Today, I joined Save the Children, the US Coalition for Child Survival, the World Pneumonia Day Coalition and Vicks at a breakfast reception on Capitol Hill to recognize the first annual World Pneumonia Day, a day for people everywhere to turn awareness into action to control the #1 killer of children under age 5: pneumonia. Each year, a disease which often starts as a cold, claims the lives of nearly 2 million children under age 5 -- more than malaria, AIDS and measles combined. Despite this staggering death toll, childhood pneumonia has never been a global health priority, and the current basic maternal child health programs --that need to be in place to control the disease-- are under-funded.

by Jenny Dyer

November 4, 2009

How can art save the world? Photographers have the gift to capture a moment of beauty. And, capturing moments of beauty for a person who has never known s/he is beautiful, can give life back to the most downtrodden of spirits--proving everyone holds a spark of the imago dei.

Jeremy Cowart wondered how he could give back, offering his gift of capturing the lovely in those who may have never seen that loveliness. His Help-Portrait movement has sparked interest around the world to provide photos to those individuals and families in need. His website provides the tools to do the following:

1. Find someone in need

2. Take their portrait

3. Print their Portrait

4. And Deliver Them.

If you're a photographer -- check out this movement. Your art could change the world. Consider joining the community:

What does Help-Portrait Look Like?

 

"Henceforth, simply the nappy."

One of the most delightful things about being in Kenya is participating in the odd mix of African bush culture and English propriety. It's what remains of the colonization of this land by the British, I guess. And it is quite nice.

For example, we all have dusty feet peering out of rubbery ‘flip-flop' like sandals in the operating area, yet we refer to the OR's as ‘theatres', and we adjourn to ‘take tea' at the proper intervals throughout the day. The Kenyans put every coffee house in the developed world to shame with their ‘chai': a creamy, sweet cup of goodness scooped from a boiling pot of tea leaves and milk, fresh from the cow, brought to the hospital that morning in a plastic bucket. It is just so very civilized and so very African. And it is mandatory, I am beginning to understand. In this picture, you can see me having tea with some of the nursery and maternity nurses. I had just given them a lecture about neonatal warning signs in the delivery room, and I was prepared to whisk away to the days doctoring tasks. They insisted that I sit and have tea. It's the proper, Kenyan way.

The influences of the Queen's English and Kiswahili also manage to trip me up on a daily basis. Example 1: intern says to Dr. Amy, "this preterm is receiving 8ml feeds, two hourly, and is retaining." Dr. Amy blinks thinking, "retaining? Is retaining good or bad?" Example 2: same intern pouts over a squeaking, stridorous baby. "Oh, he is lamenting," she says. And I think, "man, I wish I used the word lamenting." Example 3: A few days ago I noticed that there was an odd pile of gauze taped around baby Hawa's ostomy which was causing the liquid stool output to severely irritate his skin. So I asked one of the nurses, "could we stop using the dry gauze and only use a diaper from now on?" The nurse replied, "So, henceforth, simply the nappy?" "Uh, yeah, simply the nappy. Thanks."

Perhaps my favorite experience yet should have a photo but I must try words instead. I was chatting with Dr. Gary in the hospital corrider, and as we were talking, a Masai grandmom walked past with her infant grandson in a sling on her back. The little guy was healing from a chemical burn of his head, and he had even lost most of his left ear. After multiple skin grafts he still had bright pink under-flesh covering most of his head. It was a patchwork that looked like freshly groomed farm land: little squares of different soils in pinks and browns. His grandmom was covered in beads, ear lobes hanging low from a piercing type process, dark black feet flat against the hospital floor and the little guy, peering up to catch our eyes... then he giggled and hid from us in the folds of his grandmother's clothes. His happiness took over the air around us. I could not understand how such a little boy (two years old) could have so much pain-- so much to cry about -- and yet so much joy! Later I found out that this patient, Ralian, is Jim's patient. Jim is his surgeon, and he is Jim's favorite. Ralian's grandmother has said that she wants to return to visit us before we leave so she can give Jim a reward for taking care of her grandson.

So far, I have been blessed to enjoy my time here in ways I could not have foreseen. It is simply "well with my soul," as the old hymn says. And still, I am a creature of luxury, and I miss all the lavishness of my home in Colorado. Gary Finke, the pediatrician of the past 2 years, leaves roughly the same time we do. So as the days march forward and we get closer to hugging our families, our friend Stephany gets closer to being the sole pediatrician at this busy children's hospital. Her fear of taking on this mighty task is always behind the scenes. She is weary, and it is hard to leave her behind. I am asking now, reader: please pray for reinforcements for Stephany. Pray for courage and joy and wisdom and sleep for her. If you are a pediatrician - consider coming to help her. Even just a few weeks would lessen the load and give little lily pads of rest during her 2 year commitment. You will be a blessing and you will be blessed!

I have a tendency to count down days until the end of different periods of life. A physician in Nashville once advised a group of us not to wish away our lives during residency, and I hate to admit that I sometimes have that tendency, although not just in residency. Recently I have been simultaneously struggling to not count down the days until I return to my own indulgences (warm bath, constant electricity, reliable phone line to call mom and dad) and dreaming of returning to live out my days here.

I said in a previous post-my first post from Kijabe in fact-that life here is simple, hard and lovely. It is simple, and it is hard in many ways. That is true. But in the end and above all, life here is lovely.

 

 

  

1) Patient Beds

2) Hospital Compound where families clean clothes and make food for patients

3) Ingredients for Hand Sanitizer

It has been one month since I arrived in Rwanda and I am continually amazed at the obstacles my patients and coworkers face. The work can be very frustrating. Everyday I see ways to keep people alive and reduce the severity of illnesses, but implementing change is never easy, especially when resources are extremely limited.

One particular frustration is the lack of hand washing by the medical staff. An estimated 60,000 in Rwanda are infected with illnesses in hospital, which are called nosocomial infections. Nosocomial infections are often caused by health providers not having properly washed their hands. They significantly increase patient death rates as well as costs to the patient and hospital. I have seen diseases being spread in our hospital and the staff seems to accept it as normal.

All the nurses and physicians know they are supposed to wash their hands between patients, but it just is not practical. There are no sinks in the patient rooms and the nurses have to move quickly from one patient to the next to provide care for everyone. There is only one sink per floor, and it is located very far from the patients. A great majority of the patients have infectious diseases such as HIV, tuberculosis, intestinal parasites, and infectious hepatitis, so hand washing is especially important.

After two weeks of frustration I found a solution. Hand sanitizer is an effective way of killing most germs and does not require running water; unfortunately it is too expensive for the hospital to purchase. With some research I found some recipes for homemade hand sanitizers that costs a fraction of the price of commercial products yet are effective disinfectants. I tested recipes until I found one the staff members like the most. I am now working with the chief of nursing to ensure that the hospital can afford to make it in sufficient quantities indefinitely. This is only a small change but I believe it will result in a significant reduction of infections passed from patient to patient and to the workers themselves. My hope it that they not only continue to use the hand sanitizer but that this will begin to instill confidence that there are ways we can start to limit unnecessary hospital born infections.

 

 

Global Health Essay Contest

October 23, 2009

The Center for Strategic & International Studies Commission on Smart Global Health is calling for essay submissions. The essay seeks to answer the vital question, “What is the most important thing the U.S. can do to improve global health over the next 15 years?”

Essay submissions must be between 500 and 800 words are due at midnight EST on November 20, 2009. CSIS is so dedicated to answering this question that they are offering a $1,000 scholarship for the winning essay.

We encourage you to submit your philosophy and your thoughts on how the U.S. can improve Global Health, ultimate to aid in achieving the Millennium Development Goals.

Spread the word. Tell your friends.

Check out the Smart Global Health website for more details.

Saving a Life: Meet Olken Foncime, a Haitian Orphan

 

By Jenny Dyer

 

  

           

     

Christian Gilbert, M.D., Associate Medical Director of International Children's Heart Foundation (www.babyheart.org) in Memphis, TN connected with Senator Frist about a year ago to let us know the great work he was doing: providing pediatric cardiac surgical services and education to the children and health care providers in developing countries around the world.

 

We invited the International Children’s Heart Foundation to join the HTHH Tennessee Global Health Coalition, and he and his wife attended our first Gathering at the First home September 29, 2009. I had been apprised by Senator Frist of a situation in Haiti, where a young orphan, Olken, was suffering from congenital heart disease, Tetralogy of Fallot, and would likely die without immediate surgery. In meeting Dr. Gilbert for the first time, I asked him what the likelihood of his reaching this child in rural Haiti would be.

 

I’ll let Christian relay the rest of the story through his letter:

 

Jenny,
This story begins with a letter to Senator Frist which you answered and as a result invited me and ICHF to participate in the HTHH foundation. That led to an invitation to the gathering at the Senator's house. There I found out about this Haitian orphan in need of heart surgery from you.

 

I checked it out with my director and the director of the program in Dominican Republic, where I was headed for a two week mission and got the OK to help him on our mission to the DR later in the week. That set the wheels in motion and before too long I had pictures of him and his caretakers and knew his name, Olken Foncime.

 

He arrived in the Dominican Republic on Wednesday the 7th of October with his guardians, Marc, Leslie, and Pauline. When I first met him I was stunned at the profound degree of cyanosis, and equally impressed by his gentle sweet demeanor. He quickly became everyone's favorite. He was a high risk surgery with an estimated mortality risk of 15-20%. I reminded myself that it was 100% without it. He needed some things done before we could operate on him such as antibiotics and exchange transfusions because his hematocrit was 80, with normal being around 40. His blood coagulation was so abnormal the anesthesiologists was reluctant to put him to sleep for the IV line to do the exchange transfusion. Because he was so sick it was decided that rather than try a complete repair which carried a very high mortality risk I would do a shunt procedure and defer the total repair for a time when he was not so sick and had a better chance of survival.

 

On Monday October 12th he was taken for a Blalock Taussig shunt. He did very well with the operation and for the first time in his life he had pink nail beds and lips. In the picture, he is bravely holding onto his teddy bear and heart just a few hours after his surgery.

 

 

      

 

He is now 3 days post op and is starting to open up and smile and eat some food. All of his IV lines and drainage tubes are out and he has been transferred to the regular ward. It is my expectation he will be ready to return to the orphanage on Saturday or Sunday. I hope that some time in 2010 we will be able to bring him back for a total repair. We all have been blessed by this child and his caregivers who demonstrate amazing love and selflessness. God put us together and I give him all the glory as we are simply his servants here on earth. He clearly has a plan for this beautiful little boy. Thank you for bringing his story to my attention. God Bless.

 

Christian

 

…Sometimes little miracles happen through the most simple of circumstances. Building partnerships is crucial for saving lives, like Olken's, around the world. This is just the beginning of what is possible with a robust, well-connected coalition...

    

News travels fast in small rural communities, and the word about the women's clinic is quickly getting around. Women from the community women's groups have been bringing their sisters, daughters and neighbors. Each patient exam has been taking about an hour, as it includes a full history and physical. The appointment also includes an explanation of female anatomy, how a Pap smear is preformed, and how it is used to check for the changes caused by human-papilloma virus (HPV) which can cause cervical cancer. Many of the patients have never had a pelvic exam or Pap smear so teaching has become a large part of every appointment.

Primeros Pasos's mission includes increasing education about methods of disease prevention. Though it is common practice that Guatemalans only come to the clinic once already very ill, Primeros Pasos women's education program is doing a great job promoting wellness and annual check-ups. Some patients have come in for symptoms of anemia related to heavy and irregular menstrual bleeding, however many healthy feeling women have come in specifically for their Pap smear and annual physical. Currently, the Primeros Pasos clinic has the ability to process a handful of laboratory tests in house. Unfortunately, the Pap smear is not one of them. Where as many of Primeros Pasos volunteers are being trained to identify intestinal parasites from stool samples, or run different blood tests, a Pap smear slide must be read by a trained cytopathologist. Therefore, the Pap smears are being processed at a lab in the city of Xela. Once a week I take my bundle of Pap smears to the lab in the city. Each Pap smear costs 25 Quetzales, which is about the equivalent of three American dollars.  It's amazing how three dollars can make such a difference in the lives of these women.

Cervical Cancer has been the hot topic the last two weeks. Rightfully so, as it deserves a lot more attention than it ever gets. In the United States, we almost never hear of deaths from cervical cancer because we have so many methods of early detection already in place. However, according to the American Cancer Society global cancer statistics report (2002), cervical cancer is the second most common cancer among women worldwide. In select countries, such as Guatemala, cervical cancer ranks even higher as the number one cancer among women with a reported rate of less than 10% of women receiving regular screening (Ministry of Public Health and Social Aid of Guatemala, 2003). Many myths and misconceptions about cervical cancer exist in the rural communities. The last two weeks I have helped teach phase two of the women's education curriculum, which focuses on women's health issues such as uterine, ovarian and cervical cancer. In the past many, most women have lumped all the aforementioned together as the same "women's cancer" that is rarely spoken about due to fear and stigma. Through the women's education program, the myths around cervical cancer are slowly being unraveled and addressed.

The patients are not the only ones inquiring about cervical cancer. The buzz among the Guatemalan medical students prompted a lunch lecture dedicated specifically to the topic. Upon request, I will now be running a weekly lunch lecture on the essentials of obstetrics and gynecology. The new group of medical students is inquisitive and hard-working. They have already made huge leaps and bounds in their time at the clinic. I am working closely with the two female medical students to teach them to perform women's health exams. It is very culturally taboo for females to be treated by male healthcare providers for any issues related to women's health or pregnancy. So although I am foreign, my presence is accepted because I am female. Each day I hope to slowly build my patients' trust, which is the biggest thing that you can ask for as a foreigner in the Valley of Palajunoj, in a country like Guatemala that is still feeling the aftermath and distrust of a 36 year civil war.

For More Photos, Go to:  http://primerospasoswomensclinic.shutterfly.com/

Pretty sure I have fleas. Jim found these two little guys buried deep in my hair and wriggling up itches everywhere. Now I learn that the previous neonatologist had also acquired some type of stow-away and so would not sit on the mom's beds or wear his white coat thru maternity. But what am I to do? The mom's wait longingly as I speak to the woman in front of them. The want attention for their babies and for their concerns. They delight when the blond mazungu doctor hugs them and stops to visit. Maybe if I were here long term it would be different, but for just six weeks, though its not very lady like - I guess I'll have fleas.
The past two weeks have been an absolute whirlwind. After overnighting in Antigua I took a small bus for five hours up the winding mountains into the western highlands, finally arriving in Quetzaltenango. Quetzaltenango was and still is a principle center of Maya Ki'che and is often referred to by its Ki'che name Xelaju and abbreviated to Xela. Xela is a large city seemingly disconnected from the surrounding cities but by small winding dirt roads which the revamped and repainted yellow school buses ride along. Most women in the city still dress in traditional Mayan clothing, which becomes even more prevalent as you head out into the country side. Every morning we take the unmarked school bus from the bus stop at the Calvario Church into the mountains of Tierra Colorada Baja. Outside the church, venders sell flowers freshly cut from the mountains and beans and eggs out of street charts.

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