See how the Clinton Bush Haiti Fund's grant to YouthBuild International, partnering with IDEJEN, will put young people back to work in Haiti and give them the skills necessary to rebuild their country.

The centers will serve at-risk youth (ages 16--28) by providing them with vocational training in construction and leadership skills for the future. The grant will also be used to provide a two-to-one match of trainees' savings contributions, support leadership training for the Build Back Better Youth Corps. The program also provides six months of follow-up support as trainees seek viable employment opportunities or pursue self-employment.

The first training center, JENKA, was built in Leogane, the epicenter of the earthquake where nearly 90 percent of the buildings were destroyed. This first of 12 centers is where the project's local implementing partner IDEJEN (Haitian Out of School Livelyhood Initiative) is now recruiting staff and students.

Clinton Bush Haiti Fund money enabled YouthBuild to get construction underway quickly while other projects in Haiti have stalled due to funding delays.

Visit www.ClintonBushHaitiFund.org to get involved.

See how money from the Clinton Bush Haiti Fund has provided sales and marketing support for local artisans.

Their funds also helped these local business people rebuild their workshops, damaged during the earthquake. Through our support, artisans were able to complete their order to Macy's for its exclusive "Heart of Haiti" collection, inspired by the courage and culture of the Haitian people.

Clinton Bush Haiti Fund's recent loan to Fairwinds Trading, will expand this support to artisans in three additional communities and increase employment opportunities for Haitians — particularly women. This could sustain the employment of 740 artisans and artisan managers and provide secondary employment for 185 additional individuals.

Follow-up orders from Macy's could provide income to support 4,544 individuals.

Visit www.ClintonBushHaitiFund.org to get involved.

February 15, 2010

Tuesday night Senator Frist was in New York at an event for Harvard Medical School, "Conversation: Exploring Global Health." Moderated by 60 Minutes' Byron Pitts, the event was a conversation about the history and direction of global health with Dr. Paul Farmer, who among other things leads the Department of Global Health and Social Medicine at HMS and co-founded Partners In Health one of the most influential, visionary and effective international humanitarian organizations, and Dr. Joia Mukherjee, who was just named the Director of Global Medical Education and Social Change at HMS. Listen to the whole thing or just the first few minutes for my introductions.

by Emily Matos, charity:water

Below is the three month update for breaking ground in Uganda, Liberia, and Ethiopia with funding we raised through The Water=Hope Campaign on the Brad Paisley H2O world tour.

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Amount granted to charity: water

Country

$5,000

 UGANDA

Project Start date

Status

October, 2010

In Progress

           

 

Country Overview:

Uganda lies in Central West-Africa with Lake Victoria as its only water source. Uganda is a landlocked country surrounded by Kenya, Sudan, DRC, Tanzania, and Rwanda.

Northern Uganda, specifically, has suffered from a 20-year rebellion led by the Lord's Resistance Army (LRA). The insurgency has displaced approximately 1.7 million people in the Acholi and Lango sub regions. There is now relative peace in the North as the LRA has abandoned its efforts in Uganda and has moved the conflict to the Democratic Republic of Congo, South Sudan and Central African Republic. As the threat of attacks on Ugandan citizens has diminished, many Internally Displaced Persons (IDPs) have had the opportunity to return to their home communities to try to rebuild their lives.

Region Overview:

Water=Hope campaign funds will serve a community in the Lango Sub Region of Uganda. Through a comprehensive Water, Sanitation and Hygiene (WASH) program, our local partners aim to reach the communities in Northern Uganda that were displaced during the LRA insurgencies, specifically those in the Lango sub regions. These sub regions were devastated by the conflict and the many communities faced prolonged displacement. Those who are returning home to these communities face extremely impoverished conditions, including lack of access to clean water and proper sanitation facilities.

 

Amount granted to charity: water

Country

$5,000

 ETHIOPIA

Project Start date

Status

October, 2010

In Progress

Country Overview:

Ethiopia is one of the 11 poorest countries in the world. Landlocked in the Horn of Africa, Ethiopia borders Eritrea to the north, Sudan to the west, Kenya to the south, Somalia to the east, and Djibouti to the northeast. The country's economy revolves around agriculture, which in turn relies on rainfall that is inadequate, unpredictable and uneven in its distribution.

Ethiopia averages 40% clean water coverage across the country, with higher rates of clean water clustered in cities and larger towns. In rural parts of the country one in three people have access to clean water while only 13% have access to adequate sanitation services. At any given time it is estimated that half of the country's population of 80 million people is suffering from an unnecessary water-related disease, and more than 250,000 children under the age of five die each year from diarrhea.

Region Overview:

Water=Hope campaign funds will serve a community in the Tigray region of Ethiopia. Tigray is the northernmost region of the country and is home to more than 4 million people and has less than 50% clean water coverage. While water availability varies greatly across the region, the majority of Tigrineans obtain their water from rivers, ponds, streams, and unprotected springs. They also have to share these water sources with livestock and wild animals, which results in a dirty, tainted water supply.

Amount granted to charity: water

Country

$5,000

 LIBERIA

Project Start date

Status

January, 2011

In Progress


Country Overview:
 
Liberia, located in West Africa, is rebuilding after a fourteen-year civil war (1989 – 2003) that destroyed what little infrastructure there was in the country. The conflict claimed the lives of approximately 150,000 civilians and internally displaced over 1 million people.

Post-war, the international community has rolled out a major humanitarian program to help stabilize the country and bring much needed emergency support to the population. Central to the long-term recovery plan is to provide essential facilities and restore basic social services in both urban and rural communities. Water points were among the many structures destroyed during the war and slow progress is being made yearly to rebuild access to safe drinking water and basic sanitation services. 80% of the population is still under employed and 76% is living below the poverty line on less then one US dollar/day.

Region Overview:

Water=Hope campaign funds will serve a community in Nimba County Liberia with clean and safe drinking water. Nimba County is in the North East of the country and has long borders with Ivory Coast and with Guinea's forest regions. Many communities in the Nimba County are remote, underserved, and have limited or no access to basic health, sanitation, clean water or other services.

by Rebecca Cook

Vanderbilt School of Medicine

Lwala, Kenya

rebecca cook

One of the unique aspects of the model of Lwala Community Alliance, is that while there is a clinic, the program is multi-dimensional, there is also a strong water, sanitation, and hygiene program (WASH), a education initiative that partners with schools and helps to provide secondary school scholarships based on academic merit and need, Umama Salama, an initiative to train community members on basic lifesaving skills to reduce maternal and infant mortality, and a sewing cooperative. The clinic staff goes on school outreaches at local primary schools which includes health education and free preventive care.

I've had the chance to participate in the training-of trainers in the WASH program, wrote the malaria curriculum and have attended the roll-out trainings for the Umama Salama initiative, and have attended two school outreaches with the clinic staff. I've loved the opportunity to interact with individuals outside of the context of the formal clinic setting. Community members often have more candid discussions about community issues and health-related questions they have than they may when they visit as a patient. This week, I was at an Umama Salama (safe motherhood) training attended by men and women ranging from late high school to grandmothers, some were pregnant or with young kids, some were leaders in their community. One of the attendees came with some powerful persuasion from neighbors essentially because they wanted her to get medical care. They asked me to talk with her. She was cachectic with a rattling cough and became short-of-breath with talking. I learned that she'd been sick for months but had resisted going to the hospital for multiple reasons, including fear, stigma, as well as financial and family burdens. While we don't provide medical services at trainings, we were able to build enough trust to get her to come to clinic and overcome the practical barriers with the help of her friends mobilize a motorcycle ride to the health center since she was too weak to walk the 30 minutes. While this was happening, the training continued; participants first learn the lessons through verbal teaching and drawings, and then the messages are reinforced with role-play, which they really get into.

The community work at Lwala, both in terms of educating and empowering people to prevent disease as well as enabling them to be informed advocates who can capably identify illness and assist in bringing patients to appropriate care will ultimately have the greatest impact on the health of this community.

by Jeff Wagner, Coordinator - LWW Appalachian Field Operations

springfields water

Alberta and Clarence Stringfield; with Mike Skytta of LWW

You've probably heard of the plight of people living in developing countries and the struggles they go through to get water. Often they may have to walk six to ten miles to the closest water source and then back again carrying the full containers of water – some weighing 40 – 60 lbs.

Consider, if you will then, that there are communities in the US where water may only be a couple hundred yards away from your home – clean, safe water coursing through a water main and yet, you have no access to it.

That is the dilemma for many families in Appalachia – municipal water may be located 1000 feet away from their home but they simply cannot afford to access it. "How can they afford not to," you may wonder? Utility companies charge connection (tap-on) fees for residents to connect to the municipal water supply and often before the company will even consider running a pipe alongside the road, they must have a minimum number of families who will commit to connecting to the main.

Tap-on fees may exceed $700 if the resident can even have a water line run to the main. Depending on what is between the water main and the house – a road, culvert/ravine, solid bedrock, etc. the cost of accessing safe water can easily run into the thousands of dollars beyond the reach of many families.

Take for example, Alberta and Clarence, both in their 70's, on the same property near Wartburg since being married 55 years ago. They live just outside the water district that serves their area In Morgan County, TN and between their home and the road where a water line would be run if the water district had funds to lay one is a river. The cost of connecting to the water line would exceed their financial resources so for the past few years Alberta and Clarence have carried drinking water in to their house, done laundry in the small creek near their house and have otherwise had to make do as the water in their well had become unusable long ago.

Through a generous grant from Hope through Healing Hands and the efforts of Living waters for the World mission teams from West Emory Presbyterian Church and First Presbyterian Church of Cookeville, that changed recently. The two churches, installed a clean water system at Clarence and Alberta's home to treat the bacteriological contamination found in their well – now they have water that is safe for drinking, cooking bathing and washing – what a blessing it is to know there are people actively working to bring safe, clean water to people who lack access to it – no matter where they live.

 

By Brett Bechtel, MD
Department of Emergency Medicine
Vanderbilt University Medical Center 
Georgetown, Guyana

 
Georgetown Public Hospital Corporation (GPHC), is the central hospital for the country’s public health system. The A&E (Accident and Emergency) functions as the essentially Level 1 Trauma Center and the Emergency Department for the country. Referrals come in from all over the country from outlying health clinics and hospitals if more specialized care is needed. Georgetown is also the population center of the country and so most patients arrive to be seen first here with acute complaints. There are multiple clinics ranging from diabetic foot clinic to eye clinic to pediatric and surgery clinic that see and refer patient to the A&E for admission or further treatment as well.
 
The A&E has about 15 beds in addition to multiple treatment chairs and an asthma room.  It is divided into a trauma and medical section just like many US EDs. It’s air-conditioned and there aren’t any mosquitoes so it makes for a comfortable work environment. Crowds fill the waiting room and along the outside wall waiting patiently for their names to be called. Attendants carrying stretchers haul unconscious patients with hypoglycemia, seizures or bad trauma right in to a bed past the less acute crowd waiting to be seen. Multiple doctors sit at desks seeing the “non urgent” triaged complaints as other doctors tend to the sicker patients who are “urgent” and in a bed. When ready for the next patient, the doctor rings a bell and calls for staff to bring back the next patient. It all seems to flow nicely.
 
The pathology is diverse - everything from malaria to acute myocardial infarctions. In just a few hours I had seen array of trauma like femur fracture, 60% burns, mandible fracture. Medical issues like rigid abdomen with free air under the diaphragm, typhoid, multiple asthma patients and pediatric patient complaints.
 
The sea of patients in the waiting room seems endless, but sometime during the evening it beings to thin out. The medical officers keep moving patients through. Sick ones get reviewed by medicine or surgery and are admitted. Most are discharged to home with clinic follow up and maybe a prescription for a medication. A visit to A&E is free and so are the prescriptions written by the MDs, the variety of medications is limited, but there is a drug for most everything. Only pregnancy tests and CT scans cost money, the rest of the work up is covered.
 
The staff are very friendly and welcoming. Many MDs have trained in Cuba. A few of the hospital surgeons have been to Canada for extra training in their specific trade.
 
Off to a good start. Am enjoying doing bedside teaching and reviewing cases with the general medical officers and the residents in the Emergency Medicine program here. More to come on some specific cases.

by Rebecca Cook
Vanderbilt School of Medicine
Lwala, Kenya

lwala cook

One of the most heart-rending patients I saw was young man with HIV/AIDS. He had initially presented to the clinic on 12/10 with advanced disease (for the medical folks his CD4 count was 3) and was started on antiretroviral therapy (HAART). He came back to clinic in January dehydrated with diarrhea, some fairly advanced skin ulcers, cough and fever. I remember the morning he arrived he was laying outside the clinic on a mat an hour before opening, I could tell from a distance that he was incredibly emaciated, I went over to make sure he was okay, and this man, despite his illness gave me the sweetest smile. He continued to have such a warm smile throughout the few days he spent on observation with us while receiving IV fluids and antibiotics, and gradually improved though he was still very weak. He was discharged on home-based care and I walked with the community health workers to his house a few days later to see how he was. He continued to be incredibly cachectic and weak, but was interactive and eating some. We were able to clarify some of the medication regimens for the family and asked them to come back to clinic the following day. It was incredibly humbling being in his home. His wife was so happy we had come; her generosity was overwhelming, she gave us a generous basket of produce from her garden. I found out 3 days later that he had passed away at home. I felt overwhelmingly sad, and I must confess, still have lingering questions about the best plan of care. Would his course been different had he been at a major medical center? This is a question I will always have to wrestle with. In the course of the month I have seen a lot of HIV/AIDS patients, most of them have been amazingly well, living productive lives on HAART. Several at one stage or another have had immune systems as weak as this man and have recovered remarkably. There is so much hope here, but for those that do pass, like this one, are still devastating for the families and health care workers. I consider it a huge privilege to have known him and his family.

This case is just one on the spectrum of patients I have seen this month. Daily we've seen patients for a range of medical needs including wound debridement, motorbike accidents, sickle cell anemia, along with a range of infections I rarely see in the US: tuberculosis, brucellosis and of course malaria. I've helped deliver a few babies and am in awe of these women who endure childbirth with no pain medicine and very few creature comforts. I have mostly worked in the outpatient department with the clinical officers, but also spend some time in the maternal and child health room on busy days helping with prenatal care and well-child visits. One of the greatest joys has been working with and investing in the clinic staff. I have learned a lot from them about taking care of patients here, and also try to share knowledge about up-to-date treatment guidelines, management of chronic illnesses and broadening their differential diagnoses. Many have family elsewhere and living here is not without sacrifices, so we also just enjoy spending time together outside of work. Leaving Lwala is definitely bittersweet, the month has not been without frustrations or times of loneliness, but I am really sad to leave people here. I take with me lifelong lessons, not only on how to be a better individual clinician, but also in thinking about how to design systems, as well as invest in people to help effectively improve health in resource-poor settings.

 

by Liz Lightner
Vanderbilt University, Department of Emergency Medicine
Santiago Atitlan, Guatemala

I received a 24 year old pregnant woman in the ED via ambulance. Her prenatal care consisted of one ultrasound at the city clinic months earlier. She was about 36 weeks pregnant by the date of her last period, and this was her first pregnancy. She had been pushing for 3 hours at home, and someone had administered an unknown IV medication to her at her home hours earlier. She was having contractions every 2-3 minutes, her cervix was fully dilated, and late decelerations were evident on the monitor. I called Dr. Laura, the on call OB physician on call, and asked her to come as soon as she could. On her arrival, she discovered that the baby was transverse and was unable to be rotated. Delivery by forceps and vacuum was not possible. The fetal heart rate by this time was dropping into the 60s with every contraction, thus we rushed to the OR for a C-section. There are no OR teams or standby OR's here, so Drs. Laura and Carrie set up for the surgery and I prepared for procedural sedation, this process seemed to take a very long time. Another on call physician arrived and set up to resuscitate the baby. Two other volunteers heard about the situation and arrived by the start of the procedure to assist in any way possible. Nobody on our team had much more experience than a training course on neonatal resuscitation, so we were very relieved when the baby started breathing and crying seconds after delivery. The mother tolerated the surgery well. I was amazed how well our team of volunteers with experience in various areas of medicine were able to come together to ensure a good outcome for these two patients, despite practicing outside our usual scopes of practice.

by Liz Lightner
Vanderbilt University, Department of Emergency Medicine
Santiago Atitlan, Guatemala

During my last Turno, I saw two patients who had clear diagnoses and needed transfer for care that I could not provide in Santiago Atitlan, but whose families refused to allow the patient to go.

The first was an 80 year old female with acute left eye pain, headache, and photophobia. She had acute narrow angle glaucoma on exam, although I was not able to check intraocular pressure. After searching the pharmacy, I was only able to find one medication out of 3-4 recommended medications for this condition, which helped some but didn't fix the problem. She was going to require treatment by an ophthalmologist if she was going to keep her vision. I discussed this with the patient and her family. The family decided that they did not want to have the patient transferred, nor did they want to take her themselves, despite understanding that she would likely be blind in her affected eye without treatment. I believe it may have been related to financial concerns, however, they would not tell me this. Care in the national hospitals is free; the family only has to pay for transfer to the hospital (which is 200Q or about $30). The patient left the hospital with her family, with a bottle of the only medication that we had to treat her condition and the invitation to return should they change their minds.

The second patient was a 3 year old female with abdominal pain, fever, and anorexia for one day. Her examination was very consistent with appendicitis. I discussed the diagnosis and need for treatment with antibiotics and surgery with the patient's mother and grandmother. They declined any treatment of the child until they were able to discuss the problem with the child's father, who was out of town for a few days and not able to be reached. Despite repetitive explanations about what could happen to the child without treatment and pleas to at least allow antibiotics to be given until they were able to reach the child's father, they left without any treatment.

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