Honduras Medical Mission

Physicians for Peace Announces its Partnership with VonZipper Eyewear

A young girl in Nigeria awaits care from medical volunteers. Physicians for Peace
creates stories of hope and healing each day all over the world. 

Recently, we shared the story on our blog of Maryam, a woman whose life was saved by having access to proper medical care while delivering her baby boy. Life-changing stories like Maryam’s have been documented all year by Physicians for Peace medical volunteers around the world . . . 

Dr. Ruffin (left) at the APROQUEN Burn Unit in Nicaragua.

Vivian Pellas, burn survivor and founder of the Association for the
Burned Children of Nicaragua.

In recognition of its 20th anniversary, Physicians for Peace is honoring 20 Health Care Heroes in 2009, individuals who embody the organization's mission and goals to teach, heal, and empower both patients and caregivers. The Physicians for Peace Burn Care Program is a true success story in changing lives and building health care capacity for countries in need. We would like to honor Dr. Willcox Ruffin and Ms. Vivian Pellas as 20th Anniversary Care Heroes for their roles in the creation of this program which has helped so many individuals heal from the trauma of burn injury.  

The Burn Care Program was conceived when Physicians for Peace founder Dr. Charles E. Horton, Sr. visited Nicaragua in 1992.  Based on the medical education needs he identified, a team of plastic surgeons, including Dr. Willcox Ruffin, traveled to Managua and Leon in 1994. Dr. Ruffin, a devoted plastic surgeon, has served as Associate Professor of Plastic Surgery at Eastern Virginia Medical School, Chief of Plastic Surgery at Sentara Hospitals, Chief of Plastic Surgery at the Children's Hospital of The King's Daughters, and Director of the Burn Unit at Norfolk General Hospital. He has helped countless patients through his work with Physicians for Peace, and now retired from medical practice, serves on its Board of Trustees.

His purpose on that first mission to Managua was to advance medical expertise in the management of burn care, and to upgrade patient care within a burn unit built by the founder of Asociación Pro-Niños Quemados de Nicaragua (APROQUEN), Ms. Vivian Pellas. Vivian, a burn survivor herself, has devoted her life to improving the quality of care for burn victims in Nicaragua. The facility Vivian Pellas has helped to build, with the knowledge and support of plastic surgeons like Dr. Ruffin, has been able to treat tens of thousands of patients in need. With partners like Vivian, Physicians for Peace has been able to help burn clinics in other Central American countries provide better care and prevention for burns. 

 

The Burn Care Program has continued to grow and expand to include not only training and education, but the establishment of an international burn consortium. APROQUEN is now one of 19 equal partner organizations that comprise the Asociación Centroamericana y del Caribe de Quemaduras (Central American and Caribbean Burn Association) in six countries (Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, and Nicaragua.) This Association was formed in 2006 by Physicians for Peace and is dedicated to advancing pediatric burn care in Central America and the Caribbean through training, knowledge exchange, and global collaboration.

You can ensure that this program, started with the compassion and cooperation of Dr. Ruffin and Vivian Pellas, continues to help third world countries treat and prevent burn injuries and help burn victims heal. By contributing to our volunteer medical missions and international health programs, you help bring healing to a suffering world. 

Make your donation today!

 

This year Physicians for Peace was fortunate to have Dr. Duffy Casey of Global Brigades working with us in his last year at Eastern Virginia Medical School. Having extensive medical mission experience, Duffy was an excellent correspondent and brought back great stories and videos of his Honduras medical mission with Physicians for Peace. The following is an excerpt from his travel journal: 

 

 

Duffy Casey

Trip Diary

Tegucigalpa, Honduras

Plastic Surgery Mission

 

Monday Jan 19^th, 2009

 

I arrived in Honduras a couple of days ago.  It’s been almost a year since my last trip down here, and more than three years since I left after living here.  This is my first medical mission trip with Physicians for Peace, and I’m looking forward to working with Dr. Brody and the plastic surgeons at La Hospital Escuela.  During my third year of medical school I spent several months in the operating room rotating with general, vascular, and pediatric surgeons, but I’ve never had the opportunity to work with plastics so this week is sure to be filled with new experiences and learning opportunities.

 

Dr. Brody’s plane touched down at noon and I was waiting for him at the airport with a sign but the arrival area is so packed these days we missed each other.  After calling the in-country host and director of the plastic surgery residency program, Dr. Luis Gonzales, I arrived at La Hospital Escuela and met with Dr. Brody in the doctor’s lounge outside of the OR.  After spending only a few minutes with the man I can tell his wealth of knowledge is only matched by his caring and generous nature.  This is his second trip here in the last year.  In the doctor’s lounge he introduces me to the 2 plastic surgery residents who insist on being called by their first names, Oscar and Carlos.  We spend about 15 minutes together talking about our trips and sharing stories of international medical adventures around the globe before heading off to the floor to meet our patients for the week.  Dr. Brody’s been awake for nearly two days straight getting here but is just as bright and anxious to get to work as I am.  

 

Our group consists of three medical students, Carlos and Oscar, Dr. Brody and myself.  We move from bed to bed and the residents and medical students take turns introducing each patient to us.  The floor is divided into two sides, one for the men and one for the women.  We start on the men’s side and find that of our 15 patients, 2 of them have facial cancers, 2 have broken jaws from gun-shot wounds, many have severed tendons from machete wounds, a teenager lost his arm in a coffee processing machine, several have burns on various parts of their bodies, and still others have broken facial bones from trauma.  At the end of the men’s hall lies an elderly man, now 79 years old, missing half of his nose.  He gets excited when he sees Dr. Brody, and when Dr. Brody comes to his bedside he greets him with a warm hug; his name is Don Filepe.  They met in September of last year when Dr. Brody removed a very large Basal Cell Carcinoma from the man’s cheek and grafted the affected area.  He knew the man would need follow-up surgery and Physicians for Peace and the Honduran physicians arranged appropriately.  Dr. Brody is happy with the results of the first surgery and assures Don Filepe the follow-up surgery will yield even better results.  On the women’s side most suffer from burns, some from cooking, others from fires, and one who had an accident with battery acid.  After each patient is introduced, Dr. Brody asks us several questions about the diagnosis and treatment options.  He’s patient when we don’t know the appropriate answers and encouraging throughout. 

 

After talking with a few of the patients on both sides of the floor it becomes obvious that they all share one thing in common, they’ve been waiting for days or weeks for surgery.  The residents explain that there just aren’t enough plastic surgeons for all the patients who need their help.  They also explain that the X-ray machine in the hospital has been broken for some time now and that any images the patients have at their bedside were taken at a private facility outside of the hospital, paid for by the patient out of pocket.  For the ones who need X-ray images prior to surgery but lack the funds for the private facility, they sit and wait in limbo while their friends and/or family search for a way to get the money together.

 

After a few hours on the floor Dr. Brody asks which patient we’re going to start on.  It’s already starting to get late but you can see he wants to waste no time while he’s here.  He understands the value of his time here just as much as the residents and wants to make sure he’s done all he could with the time he’s had.  We head to the operating room together and begin working on the long list of surgery patients.  When we get out, the sky is dark, we are all tired but happy knowing that this was just the beginning of what is sure to be a good week.

 

Tuesday January 20^th, 2009

 

It’s 6am and I’m trying to build up enough courage to douse myself with another bucket of cold water.  I’m staying in the same house I used to live in between 2003 and 2005.  There is only running water a few hours of the day and I use a trash can to collect as much of it as I can, then in the mornings I dip a small bucket into it and toss it over my head as my make-shift shower.  The water is colder then I remember it being and I transition from my state of still waking up to an adrenaline rush the moment it hits my back.  By the time I’m through I’m wide awake and ready for another day at the hospital.  I catch a taxi and arrive at the hospital at 7am.  Dr. Brody has just arrived and is ready to get back to the OR.  

 

Our first patient today is a 25 year old man who was shot in the face several days ago.  His jaw is fractured in several places.  Dr. Brody motions for the resident to stand close to him as he examines the panorex X-ray of the man’s jaw.  They each go through pointing out where the injury is, which parts of the bone are most affected, and suggest ways to approach the repair.  We continue the conversation as we scrub in together.  Dr. Carlos acts as the primary surgeon and Dr. Brody carries the conversation throughout the surgery.  He asks a range of questions from possible complications, anatomical structures, and post operative care.  Dr. Carlos’s knowledge is extensive and he doesn’t miss a single question.  

 

During the lunch break Dr. Brody and I pause to watch Obama be sworn in as the next president of the United States.  It’s a historic moment in our country’s history and we’re celebrating in Honduras.  The physicians coming in and out of the lounge each cheer or share words of support and encouragement as CNN broadcast continues.  

 

The day continues and we are able to repair another patient’s broken jaw and place a much needed skin graft on a woman’s burnt leg.  Each patient we work with is so grateful for the help we are trying to bring it makes the work fly by and encourages us to continue to strive to do more.  After operating for 4 hours on a man who severed several tendons of his arm, we finish the day and leave the hospital around 8:30pm.  The sun went down a long time ago, and Dr. Brody is still operating on a minimal amount of sleep, but you’d never know it by looking at him.  He looks just as energized, excited, and happy as he did this morning.  

 

Wed, Jan 21^nd, 2009

I toss the first bucket of cold water over my shoulder at 6am and am instantly 100% awake.  A triple shot of espresso couldn’t have done a better job of washing away any feeling of still being tired.  I want to get to the hospital a little earlier today, so I scarf down my breakfast of fried plantains, beans, and tortillas and quickly hail a cab in front of my house in La Colonia Kennedy.   

 

I head straight for the lockers and jump into my scrubs then walk over to the check-out counter where we get our face masks, hair nets, and shoe covers necessary to enter the area outside the operating room.  After getting everything on I walk into our assigned OR for the day and get ready for a long list of patients.  

 

Our first patient is a 22 year old male who was beaten in the face with a rock.  The gang problem in Tegucigalpa has increased with the global economic collapse and with it injuries like this one are becoming more and more common amongst the hospital’s patient population.  Dr. Brody goes through the educational process of question and answer, and brainstorms the options for repair with the residents, then begins with the surgery.  The case is difficult and takes several hours to complete.  By the end, however, the team seems satisfied with the results and Dr. Brody congratulates the residents on a job well done.  As we head out to the hallway for a few minutes break, we see Don Filepe sitting patiently at a desk.  Dr. Brody quickly makes his way over and greets him with a warm smile and hand shake.  Don Filepe smiles as best he can when he sees Dr. Brody and me walk over.  He’s been waiting since 7am and is anxious for surgery.  Dr. Brody comforts him and lets him know he’ll be next.  

 

Don Filepe’s surgery lasts the majority of the afternoon.  His condition is unusual and the approach to repair his nose and lip is difficult.  With the guidance of Dr. Brody, both Dr. Carlos and Dr. Oscar move from one step of the surgery to the next without much difficulty.  It’s difficult to imagine how much this man has had to endure in his life and what would happen to him without the help of these dedicated physicians and organizations like Physicians for Peace.  After hours of surgery everyone is pleased with the outcomes, and Don Filepe moves to the post operative care ward.  We discuss the case as a group for another hour before each heading home.  It’s past 8pm, and we’re all tired after another long day in the OR.

 

Thursday Jan 22^rd, 2009

I arrive at the hospital at 7am and meet the team of medical students, residents, and attending physicians in the lecture hall.  Dr. Brody has prepared several lectures for the group, and everyone sits with notepads ready, listening attentively and taking notes.  They ask questions throughout, and Dr. Brody does his best to explain the intricacies of plastic surgery technique.  

 

When the lecture ends, we head together as a group to the operating room.  The first patient suffered from a burn to her leg more than a week ago.  She’s been waiting for a skin graft and smiles as we enter the room.  She thanks us before the surgery begins then again as she is wheeled out to the post operative care ward.  

 

Today, Dr. Brody and I are surprised when Dr. Carlos and Dr. Oscar take us out for lunch.  Dr. Carlos drives us in his car to a new restaurant in town and treats us to a wonderful Honduran meal.  We sit around the table sharing stories from our experiences with patients in operating rooms around the world, and they tell us about patients who have stood out in their mind here in Honduras.  We’ve all gotten closer during our hours together as a group in the operating room, and it’s nice to sit together and talk like friends outside of work.

 

After lunch we quickly return to the hospital and the operating room.  Patients are waiting, and although we all needed the short break, everyone is ready to get back to work.  Our next two patients are both men in their late 20’s with broken jaws.  The surgeries are complex but Dr. Carlos and Dr. Oscar get better with each repair they do.  It’s late by the time we’ve finished the second repair but the group isn’t ready to call it a day yet, so another patient is brought back and we do a quick skin graft before leaving for the day.

 

Friday Jan 23^th, 2009

Today is Dr. Brody’s last day.  His flight leaves around 1pm so we start operating early.  Today we have one patient.  The man in his 30’s is another patient Dr. Brody operated on in September.  Apparently, he was kicked in the face by a horse 2 years ago and has received several surgeries since.  Much of his tissue has been replaced by scar tissue which is currently preventing him from closing his mouth.  We take him back to the OR, and after a couple hours of surgery Dr. Brody is convinced he will no longer have to suffer from this problem.  He still has a little bit of time before he needs to be at the airport and schedules a meeting with two of the directors of the pediatric burn unit across the street.  It’s amazing to see that he is always willing to do more, to see one more patient, to try and help one more person, regardless of how late it is, how little he’s slept, or if his plane is leaving shortly.  This is the attitude I’ve found is at the heart of Physicians for Peace, and one of the elements of the organization that makes them so successful.  It has been an amazing experience working with the talented and dedicated people at PFP, and I look forward to working with them more in the future as a medical doctor.

You can contribute the work of Dr. Brody and others who are making a difference in international health care by donating to our Specialized Surgery Program today!

This blog entry was contributed by Dr. Nabeel Qureshi, a recent medical school graduate who served as an intern for Physicians for Peace in his last year at Eastern Virginia Medical School. Nabeel's contribution to the Resource Mothers Program was significant. As a student of psychiatry, he was able to provide training on two very important and difficult aspects of women's health - depression and domestic abuse. He had this to say about his experience: 

"I made my decision to work with Physicians for Peace last year when I was being introduced to the fourth year MD curriculum. In the catalog was a section on "International Medicine". I talked with Dr. Paul Aravich and Jaya Tiwari, and I decided that a medical mission trip in international health education would be a great fit for my future medical endeavours. No matter what I end up doing in the medical field, I hope to take that knowledge and help people around the world. 

Before starting work this March, I talked with Jaya Tiwari and Mary Kwasniewski, Directors of Global Health Programs at Physicians for Peace, and we decided that working with the Resource Mothers program in Santo Domingo would be a great idea. It had come to their attention that the women in Santo Domingo were having difficulty dealing with domestic abuse issues with their clients, and that they needed training with how to respond. I gathered information in English and in Spanish and put together a two hour workshop on domestic abuse training.

Before arriving in Santo Domingo, I did one week of medical mission work in Honduras. While there, I noticed that people suffering from depression received very little help, despite the pervasive effect this disease has on one's life. I began brainstorming on how this problem could be addressed, and decided the best place to start would be with diagnosing the condition and educating the people whom it affects. So when I arrived in the Dominican Republic, my focus became not only to identify domestic abuse and discuss it with the Resource Mothers, but also to determine the extent of depression amongst these women and their clients.

In Santo Domingo, I visited each client's home one at a time, documenting the location of the homes via GPS and taking pictures of the women standing outside of their residences. This was to help locate all the clients on a map to better serve them and to be able to show the work that Physicians for Peace is doing in a more tangible manner. I also wanted to get to know the clients and have a better understanding of their living situation. During this time, I also translated the World Health Organization's Major Depression Inventory into Spanish and administered it to the Resource Mothers. This inventory does two things: definitively diagnoses depression, and also determines the severity of the depression. Of course, the translation was not sanctioned by the WHO, but it was as good as we could do. In addition to the administration of the MDI, we also trained the Resource Mothers on depression and post-partum depression, as well as domestic violence. 

Traveling to the Dominican Republic and working with Ramon Lopez, Director of the Americas for Physicians for Peace, was a great experience. My eyes were opened to the conditions of people who truly are in need, and also to my condition of luxury in the States. After spending a week visiting all the clients, I had no doubt in my mind that Physicians for Peace was doing an amazing service in their lives and the lives of their new children, a service that would continue to benefit these families for their entire lifetimes. I will not soon forget the stories, the emotions, and the relationships that I experienced in this vibrant and life-loving culture."

We thank Nabeel for his work in this area of need in and helping women understand and diagnose the disease of depression in an area of the world where this problem is often overlooked. Addressing the problems of depression and domestic violence is crucial to our mission of improving third world health care and helping mothers in poverty. 

To learn more about our Resource Mothers Program, visit www.physiciansforpeace.org/wch.html

You can contribute to our Maternal and Child Health Programs. Make a donation today!

More from Susan Palmer at the Burn Consortium Annual meeting:

At the conclusion of the second full day of international health education on pediatric burn care, there was excitement in the air - Samia Jarufe from Ruth Paz in San Pedro Sula, Honduras, said “there is so much information being provided…I’m so glad we brought a team of representatives to this burn consortium meeting…it was worth every penny."

Alba Rony, the psychologist from the burn unit in APROQUEN, Managua, Nicaragua, was leafing through the beautiful, professionally printed, glossy, full-color journal that she had just been handed and said excitedly… “look there I am!...there is my presentation!”  This journal is regularly produced by the Universidad Santa Paula, but the University had devoted this whole edition to burn care and the lectures presented during the Burn Consortium -  “Articulos Especiales Sobre Quemaduras Y Nuevos Medicamentos: Salud, Nutricion, Medicamentos, Tratamientos, Temas Culturales, Documentales Cientificos, Eventos Artisticos” Copies of the journal were provided to all the attendees.

In addition to Physicians for Peace and the many burn consortium partner organizations, many other global health organizations participated, including:

1.       International Society of Burn Injuries (ISBI)

2.       Federation of  Latin American Burns (FELAQ)

3.       USA: Shriner’s Burn Hospital, Houston

4.       Chile: COANIQUEM

5.       Mexico: Hospital Civil de Guadalajara

6.       Argentina: Semillas del Corazon

In response to the recognized needs of addressing the interdisciplinary team approach to burn care, almost one full day of lectures was devoted to the psychosocial aspects of pediatric burn care. Topics included:

1.       The incorporation of the family and the patient in burn rehabilitation

2.       Music Therapy and the social reinsertion of the burned patient

3.       Recognizing the signs of child abuse and neglect

4.       Social rehabilitation of the pediatric burn patient

5.       Pediatric post traumatic stress disorder

6.       Teaching the pediatric burn patients while in the hospital

Tonight will be another business meeting of the Burn Consortium.  They are voting in their first official Board of Governors and approving the policies and procedures developed over this past year.  Excitement is high and everyone is talking about who will be president.  Several names have been bandied about and tonight we'll know for sure!

Susan Palmer, Director of Global Health Programs and Volunteer Development for Physicians for Peace, continues her report from the Burn Consortium Annual meeting taking place this week in Costa Rica:

We started off the day with a video welcome by Ron Sconyers, president and CEO of Physicians for Peace, who was unable to attend in person, which was translated by Dr. Ramon Lopez. Then Dr. Ramon Lopez, as the Director of the Americas from Physicians for Peace, welcomed everyone back, saying PFP looks forward to working with them all in the future, and emphized the commitment by Physicians for Peace to continue supporting the partner organizations in the Burn Consortium. Nyra Gaspar welcomed everyone and said how happy she was to have everyone together in Costa Rica. Nayra thanked PFP and the other local organizations who had helped with putting on this consortium. This was followed by a welcome by the newest partner organization for the burn consortium, Lic. Rocio Valverde, President/Rector of the Universidad Santa Paula.

Then there was a special welcome from the Vice Minister of the office of the Minister of Health for Costa Rica Dra. Ana Morice and Dr. Jose Rojas, Director, Social Security of Costa Rica. Dra Morice officially opened the meeting and thanked the organizers of the burn consortium, in particular the host of this year's meeting, and commited to their continued support for this need. Dr. Rojas said he wants to continue to improve the skills and training of the people who take care of the burn patients in Costa Rica. They have been working with Nyra Gaspar and recognized her and all the tremendous work done by the Asociacion Pro Ayuda al Niño Quemado, APANQ, and then they welcomed all the countries represented.

There were over 100 attendees from all over Central and South America and the Caribbean (Argentina, Brazil, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Mexico, Nicaragua and the US) all waiting to learn and exchange information on burn care with their colleagues.  Each of the Partner organizations presented, along with some key speakers from the International Society of Burn Injuries (ISBI). 

The Exhibit Hall was also a success, as attendees spoke with distributors of burn related companies including education, fire department, pharmeceutical etc. This is truly an important event in international health education! 

To learn more about Physicians for Peace's Burn Care Program, visit our web site at www.physiciansforpeace.org/burncare.html