On Thursday, I got to travel with Hassan, Griffan, and Aimee to Riviere Cyrique, another small rural health clinic that is to the north of Jungle Bay. As is typical with clinics here, we were unsure of what to expect; last week, there were only 2 patients, both of whom had wounds to treat. This day turned out to be a general clinic day, and the waiting area was packed with patients from infant to elderly.
We introduced ourselves and talked a bit with some of the patients, but most were uninterested in one-on-one discussions, so we spent the majority of our time rotating between the nurse, the physician, and the pharmacist. While in the room with the nurse, I got to hear her assess the patient's history of present illness, take vital signs, and decide whether or not the patient required a visit with the prescriber. She carefully asked each patient what medicines he or she took, and often had to ask multiple times whether that patient had remembered to take those medicines that morning. One patient in particular made me sad because she seemed to have some untreated dementia and was simply lonely, and I wish that I had more time and resources to help her. She could have used a pill box, some counseling, and definitely someone to care for her at home. Unfortunately, things like pill boxes are difficult to find in Dominica.
In spending time with the physician, we were asked drug information questions, discussed therapy recommendations, and got to know one another on a more personal level. We also saw some bedside procedures, like changing of a suprapubic urinary catheter, which was an unexpected event in such a clinic setting and allowed a great opportunity for questions about protocols and how they handle medical devices. The physician also helped us relate better to the patients and translated when they were difficult to understand. My favorite patient of the day was an elderly woman complaining of pain on her head. After some questioning, we realized that the scalp pain was likely from years of carrying heavy loads on her head; we would have never thought of that in the US, but here in Dominica, it makes a lot of sense because that is a common way to transport goods without a vehicle. It was definitely a moment of culture shock!
I also got to spend quite a bit of time with the pharmacist. This was an excellent opportunity for me to ask him questions about his resources, how he manages stock (he traveled to the clinic with a suitcase full of medications and some cardboard boxes with supplies, but cannot take more than that with him from the La Plaine clinic), and about pharmacy practice in Dominica. Because the medications are heavily restricted by government ordering, the sourcing changes frequently: his medication stock comes from all over the world, including India, Canada, the USA, and China. I was particularly intrigued by some of his stories of counterfeit medications that he found, how he reacted to them, and how he tries to prevent his patients from receiving such counterfeits. Pharmacy practice in the public sector in Dominica is tough. This pharmacist is basically on duty 24/7, and has to come in to the clinic for emergencies outside of normal clinic hours and takes patient phone calls on his cell phone. I have so much respect for the few, dedicated pharmacists in Dominica whom we had the opportunity to meet. It not only makes me grateful for the work environment that I have here in the States, but helps me see even more poignantly where I can help improve patient care (and make their jobs a tiny bit easier) from across the world.
Jessica S.
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