My Shadowing Day

Asalamwailakum again,

Bayanihan clinic has shown me the side of medicine veiled to those of us who have insurance and adequate access to primary care physicians. Underserved medical care is characterized by a lack of resources, unsteady funding, inadequate facilities, limited time, lack of trained personel, and many other limiting factors. My shadowing day at Bayanihan clinic really showed me the type of facilities these community clinics must use. Bayanihan has to share the same clinical facility with another community underserved clinic called Health for All; thus, two clinics operate out of the same exact facility. This facility isn't luxurious, in fact, its small and very old and uses donated equipment, which by the way is used and dated. Care is delivered by a medical preceptor however it is delayed by the fact that the clinic, in order to be free and supported by the U.C. Davis Medical Center, is academic, which translates into the preceptor having to teach medical students and undergraduates at every step of clinical process. The teaching process ends up taking much more waiting and examining time per patient than we would experience at private clinics, limiting the number of patients which can be seen within one clinical day. Also, the clinic can only afford to deliver free services every Saturday, which means that patients must wait multiple weeks for check-ups and follow-ups. Clerical and clinical mistakes also occur more frequently because basic blood pressures and intake is conducted by undergraduates who vary in their experience to take vitals and other parameters essential for diagnosis; which is expected because Bayanihan is a teaching clinic. Unfortunately, as with all teaching clinics and hospitals, patients must accept the risk of misdiagnosis and lower quality clinical care as a result of the learning curve. For example, if a student is not proficient in measuring various vitals, the medical preceptor may miss essential information for proper diagnosis of diabetes or hypertension. Private clinics and hospitals, on the other hand, exclusively employ trained personnel such as registered nurses, phlebotomists, etc, significantly lowering the rate of accidental misdiagnosis or mistreatment. However, one must note that the learning curve phenomenon occurs at any academic institution where medical professionals are in the process of learning their art. In fact, the repercussions at an academic undergraduate clinic are less due to the fact that medical students and undergraduate intakes have preceptors double-checking their work, which in turn reduces the likelihood of a diagnostic mistake.

I just want to note that I didn't write this to criticize the clinic or it's services. My main point was to reveal the realities of medical care when one doesn't have insurance. Without clinics like Bayanihan there would be many patients out there unable to obtain any type of medical care, which is why the clinic is an essential part of the Sacramento community. Also, clinics like these are needed to train future medical professionals who understand the plight of low income populations, and have gained the experiences and exposure to come up with viable solutions for these communities.

Ws,

Yuba City Medical Mission 2009

Asalamuwailakum!

On Saturday, I went to Yuba City with Bayanihan Clinic for our "Mini Medical Mission". The Mini Medical Mission is quite possibly the largest outreach event of the year; it's essentially a mobile clinic in which we have Bayanihan volunteers, medical students, and preceptors do free health screenings for Iraq and Afghanistan war veterans. Tables were set-up under a tent where intakes would take vital stats such as: blood pressure, heart rate, breathing rate, and blood glucose checks. The intakes also asked patients about their medical history, main concern for a check-up, pain, diet, and medications. After the data was collected and entered into the chart, the patient was sent to the preceptor-medical student team in an adjacent tent for their full check-up. While working as an intake, the high levels of patient interaction I was able to receive made the experience invaluable. I learned so much today, and I'm not sure how I will able to articulate it all into writing!

The morning of the event, I woke up at 5:35 a.m. and prayed my Fajr. It was pretty early to be up on a Saturday, and it took me a while to even realize that I had clinic! All of the volunteers met up at the University Mall in Davis, and we carpooled to Yuba City. I have to give respect to the clinical affairs and outreach student coordinators for organizing all the logistics for this mission; it probably wasn't easy. I was in Fam's car with Lorigail, and we left for Yuba around 7 a.m. The drive there was fun because I really got to know Fam and Lorigail, and in my opinion we all hit it off. The whole time I was insulting Stockton, which really got to Fam because it's her home town. I kept calling Stockton the meth-amphetamine capital of the world, and went on to explain how people did hard drugs there because of how boring the city was...Fam didn't take it well, but that's what made the trip even funnier. We arrived around 8, and started to set up the registration and intake tables.

There were three tables in the volunteer tent: registration, and two intake tables. My first job was to take blood pressure, heart rate, and breathing rate of incoming patients; I became the first person to deliver care to all the patients and it made for a great learning experience due to large amounts of interaction I had. The first two patient's I saw were veterans from either the first Iraq war or vietnam. The veterans were pretty jovial, which was good because it really made the learning process pressure-free. It took some time for me to comfortably feel out pulses as I would tend to press too hard, resulting in occlusion of the artery; luckily, the veterans were really patient while I was poking around their wrists. After taking vitals, I would enter it into the chart and the veteran would move to another table where he was asked about his medical history and had his glucose checked. Thereafter, the veteran would be sent into the adjacent tent to be examined by our onsite preceptors Dr. Guerrero (the Bayanihan Clinic Medical Director) and Dr. Vati. I became relatively proficient with vitals after about 2-3 patients, and it became a bit mundane after the 6th patient. However, it later dawned on me how important it is to measure vitals and the serious repercussions that can occur as a result of inaccuracy and carelessness, but I'll go into this later. I think checking the respiratory rate was the most frustrating vital to take because I had to subtly look at the movement of their chest without the patient knowing (if they were conscious of their breathing rate, they may alter it intentionally or unintentionally). It was hard to see respiration cycles under clothing, and some patients would vary their respirations without realizing it. All in all, taking vitals was pretty easy and being accurate with measurements comes with practice and a whole lot of PATIENCE!

After patients had their vitals taken they were directed to another intake table where they would be asked about their medical history and main health concern during their visit. During the second half of the day I was assigned to this table, and helped out my peers with medical history and glucose checks. I was trained on the glucometer earlier that day and my first patient was an 87 year old man who was thrilled that I was checking his blood sugar. He ended up donating $100 to the clinic because of how impressed he was with the concept of a free clinic that serves veterans like him. It was at this point I started to realize the real impact we had on others, and how much it meant to them to know that there were students who cared about them and their contribution to our country. At around 3 p.m. there were no more veterans so we decided to pack up and leave. It was a really productive day because we saw about 16 patients, most of them who were veterans or family of those who were veterans. Veterans were really happy about free health screenings because either they didn't have adequate insurance or they just haven't followed up with a doctor for a long time. In fact, most veterans came for the blood glucose and pressure testing because they haven't checked it for months or years, which was apparent because most of the veterans had blood pressures in the hypertensive range and elevated glucose levels (although not necessarily to the level of diabetes as opposed to the fact they didn't come fasting).

A really enriching aspect of clinic is the ability to work with peers who share the same commitment of service to the underserved as I do. It's a deeply spiritual experience because we all share the joy of interacting with the same patients, and we can cultivate each other's humanitarianism by sharing the realizations we've obtained through the collective experience. It's easy to see Marc, Fam, Camille, and Lorgail's passion for service when they interact with veterans, and it rubs off because when I interacted with veterans I was able to understand why they were passionate and develop that aspect within my soul as well. It's such a deep experience that words cannot convey the level of connection you are able to develop among your peers through these shared experiences. By midday all the volunteers had their hearts connected and we all understood each other without words. For example, when the 87 year old veterans was so overjoyed and donated to our clinic we all looked at each other and thought the exact same thing, which is was "Wow, this is the impact we have on this person's life?"..." Is this the difference I am making? This is amazing!"

On Saturday, I learned something extremely key about health care delivery and the role of providers. Until this experience, I suppose I never fully realized the impact that health care providers had on their patients. I realized that patients place their whole physical being in the hands of their provider. They trust them to make the best decisions for their health, thus the provider ends up with a HUGE responsibility in his/her hands. If providers make mistakes, patients end up paying with their either their life or quality of life. This invaluable realization dawned upon me while I was checking blood pressure. I realized that if I took inaccurate readings (ex. learning curve or carelessness) it could translate into the doctor missing vital information essential to the formulation of a correct diagnosis. Hypothetically, If I didn't enter correct information in the chart, the doctor would be using incorrect information in treating patients, which could ultimately mean that a serious health condition such as hypertension or diabetes could be missed completely, or misdiagnosing a problem (which is even worse). Who would've known that something so simple as taking blood pressure can have dire repercussions for the patient. These veterans are unlikely to get check-ups long periods of time. Thus, if a veteran has diabates and the doctor misses it because an intake made a mistake, the patient may go undiagnosed for another few months or years where his/her symptoms could intensify and cause severe damage. The mini medical mission was an INVALUABLE experience which contributed to my maturation as a health care provider. It helped me realize the large amount of responsibility that was in my hands (even for something so simple as measuring blood pressure); my mistakes would be paid by the patient with their health. The experience really showed me how important and serious the role of a health care provider is at every step and level of health care.

My First General Body Meeting

Asalamuwalaikum Everyone,

This will be an overview of my first meeting with Bayanihan Clinic. Clinic meetings take place two Mondays a month on campus, usually in Olson Hall. The meeting are all structured in generally the same way. All of the volunteers are required to attend every meeting because important updates are presented regarding the logistics of the clinic.

I was pretty excited attending the first meeting because I was able to fully realize the extent of my involvement in the clinic. Just sitting and listening to the student coordinators go over things as mundane as restocking supplies to things as interesting as patient emergencies really helped me feel as though I was part of something real. It's hard to explain, but in essence I felt alive and motivated; I wanted to jump right in and start participating in anything and everything.

The meeting starts with "Clinical Updates". Fam and Lorigail, our student coordinators, review logistics with the rest of the volunteers. For example, the Aptima tubes for Clamydia and Gonnorehia were switched so the patient had to come back to be retested; thus they had to make sure volunteers took note of this difference for future patients. Or another example, is that they made sure volunteers sent X-rays to the right places (for us its Elk Grove Diagnostics). The student coordinators proceed to ask each volunteer to summarize their interactions and experiences at clinic, which I thought was really awesome because it forces volunteers to reflect on experiences and lessons they learned during on their clinical day.

After the logistics were compeleted, the student coordinators presented upcoming dates for outreach events and fundraisers. Volunteers are expected to take note of these dates so that they can e-mail outreach coordinators in order to sign-up. I was so psyched, that I couldnt help myself from signing up for the first outreach event of the quarter at Tower II(I'll write about that in my next post). I also have to attend a "mock" clinic in which clinical situations are recreated with student coordinators and volunteers acting as patients, while new volunteers would act as intakes. My last training day is a shadowing day in which I follow each of the different clinical positions around as they interact with patients on a real clinical day. Lastly, we talked about the gold tournament fundraiser.

The golf tournament fundraiser is Bayanihan's biggest fundraiser. They hold this event at a country club in Sacramento for community doctors and high class members. The students do performances and interact with doctors, seeking donations for the clinic. This fundraiser is highly successful because every year approximately 20-50,000 dollars are donated. I am really curious to see how this event is organized, and I'm really impressed at how successful it is. The money the clinic makes from this one fundraiser is what helps it run for the rest of the year.

Lastly, a medical student does a power-point presentation on a community-health care issue such as diabetes, obesity, or family planning etc. This week a 3rd year U.C. Davis medical student Marisa Andres presented diabetes. The purpose of these presentations is to educate volunteers in the most common health care issues the clinic must deal with. The presentation was useful for volunteers in that it over-viewed the types of medications diabetic Filipinos should be taking vs. what they're really taking. It also delineated the different tests conducted for diabetes diagnosis such as HbA1c, which reveals the patient's blood blood glucose levels for the last 3 weeks (we want levels to be below 7.0 or 7%), as well as commonly associated complications such as strokes and neuropathy. Lifestyle factors such as diet and exercise are also assessed; it was shown that with proper diet and exercise patients could actually get off of insulin medications. Unfortunately, Filipinos have an unhealthy diet (high in carbs and lipids) and a relatively sedentary lifestyle; thus, the challenge with most patients it trying to convey to them the importance of exercise and dietary modifications.

To summarize, I benefitted a lot from the meeting because it really showed me how involved the volunteers are in the health care delivery process. Clinical updates allow volunteers to understand how an effective health care delivery model should logistically, which is great because as future health care professionals we need every perspective we can get of how a clinic works. The medical student presentation was really meant to educate volunteers on how to assess diabetes from both a clinical and social standpoint so that they can advise patients effectively in clinic. I can already tell that this clinic is amazing training ground for future doctors, and I couldn't ask for a better environment to continue my journey in medicine!

Bayanihan Clinic

Asalamuwailakum Everyone,

I've created this blog to reflect on my experiences at Bayanihan Clinic. By the Mercy of Allah, I was offered admission to this amazing clinic which aims to deliver health care services (mainly primary care) to underserved communities in Sacramento. Originally, the clinic was founded to serve Filipino veterans of World War II, who were unfairly deprived of health benefits previously promised to them by the U.S. government. However, within the last 2 years the Bush administration passed a bill that reinstated health coverage for these veterans. Because veterans are now able to access primary and specialty care physicians, the clinic has changed its focus to serving the greater Sacramento area.

As a new volunteer, I'm in the process of training, which should take most of spring quarter. I want to become a fully trained volunteer ASAP because that's when I'll be able to work in the actual clinic. As a full volunteer, I would be able interact with doctors, medical students, and patients; thus learning TONS about community-based health care. What really attracted me to this clinic is that it's completely run by undergraduate volunteers and medical students, the doctors' role is mainly for mentorship, guidance, and core diagnosis. The limited role of the doctor, results in more responsibility and control in the hands of undergraduates, which really enriches the experience. It's an invaluable experience because students must learn how to work with peers, doctors, medical students, and patients in order to keep the clinic running efficiently. If problems occur, it's completely in the hands of students to solve them by working with each other to come up with solutions. The experience gives Bayanihan volunteers the opportunity to mature into effective leaders in the field of health care.

So far my experiences have been great. The people in the clinic are really friendly and social; it feels like a family. I don't know most of the volunteers yet, but I expect with successive clinic and outreach days bonds will be formed. I already have a good relationship with the student coordinators Fam, Lorgail, and Mark; they're all really helpful with everything and anything. The next few blog posts will outline my first few meetings and my first outreach event.

I'll keep everyone posted.

Salams,

Saif