Brigada Medica Survival 101

Based on my experience over the past 10-days, I believe there are three basic steps to a successful medical brigade.

STEP 1: Be Flexible.

Things will change suddenly and often. Be ready to accept change and react. There probably will not be hot water for showering or "normal" food. However, these cultural differences are all part of the experience. 

STEP 2: Get Creative.

I cannot emphasize the importance of this step enough. Resources we expect to be available in the United States are often not available while on a medical brigade.

We often set up our pharmacy outdoors and "built" counters out of various desks. Our medications were left in suitcases except for some of the "fast-movers". 

Inevitably medications are misplaced or run-out. Instead of simply doing without, it is sometimes possible to compound the medication from available supplies. The dentist's topical lidocaine gel was misplaced for the first three days of the brigade. The pharmacy team was able to compound a viscous suspension of lidocaine using toothpaste, 1% lidocaine and water. In the end, the dentist actually preferred the compounded suspension over the gel because it made less of a mess when suction was not available.

 

 

Situations arose where patients did not speak English or Spanish! Sometimes the patients would even reply that they do speak Spanish when asked. This created a large communication barrier. It is important to learn how to utilize the resources in the community you are serving to help with translations from indigenous languages. 

Additional communication barriers included illiteracy, which was fairly common among the elderly populations. In order to help patients understand how to take medications, pictures of the sun and moon were drawn on bags containing medications. 

STEP 3: Do the Best You Can.

Perhaps this step is a cliche, but at the end of the day this is all anyone can ask. There are moments where you feel that you are truly helping improve the life of a patient, while there are other moments where you feel completely helpless. At times I could not help thinking, is 30 tablets of ibuprofen really going to make a difference in this patient with significant deformities due to rheumatoid arthritis? However, there are patients with no primary care provider, and patients that will benefit greatly from not only the medical care but also the emotional support from medical providers.