Physician information
PURDUE
MAY 2012
Throughout the week you will be in charge of a clipboard containing the following items:
Referral forms
Physician’s translation sheet
Medicine formulary
Plastic bag containing: colored sticky tabs, tongue depressors, gloves, hand sanitizer, otoscope covers
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Tests available at clinic: Urinalysis, Glucose, Hemoglobin, Pregnancy
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Referrals: All referral forms must be filled out in Spanish, please ask your translator to be diligent in filling
these out. There is no set quota, but please choose only patients who will most benefit from further treatment.
It is very important to specify exactly what test you would like as well as which department should follow up
with the patient. Please make a judgment of medical priority (necessity) from 1-5, with 5 being most severe on
the referral form. Examples of 1 are things such as cosmetic surgeries. Examples of 5 are things such as
emergency surgeries or anything that could provide major improvement to quality of life. If you refer a patient
for a surgical brigade, please notify Valerie or August.
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Prescriptions: Please specify dosing regiments as much as possible when prescribing medicines. If we
run out of any medicine, we will inform physicians on the morning bus ride. Try to limit the amount of
medicines you prescribe; if a patient doesn’t need it, don’t prescribe it! Be conservative with antibiotic use, high
doses of analgesics/NSAIDs, prednisone, and poly-pharmacy. Do not over-prescribe Ibuprofen, because it will go
to waste. In Quito, we see many chronic patients and Timmy’s model is focused on continuously monitoring all
chronic patients. They have reported detrimental side-effects from abruptly changing medications between
Lisinopril and Enalapril.
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GREEN tabbed patients: Signify that a patient is being or needs to be monitored for: prehypertension, pre-diabetes, anemia, underweight/stunted growth, or other medical alert. Only children under
the 3% mark should be marked with a green tab. Only people with less than 10 Hgb/dL should be given a green
tab (they should be treated with Albendazole as well as iron therapy).
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RED tabbed patients: Chronic patients have a red tab, indicating they are currently receiving
prescribed medications for one of four chronic illnesses tracked by Timmy: Hypertension (HTN), Diabetes (DM),
Asthma, and Epilepsy. If you see someone who is hypertensive and it is their first visit with high blood pressure
but you will not be starting them on medication just yet, please indicate with a green tab that says “BP check” or
“glucose check” to alert the next physician.
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HYPertension protocol: Patients previously undiagnosed who present with blood pressure (SYS >
140, DIA>90 but less than SYS>170, DIA>100) for the first time in a Timmy clinic should be counseled on lifestyle
modifications. If they are presenting for the second time (indicated by the green tab on folder), you may go
ahead and start them on a medication regime. If they are presenting for the first time in clinic with blood
pressure greater than 170/100, you may automatically start them on a medication regime and mark their folder
with a green tab to be flagged for further follow-up.
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Parasite treatment: Only patients ages 1-18 should receive prophylactic Albendazole treatment every
6 months for treatment of parasites. Pregnant or lactating women should never receive Albendazole, and
should be referred to Tierra Nueva if suspected to have active parasites. Only adults who are actively
symptomatic should be treated with Albendazole or Metronidazole. Note that children age 12-24 months
receive 200mg Albendazole, while all persons over 2 receive 400mg.
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Scabies treatment: Only patients < 15kg should be prescribed Permethrin cream in the case of scabies.
All patients > 15kg should receive a one-time Ivermection 200mcg/kg/dose in clinic, and be sent home with a
second dose to take 10 days later.
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STI Treatment of Partner: A patient suspected of having a STI should be questioned about current
sexual partners and, if applicable, sent home with treatment for a boyfriend/girlfriend/husband/wife even if
that person is unable to attend the clinic that day.
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Student shadow: Every day, students will rotate through your consult room to shadow you. Please be
mindful of how you handle students or general volunteers shadowing. The patient’s time and privacy must still
be upheld.
Cultural norms in South quito
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Breastfeeding: Please check the front of the intake form for women who are breast feeding and/or
pregnant and keep this in mind when prescribing medications. It is not uncommon for women to breast feed
much longer than in the US. Symptomatic pregnant women should be referred to an OBGYN for treatment if the
available medications in the clinic are contraindicated.
Diet: Most Ecuadorians are very traditional in the meals that are cooked at home. They often have white
bread with a coffee or hot chocolate every morning for breakfast. Lunch and dinner meals consist of juice,
soup, a half-filled plate of plain white rice with a piece of chicken or beef, and a small portion of “salad” which
could be cucumbers with radishes, mayonnaise covered corn and peas, lettuce and onions with lime juice,
cooked lentils, or beets. Snacks or supplementary meals are fruits, empanadas, quimbolitas, humitas,
quesadillas, ice cream, French fries with hotdogs, potato chips, hornadas/fritadas with mote, choclo con queso,
or cevichochos.
Things to remember: It is not common to drink water throughout the day. People typically do not consume
enough vegetables, although they are readily available. Nobody eats raw vegetables. Ecuadorians do not
consume beans on a daily basis. They typically eat chicken more than any other meat. Diets are high in
carbohydrates, and people eat traditional meals. Many people believe in drinking “jarabes”, or medicinal
homeopathic syrups, which can help cure diabetes, heal the liver, pancreas, or other internal organs.
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Home life: Many homes in south Quito are poorly cleaned, and can be extremely dusty environments. They
are often too cramped, and people do not typically have refrigerators or other items we are used to having.
Most women wash clothes by hand, on a stone. Often, they do not have warm water to bathe in. Spousal abuse
is high, divorce rates are high, there are many single mothers, and many young mothers.