By Dr. Patrocinio Sarmiento Palacios, translated by Rebecca Shifflett
During the dates of November 1 to November 10, I was invited by the group OCHO to visit different medical institutions in this country. I went to receive training in order to strengthen the area of medicine that carries out services in our new rehabilitation center in Atima SB – the CRIC-OCHO (Centro Rehabilitación Integral Communitario) – just like in the network of health services at the local level. Our goal was to implement this knowledge in order to provide services of the highest quality.
Next, we will describe in detail a short summary of the activities carried out during the visit, throughout the course of the week:
1. The first day of the week, we visited the Kennedy Krieger Institute [KKI] with Dr. Michelle Melicosta, where we took a tour, visiting the rehabilitation rooms. It is important to incorporate the family into therapies, as much for improving the patient’s progress as for the family’s knowledge of the therapies, so they can follow up at home. This reinforces the family interactions and their inclusion in the patient’s daily activities; the majority of these patients, with different diseases, are hospitalized, and undergo rehabilitation for an hour each day.
Moments later, during a consultation with patients affected by cerebral palsy, we visited Dr. Hoon, a specialist in cerebral palsy and neurodevelopment, who was interacting with the family and the patient. Later, in a small meeting, we addressed important topics and discussed seven central concepts in all diseases that you have to manage with the family:
- Diagnosis – all patients or relatives need to know the name of their disease.
- Diagnostic imaging, such as cerebral CAT scan or MRI – we need a photo of the nervous system, and what we have available to us is the brain.
- Prognosis of the patient – know how to offer the family a prognosis, never with very high expectations, because we do not know whether they will be fulfilled.
- Rehabilitation – one of the most important concepts, with the greatest impact on these patients.
- Associated problems – additional illnesses or diseases, and speaking with the family about how to prevent them.
- Responsibility – who is responsible? We must talk to the family as the basis for the monitoring and the good prognosis of our patient.
- Closing – it is very important to take time to talk with the family, saying, “Okay, this is the patient’s diagnosis, and this is how it will be handled and monitored.” (There are families that continue looking for other causes without end).
Later, we discussed the use of some medications with patients that have similar diseases here in Honduras, the adverse effects of drug interactions, and the updating of their uses. An important topic that was addressed was the flowchart for coordinating the evaluation, diagnosis, and management of medicine, as well as the rehabilitation of all of the patients.
2. The second day, we visited Franklin Square Hospital’s neonatology room with Dr. Fernando Mena. They carried out a medical evaluation of the hospitalized children, as the doctor explained the types of children, as well as the treatments that are carried out in the room. They gave a tour through the various rooms, accompanied by the rest of the team that works in the institution, and we visited the hospital’s operating room to witness a Cesarean section, in order to learn how they are handled in this country.
Then, we visited Dr. Silvia, an OB-GYN specialist in ultrasounds, reviewing several cases and using ultrasound to search for important markers in the early diagnosis of Down syndrome.
Next, Dr. Mena transferred me to the office of family medicine, attended to by Dr. Romano, a medical resident in this specialty. For the whole afternoon, we participated in the evaluation of a large number of patients in these clinics, and the doctor explained the management and treatments, and discussed interesting cases.
3. Monday, November 6, we visited Kennedy Krieger Institute’s Center for Autism and Related Diseases (CARD), accompanied by Dr. Limary, a pediatric resident in Sinai Hospital, and met with Dr. Anna Maria Wilms-Floet. We observed the evaluations of the children for autism, and the application of the ADOS-2 guide for the diagnosis and prognosis of patients with this condition.
Afterwards, we moved to Sinai Hospital to conduct a presentation to a group of doctors from this institution, and presented the results achieved in Atima SB’s health services, popularizing a new national health model, whose objective is to improve access to health services for the people that are the most overlooked.
Likewise, we visited Dr. Pedro Arrabal, an OB-GYN, to discuss some treatments at the community level and his recommendations.
4. Tuesday, November 7, we visited KKI with Dr. Sadowski, a spine specialist, to be present for the evaluations of patients with spinal problems, and to discuss cases and treatments. All of the patients agreed to us being present in these evaluations.
Likewise, during the afternoon, in this same building, we visited Dr. Korth in the spina bifida clinic. We witnessed many medical evaluations of these cases, clearing up any doubts in the treatment and diagnosis. We discussed many cases of myelomeningocele problems, one of the fairly common diseases in our community, and how to manage the consequences of this disease, in order to have a better prognosis and lifestyle.
5. Visiting the inpatient clinic with Dr. Michelle Melicosta at KKI, we took a tour of the hospitalization rooms with the multidisciplinary group that monitors these patients. We were able to observe various patients with a large variety of diseases, discussing in each assessed case their diagnosis, prognosis, current state, treatment plan, and an important central concept: rehabilitation. We were able to be present at one of the meetings for the multidisciplinary group, which has various branches that monitor each case separately, such as doctors, nurses, nutritionists, physical therapists, social workers, etc.
Dr. Michelle Melicosta, together with Dr. Joanna Burton, transferred us to the Neonatal Intensive Care room of Johns Hopkins Hospital, where we were welcomed by Dr. Chavez, a specialist in neonatal asphyxia. We toured this room, meeting the various cases, and discussing their treatment. We shared a lot of information and socialization of the community management of cases in our community of Atima, with the goal of receiving advice from this specialist.
It was a very helpful day for me.
It was a week of much benefit and learning, and knowledge that can be implemented in our rehabilitation center here in ATIMA CRIC-OCHO, enabling us to adapt some ideas and establish communication with these specialists, to clear up doubts and support our project. A visit like this one, in addition to the coordinated schedule of meetings with these specialists on different days and schedules, will serve as a great help when implementing many of the aspects learned during my stay. The collection of information, like data, for communication with them in possible situations in the future, will be a great help for our town’s health. Thank you, OCHO.
In addition, I would like to give thanks for the welcome from the whole OCHO team. They welcomed me with a lot of charisma and kindness, so it was, at least on my part, a moment in which I was able to learn as much as I could in a short time because of their ability to teach us. Thank you for that. Thanks to all of the team members, translators, volunteers, and all those that are part of OCHO.
Thank you very much,
Dr. Patrocinio Sarmiento Palacios
Network Services Coordinator of Atima Health SB