Johnson’s Journal: Honduras 2014

Since 2012, Presbyterian College of Pharmacy (PCSP) faculty and students have been able to work alongside Virginia College of Osteopathic Medicine (VCOM) faculty and students and volunteer doctors to provide medical care in the Dominican Republic, Tegucigalpa and Santa Rosa Honduras and El Salvador. Dr. Dean Sutphin and his trip coordinators have been conducting these trips for over 10 years and have partnered with individuals in each country to make these trips safe and possible. These trips are a great inter professional experience for our students and faculty members and VCOM administrators and faculty have said that these trips are often the reason why students choose their school over others. Before this partnership, VCOM had to utilize their faculty and students to dispense medications, which prevented them from being able to see as many patients. By PCSP faculty and students serving as the pharmacist and pharmacy for the trips, more patients can be seen and cared for. One of the unique things that VCOM has done is to hire in country physicians to provide medical care for patients once the mission team leaves. VCOM brings faculty and students to each location at least twice a year and some sites three times a year. This continuity of care allows the team to provide care for the same orphanages, schools and villages year after year.

A formulary of medications has to be approved by the country’s Ministry of Health about a year in advance to prevent medications that are not commonly available once the team leaves from being introduced into the country. Over 16 suitcases of children’s and adult multivitamins, antibiotics, ibuprofen, acetaminophen, anti-parasitic, GI and topical creams are brought on each trip. On a typical clinic day, the pharmacy team assesses how to set the pharmacy up in the church, school or under a tent “pharmacy” and how to arrange the suitcases to dispense the medications in a timely and orderly fashion.  Patients may have walked 5 miles or ridden in the back of a pickup truck with 12 others to come to the clinic that day. The in country physicians on the team will work with the local villages to determine which 100-150 will be seen that day. They are given a number and then called back for their medical exam. Once the patient is seen and if a medication on the formulary is selected, the VCOM student will present the case to one of the pharmacists to review the selection of the medication and if the dose is correct. We may have to calculate a dose based on the patients weight and make adjustments. Once the medications are filled, an in country interpreter which may or may not be a pharmacist will provide counseling on the medications. On  our trip to Santa Rosa Honduras last year, 4^th year student Alejandro Botero served as our pharmacy counselor. On trips to El Salvador, we are fortunate to have an in country pharmacist Dr. Leonidas Argüello provide the counseling for us. A VCOM student usually spends time in the pharmacy and the PCSP faculty member reviews dosages, uses, side effects and counseling points for the medications dispensed. Our PCSP students also get the opportunity to round in the exam rooms with VCOM students and physician faculty to see the diagnosis and decision making that goes into medical treatment, possibly including osteopathic manipulative medicine. On average 150-300 prescriptions are dispense each clinic day.

On the Honduras trips, school busses are utilized because of the poor condition of the roads. Days are long with a 2-3 hour bus ride on dirt/rock roads each way to reach the mountain villages. The average family income for the patients we see is $1/day. Common conditions treated include malnourishment, dehydration, skin conditions, aches and pains, gastrointestinal disorders, respiratory conditions, hypertension and parasites. Vision and dental care are great needs of these patients, but are not parts of these trips with the exception of sun glass and reading glass dispensing. A mixture of adults and children are seen on these trips.

On trips to El Salvador, motor coaches are used primarily due to the better quality of their roads.  Even with better roads, the patients that receive care are often without reliable transportation, potable water and adequate sanitation, which leads to some of their health problems. Malnourishment, dehydration, parasites, skin conditions, hypertension and diabetes are some of the medical conditions treated. Primarily children from 4 different orphanages and schools are seen. Adults from a mountain village in Chalatenango, EL Salvador and villages surrounding the Shalom Medical Clinic in Texacuangos, El Salvador, a village outside of San Salvador and at the schools and orphanages are examined by the physicians and VCOM students.

In addition to the medical mission services that are provided, faculty and students get to learn about the culture of the people in these countries and see beautiful countryside on the long bus rides.

PCSP faculty that have participated in these trips include Dr. Zach Anderson, Dr. Rebecca Bickley, Dr. Eddie Grace, Dr. Kate Moore, Dr. Tommy Johnson, Dr. Alfonso Romero-Sandoval and Dr. Sarah Wagener. PCSP students that have participated include McCall Anderson, Kemper Booth, Jennifer Carter, Heather Curry, Alejandro Botero, Jana Gibson, Kayla Lewis, Kimberly McDowell, Casey Mabus, Natalie Nelson, and Rome Pugh. Paula Bamis and Laleshia Cohen will accompany me on a trip to Tegucigalpa, Honduras in April 2015.

– Written by Dr. Tommy Johnson, PharmD, RPh, BC-ADM, CDE, FAAPE, who is a Professor Department of Pharmacy Practice at the Presbyterian College School of Pharmacy