Thank you for applying to work with us as a clinical associate in Achham!  Please carefully review the following sites pertaining to traveling, living, and working in Achham with Nyaya Health:

http://wiki.nyayahealth.org/NepalTripPlanning

http://wiki.nyayahealth.org/WorkingInAchham

http://wiki.nyayahealth.org/Vision

The role of short-term physicians such is to serve as clinical consultant, in which s/he:

1. deploys new technologies or new applications of existing technologies, such as ultrasound;

2. assesses the clinical skills and operations of the Nyaya clinical team and provides feedback to program improvement;

3. reviews clinical databases and makes improvements to data collection and reporting practices;

4. develops training materials and administers them to staff and health workers.

Note that although short-term physicians will have extensive exposure to patients, they will primarily play an attending physician-type role, advising and training our Nepali staff rather than directly treating patients themselves. This is designed so that these short-term rotations can have the greatest potential long-term and sustainable impact. We are flexible and pragmatic in this regard, however, particularly with regards to emergency and surgical cases.  Prior to deployment, we will put together a step-by-step itinerary for you to follow.   This will include many more tasks and programs to evaluate than would be feasible during your short stay.  We do this, however, to best prepare you for the uncertainties involved on the ground in Achham and so that there is never a moment in which you are in Achham with nothing to do. 

Finally, please view the contract that we will customize and individualize for you prior to your trip:

http://wiki.nyayahealth.org/Contracts_Clinical_Associate

We will finalize this and then email to our Program Director in Achham, who will oversee your work.  

The below is an example itinerary from one of our previous clinical assciates undertaking a 14-day mission (from Dr. Stephen Morris, December 2008 for 2 weeks): 

Priorities: 

• Implement pulse oximeter
  • write evernote pulse oximeter use and maintenance protocol
  • by jan 2, train staff on its use and incorporate into triage
• Implement paralens
  • review current TB diagnostics protocol
  • train lab tech on auramine staining and maintenance of the paralens
  • by Jan 2 have written the paralens protocol, updated the TB diagnostics section of the database, and written a blog entry with picture of paralens in use.
• Ultrasound program
  • Assess the quality of the current ultrasound program
  • Identify gaps in data management
  • by Jan 10 conduct at least four trainings
  • by Jan 10 oversee at least 5 antenatal ultrasound tests by each of the midwives

• H. Pylori screening and treatment program
  • deliver 600 h. pylori test kits
  • train staff on implementing the test kits, based on our current protocol for gastritis
• TB program
  • review database and particularly follow-up of patients
  • by  jan 3 have provided up-to-date and accurate TB database and complete clinical report of all the TB patients to date, along with recommendations for improving care and follow-up
• HIV program
  • review VCT and PMTCT clinical practices and data collection
  • by jan 3 have provided updated VCT and PMTCT databases, updated the protocols notes in evernote, and written a complete clinical report of all PMTCT patients to date, along with recommendations
• Antenatal care and safe deliveries
  • incorporate new AMDD protocols into trainings and data management
• Diabetes program
  • review the management of the current Type I diabetes patient
  • by jan 6 make recommendations for protocol improvements and database management

As time allows: 

• Improvements to triage protocols
  • to be identified following discussion with staff
  • overview here: http://wiki.nyayahealth.org/Triage
• Trainings on emergency procedures for HAs and midwives
  • to be identified following discussion with staff
• Pictures, stories, documentation   
  • it is expected that the clinical associate will take pictures and provide stories that will be of use for our blog.
  • additional technical documentation will be written in a format acceptable for our wiki.