Pre-triage procedures in mobile rural health clinics in Ethiopia.

CONTEXT: Our medical team of 12 people conducted a series of mobile health clinics sponsored by an indigenous relief organization in rural Ethiopia. Coordinating with local health authorities, the purpose of these clinics was to provide acute care medical treatment and public health teaching. ISSUE: Initially, we used a 'pre-triage' process that had evolved over a series of previous rural mobile clinic trips. This process involved the lead physician and a nurse-translator moving through the crowd selecting prospective patients based on appearance and responses to simple questions. A significant problem arose when a large crowd of people, desperate to be seen, disrupted the process and jeopardized the safety of our team. We subsequently developed a process that used an introductory session, introducing the team and describing the process of patient selection. We also modified the pre-triage process by involving more people in patient selection. In subsequent clinics, this new process was well accepted and contributed to increased efficiency and an overall improved community outreach. LESSONS LEARNED: After experiencing an adverse situation, we developed a system for patient selection that was well accepted and efficient. We found that it was essential to set expectations regarding the purpose of the mobile clinic and the scope of problems that could be treated. This was best done at the outset of the clinic in coordination with local health authorities. In actual patient selection, or pre-triage, we found it advantageous to enlist the participation of the crowd and to send several clinicians among those wishing to be seen for medical care. This new approach to patient selection became an essential element in the success of our mobile health outreach.