I know, it's been a while since I've written anything. Between clinical interventions at Clinica Esperanza, working on my first IDA order for my "new job", and exploring Roatan, I've been pretty busy. Oh yeah, and I've been catching up on 3 weeks of sleep.
Clinica Esperanza
First of all, you might be wondering what I'm doing in Roatan, or as several people have phrased it, "who said you could leave Haiti?!?!". I was asked to come to Roatan to help at Clinica Esperanza and assess the possibility of bringing students for rotations. My alma mater, Pacific University, is partnering with the small community safety net clinic on an island off the coast of Honduras. Pacific University is planning to send health profession students here for rotations starting with the Physician Assistant Program this fall.
I was pleasantly surprised at how excited everyone was when I showed up - and how grateful they have been for my help and expertise. Clinica Esperanza has been around for almost a decade and has never had a pharmacist so much as visit the facility. In fact, other than me, there is only one licensed pharmacist on the entire island that has a population of about 60,000 (more like 100,000 if you include all the ex-pats) and has several pharmacies, clinics and a hospital. Apparently, pharmacies here are run as dispensaries, with no consultations and no way to check for drug interactions. So when we visited the public hospital there were many questions for me, and again at la Clinica.
It's been an interesting experience - especially on the heels of so much time in Haiti. In many ways, things here are way more organized; we're in a building (not circus tents), with a room specifically for the pharmacy - with shelves, a computer system (with real prescription labels!), and running water. But there is a lot of work to do here - no one runs interaction checks, counsels on side effect profiles or proper use of medication. Well, let me rephrase that - the nurses here, who are often the ones explaining how to use the medications (en espanol, por su puesto) would gladly relay the information if they knew it.
For example, the other day we dispensed alendronate (generic fosamax). It has very specific instructions on how to take it: first thing in the morning with a full 8-ounce glass of water, at least 30 minutes before any other medicine, food or beverage, and the patient has to stay upright (no laying down) for at least 30 minutes after taking the pill. I explained (in Spanish) to the nurse how to take it and how important it was to take it properly, and she said no one had ever told her to tell patients that. Taking the medication incorrectly can, at the least, cause it to not be absorbed, or at the worst, cause erosion of the esophagus.
Over the past week I've been able to make some important clinical interventions, help with medication therapy management and "therapeutic substitutions". I've also been able to identify some great projects to help improve services here at Clinica Esperanza. And there's been a few added bonuses: I've been making friends and exploring a beautiful tropical island, and have been able to network with an NGO and get all sorts of advice for my new job...
"New Job"
Late one night during my last deployment in Haiti, I was discussing formulary management with Tom (the Chief Operations Officer), and said to me "I need you here - you can't leave".
It may be old news to some of you, but I have officially accepted the position of "Chief Pharmacy Officer" with University of Miami / Project Medishare. It's a temporary position that runs through the end of August, and spans the transition from "three-tent-circus" hospital to our new building - Bernard Mev.
I also found out that a move date has been set - June 5th we will be moving out of the tents and into an honest-to-God building with electricity and A/C that work all of the time! Of course, I'm not holding my breath; they've been saying we're moving for months. But we've got a lease, and an actual date, which is way more than we've had in the past!
Being here in Roatan has been so helpful for my new position! The chance to learn from health care providers experienced in matters such as IDA orders, finessing customs agents, and dealing with massive quantities of expired/un-needed donations has been invaluable.
I meant to write about my adventures here in Roatan, but I think my neighbors are taking me out to dinner so I'm gonna sign off for now...
Que tengas una buena noche!
~PJ
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