Teaching Burn Rehabilitation in the Dominican Republic

Last week, a Physicians for Peace team of volunteers from Minnesota escaped the cold for a while to travel to Santiago and Santo Domingo in the Dominican Republic. They worked with medical professionals in the local hospital, teaching new methods in fabrication of burn compression garments and masks. Here are their reports from the field:

12 January 2009
 
The team arrived safely in sunny Santiago with all of our luggage and equipment.
 
The morning started with a meeting of all therapists, doctors, a seamstress and tailor, and others from both Santiago and Santo Domingo. We shared our individual goals and expectations of this mission and reached a concensus on our plan for the week. It was learned that the prosthetist/orthotist from Santo Domingo worked previously as an artist with the man who discovered a ‘larimar’ mine in the southern part of the D.R. This beautiful blue stone is only found in the Dominican Republic and has been a favorite purchase among the Minnesota team. The stone is named after the founder’s daughter Larissa and the the Spanish word for the beautiful sea, ‘mar’, thus larimar.
We broke into 2 groups to maximize our learning. One group went to evaluate and treat the burn inpatients. Both the physiatrist and the therapists demonstrated excellent comprehension of the patient’s needs and presented an appropriate therapy plan. The other group took a facial moulage (model) of Liz Rivers, the inventor of the plastic face mask for burn survivors, as a demonstration. After the morning coffee, snack and then lunch (they feed us well here), we began to prepare the model and fabricate the plastic face mask. We had both experienced and novice learners in the face mask techniques. It was clear after our face mask was formed that we really didn’t have the same plaster or oven to heat the plastic with which we were familiar. Everyone worked together to get us a variety of D.R. dental plaster to try to find the one that would perfom most optimally. After experimentation with various mixtures of plaster, water, and salt, we decided on an acceptable formula.
All 4 learners had an opportunity to ‘pull’ a face mask and cut it out to get the feel of the material. The enthusiasm of each of the participants was amazing; the group worked long after their day was finished and everyone is eager to begin again tomorrow.
 
Signing off for now,
 
Team Minnesota

________________________________________________________

13 January 2009
 
Jana and Dr. Fisher made it to the hospital for rounds and beat the local staff there for the 8:00 start. Rounds begin and end with a prayer and a blessing. The burn unit physiatrist stressed the importance of
‘team’ rounds and checking in with the plan for the day as the Minnesota team strongly supported.
After rounds, the inpatient rehab team discussed specific patients and their care plans with the physiatrist and the rehabilitation therapists. Jana, the physical therapist from the Minnesota team, observed patient treatment and made recommendations for progressing the treatment plan for specific patients. Both therapists from the D.R. were eager to learn any new techniques.
Meanwhile, back in the outpatient lab, there were many projects happening simultaneously. Augustin from Santo Domingo taught Ana Ariceli from Santiago how to make a tight elastic shirt for a 4-year-old child with severe scars on his chest, back and arm. The boy was burned from hot coffee which spilled on him.
Another outpatient who arrived at the clinic, an 18-month-old boy who climbed on the table and spilled hot water on his face on 12/26/08, was fit with a compression headband to prevent scars from forming on his forehead.
Other therapists and orthotists were practicing making face masks and taking facial models. After some late-night experimentation in our hotel room, we figured out what we felt would be the best mix and formula for the plaster. The hospital engineer was able to get the plaster we needed today. A D.R. therapist aide volunteered to be the ‘model’ for us. The process involves holding still while your face is covered with a ‘frosting-like’ material and then covered with plaster strips. The nostrils are the only part left uncovered. He talked about not having any feelings or thoughts while waiting for the plaster to dry. He said his ‘mind went blank.’ Hopefully, he’ll be able to share this meditative technique with the kids he will be working with later.
 
Beth’s observation as a first-time volunteer: Just want to let anyone who wants to go on a mission such as this know that there were several nights of planning by our Minnesota team prior to leaving. This included setting the goals of the mission, agreeing on a loose agenda, listing and gathering supplies needed, and a packing night when we packed the 200 pounds of supplies we were going to bring. Some of these were needed for the teaching, and some we will be bringing home for use on other missions. I am finding that one needs to be both goal oriented and very flexible at the same time. While we hope to complete our goals by the end of the week, each day is filled with many challenges. Sometimes the supplies you brought before are not able to be located, or supplies you asked the host to supply are not present or even available. The people you are teaching are not always available when you need them, or the lights go out for awhile. Lots of extra people are passing through the room and watching what you are doing to name a few. These are just a few of the unexpected things that can happen. This is all offset by the enthusiasm, energy, and warmth of the people we are working with. When you are teaching a new skill, suddenly you look up and there are several other people helping out, each wanting to get their hands on the project. I love the camaraderie and how freely people offer ‘touch’, caring, and compassion during their daily interactions.
 
We all work so well together and are having a great time both during the day and in the evenings.
 
Adios amigos, hasta manana,
 
Steve, Liz, Jana, Patty and Beth

____________________________________________________

14 January 2009
 
What a great day! We had 3 outpatients who were perfect for teaching both scar and contracture management. The Dominican Republic team was able to continue practicing their skills making splints for legs, arms and a face mask on a 13-month-old child. In the U.S., we would take the facial impression under anesthesia, but here we had to take it awake. Luckily, we had the help of the prosthetist from Santo Domingo who has had experience taking models on young children awake. We were able to get a fairly good fitting face mask and the mom was willing to bring the child back on Friday for more work and to check in with her to see how things are going. This patient and her mom traveled 3 1/2 hours by bus from her home on the border of Haiti. We are breaking accessibility boundaries by providing these rehabilitative services here in Santiago instead of having her take the bus to Santo Domingo which is 2 hours further. This child also needed a custom glove. Luckily, we had 3 bags of custom compression garments donated by Bioconcepts and a pink glove in one of those bags fit the child perfectly – like a glove! There are also many opportunities to improve on the follow-through for outpatient visits, both with the doctors and with the therapists.
Dr. Fisher and Jana are working with the D.R. physiatrist and physical therapist on many things. We made some medical and rehabilitative suggestions.
We were so impressed with Augustin, the tailor from Santo Domingo. He has designed a compression glove and elbow sleeve which are extremely unique in design. We hope to publish a paper showing this effective ‘thumb’ design.
We have more ideas than time for the next 2 days, but as always, things will work out!
 
Adios amigos,
Jana, Patty, Beth, Ramon, Steve and Liz

______________________________________________________
 15 January 2009
 
The team had a very successful and busy day. The highlights of the day for us were several:
    1) A five year old who was thermally  burned in a house fire 30+ days ago, and whose mother died in the fire, had not walked and was refusing to try. The psychiatrist and staff felt there was a significant psychological component. Once the wounds were visualized, we realized that increased compression and vascular support was required to improve comfort.  In the morning she walked 15 feet with a single ace wrap. With a double ace wrap,  the child stood and walked 75 feet with support of two people. She had little or no pain complaint. About an hour later she walked out of the burn unit pushing a toy, a distance of 500 feet. We were even impressed at the success of “double ace wrapping.” The burn staff of the DR was definitely struck with the importance of a very simple rehabilitation method.
    2) We were successful in contacting and cooperating with the Orthopedic department of the children’s hospital with stretching and and beginning a program of serial casting on a complicated 8 mo old child with knee contractures secondary to contractures. We also fabricated an elastic hand garment and a transparent face mask to minimize hypertrophic scarring. We believe this type of intensive follow-up interdepartmental effort was a good initial demonstration.
   3) We continued to teach and demonstrate the art of fabrication of face orthoses and garments. The Santiago team independently took the facial moulage and poured the mold with minimal verbal directions. They continue to demonstrate great enthusiasm and rapid learning. For only the second time since we’ve been training the D.R. staff, the tailor from both Santo Domingo and Santiago came onto the unit to measure a patient for compression garments to his lower legs. They have been working on the patterns and will fit the patient tomorrow.
  4)  There is an incredible opportunity for the physical therapist to be involved in the outpatient burn clinic. Today alone, we saw 5 patients from the clinic who needed rehabilitative interventions and will require many follow-up visits from the therapist to complete their rehabilitation goals.
 
 
Liz and Beth’s view from our balcony:
Liz’s and my room has a very small balcony overlooking a bustling street. I spend a few minutes overlooking ‘our’ street in the morning, after work, and then again before bed. Two dogs live with their owner outside of a business. The dogs are frequently sleeping in the corner of the building on the sidewalk and the owner is usually outside on a lawn chair or inside the business – he may be a guard or perhaps the owner? Then, there’s the woman who sits on her piece of cardboard on the sidewalk asking for money – she’s very feisty. In the evenings, there are vendors cooking their wares in a pot of hot oil. Lots of people are passing on the street and the traffic is constant as well as the horns. Motorcycles dart in and out of the 2 lanes of cars. It’s become a friendly, familiar scene, and I’ve grown fond of our little neighborhood.
 
Last day tomorrow! We’ve got lots to do and several patients coming for more therapy.
 
Adios,
 
Patty, Steve, Jana, Beth and Liz
_______________________________________________
 16 January 2009
Again, the day was jam packed with planned and unplanned activities!!!  The Santiago 4 face mask team and Minnesota team started right away at 8 AM re-pouring to get the impression to make a new model for the young boy’s new face mask. The Minnesotans did enough of the process this time to assure a high quality plaster positive model. Ana A and August started right away finishing my experimental right hand glove. It confirmed again that their machines cannot  sew children’s gloves. These machines cut the fabric, so if it gives proper vascular support, the seams tend to tear apart. But I wore my glove all morning, and it is a better example of acceptable support to improve healing and decrease scarring. They measured an outpatient for a new garment that  helped the person stretch out his contracted shoulder and elbow, since he claimed he could not move. Nina and Steve worked with him and made considerable improvement in just the half hour it took to get his new design of garment.
The team made a very nice, well fitting face mask for the young boy and made arrangements for him to return to Santiago for revisions in 3 weeks. He will return to Santo Domingo in 6 months because he is growing so fast that he will need a new impression and model at that time.
Liz worked on getting the momentos for each of the persons we worked with and a letter in English and Spanish to thank them for their dedication, passion, and investment in this training. We passed them out while both teams drew up closure of work with the patients. Then we all had lunch and did  a little ceremony to pass out their certificates of attendance. They cheered each person, everyone had photos, and then everyone cried, hugging and kissing. We changed to street wear and set off to pack up all the equipment we need to use at the next country or burn center. Then we re-focused to plan the next couple of days’ adventure. It is 2AM, so I will pray this blog is coherent!

 
Adios,
 
Patty, Steve, Jana, Beth and Liz

First National Prosthesis Walk-a-thon in the Philippines

On December 19th, Physicians for Peace was proud to co-sponsor the First National Prosthesis Walk-a-thon in Manila. Dr. Penny Bundoc and Lyne Abanilla of Physicians for Peace Philippines helped with this extraordinary event, which featured participants who were beneficiaries of prosthetic donations through the Walking Free Program. Below are some postings of local news coverage, recounting the inspiring stories of the courage of these individuals. This is the incredible impact you have on people’s lives when you support Physicians for Peace and the Walking Free Program:

Artificial Leg Makes Amputee “Complete” by Sheila Crisotomo  posted by Philstar.com

This child joins fellow amputees in the first National Prosthesis Walkathon held last Friday along Roxas Boulevard in Manila. Edd Gumban

For the first 21 years of her life, Lhea Medrano, 24, was full of insecurity and dependent on other people.

She could not even go to the mall alone for fear that she would fall down and embarrass herself in public.

Born with severed right leg, Lhea grew up walking with the use of a crutch.

“I felt like I was not complete – physically, emotionally and mentally. I was so withdrawn, especially among strangers. Sometimes, I would feel depressed,” she told The STAR.

But in 2005, Lhea’s life drastically changed. She began walking like any normal individual, as she became a recipient of an artificial leg from the Mubility Amputee Support Group of the University of the Philippines’ MU Sigma Phi Fraternity, in partnership with the Physicians for Peace and UP-Philippine General Hospital.

“Now, I can go anywhere I want – alone. It is easier for me to go to work. My prosthesis really boosted my morale,” enthused Lhea, who now works as an assistant secretary.

The groups organized last Friday the first National Prosthesis Walkathon at the Baywalk on Roxas Boulevard in Manila to raise awareness that the technology of prosthesis-making is available at the PGH at significantly lower prices.

In a joint statement, Dr. Michael Tee and Dr. Ray Joseph Badulis, past and present Most Exalted Brothers of the fraternity, respectively, said the MU Sigma Phi Fraternity came up with the Mubility Project through the selfless effort of brod Dr. Pipo Bundoc and wife Dr. Penny Bundoc.

“The MU has been involved in all activities, from wheelchair constructions and donations to prosthesis-making, to educating the beneficiaries on the proper use of their prosthesis, especially in ambulation,” they noted.

They added that the fraternity was able to help amputees from various parts of Metro Manila and several provinces with the help of non-governmental organizations.

The fraternity had been awarded one the Ten Accomplished Youth Organizations and recognized in other award-giving bodies for its various humanitarian activities.

James Montesa, a Medicine student at UP-Manila and service chairman of the fraternity, said the walkathon aimed to showcase how prosthesis could improve the life of amputees.

Montesa said the event also gave the project beneficiaries the chance to meet their benefactors.

A total of 35 amputees joined the walkathon.

“It was just a leisurely walk, a thanksgiving marathon for those who helped the amputees get their prosthesis. We also want to raise awareness that the technology is available and how it can help regain the confidence and functionality of amputees,” he added.

Amputees join Manila ‘walkathon’ 

 

By Charles E. Buban
Philippine Daily Inquirer
First Posted 06:39:00 12/22/2008

 

MANILA, Philippines—“And the lame shall walk again … ”

As this biblical passage has promised, the indigents who took part in the 1st National Prosthesis Walkathon on Friday were blessed to walk again even if one or both of their legs were no longer those they were born with.

“I think the most challenging thing was to finally get off the crutches and be able to walk normally again,” said 17-year-old Pamela Erika Pascua, who lost her right leg to cancer.

Pascua was one of the 40 amputee-beneficiaries who participated in the morning walk at Baywalk (fronting Rajah Soliman Park) in Malate, Manila.

The event was organized by four institutions—the Mobility Amputee Support Group of the University of the Philippines’ Mu Sigma Phi fraternity, Walking Free Program of the Physicians for Peace, Prosthetics Service of UP-Philippine General Hospital (PGH) and Rotary International District 3810.

It was the UP-PGH Prosthetics Service that footed the P500,000 bill for Pascua’s prosthesis.

Fortunate

“I was fortunate in that for my very first prosthesis, they shouldered everything, including my over-a-year of rehabilitation,” said Pascua, who hails from Bacolod City and temporarily resides at P. Ocampo (formerly Vito Cruz) Street in Malate.

“My family would not have been able to afford such an expensive device, and was just lucky to be referred to this group at PGH,” she said.

“My family would not have been able to afford such an expensive device, and was just lucky to be referred to this group at PGH,” she said.

A below-the-knee prosthesis usually costs around P80,000. The above-the knee type is more expensive, with costs ranging from P120,000 to around P1 million depending on the material used (titanium, carbon fiber or ceramics).

But according to Lyne Abanilla, past district governor of Rotary International District 3810 and executive director of Physicians for Peace Philippines, the prosthesis prepared by UP-PGH for indigents only costs between P10,000 and P20,000.

“It is quite expensive to purchase a prosthetic leg. But with what the PGH people have developed and the support we are getting from abroad, we can enable more indigent individuals to enjoy greater access to a prosthesis,” Abanilla said, adding:

“Having one is a life-changing experience, indeed.”

More access

She also said those who could well afford it may also get their prosthesis at UP-PGH, but with a higher price because they would have to subsidize an indigent.

To allow people at the grassroots better access to prosthesis use, the four groups have been coordinating with other organizations like the Leader Team, Kapampangan Development Foundation and Operation Blessing, as well as local government units and the social welfare and health departments, where amputee screening and prosthesis service missions are organized and conducted.

“Through this cooperation, we are able to identify barriers to prosthesis use and how to devise a solution [to the problem],” Abanilla said.

One example is the case of 51-year-old Lourdes Lanbunao, who accidentally slipped in her home in Maiinit, Surigao del Norte, in July.

A few hours after the accident, Lanbunao’s legs became numb and were eventually paralyzed.

Through the efforts of her daughter living in Quezon City, Lanbunao was taken to PGH for examination and analysis.

Wheelchair

Immediately after Friday’s Prosthesis Walkathon, Lanbunao received along with several others a special wheelchair that the UP-PGH Prosthetic Service had developed out of a plastic monobloc chair.

“This is just an example of the group’s high-technology-low-cost devices that can be delivered to indigents as they undergo rehabilitation,” Abanilla said.

According to estimates, as many as a million Filipinos have lost a leg or both legs to diabetes (the primary cause), accidents, birth defects and cancer.

Of the number, 60 percent are between 20 and 50 years old—“their most productive years,” Abanilla said. “Because of this, our group organizes preventive education programs in the form of forums on diabetes, as well as early detection modules.”

Around 300 amputees have benefited since the program was established in 2006, Abanilla said.

“The Prosthesis Walkathon served as the beneficiaries’ token of appreciation to their donors,” she said.

“The beneficiaries also showed everyone that they are now ready to reclaim the lives that were abruptly changed by the loss of their limbs.”

 

We can help hundreds more people walk again with your support. If you would like to hold a limb drive or donate a prosthetic limb, please call our office at 757.625.7569 for details. To make an on-line donation to the Walking Free program, click here

Burn Nurse Education Teams Head to Honduras and Costa Rica

Physicians for Peace recently had the opportunity to have a great impact in Central America by training burn nurses in basic and critical care techniques. The International Infirmary Congress was held this month in Tegucigalpa, Honduras.  One of our teams, comprised of volunteers Carolyn Ramwell, Susan Vinge, and Diane Strout, was invited to present at a special two-day, pre-congress event on burn nurse education.  The number of nurses in attendance from all over the region made this an excellent opportunity to reach as many health care workers as possible and have far-reaching effects in one of the poorest countries in the western hemisphere.

The team leader, Carolyn Ramwell, then met her second group in San Jose, Costa Rica – Nicole Farrar, Eugenia Lindsey, Briana Morrison, and our own Physicians for Peace staff member, Sharon Gabriel. There they were able to assess the needs of a local pediatric burn unit and bring supplies, training, and asssistance to their staff. 

The teams posted the following updates on their experience.

12-06-08   Tegucigalpa, Honduras

Hello,

We arrived safe and sound.  Sue is here from team Minnesota and will be fantastic.  She is ready to go with the flow.  We found out today we are teaching the entire precongress with an audience of 300 nurses.  They gave us the schedule and certificates to sign.  We will pull together, but what a challenge!  We will be giving 10 lectures and then having 2 four hour sessions of hands on wound care.  We will pull the cases together from both units (adult and pediatrics) so we can focus on many wound dressing changes and hands on wound care education.  Mobility will also be a huge focus. We toured the hospital today, and I did a quick needs assessment.  I will flesh it out later in the week, but it is nothing unexpected.  This is a good site for PFP.  The staff is eager to learn and the improvements for better outcomes can be implemented right away.  With the insight from other missions, this is fertile ground to implement our burn program in its entirety.  That is it for now.  We will pick up Diana tomorrow.  This will be a crazy week.  Talk about an amazing opportunity to impact clinical practice throughout an entire country!  The nurses at the congress are from all over Honduras.

All the best,

Carolyn

 

12-08-08  Tegucigalpa, Honduras

Hello,

Well today was unbelievable.  We gave the precongress talks and then rounded in the burn unit.  This is a country in great need of our help.  75 nurses were in attendance.  We are all well but tired.

Carolyn

 12-09-08   Tegucigalpa, Honduras

Hello,

It has been another wonderful day here in Tegucigalpa, Honduras. We spent the morning speaking at the pre-congress meeting. Our topics were pain, professional nursing, psychosocial aspects of burn care, and wound care. Again we had about 70 nurses from all over the hospital and many from rural areas and clinics. We also spent time on the peds burn unit rounding with both MD’s and nurses. We were able to help with some smaller dressing changes on the unit, with supplies that were brought from the USA. The nurses and doctors were very excited to receive an O2 sat monitor as a donation from PFP. They were very excited to be able to monitor their patients as they give IV pain meds for dressing changes. The children here are beautiful, and the staff does an amazing job with limited equipment and supplies. We also toured the adult burn unit and the rest of the hospital. During the Christmas season, it is very humbling to be working here in Honduras with people who have so little and still find joy in the little things.

Susan Vinge, Diane Lohrenz, Carolyn Ramwell

12-15-08     San Jose, Costa Rica

Dear Team,

Thank you so much for this opportunity for our team to be here in Costa Rica.  As always, we volunteers receive so much more than we give.  Today we meet the entire medical team in the burn unit.  Dr. Carlos Siri, chief of medical staff of the burn unit gave us a tour of the unit and then began to share his dream for the children that are burned in Costa Rica.  He spoke with passion and commitment about the team he is building and his commitment to excellence.  Since our mission here last year, the burn unit has added a physiatrist and a psychologist. The next staff member will be an occupational therapist.  They are also in the process of starting a skin bank.  Dr Siri spoke passionately about his team. “They are young and need more experience. If we have the same dream and the same plan we can grow together over time.  It’ s not what I want it to be yet, but we do have a vision and the plan to get us there.  I just want to keep giving the staff the skills they need.”  The compassion and gentle, kind care that the children receive is because of this team’s commitment.  The nurses care deeply for the children.  The wound care is managed by anesthesia and a pain team rounds for consultation.  The commitment to a pain free unit is inspiring. The work continues here with a dream for a new unit fully staffed as a state of the art burn unit.  They are well on the road to this dream and we are so proud to be a small part of their success.

Best Regards,

Carolyn       

 

 

12-17-08  San Jose, Costa Rica

Happy Birthday!  Feliz Cumpleaños!

It is a rare occurrence on a PFP mission. Two of our five team members are celebrating their birthdays this week – RN and social worker Eugenia “Genie” Lindsey today, and EMT and 3^rd year UVA Nursing student, Briana Morrison, tomorrow.  Like most of us, and millions of other people around the world, we typically expect to receive gifts on our birthdays. But first-time PFP volunteers Genie and Briana wanted to join a mission trip to celebrate their special days –an opportunity for them to give, not receive—or so they thought.

These volunteers, like so many others, generously give of their time, expertise and knowledge. But they are receiving much, too.

“I thought spending [my birthday] in another country doing what I have a passion for would be better than being home. It is an excellent opportunity as a student,” said Briana. “I get to come on a mission, share what I know and contribute to the mission.”  She adds, “But my experience in Costa Rica, with the people, and the other team members has helped me learn a lot, too. And I am treated like an equal among my own team.”

Genie shares, “It is much more meaningful to me to be able to give what I know and help enhance the burn program in Costa Rica. To be with like-minded people who want to serve children and improve their own skills to help heal children is a real gift to me.”

Today, Genie walked into the Burn Unit at the hospital and was greeted by Chief of Medical Staff, Dr. Carlos Siri and his entire team. “Everyone came up and gave me hugs and said, ‘Happy Birthday!’ “ (Or rather, Feliz Cumpleaños, in Spanish.) Genie remarked, “I think this is the best birthday I’ve ever had.”

As the old biblical adage goes, “It is more blessed to give than to receive.” Well, perhaps it is both.

–Sharon Gabriel, Costa Rica mission team member and PFP Director of Events

 

 

12-17-08  San Jose, Costa Rica

We have just finished our first official day of teaching here in Costa Rica, our third day in the Burn Unit.  I am very impressed with this team in Costa Rica.  I use the term team because I think it is such an important part of burn care.  Back home in Arizona, our approach to burn care is multidisciplinary: clinicians, nurses, therapists, nutrition, social workers, all working together; and I see this unit here working to achieve a similar goal.  The staff is so friendly and inviting to us and very open to our suggestions on how to improve their unit.  They are so motivated to do what is best for their patients they are working on finding appropriate materials to start making their own compression garments, and have a dedicated workspace for that endeavor. 

Yesterday I was able to spend the day with them while they did wound care, which by many standards is very innovative.  All patients had their wound care under anesthesia, including tub debridements.  I was able to discuss different wound care options with the physicians and made suggestions about how to improve mobility.  

This morning I brought an entire suitcase of donated compression garments with me, along with a few other gifts for the staff, to which the physiatrist responded, “It’s like Christmas!”  I was so happy to be able to share those resources with them.  

Today we also began a 24 hour seminar for the hospital and others in the surrounding area about the care of burn patients.   I gave a lecture on the initial care of burns and fluid management and shock.  Unfortunately, my espanol es no bueno.  So, the burn unit was nice enough to arrange for me to have a translator.  My lectures went really well, and luckily some of the nurses in the room spoke English and could help out the translator with some of the technical terms like “hemodynamic” and “compartment syndrome.”

So far, this has been an incredible experience, and I have been very well received, although, it is a little difficult to explain what a Physician Assistant is exactly.  I have been treated with respect by the staff, and my experience with burn patients appreciated.  I hope this to be my first to many missions.

Thank you for this opportunity!

Nicole Farrar

 

12-18-08  San Jose, Costa Rica

Burn Nurse Seminar at Children’s Hospital in San Jose, Costa Rica

Fifteen nurses from various provinces and hospitals around Costa Rica attended a two-day workshop at Hospital Nacional de Niños, presented this week by a PFP volunteer burn team. Dr. Carlos Siri Adema, Burn Consortium member and Chief of the Burn Unit at Hospital Nacional de Niños, invited the PFP team to increase the number of burn nurses and burn knowledge in Costa Rica.  He was instrumental in developing the curriculum presented.  The program itself was hosted in partnership with hospital Educational Coordinator, Sra. Lorena Gomez Alpizar and APANQ Foundation President and Burn Consortium member, Sra. Nayra Gaspar.

 

Led by team leader Carolyn Ramwell (RN,MSN,PNP), the classes were taught by team members Physician Assistant Nicole Farrar (MMS, MBS,PA-C) from Arizona Burn Center, nurse and social worker Eugenia “Genie” Lindsey (RN,BSN,LCSW) from Virginia, and EMT and 3^rdyear UVA nursing student Briana Morrison from New Jersey.

Briana taught a session on Pre-Hospital Burn Emergency Care so the nurses could instruct their lay communities on guidelines for handling burn traumas prior to getting victims to a hospital. The nurses also received teaching/advocacy materials such as posters and pamphlets on prevention from the APANQ Foundation.

Nicole led an in-depth clinical session and lively professional exchange on Initial Burn Management, giving an overview on the types of burns including scalds, which make up 60% of the burn injuries in Costa Rica. Her sessions also covered Fluids and Shock, and how these can affect different organ systems in the body.

“These classes are important because there are different ways to approach the patients; it has been very interesting to learn different protocols and the different technologies for burn care,” said Angelina, an Intensive Care Unit Nurse from Hospital Nacional de Niños.”

Genie taught about the psychological issues related to post-traumatic stress disorders as well as non-accidental trauma and how to recognize the signs of child abuse. She gave practical demonstrations of child-centered therapy interventions, such as puppet therapy with ChaCha the Cat, color visualization therapy, story-telling, play therapy and sand-tray therapy – all designed to help heal the soul and spirit of a victim.

In addition to the educational lectures and materials, the nurses were given CDs of the presentations to take back with them. Equipped with additional knowledge, new ideas and friendships, and practical tools, these indigenous healthcare providers can leverage the seminar with Physicians for Peace to exponentially further burn education within their communities.

Sra. Gomez was very excited about the seminar and bridge-building that occurred, as well as the participation and cooperative efforts between the organizations. “They [Physicians for Peace volunteer educators] have caught the attention of the audience with the topics and material presented. It was both professional and fun at the same time.”

She added, “It doesn’t matter what country you are from, it matters more what kind of heart you have for the people. And you can tell what kinds of hearts people have – that’s why I am so glad to have met you.”

–Sharon Gabriel, Costa Rica mission team member and PFP Director of Events

          

 

 

 

 

 

 

 

 

 

 

 

Visitor from Mali

 

Last week, we were pleased to welcome Dr. Marouf Keita, Chief of Pediatrics at Gabriel Toure University Hospital in Bamako, Mali. Dr. Keita has done much to bring pediatric medicine to higher standards in his country.  During his visit, we were able to get a better understanding of the most urgent medical needs to be addressed in his country, including the need for pediatric oncology and hemotology education and equipment. We were also able to show Dr. Keita some American pediatric techniques in action by taking him on a tour of Children’s Hospital of the King’s Daughters, a state of the art facility here in Norfolk, Virginia. Dr. Keita got many ideas to take back to Mali, but expressed how difficult it would be to implement them, siting cultural differences, lack of financial support, and lack of resources for maintaining more modern equipment, as some of the obstacles facing hospitals in Mali.

Physicians for Peace has sent containers of medical supplies to Mali and hopes to begin educational programs to improve maternal and child health in Bamako and Segou. These cities were chosen by the Earth Institute as part of their Millennium Cities Initiative to implement the Millennium Development Goals of the United Nations.

We learned much from Dr. Keita about medical education in Africa and the need for more teachers and doctors to meet the demands of a new generation of students. We look forward to our on-going relationship with our friends in Mali and supporting their efforts to improve the quality of life of the people of Mali. You can also give your support – Donate now to Physicians for Peace.

Physicians for Peace in AAPA News

  “Physicians for Peace Sets Standards
for PA Medical Missions” - Read Article

Inspiration from India

Physicians for Peace work in Nagpur, India was featured in the region's English language newspaper.

One of the most important things we do at Physicians for Peace, through the talent and devotion of our volunteers, is address problems related to women’s and children’s health in developing countries. Often, sharing knowledge of simple post-natal care techniques can result in saving the lives of countless infants. Karen Horton, a senior nurse educator from Children’s Hospital of the King’s Daughters in Norfolk, Virginia, is currently on a Physicians for Peace mission to Nagpur, India where she and the Physicians for Peace team are training hundreds of pediatric nurses in these valuable techniques. She files this report about her inspiring experience:

After almost a day and a half of travel (including a 16 hour long direct flight between New York-Bombay) the Physicians for Peace team (consisting of Dr. Ed Kratokin, Dr. Sheetal Ajmani, and me) arrived at the Bombay International Airport on the evening of Oct 31st.  We left Norfolk around noon on Thursday so, by this point, we had been traveling for almost a day and a half, and all we could think of was a hot shower and bed!  Unlike Drs. Karatokin and Ajmani, who have been to India more than once, this was my very first trip to the country. I was anxious for my Indian adventure to begin and equally nervous about all our checked in bags (that included our training material and supplies) arriving in time and in one piece.
The scene at the airport, which is the busiest airport in South Asia and serves over 20 million passengers annually, could only be described as one of “organized chaos.” The minute you land, you are overwhelmed by the sheer number of people around you and yet somehow, at least as was the case with our flight, even with all the crowds and chaos, the process to get through the customs and baggage claim is rather painless (and yes, all our bags arrived safe and sound !:-). About 5 hours in a hotel room near the airport and we were back at the airport (this time it was the Mumbai domestic airport) to catch a 6AM flight to go to Nagpur, so we didn’t have any time to explore Mumbai, something we hope to do before we return to the U.S.
In my little experience, I find India to be a land of contrast, chaos, and wonderful impressions that are impossible to describe without resorting to clichés. Here in the world’s largest democracy that is home to almost 1/6th of total population, the enormous weight of history and the unparalleled drive toward development and modernity, the pervasive display of the wealth of the very rich and the stark picture of the extremely poor not only coexist but seem to flourish.  Where cows and goats and people share the same overcrowded roads along with every form of mechanized and non-mechanized mode of transportation…It’s a sight and experience unlike any I have ever had before….
After a little rest on Saturday, we started on busy and productive training days on Sunday and Monday. Our focus during these two days was to conduct neonatal/pediatric support and nursing training for health professionals in Nagpur.  On Sunday, we conducted a day long training session for over 150 pediatric nurses at the Central India’s Child Hospital and Research Institute in Nagpur. This was an overwhelming response since we were expecting less than a hundred participants to show up for this session and ended up with double the number of very keen nurses hungry to learn and had to scramble to accommodate them all since many of these nurses had travelled a good distance, and at a considerable expense of their time and money, to take part in the training… I started the training day with a lecture on infection control and basic hygiene (something that’s still a big issue health facilities in developing countries, including in India)…We also conducted S.T.A.B.L.E. (which stands for Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support) training session. S.T.A.B.L.E. is a neonatal education program focusing exclusively on the post-resuscitation/pre-transport stabilization care of sick infants and has been proven to reduce infant mortality and morbidity and to improve the future health of children and their families. It is of particular need in India where the child mortality rate is still one of the highest among the developing countries. We continued working on the following two days with lectures and training sessions for nurses, doctors, and other health professionals in the area of NG tube placement, IV therapy techniques, thermal regulation, developmental care, and much more… Jumping right into teaching big groups of very eager health professionals, while also getting adjusted to summer-like heat, coupled with jet-lag and travel fatigue, has definitely been a new, and in some ways a hard, experience for me …However, the hunger for learning and attentiveness of those being trained, and being in the company of some of the most generous and hospitable people I have ever encountered, makes this more than a worthwhile experience, and one that I am ready to do all over again the next day with a new group of health professionals. Before I do that, I must catch some sleep since it is well past midnight here, and we have to get on the road pretty early tomorrow to travel to the Jawaharlal Nehru Medical College in Swangi (a town two hours drive from the city of Nagpur where we have been working for the last three days) to conduct the second phase of the training. Stay tuned for more…

Help for Haiti

It is widely agreed at Physicians for Peace that our unsung hero is Ken Hudson, the man who single-handedly manages our Gifts in Kind program. Over the past weeks, he has been particularly busy putting together containers of medical supplies for several countries, among them Haiti.

The container to Haiti will contain life-saving medicines as well as valuable equipment for doctors and clinics in this impoverished part of the world. Dr. Norman Krell, a Virginia ophthalmologist, donated all the equipment from his practice upon his retirement. New Eyes for the Needy donated 37,000 pairs of eyeglasses and frames. Mylan Pharmaceuticals donated a variety of important medicines. The Church of the Holy Family in Virginia Beach, Virginia, also gave several pieces of important equipment for use in a clinic run by Partners in Health.

We are grateful to all of these donors, who share with us the committment to improving health care resources in the developing world. We are also grateful to Ken for his expertise and dedication in pulling it all together and making it happen. But he can’t do it without your help. Your donations give him the resources he needs to make sure these urgently needed supplies get delivered to the doctors and patients who are waiting for them. Consider making a contribution to Physicians for Peace today to support this effort. Donate now.

Watch the video below to learn more about Ken and our Gifts in Kind program -

 

Making the Difference: Notes from Eritrea

As part of our dedication to medical training and education, Physicians for Peace is part of The Partnership for Eritrea, a joint initiative with The George Washington University Medical Center and the Eritrean Ministry of Health, that established the first post-graduate residency program at Orotta Hospital in the Eritrean capital, Asmara. The program sponsors both visiting and full-time faculty in surgery and pediatrics and started training its first students in January 2008.

As usual, the dedication of our volunteers has made the difference and is helping every day to fulfill the Physicians for Peace vision of “building peace and international friendships through medicine” with the people of Eritrea.

We are pleased to share some of their letters and photos:

To All of you my Dearest Friends,

…My life has been so filled with beautiful memories every time I come back from all these wonderful missions, and thanks to all of you, my dearest friends, you  ALL have a special place in my heart. Thank you for all that you do to make every effort to make someone and everyone that we touch feel SO SPECIAL  in your own way!!! It is such a blessing to know each and everyone of you …. you make me smile whenever I reminisce about the times we spent with the patients and the bond we made with all the families -  it’s beautiful , no matter what the outcome was -they know we were there for them … I am honored to have worked with all of you…Thank you for being a part of my life , my passion and the love for the profession that we chose…You are all extraordinarily amazing !  Till then …  I love you all !!!

 Evan

 

Dear friends,

As usual, Evan has said it all and said it so eloquently. Let me just add my thanks and admiration for all that you have individually and collectively done to help the people of Eritrea. You represented the spirit of Physicians for Peace and the good side of what America and Americans stand for. On behalf of the so many patients and their families, I want to say thank you for caring and for your excellent professional work. Love and good wishes to all of you.

 Haile

 

Dear Friends!

As Haile said, Evan has said it all so eloquently. My life long dream has been to put my nursing skills to good use in a foreign land where our skin may be a slightly different color, but our blood is all the same. This year’s mission has left me profoundly moved by the warm and sincere gratitude of the people of Eritrea and the dedication of our team members. Each year I feel more and more a part of the people and Eritrea and look forward to going back another year. As “LA”, that is Louise Lower Arkansas said, the efforts put forth by our team is a WE, as in all of us working together. Thank you from the bottom of my heart for including me and the experience has brought such riches to my life. Unless you’ve been there, could never understand. My love to all and Dr. Haile please keep us update on the condition of our patients. They are in my prayers. Keep that front seat empty as I will return. 

Nancy

Physicians for Peace Celebrates the Nations!

Physicians for Peace held it’s annual “Celebrate the Nations” Gala on October 4th, 2008, at the Virginia Beach Convention Center. The evening started out with a VIP reception where guests from many countries who are involved in the work of Physicians for Peace were able to meet and mingle. Among the distinguished attendees was Senator Bill Frist, M.D., this year’s recipient of the Charles E. Horton Humanitarian Award for Global Health; as well as The Honorable Abdoulaye Diop, Ambassador from Mali; Domingo Nolasco, Minister and Consul General of the Philippines; and Meyera Oberndorf, Mayor of Virginia Beach. Also during the reception, Physicians for Peace gave special recognition to Hampton Roads area hospitals for their support of our mission work.

Then the evening got under way, and we all enjoyed an exquisite, Latin-inspired meal and mariachi serenade. The program, hosted by Kathryn Barrett of WVEC-TV, included the our first annual Volunteer of the Year Awards, as well as a performance by Latin Ballet of Virginia. Physicians for Peace Board Member Morgan Davis captivated the crowd with his charm as our very own auctioneer while raising money for our cause. An inspiring speech was given by Former Senate Majority Leader, Bill Frist, M.D., a leader in the quest for sustainable healthcare solutions for the developing world. Journalist Kate Bohner was also honored for her work in raising awareness about Physicians for Peace through video and the internet, receiving the President’s Award for Special Achievement. The award was in response to Ms. Bohner’s recent trip to Nigeria with Physicians for Peace where she began work on a documentary, “Ten Million Tears.”

 

The winners of the Volunteer of the Year – Medical Diplomat Awards were as follows:

Physician – Dr. Ed Lilly, Gastroenterologist
Health Professional (Non-physician) – Brenda Raymo, Dental Assistant
Mission Support – Stephen Katz, Photographer and Videographer

In addition, three Physicians for Peace volunteers received honorable mention for their work. These honorees are:

Mark Helbraun, MD, Colo-Rectal Surgeon, Closter, NJ – Physician Volunteer
Evan Epper, RN, Hackensack, NJ
Dino Scanio, Pediatric Orthotist, Tampa, FL – Allied Health Professional (non-physician) Volunteer
 
“Volunteers are the lifeblood of our organization,” noted Physicians for Peace President and CEO Brig. Gen. Ron Sconyers (USAF, Ret.), “and this skilled group of men and women exemplify the best of our organization. The time and dedication they have brought to our activities are critical in carrying out our mission to bring medical care to underserved populations around the world. We hope to be graced with their contributions for years to come.”

The evening continued with a presentation by Altagracia Luna and Kissairis Rodriquez, two Resource Mothers from the Dominican Republic, who traveled here to tell their stories of helping young women in need get access to prenatal care and education. Read more about their visit to the US.

The event finished up with a pinata and dance band with everyone celebrating the nations in style. We truly thank all those who attended for supporting the mission of Physicians for Peace, as well as our sponsors and volunteers for making this event possible. We are already looking forward to next year for Physicians for Peace’s 20th anniversary! So mark your calendars now for October 3rd, 2009, and join us to Celebrate the Nations!

Dominican ‘Resource Mothers’ Visit US

 

“Resource Mothers” Altagracia Luna and Kissairis Rodriquez of the Dominican Republic visited the United States for the first time last week on a trip to Physicians for Peace headquarters in Norfolk, Virginia. Altagracia and Kissairis have played an important role in establishing the “Resouce Mothers” Program in the Dominica Republic with the support of Physicians for Peace. During their visit, they were able to tour a local children’s hospital and meet women who do the same type of prenatal education and mentoring here in the US. In turn, we benefited greatly from learning about their experiences in working with mothers in need:

 

“As Resources Mothers, we help the people of the barrios we live in. We go out into the barrio, door to door, and find girls who are pregnant, and need help and advice. We are trained to teach young women about all the ways they can have a healthy pregnancy and a healthy happy baby. We help them keep away from drugs, alcohol and tobacco, which are common in our community. We accompany the girls to their prenatal check-ups, visit them at their homes, and advise them and their family how to have a healthy pregnancy.  We also advise them how to eat well, even when there is so little to eat, because of their poverty.  We help them to learn how to nourish not just their body but also their soul so they can deal with all their worries and fears.”

 

“All of us Resource Mothers are thankful for the opportunity to be part of this program. Every day, I thank God and Physicians for Peace for the chance to help my neighbors and my barrio. We feel that we are changing the lives of the girls we help. We are changing the lives of so many people for the better. In the first year of the program, 94 healthy babies were born, and we feel like we are a part of all of those families. And it has changed our lives as well! The Program has motivated me to go to Medical School in the Dominican Republic. In a few years I am going to be a Doctor. Thank all of you for making all of this happen.”

 

Their compassion and dedication is an inspiration to everyone at Physicians for Peace, and we hope they will come visit us again soon!