|Christian and Becky, sorting medications in the Pop Wuj pharmacy|
Resource Management and Sustainability of NGO Clinics
Every clinic that serves the underserved must deal with resource management. However, in the hospital setting this resource management calculus occurs far away from the provider and is typically secondary in my mind when seeing and treating patients. However, working in the Pop Wuj clinic, the primacy of resource management issues became apparent. Because I participated in the elective during a peak season for medical students, the clinic was able to see twice as many patients as usual. The clinic typically receives the medications that it dispenses to its patients through Timmy Global Health approximately every 2-3 months. However, because the clinic was able to serve more patients, the supplies for the pharmacy began to run low.
Running low on certain medications meant multiple things as someone working in the clinic. First, some patients would have to be transitioned to equivalent medications (e.g. from lisinopril to enalapril) dependent on the availability of stock in the pharmacy. In addition, we had to make decisions on how many pills to dispense to patients based upon the amount of medication left in the pharmacy. This raised issues of who should receive the full typical dispensement and who could be given fewer. In working with my panel of patients, I preferred to give the full number of pill to patients who lived very far away and were unable to return to the clinic easily. In addition, for patients who expressed that they typically purchased the medications themselves, I would usually provide a month’s supply rather than the usual two months as this indicated to me that they were more financially able to bear the burden of pay for medications themselves. I was left wondering what the best option in these situations is and I was reminded of how complicated maintaining a physician’s duty to justice and equity are in medicine today.
I am extremely grateful for the opportunity to participate in a rotation with the Pop Wuj clinic. Not only was I able to get a glimpse of what it is like to practice in the developing world but I also met a number of fantastic colleagues from all over the world who are also interested in global health. In addition, I was able to hone my proficiency in Spanish, a skill that I am sure will be useful going forward in my career.
Looking back on my experience in Xela, I realize how the global and the local are extremely interrelated. What makes global health experiences different is that constraints on resources and cultural factors make the issues we face here in the United States even more pressing when treating patients in the developing world. As I enter residency, I am very appreciative of how this experience will make me much more cognizant of the difference between what I believe my patients understand and what they actually understand. In addition, my weeks in Xela have brought up deeper questions about how to best engage male patients in health care and what the commonalities are across developing countries and how these commonalities can be utilized as leverage to improve health outcomes.
My deepest thanks go to Drs. Pascal Imperato and Denise Bruno, without whose guidance and support this project would not have been possible. In addition, I would like to thank the Alumni Fund of the College of Medicine whose generous contributions make life-changing experiences like these projects possible for students. Finally, I would like to thank Ms. Lois Hahn, whose kindness and tireless work for the students in this elective are unparalleled.