Sunday, February 26, 2012

A Day In The Life ...

Often people wonder what happens when an EB team visits one of their care centres.  Currently Eugene Bell work with six MDR care centres.  Some are near Pyongyang and some are quite a ways out in the countryside.  The picture below shows the recent fall visit itinerary.

Generally the team spend their nights in a hotel in Pyongyang which means some days there are very early morning starts - well before the sun comes up.

The day usually starts with the team gathering, sharing breakfast and then gathering all the supplies for the day and heading off to the care centre.  We drive out in the countryside. 

Its great being out early in the morning because as we drive through towns and the countryside, we see workers heading to work, children heading to school and people going about everyday life.  It's a fascinating glimpse into a way of life very different to ours.

Eventually we arrive at the care centre.  There is a sense of expectation.  The EB team have great relationships with the care centre staff and patients and look forward to visiting and seeing progress made. 

The van arrives and there is lots of bowing, hand shaking and greetings, then everyone springs into action!

Dr Stephen Linton is greeted by one of the care center directors

Centre staff are normally busy setting up stations to collect patient details …

Doctors check off the medication and put the patient identifying details on each box to ensure that the correct medication is given to the right patient (each patient gets their own treatment).

Patients gather for a talk by Dr Linton.  This normally consists of encouraging them to stay on their medicine (the treatment is harsh and makes the patients feel very ill), along with teaching patients about TB and MDR-TB. 

In the picture below, you can see patients looking at the information flyers they have been given and learning about their illness and how it is managed.  It is important to educate patients so that they understand the importance of staying on their treatment even when they have converted to TB negative.  They are not considered cured until 18 months – 2 years of consistent negatives.

Nurses fill out updated information on the patients and give each patient a name card and a sputum bottle.

Patients take their cards and are weighed and measured.  This information is written down.

Each patient is photographed.  This is for several reasons.  It helps keep a visual record of patients and ensures that the correct patient is receiving the correct medicine.

Patients then take their sputum bottles away and have to cough up a sputum sample in the bottle.  You hear lots of hacking and coughing!  Patients return their sample to the team, who mix preservative in with the sputum, and then package it to take back to South Korea.  A medical lab will analyze the sputum, and work out the current status of the patient, along with which drugs will be effective in treating their TB.

All patients are x-rayed.

Eugene Bell have an excellent mobile x-ray van they take with them around the countryside.  Patients step inside, have their chest xrays and the doctors use these to help monitor patient progress.

Often there is a visit to the pharmacy to check off drugs and make sure everything is accounted for.  Without you and EB, there would be very empty shelves in the pharmacy!

The care centre normally hosts a sit down lunch with the clinic director, the EB team and key medical staff.  During lunch Dr Linton and the center director talk about how the work is going, what needs or difficulties there are.

Patient records are checked and Dr Seung works with the doctors to educate them about TB and treatment procedures with the patients.

Dr Seung is a TB specialist.  He is from the USA and has worked all around the world with TB so he has lots of knowledge.  He has helped the Eugene Bell Foundation streamline their treatment and protocols, and we are now seeing patients get better much quicker.

After lunch, the patients are given their medical updates.  It is a hard time as they have waited 6 months since the last one.  They are waiting to hear if they have converted to negative and whether they are still that way.  Some patients will be told they have done really well and will be graduating the program cured.  Some patients don’t receive such good news.  Stephen encourages the patients to stay strong and complete their treatment. 

Patients are then presented with their medicine boxes for the next 6 months.  The patients know exactly where their medication comes from and who their sponsors are.  Sometimes a message is videoed from the patients to donors. 

The next part of the day is my favorite part.  There is a patient graduation ceremony for those who have completed treatment and are well.  There is a lot of celebrating.  In the last couple of visits, patients have been presented with paper crane garlands as a symbol of hope and wishes for health and wellness.  Graduation can be an emotional time for patients – all are happy to be going home to family, but some are nervous about coming off medication and fearful about getting TB again.

If time allows, there can be visits to patient rooms, checkups or discussions about some cases in particular. 

Before you know it, it is time to pack up and depart.  Doctors line up to wave the team goodbye.  

The vans depart and begin the long drive back to the hotel, where the team sit down for dinner and debrief about the day.  Generally there is a lot of humor, which is a good way to release the emotion of the day.  Then, everyone heads off to their rooms to rest and prepare for the next day!  In the case of the author, heading off to my room meant another 2 – 3 hours of photo editing before bed, as pictures are needed as soon as the team gets back to Seoul.  A lot of pictures are taken in the day and tidying them up at the end of each day so they are in good shape for the EB team was important!

That’s a day in the life of a visiting EB team.  Hope you enjoyed the visit!