Wednesday, November 30, 2016

November Volunteering

November was a really interesting month! I had my first ever medical school interview, and we covered some of my favorite material in pharmacology, which is treatment of respiratory pathologies. The weather took a sudden change for cold and rainy this month, which brought with it a huge spike in the asthma exacerbations and pneumonia I see at work, and while I've previously been acquainted with some of the first line asthma medications such as albuterol and atrovent, it's been really fascinating to connect conceptual class material to patient presentations.

Aside from class and work, I've continued to participate in the Street Medicine project with Dr. Zhang, an emergency medicine resident at UMC, and we went out twice this month, four hours each night. The outings consisted of walks around the downtown/French Quarter/ferry terminal area, where many homeless/houseless people stay,  reconnecting with patients recently seen at local hospitals, following up on their discharge instructions and access to medications, continuing care, and offering assessments of chronic or new complaints. One of the patients we met had a low grade fever, a productive cough, and exertional shortness of breath for three weeks, and from class lectures I immediately connected his complaints to discussions of atypical pneumonia! He didn't want to go to the hospital though, so we referred him to Healthcare for the Homeless at the VA clinic.

The second night drew a large group of volunteers, including two Tulane second year medical students, Dr. Nixdorf,  one of the doctors from Healthcare for the Homeless, and a social worker from Unity House. We were able to meet up with many of the folks who stay under I-10 by Calliope and discuss options for getting housed, in addition to checking blood pressures and glucometry.

Besides Street Medicine, I've continued to volunteer with the public health organization Trystereo, distributing clean syringes to local injection drug users and discussing strategies to reduce infections. I recalled Dr. Dery's lecture on endocarditis as I spoke to one program participant about her recent hospitalization for bacteremia. November has also seen a large increase in overdoses among illicit narcotic users, and so I've been volunteering in a campaign to more widely distribute information on overdose prevention and treatment.

Lastly, my project to get an EMT educational scholarship for Sci High students is under way! I met with the careers counselor at Sci High again this month, and submitted a grant proposal to the city vocational education funding source, Job1, and I'm hoping to hear back from them so we can try to get this project under way!

November volunteer hours: 12
Total volunteer hours: 56

Tuesday, November 1, 2016

October volunteering

October was an easier month, with material that I felt more comfortable with than in previous blocks. I was cleared to return to duty as a paramedic with the city of new orleans after a major motor vehicle collision in February, so I'm still figuring out how to balance my commitments to the city with academics and volunteering. I've definitely noticed that I have a greater awareness of medications and their clinical interactions when assessing patients in the past two weeks. I had a patient with CHF and A-Fib complaining of strange dreams last week and surely enough when I asked him about his medications he said he takes digoxin!

I worked on Halloween, which was an extremely busy day, and made my 26th birthday on October 29th.

I made it out to two nights of Street Medicine New Orleans (10/12 and 10/26) with Dr. Zhang and a group of residents, medical students, social workers and housing workers, where we made rounds of the CBD, French Quarter and nearby areas to try to encounter houseless people and offer them resources and medical care. We had meaningful conversations with about 12 people each night, on topics regarding accessing further care via referrals to Healthcare for the Homeless, getting sheltered or housed through Unity, and obtaining medications through the UMC pharmacy. I mostly checked blood pressures and blood sugars, and was able to connect a few people to needle exchange resources via New Orleans Harm Reduction Network.

Lastly, things are coming along with this scholarship program I'm working on setting up to enroll Sci High seniors in an EMT class at Tulane. We're applying for a grant from Job1, a municipal vocational education fund, the department heads at NOEMS approve of the project, and I've met with staff at Sci High on separate occasions, and they are very excited! More updates to follow, and I'm hoping to have a viable program with 6 Sci High seniors enrolled in this class by January 30th.

Total hours: 4 per night at SMNO, 2 hours with sci high EMT education organizing- 10 volunteer hours in October.

Sunday, October 2, 2016

September Volunteering


September was a very busy month with a lot of challenging classwork and studying for exams. I felt particularly challenged by this last block, which covered an enormous amount of material, and I dedicated a large amount of time to studying. I also had to take some time away for a family medical emergency which is unfortunately still unfolding. 

However, I was able to volunteer some time in September- I’ve been working with the community public health organization, the New Orleans Harm Reduction Network for over a year, and I put in two four hour days of time with them this month. NOHRN is an organization dedicated to HIV/AIDS, Hepatitis, and opiate overdose prevention, and utilizes the principles of harm reduction to deliver resources to an underserved and often isolated patient/client population. These resources include clean syringes, naloxone, HIV and HCV testing, as well as education and referral to further resources. With Dr. Kantor of the New Orleans Health Department authorizing a standing order for the organization to provide naloxone, we’ve been distributing the life saving opioid reversal medication to chronic users of opiates.

On behalf of the NOHRN, I also provided an overdose recognition, prevention and treatment workshop for members of a soup kitchen organization in New Orleans; Community Kitchen. Because Community Kitchen often distributes food in areas with high densities of IV drug users, members have often been the first to notice and call emergency services for people who have overdosed. Given this proximity, they reached out to NOHRN and asked for us to provide a workshop for soup kitchen volunteers and other interested parties. Other volunteers with NOHRN and I spent about 2 hours discussing signs and symptoms of opioid overdose, as well as emergency first aid in those situations.

I was only able to join Dr. Charles Zhang on his Street Medicine walks one night this month, but we had several meaningful encounters with homeless patients who live in the area around the French Quarter. I distributed hygiene supplies and discussed infection prevention through the use of clean socks with one fellow who had a small abscess on his foot, and the doctor provided him with some antibiotic cream. We were out on the street walk for about 4 hours.

Lastly, I’m extremely excited to discuss a project I just started working on! 
I’ve been an instructor at the Tulane University Trauma Education Institute for some time, and we teach a semester long EMT class twice a year. I’ve been inspired by the graduate Med-Pharm student involvement at Sci High, and so I spoke with the principal (Ms. Chana Benenson) and the careers counselor (Ms. Jennifer Naum) about increasing access for Sci High seniors who are interested in careers in medicine, nursing, public health, to get involved with EMS education. They were excited about the prospect, and now I’m working on writing grant proposals to build a scholarship program for students to get into the course at no cost to them.

Total volunteering in September: 14 hours.

Sunday, August 28, 2016

August Volunteering

August has been a busy month! In addition to a pretty intense courseload with lots of studying to do, I've also been putting in a lot of volunteer time. I initially only intended on getting involved with a project started by Dr. Charles Zhang, a 3rd year EM resident at UMCNO, called Street Medicine New Orleans. However, when the flooding in Baton Rouge became disastrous, I drove to Baton Rouge and put some volunteer time in at the River Center, which is currently operating as a shelter for thousands of people displaced from their homes by the floods.

One of the four atria of the River Center 

The medical coverage for the shelter is being provided by a few separate groups working in conjunction. The first is the AL-1 and AL-3 Disaster Medical Assistance Teams, deployed from Alabama, who are comprised by doctors, nurses and paramedics. The US Public Health Service has contributed a team of doctors and nurses as well. Finally, state and federal funding has been put forward to have 24/7 ambulance coverage at the River Center by local ambulance services including East Baton Rouge EMS, Acadian Ambulance, and a few other smaller services.

When I arrived at the River Center on August 22nd, I found my way to the clinic that has been set up in a room off to the side of one of the atria and introduced myself.

The clinic at the River Center

I was quickly given a task of triaging patients, assessing medical complaints and vital signs, blood sugar, etc. Many people left their homes without their medications and without any means of managing chronic health problems like hypertension, asthma/COPD, epilepsy and diabetes. Many people come by asking to have their blood sugar checked, with quite a few of them extremely hyperglycemic. I started a few IVs, hung fluids and reported to the physician my findings for each patient that came to the triage desk.  I spent 8 hours at the River Center, from 5pm to midnight that night. Most of the patients who came by had minor issues- headaches, cold symptoms, though one woman had an exacerbation of her COPD. Anyone who needed more significant treatment than what the team at the River Center could offer was transported to the ED by ambulance.

On the 24th, I went out with Dr. Zhang on his SMNO walk. Along with a Tulane medical student, the director of NOPD's homeless outreach team, and an acupuncturist, we made rounds of encampments around New Orleans to check up on chronically homeless people, some of whom had been patients of Dr. Zhang's that he wanted to follow up on.
The SMNO team that night
From 8pm to midnight we met many different folks living in tents under overpasses around downtown New Orleans, and discussed their medical issues with them. We checked a few blood pressures and blood sugars, and Dr. Zhang counseled patients on following up at the homeless health clinic at the VA. The acupuncturist (pictured at left) provided some acupuncture for folks who complained of chronic pain. We met a group of homeless people who were outside drinking on a stoop, and talked to them about questions they had regarding foot pain, fungal infections and diabetes. Officer St. Roman, of NOPD homeless outreach, wrote a few letters for people to get appointments with a housing counselor. Overall it was a really fun night, and we made a few nice connections with chronically homeless patients who were extremely appreciative of the attention they received outside a hospital setting.

On the 25th I made my way back to Baton Rouge for another round of volunteering with the DMAT at the River Center. It was an even busier day as other shelters around Baton Rouge had been condensed into the one massive convention center shelter. Now, with a little more familiarity, I jumped right in to assessing patients and presenting them to the doctor on shift. I helped clean an elderly patient who had some mobility-based hygiene issues and was experiencing skin breakdown around his upper thighs, and then applied antibiotic ointment to the affected sites. The USPHS doctor advised him to return as often as necessary to avoid further skin breakdown.

At one point we were called by a Red Cross volunteer for an older gentleman who fell unconscious in another area of the river center. We ran over and found this man who had passed out and didn't recall the fall, with a large abrasion to his forehead. He told us he hadn't been drinking much water that day and smelled strongly of alcohol, so we placed a cervical collar, lifted him to a stretcher for transport to the hospital. I rode in with the Acadian crew as we took him to a nearby hospital.
Lady of the Lake hospital in Baton Rouge 
When we got back to the River Center, I checked back in with the medical team and returned to triaging patients. One of the walk-up patients was a fellow who hadn't had his antipsychotic medication since before the storms and was experiencing worsened schizophrenia symptoms. I counseled him on getting a transport to the hospital for a safe place to get his psych meds returned to therapeutic levels and he went by ambulance. As the night continued patients continued to arrive, but I had class early the next morning I had to leave.

 So that's been my volunteering for August! It's been a fun week or so of getting involved with different groups doing important public health and medical aid work! My favorite pharm related thing that happened was when a lady came by complaining of a gum abscess and the doctor prescribed her clindamycin, and I recalled Dr. Dery's refrain: "Clinda above the diaphragm, metra below!"