DAY 2: 06/10/12

I was woken up today by the sound of roosters crowing in the early morning at 0510. The tiring activities of the previous day made for a sound sleep even in this hot and musty weather. I woke up feeling refreshed and ready to take care of some patients. I took a peek out of the opened windows of this classroom that was our dormitory to get a feel of the fresh morning breeze and to my utter surprise saw numerous silhouettes dotted in the darkness of the early morning. The locals had already started gathering outside the perimeter of our camp, waiting to be seen! Our clinic was scheduled to begin at 0800 and gathered here at 0510 were these committed and resilient people eager to take full advantage of the vast array of health services we were about to offer them free of charge. I freshened up, got some breakfast and got ready for the morning muster at 0700. We converged at the forecourt of our camp promptly at 0700, had the morning muster to ensure that all 59 military personnel and volunteers on the team were accounted for. We then deliberated on the form our workflow for the clinic will take. It was decided that patients at the entrance of the perimeter would wear color-coded bands before they are allowed passage into the perimeter. The red, orange and green bands would be used to identify patients getting services from our three main clinics: General medical care, Optometry and Dental care. Once banded, the patients would proceed to a patient admission desk placed close to the perimeter’s entrance where patients’ information will be collected, SOAP notes formulated and vital statistics taken, if needed. The patient would then be directed to the appropriate clinic they would need care from. After receiving care, the patients would head to the Pharmacy to receive their medications and the concomitant counseling points for those medications. The patient will then be ushered to the discharge desk, the last point of care right by the Pharmacy, have his band taken off and then directed out of the perimeter. We also had a makeshift laboratory set up in one of the classrooms for basic lab works like glucose checks etc. This workflow proved very efficient in ensuring that the crowd was controlled and patients were seen in an orderly fashion. The crowd had blown up into hundreds of people by the time we completed our morning huddle. After a meeting of our Operations Commander with some community leaders, it was communicated to us that the locals had made a request for us to start the day with a brief church service since it was a Sunday, a church day for the community. We readily obliged to their request and after about forty minutes of a fun service which included a sermon in Indonesian, a rendition of  “Amazing Grace” performed by us, the team and a customary offering, we started seeing patients at 0900.

                                    Locals gathering early in the morning

    

The Pharmacy was spared the initial hustle and bustle that was evident in other departments of our mission during the first few minutes the clinics were opened but began to see an influx of patients who had already received care from the various clinics at about 0930. This was a sign of how busy we will be the whole day. Unlike the three clinics, the Pharmacy had to see virtually all the patients who entered the perimeter. They had to get their prescriptions filled by us regardless of the clinic they sought care from! Thanks to the good teamwork of the Navy Pharmacist, the Navy Pharmacy Technician, our three Indonesian interpreters, and myself we were able to keep the line in check, giving the patients their medications with the appropriate counseling and getting them on their way in an average time of about four minutes. The fact that our three interpreters had prior counseling experience with MEDCAP 2 was a tremendous factor in ensuring that they had an idea of the messages we were trying to convey to the patients, resulting in efficient and effective counseling sessions with the patients. I instantly picked the Indonesian phrase for the first question we required them to ask all the patients in regards to whether they had any drug allergies; “Allergy oba?” and took the liberty to ask the patients when I had to wait for an available interpreter. It got so busy at that pharmacy that we barely had time for lunch. We had decided as a team to shut down operations at 1230 for lunch but the pharmacy still had patients trickling in after 1230 because we had to get their prescriptions from the various providers the few remaining patients had seen prior to the shutdown filled before we could take our lunch. We saw the last patient before the shutdown at about 1250 and therefore had to be content with a 15-minute lunch before the first patient for the afternoon session walked in. The afternoon session went pretty much like the morning session with a steady traffic of patients. The last patient for the day walked out of the pharmacy at about 1545.

The whole mission saw about 480 patients on the first day. The majority of medications dispensed on the day by the pharmacy were pain medications. The Dentists at the Dental Clinic performed a little more than a hundred tooth extractions only in the first day, hence the high number of prescriptions for pain medications. We also received an appreciable number of hydrocortisone, bacitracin and neomycin prescriptions for various dermatological conditions. The Optometry Clinic also wrote a lot of prescriptions for artificial tears on this day. It was a grueling day filled with brisk commuting to and from our pile of medications lined against the walls of this classroom, reconstitution of medications and nonstop verbal and physical communication. The sheer number of patients we were seeing and the realization of the tangible difference we were making in the lives of these lovely people was however the boost I needed to ensure that I felt no sense of fatigue whatsoever all through the day. We got together again as a team in the evening to reflect on our performance for the days and to fine-tune it for a better performance the next day. I had an MRE dinner of roast beef, took a bath with water drawn from the well and retired to bed early, knowing too well what awaits me the next day…….