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

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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

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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

Burn Nurse Education Teams Head to Honduras and Costa Rica

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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

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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

          

 

 

 

 

 

 

 

 

 

 

 

Angels at Work

The following entries were sent in by Teresa Glass, a volunteer working in Santiago, Dominican Republic for the Physicians for Peace Burn Care Program. They show the amazing spirit of giving and cooperation of our volunteers, as well as the importance of the work they do, helping burned children get the care they need.

Day one – August 11th, 2008

We had a successful first day. It is amazing how the universe presented all that we needed today.
When we were teaching splinting, the perfect patient arrived who needed exactly the type of splints that we wanted to teach. The same thing happened for compression garments, inserts, pockets and scar management. We had a very nice day with Carmen, Dilia, Nina and Ana Araceli. They are all eager to learn and have a gift for working together and using their hands.
We all feel very fortunate to be here, although we miss our team members Steve and Patty.
Liz, Jana and Teresa

Day Two – August 12th, 2008

Last night we had a wonderful dinner with the volunteers, along with Nina and Dilia. We had a very enjoyable and productive conversation.
Today Nina, Dilia and Carmen practiced the fabrication of hand splints. They caught on very well. The true test will be working with an uncooperative child! We also worked with Ana Araceli in the fabrication of gloves and more inserts. She had difficulty with both sewing machines today, especially when using the new fabric that we brought down, so we will continue to problem solve with her. She seems very adept at figuring out new patterns for gloves, etc.
The day was full of laughter and friendships were strengthened.
We were very fortunate to be invited to the volunteers monthly luncheon held at the hospital. We thanked them for their support and generosity and the opportunity to be collaborating with such amazing people.
Liz, Jana, Teresa

Day Three – August 13th, 2008

All three of us are again here at the computer sending you something so that you think we worked yesterday! Ha! Ha! Ha!
Wednesday we were able to teach additional techniques on garments, inserts and pockets for the garments with patients that needed exactly what we were teaching. Also there was a girl that had been sent there to receive a custom made compression garment, but we were able to problem solve with Ana Aracelis and help her come the conclusion that a Tubigrip sleeve was more suitable and easier option. We continue to be amazed at the quickness with which Ana Aracelis is able to make a new compression garment for a baby.
Liz had brought sample custom made compression garments to show Ana Aracelis how to do various things, Yesterday a boy arrived needing larger compression garments. She was able to revise one of the complete body suits to fit him…looked beautiful and provided better compression due to the superior material and zippers.
We practiced lower extremity splinting with Carmen, Dilia and Nina. They are all continuing to develop their skills and with all the cutting of plastic their hands are getting strong. They are becoming more and more confortable using a utility knife, which is a skill in itself. They demonstrate more and more awareness of safety precautions. Soft tissue massage and lubrication was practiced, and they were able to witness the effectiveness of silicone on softening a scar.
In the afternoon Dilia was gracious enough to take us on a tour of the University from which she graduated from PT School in May 2008.
Again we had a very enjoyable day.
Liz, Jana, and Teresa

Day Four – August 14th, 2008

We have realized that one of our biggest accomplishments this week is that the 4 women feel a sense of team. Ana Aracelis is especially seeming to feel more a part of the team. In fact, yesterday we invited her to join us on the burn unit, and she told us it was the first time she had ever had the opportunity to be on the unit. She expressed gratitude for being included. On the unit we brainstormed with the rehab team on ideas for utilizing toys therapeutically. They were all engaged and open to new ideas. We dialogued about Carmen’s orders and discussed possibilities to enhance efficiency. 
We continue to instruct on splinting. The women made an elbow extension splint. Ana Araceli spoke up and stated that she too is interested in learning to assist in the fabrication of splints, and Dilia remarked that she would like to learn more about making inserts for compression garments. We were very encouraged to see this and discussed with them about the advantages of cross-training to be able to assist one another and help out if someone needs to be absent.

Day Five – August 15, 2008

We started off the day giving Dr. Tom (University VA) and Anne (RN), fellow PFP volunteers,a tour of the burn unit. We enjoyed the exchange of ideas.
We had a small ceremony for Dilia, Nina, Carmen, and Ana Aracelis, presenting them each with a Physicians for Peace pin and a small butterfly symbolizing their growth and transformation, both personally and professionally. It was a very heartfelt and emotional time for all of us.
We then had the priviledge of talking to Dr. Julio Marte Sime for a long while about our progress and that of the entire burn unit.
We had a wonderful and productive time and are thankful for the opportunity to be here.
Liz, Jana and Teresa

Report from the Burn Consortium – Santiago, Dominican Republic

Brigadier General Ron Sconyers, (USAF, Ret.) Chief Executive Officer of Physicians for Peace, sends this report from Santiago, Dominican Republic, site of the 2008 Burn Consortium. Each year this conference unites healthcare workers in burn treatment clinics throughout Latin America and the Caribbean for an exchange of information and techniques that help enhance the quality of the care they give their patients. Ron writes:

“It’s a nightmare that no mother or father could ever conceive…your child locked in a garage by a neighborhood prankster and then, unspeakably, boxes of fireworks are exploded, leaving the child horrifically and mortally burned.  A traumatic experience to both sense and sensibility.  But as the Phoenix rose from the ashes, so, too, did the child’s mother, turning this Costa Rican tragedy into a passion for prevention, forming one of the regions most emulated non-profits, providing burn prevention strategies for the entire country.   And now, for all of Central America.   

 

This past week, in Santiago, Dominican Republic, such compelling stories of care and compassion were the daily fare as Physicians for Peace joined with our partners in Santiago to host the second Central American and Caribbean Pediatric Burn Association for Prevention and Treatment, founded by PFP in October 2006 in Virginia Beach, Virginia.  More than 50 people gathered there, representatives from Central America, the Caribbean and guests from Argentina and Brazil,  to exchange information and learn from one another about ways to prevent and treat the sad circumstance of burned children.     

 

While the pictures are gruesome, causing me to avert my eyes more than once, the heartfelt hope in the room gave a renewed sense of humanity and Physicians for Peace’s creed to build peace and friendships through medicine.  Nearly 15 years ago, Physicians for Peace embarked on this journey in Nicaragua, and today, we are incubating what will surely be a powerful and influential consortium of like-minded people who care.  And who have committed themselves to these vulnerable children whose lives are wrecked by a spilled cauldron of beans, or a flare up from an unattended open fire, or a fireworks explosion.

 

Yet again, I’m proud to be witness to this amazing group of people who are showing that even out of the darkest experiences, by working together, we can give both hope and life.”

Report from the Caribbean – Day 3

Another report from PFP volunteer photographer Stephen M. Katz, who is in the Dominican Republic with fellow photographer Chris Tyree, documenting our work.
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“I have shot thousands of images for Physicians For Peace and tens of thousands more for the many newspapers and magazines I have worked for. Most blend together and many are forgotten, but a rare few remain as crisp in my mind’s eye today as they were when I shot them. One such image I made two years and three and a half months ago.

She was in agony. Not just physically, but emotionally and spiritually. Her wide eyes said it all and the zoom lens I used only seemed to magnify her pain.

She was motionless, except for her quivering lips. I still hear the sound she was making – a nearly indistinguishable whine, like the dull squeaking of an old exhaust fan. I wasn’t sure if she was pleading or praying or struggling to tell me what had happened. There was no one else with me at the burn unit in Santo Domingo to translate. That is if they could understand what she was saying. I held the camera up and motioned as if to take a picture, then gave a questioning nod. She nodded back.

She was burned from head to toe. Wearing no clothing, her arms were swaddled in bandages, a tube dangled from her nose. Thick white lotion was smeared over her raw, pink skin. The room was dimly lit except for a lamp pointed at her back to help dry the oozing blisters. The smell that cannot be mistaken for anything but burned flesh hung heavy in the air. As did her sorrow. A few clicks of the shutter and I was done. The emotions I typically struggle to suppress in these situations got the best of me.

I never forgot her and it wasn’t until today that I learned what had happened to so severely scar her body and so deeply wound her soul.

Ramon, Chris and my first stop today – Monday, February 25 – was to the Dr. Thelma Rosario Burn Unit at the Dr. Arturo Grullon Children’s Hospital in Santiago. There we met with Dr. Julio Marte Sime to talk about the types of burns most common among children in the Dominican Republic. Large pots of boiling water – often for cooking – and unattended children equal disaster in the barrios. The doctor was sharing some snapshots he had made over the years of interesting cases when one immediately stole my attention. “I know her,” I inadvertently blurted out. “I know this woman,” I said again stopping the rest of the conversation. And that was when I finally learned about the worst day in Ely Silvestre‘s life.

She, her husband and two children lived in a modest, but clean home in one of the many barrios surrounding Santiago. As he did many evenings, when the sun drifted beneath the azure horizon, Ely’s husband lit a candle in the kitchen around which the family could gather when there was no electricity. This night however, the invisible vapors of a leaking propane tank had seeped through the house, instantly exploding and killing the man. Ely, her four-year-old daughter Rossy and 8-month-old son Robert – named after his father – were also consumed by the blast. Much of Ely and Robert’s skin was seared off, Rossy was severely burned as well. Both children were taken to the Children’s Hospital and Ely was later taken to the adult burn center almost three hours away in Santo Domingo. And that is where I first saw her in November of 2005. I’m unclear if she knew exactly what had happened at that point – that here husband was dead, her son within a whisper of joining him, her daughter in agony and the home they built gone. Perhaps that was the noise she was making. Maybe she was asking me if I knew anything. Or maybe she was just saying their names over and over again as if to will their safety.

We use the word ‘hero’ much too indiscriminately these days. So I won’t call the people like Dr. Marte Sime who saved these three lives heroes. They are far too extraordinary for such a common word. Considering the resources available to them and the conditions in which they work, what those medical professionals did was nothing short of astonishing. And so today brought this circle to a close when this afternoon Ramon, Chris and I visited Ely and her family in the barrio. I was surprised at how nervous I was driving up to the home they now share with Ely’s sister and her family.

Walking inside, my mind half expected to smell that pungent odor and to hear that gut wrenching whine, but a smile as wide as the island of Hispaniola itself flashed across my face when I saw Robert playing with his tricycle, Rossy eating her lunch of rice and beans and Ely seated on a red plastic chair watching them. While both children – with the exception of their severe scarring – have made full recoveries, Ely still has a way to go. During the healing process her arms and legs fused together leaving her frozen in a crouched position and her elbows bent like a boxer blocking her body. Several painful surgeries have given her mobility in both arms and one leg, still the other remains permanently folded. She shuffles around the house after her rambunctious three-year-old son placing her weight on the bent leg, propelling herself forward with the healthier one as if she were riding an invisible skateboard. Dr. Marte Sime believes more surgery will eventually give her nearly full mobility, but he is doing the operations on his own time and at his own expense and trust me when I tell you the good doctor has little to spare of either. As we saw in the hospital today, there seems to be no end to the Ely’s and Rossy’s and Robert’s of the DR.”
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Santiago Burn Unit featured in Dominican Today

Last week this story appeared in Dominican Today about PFP’s Burn Care Program in Santiago, Dominican Republic:

“Physicians For Peace (PFP), an American non-profit organization that establishes medical training missions in developing countries around the world, signed an agreement with the Dominican Ministry of Health last month establishing the unit’s regional significance after a successful mentorship exchange with a group of 14 American doctors and nurses.”

Read entire article.

Report From Santiago

Report By Carolyn Ramwell, RN, MSN, PNP, CNS

PFP Burn Nurse Education Mission

Santiago, Dominican Republic

Sunday, January 13, 2008

Dear All,

Today has been an excellent day. We met as a team to discuss the burn program, it’s history and Vivian Pellas’ story and the vision of the burn consortium. We discussed the volunteers and their committment to the burn unit. We then looked forward and planned our initial mission schedule.

Each time I travel with PFP I marvel at the way the stars align to design the perfect teaching and learning experience. This team is full of amazing people. Each one of them is a pot of gold! Every member has some wonderful book, article, lecture, or powerpoint they have shared with us. The amount of resources for our mission have quadrupled. Most of these resources are in Spanish already. To name just a few….Theresa Glass has published a book on all aspects of burn care and has translated it into spanish, Patty White de Barrios presented a cultural awareness course for Latin cultures, and Liz Rivers is the inventor of the Uvex mask! The team is in awe that they are traveling with a pioneer in burn care. We think it should be called the Rivers mask. Andrea Evans put together round sheets in spanish. I could go on about each and every team member.

The nurses are fabulous and will be a fantastically organized team. Emily Tinsley’s outreach at Shriner’s in Boston has brought us energy, enthusiasm and the future. They are going to thrive with Andrea as the education leader. She has a beautiful leadership style that has created trust and confidence amongst the team. Plus, they are all fun!

Today after our meeting we went and toured the burn unit. As we were walking around the outside ring, we looked in on a room that happened to have a patient in critical care. Pediatric Intensive Care is one aspect of this missions focus but due to the rarity of ventilated patients in the burn unit, we had planned to train in the other pediatric hospitals intensive care. The stars aligned and here was a child in need and a mission ready to teach our Dominican nurses how to give this one child the best care we know how.

As we stood there, the alarms went off and we watched the nurses trouble-shoot the ventilator, assess the patient and intervene to maintain the patients oxygenation. It was an honor to see their process and critical thinking to solve a problem we have initially introduced (taking initiative and active problem solving) and were going to address in detail on this current mission. Although it took time and they were obviously nervous with such a grave patient, the nurses were successful. Two of us went into the unit and took advantage of this golden teaching opportunity. We discussed airways and ventilation and praised the staff for the skill they are learning. We asked about their comfort level with this type of critically ill patient and they laughed and said there was none but they were ready to learn.

This staff has great pride in being our “train the trainer” site for PFP. I am honored to be part of PFP, to have Emily Tinsley as a mentor and to be part of the nursing and rehabilitation dream team! Special thanks to Ramon for hosting our group and taking such good care of us here in country. As a PFP staffer and a Dominican he brings an immense value and fuller meaning to our experience here. Susan, thank you for all the work you have done to lay the foundation for this mission to be successful.

All the best,

Carolyn