceballos, BSN, cynceb@yahoo.com  

Cell phone: +504-3231-8735

She will make all of your arrangements while you are in Honduras and will help you in your planning process.  Ongoing contact with her during the entire time of preparation is very important

It is advisable to contact your Jurisdictional and Conference UMVIM Coordinators as early as you can to advise them of your trip. They can provide additional information, resources and contacts to help in your planning as well as tracking your trip for the UMVIM Connection.  For a listing of Jurisdictional Coordinators see the following website.  http://new.gbgm-umc.org/about/us/mv/mission-teams-umvim/jurisdl-umvimcoords/ 

MEDICAL MISSION TEAM SIZE

Honduras Medical UMVIM does not have a limit on team size.  However, larger teams may incur extra transportation costs when team membership, including translators, exceeds 14 persons.  The UMVIM Health Care Coordinator will provide further information during trip planning.

TEAM COMPOSITION

Here are some guidelines for having an appropriate balance of medical and non-medical personnel.  The mix of personnel depends on site and purpose of team.

·        Physicians/Dentists: For a general medical clinic, 1 or 2 physicians are ideal.  

·        Nurses: Nurses are valuable and versatile members, and can be used in many ways including triage, arranging for follow-ups, assisting physicians, pharmacy operations

·        Physician Assistants (PAs), and Nurse Practitioners (NPs): PAs and NPs are not categories recognized by the Honduran College of Physicians.  They can function well as providers with MD supervision

·        Pharmacist or pharmacy coordinator: A nurse may assume this position to coordinate pharmacy assistants.

·        Non-medical persons (50% or more of team can be non-medical) 

a.    Pastor or someone who assumes pastoral role

b.   Fix-it expert

c.    Crowd control supervisor—may be local

d.   Can do many needed medical tasks, such as data entry, vitals, basic pharmacy duties, gofers, ambassadors, advocates, educators.

·        Translators are a crucial part of an effective team.  Recruit them!  The UMVIM Health Care Coordinator will assist in lining up Honduran translators.

Specialists are welcome.  Gynecologists are especially sought after in Honduran communities.  Health education specialists with a related and focused topic can present partnership with members of the community and/or a local health worker.

TRANSLATORS

Adequate medical care requires full communication with patients.  Skilled translators are crucial to success of a medical team.  They must be fluent in English and Spanish and should be familiar with medical terminology.  Minimally, a translator will be needed for each medical provider, one (1) for intake (unless done by locals), one (1) for triage and one (1) for pharmacy.  Consult with the UMVIM Health Care Coordinator about translator fees and costs and how many translators you will need.  Honduras UMVIM requires all medical mission teams to hire at least one local translator to assure the best communication possible between caregivers and patients. Generally, translators will reside and eat with the teams

DENTAL TEAMS

·           Dentistry at some UMVIM sites in Honduras may be limited to extracting teeth and teaching dental hygiene.

·           Other sites may be able to provide more complex services that require more sophisticated equipment and trained assistants.

·           Suggestions for equipment and supply needs can be found in “Getting Supplies and Equipment”, available for download from www.healthcarevolunteers.org.

·           A discussion on Mobile Dentistry and a list of suggested equipment needs for a dental clinic in Honduras, by Tom Brian DDS, is found in the following link.  Click here.

It is strongly recommended that the general information found in this manual be reviewed by dental teams.  For more specifics on dental team missions, see the linked Dental Manual (Click here)

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DIFFERENCES BETWEEN U.S. EXPERIENCE AND

HONDURAS UMIVM CLINICS

Operation of a medical clinic in the US is not the same as providing primary health care in a short time clinic experience in Honduras.  The following are some significant differences that health care personnel must be familiar with to serve the Honduran population most effectively.

All of the team’s medical personnel should make themselves aware of these differences early in the planning stage of their trip.

1.    Assumption:  We can take care of almost all the patients we see.

Honduras Experience:  Due to limitations in our expertise, finances and referral resources, not all illness that we see can be diagnosed or treated.

2.    Assumption: Doing a complete history and physical exam is necessary for good care.

Honduras Experience:  Number of patients sometimes dictates shortening to essentials. Triage becomes very important.  However, making a thorough evaluation may be lifesaving, and more important than treating a hundred kids for diarrhea and worms.

3.    Assumption: Patients who come to the clinic are sick and will receive the full attention of the provider.

Honduras Experience:  Many times a mother who wants the best for her family will bring all of her children.  This may be the only time they have ever seen a physician.  They also may have traveled many miles and stood in line for hours.  It will be hard to turn them away without being seen, with a handful of vitamins and worm medicine.  Take this step only if absolutely necessary.

4.     Assumption: You can confirm your diagnosis with appropriate lab and X ray

Honduras Experience:  Lab and X rays are hard to come by, very expensive, and may be totally unavailable.  Clinical acumen becomes very important.  Consider bringing a glucometer and hemoglobinometer, with lots of test strips.  Urine dipsticks are also helpful.

5.    Assumption: Specialist consultants are right across the hall.

Honduras Experience:  Short term medical mission teams are usually the end of the line.  You will need to do your best, and use your skills to the utmost.  Talk to the other members of your team and your hosts about the difficult cases.  As may be possible, the UMVIM Health Care Coordinator can advise on potential referrals.

6.    Assumption: The meds you would want on hand at a clinic in the US are the same as you’d want in Honduras.

Honduras Experience:  Disease prevalence is different in Honduras.  Experience of previous teams is valuable and reflected in Suggested Formulary-Form A, which is a generalized list based on the experiences of those teams.  No formulary is one-size-fits-all.  There are many variables, including the physicians (their preferences and specialties) and the particular site in Honduras.

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Evaluations of Typical Complaints of Honduran Patients

Based on training, practioners in the US evaluate patient complaints in a different fashion that those in Honduras.  Knowledge of some of these differences in evaluation and expectations will help US practioners better understand patient complaints and descriptions of their symptoms.  The following link to a discussion of these differences in patient complaints is important information for all treating personnel seeing patients in triage and examinations.  See Evaluation of Typical Complaints of Honduran Patients.

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SUPPLIES, EQUIPMENT, AND PHARMACEUTICALS

The following two sections provide assistance with securing supplies, equipment and pharmaceuticals.

MEDICAL & DENTAL EQUIPMENT & SUPPLIES

Health Care Teams to Honduras are responsible for providing everything they need to run a clean clinic.   Teams must arrange for procurement of supplies in Honduras or carry them with the team in transit.  There is currently no space for storage of advanced shipments.  Close, ongoing communication with the UMVIM Health Care Coordinator during pre-trip planning will help assure adequacy of supplies during your trip.

The following are some helpful hints regarding supplies and equipment.

·           You can’t possibly take everything with you that you think you will need

·           You can’t possibly foresee everything you might need.

·           Teams  seldom have to deal with large equipment if serving a small clinic

·           Teams will usually need to bring their own surgical and dental tools and examination equipment.

·           It is usually best to hand-carry on the plane any fragile or expensive small equipment.

·           Keep in mind that since Sept 11, security will not allow you to carry on any sharp instruments or anything that could even be remotely considered a weapon.

·           Medical and dental supplies such as gloves, bandages, suture materials and hand instruments are expensive and sometimes not obtainable in Honduras

·           Authorized gleaning from US clinics and hospitals is an excellent way to get these supplies at no cost.

·           Several nonprofit agencies specialize in collecting, packaging and shipping these supplies.  They basically charge only for shipping and handling.   (See ‘Getting Supplies and Equipment’) http://new.gbgm-umc.org/media/volunteerdocs/Getting%20the%20right%20stuff-19Feb08.pdf  Also see the following: http://new.gbgm-umc.org/about/us/mv/programs/umfhcv/medical-sources/

Some suggested items available in Honduras at competitive prices include:

·           Simple plastic bags for dispensing medicine (very inexpensive)

·           Household bleach for disinfecting hard surfaces

·           Liquid spray cleaners

·           Paper towels

·           Plastic garbage bags

NOTE: Credit cards are not accepted everywhere in Honduras and church credit cards are not accepted here if the name on the credit card does not match the name on the identification card of the person buying.  US dollars are not accepted at all local stores in Honduras.  Plan on changing dollars (both team and personal money) into Lempira upon arrival at the airport.  Newer, crisper US dollars are preferable.

Other Medical Equipment to Bring to Honduras:

·           One stethoscope for each person consulting with patients and for each person doing blood pressure checks.  

·           One or two blood pressure cuffs.  Multiple sizes are not necessary.  Several cuffs will facilitate the intake process.

·           One ophthalmoscope, otoscope.  Even with two or three people consulting, equipment can be handed back and forth.  Usually ears are checked when there is an ear complaint, and eyes when there is a specific indication.  The electricity is the same as in the US.  Recharging can be done in hotel room/retreat center/ministerial house each evening.

·           Several basic wound kits.

·           Thermometers for adults, children, and infants.

·           A PDR, either on a palm pilot (e.g., PDA with Epocrates software), or hard copy has been found useful by many

·           Pill Counting Trays and spatulas.

·           Many pens, pencils, and permanent markers.

·           Some rolls of tape, strapping, masking, duct, Scotch.

·           Health Brochures and Posters in Spanish, on any and all health topic. No brochure or poster is too basic!

·           Simple glucometers and hemoglobinometers are often useful, but must be accompanied by a generous supply of test strips and supplies.

PHARMACEUTICALS

Selecting and obtaining the right medicines is an important task for any medical team, and the process should be started early (at least several months before travel).  See Suggested Formulary-Form A.

There are two generally recommended sources of medications open to teams.

1.      US collected (purchased or donated) meds transported with the team to Honduras

Note: Sources of Meds in the US (free or inexpensive sources of medicines and supplies)

Ø      For great guidance on sources of meds, check the following website: United Methodist Fellowship of Health Care Volunteers, Getting the Right Stuff.  http://new.gbgm-umc.org/media/volunteerdocs/Getting%20the%20right%20stuff-19Feb08.pdf

Ø      Consider gleaning----obtaining samples of medicines from clinics and hospitals---does not always get you what you need, and have to be repackaged, but they are free.  Small quantities of drugs are not very useful.

Ø      Donations from drug companies may be very helpful, but are getting more difficult to obtain.

2.      Wholesale priced medications available in Honduras

Note: UMVIM Honduras recommends that your team buys the medicines that you can in Honduras

Ø      It supports Honduras and models that not all good medicine is from the US. 

Ø      It fits our goal of self-sustainability.

Ø      Purchasing liquids in bulk in Honduras is more convenient due to excess baggage weight.

The medicines are purchased in Honduras under the direction of the UMVIM Health Care Coordinator before the team arrives and are transported with the team to the worksite.  Sometimes certain medicines are out of stock in Honduras, therefore give lots of lead time.

START EARLY, PLAN AHEAD!  Unless the team is working in the city of Tegucigalpa, this is the only chance to buy medicines at a wholesale price.  Once the clinic has started, the only option to replenish your pharmacy will be to buy from a local pharmacy, which will have limited supply and higher costs.  Therefore, your team needs to think carefully (well in advance of your trip), with the help of the Suggested Formulary-Form A and the Medicine Price List-Form B, about what the team wants to have purchased locally in Honduras.

Some additions thoughts on pharmaceuticals include:

·           Include a pharmacist either on the team or as a consultant.

·           For patients requiring long-term drug therapy, try to select medicines that are affordable and can be purchased locally by the patient.  Consult with the UMVIM Health Care Coordinator.

·           Most teams tend to run short of vitamins and analgesics (acetaminophen, ibuprofen, naprosyn, etc.)

·           Vitamins - Bring lots of vitamins – at least 30 for every patient you see, plus some!

Ø      Expensive in Honduras, so plan to carry these from the US 

Ø      Leftover vitamins will certainly get used in the weeks after the team leaves

Ø      4 kinds of vitamins are needed:  infant (liquid), children (chewable), adult, and prenatal vitamins. 

Ø      Vitamins with iron are the best.

·           Some great items for The Team’s congregation(s) to donate (generics or house brands are cheapest)

Ø      Acetaminophen (Tylenol)—for adults, kids, and babies. 

Ø      Ibuprofen (Advil)—for adults, kids, and babies. 

Ø      Antifungal cream

Ø      Lots (2-3,000) of sandwich-size and snack-size Ziploc baggies. 

Ø      Some (1 for each patient family) gallon-size Ziploc baggies.

Ø      Children’s chewable VITAMINS with Iron

Ø      Cortisone cream

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OTHER IMPORTANT MEDICAL CONSIDERATIONS AND PREPARATION ISSUES

There are a number of other considerations and preparation issues that need to be addressed to assure a successful medical mission trip experience.

Commonly Seen Illnesses in Honduras

Common illnesses of:

Patients less than 5 years of age: colds and fever, intestinal parasites, skin problems (especially fungus) and diarrhea, 

Patients 5 to 14: intestinal parasites, respiratory problems, sore throat, and skin problems (fungus), 

Patients 15 to 49: intestinal parasites, colds, gastritis, urinary infections,

Patients 50 and over:  heart problems, diabetes, arthritis and gastritis. 

PHYSICIAN AND DENTIST CREDENTIALS

Physicians will need certification of current licensure and permission to work with the Honduras Methodist Church through the Honduras College of Physicians.  Dentists need similar permission through the College of Dental Surgeons

·           You will need to submit the following 2 MONTHS PRIOR TO THE TRIP.

1.            Copy of general medical or specialist degree (diploma).

2.            Copy of the current license to practice medicine or dentistry

3.            Copy of passport.

               Be sure to label all documents with name of team leader and dates of the mission trip.

·           Copies do not need to be notarized or authenticated. 

·           Scanned copies are best if at all possible.  Scan at medium to high resolution and email to UMVIM Health Care Coordinator. 

·           Faxing might be possible.  Check with  .

·           Nurses and other health professionals do not need documentation or registration.

·           The Honduras College of Physicians does not recognize physician assistants or nurse practitioners as separate categories.  They can serve as medical providers under the supervision of a physician.  The same is true of medical students.

GETTING THROUGH CUSTOMS

Experience has shown that teams are most frequently waved through customs due to the strong positive reputation that Honduras UMVIM has established over the years.  In the event that questions are asked in customs, thoroughly prepared packing lists for each suitcase help expedite the customs process.  The following preparations will facilitate the customs process.

·           Pack medical items in suitcases (recommend those that may be left in Honduras).  Avoid checking cardboard boxes to help assure arrival of team materials with the flight.

·           Have a detailed Luggage Inventory Sheet Excel or Word (for each suitcase) available for customs.  The list should include the name, strength, amount and the expiration date of the medications in that container.

Ø      Send a Word formatted copy to the UMVIM Health Care Coordinator prior to travel

Ø      Put a copy of the list in each checked suitcase or box that contains medications.

Ø      The team leader should carry a copy of the lists in his/her carry-on

·           Obtain a notarized letter from a church official, preferably one of high rank, vouching that the medicines and supplies are not for sale, but will be used to treat the poor.  Include in this letter a request that the container be expedited through customs.

·           It may help to be met at customs by someone from the local church who has expertise in getting through customs and can explain the purpose and intent of your visit. (This may not be possible with the security increases after September 11.

·           Do not have any outdated medicine or you may risk confiscation of the entire lot.

LIABILITY ISSUES

The following includes a brief synopsis on the issue of malpractice liability

·              There has never been a malpractice claim or other liability claim filed against any member of an UMVIM team either in Honduras or any other site outside the United States. 

·              A recent legal opinion has stated that the risk for this occurring is virtually nil.  (See malpractice issues for HCV, www.healthcarevolunteers.org.)

·              UMVIM does not provide malpractice insurance coverage.

CHARGING A FEE

Almost all of the Health Care Clinics hosted by the Methodist congregations in Honduras charge a consult fee, usually 10 lempira (55cents).  A great deal of thought has gone into this decision.

·     The money goes to the local church, and helps to offset the local costs of setting up and running the clinic.

·     There are also good reasons for charging a small fee.

Ø      It preserves dignity.  People are reluctant to take handouts

Ø      It increases the perceived value of the care that is given.  Patients are more likely to follow the medical advice they have paid for.

Ø      It is another way to teach the connection between health, value and budget.

Ø      It fits the model of sustainability.  The local nurse salary is entirely made up of these small fees.

Ø      There is no charge for medicines.  Note: US Agencies that donate medicines stipulate that medicines may not be sold.  Honduras customs rules also state that imported medicines may not be sold.

Ø      NO ONE IS EVER TURNED AWAY BECAUSE OF INABILITY TO PAY. 

Ø     The money is collected by a trusted, discerning church member who is able who can and who cannot pay.

Gift-giving

Please do NOT give items away directly to patients, other than vitamins and medicine. 

Any donations such as shoes, shower sandals, candy, toys, pencils, etc, should all go to the pastor to distribute in a fair way after a team leaves.  There are many good reasons not to give things away to individuals (see Gift-Giving Guidelines). http://www.gbgm-umc.org/hondurasini/giftgiving_main.htm   In addition, if a medical team gives things away, it attracts people who are not sick to the clinic, and thus decreases the efficiency of the medical team over the week.

HIV/AIDS

HIV/AIDS is spreading and killing fast in Honduras.  Providers should always protect themselves against the spread of HIV.  Literature and workshops for the community on the prevention of HIV/AIDS are welcome, condom references included.

Birth Control

Discussing birth control and providing birth control information and products is an unresolved challenge in Honduras, because of the Catholic cultural.  However, birth control pills are requested at times by women, so consider carrying to Honduras methods of birth control for women, including birth control injections on a 3 month basis.  

Left-Over Meds

The UMVIM coordinators and Methodist pastors in Honduras have identified places and doctors who are reputable and honest to which we can donate leftover medications.  The UMVIM Coordinator will make an inventory list of everything you leave behind and where it was left. Contact the UMVIM Health Care Coordinator for the specifics at your site.

Security Considerations

·        Be careful.  Be sure that the person who will be using the equipment accepts responsibility for it.  It is easy to be distracted and have equipment walk away!

·        A designated secure place should be identified for the storage of valuables such as equipment, purses, cameras, etc. that can be locked or is under strict control of a team member.  The Pharmacy works well for many teams.  Lock the pharmacy during periods when team members are absent.  The locked team vehicle also is a secure spot for valuables

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SETTING UP A MEDICAL CLINIC

THE NUTS AND BOLTS

The exact physical set up for a medical clinic depends on a number of factors, including the location, the number of health providers, and the expected number of patients.  Flexibility and ingenuity are critically important in these situations.  Some clinics are held in a school or church (including sanctuary and classrooms).  Others may be in an existing clinic building.  Flexibility and ingenuity are essential.

The local pastor usually arranges for Honduran volunteers from the local Methodist congregation to assist the medical team.  Local volunteers are great to use up front in registration, with crowd control.  They are an invaluable help.  Often they’ve had experience helping with other visiting Health Care Teams, but don’t be afraid to train new, inexperienced local volunteers.  This supports our model of sustainability and is a way for medical team members to develop the relationships that are such a vital part of the mission experience

There are usually five general areas, intake, triage, patient waiting, exam rooms, and pharmacy.

INTAKE

Responsible for initial contact  Team member or local community member presents a friendly and welcoming attitude, not that of a rigid gatekeeper.

·        Starts patient record, recording initial data; name, age, community and chief complaint.  Use the two (2)-sided Patient Information sheet. Print, copy and bring enough copies to Honduras to accommodate the anticipated number of patients to be seen during the length of the trip.

·        Assigns a number to each patient on the form to control a smooth and equitable flow of patients.  Also daily quitting time can be estimated/controlled  by the number of patients who sign up and are assigned numbers.  

·        Collects clinic fee for each patient. Assure that no one is turned away because of inability to pay.  Use a sliding fee schedule if indicated.

·        Identify sicker patients that may need priority attention.

·        Keep track of numbers and patient flow, so as not to keep too many patients being turned away at the end of the day

·        This position is usually held by a discerning local person who knows the community well and also understands the function of the clinic.

·        Need benches and chairs between Intake and Triage for those waiting to be seen by triage personnel

TRIAGE

The triage team determines the treatment path through the clinic for each patient, and dispenses vitamins and parasite treatment to each patient. 

·        This area must include one bilingual person

·        Take vitals, including pulse and blood pressure, weight in pregnant women and children under 5, and if otherwise indicated.

·        The 3 treatment paths are:

a.          Those patients who need to consult with a physician. 

b.         Those patients who are sick, but can be treated with over the counter medicines in triage. 

c.          Those patients who don’t have ailments, and will leave after receiving vitamins and anti-parasitic.

·        A triage team member dispenses vitamins (prepackaged and pre-labeled) to each patient: prenatal, adult vitamins, children’s’ chewable vitamins, or pediatric vitamin drops.

·        A triage team member administers albendazole (anti-parasitic medicine) to everyone: liquid or tablets.  **Each patient should be asked if they’ve received medicine for parasites in the last 6 months.

·        Patients who don’t see a physician are said goodbye to and they leave the clinic.

·        If assessing nutritional status, take mid upper arm circumference in children.

·        Identify sicker patients and access them to priority treatment

·        Select appropriate provider.  Suggest color-coded sticker or colored marker on patient record to indicate patient path.

·        As available, this area may perform routine labs on order of providers.

·        Direct the patient to the appropriate waiting area.

Cautionary Note: Children regard chewable vitamins as candy and may consume a month’s supply at a sitting, with disastrous results. Vitamins should never be giving directly to children, and parents need to be cautioned about the risk.

PATIENT WAITING AREA

Patients who are seeing a physician wait here.  This can be a good time to do some organized activities with the children (reading, coloring, etc.).  It’s also an ideal time to present health care related education program your team might deem useful in the community (i.e. dental hygiene, nutrition, women’s health issues, basic skin care, personal hygiene, HIV/AIDS, how to use scabacide for lice, etc.)

·        Need plenty of chairs, benches

·        Need a crowd control team.  Local volunteers may be used.

·        Suggest providing children’s activities

EXAM ROOMS/PHYSICIAN TEAMS

·        Separate rooms for each provider if possible.  Otherwise partitions or curtains.  Privacy is needed for exams.  Large sheets of opaque plastic can be suspended from the ceiling or roof structure to provide privacy.  Consider this when packing for the trip.  Check with the UMVIM Health Care Coordinator as to such needs.

·        Provide exam table, and small writing table, chairs for patient and family, translator and physician, good light source,  Check with the UMVIM Health Care Coordinator on the availability of electricity and a good light source.  Small flashlights with backup batteries work well.

·        Each person consulting one-on-one with patients (including physicians, physicians’ assistants, nurse practitioners, ophthalmologists, dentists, etc). should work with their own translator, if they don’t already speak Spanish very well. 

·        The physician receives the half sheet Patient Form and after diagnosis, writes the prescription in the bottom section. The patient carries the half-sheet Patient Form to the pharmacy.

PHARMACY

·        The pharmacy area can be a major bottleneck to patient flow, so advanced preparation is very helpful.  Teams need a pharmacist or designated pharmacy chief, and plenty of help.

·        Need to have meds organized, labeled, and readily accessible in the pharmacy

·        Assistants may count pills, and label bottles.  Locate pill counting functions out of the direct flow of medication selection, filling, and labeling to avoid congestion.

·        Since many persons are illiterate and need verbal instructions, bilingual person must be available in the pharmacy to give instructions and answer all patient questions. 

·        World Health Organization instruction form can be used for non-literate patients.  Click here.

·        The following are some pre-clinic preparations that can be undertaken to help make the pharmacy go more smoothly.  Prepackaging of the most commonly used meds, vitamins, and anti-parasitics is helpful.  It is advisable to consult with the physician(s) who will be working on the team as to their prescription preferences.  See that section on Labels for Meds in Spanish-Form C.  The following are some examples of common pre-trip packaging and labeling.

Ø      Count 30 once-a-day chewable vitamins (with iron preferred) into a ziplock bag, label as to contents (drug name, strength, pill count, and expiration date), and seal.

Ø      Count 21, 200mg Ibuprofen into a ziplock bag, label each as to contents (drug name, strength, pill count, and expiration date), and seal.

Ø      Count 24, 500mg acetaminophen into a ziplock bag, label each as to contents (drug name, strength, pill count, and expiration date), and seal.

Ø      Count 30 antacids into a ziplock bag, label each as to contents (drug name, strength, pill count, and expiration date), and seal.

Ø      If prenatal vitamins are not going to be taken to Honduras, count 30 1mg folic acid tablets into a ziplock bag, label each as to contents (drug name, strength, pill count, and expiration date), and seal. 

Ø      A Luggage Inventory Sheet Excel or Word should be filled out enumerating all contents of the item of luggage including drug names, strength, # of packages, pill count per package and expiration date.  A copy should be sent to the UMVIM Health Care

Ø      Coordinator prior to the trip; a copy should be placed in the piece of luggage, and a copy should be carried by the team leader.

Ø      Counting can be done prior to the trip or during the evenings after clinic hours.

Ø      Have pre-printed labels (in Spanish) available for anticipated labeling of all containers of medicine to be dispensed.  A sheet of envelope mailing labels is ideal for this.  See Labels for Meds in Spanish - Form C. 

RECORD KEEPING

The UMVIM Health Care Coordinator is working with the governmental health agencies to develop a recordkeeping mechanism to be used universally at public health clinics and by medical mission teams.  Teams should take sufficient copies of the form to Honduras to accommodate the number of patients anticipated to be seen.  See Patient Information sheet.

Health Education

Most often, the biggest obstacle to a community's good health is a lack of information and education. Consider, as part of your medical mission clinic, presenting in-services/ workshops/ informative talks on a variety of topics to the patients who come to the clinic. These in-services could be presented to patients waiting to see a physician. 

Even the most basic information is helpful:  nutrition and diet, skin care, menstrual and ovulation cycles, menopause, child development, prenatal care, dental hygiene, sanitation and water treatment, malaria and dengue prevention, nutrition for diabetes, HIV/AIDS prevention, sexually transmitted diseases, birth control, etc. 

They can be verbal with the help of a translator, or handouts could be found or developed in Spanish.  Teams can look for brochures and posters in Spanish.   No information is too basic.  Education should be part of our team effort.

Watch the web-site for new education Information Ideas.

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TREATMENT PROTOCOLS

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COMMUNITY BASED PRIMARY HEALTH CARE

The principles of community based primary health care are in alignment with the philosophy for health care of the United Methodist Mission Church of Honduras, that is systems that are continuous, sustainable, and centered in the communities they serve.  Read more.

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COMMUNITY HEALTH NEEDS ASSESSMENT

Any health program that hopes to improve the health and well being of a community needs as an essential first step to have a means of accurately identifying the health problems of that community, and the possible causes of those problems.  Only when this information is obtained can appropriate health plans be developed and implemented.  Read More.  The Honduras Methodist Church is currently implementing a community health needs assessment process in communities where our congregations are located.  If your team would be interested in facilitating an assessment in one of our site communities and would like to receive a copy of the site survey to be used in a particular community, contact the UMVIM Health Care Coordinator regarding the Community Health Needs Assessment Process.

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OTHER LOGISTICAL CONCERNS FOR MEDICAL TEAM LEADERSHIP

Abbreviated Checklist for Health Care Teams

The following is an abbreviated checklist to gauge preparation and execution times for an UMVIM Health Care mission trip to Honduras.   An expanded checklist, prepared by Dr. Roger Boe, is available; Click here..

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Medical Team Immunizations

It is recommended that all team members have the following immunizations:

·              Tetanus (if seven years or more since your last shot)

·              Hepatitis A (two shots)

·              Hepatitis B (three shots)

·              Typhoid (one shot and a booster periodically)

·              Malaria medication in rural areas.

The quantity varies depending on the length of stay.

500mg. of Aralin or Chloroquine-Take with a full meal

Take one tablet one week before entering Honduras

For 1-7 days in country- Take one tablet each week on the same day as your first dose.

For more than 7 days-continue pattern, one tablet each week on the same day

After leaving country, take as before, one tablet each week for 4 more weeks or as directed by you prescribing physician.

Other Tips include:

·              See CDC Traveler’s Health site for more info.  http://wwwn.cdc.gov/travel/destinationHonduras.aspx

·              Note: immunosuppressed patients and pregnant women should avoid live vaccines. These include: Typhoid, Yellow Fever, Oral polio and the MMR.

·              Malaria and Dengue Fever, as well as other illnesses are common in some areas at various times of  the year.  Use insect repellent at all times.

·              Gastrointestinal Disease: traveler’s diarrhea, typhoid and hepatitis A are spread by contaminated water and improperly cooked foods. Follow correct precautions. Generally the food in the restaurants we use are safe but we ask that you avoid tap water and drink ONLY bottled water and avoid fruits that cannot be peeled prior to consumption.

·              Place any personal medication and /or medical equipment in a carry on.  Medical staff should also carry on any smaller, more expensive equipment such as otoscopes.

Flexibility and Packing Suggestions

Please remember that it is almost impossible to know exactly what your team will be doing and that things may change at any given moment.  Flexibility is always important--and teams that are trained to think this way have an easier time.  The medical work that you will be doing depends on many variables that are hard to predict and illnesses may vary depending on time of the year and location that you serve.

We typically ask all Health Care Teams to bring at minimum:

·              hand sanitizers

·              a team first aid kit

·              snack size Ziploc baggies for dispensing medications

·              labels (may be pre-printed)

·              plastic gloves

Personal Packing

·              Scrubs or personal clothing

·              comfortable shoes to work in, no open toed for clinic

·              one nice outfit for worship services, simple and modest (summer business casual)

·              sunscreen and sunglasses

·              mosquito repellent

·              personal Kleenex and toilet paper

·              -light rain jacket or sweatshirt

·              small mirror

·              Camera, flashlight and extra batteries

·              Personal Water Bottle

·              Wash cloth, most Hotels do not supply them

·              Watch with an alarm or small alarm clock

·              Ear plugs

·              YOUR BIBLE, journal and a good book.

·              Snack Food

Honduras Travel Tips for Health Care Teams        

Here are some last minute suggestions to help make your arrival here go smoothly. 

Arrival: 

Before you land 

During the flight to Honduras, each person will be handed two forms to fill out: one for immigration, and one for customs.  Each person (or family) should fill these out, including the address and phone number of the Honduras Methodist Church office:

Iglesia Metodista de Honduras

Residenecia San Juan

Lote 28, Casa 1

Tegucigalpa

Phone – from US (011)-504-232-2555

Immigration

After disembarking and entering the airport terminal, you will enter immigration. Each team member should have their passport and customs forms ready for inspection. After passing through immigration, you will enter the luggage claim area.

Claiming your luggage

·              The luggage claim area is VERY SMALL and there are a LIMITED NUMBER OF CARTS AVAILABLE for luggage.  For this reason, we suggest that everyone pile all carry-on luggage in one spot, with ONE team member watching it.

·              Each team member should retrieve pieces of checked luggage that have been assigned to them when the team checked-in at the airport in the US.  Keep carry-on luggage and checked luggage separate at this point.  This makes it easier to count and re-count the number of checked luggage that arrived.

·              ANOTHER TEAM MEMBER should count (and re-count) the number of checked bags that arrive.  The number of bags should match the number of white claim check tickets.

·              After all the luggage has been retrieved, each piece must go through X-RAY and then be checked by the customs agents. Each piece will be checked with the claim ticket and then you may leave this area.

·              Missing Luggage?  Talk to the appropriate desk in baggage claim.  They speak English.

Leaving the Airport:

Porters

·              Airport porters will be available to take the luggage through the lobby to the loading zone. Use TWO TEAM MEMBERS to precede the luggage and follow the luggage with the porters. Your team will be met by an UMVIM staff member in the lobby of the airport. DO NOT leave the lobby. UMVIM staff will direct the team and the porters to the vehicles to be used.

·              ONE person on the team should be ready to pay the tip to the lead porter.  The going rate is about $1.00 per bag (about L.20 per bag) which can be paid in dollars or lempira. DO NOT pay anyone except for the lead porter. He will pay any others who helped with the luggage. 

Money Exchange:

·              We've had problems in the past with certain US dollars not being accepted here because they are written on, have stains, or are ripped. The dollars that team members bring should be on the newer and crisper side (brand new is fine, but not necessary).  Bring $20 bills to exchange.

·              The UMVIM coordinator will direct you to a reliable currency exchange person to assist you in changing your dollars into lempira.

·              The airport is a good place to change dollars into lempira before you leave for the site.  The UMVIM staff will contact someone to change money for the group.  Be sure to re-count the money that is given to you. 

·              You will not need to change a lot of money for personal use. Restaurants in Tegucigalpa and the shops in Valle de Angeles accept dollars or credit cards. Restaurants in San Pedro Sula accept dollars or credit cards.

Leaving Honduras:

There is an airport exit fee of approximately $35.00 (can be paid in dollars or lempira). After you check in at the ticket counter, you must take your passport and boarding pass to the exit fee counter to pay this tax.  

UMVIM POLICIES SPECIFIC TO HEALTH CARE TEAMS

·              Health Care Teams are expected to conform to the same general policies set out for all UMVIM teams. See FAQs and Preparation elsewhere on Honduras UM Mission Church website.

·              They work under the priorities set by the Honduras Methodist Church

·              They follow the guidelines for gift giving and prohibition of alcohol and smoking. http://www.gbgm-umc.org/hondurasini/cultural_preparation_main.htm

·              http://www.gbgm-umc.org/hondurasini/giftgiving_main.htm

·              In addition Health Care Teams are advised:

a.          To respect the minimal fee policy for clinic patients

b.         To keep in mind that quality of care is more important than quantity of care

c.          To bring with them or purchase locally supplies to keep the clinic as clean as possible

d.         To practice AIDS and hepatitis precautions

e.          To leave excess supplies and medicines with the UMVIM Health Coordinator.

·              Be sure to refer to the general guidelines for volunteer teams on the Honduras Methodist Church Website: www.gbgm-umc.org/hondurasini. Go to ‘Volunteer Teams’ and review the components.

EMERGENCY PHONE NUMBERS AND INTERNET ACCESS:

Iglesia Metodista Oficina--011-504-232-2555 (the secretary and AFE speak English.)

Iglesia Metodista de Honduras

Residencial San Juan

Lote 28, Casa 1

Tegucigalpa

US Embassy 001-504-236-9320

Cynthia Ceballos—house, 011-504-763-3102  cell , 011-504-3231-8735

Ron Davidson--house, 011-504-235-8360   cell, 011-504-9929-8768

Rev. Roberto Pena--house, 011-504-232-6016   cell, 011-504-971-4788

You will be able to communicate with your friends and family in the US at a local internet café at all locations except at Monte Carmelo (in Tegucigalpa) or in Subirana. The cost is about 5 cents per minute for internet use for emails or phone calls.

The United Methodist Mission Church of Honduras thanks you for choosing to come here to work with you “brothers and sisters in Christ” to build God’s kingdom. May God richly bless your trip to Honduras and your fellowship with the people here.

QUE LE VAYA BIEN (Have a safe trip)!

Cindy Ceballos BSN, UMVIM Health Care Coordinator

United Methodist Mission Church in Honduras

http://www.gbgm-umc.org/hondurasini/

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Other Helpful Links

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Posted June, 2005