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The 6th Annual Latina Health Fair

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					The Sixth Annual Latina Health Fair
   Community Health Screening
           The Screeners’ Manual




                May 14, 2008

                   Ian Maki, MPH
                  SPARX Program
        Office of the Dean, Regional Affairs
    University of Washington School of Medicine
                     Box 354982
              Seattle, WA 98195-4982
                       The 6th Annual Latina Health Fair
                       North Seattle Community College
                            May 17, 2008, 10a-3p
                 Produced by the Washington Health Foundation and
        Screenings provided by UW SPARX, SeaMar CHC, UW Unite for Sight,
                         Washington Osteoporosis Coalition

This document describes the screening area and is full of great information that will help
you help others at the Latina Health Fair. Please take the time to at least read the sections
pertaining to your specific assignment.


About the fair:
Washington cannot become the Healthiest State in the Nation without the elimination of
health disparities. Since 2003, the Washington Health Foundation has provided
preventive health care and screenings to women through its annual Latina Health Fair.

At the Latina Health Fair, hundreds of women receive free medical exams including
mammograms, pap/pelvic exams, diabetes testing, dental screenings and more. Each
woman receives a “Health Report Card” and the opportunity to review the results with a
health professional on site. WHF’s Latina Health Fair also provides unique telephone
follow-up with anyone who has abnormal screening results from their pap and pelvic
examinations or labs or their mammograms. (Referral and recommendations are provided
on site for the general health screening area, the SPARX area). This is done through the
Foundation’s Community Health Access Program, a direct service program that provides
connections to health care and referrals to more than 7,000 King County residents
annually.

The Latina Health Fair is in conjunction with Women’s Health Week, and the 6th Annual
Latina Health Fair will be held on Saturday, May 17, 2008 at North Seattle Community
College. Families are encouraged to attend and enjoy a day of entertainment, as well as a
numerous exhibits hosted by community organizations and sponsors.


SPARX Volunteers
SPARX is a major sponsor of this event, with in kind and purchased contributions
exceeding $5,000 per year. I am very proud of the student and administrative support for
this activity which is both fun, and an opportunity to interact and serve a large, largely
medically underserved population in King County.

General info and the purpose of the event:
This large fair, which has grown each year since 2003, is an opportunity for the Latino
community to learn about health resources, connect to services, learn about health, and
obtain screening. Health screening of this nature is NOT A SUBSTITUTE FOR
HEALTH CARE. It is a tool to focus people’s attention on their health, to convey a sense
of community support for healthier lifestyles, and often an important conduit to health
services. Our goal is to educate this population about resources in the area for low cost,
high-quality health care. More than 40 community organizations are present at the fair
offering a variety of information about countless programs and health concerns and
services from insurance and public benefits.

Your role is to measure, assess, educate and inform, and ultimately provide resources and
referrals (not all at the same time) NOT to diagnose and treat. WE will not diagnose
disease at the fair, but we will educate about disease risk and encourage people to follow
up with a health care professional if we detect anything unusual or abnormal.

In general screeners educate and measure, results people educate and inform, and the
providers make recommendations and suggest referrals and resources. We have a special
table at the fair to provide immediate connections to resources present at the fair and
available in the community.

When you arrive:
Arrive at least 15 minutes before your shift (except the 9:30 shift) to allow time to
register and find us. You might want to come much earlier to register and get lunch if you
start at 11:30 am or 1:30 pm. The food is one of the most popular (read long lines) part of
the fair.

You need to stop in and register yourself as a volunteer with the WHF staff when you
arrive. This is done at the fair’s main entrance, which is the SOUTH door to the cafeteria
of the Campus Center, the building in which the fair is held on the campus of the North
Seattle Community College (9600 College Way N, Seattle 98103). This is also the
exhibitor hall. The volunteers there will have your name, and will give you a food ticket
and a name badge and a sign to wear indicating you are somebody who speaks Spanish
(if applicable). They will not be able to provide much information about screening, your
shift responsibilities.

Please see Ian for your questions. Ian will be the Tasmanian devil whirling around the
screening area in a sweat. If you can catch him, he’s approachable.

Then you come to the health screening area. The health screening area is in the middle of
the campus center, and the volunteer can show you on the map. The room is north of the
exhibitor hall (cafeteria) and takes place in a large room separated from the main hallway
by a collapsible wall (that will be closed.) The EXIT to the screening area is the first
entrance, and the hallway just beyond that is where the registration area for health
screening is and the entrance to the health screening area.

One of the registration people will have the volunteer sign in and assignments of all
SPARX volunteers. Please check in there briefly for any last minute changes.

Do not go to what will be signed at the “Women’s Health Area”. This is a women’s only
space where ladies with appointments, are getting pap test, pelvic exams and
mammograms. Keep going through the hall unit you see the entrance to the screening
area.

Take you things, if you brought them, to the stage (behind the curtains) in the screening
room. This area is moderately secure and a good place to leave your bookbag.

What follows is a map of and the flow of the screening area, and what happens at each
place. Please take the time to at least read the sections pertaining to your assignment.


                      Health Screening LHF 2008
                                                         4 Glucose
                                                         Screening                              6
                                                                                                feet
                 2 HT/Wt/BMI


                                       3 Blood
                                       Pressure Area
                                       (Chairs only +
                                       Small table      Diabetes/Heart/
                                                        Health
                                                        Education
                                                                                  5 Cholesterol Screening




                                                                      6 Lung
                                          Results/Medical             Function
                                          Consult                                        7 Osteoporosis
                                                                                                       Stage/Storage

                                      Health
                                      Resource



          1 Registration                                                    Vision Ed
                                                        Eye               8 Vision
                                                        Exams             Screening
             Enter                      Exit                                     20 ft




       Health Ed Talks                 Main Hallway                     Exhibits 
1) Health Fair Reports/Registration
This is the first and most important part of the screening experience for the guests. Your
job is to greet the guest and welcome them to the fair and prepare them for the screening
area. Families will come to the fair expecting to get screening, but will not know very
much about our protocols, and even what screenings they can get in our area. You are the
first and best resource for people coming in to the screening area. Once the people get
past you, there are fewer opportunities to get their questions answered, so please take a
few minutes to get them oriented. Do not worry that the line is big. The line is always
big. If you take some time, you can actually help moderate the flow of people moving
through the screening room and improve the overall functioning of the area. Be deliberate
and ask open ended questions. (What type of health information do you hope to learn at
the fair today?)

First, ask the name of the guest and ask how many adults are in their party or family. You
can then orient the whole family at one time.

It is common for sisters, aunts, grandmothers, brothers, uncles, husbands, boyfriends and
CHILDREN to come to the fair together. We will screen adults, but not children. They
are welcome to bring their children through the screening area, but that it gets crowded.
Suggest to groups that they can split up and have one group take the kids and explore that
fair while the rest get screened, and then trade off. Do not insist; make it a helpful
suggestion to reduce the number of strollers in the screening area and to improve the
speed of the screening for everyone. Tell them it will take about one hour to go through
all the screening stations unless it gets very crowded.

Give each adult a NUMBERED health fair report (Each Health Fair Report MUST BE
and WILL BE numbered with an individual number code for the results of their
cholesterol test, this allows us to never handle personal identifiers and be HIPPA
compliant. Each of you will have a stack of numbered health fair reports to use. Ask them
to please write down their name, their age in years, and the name of their doctor and their
usual clinic. If they do not have a doctor or clinic, tell them that is perfectly fine; we can
help them to find a medical home at the end of the screenings. (This is a way to find out
if people have a regular source of care, and is important when they talk to the provider at
the end of screening.) As they are doing this you can cover some of these issues:

Tell the guests that we are able to offer free screenings to adults (18 years or older) in this
area. We are offering these screenings today:
     ht/wt and body mass index
     blood pressure screening,
     finger-stick glucose testing (and Hb1c1 testing if indicated after testing glucose.
        i.e. the person’s glucose was abnormally high. This testing is being conducted by
        SeaMar, but our providers will offer interpretation and recommendations.)

1
 Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HbA1c) is a form of hemoglobin used
primarily to identify the average plasma glucose concentration over prolonged periods of time. Its name is sometimes
abbreviated to A1C. It is formed in a non-enzymatic pathway by hemoglobin's normal exposure to high plasma levels
        finger-stick cholesterol screening (total cholesterol-TC and High density
         lipoprotein-HDL)
        osteoporosis screening (by the Washington Osteoporosis Coalition, our students
         providing education)
        lung function testing (spirometry/peak flow)
        vision checks and eye exams,
        consultation with medical providers, and
        resource launch point, which connects fairgoers to exhibitors or community
         resources for their health.

Explain that medical and other health students from the University of Washington are
volunteering to conduct this screening today. They are trained to perform these tests and
are supervised by medical faculty from the university. Some speak Spanish, some do not,
but all of us care about this community and want everybody to enjoy good health.

If they have questions about anything, they should ask. If the students cannot answer their
questions, they should visit with the provider who can review their report and answer any
questions. There is also a resource table at the exit of the screening room where they can
find out about and connect to services that are represented at the fair or available in the
community. Ask them to please see a provider before they leave if they have any
questions or concerns. Remind them this consult and conversation is free and
confidential.

All screening is 100% voluntary. Nobody will be forced to have any screening test they
do not want. They may skip any screening test, but the point of screening is to get as
complete a picture of their health as possible and missing information will make it more
difficult to give them useful advice at the end. For this reason alone, we do encourage
them to have each screening test done. The one exception is the osteoporosis screen,
which they will consent to separately and some people will not need.

IMPORTANT: Tell them that these screening is not the same as and not a substitute for
a visit with a health care provider. We are unable to diagnose disease at this fair, which
requires more information than we can obtain, and we feel is best done by visiting a
licensed medical provider, and we can help connect them to clinics and doctors as they
leave the screening area. There are community resources that are not expensive and are
easy to use, but you are unable to tell them about these here and now. The best people to
ask are the doctors and the “resources” table at the exit of the screening area.

If they stand in line and have screening test done, we will consider that they have agreed
to/consented to having the test, and receiving the results. The results are thiers and will
not be recorded or kept anywhere but inside their very own “Health Fair Report”



of glucose. Glycosylation of hemoglobin has been implicated in nephropathy and retinopathy in diabetes mellitus.
Monitoring the HbA1c in diabetic patients may improve treatment.[1]
The Health Fair Report
Este documento es un comprobante de los resultados de los análisis que usted
recibió en la feria de salud hoy—es como su archivo personal. Muéstreselo a su
doctor en su próxima cita. (This is a record of your results from the fair today—it is
your personal record. Show this to one of the medical providers at the end of the
screening room, or take this with you to your next doctor’s appointment.)

Each adult fairgoer must have a “Health Fair Report” This is a document that SPARX
developed for the fair to facilitate the collection of a variety of health information which
is theirs to keep. It is their record of results from the fair. It has two purposes: It is a
record of their health screening results, and it is the basis for individualized risk reduction
counseling offered at the end of the fair by UW faculty and community medical provider
volunteers. Explain to the guest that every fairgoer will get their own report, and we will
identify the person by a number so we can match some screening results with the patient
(see ”Cholesterol testing” or “Results” sections). Tell them it is their document to share
with the health care provider at the end of the screening and when they see the doctor the
next time. It is a picture or snapshot of their health screening results at the fair. (“Estos
son los resultados de las pruebas de su Salud”) Explain they will give this to the screeners
at each station, so to keep it out and available at all times, and make sure they take it with
them from station to station.

Ask them if they have any questions about what you have told them and point them
toward the first station, where we will measure their height, their weight, and calculate
their Body Mass Index.

2) Height/Weight/BMI Station
Índice de masa corporal (IMC)/Body Mass Index (BMI)
El Indice de Masa Corporal (IMC) mide el contenido de grasa corporal en relación a la
estatura y el peso que presentan tanto los hombres como las mujeres. Si usted es muy
atlético/a y musculoso/a, puede ser que un número alto no indica el sobrepeso.
(Body mass index (BMI) is a measure of body fat based on height and weight that
applies to both adult men and women.If you are very athletic and muscular, a higher
number may not indicate overweight.)

This is the first stop in the journey to better health. We can learn a lot about a person’s
health and disease risk simply by their age, height and weight, and use these to calcuatle
the Body Mass Index, BMI.

Have the patient sit and remove their shoes. Measure their height against one of the
marked rulers on the wall, and then have them step on the scale. Then have them sit back
down and put their shoes on. This is the only time we will ask them to remove clothing. If
they are shy or reluctant, tell them it is OK and you can compensate for their sole
thickness and the weight of their shoes in making your calculations. Note that shoes were
on on the report. You will have a clipboard with a BMI calculation table, or you can
manually calculate the BMI:

BMI = ( Weight in Pounds / ( Height in inches ) x ( Height in inches ) ) x 703
Example: A 140 pound woman who is 5’4” tall
(140)/(64)*(64) x 703 = 24. The BMI is 24 (normal)

BMI Categories:
      Underweight = <18.5
      Normal weight = 18.5-24.9
      Overweight = 25-29.9
      Obesity = BMI of 30 or greater

   The guest is then shown the doorway/passageway leading in to the screening room.

Also, there will be health talks at the fair, and one is on child nutrition and another on
obesity and physical activity. If people have questions about controlling weight, give
them/show them the schedule of health talks (Platicas de Salud) that are happening next
door (to the north) in the small theater. Child nutrition is at 12:15 and 1:45, and the
obesity/exercise talks are at 12:30 and 2:00pm. (They can leave the screening area to hear
a talk and resume where they left off in the screening process.)

3) Blood Pressure Station
La presión arterial/Blood Pressure
Su nivel de presión de sangre muestra que tanto está trabajando el corazón para
circular la sangre por el cuerpo. El número más grande indica la presión de sangre
cuando el corazón trabaja, y el número más pequeño indica la presión cuando el
corazón se relaja. Una presión de sangre elevada puede ser un riesgo para
enfermedades cardiacas o ataques cerebrales. La presión alta puede ser controlada.
(Blood pressure readings show how hard the heart must work to move blood around
your body. The bigger number is the pressure of blood when the heart pumps, the
smaller number is the pressure when the heart relaxes. Elevated blood pressure can be
a sign of risk for heart disease or stroke. High blood pressure can be controlled.)

Su presión arterial hoy es: (Your blood pressure reading today was):
                                           /
Los números indican lo siguiente/What the numbers mean:
 Presión arterial normal: menos de 120/80        Normal Blood Pressure: up to
 120/80
 Hipertensión Marginal: más de 135/85            Borderline Hypertension: above
 135/85
 Presión alta: más de 140/90                     High blood pressure: above 140/90

Please bring your own cuff and stethoscope if you have one. If not, SPARX will provide.
Our supplies will be on the stage behind the curtain.

Take a seated manual blood pressure of the guest. Please see the handout to refresh
yourself on the proper technique.

The fair is VERY LOUD, making accurate readings a challenge (but great practice). If
you are in doubt, use one of the two automatic blood pressure measuring devices to
confirm your reading.
Recheck anything higher than 135/85. Record their BP results on their Health Fair Report
and put an asterisk on it to alert the providers later on for any prehypretensive or high
blood pressure readings. Verbally tell the guest what their results are based on the
following guide (either normal, or slightly high, or very high).

Categories for Blood Pressure Levels in Adults
        Category                  Systolic                                 Diastolic
Normal                         Less than 120             And             Less than 80
Prehypertension                   120–139                 Or                 80–89
High blood pressure
   Stage 1                        140–159                 Or                 90–99
   Stage 2                     160 or higher              Or             100 or higher
The ranges in the table apply to most adults (aged 18 and older) who don’t have short-
term serious illnesses.
All levels above 120/80 mmHg raise your risk, and the risk grows as blood pressure
levels rise. “Prehypertension” means you’re likely to end up with high blood pressure
unless you take steps to prevent it. There are many ways to control blood pressure.
Strongly encourage anybody with a reading above 140/90 to stop and talk to the provider
as they leave, and tell them they can learn about their heart at a health talk at the fair
(north end of the building) at 12:45 pm and again at 2:15 pm.

4) Glucose Testing/Diabetes Testing
Prueba de la Glucosa en la sangre/Blood Glucose Test
La glucosa es un tipo de azucar que se encuentra en comidas de carbohidratos. La
glucosa es la fuente principal de energia del cuerpo. El prueba que hizimos ahora se
llama azucar en la sangre esporadico. Azucar elevada en su sangre es un riesgo para
la diabetes. (Glucose is a type of sugar found in carbohydrate foods. It is the main
source of energy used by the body. The test we did today is called a random blood
sugar (RBS) test. Elevated blood sugar is a risk factor for diabetes.)
Su nivel de glucosa en la sangre fue/(Your blood glucose reading was):
____________ at _________(time) on ________ (date)
 El nivel indica lo siguente/What the numbers mean:
       126 mg/dL o menos             Normal
       126 mg/dL o mas               Elevado
 A normal fasting (no food for over 8 ours) blood glucose reading is: under 126 mg/dL
An elevated fasting blood glucose level is: above 126 mg/dL

SeaMar CHC volunteers are doing this testing. They will also obtain a Hb1c result in
those with critically high blood sugar. If you notice a glucose reading on the report above
150, encourage the guest to see the providers at the end of the screening room before they
leave.
Prueba de hemoglobina A1c/Hemoglobin A1c
Una prueba que le revisa el nivel de azucar en la sangre durante los dos o tres meses
pasados. Provee informacion acerca la capacidad de su cuerpo a regular la glucosa.
(A blood test that checks average blood sugar level for the past two to three
months. It provides more information about your body’s ability to regulate glucose.)
Su resultado de prueba de hemoglobina A1c fue:              %

El nivel indica lo siguente (What the score means):
Para los no-diabeticos, entre 4-6% indica el buen control de azucar. Los numeros
mas altos deben ser discutidos con el/la doctor/a. (For non-diabetics, good sugar
control is between 4-6%. Higher numbers must be discussed with a health provider.)

Anybody who has been given the HB1c test has already presented with higher than
expected glucose. The presence of this score—the fact that the test was done at all—
means we want this person to talk with one of our providers before they leave the fair.

5) Cholesterol Testing
Prueba de colesterol/Cholesterol Test
La sangre contiene tres diferentes clases de grasa. Esta prueba de sangre mide el nivel
total de grasa que se conoce como el colesterol. El nivel de colesterol se puede usar
para determinar su riesgo de enfermedades del corazón o arteriosclerosis, que es
cuando sus arterias se endurecen, entrecierran o tapan. Un nivel elevado de colesterol
aumenta su riesgo para enfermedades del corazón. (This is a blood test that measures
a kind of fat in the blood called cholesterol. The total cholesterol test measures the sum
of 3 kinds of lipids in your blood. The total cholesterol test helps check your risk for heart
disease or atherosclerosis, which is a hardening, narrowing, or blockage of the arteries.
A high level of total cholesterol in your blood increases your risk of heart disease.)
Su nivel de colesterol fue (Your total cholesterol reading today was):

 El nivel indica lo siguente (What the score means):
 199 o menos/199 or lower                    Bueno/good
 200 a 239/200 to 239                        Elelvado margenal/borderline high
 240 o mas alto/240 or higher                Elevado/high

Su nivel de colesterol typo HDL fue (Your HDL cholesterol reading today was):

 El nivel indica lo siguente (What the score means):
 60 o mas alto/60 or higher                  Elevado/high = bueno/good
 40 o menos/40 or lower                      Bajo/low = no preferible/undesirable

HDL se considera “bueno” porque facilita el regresa del colesterol al hígado, donde se
puede eliminar del cuerpo. Generalmente con respeto HDL, mientras más alto el nivel,
es mejor. (HDL is considered "good" because it helps return cholesterol to the liver,
where it can be eliminated from the body. Generally with HDL, the higher the number,
the better. )

Student doing this test should have received special instruction at the training on May 8.
This involves setting up the field and supplies, obtaining verbal consent for a finger-stick,
observing universal precautions against infection or contamination, handling blood,
obtaining blood samples, recording patient identifier codes, and communicating with the
technicians who are staffing the machines an running the analysis.

The basic flow is this:
   1. Prepare your area:
        Throw away any waste
        Manage sharps!
        Test cartridge ready/open
        Alcohol swap open
        Gauze ready
        Lancet ready
        Bandaid open ready
        Capillary tube and plunger set and ready
   2. Greet the guest and tell them that you are doing a cholesterol test that requires a
       drop of blood. You will get this by pricking their finger with a tiny needle. We
       will be able to tell them their total cholesterol and their HDL cholesterol, the
       “good” cholesterol.
   3. Sk for their Health Fair Report, and record the Health Fair Report number on the
       index card AND test cartridge using a Sharpie.
   4. Glove (fresh each time)
   5. Warm the hand, encourage flow of blood to finger tips
   6. Swipe area (side of middle finger is best-then ring finger.Index finger likely to be
       most calloused and also sensitive. Side of fingertip not pad—too much skin and
       many nerve endings.)
   7. Allow to air dry while preparing Lancet
   8. Stick finger, dispose of lancet (SHARPS) draw a drop of blood and wipe away
       with gauze.
   9. Obtain blood sample from second drop of blood.
   10. Use gauze on finger stick
   11. Deposit whole blood using plunger from cap tube onto cartridge as trained.
   12. Dispose of capillary tube (sharps)
   13. Hand off numbered cartridge, index card to your tech.
   14. Apply bandaid to finger. Deglove.
   15. Thank patient, show where their results will be available (by report number) in
       about 15 minutes. Remind them that their result will be coded by Report number,
       and they need to show their Report to get their results.
   16. Prep for the next patient.

You will get a cue from the bank of analyzer techs who are operating the Cholestech
machines when they are ready for a sample. There is a very short window between
drawing the blood and putting it into the cassette, and getting the cassette into the
machine (less than 5 minutes) The machines take 6 minutes to run a sample. There are
four people obtaining samples and four people operating 8 machines. Our capacity is 80
tests an hour. We need to run sixty tests an hour. So this area requires perfect
coordination of efforts and excellent communication.
For this reason, we do not do counseling and risk assessment at this time. Tell the guest
that you will obtain the sample and run the test, and they can obtain their results at the
results table about 15 minutes after they leave the table. The results table is staffed with
Spanish speakers who will give normal results. Abnormal results will automatically
bumped to a provider for counseling.

Encourage anybody who expresses concern to stop and talk to the provider as they leave,
and tell them they can learn about their heart at a health talk at the fair (north end of the
building) at 12:45 pm and again at 2:15 pm.

NOTE: We are using a lab assay that will also give a glucose reading. Some people may
skip the SeaMar glucose testing table and get both tests with one stick. Feel free to call
anybody over from the glucose line to have you do both tests in one time. Those who
have had their glucose tested and want to have the cholesterol test will need to have the
cholesterol assay and glucose done at our table, an unfortunate redundancy.

Cholesterol Test Machine Operators
You control the testers, telling them when you can accept samples. You will run and
monitor two Cholestech machines and be responsible for maximizing time and
utilization. Each test takes 5-6 minutes to process, and the sample must not be old when
put in the machine. Clotted blood will not process.

Your basic steps:
   1. Get a loaded test cartridge and results card from tester
   2. Verify the number on the cartridge and the number on the card match.
   3. Load your machine
   4. Run the machine
   5. You should open cartridges for testers, and give them an opened cartridge
       wrapper with the cartridge still inside.
   6. Give the two minute warning when you are close to ready for a new sample.
       (“Luis, I am ready in 2!”)
   7. Monitor other tester supplies. (bandaids, lancets, gauze, alcohol swabs)
   8. When a test is done, record the results (from printer or display) on the card
   9. Dispose of the cartridge
   10. Put results card in box to go to results table.

This may seem easy, but it will require your utmost attention and focus. It is easy to get
mixed up.

6) Peak Flow/Lung Function
Función Pulmonar (Espirometría)Lung Function (spirometry)
Esta prueba mide la función de sus pulmones, para lo cual se le pide que usted sople
dentro de una maquina pequeña, que mide la cantidad de aire que sale de sus
pulmones. Nosotros compararemos sus resultados con los de los valores normales que
tenemos para las personas de su mismo sexo, edad y estatura. Esta prueba puede
ayudar a detectar enfermedades pulmonares. (This test measures the function of your
lungs by having you blow into a small machine that measures airflow. We will compare
your results with normal values for a person of your gender, age and height. This test
can help detect illnesses of the lungs.)

Su punto más elevado de flujo de aire fue (Your peak flow was): ___________, este
resultado es normal/anormal. (This result is normal/abnormal)

For some reason, this particular screening test is usually not in much demand. Many
people are reluctant to have this test, and the evidence base for its usefulness is sparse.
Peak flow is often measured to gauge the degree of lung restriction in asthmatics, to
assess the severity of an asthma attack. We use this station as a way to teach about
asthma, TB and common lung ailments and to distribute patient education materials.

So mostly what you are doing is asking if people have any problems breathing, coughing,
wheezing, shortness of breath, tightness in their chest, and other signs of breathing
disorders. Find out if they are a smoker. If they respond positively to any of these
questions, tell them you have a simple test that measures their ability to breathe and allow
us to compare that with what we expect from a person of their gender, age, and weight.

Peak Flow Procedures:
   1. Ask people in line if they are interested in having their lung function measured.
       Ask them if they would like any information about respiratory illness. Use the
       patient education resources. (Hand them to people)
   2. Prepare the peak flow meter by inserting a new, disposable, mouthpiece
       extension.
   3. Have the person stand next to you behind the table, away from the others, and
       hand them the meter
   4. Ask them to take a few deep breaths, inhaling and exhaling completely
   5. After two breaths tell them to inhale, put the meter to their lips, and to exhale as
       forcefully as they can until they have completely emptied their lungs.
   6. As they blow into the meter, encourage them by saying “Blow, blow, blow!” or
       “Harder, harder!”, but be nice and smile.
   7. Have them relax.
   8. Take the peak flow meter, note the result on your pad, reset it to zero, and have
       them repeat the test two more times (3 times altogether),
   9. Record the highest reading on their Health Fair Report and circle normal if in the
       green zone (on the chart), abnormal if in the yellow or red zones.
   10. Dispose of the mouthpiece and

Tell anybody whose results are yellow or red that it would be a good idea to discuss this
in greater detail with a provider at the fair. Ask them to stop by the provider table before
leaving the room for a brief chat.

Also, there will be health talks at the fair, and one is on asthma. If people have questions
about asthma, give them/show them the schedule of health talks (Platicas de Salud) that
are happening next door (to the north) in the small theater. Asthma talks are scheduled for
12:00 and 1:30 pm.
7) Osteoporosis Screening
Análisis de Osteoporosis/Osteoporosis Test
La osteoporosis es una debilitación de los huesos debido a una perdida de calcio. Es
una condición común en las mujeres, especialmente las mujeres que tienen más de 50
años, y aumenta el riesgo de huesos quebrados. (Osteoporosis is a weakening of the
bones because of a loss of calcium. Osteoporosis is a common condition in women,
especially women over 50, and increases their risk of broken bones.)
       T-score:
       ¿Qué significa el “T-score”? (What the score means):
       Es la cantidad de hueso que usted tiene comparado/a a un adulto sano y joven
       quien tenga la masa ósea máxima. (The T-score is the amount of bone you have
       in comparison to a young healthy adult who is at peak bone mass.)
       Normal (riesgo bajo)/low risk               más de/above –1
       Osteopenia (riesgo medio)/medium risk              entre/between -1 y/and -2.5
       Osteoporosis (riesgo alto)/high risk        menos de/less than -2.5

The Washington Osteoporosis Coalition (WOC) is offering this screening at the LHF.
Their technicians will actually conduct the screening test using a bone density testing
device on the heel.

The WOC provided this summary of volunteer activities at this station:
Greet booth visitors and explain the services we are offering at the NW Women’s
Show. Services include:
     Bone density screening (takes approximately 5 minutes depending on volume)
       (Technicians will be doing the bone density screening)
     Interpretation of screening results
     Educational materials
     Height measurement (losing inches in height can be a sign of osteoporosis)
     Calcium samples

Assist with crowd control if a line forms for bone density screening
   Check that the line does not block traffic or other booths
   Individuals waiting to be screened should complete a consent form for testing
       (clipboards are available)
   Getting height measured is a suggested activity while waiting for screening (this
       will already be done)
   Some may wish to schedule a time to return for testing if the wait time is lengthy

Help with preparation for bone density screening.
    Suggest that visitors review the “at-risk” criteria on the tabletop display and on
      the small risk assessments to determine whether they are good candidates for
      screening
    Ask those getting screened to complete consent forms
    Provide flyers
Replenish supplies
    Keep an eye on brochures, flyers, and incentives (calcium, etc.) that are getting
      low and replenish as needed
    Collect pens and clipboards from booth visitors when they are finished with them

Please also make sure the T-score is recorded on the Health Fair Report. The printout can
be stapled directly to the back of the report.

8) Vision Education, Screening and Eye Exams.
Prueba de la Vista/Vision Screening
Estamos haciendo una prueba de agudeza visual por medio del uso de un cartel en la pared y
un tapaojos con pequeños hoyitos. Esta prueba sirve para saber si usted puede ver objetos a
distancia, y si usted tiene mala vista, y si esta puede ser corregida con lentes. (We conducted a
visual acuity test using a standard eye chart and a pinhole occluder. This test measures how
clearly you can see objects at a distance, and if poor vision can be corrected with lenses.)

Su agudeza visual obtenida el día de hoy con este método fue:
(Your visual acuity by this method today was:)
                                                 Without pinhole          With pinhole shield

      Ojo derecha/right eye                      20/                      20/

      Ojo izquierda/left eye                     20/                      20/

      Vision was tested with/without corrective lenses

      Mejoraría su vista con un tapaojos?
      Improved with pinhole?                     Si/yes No/no
We are providing visual acuity checks using a Snellen eye chart read at 20’, pinhole tests,
followed by optinal eye exams by two licensed optometrists, long time supporters of this
event, Dr. Chris Barry and Dr. Pat Squires.

Unite For Sight, a student organization, is providing eye health information and
education, will be assisting with the vision checks and the interpretation for providers.

Test visual acuity with and without correction (or at least note if the patient wears glasses
or contacts) using the eye chart and the occluder. Test both eyes. If visual acuity greater
than (worse than) 20/20, recheck using the occluder with the pinhole shield. Re-record
the results with the pinhole on the health fair report and note if the vision improved using
the pinhole test

Offer anybody who has any reported vision problems, high glucose, impaired vision, to
have a free eye exam. If no issues, the optometrists are going to have a wait, so you
might encourage the people to skip if they are not having problems and go directly to the
results table and to a provider consultation before leaving.
9) Results Table (Cholesterol results)
To keep a bottleneck from forming and limiting our ability to keep flow going, we are
splitting cholesterol into two parts: the test, and the results. Results are recorded on an
index card with the patient’s Health Fair Report number (VERY IMPORTANT: Results
are matched with people using the report code. Do not accept any results that are not
numbered) Results should be separated into odd and even numbers in the results box and
kept as sequential as time and circumstances allow. The runner should be doing this and
maintaining the boxes. If the runner is adding results to the box, ask for the number you
need and have them give it to you.

You will have a line; try to keep people back a few feet for some privacy. Ask for the
patient’s Health Fair Report.

Record the TC and HDL results and the glucose reading, even if there is already one from
SeaMar.

Review the entire report quickly, look for ANY abnormal readings. If there are any
abnormal readings, the results will be given and reviewed by one of the three provider in
their little offices behind you. Ask for a consult and tell the guest that the doctor (Also do
this if you are busy and they are not.) will review their report. Hand the report to the
student or provider and introduce the patient. (Doctor Mayer, this is Emelda Ruiz and she
needs her record reviewed, or …she has a question about her blood sugar.)

If everything looks in normal range, you can say that their screening results are normal,
and ask if they have any questions. Questions can be handled one of three ways:
    1. Answer the question if you know the answer and it is not too detailed.
    2. Tell them a provider can answer their question and call for a consult
    3. Tell them the question can be answered by the resource table, and send them to
        the Resource table to your right.

Offer any patient education materials they might be interested in from your display on the
right. People can wait for consults by standing to your left, and waiting for a
provider/student to emerge and take them.

You should be in verbal contact with the providers and the resource folks.

IN GENERAL:
    Questions about their health go to the providers behind you.
    Questions about health resources in the community or at the fair go to the
      Resources table.

				
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