HOW THE CLINICS WORK

The Clinics and Medical Consult:
The clinics will be opened to serve patients only when employees and/or volunteers of the clinics are present. This ensures smooth operation of the clinics and maintenance of the systems of operation that have been established.
There is limited access to the clinics due to the past loss of equipment, materials, supplies, and medicine. Only select individuals have keys to access the clinics.
The clinic in Canton Camanchaj is open on Mondays and Tuesdays, and the clinic in Canton Urbina on Wednesdays and Thursdays, both from 8:30a.m. – 4:00p.m.
Patients begin arriving at around 4a.m. to get in line. At around 7a.m. they are given a number on a first come, first serve basis, and a blue card used for charting. Dr. Fredy Salanic is able to see 35 patients per day. He is very willing to help with exams, answer questions, or to write referral letters to specialists when needed. If a patient needs to go to the hospital, please ask us to make arrangements.
We generally do not have a triage set up, although if a patient looks acutely ill we will see him/her first. There usually is not a nurse assisting in the exam so you are responsible for obtaining vital signs. We do have translators (Quiche/Spanish) at the Camanchaj clinic and they are often trained to do BP and weight. When groups come with doctors and nurses you may prefer to set up a triage station.

** Note: The clinics are closed the following 3 weeks each year: Semana Santa (Holy Week), Christmas Week, and the week of New Years. The 11 official Guatemalan holidays are also observed when they fall on Monday through Thursday.

Patient Fees
The patient is asked to give Q10 (ten quetzales) for the medical consult, dental services, eyeglasses, and lab tests. IF A PATIENT DOES NOT HAVE THE QUETZALES, THEY ARE SERVED. NO ONE IS DENIED SERVICE. A family never pays more than Q30, regardless of the number of family members seeing the doctor. A single patient never pays more than Q30 for a battery of lab tests. In the dental clinic, patient fees vary, depending on the services rendered.

Patient Records
All patients will be given a card, which will be kept as a permanent record in the clinic (medical record – blue; dental record – yellow; vision record – green). Lab reports are slips of white paper attached to the record. For children age 3 and under, a white card recording the child’s development is attached to the blue card. After one year of inactivity, a patient’s medical record is removed from the files. All other cards are maintained.
The blue medical card is used for recording vital signs, pt complaint, exam findings, diagnosis, and treatment. After the consult the patient brings the blue card to the pharmacy where our nurse or a clinic volunteer dispenses the medicine (no cost except for diabetic and hypertensive meds). Please write clearly the name of the med, dose, frequency/duration, and number of pills to be dispensed. We give multivitamins (MVI) to every patient. If you treat another member of the family who was not signed up for a medical consult, please fill out a blue card on that person.

Appointments
We give appointments, “citas”, to patients with chronic illnesses such as diabetes or hypertension who need regular follow-up. (Gastritis qualifies only if it is severe). Giving a “cita” means that the patient can pay ahead for their next appointment and therefore reserve their place, meaning they will be seen first and do not have to arrive at 4 a.m.! If a patient with an appointment does not arrive before 8:00am, his/her slot is given away. Due to such extensive waiting time, many patients will ask for a cita, but please reserve these for those patients with chronic illnesses (kindly tell the others they are very welcome to come back but will have to wait in line “tiene que hacer cola”). Write “cita” with the date on the blue card and also on a slip of paper for the patient to present either at the front desk or in the pharmacy to pay.
If you want the patient to have a certain lab test done (i.e. fasting blood glucose) when they come back for follow-up, give them a slip of paper with their name and the name of the lab test and instructions to go first to the lab before seeing the doctor on their next visit.
Laboratory
Edwin Chay, the lab technician, is able to do the following exams: CBC (hematologia completa), Stool O&P (coproanalisis) Hb y Ht Fecal Occult Blood (sangre oculta), ESR (sedimentacion), Blood Glucose (glucemia-pre), Urinalysis (uroanalisis), HIV (VIH), BUN ASO (antiestreptolisinas), Pregnancy test (grabindex), AFB for TB (esputo para AFB), H.Pylori KOH
Write the patient’s name and name of the lab test on a slip of paper; send the patient to the lab and hold on to their blue card until they return to your exam room with test results.

Pharmacy
The clinic’s pharmacy workers (nurses, volunteers, and other trained personnel) dispense the medicine. It is a good idea to look around the pharmacy before seeing patients in the morning to see what meds are available that day. If you brought your own medications, it is helpful to give the pharmacy a list of those meds and in which suitcase they are located. For diabetes we generally use two meds: Metformin and Glyburide/Glipizide which, when we run out of donated meds, can be purchased relatively inexpensively here in Guatemala. We dispense up to one month’s supply of meds unless someone has consistently well-controlled diabetes or HTN when we may dispense up to 2 months.

Pharmacy Risk Management Procedure:

1) All medicine is dispensed from the pharmacy.

2) No medicine is given out of the pharmacy unless the patient, him or herself, has seen the doctor that day. This applies to employees and volunteers of the clinics, as well as the members of the Executive Committee and pastors (and their families) of the IENMPG, Iglesia Evangelica Nacional Metodista Primativa de Guatemala.
There are two reasons for the above policy. They are as follows:
a) All of the medicines are donated from the U.S. The medical mission teams that bring the medicine have a contract with an organization in the U.S. that furnishes the medicine. The contract states that all medicine will not be sold and must be dispensed under a doctor’s orders.
b) The clinics of SyP are operated under licensed doctors and dentists. The clinics and the doctors are responsible for the health and well-being of their patients and must see a patient in order to prescribe accurately and in good conscience.

3) All medicine given out from the clinic will be recorded on a medical or dental record card.

Dental Clinic
The dental clinic attends approximately 20-40 patients per dentist per day. The services they provide are: cleaning, extractions, fillings, root canal (Q100), dentures and braces.
If a patient presents with tooth abscess please give antibiotics and make an appointment with the dental clinic for follow-up.

Eye Clinic
We operate an eye clinic once a month in both Camanchaj and Urbina. The eye clinic is for vision testing and fitting for corrective lenses only, not for treating diseases of the eye. The cost for vision testing and eyeglasses (if needed) is 10 Quetzales. If you see a patient in the medical exam that has a correctable vision problem, please refer them to the eye clinic. Please ask Jose Hernandez or Candelaria Xiloj to put their name on the list for the next clinic.

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