Learning

JVMC goes mobile
Originally uploaded by hibiscusfire.

Last week, which was also the first week of Spring quarter, I went back to the Bay Area for four days to attend two International Health conferences. Though they were educational and inspiring, I have definitely started to feel like I'm beginning to stretch myself too thin again. (Though it didn't stop me from signing up to be one of the coordinators of the International Health student organization at our school. These trips and responsibilities -together with being co-director of one of the student run clinics- pretty much took up most of my study time in the first two weeks of school).

Joan Viteri Memorial Clinic (JVMC) is a weekly volunteer run acute care clinic in the Oak Park district of Sacramento. Our clinic primarly serves drug users and sex workers, though we often also privide health care to people in the community. We work in collaboration with Harm Reduction Services, a grassroots organization that works to reduce the spread of HIV, Hep C and other diseases among IV drug users, while providing couseling and referrals for treatment to people with substance abuse issues. Here's a link to our website JVMC

The clinic usually runs from 1-5 pm on Saturdays and we try see 10 patients each time. Medical students interview and examine the patients, a process that always takes longer than anyone expects, and then "present" the patient to the attending physican. They then go back to the exam room together and complete the examination and treatment. If there is time, the physician often teachs the student about the relevant points to that particular health issue. It is a system that attempts to satisfy many goals, and we are still working out many of the bumps. Students learn by practicing on patients, while patients receive healthcare that they normally do not have access to. They also receive treatment free of judgement (which is not always available at the local ER and county hospitals), and are given education about health issues that they might not get anywhere else. The doctors come because they're saints. Really, there can't be another explanation. Many have experience working with this population (today's doctor is a physician at a nearby corrections facility) and they have patience and empathy that is sometimes hard to find among their ranks.

Though clinic is open for only a few hours, it is still exhausting. First of all, we opperate out of an old van, which means that we (medical students, the attending physician, and patients) are all crammed into a very small space. Sometimes, when there's a short in the electrical system or our gas has been syphoned away during the week, we find ourselves draining an abscess or performing a pelvic exam under little, flickering (or no) light.

I spent most of today at clinic, which left me feeling overwhelmed, accomplished, frustrated and even further behind in class. I love learning something new and getting the hang of things, but I don't like the actual process and I hate feeling incompetent. Often, when I find myself trying to do too many things at once, I feel overwhelmed by a growing feeling of mediocrity in everything I'm doing. Today was kind of like that. I was in charge of running the intake, distributing meds, handling labs, and keeping track of what everything and everyone was doing. Those that know me well can appreciate how much I love being in everyone's business, and this was the perfect set up ;-) I was even starting to feel really good about how things were running, when I began to see things around me slowly disintegrating. Too many patients, not enough time left before the doctor had to leave, and too many of us pulled into too many directions at once. I started seeing patients because all the other students were being buried under unfinished SOAP notes, but the transition from "big picture" girl to calm and patient health provider was hard to make. I nearly forgot to listen to the lungs of a patient complaining of bronchitis and I never even checked her lymph nodes, nose or thoat. When I presented my patients to the doctor, I would forget to tell him pertinent information or would later toss points in at random moments in a tourette-like manner. And as we were rushing to get the last patients in and clean up the clinic, I couldn't even complete a thought while trying to write my SOAP notes (and medical documents are not things you want to be messing up on these days). Fortunately, our doctor was calm and thorough, and most of our patients weren't aware of the chaos going on behind the exam room doors. Nevertheless, it made me feel like I had a lot of work to do on my actual "medical" skills.

The day finished rather chaotically. We had kept the clinic open late and the HRS the staff that usually take care of the van had already left-- with the keys to the van. So, I had to lock it from the inside and crawl out of a (very) small window six feet above the ground. (I had images of some of our gas-syphoning neighbors taking notes on my technique, in case they decided they were in need of some of the medical equipment that we store in the van.)

Once I had a moment to think about the day, I realized that we had seen 13 patients that may not have had any other access to care, and we treated all of them well. I was also strongly reminded of my limits and weaknesses. Now if I just slow down enough to learn from them, they will may become important lessons in my life.