Mission Ryan Dominican Republic Mission Detail
Objectives and Timetable: Plan A – 7 years
The mission is divided into 3 tours. The first tour is three years, the second tour three years, and the third one year. (Plan B: four-year plan is also proposed as an expedited alternative.)
A. Tour 1
Year 1: 2010, Jan 22 – departure date for Dominican Republic
Field officers
- Secure our basic needs in Boca Chica:
- access to housing and communication,
- purchase SUV with off-road modification
- completion of governmental paper work,
- procurement of residency card
Community liaisons:
- Identify target communities and locations
- Introduce physician and field officer to community leaders
- Present draft of program of intent to community leaders and modify, if needed
- Assemble villagers to introduce the plan via speakers, literature, film, etc.
- Initiate community involvement and promote relationship.
- Seek and cultivate potential native leaders
- Seek and develop relationship with plantation owners.
- Motivate villagers to be independent and self-sustaining
Medical:
- Revisit the target villages and start remote medical clinic
- Screen patients to enroll into the program
- Start treatment with enrolled patients
- Educate population on proper hygiene and self-care using slides, literature, and town meetings
Year 2: 2011
- Decrease 20%–40 % state of 3 targeted diseases in 3 villages
- Continue involvement of whole communities by further promoting public relation.
- Arrange summit conference of all community leaders
- Create plan to expand to other villages
Year 3: 2012
- Fine-tune the prototype
- Expand into other villages, using the model
B. Tour 2
Year 4: 2013
- Continue Tour 1 visiting and following all the patients and all the villages (grand-round)
- Initiate establishment/building of mini clinics, incorporating components such as cement or cinderblock walls, tin roof, and toilet, bedding area for health officers. Funding from Mission Ryan will be used for building materials; actual construction of the buildings is to be done by villagers
- Establish regular and follow-up visits to villages by native health care workers
Year 5: 2014
- Continue Tour 1 grand-round
- Expand the number of mini-clinics
- Continue regular and follow-up visits to villages by native health care workers
Year 6: 2015
- Continue Tour 1 grand-round
- Continue expanding the number of mini-clinics
- Continue regular and follow-up visits to villages by native health care workers
- Search for and identify a town to be a location for the main clearinghouse clinic to coordinate the mini-clinics
C. Tour 3
Year 7: 2016
- Continue Tour 1 grand round
- Continue expanding the number of mini-clinics
- Continue regular and follow up visits to villages by native healthcare workers
- Establish/build structure for central clearinghouse clinic, central medication depot, and central medical personnel housing
Objectives and Timetable: Plan B – four years
Year 1: 2010 - Tour 1
Year 2: 2011 - Tour 1 & 2
Year 3: 2012 - Tour 2
Year 4: 2013 - Tour 3
Projects & Methods
I. Sanitary disposal of waste
- Educate villagers on the direct consequences of drinking contaminated water. Educate villagers how intestinal parasites are transmitted through fecal contaminated water and direct hand-to-mouth transmission.
- Educate villagers on the necessity of hand washing
- Seek practical means of composting present human waste
II. Purification of drinking water
- If a well is in place, provide education on the importance of drinking clean, organism-free water.
- Provide tablet water purification system
- Provide water purification filtering system
- Determine other practical means of purifying drinking water
- If a well is not in place, provide education and tablet purification or filters.
III. Eradication of intestinal parasites
127.0 Ascariasis (round worm)
1. Provide education on the type, transmission vectors of parasites: worms, flagellates, virus, bacteria, amoebas
2. Conduct mass periodic empiric treatment with mebendazole 100mg twice a day for three days, without requiring ova and parasite stool exam.
IV. Identification and treatment of metabolic syndrome: diabetes mellitus, hypertension, hyperlipidemia
The numbered codes listed below are from the International Classification of Diseases codebook.
1. Diabetes Mellitus (Type 2, Non-Insulin-Dependent Diabetes (NIDDM), Adult Onset Diabetes)
250.00 Diabetes Mellitus without mention of complication, type II non-insulin dependent adult onset or unspecified type, not stated as uncontrolled
250.02 Diabetes Mellitus without mention of complication, type II non-insulin dependent adult onset or unspecified type, uncontrolled
- Conduct initial intake of target population:
- Perform physical exams
- Create permanent medical records
- Measure fasting morning glucose
- Test Hgb A1C, using Bayer DCA 2000+ Analyzer
- Initiate sulfonylureas, metformins as needed
- Deliver educational lecture on side effects and how to manage side effects.
- Follow up morning fasting glucose level of patients receiving medicine
- Recheck HgbA1C 2-3 months after
2. Hypertension (HTN)
401.0 Essential Hypertension, malignant
401.1 Essential Hypertension, benign
401.9 Essential Hypertension, unspecified
- Conduct initial intake of the population (as in A, above)
- Identify HTN patients
- Identify patients who have contra-indications to use of ACE inhibitors, calcium channel blockers, and beta-blockers, such as patients with bradycardia, heart blocks, and renal insufficiency.
3. Hyperlipidemia
272.0 Pure hypercholesterolemia
272.1 Pure hypertriglyceridemia
272.3 Mixed hyperlipidemia
- Identify high-risk patients with both HTN and NIDDM
- Test serum lipids
- Start hyperlipidemic oral agents
- Deliver educational lecture on side effects and how to manage side effects.
V. Provision of primary care medicine
- Furnish basic medical care during each visit to the villages
- Create and maintain medical records
- Maintain continuity of care by frequent visits to villages
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