First clinic!

    Jambo! The day started bright and early in preparation for our first clinic.  The Mashavu team left Ivory by 7:30am and made it to the CYEC around 8am.  We spent the first two hours setting up the physical clinic, creating three independent kiosks.  We also arranged 2 stations for pre-Mashavu medical information collection and 2 stations for post-Mashavu interviews.  Additionally, the doctors (Carol, Ross, and Susan) set up a room to examine the patients at the end of the Mashavu experience.  Each person on the Mashavu team played a vital role in the concept of operations of the clinic.  Julie and Brianna were in charge of welcoming and consent/recruitment at the start of Mashavu.  Rene’ and Tara Y were responsible for pre-Mashavu information collection.  Kiosk 1 was run by Alice L and Bello, Kiosk 2 by Rachel and Pat, and Kiosk 3 by Jeff and Colin.  Alice C, Carey, Tom, and Tara S performed post-Mashavu interviews and Shengnan guided the patients from the interview to the doctors.  Lastly, Steve, Gill, Roma, and Samir concentrated on troubleshooting and overall management of the clinic.
   

    The Mashavu experience for the patient was the following.  When the patient arrived, Julie or Brianna greeted them and acquired informed consent.  Each patient was given a copy of the Mashavu consent form before moving on to the next step in the experience.  The patient went to one of the two pre-Mashavu stations with either Rene’ or Tara where the patient gave contact information, case information (health complaints), and medical history.  Tara and Rene’ recorded all information onto paper for the patient to take with them to the kiosk.  The patient then entered the kiosk room and were directed to one of the three kiosks.  Kiosks 1 and 2 were for adult patients and Kiosk 3 was for children.  Kiosks 1 and 2 had the following off the shelf devices: weighing scale, blood pressure cuff, thermometer, and a shared pulse oximeter.  Additionally, the two kiosks had the Bio-E’s blood pressure cuff, thermometer, and pulse oximeter.  Kiosk 1 also contained a webcam used to take a picture of the patient for their account.  When the patient arrived at the kiosk, they got their height taken, followed by measurements from all of the devices.  At least one of the CYEC students was helping to operate each kiosk; they took measurements using the devices and also aided in communication between the Mashavu team and the patients.  The numbers collected from the devices were recorded and copied onto a slip for the patient to take with them.  While the measurements were being taken, the hand written pre-Mashavu information was typed into the computer into the patient’s file.  After leaving the kiosk, the patient went to a post-Mashavu interview with either Alice Cheng and Carey or Tom and Tara S. In place of a post-Mashavu interview, six women were invited to participate in a focus group with Brianna and Gill to give feedback on the Mashavu experience.  Following the interview or focus group, the patient was directed by Shengnan to the doctors.  One of the doctors performed an examination of the patient to conclude the Mashavu experience.  The doctors noted that Nurse Mary was critical in aiding them in the examinations, offering insight into what was the best treatment available.  Besides operating the kiosks, the CYEC students were very helpful in the overall running of the clinic.  This was particularly tru`e for increasing communication between the Mashavu team and the patients; the students were able to clarify what we were saying in English using Swahili words.  The clinic was officially open from 10am to 3pm but the final patients finished up with the doctors around 4pm.  Approximately 40 adults and 10 CYEC students (over the age of 18) went through the clinic during the 5 hours.
   

    During the course of the day, 52 patients were Mashavued. Many of the patients had serious health issues and were at the CYEC to take advantage of the free clinic offered by the doctors. High blood pressure was very often observed and it is important to incourage awareness about this problem because there are no noticable symptoms. The Mashavu clinic can take vital measurements, blood pressure, height, weight, temperature, heart rate, % oxygen saturation, spirometery and health history questions, so people can catch their health problems before they become serious. One of the goals of Mashavu is to increase awareness about health care, particlarily about preventative care, and yesterday at the clinic we accomplished this.
   

    Both off the shelf and BioE devices were used for comparison purposes.  The BioE weighing scales immediately saturated so they weren’t used during the clinic.  The BioE team is currently rebuilding the circuit to get it working for our next clinic.  Because the off the shelf scale (in pounds) was used, the patients were confused at the numbers they were seeing for their weight.  The BioE blood pressure cuff gave consistenly similar readings to the automated off the shelf blood pressure device.  Off the shelf thermometers weren’t used orally due to cleanliness so instead temperature was measured either in the crease of the elbow or in the armpit, sometimes over clothing.  Both the off the shelf and BioE thermometer were giving low readings but this was most likely due to incorrect placement.  From now on, we will be using new mercury off the shelf thermometers and placement in the armpit.  The off the shelf pulse oximeter isn’t giving accurate measurements so calibration of the BioE pulse oximeter isn’t currently possible.  The BioE version is giving accurate pulse rate but needs work on the oxygen saturation measurement.  The spirometer and stethoscope were not used at this clinic but are continually being worked on; there are some mathetmatical and filtering issues to be solved.  Our current plan for the weighing scale, blood pressure cuff, and thermometer is to compare values from the off the shelf device to the BioE device for calibration purposes.  We also plan to work on getting the internet working so that the information can be sent over Gmail to the doctors.  Lastly, today will be used for surveys in the community and completing work for the 2 upcoming clinics.

Thanks for reading!