January 20, 2015 - First Clinic Day

Today was the first day of clinic, the “real meat and potatoes” as Tressa says. Our group was to go to Petite Savanne, but upon arriving there, we soon found out that it was cancelled due to an emergency. Dr. Abrons knew this was a sign we were all supposed to stick together today, so we went to La Plaine with the others. We started off in the waiting area and chatted with the locals by introducing ourselves, inquiring about the patient’s background, and then asking what brought them in to the clinic. This then led to further inquiry depending on whether they were in for a follow-up appointment or if they have a more recent problem to address.

We also had an opportunity to talk with the health aid at the center, and she showed us the casualty room, which is where acute situations are managed, such as wound care and motor vehicle accidents. She opened the cupboards and drawers for us and showed us the supplies that were available.

Through these interactions, we learned just how difficult it was for the patients in these rural areas to access healthcare as a single doctor and pharmacist are relied upon to serve multiple communities, and the system falls apart when one falls ill or is unable to make it to the center. We also learned that there are limited resources, as the pharmacy inventory was very small and equipment had to be sterilized in Roseau. We were pleasantly surprised to find that everything at the clinic, including the medication, was free for the patient. Unfortunately, adherence remains an issue, probably due to availability, lack of understanding of medication’s importance and worry of side effects.

Although we did not get to meet Kent today because he was ill, Dr. A filled us in on his role in the pharmacy and we were surprised to hear that he carries around much of his medication supply in a suitcase and is not only responsible for ordering medications, but also medical supplies. Dr. A informed us that he used to also perform blood draws to obtain labs, something that none of us would be capable of doing.

After clinic, Orrin from Jolly’s came to talk with us, and we found it surprising that there is no regulating agency in Dominica, allowing medications to be obtained from any country and for pharmacists to compound any medication they desire. Through this day, we have reflected on how we can make a greater impact at our next clinic days. We hope to have more time to talk with the patients and to have a chance to look at their medical record book before they see the doctor, as well as follow up after they are finished with their appointment. We also hope to find patients with the disease states that we have “become experts” on, and educate them on those topics and provide them with further resources like our brochures.

The three of us finished off the day with some advertising for our health fair on Monday at the La Plaine Health Center, riding around the La Plaine villages and Delice with a bullhorn and announcing details. “Bonjour! Sakafet! Come one, come all!” We’re expecting a great turnout!