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Policlinico Peruano Americano, San Clemente, Pisco, Peru March 2, 2010 By Steve Henrichon Thus far, 2010 has been a busy year for Real Medicine Foundation Peru. At the Policlinico Peruano Americano in San Clemente, Pisco, patient volume remains consistent at approximately 60 patients per day. Respiratory infections still compose the largest portion of cases, comprising 36% of total cases. This number is the same percentage of respiratory cases from Jan-Feb 2009. Being in the southern hemisphere, it is summer in Peru right now. Come July and August (the Peruvian winter), we expect a spike in respiratory infections as high as 50% of total cases, as we have seen in years past. Below is an overview of the cases seen at the clinic in the month of January.
Education and outreach has always been an integral aspect of our work at the clinic. The nursing staff has been conducting a weekly educational presentation in the waiting room for the patients. These presentations are often attended by additional people from the community who are interested in the weekly topic. Most recently, topics have included pneumonia, alcoholism, fever, and diarrhea. Peruvians Helping Haitians:Being much too familiar with the horror of a catastrophic earthquake, on January 23, the clinic team expressed their empathy and support for Haiti by organizing a fundraiser to benefit the earthquake victims. The Peruvians opened their wallets during a time of need, raising $300 for RMF's Haiti relief efforts. Magali Mancini Pujalt, the Administrative Director of the Policlinico Peruano Americano, echoed the RMF slogan as their motivation for helping, "friends helping friends," or more appropriately "amigos ayudando amigos." Below are photos of some dedicated RMF Peru volunteers helping to prepare food prior to the fundraiser.
Preparations for Direct Relief Shipment: We have been busy making arrangements with customs to receive a shipment of medical equipment, supplies, and medicine from Direct Relief International. DRI continues to support our clinic, and for that, we are grateful. Over the years, through Direct Relief we have received an ultrasound machine, suction unit, oxygen equipment, hospital beds, exam tables, and a plethora of medicine and supplies. This next shipment will include some additional exam tables, hospital beds, EKG, centrifuge, medicine, and supplies. Malnutrition: Every child (and every adult) who visits the clinic is assessed for malnourishment. Data is collected, and at risk children are monitored over time. We currently have a program in place to monitor severe acute malnourished children. There are currently 12 children with severe acute malnourishment (SAM) in the program and their condition is monitored every week. Preparations are being made to add 7 more children to the program in the next week. The families of the children under surveillance are counseled on appropriate food preparation and how to manage a high-caloric diet for the children. The children are also treated pharmacologically with micronutrients, vitamin A, and ferrous sulfate if they present with accompanied anemia. A proposal is currently being drafted which will greatly expand our malnutrition program by expanding our catchment area to include many small villages in Ica as well as east into the mountainous state of Huancavelica. Field workers will be trained and charged with managing the surveillance programs in their district. In addition to providing food baskets to families in the program which include many nutritious and appropriate foods, we are also exploring the option of using ready-to-use therapeutic foods such as Plumpynut and F100. In January, we saw 337 children and the nutritional assessment breakdown is displayed in the following graph.
The Policlinico Peruano Americano
The Policl�nico Peruano Americano
The RMF team in Pisco, Peru is busy serving an average of 68 patients a day! The most common cases in the month of July were Respiratory System Diseases, Infectious and Parasitic Diseases, Muscular/Physical Disorders and Injuries, Urological Diseases, and Digestive System Diseases. The health services provided include:
In addition to the daily health care services we provide to individual patients at Policl�nico Peruano Americano, the staff has also focused on community education. They have offered four educational sessions at the clinic during the month of July: 1) breastfeeding, 2) hand-washing, 3) body hygiene, and 4) pneumonia.
They have also continued their focus on outreach to the community outside of the clinic walls. Early in the month, the Ministry of Health provided special information and instructions to staff concerning the AH1N1 virus. On July 24th, our clinic staff was placed in charge of educating the community in the district of Villa Tupac Amaru on the AH1N1 virus. They distributed educational materials and presented a question and answer session at a Health Education Fair put on by the organization �Amar es Vivir�. Sixty people participated. Please visit our latest web album for more photos from the Fair and Seminars! Real Medicine Foundation projects often partner with local organizations in our project countries. In Peru, the RMF team is also gearing up to be designated as a licensed Ministry of Health Clinic. On July 6th, the RMF Clinic Director travelled to Ica, Peru to visit the Ministry of Health and SUNAT. They hosted a visit two weeks later for the Ministry staff to see our space. The goal of the visit was to complete paperwork necessary to move forward with the certification process! If you have any questions or would like to make a donation to support clinical operations or community outreach, please contact me at carly@realmedicinefoundation.org. The team is gearing up for a holiday celebration this Christmas, and is already designating children in need of gifts. If you would like to send a gift or make a donation for the team to purchase a gift nearby in Peru, please include your request in an email. Thank you for your support!
July 2009 Winter has arrived in Pisco, Peru and the clinic team has been busy in the months of May and June. We have maintained an average of 60 patients per day, with the most common cases being respiratory (46%), parasitic (12%), physical/muscular (10%), digestive (7%), and skin disorders (6%). As the weather gets colder, we anticipate the percentage of respiratory ailments to increase. To treat patients with respiratory conditions, we make use of nebulizers, suction unit, oxygen tanks, as well as prescription pharmaceuticals & inhalers accessible from our in-house pharmacy. Laboratory Services are now available at the clinic. A 3rd party lab in Pisco administers the tests and we now have a full time lab technician, Senorita Milagros. We are able to get same day test results which greatly improves continuity of care and quality of service offered at the clinic. In June, 124 blood samples were drawn for a full battery of different tests.
At the Policlínico Peruano Americano, we are always trying to promote education and prevention amongst the community. The clinic team has taken the initiative to participate/organize different community educational seminars on such topics as H1V1 and AIDS/HIV. For the latter, we have partnered with a local organization, Mirades y Voces, aimed at educating the public about AIDS/HIV. Please see our latest web album for photos from the seminars. In June, the clinic team also hosted a Health Information Fair for the entire community. The fair was sponsored by the town of San Clemente. For any questions, comments, or if you wish to make a donation to help continue the operation of the Policlínico Peruano Americano through these tough economic times, please don’t hesitate to contact me. The Policl�nico Peruano Americano
The pace is picking up at the Policl�nico Peruano Americano in San Clemente, Pisco, Peru. We have had to make several midstream adjustments to expand our service line and make our services accessible to as many P�squenos as possible. Here is our most recent update: Patient Flow: We are now seeing 90+ patients per day on average. We have extended the hours and the doctors have really been taken strides to make most efficient use of their time to handle so many patients. Morale amongst the team is high and everyone is excited about the clinic's success and new equipment to help improve delivery of care. Equipment: We have received and installed all of the equipment from the Direct Relief International equipment grant. With this money, we have been able to purchase an ultrasound machine, hospitalization bed, suction unit, pulse oximeter, oxygen tanks, medicine cabinets, autoclave, etc.
To help protect these investments, we have also increased security measures at the clinic by closing up open spaces, reinforcing outside doors and windows, and reinforcing inside doors/windows to the office in which the ultrasound unit is kept.
For more photos of the equipment purchase and security upgrade, click here. Consultation Fee: On March 1st, we instituted a symbolic 1 Peru Nuevos Soles (PEN) fee per consultation as an experiment. Our goal is to find a way to keep our clinic operations sustainable, to create a partnership in health with the patients at our clinic and allow them to take co-responsibility for their health and wellbeing, and ultimately make them self-sufficient and independent of our support. At 90 patients per day, this money will also � to a small degree � help subsidize the increased medicine costs. In certain cases where the patients are in desperate financial need, the consultation fee will of course be waived. We do not anticipate that this fee will prevent anyone who needs treatment from actually receiving it, although it may prevent people from abusing the �free� nature of the clinic. Ultrasound Fee: We are planning to charge S/15 for each ultrasound procedure. We are receiving referrals from the other clinics and the hospital in Pisco. This fee will also go towards subsidizing ultrasound services for those patients who cannot afford such a fee.
RMF Campaigns: We continue to perform RMF Campaigns. Most recently, we participated in a campaign (with other health providers) aimed at increasing health education and prevention in the community.
For more photos of RMF Campaigns and clinic activity, click here. The Policl�nico Peruano Americano
Its Christmas time and at the RMF clinic in Pisco Peru, "Policl�nico Peruano Americano," we are preparing for our annual chocolatada where we give a soccer ball, panet�n, and a glass of chocolate milk to all the children in the community. All of the gifts have been donated by local organizations and families in the community. December 10th marked the 1-year anniversary of the Policl�nico Peruano Americano. Special thanks to Dr David, Dr Guillermo, Nurse Glenda, Nurse Richard, Pharmacist Vicky, and our new Administrative Director, Magali. 10,000 patients have been seen at the clinic over the course of our first year, and we have reached out to many thousands more through medical RMF Campaigns, home visits, community workshops, and the infirmary at the local school. We are currently in the process of purchasing equipment with a $16,000 equipment grant from Direct Relief International. Respiratory infections still account for the majority of cases seen at the clinic and a portion of the grant money will go towards purchasing a suction unit and oxygen tanks. We would like to welcome two new members to our team: Magali Mancini Pujalt and Dr Pia Aguinaga. Magali is our new Administrative Director and she has been working in this capacity since the beginning of November. She has already added significant value by streamlining many processes, creating a more efficient environment where additional patients can be seen. We currently see an average of 65 patients per day, reaching as high as 95. Dr Pia has been hired as a staff physician. Dr Pia attended medical school in Bolivia and she just completed her internship in Ica , Peru . She is scheduled to begin work at the clinic on January 2nd. In early 2009, we will be exploring avenues for implementing an HIV Voluntary Counseling and Testing program out of the clinic, making use of rapid testing kits. We will also be increasing the number of medical RMF Campaigns done in surrounding communities, and looking to further align ourselves with the Ministry of Health so we can participate in government funded programs. The Policl�nico Peruano Americano
Spring time is approaching in Peru. The patient stream remains steady at about 30 patients per day and in the month of August we were able to enlist 242 new patients from the community. Females patient still outnumber the males, 2 to 1. In the local school of 3600 children which we sponsor, Nurse Maria Elisa was visited by 442 children. Maria Elisa also conducted many health workshops for the students and their parents.
Upwards of 50% of the cases in August were respiratory related. Due to the high volume of such cases, we need to consider our ability to treat such ailments. We currently use a nebulizer but we could certainly benefit from both an oxygen tank as well as a suction unit to help clear congestion in children. Can you help us purchase an oxygen tank or suction unit? Click here to help.
In August, our donated shipment from Direct Relief International cleared customs. The shipment contained an a vast amount of medicine, medical supplies, and basic consumer health products for the community such as Shampoo and Strawberry Shortcake toothbrushes for the children. On behalf of Real Medicine Foundation, Policlinico Peruano Americano, and the community of San Clemente��Thanks Direct Relief! We are thankful for your participation!
October is a busy month for the clinic. Emergency Medicine Physician and Real Medicine Volunteer, Helen Ouyang, is currently in San Clemente to oversee clinical operations and to help streamline the protocol. She will be in San Clemente for two more weeks. The Policlinico Peruano Americano will be hosting important visitors in mid-October. Representatives from the Creative Artists Association are intrigued with the clinic and they will spend 3 days with Dr Ouyang, Dr Huasasquiche, Dr Torrealva, and the nursing team to determine how best CAA can become involved with Policlinico Peruano Americano. Everyone is very excited for our special visitors.
The Policl�nico Peruano Americano
We opened the doors to the Policl�nico Peruano Americano in its permanent location on December 10, 2008. We had an inauguration that was attended by the residents from San Clemente, government officials, all of our friends who have helped us out along the way, hospitals administrators from hospitals in Lima, and a national news team that provided coverage of the story. The permanent location is an earthquake safe house with several rooms for exams, a large waiting area, a kitchen area which will eventually be used for a lab. The whole house had been renovated and converted into a clinic just before the inauguration. An addition to the clinic is also being constructed where we will have two additional exam rooms, a larger open-air waiting room, and a garage to house an ambulance. The long line of patients starts to form 2 hours before the clinic opens in the morning. Since December, the clinic has average 31 patients per day. Some days, the number of patients exceeds 70. It is now the middle of the winter and people are more reluctant to leave their homes and travel to the clinic despite their ailments. The patient flow will pick back up as the weather improves. To date, 4750 patients have received medical attention at the clinic.
Cases Seen at Clinic
School Nurse Program
RMF Campaigns In the following months, the clinic team traveled to three very impoverished communities on the outskirts of San Clemente without access to healthcare. During these RMF Campaigns, the clinic team was able to attend to over 1200 patients in total.
Educational Presentations
Nutrition Program Psychology Program Direct Relief International
Other news at the clinic:
Informe sobre el progreso del Policl�nico de Per�, Febrero 2008 (.6 MB doc) Febrero 2008 Photos (2.5 MB pdf) Informe sobre el progreso del Policl�nico de Per�, Enero 2008 1.4 MB pdf) Peru Clinic Progress Report December 2007 (.6 MB pdf) Informe sobre el progreso del Policl�nico de Per�, Diciembre 2007 (.5 MB pdf) Diciembre 2007 Photos (2 MB pdf) Local press coverage of our Clinic in Peru - 12/17/07 Peru Clinic Progress Report (.doc 1 Mb.) Progress Report
The RMF Clinic in Peru officially opened for business on November 12, just one month since our small team arrived in Peru.� The clinic is currently operating in a temporary capacity in the parish hall at the Catholic Church in San Clemente.� While health services are being administered from the Church, we are busily searching the area for a permanent edifice to house the clinic.� There are a few locations in the pipeline that have potential to serve as the permanent clinic.� We are currently employing four people at the RMF clinic:� physician, nurse, pharmacist, and night guard.� The temporary clinic consists of a triage, examining room, and pharmacy.� The clinic hours are from 8am-3pm, Monday � Friday.� In the first week (ending on Nov 16), 168 patients of all ages were treated by Dr David Torrealva. The most numerable cases treated include respiratory related infections (57 cases), urinary tract infections (35), aches/pains (24), skin allergies/infections (11), and intestinal infections (8). There has been an influx of respiratory ailments and skin disorders throughout Pisco following the earthquake, which can be attributed to the large amounts of newly created dust in the air from several thousand collapsed buildings.
To accompany the opening of the clinic, we have taken the initiative to announce our presence in the community by sponsoring various events.� On Saturday, November 17, we sponsored two workshops in the community, administered by RMF Advisory Board Member, Dr Dotun Ogunyemi (OB/GYN Residency Director � Cedars Sinai Hospital, OB/GYN Associate Professor � UCLA).� Dr Ogunyemi presented to a group of 16 local Peruvian physicians on such topics as Hypertension in Pregnancy, Post Partum Hemorrhaging, and especially HIV Transmission in Pregnancy, an important topic few physicians are familiar with in the area.� This event helped identify the RMF Clinic as a leader in the medical community.
The second workshop, also administered by Dr Ogunyemi, targeted pregnant women in the community.� Dr Ogunyemi discussed many facets of normal pregnancy, complications in pregnancy, STDs, and cancer prevention.� 13 women attended the workshop and it was very interactive and well-received.� We marketed the opening of the RMF clinic and the Community Pregnancy workshop by A) visiting 20 communal kitchens which directly feed the entire community of San Clemente and B) by introducing the RMF clinic on a local Television talk show for 15 minutes.�
In addition, the RMF clinic team participated in a medical campaign on Monday, Nov 19, at the local school in San Clemente (3600 students).� Services were offered out of a classroom and approximately 45 children were seen and treated.� The school cannot afford a school nurse and we are currently making preliminary plans to staff the school with a nurse.
Peru - Random Thoughts
Dust - Everything in Pisco is covered in dust. So much dust has been generated in Pisco due to the many collapsed buildings. Sometimes when walking around, you find yourself in a haze of dust where your entire surroundings appear cloudy. It�s also not very comforting to know that you are breathing the dust. Many people wear a mask over their mouths to filter the dust. We have been told that many people are suffering from respiratory ailments brought on from the dust and I expect that many cases at our clinic will involve respiratory sicknesses.
Jitters - It is no surprise that the people in Pisco are on edge following such a catastrophe. On a few separate occasions, large trucks have rumbled by and the people�s hearts skip a beat as they think another earthquake is upon them. One teenager named Pedro was listening to Rene�s ipod and a truck drove by. Before I even noticed the truck, Pedro had already stripped the ipod from his ears and he was half way to the door, full of fear. These people have seen carnage which I hope they never have to experience again. I imagine they will live in fear for the next few years. School - Even though Pisco looks like a WWII war zone, everyone has done their best to resume to normalcy. The kids have all returned to school. Classrooms were some of the first structures to be rebuilt. They are merely cabins made out of plywood, but they serve their purpose. All of the school children wear very clean uniforms and it is amusing when school is let out and the children flood the streets.
Peru - San Clemente We met with an engineer with ACER who showed us some potential lots in the town of San Clemente which we could use for our clinic. It�s looking more likely that we will be setting up shop in San Clemente. This town is about 6 km from Pisco along the major coastal road. They were very affected by the earthquake and it is actually a more impoverished area than Pisco. 25,000 people reside in San Clemente and the area is growing rapidly. They are very much in need of healthcare. San Clemente can be easily accessed by residents from Pisco who are looking to receive our free services. In addition, San Clemente is gateway into Huancavelica. Huancavelica is a mountain state and they currently do not have any healthcare at all. People are trying to make the journey down to San Clemente by foot to see a doctor and they are dying along the road. Normally, the trip is 3 hours by car from San Clemente. We told ACER that we could set up an outreach program to train local people from different communities in Huancavelica to administer first aid...and to also identify those cases that need advanced treatment. We will then pay to have people transported down (or pick them up in our ambulance) to our clinic in San Clemente where they can receive further treatment. Our location and partnership will most likely be finalized next week, but this situation seems ideal.
We are also looking forward to collaboration with PAMS (Peruvian American Medical Society). PAMS is an American NGO working in Peru doing very similar work to RMF but on a much larger scale. They are planning to build a medical complex, probably in Pisco, with Peruvian and American specialists such as OB/GYN, Radiologists, etc. Our clinic will be affiliated with the PAMS clinic and it will serve as a place we can refer our patients for x-rays or advanced procedures that we are not equipped to handle. It will also expand the reach of PAMS/RMF services as the 2 clinics will be in different locations near Pisco and will be able to service a larger population of people. Peru - Distribution Yesterday morning, we participated in a distribution. Tzu Chi had plans to distribute a 110 lb sack of rice, mattress, bag of beans, blanket, and cooking oil to each of the 2000 families that live in the San Andreas district of Pisco. It is more manageable to help everyone in a single designated area versus helping a few people all over town (and riots can be avoided). We left at 6am on the bus with 40 uniformed Tzu Chi volunteers from Taiwan, US, Peru, Paraguay, and Argentina. The distribution took place at a fish factory in San Andreas. When we arrived, many residents were already there to welcome us. After a 45 minute ceremony, the distribution began. They would allow about 60 people into the building at a time...they would be given their goods...then we would help them out with their rice as they exited the back door of the warehouse. Most of these people don�t have cars so eventually taxis started to arrive and they were charging a premium to cart everyone�s goods to their house. People were sharing taxis and mattresses were piled on top of the cars. Even the little motor taxis (which are basically like scooters that can fit two people) somehow figured out a way to also fit a few bags of rice and actually strap several mattresses on top.
More and more families would gather outside with their goods without transportation. It became very crowded. Rene spent the majority of his time outside helping the people with there rice to the taxis. He was doing a great job a directing traffic and making sure people moved their goods to the side of the road so the taxis could get through. There were also a few hundred people outside near the exit who did not live in San Andreas and therefore were not eligible to receive the rice. Mothers, children, and men would surround me every time I went outside and plead for food...or ask me how they could get inside. I got used to saying �Solamente estoy ayudando otra organizaci�n. Hable con los chinitos.� I am only helping another organization. Speak with the Chinese people. It was sad to see. I don�t blame them. They are hungry too...but this is not a problem that will be solved over night. It will be a long time before everyone is helped. I liked helping the mothers out with their rice because I would talk to them about their children...with their rosy chapped cheeks. It gets them to open up a bit and sometimes I would take a picture. Everyone who actually received their goods where very appreciative. One woman even started crying because she was so thankful for our support. The people who were not eligible, however, were getting more frustrated. Eventually, people started receiving goods with false tickets and the police shut the operation down because the scene outside was getting hostile. At the end of the day, I was worn out...and very sunburned. I must�ve moved close to one hundred 110 lb bags of rice. My whole body ached and I started to shiver even though it was very hot out. I knew I needed to rest. That night a slept for 17 hours and I feel much better today! Helping out with the distribution was a great experience for both of us. I am glad we were there to help out Tzu Chi so we can live up to RMF�s motto �Friends Helping Friends.� We all have the same goal so collaboration between organizations is very important. We will be relying on help from other organizations during this entire process so what goes around, comes around. Relief Effort PERU Earthquake August 15, 2007 Peru Medical
Clinic (.pdf 558KB) You can help by donating here , and specifying 'Peru Earthquake Relief'' in the Note to Real Medicine. Please help us to help!
Photos and power point presentations: courtesy of Zoila Webster A magnitude-8 earthquake struck just off the coast of central Peru on August 15, 2007. Reports from Peru count more than 1,000 deaths and at least 3,000 injured people in towns along Peru�s central and southern coast. The majority of the damage and casualties occurred in Chincha Alta, Ica and Pisco. At least 80,000 people have suffered the quake�s impact through the loss of loved ones or destroyed or damaged homes. We are specifically asking for help to support the Children's Hospital of Peru-USA in Lima. There are not enough beds for all children who come from the earthquake affected areas and need medical care. Many have to sleep in the streets, and every day more injured children are found. Urgently needed are medical supplies, clothes and water.
Coastal Peru has a history of very large earthquakes. The August 15 shock originated just south of the source region of the magnitude 8.1 earthquake of October 1974 and just north of the source regions of major earthquakes that occurred in August 1942 (magnitude 7.7) and 1996 (magnitude 7.7). The largest coastal Peru earthquake of the last two centuries was the magnitude 9 earthquake of 1868, which was centered about 700 km southeast of the August 15 earthquake. The 1868 shock produced a tsunami that killed several thousand people along the South American coast and also caused damage in Hawaii. |
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Also in January, 47 ultrasounds were performed and 160 laboratory
samples were taken. Though a small fee is collected for these services, we are
careful to preserve the free nature of the clinic and the fees are waived for
those families who cannot afford to pay.
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� Map
of PERU, U.S. Geological Survey, National Earthquake Information Center, World
Data Center for Seismology, Denver |
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