We opened our clinic in Haiti, Centre de Sante de Gatineau, on Monday, June 8th, in spite of the fact that COVID-19 is spreading rapidly throughout the country. After being closed for the months of April and May, we felt that it was important to open again in order to provide medical care and needed medications for the hundreds of patients with chronic illnesses who depend on us for their care. And, although we realize there are risks for any frontline healthcare workers during this pandemic, we have instituted policies and procedures to minimize these risks as much as possible. The coronavirus is not going to be eradicated any time soon and until a vaccine works and is readily available to everyone around the world, we realized that we need to adopt a “new normal” in terms of our practices and the way our clinic functions. So, we’d like to welcome you to the new normal at Centre de Sante de Gatineau!

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We now have the following procedures in place:

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• Additional benches were placed on the front porch of the clinic with two numbers (two patients) per bench. The total number of patients being seen each day will be limited to 45.

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• We are encouraging patients not to spend the night on our front porch. If they need to sleep here because of the distances they have to travel, they need to leave 1.5m (6 feet) between themselves and others when sleeping.

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• Everyone who comes to the clinic needs to wear a face mask and before they enter the clinic, they all need to wash their hands with soap and water from a tippy-tap we have placed at the clinic entrance.

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Patients sit with two patients per bench outside the clinic and are required to wear masks.

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• Patients are no longer given cards with numbers on them in the morning. Instead, they are told the number on which they are sitting on the benches and names are taken of those who are standing. If we are able to see them that day, their names will be called, otherwise, they can return the following day to be seen. Patients with follow up appointments and those in our diabetes and hypertension programs are called by name to be seen, rather than giving them numbers.

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• One of our nurses checks everyone’s temperature with a no-touch thermometer to be sure we see those with fevers first thing in the morning. All employees have their temperatures checked as well each morning.

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Nurse Marie Laura checks the temperature of all patients on the front porch of the clinic.

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• When they register, each patient holds up their old receipt for the registration clerk to see their name and medical record number. Then, those old receipts are thrown away by the patient in a wastebasket on the front porch. New patients show a form of identification, if they have one, but these are not handled by the registration clerk.

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• The patient’s chart and new receipt are not touched by the patient at all during their time in the clinic. A nurse takes the chart from the registration clerk, calls the patient’s name and vital signs and weights are taken by the nurses outside the clinic on a table on the front porch. Privacy is provided by a portable room divider which is placed next to the new “triage area”. The nurses are equipped with surgical caps, goggles and masks and they wear cloth gowns while working. They use hand sanitizer after each patient interaction.

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Nurses’ triage area outside the clinic where they take vital signs and weigh patients.

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• After vital signs and weights are recorded and the nurses finish their assessment of the patient, the patient is directed to a bench inside the clinic and their chart is placed in a box outside the physician consultation room. No more than two patients are in the clinic at any one time.

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• The patient is seen by me in my usual exam room but I interview everyone at a distance of six feet, perform a quick physical exam and do any lab testing that is felt to be necessary. I wear a surgical mask and an N95mask (if one is good, two are better, right?), goggles and gown when seeing patients and sanitize my hands after each consultation. When I finish, I give the patient’s chart to one of the nurses, who escorts the patient and takes the chart to the pharmacy, where it is placed on the pharmacy desk.

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Dr. Wolf dressed for the front line battle with goggles, 2 masks and gown.

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• Patients with fever, cough or cold symptoms are placed in a separate exam room at the end of the hallway and I see them immediately, in case they may have COVID-19. If their symptoms are consistent with coronavirus, we give them symptomatic medications and send them home. We strongly advise them to self-quarantine at their home for two weeks and tell them to go to the hospital if they develop shortness of breath or if they want to be tested.

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• The medications are prepared in the pharmacy and Cherlie takes them to the patient, who waits on a bench outside the pharmacy, giving them instructions on how to take the medications as she sits on the opposite end of the bench. Gloves are worn when handling money and giving change.

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Cherlie in mask and goggles, ready to work in the pharmacy.

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• Each employee is given an N95 mask which they place in a plastic bag at the end of each clinic day. These masks are reused since our supply of them is limited. The nurses wear cloth masks or surgical masks when riding in our jeep up and down to clinic, as do Cherlie and I.

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• All benches, inside and outside the clinic, all work areas and equipment are sanitized each afternoon before we leave.

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So, how did the first week go? Things really went very smoothly and patients were very receptive to and compliant with our new procedures. In fact, they were quite impressed with all the precautions we were taking to ensure the safety of all. We did a lot of teaching regarding COVID-19, the difference between it and other common respiratory illnesses down here such as tuberculosis. And we advise them to encourage those at home and in their communities to avoid coming to the clinic if they have symptoms consistent with coronavirus. They should stay home and isolate themselves and consider going to the government hospital if they become more ill.

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Our staff did a wonderful job of implementing the new procedures and seemed to be much more comfortable at work knowing that we had done a lot of research on best practices in developing our procedures and new ways of providing care.

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For myself personally, at the end of each day the front of my ears hurt where the elastic from the masks rubbed them, my nose was stuffed up because the mask squished it and my clothes were wet with sweat under the surgical gown I wore all day in 95 degree heat! But, my heart was joyful in having heard so many words of gratitude from our patients who were thrilled that the clinic was open, grateful that we were safe and healthy and appreciative of all they were learning about coronavirus from visiting us. All in all, it was a fine week! Thanks for your prayers.

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