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Clinic Set Up 
| The clinic should be well visible and easily accessible to all patients, including those with amputations and other disabilities. There should be a large enough waiting room to handle the above mentioned volume of potential patients (approximately half of the population lives in or near PAP). There should be a receptionist or two to check patients in and out and handle the paperwork and putting together of the charts. I would suggest having at least 6-8 RNs, using the Nurse 1 and Nurse 2 method of patient care. One of the RNs would be designated as the director of nursing. I would suggest at least 4 to 5 treatment rooms with some type of bed for
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the patient to lie on, and a stool for the doctor to sit on. Nurse 1 would see the patient initially to obtain vitals and perform some of the initial exam, additionally filling out the initial ulcer documentation paperwork and photographing the wound periodically. It would be imperative to at least have hand-held dopplers available for Nurse 1 to document blood flow on initial exam. Any other available lower extremity arterial evaluation equipment is probably not realistic in Haiti due to expense, unless donated. Even then maintenance and repairs would be on-going issues for either skin profusion equipment or TCPO2 equipment. An arterial doppler lab, if possible, would be more realistic and cost-effective in this setting. I am not sure of the current status of vascular surgery in Haiti, but this is a roadblock for those patients with peripheral arterial disease. Nurse 2 and the doctor would then see the patient together for treatment and other testing/care. Nurse 1 would then return to the room to apply the ordered dressing, educated the patient on recommended care, schedule further testing and/or treatments. Having a diabetic educator and a dietician would be very helpful in prevention and on-going care for the patients.
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