GLOBAL MEDICAL BRIGADES SETUP

Anatomy of a Medical Brigade

It is necessary to gain a strong understanding of the components and operations of a medical brigade.  A medical brigade consists of a team of student and medical professional volunteers functioning like a mobile medical unit, setting up temporary day clinics to diagnose and treat patients at no cost. From in-take, to triage, to medical consultations, to filling prescriptions, the student volunteers experience the many realms of the medical profession under the guidance of licensed professionals.  

Location and Setup
The physical site of the medical brigade and details of setup will vary depending on the community and available resources.  Most often, the site will be a school or church in the village. Spatial areas or different rooms will be designated for distinct functions. 

Similarly to a traditional hospital, patients will be transitioned from intake, to triage, to a consultation, and ultimately the pharmacy. After receiving their medication, patients will turn in their patient sheet to students entering the information into the database.  Depending on the interest of students and volunteer skill-sets, public health workshops, dental and eye examinations can be conducted in conjunction with the brigade.  

Before being treated, each patient is given a form  used to record demographic, vitals, complaints, diagnoses and prescription information. Generated reports based on the patient intake forms allow the department to determine the health trends of each community/village in addition to understanding the overall basic medical health needs of Hondurans.  The next section will go over the different components of the brigade and how the patient sheet is to be utilized throughout. 

1. Intake: The intake station is generally comprised of at least two people depending on the size of the volunteer group.  It is helpful if the volunteers working in intake have some knowledge of Spanish as they will have to communicate with patients and write down unfamiliar names.

Intake volunteers will be responsible for filling out the section of the patient sheet shown below:

*Please note that the patient sheet travels with the patient until after they have received their medication.

2. Triage: This station is usually comprised of nurses and skilled individuals, and is the next stop for patients after intake. In triage, patients relay their symptoms/ ailments while volunteers:

 Once again, a grasp of Spanish is helpful in order to fill out allergies, medications, and symptoms:

Spanish is not required to take blood pressure, blood glucose, etc. although learning a few specific phrases helps.

3. Consultation Room: This station is comprised of doctors who attend to patients after they have been through triage. Doctors consult, diagnose, and then prescribe the medication they feel is best suited for each individual patient. Please note that Honduran law requires a Honduran doctor to accompany all medical brigades, and that this Honduran doctor will assume all medical liability for treatment received on brigades. We will provide a Honduran doctor to join your brigade; it is not your responsibility to recruit them. Interpreters are of great use here for doctors who do not speak Spanish.  Interpreting is a great way to walk through the patient assessment process with a doctor first hand for those interested in the medical field. If a doctor comes across an ailment they feel the brigade does not have the proper medication/ equipment to address, that doctor can refer the patient to the Clinica Santa Rosa de Lima for further treatment provided free of cost by Global Medical Brigades. ONLY the doctors can write in this part of the patient sheet:
 
The consultation room is often a school room, and depending on the location, set-up will vary.  Doctors can expect tables and chairs.  Students will need to collect, or doctors will need to bring, all other needed supplies for the clinic (gloves, examination equipment, etc.).

If a referral is given, the bottom right corner of the patient sheet, shown above, must be cut out and given to the patient for them to take with them to Clinica Lima.

Runners:  When the pharmacy runs out of a certain type of medicine, a few runners are designated to go update the doctors’ medicine inventory lists (which they use to prescribe).  After the brigade, runners should ensure that all medicine inventory lists match (some will be in the pharmacy, others in the clinic).  This way, doctors are not prescribing medicines that you do not have.  Runners also refresh supplies that will be needed in triage and the consultation room, such as gloves, hand sanitizer, etc.

4. Pharmacy: In this station, prescriptions are filled with either a doctor or pharmacist to approve the finished products and answer volunteers’ questions.  Considered by some to be the most high-energy station, volunteers in pharmacy should be prepared for long, fast-paced days.  It will behoove the pharmacy to consider how best to set up the pharmacy on the first day (ex: vitamins and anti-parasite meds by the door since these will be most common), and continue this set-up each day to minimize the time spent searching for a correct medicine.  Place all prescriptions for the same patient in one plastic bag.  Keeping family’s patient sheets together is important, so they don’t wait on one person’s medicine for a long time.  No Spanish is required for this station.

Medicine Directions: Translators are responsible for giving patients their medicine and relaying its corresponding instructions. Spanish skills are crucial for conveying complex directions for certain medications.  However, those with no Spanish speaking skills can also participate by learning the basic phrases (ex: Take one vitamin a day = Tome una vitamina cada dia) for the most common, simple medications given.
*Once Medicine is given to a patient, they must NOT walk away with their patient sheet.  Walk the sheets over to the Data Entry station for processing.

Data Entry**: At this station, volunteers should be sorting patient sheets into 3 piles:
Group #1 – Patients to whom we prescribed heart or diabetes medication that needs to be monitored.
Group #2 – Patients to whom we prescribed an antibiotic or other prescription drug that may require follow-up.
Group #3 – Patients to whom we prescribed only over-the-counter medications and/or who do not require any follow-up care.

After the brigade when back at the hotel packing medicines for the next day, students should enter Group #1 and Group #2 patients into the GMB database on laptops provided by the GMB staff.  Creating a database where we can track patient history is a crucial part of creating sustainable health care in these villages.

**We are in the final stages of developing our Data Informatics System, which is going to track all of the information from every patient seen during each medical brigade. Keep in mind that this is a temporary solution until our Data Informatics System is up and running. See page 16 for more information.

Dental Station: Every brigade will have a dental station led by your Global Dental Brigades Group (minimum 9 students and 3 dentists), which provides patients with the opportunity to learn about dental care and have dentists extract decayed teeth. The dental station is comprised of at least three dentists for extractions, two assistants to sterilize equipment, and any translators that might be needed, who will also educate children on how to brush their teeth and hand out toothbrushes.

Interpreters: Volunteers proficient in Spanish are crucial parts of the brigades so that doctors and nurses alike know exactly what problems are plaguing each patient.  At least five interpreters are required for every volunteer group.

Crowd Control: These are the volunteers who direct traffic from one station to the next and maintain a sense of order within the brigade. Medical brigades vary in size but can involve treating several hundred patients in one day, making crowd control an essential part of the brigade machine. 

Educational Stations: An important part of creating sustainable health care in a community is educating people about their health.  Multiple stations should be present for people to visit after they have received their medicine.  The specific topics of education should be tailored to the specific community, so you will need to coordinate with the current intern in Honduras in order to see what each village really needs.  Topics will range from Nutrition to Home Ventilation to Women’s Health to AIDS prevention.

Extra Positions:Extra positions depend on the size of the volunteer group. Volunteers to entertain the many children of the brigades, whether through crafts, games or toys, are always needed. Additionally, stations are often set up based upon specific careers or skills that volunteers possess. If for example a physical therapist or audiologist comes to volunteer, they can create their own station to address patients’ specific problems, or conduct hearing tests.

Clinica Santa Rosa de Lima
The Santa Rosa de Lima Clinic is located in Nuevo Paraíso, a rural village located outside of the capital city of Tegucigalpa. The Santa Rosa Clinic specializes in Emergency Medicine, OB/GYN, Ophthalmology, Internal Medicine, and the distribution of pharmaceuticals. Consultations are given to patients at greatly reduced fees. Additionally, the clinic is completing its surgical unit. More than 30,000 patients visited the clinic in 2006.

If a medical brigade group encounters a patient that needs immediate or specialized attention, they are referred to the Santa Rosa Clinic and receive treatment at no cost. Hundreds of patients are referred to the clinic by GMB each year.  GMB also provides a large amount of medical supplies that are left over from brigades to the clinic to be given to patients at no cost.