Saturday, November 25, 2006

Doctor’s Meeting Minutes (DRAFT), 24 Nov 2006

Suppose you were a fly on the wall...

Doctor’s Meeting Minutes (DRAFT), 24 November, 2006
(Respectfully submitted by Ryan. Actionable items in red. Contact me with additions/corrections.)

1) Patient flow log (Delouis)
· Reviewed purpose of log, which we will use for 2-3 days to gather info on pt flow and complexity of visits. Translators to fill out with MD help as needed.
· Also logging lab entry time to measure how many MD-hours being used.
· We are doing both of these logs to improve efficiency and to build argument to hire digitizing staff to protect MD time. Discussion ensued.

2) Outreach updates (Dewey et al.)
· What is going on, in brief? Are folks happy or wanting to rotate?
· Piggs Peak
- Dave and Dan D. in PP, getting to know folks and doing bit of everything.
- There are 5 docs there, but PMTCT strategies are high yield investment opps for our docs (little VCT, with 50% or more HIV+ but poor f/u).
· Shumwula/Lomahasha/Good Shepard (Gretchen and Helga)
- Gretchen and Helga happy to have other docs come with them.
- The perspective from being “out in the field” very valuable.
- Gretchen recommends grant-writing over holidays to try to ensure some inflow, esp. for transport. (UNICEF a “maybe” at this point.)
· Matsangeni Govt Hlth Center (Sach)
- Many challenges, esp. in peds and PMTCT. (Eg: Cotrim/MVTs often not available.)
- Still, have made great strides in short time, building inroads and demonstrating partnership and support.
· Mbabane Govt. Hosp (Nanda)
- This has been Nanda’s site for 3 months, and she sees positive changes with her persistent presence. (Eg: Malnutrition protocol starting to work.)
· COE (Amy, Julia, Eric, Ryan, Johanna, and others):
- All generally happy at COE, but little protected time for other projects.
- Working on pt flow.

3) Protocol committee
· Diarrhea (Helga)
- Reviewed “Diarrhea SOP” draft, derived from Uganda SOP.
- Reviewed zinc, vit A, antimicrobials, and antidiarrheal data, in brief.
- Plan to look over diarrhea SOP and discuss/edit next week.
- Need for water hygiene handout and rehydration SOP.
· Adult ARVs (Eileen)
- AZT vs D4T for adult is a question that freq comes up
- Proposes we shift from D4T to AZT for new ARV pts unless good reason not to
- Also cited 2 recent studies from Uganda and SA (see Eileen for refs)
- Cut-off for anemia in adults <>



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