The first few days at my clinical site have been a great learning experience. I have not had any rotations in public health, so seeing how the Municipality addresses public health issues was super interesting. Some background on the facility: there are two departments on the floor I am working on– reproductive health, and disease prevention and control. The disease prevention and control’s focus is split between epidemiology, vaccinations, and tuberculosis. The first half of my 8 hour shift on Tuesday was in the vaccinations room. They serve primarily walk-ins, but a number of the patients I saw had scheduled appointments. The electronic health record they use is called ‘insight’. The format looks a little basic but what I found interesting was the Alaskan vaccination database called “VactrAK”. VactrAK is super helpful because any time a patient gets some sort of vaccination it gets entered into VactrAK; if someone comes in to the municipality and has no record of vaccines they have received but they have lived in Alaska for some time, then we can go on VactrAK and look it up. It’s universal in that fact that it eliminates the barriers we experience when a patient’s information is in an EHR at another hospital and we are not able to access those records. Another thing I noticed was that there are a lot of features in their EHR that are missing compared to the EHR used at Essentia. For example, if anyone has any allergies, they have a binder called the ‘paper brain’ that they refer to and check to make sure they can still give the vaccination (rather than being having the ability to refer to an allergies section in the EHR). The paper brain is their go-to. It has everything you could ever need to know about vaccinations, their billing requirements for children, Alaskan Natives, etc, and even contains evidence-based research about vaccinating young children and how there is no direct link between vaccinations and autism. |
The second part of my day was in the tuberculosis center. Anchorage Municipality has one of the best TB control clinics in the US. They have negative-pressure rooms and nebulizer machines to help get a controlled sputa sample. They have about 12 patients with active TB that are receiving treatment, and many more with latent TB that come in once a week or so to receive their medicine. I was amazed by the diversity that comes to the TB clinic, and how well the faculty at the clinic handles that diversity appropriately. I was able to observe two different situations in which an interpreter was used over the phone (sort of like a conference call). The following day I was able to go with one of the DOTAs (direct observation therapy aides). Direct observation therapy is evidence-based and shown to improve outcomes more than the traditional method of sending medications home with the patient. That being said, the municipality has one person whose job it is to make home visits to patients with active TB. Some of the patients are homeless so it can be challenging finding them. Incentives are huge with that population in particular. Bus passes and gift cards are used to encourage patients to either come to the clinic, or contact the clinic so the DOTA knows where to meet them.
Today (Wednesday) Val and I also were able to participate in testing for group A strep in a local soup kitchen called Bean’s Cafe. There has been a recent outbreak among the homeless population so the Municipality is testing to find those that are infected, and possibly identify the central location where most of the transmission occurred. It was a really great experience, I talked to a lot of people- especially Alaskan Natives- and it was really humbling hearing them tell their stories.