By Sage P. Whitmore, M.D.
Vanderbilt University Medical Center: Emergency Medicine
Georgetown, Guyana

I had plenty of time to contemplate all that I had seen during 12 hours of travel back home from a medical mission trip to Georgetown, Guyana. I had just spent three weeks working in the Accident & Emergency (A&E) department at Georgetown Public Hospital and using my training as an Emergency Medicine resident in the United States to help teach new ER doctors core material such as EKG reading, airway management, and the approach to shortness of breath and chest pain. I had not realized when I arrived how much of my time would be dedicated to sitting in the metaphorical trenches and caring directly for patients coming to the A&E. I was prepared for a foreign experience in a distant land, but instead I found myself right in my element.

The minute-to-minute practice of medicine was in Georgetown was very similar to what I was used to; see as many patients as possible, gather all the information you can, make a decision—often instinctual—to admit a patient or treat them at home. One important difference, however, is that in the United States it is easy to get caught up in which hospital has a trauma center, who has immediate cardiac catheterization capabilities, and how long it might take to get a specialized MRI or exotic blood test; these distinctions do not exist in Georgetown, and as a physician I got back to basics. In medical school what we really learn is how to interact with and assess a patient; how to sit, what to ask and how to listen, where to push and prod, how to translate the patient’s presentation into terms of anatomy and disease process, and how to offer comfort. These remain the most useful tools in a physician’s arsenal and are the foundation of all medical care no matter how many elaborate adjunctive capabilities you have at your disposal. 

When a concerned mother presented her coughing infant for evaluation, rather than immediately ordering an expensive antibody test for respiratory viruses, I got to be a doctor. Does the patient look ill, or does she look like a normal baby who happens to be coughing? How long had she been sick, did she have a fever, did she have any prior medical problems? What do her lungs sound like? While I was thinking about the possibilities, I used the moment to reassure the mother how well her baby looked, and her look of relief reminded me why my job can be so gratifying. Ultimately the baby checked out fine, required no testing, and the decision to discharge her was as practical as it was scientific—her mother was reliable, lived nearby, and would return if the situation worsened. In this case, practicing medicine meant relieving anxiety and educating a family member, at the cost of merely a few minutes of focused attention and interaction. 

One early morning, a young man was brought in by his family members for confusion and shortness of breath. Sitting in a wheelchair, he was having difficulty concentrating on my questions and panting as if he had just finished a marathon. Virtually any cause of confusion and shortness of breath can be diagnosed for the price of a couple CT scans, a blood gas analysis, full panel of labs, possibly a cardiology consult and stress test, maybe an ultrasound or MRI. If resources were unlimited, one could simply check all the boxes on an order sheet at home if so inclined. Instead, we started with the basics—looking and listening. This shortness of breath had not started suddenly. He had no pain. He was not blue from lack of oxygen. He looked very dehydrated. Despite his rapid rate of breathing, his lungs sounded clear and he was not sucking in at the ribs or working hard to breath through fluid or inflammation in the airways. In medical school we learned about “Kussmaul” respirations, a pattern of deep breathing meant to get rid of acids in the blood, usually from undiagnosed diabetes. We did have a glucose meter on hand, and it turned out his blood sugar was critically elevated, proving the diagnosis. The treatment is simple, and he improved over several hours with IV fluids and insulin. In this case, practicing medicine meant a thorough history and physical examination, and the cost of one glucose check and widely available basic medications.

In a blur of activity, orderlies whipped into the A&E with a woman found unconscious at home. She was limp, unresponsive, snoring and gurgling through her oral secretions. In this situation, protecting the patient’s airway with a breathing tube is essential to prevent secretions from draining into the lungs and getting infected. There is no fancy test required, but getting the tube in place can be difficult and can require specialized equipment. At my home institution, a cutting edge machine with a fiberoptic camera at the tip and a high definition screen can be used to look around the patient’s tongue and place the breathing tube through the vocal cords. In this A&E we had one basic device, and with it the resident was having difficulty passing the tube as the patient’s oxygen dropped lower and lower. Even in this extreme case, going back to the basics proved life saving. As we learn in our airway courses, what saves lives initially is not placing a breathing tube, but rather simply ventilating the patient with a bag and a facemask, by holding the jaw just so. Employing this technique brought the patient’s oxygen back up and gave us time to change the patient’s position, the size of the breathing tube, the height and angle of the bed, and optimize the conditions for the procedure. When the situation had calmed down, we took a slow, deliberate look for the vocal cords and passed the tube successfully.

I came away from these clinical scenarios with a new appreciation for basic medicine. In the era of whole body CT scans, unlimited lab analysis, and myriad medical gadgets, the fall back is always our own eyes, ears, and hands. Forming a therapeutic bond with a patient, asking the right questions, searching for the right clues, combining instinct and basic life support skills, and caring for patients with compassion are principals that know no borders. 

By Sage P. Whitmore, M.D.
Vanderbilt University Medical Center: Emergency Medicine
Georgetown, Guyana

As I was packing for my first international medical trip to Guyana, South America, my wandering mind conjured image after image of third-world medicine based on popular notions and dramatic stories I have heard over the years. I imagined a row of soiled cots where emaciated children without IV access spent their final hours. I pictured a sweltering tent full of tuberculosis patients collectively coughing up blood; or a bathroom-sized emergency department packed with fever-stricken, jaundiced, indigenous peoples dying of AIDS, malaria, and other ailments while overwhelmed healthcare workers looked the other way out of emotional self-preservation because they had nothing to offer. As described to me by some physicians who had been there in recent years, some of these were features specific to the hospital I was heading to in the capital city of Georgetown.

I am delighted to tell you how antiquated and cynical my preconceived notions had been.

On my very first day in the Accident and Emergency Department (A&E), my first patient did not have AIDS or malaria or tuberculosis; he had hypertension and diabetes, and came in for chest pain. I have seen this exact patient many times in my own tertiary hospital in the States! I caught myself thinking perhaps my view of international medicine was a bit narrow. But, I thought, we probably wouldn’t have the equipment to diagnose him, and even then certainly we would have no treatment to offer. Wrong again. A junior resident from the brand new graduate training program in Emergency Medicine appeared beside me and handed me an EKG. “Inferior wall MI (heart attack). He’s gotten fluids, aspirin, oxygen, and morphine. Holding the nitro. We’re waiting for his portable chest x-ray so we can start heparin, and the admitting team is on their way down to evaluate him for streptokinase (clot busting medication).” Incredible! His care was nearly equivalent to that in thousands of small hospitals across the United States.

My very next patient was brought in on a gurney in full cardiac arrest for unknown reasons. Far from looking the other way, a team of three physicians including myself and four nurses started CPR, provided oxygen and ventilation, established two IVs, started fluids, checked his blood sugar, attached a cardiac monitor, gave epinephrine and sodium bicarbonate, and attempted defibrillation before finally pronouncing him dead. This was fully consistent with my own training.

Time and time again, I was surprised and humbled by the world-class care being delivered in this developing nation, from the availability of a neurosurgery consultation for head trauma, to blood cultures and antibiotics for septic shock, to the text book intubation of a comatose stroke patient (there was an available ventilator in the ICU), to the use of an “asthma room” for wheezing asthmatics receiving inhaled medications, oral steroids, and intravenous magnesium just like we would do back home. To be sure, this is not always the case, and there are countless places in the developing world with no medical resources at all, but the quality of care delivered in this public hospital in one of the poorest western nations is remarkable. I believe this is a great example of the success and power of international health efforts.

In Georgetown, an American team of Emergency Medicine residents and faculty, of which I am a member, are staying in a compound called Project Dawn, an international collaboration which houses teams of physicians and healthcare workers from the United States, Canada, Scotland, India, and many other countries around the world year-round. Like ours, these teams spend intensive time in the city helping provide direct patient care, teaching at the bedside, and setting up infrastructure and training programs. This, combined with the ambition of the local physicians who have trained in Guyana as well as places like Canada, the US, Cuba, India, and Europe, is a recipe for excellent patient care.

I am particularly proud of my home institution, Vanderbilt University and its Department of Emergency Medicine, and our involvement here. Within the last few years, we have had the privilege of assisting the Georgetown Public Hospital Corporation create a self-sufficient Emergency Medicine residency program to train new classes of emergency physicians who are specially trained in resuscitation and acute care of a wide variety of problems, from cardiac arrest to broken bones to childbirth to infections and trauma. As we’ve seen in the US, this training benefits patients by relieving the surgeons and family practitioners who typically cover emergency rooms but may not be well versed in the care of medical problems outside their usual scope of practice.

As my American colleagues and I led a didactic conference last week with the new residents, I witnessed with awe the geographical boundaries and disparities of health care dissolve. Together we interpreted the mysterious subtleties of EKGs, discussed strategies for resuscitation of shock, airway management, differentiating types of bleeds around the brain on CT scan. The local residents brought their own real-life cases for a conference, calling on each other to think though work-up and treatment of various life-threatening conditions. These residents would be as at home in our conference room in Tennessee as we are in theirs.

The far-reaching positive impact of international health efforts are all around me, and it is truly remarkable. Of course, none of this is possible without the enthusiasm and dedication of a well-educated and well-trained Guyanese health care force. I feel very honored to be part of something so inspirational, and I urge readers to continue to support international health efforts, as the gains from these investments are tangible and quite amazing to behold.

Matt Landman
Resident
Kijabe, Kenya
Vanderbilt International Anesthesia

matt landman and erik

(Photo: Matt Hansen and Kenyan Colleague)

I've probably done more than 30 appendectomies so far during my general surgical residency. For all the times I've taken care of someone with appendicitis, rarely, if ever, has the thought that they might die from the illness crossed my mind.  Indeed, some of these patients were quite sick; but once they presented to medical attention, we could get them through their illness.  Many of these patients were young which help in their recovery. 

My first week in Kenya changed my history with this nearly ubiquitous American surgical disease.  We took care of a 20 year old male who presented to an outside facility with appendicitis of about two weeks duration.  While he didn't have a CT scan to review, I'm sure his appendix was perforated.  He, appropriately, underwent an open appendectomy by these physicians. Unfortunately, he required another operation shortly thereafter necessitating resection of the right side of his colon (the part of the colon to which the appendix is attached).   He was discharged from that hospital and presented to Kijabe Hospital with stool leaking from his wound.  The connection of his intestine had completely broken down, likely result of weeks of malnutrition and intra-abdominal infection.  We performed additional operations to resect the damaged colon but the insult was too great.  He died during my second weekend in Kijabe. 

There I was, presented with a 20 year old, previously healthy man who died of an illness I’d not ever known in my short professional career to be fatal (although I think it's important to note that there is still a generation of American surgeons who certainly understand death secondary to appendicitis).  Admittedly, appendicitis is much less common in Kenya, but nevertheless, his death was a tangible reminder to me of how the lack of medical resources and access to healthcare can truly affect patient outcomes.   I’m not sure what kept this young man from presenting to medical attention sooner, it was probably a combination of lack of financial resources, poor access to care and cultural limitations, but had he presented earlier, he would have likely survived.

This, and other, experiences in Kijabe changed my view of global health.  It’s so much more than just doing operations or treating patients in a hospital or clinic.  Where the real efforts are being made and continue to be made is in creating a system in which patients get open access and timely care for both acute and chronic disease.  Surely, as long as there is poverty, this will be difficult.   However, if healthcare professionals of the caliber I interacted with in Kijabe continue to commit time and resources to a needy people, the outlook continues to look bright.   

 

An Impatient Optimist

Dec 01 2011

An Impatient Optimist's View of HIV
by SENATOR WILLIAM H FRIST MD

Impatient Optimists: The Bill and Melinda Gates Foundation
 
In 1981, I was a surgeon in training at Massachusetts General Hospital in Boston. I still remember the day we learned about a strange, new, deadly infection that presented on the West Coast. A little over a year later, we learned it was caused by a virus transmitted in the blood, a vital fact for a doctor performing surgery every day.

As I watched the epidemic grow from a handful of cases to a few hundred to several million, I also witnessed the cases grow in biblical proportions in less developed nations, namely across Africa. While I served in the Senate, I volunteered on annual mission trips to do surgery in villages ravaged by civil war. In these forgotten corners of the world, I witnessed how HIV was hollowing out societies.

Drawing on these firsthand experiences, as the Senate Majority Leader I encouraged and supported both the PEPFAR program and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The Global Fund, a multilateral institution with the U.S. as the leading contributor, leverages $2 for every single dollar given, all to combat this trilogy of diseases that disproportionately attack children and young adults in the poorest nations on the planet.

The remarkable news is that millions of lives have been saved by these investments. Thanks to the Global Fund, over 3.2 million people living with HIV are on lifesaving treatment.

I am proud to have been part of a government whose leadership, acting on behalf of the American people, has led the world and literally saved the lives of millions of people globally.  

In 2008, I co-chaired the ONE Campaign’s ONE Vote ’08 Campaign. We brought a delegation of Republicans and Democrats to Rwanda to see firsthand the good work being done by the funding of the Global Fund, PEPFAR, and the President’s Malaria Initiative.

In Eastern Rwanda we visited the inspiring Rwinkwavu Clinic, run by Dr. Paul Farmer’s Partners in Health. With 110 beds and eight health centers, this clinic provides essential medicines, supplies, and equipment and recruits, trains, and retains staff to ensure a sustainable infrastructure for the future.

But without Global Fund funding, the Rwinkwavu Clinic could not provide health care services to the people of Rwanda. This is true for so many organizations and clinics worldwide.

And it’s unfortunate that even though we see investments pay off, lives saved, and economies grow, the Global Fund was forced to cancel its round 11 funding. This means clinics like Rwinkawvu will only be able to support those currently on HIV treatment and not add any new patients. This is alarming because in low-income countries half of people living with HIV are not receiving treatment.

At a time when our own economy is faltering, and our national debt is growing unacceptably, we have to tighten our belts. To do so, we need to decide where we make smart investments and where we do not.

The fact is that the American people spend less than one-quarter of 1% of our federal budget on global health and fighting global epidemics like HIV, tuberculosis, and malaria. With this little sliver of the pie, the Global Fund’s return on investment means more sustainable economies, less global instability, and healthier families. For less than a penny to the dollar spent on all foreign aid, we are investing in the lives of children, mothers, and our own national security.

On the horizon is excellent news for HIV. New evidence suggests male circumcision, microbicides, and quicker AIDS treatment will markedly decrease the disease. Combined with known prevention methods like condoms and nevirapine, we are on the right track to substantially halt the growth of HIV/AIDS.

I’m an optimist, an impatient optimist. We will win the war on HIV, tuberculosis, and malaria.  Our investments have worked. The end is in sight. We just have to be smart enough to continue to invest wisely, using health as a currency for peace around the world.

Matt Landman
Resident
Kijabe, Kenya
Vanderbilt International Surgery

matt landman kijabe 1

(Photo: Matt Landman at left)

It’s now been one full week since my arrival in Kijabe, Kenya.  Simply speaking, to understand everything I’ve seen and experienced in the past week will take months of careful thought and reflection.   I’ve seen the shackling consequences of poverty, the natural history of surgical disease more advanced than I’d ever seen before, a lack of medical resources, and the list goes on; but, overshadowing all of this, I’ve seen the good several committed people can do at one place in time to positively affect patients and their families for a lifetime. 

My first full day in the hospital was spent in the general surgery clinic.  I use the description “general surgery” but in reality, if forced to label it back at my home institution in the U.S. it would be better described as the general surgery - urologic surgery- otolaryngology -surgical oncology -endocrine surgery -thoracic surgery –vascular surgery-wound care-palliative care clinic. 

I never imagined a more unique conglomeration of surgical diseases coming through the door in a single day.  While the pathology was interesting (and inspiring to hit the books to expand my surgical knowledge) I was most struck by what each procedure meant for the patient—particularly the financial toll.  Instead of flashing an insurance card and putting down a small copayment, each patient (and many times their family) was required to produce a down payment for the recommended procedure.  If they required a cholecystectomy it would be x-amount of Kenyan shillings.  If they required a colonoscopy it would be y-shillings.  Quite foreign to me (and most in the US) was the readily available price tag, if you will, for each procedure (I should note that the payment system was different for emergency cases).  That price tag allowed me to clearly see the financial sacrifice, relatively extreme in some cases, made by patients and their families to improve (or simply maintain) their health. 

I often wonder what would happen to Americans if we were put in a similar situation.  Would we still spend most of our healthcare dollars at the end of life?  Would we be doing radical resections with small chances of cure?  Would emergency rooms still be overcrowded?  What would I give up in order to pay for me or my family’s medical care?  While I’m not sure of the answers, I know that many Americans, as I’ve seen these Kenyans do countless times this week, would step back and evaluate their priorities and healthcare need. 

The knowledge of these costs has another effect.  Physicians are forced to understand their healthcare consumption.   I certainly have been more cognizant here of what each laboratory test, imaging procedure or recommended operation would mean for my patients and have tapered my practice and recommendations to be cost-conscious while maintaining medical effectiveness.   Seeing the results of our operations and care here, I’m confronted with excellent results that don’t necessarily correspond to the amount spent on each case. 

It’s been a week and I’ve learned quite a bit, both medically and professionally.  I look forward to the coming weeks for more experiences in which I can look back and evaluate my role in this place and in surgery as a whole globally and in the U.S.

 

by Allison Greening

Vanderbilt International Anesthesia

Kibaje, Kenya

anesthesia

I arrived in Kijabe, Kenya with two other senior anesthesia residents from Vanderbilt midday Sat Oct 29th, after departing Nashville Thursday Oct 27th, flying overnight to London, and then all day to Nairobi. We spent the night in the Mennonite Guest House in Nairobi, where we met several missionaries coming and going to and from various parts of east Africa, and then were driven up to Kijabe the next morning.

We had been scheduled to travel Monday Oct 24th, but were delayed with security concerns due to the Kenyan army invading Somalia in response to recent kidnappings in northern Kenya, and threats of Al-Shabaab retaliation in Nairobi for a few days. Effectively this means we’ve missed a week, but three weeks are better than none! One of the first things we noticed about the place is its utopian feel. Justin, one of the other residents, referred to it as a “summer camp” feel.  It seems funny to think of any sort of terror attack happening here, in an idyllic small town mostly made up of missionaries who either work at the hospital or international school, but evidently someone has thought of it, as it’s surprisingly secure.

We spent the weekend getting settled in, and then started in the operating rooms on Monday. I have an interest in pediatric anesthesia, so have been running the pediatric room, though my compadres have been doing lots of regional anesthesia with the new ultrasound donated to the hospital recently from Vanderbilt and Dr. Randy Malchow. (1st photo) We’ve also been involved in a couple of airway cases, using the brand new glidescope, all of which has drawn quite an audience! (2nd photo below) I’ve done some amazing pediatric cases; the two that stand out the most were an open thoracotomy to repair a patent ductus arteriosus (PDA) in a 15 kg, 7 year old boy who was an achondroplastic dwarf, and a debridement of a severe, 48 hour old burn to the face of a 3year old boy. 

jace perkerson

The first case was a pretty big deal, basically minor heart surgery in a third world country, and I was the experienced one in the room, with both a Kenyan nurse anesthetist and a Kenyan nurse anesthetist student helping. A few aspects of the case amazed me, especially how well we did with so much less than we do in the states, and even more so, how well the boy did after having such a major, and painful, surgery. Kenyans are tough!

The burn case was very memorable as well, and also good teaching for the nurse anesthetist and student. The boy also happened to have muscular dystrophy, which presented its own anesthetic challenges, on top of those unique to burns, such as not being able to use certain drugs, and potentially having trouble breathing for the patient after putting him to sleep. The burn patient, like the PDA patient, looked great the next day. There’s even quite a lot to be learned from a fairly basic case like we did today, when just a few minor speed bumps along the way became important teaching points! I should be clear though, that I am not the only one doing the teaching!! I have learned quite a bit, and already in the first week had experiences that will rival any that I’ll get during my pediatric anesthesia fellowship next year!

 

by Jenny Eaton Dyer, Ph.D.

Both Friend Force of Knoxville and Friend Force of Memphis are hosting the Russian delegates this week, including today. 

The Russian delegates in Knoxville will be meeting with governmental officials Mayor Daniel Brown as well as Judge Tom Varlan today. They will be briefed on the bluegrass music of Appalachia at the Knoxville Visitor's Center, and their afternoon will be spent visiting with Cherokee Health Systems. This evening, the North Rotary Club of Knoxville will host the Russian delegates for dinner.

In Memphis, the delegates will meet with the Memphis Medical Society as well as with the University of Memphis. At the University, there will be round table discussions regarding healthcare delivery in Russia and the United States among other presentations.

TASO sets another milestone: Launches a House of Hope for persons affected by HIV and AIDS in Uganda.  

house of hope

As 2011 draws to an end, The AIDS Support Organisation (TASO) is elated to record yet another milestone in restoring hope to people affected by HIV and AIDs pandemic in Uganda.  The organization, with support from her development partners and friends, has completed the construction of a multi-million complex, named House of Hope.

The attractive building, located at Plot 10 Windsor Loop, Kampala, was officially opened on 16th of September 2011 in a grand ceremony presided by Hon. Princess Kabakumba Masiko, Minister of Presidency, who represented H.E Yoweri Kaguta Museveni, President of the Republic of Uganda.  

The colorful event was attended by over 400 guests including members of the diplomatic community, representatives of development partners, Ministry of Health, Uganda AIDS Commission, leaders of various local and international AIDs Support Organisations and other civil society organizations, TASO governance bodies, TASO founder members, management and staff and above all, the gallant clients living with HIV.

In her remarks to launch the House of Hope, Hon. Masiko appreciated TASO for the innovativeness in the fight against the AIDS pandemic and for standing tall in the country and the world over in providing hope to people living with HIV. She pledged continued support to TASO and other stakeholders from the Government of Uganda.

The vision of the House of Hope was conceived as one of those strategies of sustaining provision and quality of HIV prevention, care support and treatment services to the TASO clients. Faced with the challenge of a growing number of clients seeking services especially following the initiation of ART programme, the available physical space and related resources at the Mulago Service Centre, which also housed the TASO Headquarters, were increasingly becoming inadequate. Therefore a need to decongest the facility at Mulago became more apparent and had to be addressed.

The management of TASO, with the approval of the Board of Trustees (BOT) then decided to construct a building to house the TASO Headquarters with additional space for generating resources for continued innovations and work in the provision of services to the clients and HIV prevention interventions.

The construction of the building commenced in November 2005 with the laying of the foundation stone in a ceremony officiated by Dr. Sam Okware, a prominent HIV activists and then a Director at the Ministry of Health.

The initial funding for the House of Hope project was provided by the World of Hope Foundation, USA. This funding followed a visit to TASO by a US Senator Bill Frist in 2005. During that visit, Senator Frist, a medical doctor, was taken around and briefed about TASOs work by the then TASO Executive Director(ED), Dr. Alex Coutinho and Dr. Matovu, then BOT Chairperson and Member of Parliament. Senator Frist was deeply touched by the great work TASO was doing in preventing HIV infection, restoring hope and improving the quality of life of individuals, families and communities affected by HIV infection and disease.

On going back to the US, Senator Bill Frist, M.D. nominated TASO to The World of Hope Foundation to be considered as one of the recipients of funds left over from former US President Bush’s election campaign. His nomination of TASO was accepted and gratefully, a generous contribution of US $500,000 was given to TASO, out of which about US $ 350,000 went into the House of Hope project.

The House of Hope project is one of the biggest projects that the current ED, Mr. Robert Ochai inherited when he assumed office. Together with his team, he raised additional funding from TASO friends from near and far, including the Board of Trustees, Staff, Subscriber Members and Clients, to complete this dream of a symbol of hope for TASO clients and friends. TASO pays great tribute to all the friends who contributed to make this big dream a reality.

Speaking at the opening ceremony, Mr. Micheal A Strong, the PEPFAR Coordinator, US Mission Kampala, Uganda, noted that the House of Hope is an investment for people living with HIV and will generate revenue for TASO for years to come to sustain the excellent work on HIV and AIDS prevention, care and support. He urged all organizations to emulate TASOs example of looking outside our narrow boxes to find creative ways to fund and sustain the efforts to improve the health of all Ugandans.  On their part, the ED, Mr. Robert Ochai and the Immediate former ED, Dr Alex Coutinho, noted that TASO‘s commitment to preventing HIV infection, restoring hope and improving the quality of life of persons, families and communities affected by HIV infection and disease, has resulted into the organization taking up a pioneering pace setter role in the fight against HIV and AIDS in the country and the region.  From the enviable milestones recorded over the years, the name TASO has now come to be synonymous with any initiatives in HIV prevention, care, support and treatment in Uganda.

The House of Hope is a modern facility, complete with a 400 seater conference facility/board room and a parking yard of over 30 vehicles. The facility also has a wall of memory of over 100,000 departed TASO clients. TASO is pleased to posses this facility on behalf of everybody involved in the fight against the HIV pandemic and especially the gallant clients who have given HIV a face. There is hope and together we shall fight on to defeat HIV so we can, one day, reach our vision of “A world without HIV”.

by Jenny Eaton Dyer, Ph.D.

In following the meetings and events of the Russian delegation learning from Tennessee's wealth of health care corporations, universities, and institutions, we will share their schedule throughout the week.

Today, Tuesday, November 1, the delegates visiting Knoxville have spent the morning at Pellissippi State Community College touring the Nursing Department. This afternoon, they toured the UT Hospital and had a quick photo at the Rachmaninoff statue in World’s Fair Park. Afterwards, they will visit the Knoxville Museum of Art and learn about their Mobile Meals program for the elderly.

In Memphis, the other delegates met this morning at the Christ Community Health Services. This organization is a faith-based network of medical and dental clinics supplemented by a range of community outreach activities.  CCHS serves a primarily low-income minority population that does not have the resources to obtain care elsewhere. For lunch, they visited the Caritas Village. And, this afternoon, they visited the Assisi Foundation of Memphis for a presentation and discussion on current health care reform initiatives and then the Hope and Healing Center to learn about their wellness and fitness program for a low-income population.

by Walter Schratt
Vanderbilt Department of Surgery
Kijabe, Kenya

I arrived at the beginning of September for my first time in Africa. I really did not know what to expect but after 2 weeks I am really deeply impressed. Kijabe hospital is a medical center in Kenya where people get medical treatment at a high level for a reasonable price. The doctors are well trained – mostly in America and Australia, the residents, house and medical officers are highly motivated, have abundant basic medical knowledge, and, on top of that, they receive a detailed and profound training in their specialties that will prepare them for their challenges in the smaller community hospitals. Politics just has to make sure that they stay here in Africa to serve their countries and their people after they are finished with their training.

Same for the nursing staff. The nurses are competent, helpful, motivated.  A substantial number of nurses who are trained here are hired at the big and prestigious hospitals in Nairobi – unfortunately for the Kijabe hospital but also an expression of the quality of training they receive at Kijabe hospital.

The African people are friendly, open and very patient and generally happy.  Imagine 100 people in surgical clinic, first come  first serve, waiting from 9 am to be seen at 3 pm – no complaints, still happy to be seen after a 6 h wait. Those people deserve our help despite political uncertainties. The fellow doctors who work here full time on their missionary dedication deserve our full recognition and support. I am lucky to be here. I am looking forward to the rest of my stay and hopefully I will be back some time.

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