Sunday, August 7, 2011

By Senator Bill Frist, MD
Chair, Hope Through Healing Hands

WHF and Biden 8.8.11

(WHF and Dr. Biden: 8.8.11)

Over 29,000 young children have died of malnutrition and disease in Somalia over the past 90 days. We are now on our way to the Horn of Africa to see what more we as a nation can do.

Early this morning, our plane left Washington DC bound for East Africa. I’m flying with Second Lady Dr. Jill Biden and USAID Administrator Raj Shah to study the famine affecting the lives of over 12 million people, many of them children.

In fact, it is now being called “The Children’s Famine.” 

Over the years, I have delivered medical care in refugee camps on a number of trips, both to camps in Darfur, in Chad (right on the border of Sudan), and in boy soldier camps in southern Sudan.  I went as a doctor. Providing age appropriate health care to the compromised and malnourished children and adults is crucial to combat rapidly spreading disease and death.

It begins with identifying the specific needs, which we will be doing, then ensuring access, which is a challenge especially in Somalia.

Aid agencies estimate that over $1 billion more is needed during this critical period to stop further deaths and get proper food, water, and health care especially to the children who are most vulnerable.

In the camps we visit, I will focus on the vaccinations given for measles, polio, and malaria; oral rehydration distributed to those suffering from diarrhea; and, vitamins for children to bolster their immune systems. These are simple, cheap interventions to fight disease in the malnourished.  I am eager to learn what is being accomplished and what more needs to be done.  America has done a lot which has lessened the unfolding tragedy in the region, but there is a lot more we can do to reverse the course underway.

We will learn much over the next few days.

I am on this trip to hear the stories of the families and their journeys, and I will share those stories with you. 

Please sign the ONE petition today to urge world leaders to provide the full funding that the UN has identified as necessary to help people in the Horn of Africa, and please keep your promises to deliver the long term solutions which could prevent crises like this from happening again.


by Megan Quinn
ETSU College of Public Health
Munsieville, South Africa

megan quinn 4

When thinking about public health in the developed world, we generally think about preventing chronic disease through behavior change.  However, in Mshenguville (the informal settlement/shack town in Munsieville), the public health needs are drastically different and much more basic.  One of the key issues in Mshenguville is the need for basic sanitation/waste management.  Illegal dumping around various sites in Mshenguville occurs because people do not think that there other alternatives and do not understand the consequences of poor sanitation. 

One particular dumping site is around the community water tap.  While this tap provides safe, clean drinking water, the environment surrounding it is ripe with health hazards.  The tap is surrounded by waste, including diapers, clothes, and general rubbish and serves as a food source for chickens and dogs.  Further, the tap does not have proper drainage and therefore provides a nice source of stagnant water for insects to breed in.  Luckily, malaria is not a major issue in this area due to the high altitude, however; other vector borne illnesses could potentially have high infectious rates during the warm summer months.  Not surprisingly, local have identified diarrheal diseases as a concern in this area of Munsieville.  Poor sanitation in this community elevates the risk for infectious disease, specifically in the vulnerable populations: children and the elderly.

With the assistance of the Councillor for this ward of Munsieville, Thapi Thage, and the local Community Work Program, we completed a community clean-up in this part of Munsieville on Tuesday July 26th.  Over thirty people assisted in the clean-up and these efforts could aid over 250 people that live in Mshenguville.  However, the clean-up only served as a preliminary effort as we were not able to completely clean the entire area due to the immense amount of rubbish.  We need additional long-term, sustainable solutions to aid in providing proper sanitation and waste management to this community. 

Feedback from one of the focus groups we conducted with the children earlier this summer will be utilized to provide some solutions to this public health issue.  The children independently identified illegal dumping as a health related issue in their community.  The following solutions were listed: put a billboard up to signify “no dumping” in that area, put rubbish bins all over Munsieville, form a community worker program, provide a billboard that lists the rules of waste disposal and teaches people to take care of their community, require people to pay for the damage they are causing to their community.

Project Hope UK/The Thoughtful Path will continue working with Thapi and the municipality government to employ the solutions the children listed and provide the appropriate resources for proper waste disposal, including: trash bins for every household, community dumpster, and trash pick-up by the local waste management services.  Finally, community meetings in Mshenguville will be held to provide general education on waste disposal and the burden of disease due to improper sanitation, assess the community needs for proper waste disposal, and the barriers to effectively disposing waste.  Hopefully these efforts will provide a safe, healthy community and create a sense of pride for the people of Mshenguville and the overall Munsieville public.  Providing the basic public health needs in this community will effectively prevent infectious disease and reduce the morbidity and mortality of sanitation related diseases in vulnerable populations.      

by Jenny Eaton Dyer, Ph.D.

The numbers are staggering. Over 12 million people are reported to be in dire need of food and clean water. And more continue to trickle in daily to the refugee camps. Somalia has seen famines before, but this is said to be the worst. Perhaps the greatest crisis of the decade.

Today, Mohammad Ibrahim writes about the emergency in the NYT, "Somalis Waste Away as Insurgents Block Escape from Famine."

It is an extremely complex and difficult situation. Aid agencies are having trouble getting into and providing care for the most vunerable. Governmental funding is especially and desperately needed to avert the loss of millions of lives. 

How can you help? For starters, support Save the Children.

East Africa Drought and Food Crisis: A dollar a day for 100 days can help us keep a child alive. Give online at or text "SURVIVE" to 20222 to donate $10 (Standard message rates apply)

Recommended Reading: "Global Food Crisis Takes Heavy Toll in East Africa," by Samuel Loewenberg, in The Lancet.

by Omo Aisagbonhi
Vanderbilt University School of Medicine
Ogbomoso, Nigeria

omo 1

We had orthopedic clinic today. Many of our adult patients presented with fractures secondary to road traffic accidents. The pediatric cases were more varied. Some of the patients seen included:

  1. 2yo with hereditary neurofibromatosis; over here, neurofibromatosis is diagnosed clinically. The diagnostic criteria are the presence of two or more of the following: 1. six or more café-au-lait spots 5mm or greater in diameter; 2. freckling in the armpit or groin; 3. two or more neurofibromas of any type or one plexiform neurofibroma; 4. two or more Lisch nodules; 5. optic glioma; 6. distinctive bone lesions, particularly an abnormally formed sphenoid bone or tibial pseudoarthrosis; and 7. a first-degree relative diagnosed with neurofibromatosis using the above criteria. This two year old has several café-au-lait spots along with left leg hypertrophy, with left long being longer and wider than the right, due to both bone (femur, tibia and fibular) and soft tissue hypertrophy. She also has a lower limb deformity, genu valgus, which we plan to correct at a later date. Her mom has several café-au-lait spots (but no limb abnormalities) and her 5yo older sister has no café-au-lait spots, but hypertrophic left hand digits and left toes. Her mom and sister did not carry official neurofibromatosis diagnoses, but do now since she clearly has neurofibromatosis based on clinical criteria. Genetic tests are not readily available, but this is a classic example of variable expression routinely observed in autosomal dominant neurofibromatosis.
  1. 4yo with club foot secondary to polio; we did her corrective surgery today. The surgery was interesting. First, we did an ETA (elongation of the tendo-achilles), in which the calcaneal (Achilles) tendon was identified and bisected in a Z configuration, then re-attached. Then, the bursa deep to the calceneal tendon was ruptured. Finally, a wedge resection of the cuboid was performed. Pins were placed to close the resected segment; subcutaneous tissue and skin were closed, and the foot was placed in a cast to help set it in the proper configuration.
  1. 2yo M with bowed legs (bilateral genu varus). The big thing was to rule out Ricketts. This was assessed by checking for costochondrial rosary beading, wrist flaring and forehead bossing. The plan is to have him follow up in 6months. Follow up involves regular measurement of the intercondylar distance and varus angle; expect correction in physiological bowing. The orthopedic surgeons here have observed that an intercondylar distance <9cm is likely to correct itself with time; >9cm often needs to be surgically corrected.
  1. 14yo with Blount’s disease (pathological bowing). She had very bowed legs that had been surgically corrected two other times in childhood, but became bowed as she grew. Plan is for one more correction in a year or so; she’s likely stopped growing and would no longer need corrections after this one.
  1. 6yo with physiologic genu valgus expected to correct on its own with time; for valgus, the follow up is of the inter malleolar distance and valgus angle.
  1. 2yo with foot drop and high stepping gait secondary to IM injection that caused damaged to the common peroneal branch of her sciatic nerve. Plan is for long-term physiotherapy and toe-raising splint.
  1. 3mo with osteogenesis imperfecta which was clinically diagnosed on basis of neonatal femoral and tibial fractures as well as the presence of bluish sclera (she was compared to her healthy twin). This was quite interesting to me as I did not expect to see a child with OI in Nigeria. Anyway, the plan is to treat her fractures as they occur; babies with her type of OI (OI type I, not type II, which is so severe the babies die following the trauma of birth) usually do well as they learn to avoid doing things that will cause them injury.
  1. 14yo with congenital absence of the R. proximal femur that walks by bending her left leg to compensate for the very short right leg; she appears to be kneeling/crawling as she walks, but she’s able to stand upright on the L. leg. The correction would be to amputate the R. lower limb and place a prosthetic; she does not want this.
  1. Neonate with bilateral club foot due to congenital bilateral absent fibulas. We placed casts to begin serially correcting the clubbing.
  1. 28yo with remote history of ectopic pregnancy, presented with bilateral hip pain. X-ray showed bilateral cystic lesions at the femoral head and narrowed interarticular space. We did a TB skin test (which is non-specific in this population exposed to BCG vaccine, but the more specific IFN-gamma release assay is also considerably more expensive), also sent her for HIV testing and her blood group was checked because people with sickle cell disease are prone to avascular necrosis of the hip (she’s AA). I think, given her h/o ectopic pregnancy, there is a likelihood of gonorrhea/chlamydia exposure and possibility of septic arthritis from gonococcus; but this would be an atypical presentation.

Later in the day, I attended morbidity and mortalilty conference where I learned that the most common admissions on the medicine service are due to cardiovascular/ cerebrovascular diseases and CHF; not infectious diseases though, in the month of July, one patient died of malaria and another of AIDS. Another thing that was interesting to note is that for some patients, cause of death ends up being undetermined. E.g. the case presented of a man who presumptively died of hypoglycemia secondary to metastatic liver cancer; assumed to have liver cancer because his liver enzymes were elevated and he had a bone tumor. However, he was initially diagnosed with bone TB in the ortho clinic, but did not receive TB treatment (again, here, TB diagnosis is non-specific due to BCG vaccination). He never had any scans to show or disprove liver tumor and did not have an autopsy at death. All we know is that he came to the hospital with hypoglycemia and his labs showed elevated liver enzymes. There is a need for better access to pathology.


by Katie Baker
ETSU College of Public Health
Appalachia Region

katie baker farmer market

Friday, July 22, 2011

Since my last post, I have been very, very busy!  First, the skin cancer prevention program I’m developing is really coming together.  At this point, I have developed two of the four modules, completed a formal recording of “Sabrina’s Story,” a local melanoma survivor’s story, with the help of ETSU’s Communications Department, and scheduled meetings with each of our region’s eight county Health Councils as a way of disseminating the program once it’s complete.   As I will be collecting baseline and posttest data from 135 students at David Crockett High School, the pilot site for the program, I will also begin the IRB (Institutional Review Board) application and approval process very soon. 

In addition to working on components of the skin cancer prevention program, I organized and conducted sun safety events at the Johnson City Farmers’ Market and Kingsport’s annual Fun Fest Splash Day and participated in the National Cancer Institute’s Research to Reality Cyber-Seminar “From the Seaside to the Slopes: Implementing Sun Safety Programs through Partnerships.”

Sun Safety at the Johnson City Farmers’ Market

July 16, 2011

Each year, the Washington County Health Council organizes a health fair/health screening event to be held during the Johnson City Farmers’ Market in Johnson City, Tennessee.  This year, the event took place on Saturday, July 16th.  Members of the Health Council invited me to set up a sun safety booth similar to the one we had at the Blue Plum Festival in June, and I gladly accepted their invitation.  For this event, I distributed educational materials donated by the American Cancer Society and Wellmont Health System describing the importance of practicing sun safety and ways to protect your skin from ultraviolet radiation (UVR).  I also distributed no-cost protective aids including foam visors from TC2 and sunscreen donated by the American Cancer Society.  Lastly, I counseled those participants that visited my table on the following topics: the dangers of UVR on a cloudy day; choosing the right sunscreen; and skin self-examinations.  One hundred participants registered (i.e., completed a survey) for the Health Fair, and the majority of participants stopped at the sun safety table.  Each participant I spoke with reported intentions to use sunscreen, and approximately 50% took a sunscreen sample from the table.  As the day was cloudy, I was able to educate participants on the importance of wearing sunscreen even in bad weather.

Research to Reality Cyber-Seminar “From the Seaside to the Slopes: Implementing Sun Safety Programs through Partnerships.”

July 19, 2011

Surprisingly, this was my first cyber-seminar, and I must say, I thought this was an excellent mechanism through which to share best practices in public health!  This particular seminar focused on large-scale dissemination of skin cancer prevention/sun safety programs.  From the Moffitt Cancer Center in Florida, the first two speakers detailed their experiences with the “Mole Patrol” program.  This community service-type program focuses on the provision of free skin cancer screenings to coincide with Major League Baseball’s (MLB) spring training.  To date, the Mole Patrol has partnered with MLB, hospitals affiliated with the Moffitt Cancer Center, local county governments, AAA, local county school boards, and the Air Force.  From 2008-2011, they hosted 59 screening events, screening 6,367 people.  Dr. Dave Buller of Klein Buendel, Inc. in Golden, Colorado presented on his experiences with sun safety programs in occupational settings, specifically ski resort employees.  He explained that to achieve maximum program dissemination and uptake, program developers must use a two-pronged strategy.  First, they must partner with the professional associations in the industry.  Benefits of partnering with professional organizations include: access; legitimacy; problem and solution identification; program development; and the facilitation of dissemination.  Second, they must partner with individual operators/employers to reduce uncertainty about the program, build trust among senior managers, and identify internal champions who will sustain the program. 

I feel as though I can apply several of the lessons I learned during this cyber-seminar to my field experience project.  I intend on partnering with a large organization, the Heath Occupations Students of America (HOSA) group, for access to students and program dissemination.  Also, I will be personally visiting each of the eight county Health Councils in our region to obtain public commitment to the initiative and create a plan for program use.

Sun Safety during Splash Day at Fun Fest’s Kids Central
July 20, 2011
Andrew Johnson Elementary School in Kingsport, Tennessee

For the last several years, the Tennessee Cancer Coalition (TC2) and its local partners have organized a sun safety booth to be held in conjunction with Splash Day at Kingsport’s annual Fun Fest.  This year, TC2 members in our region asked me to organize the booth and attend the event.  This was the largest sun safety event I’ve organized to date.  I distributed many of the same educational materials I used for the Blue Plum Festival in Johnson City and the Johnson City Farmers’ Market.  In addition, for this event, I made and gave out UV-bead bracelets from TC2 meant to teach children the importance of wearing sunscreen when the UV rays cause the beads to turn color.  I also distributed no-cost protective aids including sunglasses donated by Wellmont Health System and sunscreen from TC2.  Lastly, I counseled those participants (children and parents/caregivers) that visited our table on the following topics: the dangers of UVR on a cloudy day; the importance of wearing sunscreen to prevent skin cancer and sunglasses to protect the eyes from UVR; and proper sunscreen application (i.e., reapply after getting in the water, etc.).  Over 2,000 children and parents/caregivers attended Fun Fest’s Splash Day.  I estimate that approximately 800 children visited the sun safety table.  When asked if they were wearing sunscreen, approximately 5% reported they were, leaving 95% of children attending the event unprotected against the sun.  I gave sunscreen to each child who reported not wearing any that day; this means I distributed approximately 750 packets of TC2 sunscreen.  I asked each child who visited the table if they could tell me why it was important to wear sunscreen, and approximately 85% responded correctly (i.e., “to keep from getting skin cancer;” “to keep from getting a sunburn”).  In total, I distributed: 500 pairs of sunglasses (donated by Wellmont Health System); 300 UV-bead bracelets (sponsored by TC2); 750 TC2 sunscreen samples; and 25 sun safety pamphlets (donated by ACS).

by Megan Quinn
ETSU College of Public Health
Munsieville, South Africa

megan quinn gardens

On Thursday July 14th, 74 individuals came together and made the decision to change their lives and end hunger, malnutrition, and poverty in Munsieville , South Africa by planting gardens.  Many families in Munsieville struggle to have a well-balanced meal every day and building gardens will create a sustainable way to ensure that individuals do not have to go hungry.  Further, vegetable gardens will help to fight malnutrition in the children of Munsieville.  According to the World Health organization, malnutrition contributes to more than one third of all child deaths and can occur due to offering the wrong foods, inadequate breast feeding, and not ensuring that the child receives enough nutritious foods1.  The people of Munsieville are going back to the soil to make sure their children and families are adequately fed and nourished. 

The 74 individuals were divided into 15 groups to begin building the gardens.  Group members will assist each other in building gardens at each of their houses and training other individuals in the community as well.  The keyhole garden method will be used to build the gardens in small spaces and use recyclable materials and water.  For more information about keyhole gardens, follow this link.  Community members of Munsieville are very excited to begin this endeavor! Everyone should have enough vegetables to feed their families and maybe even sell the extras.  Additionally, once they start growing vegetables, some of the women would like to open a soup kitchen for the orphaned and vulnerable children in the area.

A few of the leaders of the community garden groups met on Wednesday, July 20th to receive training about the keyhole gardens and develop plans to begin building.  These key leaders will assist us to ensure that gardens are built for all of the individuals participating in the program.  Additionally, we hope to utilize these leaders to train individuals to build gardens in other parts of Munsieville.    

We broke ground on our first garden on Friday, July 22nd.  Roughly 10 women helped the “Star Garden” group build their first garden.   The women collected materials from around the community (bricks, straw, cans, and soil) and compost and seedlings were provided through donations from the United States.  This small garden, containing spring onion, beet root, cabbage, parsley, and spinach, will feed approximately 5-10 people and will change the lives of the owner and her family.  Further, plans were made on Friday for the next set of gardens to be built.  The women continued collecting materials over the weekend and plan to build several more gardens this week.  This small effort will make a huge difference in the lives of the community; providing healthy, nutrient rich foods to the people of Munsieville.   



  1.  World Health Organization.  2011.  Accessed 7/22/2011. 


Brad Paisley talks about the importance of clean water for the 1 out of 7 people around the world who lacks access. Please join our Water=Hope campaign today at Donate $10 by texting H2O to 25383; you will receive a confirmation, reply YES. It really is that simple!

WASHINGTON, DC – The Clinton Bush Haiti Fund today announced a $1.8 million grant to the Boston-based nonprofit Partners In Health to support its Haitian sister organization Zanmi Lasante in a program that will make long-term, sustainable improvements in the scope and quality of Haiti’s healthcare and medical education sectors. The grant will be used to launch a residency program for family practice physicians and a certification program for auxiliary nurses at the public hospital in St. Marc supported by Partners In Health and Zanmi Lasante.

“The earthquake and cholera outbreak have only heightened the healthcare sector’s challenges,” Clinton Bush Haiti Fund CEO Gary Edson explains. “The Clinton Bush Haiti Fund’s three-year grant for Zanmi Lasante’s work is an investment in Haiti’s human capital. It will provide training for critically needed family practice physicians and auxiliary nurses at l’Ho?pital Saint Nicolas, the chronically understaffed public hospital serving 220,000 St. Marc residents and, ultimately, the 1.5 million people of the surrounding Artibonite region.”
Additionally, Zanmi Lasante will leave a lasting legacy for the nation’s public health system by upgrading and standardizing auxiliary nurse education, creating a first-ever certification program to be replicated by other medical training centers throughout Haiti.

Amplifying the impact of the Clinton Bush Haiti Fund’s grant, Partners In Health will match the funds more than one to one, and will work closely with the National Faculty of Medicine and Haiti’s Ministry of Public Health and Population.

Today’s announcement is an example of the Clinton Bush Haiti Fund’s support for projects that provide both humanitarian assistance and economic opportunity, helping Haiti “build back better.”

“This grant represents an invaluable investment in the decentralization and long-term, sustainable reconstruction of Haiti’s health system,” said Dr. Paul Farmer, co-founder of Partners In Health and chair of the Department of Global Health and Social Medicine at Harvard Medical School. “It will enable Zanmi Lasante and Partners In Health – working in partnership with Haiti’s Ministry of Health and national medical school – both to improve the quality of care for the people of St. Marc and to train a new generation of healthcare providers to deliver comprehensive, community-based care in even the poorest and most remote places.”

Clinton Bush Haiti Fund
The Clinton Bush Haiti Fund is a 501(c)(3) nonprofit organization founded after Haiti’s January 12, 2010 earthquake, when President Barack Obama asked former Presidents Bill Clinton and George W. Bush to head a fund aimed at easing the suffering of the Haitian people while laying the groundwork for “building back better.” The Clinton Bush Haiti Fund initially responded to the catastrophe with millions in humanitarian relief. By the time the Fund began independent operations in May 2010, it transitioned to primarily serving its longer-term mission of sustainable reconstruction efforts designed to promote jobs and create economic opportunity, enabling Haiti to chart its own successful future. To date, the American people have entrusted the Fund with more than $53 million from 200,000 individuals, supporting innovative programs that help Haitians to help themselves. To learn more, visit

Partners In Health
Partners In Health (PIH) works in 12 countries around the world to provide quality healthcare to people and communities devastated by joint burdens of poverty and disease. PIH has been providing vital healthcare services in Haiti for more than 20 years, working with the Haitian Ministry of Health to deliver comprehensive health care services across the Central Plateau and Lower Artibonite Valley. For more information please visit

by Karie Castle
ETSU College of Public Health
ASPIRE Scholar/Appalachia

During the past month and a half, I have been working and an intern with the Boone Watershed Partnership, Inc. (BWP) a non-profit organization currently in the process of performing restoration projects on two creeks, Sinking Creek and Gap Creek. Sinking Creek is mainly located within Johnson City, while Gap Creek is located mainly in Elizabethton. Both creeks are an essential asset to these two Appalachian communities. Both of these creeks are on the 303(d) list, meaning that they are not capable of sustaining life. Sinking Creek has been put on the list due to E.Coli pollution, while Gap Creek’s main problem is sediment.

Most of the work that I have been doing has been with Project Manager, Sarah Ketron. The main focus of the Sinking Creek project is to inform the community of the pollution in Sinking Creek and inform them on how they can help. On July 9th, Sarah, Gary Barrigar (President of BWP), and I went on a Septic Survey. On this trip, we went door to door asking people if they were connected to the sewer. Part of the grant given to the BWP from the EPA allows the BWP to assist residents in getting connected to sewer, if they are not already. The BWP pays all the costs, except for the monthly tap fee. This is a huge benefit to residents, considering this is something that could cost thousands of dollars. Also, if a resident is currently using a septic tank and is not able or does not wish to connect to sewer, BWP will assist in emptying or repairing the current septic tanks and/or field lines. BWP pays 100% of the costs. Once again, this is a huge incentive for the rural communities, considering the amount of money they would have to pay without BWP assistance. Sarah and I will be conducting another survey this weekend.

Aside from the two restoration projects that are currently up and running, the Boone Watershed Partnership, Inc. also assists in clean ups of other streams and rivers. So far, I have assisted with one clean up. BWP teamed up with Wal-Mart of Elizabethton to help clean up a portion of the Doe River in Elizabethton. We managed to clean out about four truck loads of trash and debris in about three hours. The community living along this portion of this river really appreciates what BWP is doing and even sometimes come out and assist in the clean up. It’s a really good feeling knowing that what you’re doing is helping others, especially in such rural Appalachian communities.  Thank you LoveEverybody  foundation for the ASPIRE Appalachia scholarship support.


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