Third World Health Care

Shortly after the earthquake ripped open the heart of Haiti, Physicians for Peace responded with a fundraising drive to support its two partners in Haiti, both of which were reduced to rubble. This week, Physicians of Peace sent checks of almost $27,000 each directly to Healing Hands for Haiti and St. Vincent's School for Handicapped. These funds represented the donations collected by Physicians for Peace in the direct aftermath of the earthquake and were intended for immediate relief operations in Haiti.

Prior to the devastating earthquake, there were an estimated 800,000 disabled people in Haiti. This population was disproportionately underserved and in many cases, shunned as outcasts. To meet the needs of Haiti’s disabled, Physicians for Peace, a Norfolk, VA-based nonprofit that provides medical training for health care providers in the developing world, began working in Haiti in 2005 as part of its Walking Free program—one of a very limited number of agencies with a sustainable track record in Haiti working with amputees. 

Physicians for Peace has now strategically shifted its focus from the initial relief operations to the long term rebuilding effort in support of Haiti's disabled population. All cash and material donations will be used as part of Physicians for Peace’s Walking Free program in Haitito organize, train and supply prosthetic and orthotic production and training facilities.

Walking Free—An Initiative of Hope for Haiti’s Disabled   

Amputee and celebrity Heather Mills publicly launched the campaign on Larry King Live. Physicians for Peace also enlisted the aid of Hanger Orthotics and Prosthetics, the nation’s largest manufacturer, to use its 670+ sites across the nation as collection points. Dozens of cities, agencies and companies are now sponsoring local drives and Physicians for Peace has become the “go to” agency to donate desperately needed mobility equipment. Our 10,000 sq. ft. warehouse is now overflowing, and we have partnered with Arpin Van Linesand  Hampton Roads Moving and Storage for additional storage capacity. These items will be shipped via container to Haiti over the coming weeks.

Physicians for Peace has formed two coalitions to ensure that amputee victims of the earthquake will soon walk again and play an active role in Haiti’s recovery. The first alliance is the Hispaniola Prosthetics and Orthotics Education Coalition with Healing Hands for Haiti and the International Society of Prosthetics and Orthotics-US. Healing Hands for Haiti has been  our long-term partner in the devastated capital city Port-au-Prince and is settin up temporary (and eventually, permanent) work space in the city and will soon be  able to begin prosthetic production. There are vital equipment, medical supplies and professional medical volunteers we need to send. With your generous donations, we can mobilize these efforts quickly.

Second, recognizing that considerable activity is focused in the capital city, Physicians for Peace has joined Hanger Orthopedic Group, Inc., Shepherd Spinal Center, and the Harold & Kayrita Anderson Family Foundation to launch the “Haitian Amputee Coalition” to support the central plateau region. This coalition is creating a long-term prosthetic production center at Hôpital Albert Schweitzer, an undamaged local hospital 60 miles from Port-au-Prince. 

You can help Haiti’s disabled.

Your monetary donations will help restore the production, training and rehabilitation infrastructure for Haiti’s disabled and will give Physicians for Peace the leverage to adequately organize, train and supply our Walking Free program.

 Thank you for all you have already done for the people in Haiti and for supporting our work.

For the past few years, Physicians for Peace has been working in partnership with the government of Eritrea and The George Washington University Medical Center to bring post-graduate medical education to Asmara. Last week, a dream was realized for The Partnership for Eritrea, as the Orotta Medical School graduated its first class of doctors and pediatricians, a priceless contribution to the health care system of a country affected by years of conflict. 
President and CEO of Physicians for Peace, Brig. Gen. Ron Sconyers (USAF, Ret.) attended the graduation, which marked an important milestone for medical education in Africa. He shares his thoughts on this experience:

I have just returned from Eritrea…after a most stirring and historical experience. 

When Dr. Horton conceived Physicians for Peace, it was his vision to build international peace and lasting friendships by bringing America’s best medical talent together with the medical talent of the world’s underserved to not only heal and teach, but through “people to people”  outreach, create unwavering friendships, regardless of politics, geography, religion, or other artificial boundaries.  What  transpired this  past weekend sets the standard for Dr. Horton’s vision of medical diplomacy. 

Picture this:  the dais at the graduation ceremony of the first class of Eritrea’s new medical school.  Eight dignitaries prepare to convey degrees on 31 medical doctors and 8 pediatricians.  Four of those about to honor these students are directly affiliated with  Physicians for Peace;  three are from Eritrea, a country with “not so good” relationships with America (but life long friends of PFP);  and one from Cuba (and new PFP friend), who in fact is the Dean of Eritrea’s Orotta School of Medicine…another country with severely strained relationships with its neighbor to the North.  But here they stood, as friends and colleagues, in the name of medicine.   No politics, no animosity. Just a common cause of bringing the best medicine to a nation’s people. 

In 2001, PFP, under the leadership of Dr. Haile Mezghebe, of Howard University (and personally recruited by Dr. Horton)  began a series of medical missions to Eritrea that opened doors and hearts to the way of PFP.  And then in 2005, PFP joined forces with The George Washington University Medical Center to establish the Partnership for Eritrea, bringing the first post graduate medical education to this nation…in the face of severe challenges and uncertainty.

Today, 31 new Eritrean doctors and 8 new Eritrean pediatricians begin their lives anew, fulfilling their aspirations to serve others.  And Physicians for Peace yet again demonstrates that if you heal a man, you heal only one, but if you teach a man to heal, you heal many.  Today, thousands will be healed in Eritrea.   

We can take great pride in our work there!  While it remains unfinished, this is a milestone of watershed proportions. 

As I gather more of my thoughts, more will follow.  But just know that what has been accomplished in Eritrea is game-changing.

Congratulations to all!!!  

Ron 

Find out more about The Partnership for Eritrea at www.partnershipforeritrea.org

Greetings from Nigeria!

This week wasn’t nearly as exciting as last week - No births at the clinic. We did see a woman who said she had been leaking fluid for two days. She wasn’t in labor so we referred her to the hospital, after we found her husband who was off working in a neighboring field. She went to the hospital on Tuesday for induction of labor. Today she returned to the village with her beautiful, healthy baby!

A woman we referred for an ultrasound last week found me and gave me the report. When we examined her we could only feel the baby below her belly button and we heard the baby’s heart beat on the left and right side. Not sure if the baby was lying horizontally or there might be twins.  The report came back that the baby is transverse (horizontal).  She is about 8 months pregnant. We will watch her closely - if the baby doesn’t turn head down we will refer her for a Cesarean delivery.

Our babies from last week came back for weight checks and vaccines. The little girl who weighed 2.3 kg at birth was down to 2 kg so we reviewed breastfeeding with Mom. This is her first baby. She came back the next day and the baby had gained. No signs of dehydration. Mom brought me a bag of ground nuts (peanuts) as thanks. My “grandson”  gained .25 kg. I gave his mom a bag with powdered milk (for her, not the baby), another protein based beverage powder and 4 cans of sardines. After all her blood loss, we want to build her back up. We are encouraging greens and liver also. Maryam #2 gave me another bag of ground nuts and 6 bars of soap. I was overwhelmed - they have so very little. 70% of the people in the village are living on less than $1/day, and they are giving me gifts!

I have been walking every day and said I wanted to walk from Pampaida to Saulawa. Everyone kept telling me it is too far, too hot, etc. Yesterday, Dr. Ojo left to go to another clinic to get vaccines for our new babies (we don’t have a refrigerator). I got bored waiting for him - and decided to trek to Saulawa to help with the prenatal clinic. Several people stopped on motorcycles and offered me a ride. Thank you, no! I did it. I walked 9 kilometers. I think I probably sweat 3 liters, but I did it! Dr. Ojo started teasing Banke (she is 25) that the elderly woman is more fit than she is! I could be their mother, but elderly? Though 48 is the typical life span here, and  I am 52.

This weekend, I am taking Dr. Ojo and Banke to dinner. There is a Chinese buffet, but they want to go to Chicken Republic. I will let you know if it is like our KFC! They also want to go to a photographer and get a formal picture of the three of us. “The Pampaida Birth Team." Also, Banke and I plan to go to the market this weekend to see if I can find something for Matt’s (my son-in-law) wall. He is a history/geography teacher. Also my “sister” Joy wants some Nigerian fabric for a quilt.  So we will go exploring. 

I am counting down the days until I go home - in 8 days I will be on the plane. It will be a bittersweet farewell. I have made some lifelong friends here. Mary, from Physicians for Peace, is already starting to talk about my next trip. Right now, I just want to spend some quality time with my family.

Not sure if I will write again before I return. I promise to post lots of pictures when I get back.

Blessings!

Robin

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Robin Jones, Registered Nurse and Women's Health Care Nurse Practitioner, has been writing about her experiences in the Millennium Village of Pampaida in Zaria, Nigeria. If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site at www.physiciansforpeace.org. 

We couldn’t go to Saulawa for clinic today because the ambulance driver was no where to be found and no one knew where the keys to the vehicle were. I was resting from our first delivery, when Banke woke me around noon and said we had another woman in labor.

Her name was also Maryam.  She is 20 years old and this is her 5^th pregnancy. It seems she only has one living child, and we never did find out what the circumstances were of the deaths of the other 3.  She has a 4 year old daughter.

She was dilated 5 cm and Dr. Ojo said her bag of waters had ruptured 2 hours earlier. We started monitoring her contractions and the baby’s heartbeat every 30 minutes. We are committed to being more diligent with the partograph. It was decided that we will have Banke “catch” this baby. Maryam was on the bed. The contractions were only 2 in 10 minutes, so we decided to walk a bit. These women make very little noise during the labor. I would occasionally see a grimace, or more likely I would see her just bend over when she got a contraction. Around 4 we checked her progress - only 8 cm. She is going slower than we expected. Dr Ojo decided to go play some soccer.  We told him to be sure to be back before dark to start up the generator so we could have some light.

We just hung out walking with Maryam, setting up our equipment and patiently waiting. At around 8, we checked her again - only 9 cm. Hmm, time to consider a plan. Baby’s heartbeat was beautiful. We felt Mom might be anxious, so we would be patient. (And still no driver or vehicle keys) Around 10, I noticed Maryam had some vaginal bleeding - a little more than we normally see. Baby looked great, but she really wasn’t pushing effectively. As the head moved down, Banke assumed the  “Catcher’s” position. She did a beautiful job! At 10:35 pm, a beautiful baby boy was born. No lacerations, either. He was a nice 3.5 Kg (7 ½ pounds). I took him and did the ‘baby stuff’ while Dr. Ojo and Banke took care of Mom. The placenta delivered intact 10 minutes later. 

Around 11, Banke was cleaning instruments, Dr. Ojo was in the hall chatting with family, and I went to check the Mom. She was lying in a pool of blood. She was starting to go unconscious. We put in an IV, gave her 10 Units of Pitocin in 500 cc of IV fluid rapidly to contract the uterus and drained her bladder with a catheter. So glad the class this week was on Post Partum Hemorrhage. We responded quickly without wasting any time. Mom’s pulse and blood pressure stayed normal. We put the baby to breast, elevated Mom’s legs and continued to monitor closely. The uterus firmed up for a short time, but the bleeding continued. We decided to give another drug - Misoprostel to firm up the uterus. This worked very nicely.  We reexamined the cervix and birth canal for any tears that might have been missed. None.

By around 2:30 things had calmed down. Maryam’s pulse and blood pressure remained stable and the bleeding had become normal. In all, we estimated she lost a little over a liter of blood.  Everyone was exhausted. I told the others to go to bed for a couple of hours and I would stay up. The generator ran out of fuel at 4:17 am. So my checks were done by lantern light.  The baby nursed again.  Maryam was resting comfortably.

Dr. Ojo relieved me at 6. When I went back to check on them at 8, Maryam had gotten up to go to relieve herself and had eaten some food.  She is pale and will be on iron supplements for a while.  God was definitely with us. We have no doubt if she would have stayed home to deliver, she would not be alive today.  We are hoping that this will encourage more women to come to the clinic to deliver.

That is the story of Pampaida ‘s second delivery! The training prepared us for this emergency. We are reminded to always be alert and ready to respond in a systematic, calm manner.

I have claimed this little boy as my African grandson. I will post pictures when I get back home. 

That’s all for now.  I need sleep!

Blessings!

Robin

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Robin Jones, Registered Nurse and Women's Health Care Nurse Practitioner, has been writing about her experiences in the Millennium Village of Pampaida in Zaria Nigeria. If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site at www.physiciansforpeace.org. 

Maryam is a 17 year old mother with her first pregnancy. The team tonight consisted of Dr. Ojo, Banke, the nurse, a CHEW-community health worker, and me. Maryam had her mother-in-law, aunt, husband, a niece and nephew and about 5 other men in her entourage. The men and children quickly found a bench or position on the floor and went to sleep.

We timed her contractions. This was something I hadn’t done in about 8 years. I had really become dependent on the fetal monitors for telling me when contractions we occurring and how long they were lasting. She was having 2 contractions in 10 minutes. They were only lasting about 30 seconds. We started a partograph to frequently record information on the labor. The baby’s heart rate was wonderful and the head was well down in the pelvis. Maryam’s blood pressure was a little high at 142/90 and she had a little protein in her urine. We would have to watch her closely.

Around 1 am, we saw much more restlessness and quiet moaning. Maryam would grab her back during a contraction. I started apply pressure on her lower back or squeezing her hips to help relieve her discomfort. The two men were busy playing video games on their cell phones. I guess some things are just universal!!!

We let Maryam push as she felt the need. No coaching, yelling or bright lights! So nice. The baby’s head slowly came out. The rest of the baby followed quickly. Time of birth 2:12 am Oct 27, 2009! We dried off the baby girl. She had a  nice strong cry. Banke and I tended to the baby. Her Apgars were 8 and 9. This is a scale to determine how well the baby is adapting to life outside the womb. She was doing great! We  tied off the cord with a fine string that had been soaked in alcohol (Spirits). Dr Ojo checked to make sure there were no more babies and gave Maryam 3 tablets of Misoprostel. This is a drug to help contract the uterus, deliver the placenta and prevent excessive bleeding. 

For the next two hours we continued to monitor Maryam and the baby.  They were doing well, so after cleaning up we went to bed at 4 am. I woke up at 6, checked Mom and baby were doing well. 

We had breakfast, saw 28 women in prenatal clinic and then went to discharge the new family. We did a discharge physical on both mother and baby and taught Maryam, her husband and the mother-in-law what to expect, when to return if certain signs developed, how to monitor the baby for dehydration and how to take care of the umbilical cord. We will see the baby back in 1 week. We will check her weight. Her birth weight was 2.3 kg - just a smidge over 5 pounds. She will get her BCG vaccine (to prevent TB), a Hepatitis B vaccine and her oral polio vaccine. Ideally, she would have received these right after birth but we have no refrigerator to store the vaccines so we have to get them from the clinic in Ikara and carry them in a cooler. Maryam will return for a check in 2 weeks.

We were all exhausted. So after pictures with the family, we sent them home in the ambulance (Maryam wasn’t quite ready to travel on the back of a motor bike), we all went to take a much deserved nap.

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Robin Jones, Registered Nurse and Women's Health Care Nurse Practitioner, has been writing about her experiences in the Millennium Village of Pampaida in Zaria Nigeria. If you would like to make a donation to help mothers in poverty and support volunteers like Robin on our medical missions in Africa, visit our web site at www.physiciansforpeace.org. 

The first couple of days of our mission to the Philippines focused on the “Walking Free” program and how we could better meet the needs of its patients. We had visited the facilities at PGH (Philippine General Hospital) and Clark Air Field. Today would be different since we would be participating in a relief effort which is something that we normally do not do - Physicians for Peace is an organization that focuses primarily on medical education.

During this part of the mission we were supposed to visit the area of the Philippines called Northern Luzon.  Unfortunately we were not able to do so because of the damage that the area had sustained from typhoons Ondong and Pepeng. Lyne Abanilla, PFP’s representative on the ground in the Philippines, asked our team if we would like to help hand out relief supplies to victims of the recent flooding caused by the typhoons. The effort would be in Pasig which is part of Metro Manila. We jumped at the chance to help.

We meet Lyne at the Manila Bulletin which is where she works. The Manila Bulletin is the nation’s second oldest newspaper and claims the second largest circulation in the Phlippines. The paper is located in the historic Intramuros section of Manila.

When we arrive we are noisily greeted by a room full of volunteers that are busy packing the supplies that will be taken to Pasig. The volunteers include Rotarians, business owners, and doctors. The volunteers are eagerly making and packing peanut butter sandwiches. We quickly pitch in, and in no time everything is finished and ready for transport. Once loaded, we head for the police station to pick up our police escort and the truck that will transport the supplies and the volunteers.

Once we get to Pasig, we are greeted by our security escorts. Our truck that will carry the volunteers and supplies is a standard troop/personnel carrier. There will be seats for 8 people but about a dozen or so of the volunteers will have to stand up during the trip with only the wire from the surrounding cage to hang on to.

We are escorted by two police vehicles as we leave the compound. As we slowly make our way through traffic we notice that we are waved through at every intersection by the local traffic cops. Apparently word has been sent ahead in order to help ease our way through the heavy traffic.

The traffic, which is always backed up, becomes even harder to work our way through. We realize that this is due to the roads being closed due to the flooding and landslides. Then traffic comes to an abrupt halt. Right in front of us is a section of road that is completely submerged. Our escorts slowly ease their way through the water and for a while look as if they are getting ready to float away. We are nervous and are sure that they are not going to make it but eventually they are out of the water. As we inch our way forward, we are greeted by people in boats and tricycles. Some people are actually swimming or wading in the dirty water. To the left of us we notice personnel bridges made of two by fours supported by wooden bases that have been hastily constructed so that people can get in and out of the area. This is a scene that I had never witnessed and am once again awestruck at the ingenuity of the Filipino people.

Once we make it out of the water we arrive at our destination. Suddenly we are greeted by a large crowd that starts cheering and waving. These are the people that we have been sent to help.

Suddenly we are out of the truck and on the ground. The supplies are taken off of the truck and moved to a gymnasium that will be the main distribution point. There are also a large number of people in the gym. We are told that the people outside have suffered some damage to their homes but their homes are still habitable. The people inside the gym have lost most of their possessions and their homes were destroyed or almost completely destroyed.

While everyone is busy getting the supplies ready for distribution I grab my camera and spot a set of stairs inside the gym where I can get a few good pictures of what is going on inside. As soon as I get to the top of the stairs, a door flies open and I am greeted by a young man.  I realize that I am invading someone’s “home”. But instead of being angry, the young man asks if I can take a picture of his family. I agree and suddenly they are all in front of me eagerly posing for the camera. Once again, here is a family that instead of focusing on their terrible loss, are instead trying to have fun by posing for a picture.

I quickly turn around and start snapping pictures of the scene on the gym floor. The sight that appears before me is shocking. These are families that have been dislocated. It looks as if some of them had little or no time to grab anything of value. Dirty blankets and sheets have been erected in an attempt at privacy. Some of the people look as if they do not have any clean clothes. Children are running in and out of the makeshift dwellings playing and laughing. The crowd is starting to murmur with anticipation of a chance to receive some water and a little bit of food.

As I make my way to the floor and start walking in and out of the dwellings, I am greeted by calls of “hello sir”,  “good evening sir”, and “how are you doing sir”.  Everyone has a smile as I greet them.

After taking pictures for a few minutes I notice that Lyne has the volunteers ready to hand out the supplies to the people inside the gym. I run over and grab a big box of bottled water and drag it on the floor as someone else passes out the bottles. We are told to try to limit each family to one bottle. We need to make sure that everyone, including the people outside, receives their fair share of supplies. The first box empties rather quickly and then we start working on a second box of water. Suddenly people start running up to me and asking “tubig please”, water please. Though I know that every family should have received a bottle of water I cannot turn them down. What if their family is very large? How long has it been since they had fresh drinking water? What if they have small children? So I give them some more.  Once again I hear many “thank you sirs” and “salamat po”. Then I spot Doc Montero who is also busy handing out water. Someone is asking him to limit the amount of water that he is giving away. He shouts back that the children keep asking him for water and how can he turn them down. My thoughts exactly.

Eventually mats and blankets are also passed out. A small amount of cooked noodles and bread with peanut butter is given to each family. We are finished handing out supplies to the “residents” of the gym.

Now we shift to the people waiting outside. Everyone is standing in two lines. The supplies start moving down the line but we need to move a little quicker. These people have been waiting for quite some time and we want to make sure that they get their fair share. Lyne is urging everyone to move a little quicker. We certainly don’t want anyone to think that they are going to be left out. It seems that the supplies move a little quicker this time and before we know it we are finished. Through all of the commotion there is no pushing, shoving, fighting or cursing. Everyone is well-behaved and courteous.

Night has come, so we start to gather the few supplies that we have left and put them on the truck. As we make our way to the truck to leave we are greeted with “thank you ate” (older sister), “thank you kuya” (older brother), “thank you sir” or salamat po.  Some of the volunteers are on the truck. As I get ready to climb on I hear a child call out “tanapay sir”, “bread please sir”. I notice a box of bread at the end of the truck. I hand the little boy a roll. Then where there was one hand there are now two. So I hand out two more rolls. Now there are four more hands stretched out toward me, so I give up four more rolls. Now there are six and then eight more hands. So I hand out more bread. The people inside the truck are telling me that we need to leave because it is getting late. Suddenly there is a hand around my right arm and then one on my left. Then there is a hand from behind and then I am in the truck.

As we start to leave we pass by a crowd of people. Some of them are cheering while others are waving. I hear some goodbyes and few more salamats and then we are gone.

Our trip out of the flooded area is a bit quicker since it is late and there is a lot less traffic. Once again we receive a free pass because of our escort and because of our mission.

Once we arrive back at the police station it is decided that we will all meet somewhere to eat. We are all thirsty, hungry, and tired. The restaurant of choice is Jolibees. This is the Philippines version of KFC.

When I receive my order and start to eat, I can’t help but wonder how easy it is for me to take for granted that I have the ability to eat anything that I want at anytime but that there were going to be many mouths tonight that would not be fed. Even though I finish my meal, it seems that it is a little harder to swallow than usual.

P.S. - At some point during the relief mission in Pasig a woman handed me a note. The note had her name and phone number. On it she stated that her daughter had scoliosis (curvature of the spine) and asks for help. When I meet Dr. Pipo Bundoc the next day and ask him if he could help he tells me “I can do this”.  Once again our friends in the Philippines will come through.

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The work of Physicians for Peace to improve third world health care is vital to those in need. Find out more about our medical missions in the Philippines and how you can make a medical donation to support our international health programs there - visit www.physiciansforpeace.org 

Greetings from Pampaida!

Wow! What a week! Monday, a woman came to the office in Zairia. She was introduced to me as a Midwife/Lecturer at the local Training Hospital. Dr. Woje asked that we meet and have open discussions and perhaps I could lecture with the students one day. We traveled over to the teaching hospital, where I was introduced to the Director of Midwifery and the Principal (Dean of Nursing Education). A meeting with the Faculty has been arranged for Friday (tomorrow) morning. I have also requested to spend a day following a midwife. I have drafted a list of questions for discussion. Also, I will ask their help in developing a Safe Childbirth Checklist.

Monday afternoon, in the middle of a rain storm, we headed out to Pampaida Village. There were 17 of us crammed in a small van, plus supplies. I did wear my seatbelt (ALWAYS!) The driving is a bit crazy. They use the horn all the time.

I settled in my room. I have a bed net here. No mosquito buzz attacks in the middle of the night. Banke, one of the nurses, has the other room on the women’s side of the quarters. She also does the cooking. She is an excellent cook. I have had French fries, fried yams, fried plantain, beef stew, spaghetti, rice, beans, greens, and melon and custard. My stomach hasn’t adjusted to the greens just yet. A sauce is made from sun-dried tomatoes and red peppers. It is put on rice, meat, vegetables and spaghetti. I am really enjoying the food. This morning for breakfast I have spaghetti with sardines and hash brown plantain. I was finally able to convince Banke to let me wash dishes. I told her the cook should rest after the meal and allow the ones she served, to serve her.

In clinic at MV1, Maru-a village Health Worker, has learned to do tummy checks. She measures the uterine height and also assesses how the baby is positioned so we know where to listen for the heart beat. She learned very quickly. Next week, I will work with Banke.  The Doppler is a hit with Dr. Oje. He works with the Doppler and I follow with the fetoscope to perfect my newly learned skill.  We have discussed the need to maintain the fetoscope skill as it is not dependant on batteries, nor does it have components that can break. The problems with technology...

In the late afternoons, Banke and I have been strolling through the village. The small children- toddlers are still frightened of the white skinned woman! The rest of the children flock around as they love having pictures snapped. I have to be careful - sometimes there is shoving to get attention and the littler one are pushed to the ground. I took pictures of the settlement-cooking, bedrooms, shops,etc. I have finally learned what millet is. It is a grain that grows on a stalk that looks similar to bamboo.  The grain grows on the top, similar to the tops of the corn stalk. When it is harvested, they beat the stalk to remove and collect the grain.

Today, we had our first training session. We discussed the reproductive system, fertilization and fetal development and prenatal care before the computer died. I have 4 students, one of which is a male. Lots of great questions were asked. We will continue on Monday.

I have enjoyed sleeping with a mosquito net. When I arrived back in Zairia, I was told they are going to put one up here also.  Not sure if it was the open spaces of the village or the net,but I certainly slept well there.

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Monday

Oct. 19, 2009

As another week begins, we will be heading out to Pampaida in the next hour. I will do another lecture today.  We will wrap up prenantal care-maybe even a quiz. Then we will go over the components of labor. Tomorrow, I will be working with Banke in the clinical setting-doing ‘tummy checks’.

This weekend was much better than last weekend. I spoke with Jeff on Friday via Skype, so the feelings of homesickness weren’t so bad.  Saturday, I did some laundry. Boy, did I take my washer and dryer for granted!  I used a bucket and a large bowl to wash the clothes.  I ran out of bottled water so I boiled the municipal water (when it was on). Even after 20 minutes of boiling there was still a dirty looking sediment. I only used it for cooking. I couldn’t bring myself to drink it.

I read 2 books this weekend and did some knitting.  My exercise routine is up to 20 laps around the compound, 30 toe touches, 50 sit-ups and 50 leg lifts a day.

Yesterday, Dr Woje and his family came by to take me to church.  The message was on willingly doing God’s work. Another timely message. The Sunday school lesson was on daily Bible reading and study.  Mrs. Woje (Hannah) was very disturbed that I only brought my little New Testament. She has lent me a Parallel Bible and also given me a Study Booklet.  She has invited me to go to a Revival Convocation in Kaduna the last weekend of the month. She is going to be the boost I need to become more disciplined in reading/studying the Bible!  After church, I was invited to have lunch with the family at their home.  I helped cut up cabbage for cole slaw.  The meal was wonderful-rice with the spicy red sauce, curry, fried plantain, cole slaw (not quite like ours) and paw-paw. It was my first time trying paw-paw.  It is almost like a cross between the mango fruit, papya and cantaloupe. Very good!  Dr Woje extended an invitation that I stay in their guest wing on the weekends. I thanked him, but declined.

His wife has a water filtering business next door to the house.  They take the municipal water and filter it through sand and ultraviolet filtration, then bag it in small bags. People bite a hole in the corner of the bag and can enjoy clean water. Quite impressive!  He dropped off about 50 bags last evening.  I will take about half out to the village with me.

I transferred another 180 pictures from my camera. Maybe Friday, the IT guys can show me how to attach/send them. Or I can figure out Flickr. 

Signing off until Thursday afternoon when I return to the city.

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Friday, Oct 23,2009

Greetings from Nigeria!

This was a very busy week. I taught Monday and Thursday. We covered labor and delivery and complications. They have grasped previous concepts well. I continually quiz them on things we have already covered. Prenatal clinic days  are Tuesday and Wednesday. The male student, Tajudeen, did  "tummy checks" with me on Tuesday. He did a very good job.  He also taught the  pregnant women about condom use. I know...too late to prevent pregnancy, but they are encouraging condom use to cut down on the HIV incidence. He always asks the most questions during class.

We had a little girl that the doctor thinks might have sickle cell disease. She was dehydrated, febrile and didn't make a sound when they put the IV in. By late afternoon, she had perked up and was eating without vomiting. They will send blood for Hgb electrophoresis.

On Wed, at the other clinic, we saw 52 pregnant women! The nurse was gone to a conference so the doctor and I were busy. We took Maru, another nurse, with us. One woman said she was 4 months pregnant, but we couldn't feel anything on palpation. Did a pregnancy test which was a very faint positive. So we will see her back in 4 weeks. Either she is newly pregnant or had a blighted ovum. Another thought she was 6 to 7 months but had no uterine enlargement above the umbilicus. There was a lot below-either twins- I heard heart tones in the right and left quadrants or the baby was transverse. We referred her for an ultrasound.

After clinic, I showed Maru and Tajudeen how to clean up - wash the exam table, doppler, tape measure and scale with alcohol. They are using hand sanitizer between each patient. I have enough to last a couple of months. We had an assistant clean cobwebs, wasp nests and mouse and lizard droppings from the exam room in Saulawa. I wanted to do it, but the doctor vetoed the idea. The clinic is scheduled for a renovation, but we need to have it as clean as we can for the sake of the patients.

I have been doing a lot of walking - through the village or just down the road. It feels good to move. I have watched the men play football a few times. (soccer) They sure are good at heading the ball and also lots of fancy footwork - even barefoot or in flip-flops. There is certainly that sense of competitiveness. I guess that is a universal trait among males!!!

Banke, my housemate in the village, is coming by to take me to the market today. I want to get some material and have an outfit or two made. It will be my first trip out. I need that. The weekends are the worst as far as homesickness goes. Today is the halfway mark. Part of me wants to leave today and the other part knows there is still much to do. 

We have 9 women at term at Saulawa clinic so I am hoping we are around for a couple so the nurses who haven't done deliveries get some experience before I leave. The goal is to have the women come to the clinics to deliver. I warned the doctor that change takes time. If the nurses can train the TBAs (Traditional birth attendants) in warning signs and when transfer to the clinic or hospital is appropriate, they may be more successful with their goals.

I showed my Breech delivery/Shoulder dystocia video yesterday. Dr Woje informed the staff that I would leave the video so they can review it whenever they want. Guess I will get another when I get home! I have been able to utilize my teaching powerpoints from school. Most of the time my computer battery lets me get through the lecture.

Banke has asked me to let her take notes from the powerpoints in the evening when we have generator power.  I will probably download my powerpoints on Dr Woje's computer or a flash drive if he has one. Also, he has asked me to download the soft copy of "A Book for Midwives." I told them we believe in See one, Do one, Teach one - so I expect everyone to pass on the knowledge they are obtaining.

I will talk with Bala today to see if he can arrange a visit with Biya Dogon before I leave. Dr Woje doesn't know the name.

That's about it for now. Have a great weekend!

Robin

_______________________________________________________________

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.

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!

  I finally arrived in Nigeria yesterday at 11 am. We had a 3 1/2 hr drive to Zaria, where the Pampaidas Millenium Project offices are located. I checked into a hotel for 2 nights.  The accomodations are meager but sufficient. Water was off until this morning and electricity is sporadic. The 24 hr internet cafe was locked up. But the office has wireless, so I will be able to keep in touch with those in the States!

I was given an overview of the Millenium Village project this morning, watched a documentary of the project and met with the various directors.

There are roughly 5,000 people in Pampaidas village. Seventy percent of the village are below the poverty level (live on < $1 US/day) The areas being addressed over this 5 year project are
 

    1. Education- the children are educated from grades 1-6. They are working at ensuring the girls, as well as boys, attend school. Each child is given a backpack with books, paper and pencils. School furniture was obtained and they are completing the building of a school kitchen. Each child is guaranteed one meal a day at school.

      Goal: to sensitize parents on the need of school enrollments

    2.  Health- they now have 2 operating clinics.  Last week the clinics saw 221/158 patients.  Total antenatal care was 15/24 with 4/8 new OB patients.   .

       a. Outpatient consultations- provide basic PHC (Public Health Care ) services to all villagers; treatment of common diseases; provide short-term in-patient care.

       b.  Antenatal care - to provide routine prenatal monitoring including interventions such as deworming, IPT  Iron/folate and vitamin A supplementations.

        c.  Child welfare clinic where basic immunizations, growth monitoring, Vit. A supplements are provided. Deworming and treatment of  common nutrition/infection related illnesses are treated. 

       d.  Outreach activities- provision of proximity interventions that target families in their homes, build trust and ownership throughout the communities, and address cultural beliefs and socio-economic and behavioral barriers to care.

     I will tour the village and clinics tomorrow and meet with the clinic staff to formulate the needs/teaching plan.  I am excited to get started.

    3..  Gender and Community Mobilization- to mobilize the community (men and women) for farmer field day and to mobilize community clusters for training in agriculture and business development.

    4.  Water and Sanitation- 23 wells have been dug and capped to provide clean water with easy access, Latrines are being built.

    5.  Agricultural Business development and environment- on-going improvement and training on agriculture and business; develop receipts for repayments of loans; Improve on grains banking; increase fish farming activity and business; encourage home gardening to improve nutrition; start stocking agro input supply centerwithin cluster.

    6.  Infrastructure- receive materials for completion of work on poultry houses and agro processing centers.

   As you can see, a lot is happening here in the Millenium Village Project. I am excited to be a part of helping this village to become healthier, more educated and sustainable. I will try to send frequent updates

Peace on Earth Begins with Birth!

Blessings!

Robin

Day 2 - 
 

My body is still on US time so sleep is quite elusive.  When the electricity is up, I read. Currently I am reading Three Cups of Tea by Greg Mortenson.  It is about an American who decided to build a school in the mountains of Pakistan.  It is amazing what people can do when they put others before their own comfort. When the electricity is down, I have been listening to my IPod- music or audiobooks.

Last night I had my first full “splash bath”. You fill a bucket with water (cold), use a bowl to splash water on yourself, soap up, and then splash to rinse. It felt good to cool off. Much better than the Baby wipe bath the day before!  When finished, you mop the bathroom floor of all the water you splashed!

For breakfast, I had bread with peanut butter. I remembered to take my weekly Malaria Prophylaxis today. Several mosquitoes have already dined on me, so I don’t want to take any chances!

Last night I plugged my phone in at the office to recharge. When I walked in this morning, they turned the generator on. I heard a POP! And saw flames shooting out of my adapter/converter. That is now fried. The phone is OK but didn’t charge. I brought 2 adapters so I was able to get the phone charged. Glad I brought two.  I may have to get another locally!

Today we were at MV2 doing prenatal care. I worked with Hadassah, the midwife. Unfortunately, she said the BP cuff didn’t work. Dr. Oje had the Doppler at the other clinic, so while we waited for him, I did the weights, tummy checks, and improved my skills with the fetoscope.  Dating is difficult as women do not use calendars as we know them and most today had no idea how far along they were. Babies come when they come.  So the pregnancy wheels I made will be of little use.  We just measure the belly and see if there are appropriate changes in size and weight between visits.

I taught Dr. Oje how to use the Doppler. It is just an $80 model off E-Bay but it works well.  He was amazed when we found heart tones on a 14 week fetus.. Yesterday he wore and changed gloves between each woman. I have just used hand sanitizer between patients as we only do external exams.  I will bring extra for the clinics next time. Gloves seem to be a bit much just for measurements!

We had one girl, about 15 or 16 years old here with her first pregnancy.  They explained that she is of Low IQ, as is her husband.  She was very anxious, but we were able to get her calmed down and check the baby.

There is a lot of anemia due to the poor nutritious quality of the diets.  The primary stable is maize (corn) They grind it up and make a cereal or paste.  All the women are given iron supplements and also folate (B vitamin).  I saw several women with Vit B deficiency.  They develop cracks in the corners of their lips.
 

They admitted a young child to the ward who was having a seizure.  They gave her IV medications to stop the seizure.  The doctor felt it was a febrile seizure as a result of malaria. I said a short prayer for her.  

The staff are teaching me short phrases “senu de zwa” means Welcome; “Na Gode” is Thank you,” "Ina quana” is good morning and “Sa hanjuma” means See you later.  I hope to add a phrase or two each day. At my age, I can only retain small amounts with lots of repetition.  I am learning so much from them. I hope when we formally start classes, they will learn from me.

We will have a meeting with the health workers tomorrow to set up a class schedule that won’t interfere with the clinic work. Today, the doctor, midwife and I were a very efficient team. Between 11 and 1:30, we saw around 30 women. The midwife documented while the doctor and I did the exam.  Team work is great.  I will also poll them to see how they want to proceed with the classes. I think we will start with prenatal and move on from there. If a delivery comes in, we will immediately do “on-the-job training.”

Time to go to my room and relax a bit. I hope all is well back in the States.

From Nigeria,

Robin

We look forward to hearing more from Robin as we receive her reports from the field! If you would like to make a donation to help mothers in poverty and support our medical missions in Africa, visit our web site at www.physiciansforpeace.org.

Dr. Josephine Bundoc (left) participates in the first national prosthesis Walkathon in Manila.

David is President of Lawrence Rehabilitation Specialists Inc. which manages the LRS Gait Center Richmond, Gait Center Hampton Roads, and the Country Club of Virginia Manual Therapy Center.  He is also Program Director for the Stepping Back to Life Project, AT Home Care Inc.

Throughout much of the world, amputee victims of land mines, earthquakes, motor vehicle accidents, industrial and agricultural accidents, birth defects, disease, and war receive little or no medical treatment. The Physicians for Peace Walking Free Program was designed to help third world countries meet the needs of amputees. Following the first initiative in Diyarbakir, Turkey in 2000, Physicians for Peace brought the Walking Free program to Santo Domingo, Dominican Republic in 2001 and has since expanded it to Port-au-Prince, Haiti; Manila, Philippines; and Guatemala City, Guatemala. The Walking Free Program has helped more than ten thousand patients with prosthetic and orthotic needs and has provided more than $2 million in prosthetic and orthotic in-kind contributions including rehabilitation and surgical supplies and equipment.

David Lawrence's contributions to Walking Free have been invaluable. He has helped Physicians for Peace establish prosthetic and rehabilitation centers in developing nations worldwide, implementing a strategy that gets volunteers actively involved with prosthetic and physical therapy training for 4-5 years.  “We are empowering the therapists and prosthetists abroad with the skills to be independent.  Success is complete when the clinics are able to not only operate on their own, but to expand their business and patient care,” emphasizes Lawrence. He continues to work tirelessly to help those in need, and his passion for the mission of Walking Free is an inspiration to all.

 
Today is also David's birthday, so from all of us at Physicians for Peace, THANK YOU DAVID AND HAPPY BIRTHDAY!!!

Baby Hazel was almost one of those statistics.

It was the end of a long day of medical volunteer work for the Physicians for Peace doctors in Metro Manila, Philippines, when a mother carrying her two year old daughter came through the doors of the My Children’s House of Hope medical clinic. This two year old child quickly became affectionately known by Physicians for Peace volunteers as Baby Hazel.

Baby Hazel had a tumor on her back the size of a watermelon and her head was swollen with excessive fluids.  The tumor was so large that Baby Hazel could not sit up.

My Children’s House of Hope was a dream of Rev. Joe McGourn to provide medical care to some of the most impoverished children in the Philippines.  Several Physicians for Peace doctors and nurses volunteer their time to operate the clinic and care for the patients.  The clinic, which sits right next to the largest dump in Asia, truly offers a house of hope to those that enter the doors.  The doctors at House of Hope are accustomed to seeing patients with serious medical conditions due to inconsistent access to proper medical care.

But, Baby Hazel was different. “The kid was a fighter,” witnessed Rev McGourn.

Her mother wept as the doctors told her that Baby Hazel needed a shunt or she wouldn’t make it.  The $5,000 price tag of the shunt was an impossibly mountain for this impoverished family to climb.  Where would they get the money to save Baby Hazel?

“It was Physicians for Peace to the rescue again,” McGourn excitedly and passionately exclaimed.

Physicians for Peace Board Member, Dr. Juan Montero and Physicians for Peace Philippines Chairman of the Board, Dr. Ted Herbosa knew exactly what to do.  Physicians for Peace would provide Baby Hazel with the life-saving shunt.

Before Baby Hazel could go in for surgery, she had to fight a lengthy battle of fevers and infections.  But, finally the long-awaited day came.

Three days after her surgery, Baby Hazel was out of the hospital.  Now, she’s a smiling, laughing, happy and vibrant 4-year-old.

“If it weren’t for Physicians for Peace, she [Baby Hazel] would not be alive today,” McGourn proudly expressed.

Baby Hazel’s story is one of many written by Physicians for Peace mission teams around the globe.  In our 20^th Anniversary year, we are celebrating the completion of over 540 teaching and healing missions in 50+ countries.  

We’d like to extend to you a special invitation to help the next Baby Hazel by joining us as a Partner for Peace.  The Partner’s for Peace monthly giving program was developed for friends like you.  By joining the cause as a Partner for Peace, you can help provide quality medical care and training to those in need around the world.

Your monthly pledge is important to Physicians for Peace as it provides a guarantee of steady and predictable funds at a much lower cost than other methods of fundraising.  Your monthly gift of $15, $25, $50, $100 or more will help ensure those with unmet medical needs will receive access to quality medical care.

Every $1 donated to Physicians for Peace generates $8 in additional cash and in-kind essential medicines and supplies to help those in need and improve third world health care. 

Won’t you please support our international health programs by joining this very special program as a Partner for Peace? Monthly giving is easy, convenient and saves lives!

Find out more about the benefits of becoming a member...

Join Today!

Sam Hill (above) has been an important part of Physicians for Peace for
many years, raising funds to train thousands of medical 
professionals around the world. 

Twenty years ago, Physicians for Peace was founded by my father, Dr. Charles E. Horton Sr.  Throughout his career as a doctor, he travelled the world, taking on difficult patient cases, training medical professionals in the latest techniques and, most importantly to him, making lifelong friendships with the doctors he worked with.  From these experiences, he saw the possibility that international health education could be the key to bringing quality health care to the developing world. At the same time, he could be establishing and connecting long-lasting personal friends to foster peace between cultures through medical volunteer work.  

This year, as Physicians for Peace celebrates its 20^th anniversary, we are honoring 20 health care heroes, 20 amazing individuals or groups who have contributed to our success over the years.  We are spotlighting doctors, nurses, board members, donors, supporters of all types -- a cross-section of the caring volunteers who made my dad’s vision a reality. 

One individual who has been key to our success is Sam Hill, a close personal friend of dad’s who has been with Physicians for Peace practically since the beginning. In celebration of Sam’s birthday this month, he is our health care hero for July. 

Sam has made significant contributions to Physicians for Peace in so many areas.  First and foremost, Sam is one of those rare individuals who becomes lifelong friends with everyone he meets, and so he has been able to bring countless people into the Physicians for Peace family. Sam often talks about his lunches with dad, when they would put their heads together and figure out how to convert friends into volunteers, and volunteers into cheerleaders for the work of Physicians for Peace. 

Along with my father, Sam has long been the public face of Physicians for Peace. In 1995, Sam became our Executive Director, and more recently served as Director of Development. He is a fundraising powerhouse who helped build Physicians for Peace into the global health organization it is today. Tapping into his vast network of friends and contacts, Sam has almost single-handedly brought in some of our most significant investors.  He has also served his time doing hands-on work on mission trips in the Philippines and Haiti, all the better to explain the importance of Physicians for Peace international health programs to potential supporters. 

Another close friend of my dad’s, Catherine Colgan, a long time board member and someone who has been with Physicians for Peace since the beginning, said of Sam, “He is a quality gentleman, humble to a fault, but everyone can see the strength and caliber of his ability. His people skills and networking ability make him an invaluable asset to Physicians for Peace.”

Congratulations to our July Physicians for Peace health care hero, Sam Hill! Sam’s devoted work with Physicians for Peace has directly resulted in the training of thousands of medical professionals in the 50+ countries where we have sent our volunteers.  Over the past 20 years, these newly-trained caregivers have healed hundreds of thousands of patients in some of the poorest countries around the world. 

You, too, can help Physicians for Peace continue to train medical professionals and heal the sick around the globe. This month, in honor of Sam’s birthday, you can give the gift of life.  Please make a donation so that we can continue our healing work for another 20 years.  Help us create a world of hope!

Warmest Regards,

Dr. Charles E. “Chuck” Horton Jr.

Make a Donation in Honor of Sam Hill 

These three women developed post-graduate medical education programs in surgery and pediatrics to be conducted at the Orotta School of Medicine in Eritrea’s capital of Asmara.  In a country where the health care system has been wracked by a war of independence and no medical school existed until 2004, they became the first post-graduate faculty as part of the Partnership for Eritrea, a collaboration between The George Washington University Medical Center, the Eritrean Ministry of Health, and Physicians for Peace. In conjunction with these new partners, they built new residency programs from the ground up to address the urgent need for doctors. 

In the United States, two other heroes are the glue that makes this Partnership work - 

The Partnership has seen great success and plans to graduate the first class of pediatricians in December, 2009, and surgeons in 2010. They have also expanded to new medical specialties, adding an Obstetrics and Gynecology program this year with the help of Columbia University. There are plans with Yale University to launch an Internal Medicine program in 2010. We congratulate the women who have worked so hard over the last several years to make this dream a reality for both the medical students and the people of Eritrea who need their care. Find out more at www.partnershipforeritea.org

You can be a part of this exciting opportunity to build the future of medical care in Erirea - Your gift to the Partnership Program helps an Eritrean medical student receive training in his own country and gives the people of Eritrea a chance to get the medical care they need...

Please support the Partnership today! 

For more information about Physicians for Peace medical volunteer work and international health programs visit our web site at www.physiciansforpeace.org

"As a premed student at the University of North Carolina at Chapel Hill, I have always been interested in the combination of community service and healthcare.  Having come across this organization, I believe it is the perfect opportunity to do my part.  I designed a shirt with the theme of "peace" in mind and am selling them for $18 with all proceeds benefitting Physicians for Peace.  Please visit my web site to purchase a shirt and show support for medical volunteer work to improve third world health care." 

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!

Day two:
Dr. Alberto Bolgiani (Argentina) and Dr. Christine Serra (Brazil) and Dr. Ariel Miranda (Mexico) presented a day long advanced burn life-support training.  Dr Miranda is the Latin America representative of ISBI.  Over 80 were in attendance.

In the evening we held our first business meeting of the burn consortium.  We had a great turn out. The highlight of the meeting was the signing of the Memorandum of Agreement with the newest partner organization to the burn consortium, the Universidad Santa Paula and Instituto de Dessarrollo Integral. This was followed by a discussion on nominations.  The voting will be tomorrow to elect the board officers for the burn consortium.

I met with Michael Serghiou, who is with Shriner's in Houston, and have recruited him to join the PFP burn rehab team.  He has been invited to come back with Teresa Glass in October to teach burn splinting.

Tomorrow the Vice Minister as representative for the Minister will be attending.

I've met with Genie and Alba and have set the date for the burn psych mission to Santiago, Dominican Republic for the second week of December.

One highlight is that El Salvador has sent three reps last year they had sent none.

Too many stories to tell! More later...

Susan