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Introduction

Within our partner communities, access to healthcare remains one of the largest challenges. In these communities, clinics are scarce, and when they do exist they are often without sufficient medicine or are severely under staffed, leaving families with ailments both untreated and undiagnosed, sometimes for an entire lifetime.  To help resolve this disparity, Global Brigades has worked with local government, international and local doctors, and student leaders to develop a Medical program  with the goal to provide consistent access to healthcare using an economically sustainable model. Our Medical program has three complimentary initiatives: mobile clinics (medical brigades), resident community health workers, and a patient referral program with local specialists. 

Through these three initiatives, we aim to achieve short-term Success Indicators:
     •  Provide consultations to 150,000 patients each year with mobile medical clinics who would not

        otherwise be able to afford or have access to healthcare
     •  Provide all 126 community partners with a team of licensed doctors and appropriate medicine at

        least three times per year
     •  Provide funding for 90% of patient referrals identified on clinic days or by CHWs

Over the next three years, measure long-term quality of life improvements, including:
    •  Ensure that 50% of community partners have year-round primary care access with a resident

       community health worker
    •  Increase the percentage of chronic patients to seek consistent treatment to 70%
    •  Increase early detection of cervical cancer by 10% (in countries that provide pap smears)

And we aim to continue to achieve all of these goals without a single instance of malpractice.

Program Components

Community Organization and Brigade Preparation

Community Trainings:

Before each brigade, our local Medical team conducts at least one community visit to meet with community-based leaders and prepare them for their role in the upcoming brigade. During these visits community volunteers are trained to prepare patient consultation spaces, assist with patient intake, direct patient traffic and give health education workshops (charlas) during the brigade. These trainings build leadership capacities within the community as well as increase improve knowledge-sharing around important public health education between brigades.
    
Site preparation:

The physical site of the Medical Brigade and details of setup will vary depending on the community and available resources. During the site visits, the team works with the community leaders to identify the space, most often a school to utilize the versatility of neighboring rooms to operate the clinic. Different rooms are designated for distinct functions, similar to a traditional hospital, with patients will transitioning through the different stations.

Government Collaboration

In Ghana, Medical Brigades works with the Food and Drug Association and District of Health at a regional level. Through these relationships, the Medical program receives clearance to administer medication and health education workshops. Local nurses also offer assistance on brigades by working in the dental, gynecology, or health education stations.

In Honduras, Medical Brigades works closely with the Ministry of Health and the Ministry of Education at the departmental (or state) level. Through these relationships, cooperation is ensured with nearby health centers via nurses volunteering their time and lending certain needed equipment and the usage of school buildings for the brigade itself.   

In Panama and Nicaragua, Medical Brigades has established close relationships with the Ministry of Health and the Ministry of Education. These formal relationships allow Medical Brigades to synchronize their medication list with that being used in the by community health centers, use primary or secondary schools as a site for mobile clinics and solicit the assistance of local health professionals, such as nurses, that can provide routine vaccinations, or specialists in the region to compliment the basal level of what a medical and dental brigade can provide.

Mobile Clinics (Medical Brigades)

Mobile medical clinics and preventative health workshops are implemented within partner communities through the utilization of student and health professional volunteers participating in 7-10 day programs called "Medical Brigades."

Medical Brigades are typically made up of about 30 university student volunteers and a mix of local and international doctors, accompanied by translators, local pharmacists and other members of the Global Brigades team.  Typically the volunteer to staff ration is about 3:1.  Depending on the duration and  country, each volunteer fundraises  between $1,400-$2,200 which covers the entire cost of implementing the mobile clinics, airfare for the participants, and the follow-up and support initiatives such as the Community Health Worker Program.  Some of the specific costs are: , medicine, healthcare professionals, supplies, travel insurance, meals, lodging, interpreters, coordinators, ground transportation, training of community volunteers, and program staff salaries to make evaluation and improve sustainability.

Depending on the number of volunteer groups, and weather limitations, two- fourday-long mobile clinics are implemented in each partner community at least twice a year. In 2011, Global Brigades shifted from its previous model of visiting a different community each day with one volunteer group to working with one community over the duration of several days with one group. This change was implemented in order to increase patient time with healthcare professionals and increase quality of care.

The mobile clinic is made up of six primary stations:  
     •  Intake: Community volunteers record the patient’s name, age, gender, and community nameon a Patient Form that is 

        sent to student volunteers to input into the Data Informatics System (electronic patient records).
    •  Triage: Comprised of nurses and licensed volunteers, this is the next station for patients after intake. In triage, patients

        relay their symptoms and ailments while student volunteers take blood pressure and vitals, weigh children under 12, and

        take temperature of children under 12 and those who report a fever.
    •  Consultation: This station is comprised of licensed local and international doctors who attend to patients after triage.

       Doctors consult, diagnose, and then prescribe the medication. During this station, student volunteers observe health care

      professionals, ask questions and learn about the most prevalent symptoms and diseases in the community. Health care

      professionals who do not speak the local language are equipped with a fluent or advanced translator to interpret. Each

      health care provider is also partnered with a Data Entry Clerk (each with a computer) who fills out the electronic patient

      form.
    •  Dental Station:  See Dental Program Methodology
    •  Pharmacy: Prescriptions are filled under the supervision of a licensed local pharmacist who approves finished bags and

       answer volunteers’ questions. Volunteers or staff members who speak the local language then take the finished bags to

       each patient and provide instruction on its proper use.
    •  Education Workshops: Medical Brigades strive to not only provide essential medications to treat the patients' current

       illnesses but to also provide each patient with the knowledge of how to prevent the most prevalent diseases within the

       community. Workshops are delivered by three-five student volunteers accompanied by local team members and offered to

       each family visiting the mobile clinic.  

Additional Stations
Each country strongly encourages specialist doctors to join the Medical Brigade to offer patients more diverse services.  For example, past Medical Brigades have implemented sexual education stations, physical therapy sessions, and optometry stations with reading glasses to distribute.

In addition to these optional add-ons, each country has developed their own specialty stations to complement the existing primary care services.  

Ghana - Gynecology and In-Home Visits: , The Ghana Medical Brigades offer a gynecology station testing for cervical cancer through visual inspection with acidic acid (VIA). Additionally, student volunteers observe in-home follow-up visits with health care providers after the clinic days and deliver public health education to individual families.

Honduras – Gynecology Station: Medical Brigades in Honduras offer gynecology stations for PAP smears depending on the resources and healthcare professionals that the volunteer group obtains. Pap smears are available to any woman who chooses to have one. Pap smears are especially important for those complaining of gynecological issues. Female student volunteers support the   licensed healthcare professional performing the exam as the Data Entry Clerk and general assistant.

Nicaragua – Gynecology: The Nicaraguan Medical Brigades also offer gynecology stations for PAP smears and specialty stations depending on the professionals accompanying the brigade groups.  Any woman with 6 or more months since her last PAP smear exam and all pregnant women are encouraged to take advantage of the gynecological station, which is set up in a private area at the brigade site.  Results of these exams are delivered after each brigade to the patient with the appropriate treatments provided.

 

Panama – Vaccinations: Through partnership with the Ministry of Health, Medical Brigades in Panama are able to provide an immunization station on some brigades. Before each brigade season, the directors of the local health centers are contacted to request assistance from certified health assistants working in the region. If a health assistant is available during the clinic days of brigades, he or she will provide routine vaccinations or any vaccines that may be available in the health centers, such as influenza or yellow fever.

Community Health Workers

To complement mobile clinics, the Medical program implements a Community Health Workers (CHWs) program.  Initiated in 2009 in Honduras by a group of students from UC Berkeley, the program trains and empowers community-elected volunteers to be first-responders, health educators, and health promoters. The CHWs aim to provide basic medical care, monitor chronic conditions, and serve as point persons for healthcare issues from within their homes year-round.  Currently there are 39 CHWs serving 18 communities in Honduras with plans of aggressively expanding into all four countries by 2014.

The CHWs receive approximately six months of training, a comprehensive guidebook, and telephone numbers of full-time licensed doctors to ensure patients receive adequate follow-up between Medical Brigades. Furthermore, the CHWs help to prevent potential health complications in their communities through emergency treatment, and healthcare education.  They are trained in first aid and wound care, treatment of tropical diseases, STD transmission and prevention, family planning, nutrition, hygiene, and other topics depending on the need of the region. CHWs also learn how to monitor the health status of community members (specifically patients with chronic conditions) and teach fellow community members about preventive health measures.

Based on relationships with the government and existing local infrastructure, Global Brigades will be implementing the program slightly different outside of Honduras.  
 
In Ghana, the communities have established Community Health Posts (CHPs), which are staffed with nurses hired by the government. These nurses also have volunteers in each of the surrounding communities who act as their liaisons to community members. The Medical program supports this network by facilitating more in-depth trainings of the volunteers, increasing their incentive to promote health in their community, and creating a better system of accountability by offering extra resources to ensure community leadership and continuity as funding is a major constraint.  We are currently working alongside the District of Health to get this initiative off the ground by the end of 2013.  

In Nicaragua, there is an already existing Community Health Worker system implemented by the Ministry of Health, mobilizing individuals called brigadistas or “brigaders” to act as a primary community health network. Global Brigades hopes to strengthen this network, increasing their knowledge base in first aid techniques and referrals for critical cases. Working alongside the Ministry of Health in the regions where we work, our Medical program aims to develop a detailed curriculum for the further education of these already trained individuals and provide funds to support its continuity.

In Panama, the CHW program will be created in close accordance with the Ministry of Health. The Medical staff in Panama is currently in the process of presenting the program to the Ministry to design a collaborative curriculum that allows for training of CHWs in Global Brigades holistic communities and will provide funding to help perpetuate it.

Patient Referrals

Our Medical program is actually saving lives and the cornerstone to getting severe patients the care they need is our Referral program.  It also supports the sustainability of our Medical program by ensuring that patients receive necessary care, even if that care extends beyond the means of a typical brigade or scope of the Community Health Workers program.

During a Medical Brigade, Global Brigades physicians identify patients who cannot be fully treated during the brigade. For an emergency case, a staff member will take the patient to the nearest health clinic or hospital to receive care that cannot be administered on the brigade site. For cases that require follow-up within a few weeks, the Global Brigades physician will give the patient a referral form, which guarantees the patient an appointment at the nearest health clinic or hospital. The patient is then advised to go to their referral appointment within a couple weeks of the brigade. The Patient Referral program follows up with patients after a brigade season to assess the status of the consultations and determine if further care is needed, as well as discuss any problems within the logistics of the consultation. Depending on the outcome of the consult(s), the Medical program determines if it is feasible to open a patient case for the referral system (i.e. duration of care, costs of care, type of condition/illness). Often times, student groups who meet these patients during their clinic days are interested in sponsoring the case to achieve the necessary care. The program is dependent on that extra support from the volunteers and Global Brigades acts as the liaison for these groups once they return home to maintain communication with the group through their fundraising efforts.

Please review the Patient Referral tab on the left side of the page for more details about the program, patient cases, and what you can do to get involved.

Honduras has established long relationships with local public hospitals such as Hospital Escuela and Hospital San Felipe for the patient referrals.  On average, each brigade season has 35 patients who receive a referral to one of these hospitals in which they receive the care they need.

In Ghana, the Medical program has completed 3 referral cases with the full support of student groups. These cases have ranged from supporting a pregnant teenager with ringworm, to obtaining a knee surgery for a 16 year old patient with a musculoskeletal birth defect. These cases were made possible by the dedication and fundraising efforts of Kings College and Dalhousie University.

In Nicaragua, referral patients are sent to the local hospital, where health workers have been instructed to provide specialized care. Considering the socialist health care system in Nicaragua, any Patient Referral that shows up at the hospital is provided with a consult and treatment free of charge.  

In Panama, the Patient Referral program was outlined in 2012 and is working to develop a formal system for their Patient Referral program. It has been observed that brigades in the Embera and Kuna communities have patients that can benefit from the referral program.

Monitoring & Electronic Record System

Upon entering the brigade every patient receives a Medical/Dental Patient form. These forms are utilized at every station of the brigade and collected at the end of the brigade, recorded and stored. Depending on the group size, patient records are electronically recorded at different stations throughout the brigade and/or post-brigade. Paper copies of the forms are stored for up to a year while the electronic versions are compiled and analyzed by the Medical staff’s Data Informatics Lead. The compiled data can be used to show trends in a specific community over time and impact that the Medical Brigades, among other programs, has on a community.

Role in Sustainable Transition Strategy

Access to consistent healthcare and medical professionals is essential to progressing a community’s health and economic development goals, which ultimately leads to the transition of Global Brigades relationship with a community from actively implementing brigades to one of follow-up.  Through the Community Health Worker system, Patient Referral program, and collaboration of other Global Brigades programs, Medical Brigades’ goal is to be able to discontinue Mobile Medical Clinics in certain communities to free resources to enter others.

Medical Brigades is typically the first program to enter a community as it builds trust with families and creates a foundation for research and evaluation to determine both assets and needs the community has to successfully implement our other programs.  We are able to leverage our community relationships, all the capacity building with community leaders and sentiment of partnership that is critical for any of the other projects to be implemented sustainably.  

Greatest Funding Needs

Our Medical program has three urgent needs for additional funding:  

Medicine
The most costly part of our Medical program are the medicines used during mobile medical clinics and distributed by the CHWs between brigades.  The largest threat to the success of our CHW program and what is preventing effective care in any existing clinics in our partner communities is lack of medicine.  For about $2,500, our teams can purchase medicine kits from our partners that will effectively treat more than 1,000 patients during a Medical Brigade.  

Patient Referral Program
For just a few hundred dollars, we can and have saved dozens of lives.  Each unique patient case has various funding needs for medicine, surgery or procedures, transportation, and follow-up care. For more information view the Patient Referral program tab.  

CHW Program
With additional funding, we will be able to train and equip more Community Health workers to provide year-round care in our community partners.  With strong CHWs and relationships with local hospitals, Global Brigades can gradually stop implementing mobile medical clinics and expand its scope of services to partner with other communities.  For approximately $40 a month, we can train and equip one life-changing CHW.  

 

MEDICAL BLOG FEED  |  view all articles

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