Our New Clinic Structure
When there is such intense need for accessible and affordable primary care in an area like Pont Morel, it can be overwhelming to try and provide those services efficiently and effectively. YourStory International is a young, growing organization and, as we expand, so does our capacity for treating patients. With an increase in resources comes a need for a primary and emergency care system that can capitalize on the potential of our staff and advocates
The initiative to standardize our PMPECS (Pont Morel Primary and Emergency Care System) has been long underway. This past winter, we made great strides in improving our previous system.
Here’s what we did:
The day preceding the clinic is dedicated to surveying nearby towns and identifying individuals who appear to be suffering from severe ailments. These people are given appointment slips to guarantee they have the opportunity to see Dr. Tony, the Haitian doctor who helped found YSI. The slips also ensure that appointments are staggered throughout the day, rather than all at once. For those not given an appointment slip, the option to walk into the clinic is always available. Word of PMPECS spreads quickly, so a line of patients usually begins to form as early as 7:30 am outside our gate.
When a patient arrives, he or she is greeted by the door guard. If the patient presents an appointment slip, he or she is led by a runner directly to the waiting room. Those without an appointment are sent to our triage station where students (either nursing students, EMTs, or CNAs) will take their vitals, assess their symptoms, and assign them a color that corresponds with the severity of their ailments. The color categories are:
1. Probable malaria
2. Recurrent UTIs with antibiotics
3. Serious Infections
4. Bloody vomit or stool
5. Unusual or concerning
Three or four chronic illnesses
Ailments that can be remedied with public health education, such as a first-time UTI or menstrual cycle symptoms
Green patients are sent to the public health education area, where they are presented with information about their ailments and ways to prevent or remedy them in the future. Additionally, everybody who visits public health education is reminded of the prevention techniques for waterborne illnesses, mosquito-borne ailments, and common dietary-related issues.
The reds are immediately taken to the waiting room as if they had an appointment. Yellows are told that a doctor will see them, but it may be a long wait because there are people with pre-scheduled appointments, as well as red patients ahead of them. Almost every person will agree to wait, so the yellows are brought over to a secondary waiting room. Red and yellow patients have their vitals taken at triage and are sent to their respective waiting rooms with a patient intake packet. Those with appointments receive their intake packet once they reach the waiting room, where the intake students will record their vital signs, complete their medical history, write down their chief complaint, and ask them some questions about their lifestyle, such as whether or not they sleep under a mosquito net.
As the intake forms are completed, they are handed to the patient manager, who will arrange the forms in order of urgency of symptoms, the patient's arrival time, their color assignment, and whether or not they had an appointment. Being a patient manager is challenging, but our students do an amazing job with this task.
Once the patient is led into an exam room, one of our professional nurses addresses any changes in lifestyle the patient could make to prevent common ailments. The nurse will then assess the patient's chief complaint, asking the necessary questions to make a diagnosis. Dr. Tony, who rotates between the two exam rooms, will then come in to review the diagnosis, write any needed prescriptions, and complete post-education to explain to the patient how to resolve their sickness. The student scribing the appointment then leads the patient to the medication room, where one of our professional Haitian nurses will fill their prescriptions and explain the proper intake regimen. Meanwhile, the next patient enters the exam room and starts their appointment with the second student scribe.
Throughout PMPECS, the majority of responsibilities are held by our student advocates. Students choose a morning position and an afternoon position. The roles are as follows:
Door guard: Greet and manage the flow of patients, send them to appropriate location
Scribe/Observer: Two in each exam room, rotate scribing for every other patient
Triage: Label walk-in patients red, yellow, or green
Triage assistant: Start intake forms for red and yellow patients
Patient manager: Manage the waiting room, arranging the order in which patients enter the exam rooms
Public health education: Provide education to all of the green patients
Runner: Lead patients from one area of the clinic to the next
Vitals and intake: Finish intake forms for appointment-holders, as well as red and yellow patients while they’re in the waiting room
Child manager: Play with the children whose parents are in the waiting rooms or the exam rooms to avoid crowding essential areas and keep them entertained
Medical inventory: Keep track of how much of each medication is being prescribed and given to patients
Multiple people fill each of these roles. Additionally, one Haitian nurse runs an exam room while an American nurse runs the other. Another Haitian nurse handles medication. Dr. Tony oversees both exam rooms. Our translators work extremely hard to bridge communication gaps, and they continually rotate positions throughout the day where they are needed. PMPECS would not work without their dedication and efforts.
An explanation of this system has been incorporated into our advocate training the day after they arrive in Haiti. This new system was developed primarily by our session two advocates, greatly assisted by our three post-bac students who joined us this winter. Prior to this system, we saw an average of about sixty patients a day (from 9am-7pm). Now, because of system improvements, we are able to see over 100 patients in one day and end our clinic by about 4pm. We are extremely excited to continue this system throughout our summer sessions.