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Medical Missions Deliver Care
Sugar Land church fulfills a promise of continued service to colonias
Christ United Methodist Church (CUMC) Mexico Medical Missions (MMM) began in summer 2002 to provide medical care to the people in Reynosa, Mexico served during its Vacation Bible School Mission. On that first trip, Dr.Yong Han, assistant professor at Baylor College of Medicine and emergency physician at Texas Children's Hospital saw approximately 200 patients in four colonias over four days. His one-man show has grown to a team of over 30 health care practitioners, translators, and lay people. Han and Janis Parsley, a pharmacist who is a member of CUMC and UH development officer, share the responsibility of coordinating the mission project.
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MMM now schedules a minimum of three weekend trips per year, one every four months, with mini-clinics on other CUMC mission trips. This ensures reliable follow-up as well as continuous delivery of medicine/medical goods. The teams stay in Reynosa, Mexico in a mission house, orphanage dorm, or hotel-depending on availability and the weather. The trips only cost about $100 per person, and all of the participants pay their own way.
Each trip consists of two teams of physicians and optometrists, pharmacy personnel, nurses, translators, and lay people. A retired veterinarian is also a member of the team and received permission from the Mexican government to vaccinate animals for rabies. Approximately 125 animals were vaccinated on the March and June 2004 trips.
"I was the first pharmacist to join the team," says Parsley, who went on her first trip in April 2003. "I knew immediately that having pharmacists on the team could expand and improve the services provided by the mission team. I was also confident that I could identify corporations who would donate the products we would need."
Parsley, who worked at the UH College of Pharmacy for eight years, knew that this was the perfect opportunity for service learning for pharmacy students. "That's when I contacted Barbara Tatum at the College of Pharmacy," she adds. Tatum, who is also a pharmacist, is director of advising and counseling at the College of Pharmacy and is the advisor for the pharmacy student organization Christian Pharmacists Fellowship International (CPFI).
"We are so blessed that our students wanted to serve on the team," says Tatum. "And this was the perfect opportunity for CPFI members to use their talents in a meaningful way."
On the March 2004 trip, pharmacy students took blood pressures on most adult patients and the statistics showed that 18 to 58% of the patients at four colonias had hypertension. This was a bit surprising since a recent study reported the incidence of hypertension in Mexico City to be 19%. The high incidence in the colonia populations could be due to obesity, a high sodium diet rich in carbohydrates (e.g., beans, rice, tortillas), inactivity or genetics.
After screening for diabetes, the incidence of diabetes was determined to be 17 to 25% of adults tested. This is 1.5 to 2 times the incidence in Mexican Americans. In August 2004, Reuters Health Information reported that diabetes is the leading cause of death in Mexico. While diabetes is often thought of as a rich person's disease, its incidence is increasing in poor countries - often in tandem with obesity.
With this data in hand, the MMM committed to treat both diabetic and hypertensive patients. Both of these chronic diseases have serious long-term impacts on the quality of life. For example, lowering the systolic blood pressure by one point decreases the risk of stroke by 3%. Strokes in any population are debilitating, but in a low socioecomic population with little access to health care, the impact is tremendous, especially if the sole breadwinner is unable to work or care for themselves.
With the aid of an endocrinologist, internist, and cardiologist, Dr. Han and Janis Parsley developed protocols (treatment plans) for diabetes and hypertension and committed to purchasing the prescription drugs necessary for treatment. Diabetes treatment began in March 2004, and hypertension treatment began in June 2004.
Pharmacy students from the University of Houston College of Pharmacy have played an integral role in providing these services to patients. "The pharmacy students are amazing!" says Han. "They spoiled us, and now we want them on every trip."
The students are responsible for taking the patients' blood pressures and following the prescribed protocol under the supervision of a pharmacist or physician. In addition, students test patients for diabetes and follow the prescribing protocol for those whose tests indicate a positive diabetes diagnosis. Each patient is given a diabetes and/or hypertension card with their test results and advised to bring the card whenever they see a health care professional. The card has the treatment plan written on the back, and the goal is to continue the plan without disruption in drug therapy. MMM has promised to provide the medications for these patients.
Pharmacy and pre-pharmacy students work in the traveling pharmacy assisting the pharmacists in dispensing the medications, which are kept in duffle bags. Before the trip, the team pre-packs the drug products into 5 to 10 days supplies with Spanish labels for ease of dispensing. Children's vitamins, diabetes and hypertension meds are pre-packed in three to four month supplies. "It really makes it easier to dispense the medicine to the patients when it's ready to go," says Barbara Tatum, College of Pharmacy faculty member. "The families frequently get multiple medications, and this just keeps it simpler." She adds it is also nice that the Spanish directions are usually on the container. "I don't really speak Spanish, so it is very helpful to me."
On early trips, the doctors selected the drug product to be dispensed, but with the participation of the pharmacy students on the team, the doctors simply write a diagnosis or drug category, and the pharmacy team members select the product based on availability. "This has been an incredible time-saver for our doctors," says Parsley. "It allows the doctors to spend more time with the patients, and our students get to use the knowledge they have learned in the classroom in a real-life setting."
To meet the growing need for quality and efficiency of medical care, MMM has initiated a database of patients encountered to ensure accurate and sustainable delivery of both medical care and supplies. "We realized we needed to keep patient records so that we could follow-up on our patients with chronic diseases," says Parsley. "We also wanted to keep track of the number of patients with diabetes and hypertension," she adds. For portability, the patient records from each clinic are kept in recipe boxes and the information is entered into a database kept in Houston. The plan is to continue to follow patients' medical histories and monitor blood glucose and blood pressures in those with diabetes and hypertension.
In June 2004, faculty members Lloyd Pate and Norman Bailey and student Kelly Mai from the University of Houston College of Optometry joined the team and screened over 100 children for glasses. Much to the surprise of the optometry team, only nine children needed glasses. Spectacle prescriptions were brought back to the College of Optometry optical shop, and the children received their glasses in July during the CUMC Vacation Bible School Mission trip. On the October 2004 trip, adults will be screened. Best Storage from San Marcos, Texas is underwriting the cost of the glasses.
The unique partnerships created through this effort have been synergistic in providing health care, medical supplies and medication for the patients. Baylor College of Medicine has supplied medical residents and medical students, UH has provided pharmacy and optometry faculty and students, and many CUMC church members have participated. Corporations such as AmerisourceBergen (a drug wholesaler), Walgreens, CVS, and Randalls have provided thousands of dollars of over-the-counter drug and personal hygiene products. Texas Childrens Hospital donated diabetes-testing equipment and a pediatric wheel chair for a young boy with spina bifida. Best Storage and CUMC church member Robin Clearman have provided private planes for transportation to and from the Mexican border. College of Pharmacy alumni also sponsor students to go on the trips.
"If you add it all up," says Parsley. "We probably give away at least $15,000 worth of medication and other products each year."
As MMM progressively improves the quality and scope of medical care delivery, the capital needs for the group increases exponentially. "The church's mission budget has gone from zero to about $4,000 per year," remarks Han. Although pharmacy corporations and physicians donate the majority of the supplies, children's vitamins and medications for diabetes and hypertension are purchased. The children's vitamins are bought in boxes of 25,000 and cost about $1,500 per year for 100,000 tablets. The diabetes and hypertension drugs are the biggest expense and are the remainder of the budget. "We really stretch our dollars," says Han. "Through God's grace and will, MMM has always been provided what is needed and we're confident that this will continue."
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