Peru – Opening of the Clinic

Okay. We are now back in November. We opened the temporary clinic on Monday, November 12th. The idea is to work in a temporary capacity until we have arranged for a permanent location for which to house the clinic. Maybe 3 or 4 weeks. We did not do any advertising because we wanted to grow our patient population organically. This way, the clinical team could refine the processes and get used to the idea of working in a church. On Monday morning, there were just a few people waiting to be seen when we opened the doors at 8am. It was an exciting day, however. In just one short month since arriving in Peru without knowing anybody, we already had a makeshift clinic set up and we were treating people albeit with limited resources. The temporary clinic consists of:

• Exam room – Really just a big orange tent to ensure a little more privacy. Inside the tent, there is a desk for Dr David to consult with his patients, an exam table, and a utility table to store different instruments, supplies, and solutions.
• Triage – We curtained off a corner of the room and called it a triage. This is where the nurse does the initial intake, checks vitals, takes weight/height measurements, etc.
• Pharmacy – This is a glass bookcase which could be locked. We replaced all the religious books with medicine. We kept the majority of the medicine at our apartment in San Andres for security reasons.
• We simply replenished the stock of various medicines in the temporary clinic as needed.

Patients come into the clinic and sign in. They then have a seat in the waiting room (a few rows of school chairs set up next to the triage). The nurse then calls each patient into triage where she interviews them about their clinical history and gets a quick synopsis of the purpose for their visit.
The patient then has a seat back in the waiting area until they are called by the Good Doctor. They then visit with the doc for about 10-30 minutes depending on their case. Doc usually writes them a prescription and then they bring that prescription to the pharmacy. The pharmacist then dispenses the medication and the patient goes on their merry way. Its really as easy as that. At least for now.

The temporary clinic team consists of one physician (Doctor David), a nurse (Maria Elisa), and a pharmacist (Rosa). Doctor David took the initiative to find and hire Maria and Rosy with the expectation that we would only need them for the duration of the temporary clinic. If they prove to be diligent workers, we can reserve the option to extend a contract to each of them to work at the clinic in a permanent capacity once we move out of the church. Rosy is actually a biologist by trade. She has experience as a laboratory technician at medical facilities. We hired her as our pharmacist because it is much easier to train her as a pharmacist then to hire a pharmacist who we train as a laboratory technician. Down the road, I expect she will be performing both functions and so it makes sense to hire the biologist now. She is able to provide us a lot of direction on the design of the lab. She had given me a list of equipment and supplies we would need in the lab as well as the complete list of tests she could administer based on the equipment.

In the first week, we saw about 160 patients which is about 32 patients per day. This is a huge amount of patients for one doctor to see. The trick is to find a balance where the doctor is spending sufficient time with each patient but not too much time or else people end up waiting for hours. We also try not to turn anyone away.

In the first week, the majority of the cases treated were respiratory infections, followed by urinary tract infections, skin disorders/infections, and intestinal infections. The significant amount of respiratory infections, skin infections, and even UTIs can be attributed to the increased amount of dust in the air from several thousand collapsed buildings.

I was content with the first week in the temporary clinic. We have compiled a great team. David, Rosy, and Maria are all very honest and compassionate individuals. Furthermore, they take the initiative to create efficiency. Neither me or Rene needed to stay at the clinic for the duration of the work day. We would each help out at the clinic for at least a couple hours during the day but we felt confident leaving the clinic in the team’s hands so we could focus our attention on other tasks.