LINDA:  And in the past two CHAMs, the road has been a very -- only sort of -- it's kind of like one way, and then you've had to really struggle to sort out if you had a recheck or if you had a chronic care. 

And a chronic care visit, to put more understanding on that, would be like if somebody has diabetes or high blood pressure, or chronic obstructive pulmonary disease, or emphysema.  Those patients, you're not assessing a new problem, you're actually trying to support them in whatever element they are in their care now, whether that means just a recheck quick and given new meds, or maybe they have another problem, or it's getting worse.  It's just a very different kind of case. 

And then preventative care, whether it's a well elder visit or prenatal or well child, et cetera.  So that -- that has changed the use of the book. 

And then the elements that we looked at also was how to have a book that you can easily navigate.  Again, you don't want to be lost in a -- in a book, you want to be able to quickly navigate. 

And whether we used -- we've used color to help sort of see where you are, but also we have had -- added headers at the top of the page, not only with the body system, but with the section that you're in. 

So you can quickly scan those, table of contents at the beginning of the CHAM, so you can always get an overview, but that's probably not how you get into the book.
 
And then the reference to, as I mentioned before we had the CHAM and the Village Medicine Reference, which were two books actually published years apart. 

And so when a health aide, say, you know, gets through the visit, medication is often an element of treatment.  And so they've had a book that goes in and gives them information about medicine because they are actually dispensing, based upon the physician's order or the plan in the CHAM, and when they have gone to the Village Medicine Reference, it's given them information about it and warnings and side effects and some information. 

But they've had to interpret and do patient education from those.  The others, it took quite awhile to sort of sort -- sort of goes from one book to the next. 

So one element of the new materials is that the Community Health Aide Manual will have its own medicine book.  And so, for example, in acute otitis media, if it says give amoxacillin, it -- it will give you a page number right there, and it will take you to the medicine book for amoxacillin.  When you get to amoxacillin, you will see the plan that you just came from and the page.  So if you close one, you have the other, and back and forth.
 
And we've organized the materials very similarly, but we've added a new element which we hope and I think will really help the health aides, and again, that's been our goal is how do we make it easier for them so that they can do this very difficult, complex job. 

And so we have a new box called Warnings Before You Give This Medicine.  So they don't have to interpret or look through, they can actually look at this quickly. 

And for example, if someone is taking one medicine, they may be contraindicated to take this new one, or they may be breast-feeding would be contraindicated in some cases.  Just that warnings box.  But it's not warnings for the patient, it's so that the health aide is directed --

KAREN:  Right. 

LINDA:  -- and can know what to do. 

KAREN:  And know what questions to ask. 

LINDA:  Exactly.  And they may have to actually -- if the doctor -- we try to get all of that information before they talk to the doctor, but it may be one more thing that hadn't been considered so that they will have that. 

And then the other element that we've added to these is patient education pages for every medication that will -- will have a CD ROM that will accompany the four books, and allow them to print out patient education. 

So the CHAM project has been just an amazing process.  And we're excited, we'll be actually going to the printers and sending this to press within the month.  So the timing of this interview, I'm actually working on the index as we speak, and you know, I have had several people ask me, you know, how on earth did you come to this. 

KAREN:  Yeah. 

LINDA:  But I think it's been the 20, 25 years of prep to get here.  It's been working closely with health aides, whether it's in basic training or in the village, but it's also being a part of writing the right CHAM to working on curriculum and all the curriculum revisions, and the BMR, and I think all of it's been training to this point.  And we're excited to -- to put this into the hands of the health aides. 

And our goal has -- it continues to be the same, which is quality health care for each individual through well-trained health aides who are supported, whether they are supported by their community, their supervisor instructor, or supported by the materials they have to use.  Just key.  Because they are amazing individuals.