New Health Clinic Visit January 24, 2013

January 24, 2013. 

Today we went to a new health clinic for this rotation and were able to talk to patients that were waiting to be seen.  I spoke to one lady who was there for follow up on a new blood pressure medication she had been given the month before. Another woman was there to get refills of her medication and also because she was experiencing some constipation.  She was pretty upset because the pharmacist was supposed to be there so she could get her medication but he wasn't able to come that week.  There is only one pharmacist who takes care of all the health clinics in a district. He carries around his medication supply in a suitcase.  He tries to visit each clinic once per week unless there is a special problem.  The poor guy hasn't had a day off in 2 years.

The last patient I spoke to was a young woman in her early 20's who had asthma.  She had recently purchased a nebulizer from Jolly's Pharmacy located on the other side of the island.  She was at the clinic to learn how to use her nebulizer and how to prepare her medication for it. Instead of prefilled vials like we are used to in the U.S. the patients of Dominica have to measure out doses themselves.  The patient had been given a 20 mL bottle of salbutomol and a 1L IV bag of Dextrose 5% and Sodium 0.2%. She was to measure out 1cc of the salbutomol and 3 cc of the Dextrose for each dose. I was able to demonstrate the easiest way to measure out the salbutomol with the dropper bottle and we provided her with a syringe to measure out the dextrose.  As I was counseling her on how to use the nebulizer we put it together and prepared a trial dose using just NS, also drawn up from an IV bag. She was pretty quick to understand and did not hesitate to ask any questions. It was great to be able to do my part and give the doctor and nurse more time to see other patients and to let the patient be able to have a shorter wait.
It just continues to amaze me how self sufficient the Dominicans are especially when compared to Americans. In the U.S. we are pretty spoiled with the dosage forms and availability of medications. These people have to manage their medications themselves and prepare their own doses. In addition, they carry around a complete medical record with them of every clinic visit and what medications are prescribed. I am not sure that my patients back home would be able to handle that kind of responsibility. I think that it may result from the lack of accessibility to healthcare. They appreciate it more and are more receptive when the doctor is only available once or twice a month.