Working Out the Nuts & Bolts of Overseas Medical Missions

Transcription

1 Working Out the Nuts & Bolts of Overseas Medical Missions Mark R. Paschall, M.D. Program Director St. John Hospital Family Medicine Residency Program

2 Working Out the Nuts, Bolts and Duct Tape of Overseas Medical Missions

3 Initial Questions Scope and focus of trip Do a little for a lot = Primary Care Clinics Do a lot for a little = Specialized Surgeries Medical students, residents, or both? Implications for timing of trip Jan-Feb most popular for students Nov-Dec not popular but often need is greatest Residents generally more flexible Size of team

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5 Initial Questions Country, location of trip Partnering organization Consider safety issues in country U.S. Embassy Travel services (Raptim) Consider licensing requirements of host country Letter of Invitation required? Go in as tourists? Visiting friends? Consider costs

6 Plan Early Most suggest months Many established rotations fill up 1 year in advance (Kinjabe, Tenwyk) Immunizations Passports, Visas (Always carry extra photos) DIO, Department Chief, Hospital President approval

7 Preparation Prior to Departure Travel to host country Raptim Travel Services: NTS Travel: Group travel if >12 individuals Airline websites for luggage specs, requirements (Delta Platinum) Box Embargo Travel while on the ground in host country Greatest chance of dying

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9 Preparation Prior to Departure Contact embassy in host country Establish goals/objectives for learners Develop required reading list Medical resources (CDC, American Family Physician) Cultural preparation Plan for debriefing session(s) Housing, food in host country

10 Health Considerations Immunizations check with people on the ground if possible CDC Yellow Fever? Polio? Rabies? Anti-venom? Elevation of planned clinic locations Health Insurance Check own policies Evacuation insurance Insurance if you die Adams and Associates Red 24

11 Travel Considerations Luggage identification ASA on plane Earplugs, masks, Melatonin, sleep aids Malaria prophylaxis Cipro, Lomotil Insulin timing considerations Bottled water Food/Lodging plans Mosquito nets Voltage adapters, satellite phone, car chargers

12 Medications and Supplies Scope of care Treat chronic conditions? Don t take expensive samples if not sustainable Consider local geography, travel conditions Supplies generally more expensive overseas Pulse oximetry, nebulizers Dressing materials Casting/splinting materials (ALWAYS PLASTER) Difficult to procure items IV set-ups, tubing Spinal needles Specialized ENT equipment OTCs

13 Medications: There or Here? Caveats Can t carry > $10,000 out of U.S. Exchanging money can be costly, time-consuming Must take new, small denomination U.S. bills Local medications often much cheaper overseas Be aware of specific transport regulations (MDIs) Be aware of local specific concerns El Salvador and Sudafed Mexico India and local governments Ethiopia

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16 Practical Considerations for Clinics Logistics Patient registration/identification Medical records? Crowd control/patient flow Three distinct areas if possible Registration/Waiting area Medical evaluation Pharmacy/Treatment Translation

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24 Medications Search for funding/donations Allergen eye drops King Pharmaceuticals Low or at cost medication sources International Dispensary Association InMed MedPharm MAP (Travel packs)

25 Formulary Examples H. Bruce Carr Praxis Meds IDA MedicalMissions

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27 Pharmacy Considerations Logistics, crowd control, translation, patient registration and identification Illiteracy labels/bags

28 Leaving Well When leaving: Cut bottoms out of containers with toxic substances Disposal of sharps, tubing, etc. Community Health Materials