A Comparison Between Dominica and the United States

When looking at the percentage of children at the age of 1 immunized in the country of Dominica, a higher percentage of children are vaccinated against diseases such as measles, diphtheria, and hepatitis B than the United States. I also found these trends were very consistent within the past couple of years when researching this data on the World Health Organization website. As a future pharmacist able to immunize, I congratulate health care providers in Dominica. Being able to administer these vaccinations are extremely crucial in preventing the bacterial and viral toxins as causation of these communicable diseases.

Comparison

When looking at Dominica compared to the United States it is hard to determine any differences in several quality of life parameters such as maternal mortality rate and the percent of children under five years old who are underweight.   This is mainly due to the fact that no data has been collected to assess the numbers.  Without the data it makes it hard to determine how well the population of Dominica is doing.  An interesting reality to look at is the availability of sanitary water sources.  It is hard to imagine that people in Dominica do not have access to proper drinking water and sanitation but due to the lack of development and roadways it is very possible that a part of the population struggle to find appropriate amounts of water.  However, the reality that people in countries around the world are fighting daily to get drinking water is the really devastating matter.  After watching parts of “Blue Gold”, I am appalled at my own personal abuse of water.  If I could change one thing about myself it would be my consumption of water.

United States vs Dominica

Yesterday's lesson was very informative in the fact that I never really stopped to realize how good we have it in the US, especially in regards to clean/purified water.  Water is an essential to any living object's being and the fact that a lot of people monopolize water in order to make profit is really sad.  I am not really sure how the few people can take extensive amounts of water, charge everyone else for this natural product, and not even care or think about the problems that will eventually occur.  Whether it is the lack of knowledge that these CEO's have, or just pure ignorance, something needs to be done in order to help our future and also people in countries that are dying because of their lack of good water.  The country of Dominica does not have as much of a "clean" water shortage, but they are lacking many things such as nutrients and health care that they deserve.  It is extremely sad to know that there are so many health care settings available in the US that most people take for granted, when we could send our resources and supplies over to places such as Dominica where people would appreciate more if they had such things available to them. Hopefully we will help a change begin in countries, particularly Dominica, to give those less fortunate the care they deserve which then can branch to other countries in need also.

Difference in Drinking Water:

It's a pretty easy concept. You head to the water fountain, turn on the faucet, wait a second, take your drink and leave. You never worry if the water is safe to drink or not, or indeed, if the water will come in the first place. In fact, the only worry is often whether the water will be the temperature you want it to be.

As we continue to learn more about the infrastructure of Dominica, I wasn't surprised to hear about the lack of access to clean water by the citizens of Dominica. In my country of birth, Pakistan, we share the same issue. There are hours where there will be no water. Where someone will shout, "Water's on!", and people will rush to fill their jugs before the water shuts off again. Worse, the water is often undrinkable to anyone not accustomed to it; the entirety of my stay in Pakistan I was hydrated with soft-drinks, or boiled-water for my safety.

Whats worse is that often times, it was cheaper for me to walk down the street and buy a soft-drink as opposed to the same quantity of bottled-water. Better yet was when the company that produced the water was often the same as the one producing the soft-drink.

As we inch closer toward Dominica, I hope we can observe the situation on-site. Water should be a right-not a luxury.

United States vs. Dominica

It was certainly interesting learning about the differences between the United States and Dominica health statistics.  In our society we live busy lives, always on the go; we often forget about other countries that may not have the things that we do, things like access to health care, or proper food and nutrition.  I was surprised to learn about the significant number of children suffering from poor nutrition and being underweight globally and not just in Dominica.  It was interesting to find out about the lack of data for some of the statistics in Dominica.  This is a constant reminder of the difficulty individuals face to have access to proper technology and resources to report this information and allow people to live healthier lifestyles.

US vs Dominica health

US and Dominica health statistics can be difficult to compare because there is a lack of data from Dominica.  In the US we conduct many studies and record a lot of information to help us follow health trends.  We are able to compare this with many countries; however, as Dominica is a developing a country they do not collect data to the same extent.  In the US, 1.3% of children are underweight; while one might think this number is higher in Dominica, we do not know because they do not have this data.  Similarly, we are not able to compare the mother mortality rate, infant mortality rate, or fertility rates.  It is interesting to note that there is one case where Dominica has 100% coverage but the US does not have data available.  This is the case of post-natal care; however there is only one postnatal visit in Dominica.  In order to optimize health in Dominica we need to first become aware of the current situation.  To do this we need to start by gathering data to analyze and comparing it to what we know about other countries. 

Krissy Wright

Reflections of Healthcare Disparities

In countries where Plasmodium falciparum, the parasite responsible for malaria, is endemic the average GDP of the country is dramatically less than countries that are comparable in workforce size. With this startling example, the health of the population is absolutely critical to the growth of a nation. This is especially true in the developing world. However, the developing world contends with the unnecessary burden of the world’s major healthcare disparities: lack of proper sanitation, medical supplies and personnel, high rates of both maternal and child mortality, and malnutrition. Neither I nor the rest of the developed world can hide behind the excuse of ignorance anymore due to publications such as the World Health Organizations’ World Health Statistics, 2009. Although many developed countries have good intentions, the response to the developing world has been historically disorganized and fraught with a multitude of issues, such as (never ending) conflicts, political motives, and lack of many nations willingness to accept help. However, non-governmental organizations such as the Carter Foundation and The Bill and Melinda Gates Foundation, have begun the arduous task of helping these countries, especially in basic infrastructure (e.g. proper sanitation). Although this is an excellent start, more must be done especially in a world where the climate is changing and population levels are increasing exponentially. Diseases such as malaria, cholera, and many preventable illness such as malnutrition will claim more and more innocent lives. The time for action is not today, it was yesterday. Will we ever be ready to act?

How to teach

Teaching patients about their medications is one of the highlights of my job as a Price Chopper Intern.  I love explaining to them what they are receiving and what side effects it may cause.   By teaching people, it also helps me remember what I need to know for my future practice as a licensed pharmacist.  The way I like to help patients learn is by asking questions.  If they hesitate, I usually just re-iterate the important facts about a medication or device briefly which sometimes allows a patient to let their guard down and talk about things they may have been embarrassed about.  I also feel as though teaching patients how to learn by using diagrams and pictures helps them focus more instead of just listening to words that they may not comprehend. These are the two specific ways I like to teach patients how to learn and would like to become more comfortable with doing without having any hesitations of my own.

Techniques that aid in learning.

Learning is as diverse as learners. From conditioning to rote, episodic to habitual, active to passive and cognitive to psychomotor; the act of learning varies tremendously by individual, place, time and topic. One will quickly find that it is often as important to understand who you’re teaching as it is what you’re teaching or you risk losing your lessons along the winding road of communication. It is for this reason that when engaging in a medical discourse with a patient, one must assume the role of both a student and a teacher. One must learn their patient before they may effectively teach their patient.  But how can one enhance their lessons such that the patient is likely to both understand and remember? It is commonly effective to directly engage your patient in the concepts you’re trying to convey; solicit the patient to assume an active role in their own health care. If you’ve learned enough about your patient from your discourse, it is often effective to conceptualize your points within the fabric of the patient’s past experiences, interests and understandings. An avid fisherman is more opt to remember the mechanism of their antibiotic course when described using a fishing analogy. In short, you must be a student of your patient, allowing the patient to teach you how they learn. Then, you may actively engage them in your concepts and tie the lessons into their past experiences to reinforce the recall process. 

Techniques to help patients learn

When we are trying to educate patients, it is very important to make sure that they actually understand the message we are trying to convey to them.  One method I will use to help patients learn will be to make sure I am delivering the information in an appropriate manner.  For example, speaking in terms that are appropriate for the patient’s age and education level is important; speaking slowly and clearly is helpful; and stopping to let the patient absorb information and ask questions shows that I have time for them and that I care about helping them.  Another technique I will use to help patients learn will be to ask them to repeat back to me what they understand from our conversation.  If they seem unable to summarize our counseling session, they probably won’t be able to effectively implement any changes we discussed.  If this is the case, I will go over with them the most important points of what we discussed and try to keep it interactive.  Another way to help patients who might not remember everything we talked about is to write down the most important points.  I used this method during my previous rotation for a patient who was confused about which form of calcium to take.  After we talked, I wrote down for her the differences between calcium carbonate and calcium citrate, and I think she was happy to have something to remind her what we had discussed. 

Krissy Wright

Treating Patients

There are many different techniques out there for helping patients learn and understand information.  I think the biggest thing I can do as a student pharmacist is to simply listen and understand their needs and concerns.  I think it is a great technique to try and repeat information for better understanding and reinforcement.  I also think it is important to speak at a level where the patient is able to understand what I have to say and put the information in patient friendly language.  Most definitely I would want to treat a patient like I would want to be treated by showing interest, empathy, concern, and having a positive attitude.  

Valuable Teaching Techniques for Patients

Today our lesson focused on our ability to incorporate different components of teaching to use with the specific disease states each student will research, which will then be used at the health clinics in Dominica. It is important and valuable to always use care and respect when presenting information to others. This ensures both are engaged and there is a feeling of mutual interest in learning. For my particular topic, immunizations, I hope to use an interactive approach which reinforces the information about the different types of vaccinations available and the diseases they prevent against. It is important that the information is conveyed in a way that can be remembered and leave a lasting impact.

Techniques to help patients learn

It is so important to not only teach patients but hear what a patient can teach you.  In an effort to help patients learn I plan to first find out what knowledge the patient already has.  I think it facilitates an acknowledgment of openness and care by starting with open-ended questions.  It is critical to assess each individual’s personal needs and focus on those aspects while teaching.  I feel that whenever possible multiple forms of presentation are also useful.  Developing visuals and handouts, in addition to verbal communication can help to reiterate the importance of a lesson to a person.  Overall, I hope to have the time to develop a personal relationship with each patient to help enhance his/her health and well-being.

Patient Education:

When attempting to counsel patient's, I had a tendency to launch into a giant speech regarding their medication. I'll go over dosage, side-effect profiles, mechanism of action, the whole nine-yards in an attempt to better educate the patient about their own health needs. When launching into a speech was my only counseling technique, I would notice that it wouldn't take long for patients to assume a glazed-eye look, and to nod their way through the rest of our conversation.  


Now, however, I try a different approach:

1. I ask the patient to explain to me what they know about the medication. Most patient's are happy to volunteer what information they've previously heard and from there-on, my job is to gently fix any mis-conceptions or review any key-points.

2. I see if I have a physical object available that the patient can touch, or look at. One of the best tool's I've seen used was a piece of spare-tubing that the pharmacist I was rotating with  would use to explain how blood flows through heart vessels to patients. 

3. Diagrams. This was perhaps the best tool I had at my disposal while rotating through IHS, a giant white-board that sat in the counseling room with a black dry-erase marker for our patients to use. I went back to this white-board numerous times to illustrate a point, or to explain complicated dosing regimens. 

4. Lastly, I would ask my patients to explain to me what they had learned after our session. Simply asking if they had any questions is often useless; most patient's are busy with their own lives and are worried that responding with a "Yes" will lead into another series of lectures.

As I continue to develop into a Pharmacist, I hope to learn from the techniques of my peers and superiors so that by the end of my Clerkships, I am ready to engage my patients in the manner most beneficial to them.

Our Mission to Provide Compassion at the House of Hope

As part of the rotation experience to the island of Dominica, Dr. Abrons has asked a couple of students to provide inspirational quotes which we would draw on the walls at the House of Hope. Hassan as greatly shared one quote shown below by President Roosevelt in his post, The Challenge of Hope. One quote I have found which has been a personal favorite of mine is a poem by Helen Steiner Rice, entitled "There's Sunshine in a Smile".

“Life is a mixture of sunshine and rain, laughter and pleasure, tear-drops and pain; All days can’t be bright, but it’s certainly true, there was never a cloud the sun didn’t shine through. So just keep on smiling whatever betide you secure in the knowledge God is always beside you. And you’ll find when you smile your day will be brighter and all your burdens will seem so much lighter. For each time you smile you will find it is true somebody, somewhere will smile back at you and nothing on earth can make life more worthwhile than the sunshine and warmth of a beautiful smile”

I have always been touched by the message from this quote, and I believe its place in the House of Hope will be truly amazing. I am looking forward to displaying this with the help of my fellow colleagues.

Reflections of the Transition From the Classroom to the Counseling Session

In my free time I’m a substitute teacher at a rural middle school and high school. In this position I have learned multiple skills that I have transitioned to my counseling sessions with great success. Although there are many skills I could write on, two major skills I have learned in the classroom are respect and active listening. The skill of respect I have found the most important. Respect is a two way street, instructor to student and student to instructor.  In healthcare, this is no different. One must respect the boundaries and limitations (e.g. mental, physical, and financial) of the patient, while the patient must respect the knowledge of the practitioner.  This skill in the classroom can turn a student that is antagonistic into a stellar pupil. In the counseling setting it can turn a patient that outright refuses care into going to the doctor. Another skill I have learned in the classroom that I have seen to have a positive impact on learning during counseling is active listening. Students are masters of active listening (and seeing) and can pinpoint the exact mood (e.g. nervousness) of the teacher from their non-verbal communication (e.g. tapping a pen on a desk) and from the statement of, “Good morning, class” (Was that a quiver in the voice?). In a counseling session through the use of active listening I have been able to direct the conversation to ensure adequate dialogue, discussion, and understanding. From these experiences I have had excellent opportunities to teach and motivate the patient (and student) towards positive goals, and I hope I can continue this trend while in Dominica.  

What happens if I am sick

When I am sick, I usually just lay down and feel worthless.  I also feel bad when I do not feel well because I then have to ask people to make me food or even get me a drink. It is very difficult for me to ask people for help because I do not like the feeling of being helpless at all, I usually am the one helping.

How you behave differently sick and healthy

Being sick makes me feel really unhappy.  First of all, I hate doing nothing, and being sick usually means lying around in bed all day.  When I am sick I am frustrated that I cannot do the things I normally like to do like exercise, go to work, cook for myself, and socialize.  I do not like when I am sick because getting better usually takes about a week, and I feel like I cannot control the fact that I do not feel well.  I am lucky to have people to take care of me, but I still like to be able to take care of myself, so this also puts me in a bad mood.  When I am healthy I like to keep busy doing things I enjoy; however, when I am sick it is difficult because I cannot really leave the house, or my bed even. 

My Reflection

            The profession of pharmacy allows for many unique opportunities for individuals to not only help patients on an everyday basis but to work with other medical professionals to make a difference in others lives and the health care system.  One of the main reasons I wanted to pursue a career in pharmacy was the ability to serve as resource for people in the community setting by answering the questions on prescription medications, over-the-counter treatments, health, and wellness.  Pharmacists are readily accessible health care professionals and always willing to help. 

            Having the opportunity to visit the country of Dominica and spend time with other medical professionals and patients is going to be a great experience.  As a student pharmacist I feel like I can definitely make an impact with the health care providers in the country.   After spending several years in the classroom, I will definitely be willing and able to share my knowledge of pharmacy with others.  Hopefully I will be able to offer insight on various medications and disease state treatment protocols.  I will be able to provide counseling services to both patients and health care providers and answer questions or concerns they may have.  I also hope to offer insight to the providers on the current health care system in the United States and how medical care is currently utilized in the country.  I hope to help providers in any way possible while in Dominica, whether it be organizing their facilities or helping with patients.   Being able to bring down resources such as posters and flyers on medical topics will also make an impact by increasing awareness to providers and patients.  Understanding that many individuals in Dominica may not be familiar of some of the disease states, this will provide a great opportunity to increase their knowledge and awareness.  Lastly, I hope to learn from each other. We come from different areas of the world and there are cultural differences between us.  Being able to share knowledge with each other will make a big impact and hopefully we will have many memories from the experience. 

            I look forward to this experience and working with both the health care providers and patients in Dominica.   I hope my efforts along with the rest of the ACPHS student pharmacist group will make a difference in the areas we visit.