Patient Visits

Today was spent shadowing a nurse while she went through her patient consults (encounters) for that day.  I'm finally starting to figure out the whole process!  Here's what I've determined so far:

1. Patient checks in to the Reception area with their HIV Tracking booklet and insurance card.

2. Patient is given a number and their chart is pulled.

• Each patient chart (Fr: Dossier) contains a colored dot that corresponds to one of the nurses.  Each patient has the same nurse each visit (unless their assigned nurse is on leave).

3. Nurse is given stacks of patient charts in the order that she should see them.  She then calls patients in one by one.

• Depending on the number of nurses present (there are 4 but on average 3 are present each day) and the number of patients, nurses see anywhere from 20-40 patients per day.
• WE-ACTx averages about 1,800 patients per month.

4. Nurse screens for TB and STI's and takes the patients weight to monitor BMI.

• A positive screening for TB is indicated if the patient reports any of the following:
• Productive cough
• Fever
• Weight loss
• Decreased appetite
• Vomiting
• Fatigue

• A positive screening for STI is indicated if the patient reports any of the following: 
• Gential discharge
• Genital itching
• Lower abdominal pain

5. Nurse evaluates patient's adherence and educates them if necessary.

6. Nurse records patients visit in their chart (Dossier).

7. Nurse also records current visit date and next visit date, in addition to any changes in medications, in each patient's HIV Tracking Booklet, Kubonana na Muganga (see below!).

This is where HIV positive patients track their current
medications (prophylaxis, ARV's) and appointment dates.

8. Nurse gives patient a prescription for their ARV's, Bactrim and any other complaints.

• Patients today also complained of sinus infection, cough and possible pregnancy.

9. Patient goes to lab for any tests, pharmacy for medications (including ARV's) and reception to check out.

10. Patient completes a guided research assessment with one of the staff about their family members and whether or not they've all been tested for HIV.

10 Fast Facts about WE-ACTx for Hope Clinic

1.  WE-ACTx for Hope is located in downtown Kigali, the capital of Rwanda.

2.  They only treat HIV positive patients.

3.  Clinic runs from 8am-4pm each day, except for Fridays (8-12pm).

4.  Each clinic day is started with an educational session for all patients in the waiting room where the nurses, doctor or technicians lecture briefly about topics related to patients’ health.

5.  They treats about 80-100 patients per day.

6.  Wednesday is Children’s Day.  This means that only children are treated on Wednesdays each week.

7.  Friday is Screening Day.  New patients can come to be screened for HIV/AIDS on each Friday.

8.  They have has 1 doctor, 4 nurses, 1 lab tech, 2 pharmacy techs, 4 counselors and multiple other staff members that help the clinic function fluidly each day.

9.  The nurse only give out 30 day supplies of medication, including ART’s.  Special exceptions are made in circumstances where children are going away to boarding school and adults are going on business trips.

10.  Patients can send their parents, siblings, significant other or guardians in lieu of themselves.

Nurses Rock!

Nurses play a pivotal role at WE-ACTx.  While the doctors are in charge of starting patients on medication and overseeing day-to-day issues that arise, nurses are each assigned a particular set of patients that they will see 20-40 of each day, depending on how many are scheduled and the number of nurses in the office.  During each visit, nurses evaluate patients for ART adherence by asking them how they are taking their medication, if they have missed any doses and, if so, why that was.  In addition, they perform a nutritional assessment of children under 15 years of age, document patient encounters in paper charts (Fr: Dossier) and address additional concerns related or unrelated to ART.  They are the ones that patients first talk to about their physical and psychosocial needs and determine if the patient needs to see a counselor, talk to the doctor or seek any other lab tests.

Thank goodness for amazing nurses!

Nyacyonga Clinic

                                  

                                       Nyacyonga Clinic

    Located about a 40 minute drive outside Kigali (per private car), we sped past the dwindling villages until we reached this clinic perched upon a hill.  The nurse was very relaxed as patients passed their HIV tracking books (Kubonana Na Muganga) through the metal grates of the open windows and the social worker-in-training typed their names into the Rwandan National Electronic Medical Record (EMR) to check their insurance and registration.  They then passed whichever combination of meds the patient needed back through the window along with their little tracking books.

Here are some of the materials (aside from the computer and EMR) that the clinic used to ARV info:

List and explanation of dosing of ARV's for children under 15yo

Book to track discordant couples, or couples with one
HIV+ partner and one HIV negative partner

Book of Patient records (Dossier) plus a prescription pad

See a brief video of the scenic drive here:

First day in Clinic! Yay!

Today was my first day learning about the in's and out's of WE-ACTx For Hope Clinic, local NGO in Rwanda.

Front of WE-ACTx For Hope Clinic in downtown Kigali, Rwanda

I met with Chantal, the Clinical Director here, and she gave me the grand tour: Laboratory, Pharmacy, Nurses Station, Consulation Rooms, Psychosocial services, Logstics and Accounting offices and Reception/Patient Waiting Room.  The morning was spent shadowing in the pharmacy and counting pills of Bactrim, an anitbiotic used to treat bacterial infections (opportunistic infections) that all HIV+ patients must take with their Antiretrovirals (ARV's).  For those who don't know, ARV's are the medications that are used to control the HIV virus and preventing it from replicating, spreading and developing into AIDS.  In this day and age, ARV's are advanced enough that patients can long, healthy lives comparable to those who are HIV negative.  ARV's typically come in "cocktails" that involve multiple types of ARV's taken simulaneously to best control the HIV.

Afterwards, I sat in on several consultation visits with one of the nurses.  She's been with WE-ACTx for Hope for over a year and working as a nurse for over 25.  Typically, her day consists of seeing about 40 patients and discussing any recent labs and how they are adhering to their ARV's.  If they need any sort of counseling, she will direct them to several of the pyschosocial directors, including those dealing with trauma, mothers and children and yound adults.

After breaking for lunch and exploring the town a bit (including a vibrant rendition of church songs in Kinyarwanda), Lizzy and I returned to sit in on a meeting where the psychosocial directors and nurses discussed specific patient cases.  One particular case involved a boy who's mother was not giving him his ARV's on schedule since his CD4 was decreaseing and his Viral Load (CV) was decreasing, both bad things, despite being previously successful on ARV's for several years.  They all suspected that his mother was not ensuring that he adhered to his medication on time each day and, since the father was at work most days, were considering relaying responsibility to the boy's older sibling to ensure his adherence.

View of the streets of Kigali and surrounding mountains from WE-ACTx clinic

That was all for today!  You can watch videos of Kigali buzzing under the morning light or of a man trying to hail a motorcycle (moto) along the street.

Welcome to Kigali!

I woke up this morning to the sound of birds sing-songing at my window.  It was glorious! The fresh breeze bathed over my face as I squinted into the bright sunlight streaming through the grates and tried to determine the local time (11am!) and then my body's time (4am!).  Hearing the pitter-patter of footsteps and clanging of pots, my best guess what that the housemaid(s) were doing their thing.  I sleepily meandered out of my bed to greet them, wondering what level of English I'd encounter and prepping my best African-English accent.  I first stumbled upon Serafine, our cook who has 5 children and spends her days making us (there are 5 of us staying here) a delicious barrage of Rwandan-American cuisine for dinner and stocking our endless fruit, coffee and tea supply.  She is the definition of kind, reserved, and loving.  Her sister, Josie, was my second Rwandan of the day.  She works as our house cleaner and maid, doing our endless supply of work/running clothes and making our beds each morning.  In addition, she speaks some Swahili, as does our gardener, John.  My elation is hardly contained....okay, it is not contained.  My battered, broken Swahili is dusted off of the crevices of my mind as I listen to their Congolese Swahili tinged in French.  Later, I explore the streets I will be roaming down the next months as I run to the edge of our neighborhood, Kiyovu, and buy a SIM card for my phone, forgetting the voucher for phone credit.  Alas!  I later discover that Kiyovu is the wealthiest neighborhood in all of Kigali and the current president of Rwanda, Mr. Paul Kagame, is our neirghbor.  If only all those guards weren't posted as each entrance, I might attempt to sneak a glance.

Intro to Kinyarwanda:

Good morning! --- Mwaramutse!

Good afternoon! --- Mwiriwe!

Thank you! --- Murakoze!

How are you? --- Amakuru (ki)?

I'm good! --- Ni meza!

Yes --- Yego

No --- Oya

Who am I?

Je m'appelle Stephanie.

I am a Rush Medical College rising M2 and former Peace Corps Volunteer (PCV).  

From 2011 to 2013, I lived and taught in rural Tanzania at a local secondary school.  Teaching classrooms of anywhere from 50-80 students high school level Biology and some introductory English in both Swahili and English. 

As a PCV, I also worked closely with my school and counterparts to establish a school library through the renovation of an abandoned classroom, purchase of updated textbooks and developed of a modified Dewey Decimal system.  This was funded through both a Peace Corps Partnership Program (PCPP) grant and donations from the NGO, Tanzania Reads.

After finishing my service, I backpacked for several months throughout Southern Africa (much to the dismay of my mother) before returning home to study for the MCAT and apply to medical school.  After choosing Rush for my MD, I spent a month in Japan backpacking with my sister and best friend before strapping down to study the next year away.  

While my ambition is to become a dedicated, inventive doctor, I heart truly lives in the countries outside my home and I hope one day to practice medicine in these settings.  I'm ecstatic to be returning to East Africa and learn about serving vulnerable communities through healthcare initiatives.  The NGO that I'll be working under, WE-ACTx is doing phenomenal work in Kigali with HIV positive Rwandans.  While I have much to learn, I'm excited to be dedicating my time between M1 and M2 years soaking up Rwandan culture, experiencing how healthcare clinics are serving HIV patients and contributing some of my skills and expertise to analyzing a Family Needs Assessment that was performed in the past year to look for trends and brainstorm ideas of catering services to our patients.  

Me!