August 22, 2009

Frist Update and Expectations: Written on the plane to Shanghai

Just getting used to the new Prius. I am taking a lot of heat from my family who see me more the Tahoe or Suburban type. It was tough trading my 1992 Suburban (my only car) because of the family memories that centered on that car. I had saved some money back in ‘92 by getting a two wheel drive (though I regretted it later when in DC I kept getting stuck in the snow - sometimes doesn't pay to be too cheap); it was the car the boys learned to drive in the narrow streets of Georgetown (side mirrors a little scratched). I resisted this clunker deal initially because I thought it wrong that the taxpayer was buying my new car for me, but after a few days I broke down on the moral argument of mileage, pollution, etc (and the gift of the average taxpayer!!). I always buy my cars from Lee Beaman; his dad and mine were best friends. Christi, who works with me, picked out a great Yukon for me. But I opted for the Prius - why? Because it gets 4 times the gas mileage and I want to reduce gas consumption since so much of the proceeds goes to those who feed terrorism. And it is cheap - we actually ended buying two Pri(i) - one for me and one for my brother Tommy - for the price equal to one Yukon. Still hate to see the Suburban go - and it sounds like they poison it to kill it. Ugh.

Last week Karyn and I were in Nantucket and we hosted an annual clambake for family and friends. Brother Tommy and Trisha come up each year and on Friday night he said that he was going to China in two weeks. "Bill, why don't you and Karyn join us? You know many of the Chinese leaders from your previous Senate trips there; if you were there we could explain what we are doing and what we could potentially do to the central government." You see Tommy and his son-in-law are constructing a hospital that is public-private (government is 70%) in a community about 2 hours south of Shanghai.

Karyn and I had a trip planed to Italy that was to begin on September 1; we hade never vacationed in Italy and it was time for me to take her there since most of our friends at our age that we see day to day have been there multiple times. Our summer vacations have been working and doing surgery in Bangladesh, Mozambique, Uganda, southern Sudan, Darfur, and the Congo. Doing surgery in the bush is a far cry from Florence and Venice and the Amalfi Coast (as I was reminded by Karyn); Italy is the destination this year (and no surgery). No skimping here, I called the famed travel agent Andrew Harper and said just put together the rip for us. Karyn deserves it.

So now 2 weeks before departing to Italy how was I going to get a visa for us to China and then organize a trip there? With a lot of help we did it, and this morning at 3:15am we got up to board Delta to Atlanta and then Atlanta to Shanghai to Beijing. At this point, we have no idea what the plan will be until we see the Minister of Health on Wednesday (today is Saturday in the US).

I am not a China expert, but I am fascinated by the country and when I am advising young people today I tell them to focus on China and figure out some way to go there and live for awhile. The demographics and economic direction are just too clear as we look forward over the next 30 years.

In terms of health, the central government has made a major commitment in funding health services throughout China. And though the "down-side" of central command we all know in America is lack of democratic decision making and transparency, the "up-side" is that once a decision is made there is not a fiddling around to fund and accomplish the result. So with that much boldness directed at solving health inequities and improving health services, coupled with huge investment, I knew I wanted to be in China and get the lay of the land.

We will build the next 8 days around health and healing, be open to opportunities to share our expertise, learn from their culture and approach, and then just see what happens in the future. We're in the information gathering stages ... we are not up to the "conceive it, believe it, do it" phases frequently quoted by my mentor the pioneering heart surgeon Dr. Norman Shumway.

Everyone has a bucket list and we tend to pay more attention to them the older we get. Tommy says Tibet is on his, so the group said let's go. Then we heard that the altitude is 14,000 with no acclimation; I get altitude sickness and he had a minor heart procedure two weeks ago so the doctors said wait 6 months. A relief to me because I know I would be sick. Karyn does well at high altitude (like when we hiked the Virunga Mountains on the order of Rwanda and Uganda looking for the mountain gorillas - at 12,500 feet we eventually found them but I was so hypoxic I don't remember anything we did. Karyn thrived. I should just keep my medical work with the gorillas focused on the National Zoo over in Washington, DC instead of trekking in Rwanda, which was last year's trip - I know ... that is why we are doing Tuscany and Florence!).

So now that Tibet is out, we will do a non-health side trip to Xi'an, China, the ancient walled city, once the capital of China, and often overlooked. It is now known for the unearthed Terracotta Army of Warriors and horses of Emperor Qin Shi Huang. Apparently at night the city becomes the City of Lights and an atmosphere that leans on fantasy. One article describes an 18 course dumpling banquet (at De Fa Chang). That is the extent of what I know about the area now, more to come once Karyn and I figure out to get there.

So what is the kernel behind this trip in the first place? It starts with my oldest brother
Tom Frist who founded and ran Hospital Corporation of America, the largest hospital company in the world, and his son-in-law Chuck Elcan who two years ago set out on building a hospital in partnership with the government in China. The location for the hospital (approvals and funding have been obtained) is the city of Cixi (1.8 million people in immediate area) which is in the Zhejiang Providence. Cixi is directly east of Hangzhou and is a little over 2 hours south of Shanghai (directly across the bay).

So that hospital will be built and staffed and locally run (manages using the systems that have been fine tuned by years of western hospital management expertise). If that works and works well, what would the next step be? Our trip and our meetings with the government will help answer that, so it will be fun sharing my observations with you as we go through all this over the next 8 days. What we do know is that the Chinese government is making an unprecedented and monumental commitment to its health sector; they could use, I would think, some western expertise. This is not a venture of HCA. Luckily the third partner Henry Zhou lives in China and will be our host once we hit the ground.


August 22, 2009


This morning, we awoke early to catch a 5:00am flight out of Nashville, through Atlanta to Shanghai, China. Karyn, youngest son Bryan (21), brother Tommy, his wife Trish, and his son-in-law Chuck Elcan and I are all traveling to China to explore the Chinese delivery of health care. During my time in the Senate, at the height of the SARS crisis, I led a Senate delegation to China. They were honored we would come during this period, exhibiting the United States’ trust in the Chinese government to handle this unknown crisis.

      Today, we have a 14 hour flight to Beijing. Once there, we look forward to meeting the new Ambassador to China, Jon Huntsman, Jr. as well as the Minister of Health. We will be in Beijing, Shanghai, and Hong Kong over the next week. And, I’ll be blogging daily with updates on events and health care in China today. Stay tuned…


Overcoming Obstacles to Keep Girls in School: Sustainable, Environmental, and Economic Practices

by Anita Henderlight

August 18, 2009

Shortly after NESEI opened our first girls' boarding secondary school in South Sudan, we observed that many of the girls skipped classes routinely each month. Why? Because they did not have necessary supplies for comfort or cleanliness during menstruation. Most were using leaves or old rags to absorb their flow.

We began to supply the students with "comfort kits" - disposable sanitary products imported from more industrialized countries. They met our primary goal - keeping our girls in school.

We soon realized that we would eventually spend more on comfort kits than tuition fees and that we were creating a disposal and environmental problem in a community that had no functioning way to deal with garbage. We needed a financially and culturally appropriate solution - one that would keep girls self-assured and in class.

Thus, the NESEI sanitary pad sewing project was born. A generous group of people from York, South Carolina, invested $250 in a treadle sewing machine and donated patterns, fabric, thread, and needles. Our students begin making their own sanitary pads.

The locally-made pads are absorbent, soft and inexpensive to make. And because they are reusable, they are environmentally and community friendly.

In the first two months of the sewing project, the students made 500 pads. School attendance and personal hygiene have improved. And now the girls are coming up with a plan for a small business packaging and selling surplus pads to girls and women in the surrounding villages.

NESEI hopes to build capacity so we can help the girls market pads to other NGOs working in South Sudan. The girls will use the extra income to purchase additional scholastic materials and other needed items.

The sanitary pad program is another NESEI example of empowerment at work - a small investment is giving our girls the opportunity to find practical solutions to real problems.

In September, NESEI will launch a new, updated website ( with information about the sanitary pad project and other programs which are contributing to the improved health and welfare of our young Sudanese friends.

**NESEI is a proud partner of the HTHH Global Health Coalition.



Glenn Quarles, Global Health Scholar

Munsieville, South Africa

August 17, 2009

Loni and I have continued our work on the Munsieville Survey and rapid needs assessment data collection. We can now officially say that our Munsieville Survey is fine-tuned and ready for implementation. Each survey takes about 45 minutes to an hour. I mentioned in an earlier update that Project HOPE had planned to get 1000 surveys. Well, thanks to some mathematical wizardry on my and Loni's part, we discovered that we would only need about 400 surveys to get the same statistical power (something that SIGNIFICANTLY cut on costs for this project). So, with 10 hired surveyors it would take a little less than 2 weeks to complete data collection.

Unfortunately, due to government holidays and political unrest, we will not be able to implement the survey before leaving South Africa. However, we have drawn up a strategy for implementation to help things go more smoothly for our boss, Stefan, when he finds the time and resources to carry it out in the next month or so.

As Loni mentioned in an earlier update, we have been continuing Project HOPE's ongoing quest to find a suitable location for its Munsieville Model by conducting rapid needs assessments in the informal settlements of the Randfontein area. Most recently, we have been shack counting and surveying in Big Elandsvlei (this is in addition to Master, Jabulane, Elandsvlei Klein or "small", and Zenzele). They call it "Big" Elandsvlei because it has more land than the other Elandsvlei settlement, though this in itself is misleading. We counted a total of 210 homes there, whereas at Elandsvlei Klein there were 350 densely packed onto a smaller plot of land. Elandsvlei was a bit different from the other settlements in that it had no formal system of sanitation, not even latrines. Nearly everyone used a bush toilet (i.e., dug a hole in the woods). One of the women we surveyed informed us that rape is a big problem when using the bush toilet in that settlement, something I'd never even considered before.

Due to the aforementioned political issues, there have been many strikes occurring throughout the entire country of South Africa, including both municipality workers and even physicians. The municipality worker strike has had a grave impact on the people living in informal settlements who have to rely on the water tanks to survive. Already residents in Big Elandsvlei were reporting to us that they'd been without a water tank refill for the past three days. Besides a dwindling supply of drinking water, this has had other impacts on the residents, specifically the children. They have not been going to school because there was not enough water to bathe or wash clothes. The parents are consequently refusing to send their children to school because of it.

In spite of the municipality strikes and the resultant disruption in services, we haven't had any issues with our rapid needs assessments. Big Elandsvlei is the last settlement Loni and I were tasked with surveying. Naturally, being interns, we were given the sacred responsibility of doing data entry for all of the surveys we have collected. We are nearly finished with inputting data for the 185 caregivers and 266 children in the above 5 mentioned settlements. Once finished, we'll hopefully have a preliminary analysis completed for Project HOPE before leaving for the States.


Senator Frist said "I fast to send a message to fellow leaders, fasters and activists that we must definitively address the cause of the ongoing violence and persecution in Darfur. It is an affront to our compassion, our decency and our very humanity that the government of Sudan has put racism, political and financial interests ahead of its people. I want the refugees in Darfur to know they are not forgotten and that we will not give up until we see peace come to our Sudanese brothers, sisters and children."

From Tanzania: Update from Krista Ford

August 10, 2009

           I haven't had the chance to go on anymore exciting field visits yet, but I have become more familiar with how NGOs work. My supervisor has been out of the country for the last two weeks and consequently I've been given a lot more responsibility. For example, I lead this month's meeting of the Quality Improvement Task Force. The Q.I. Task Force meets monthly to discuss issues pertaining to the quality and guidelines of the care and support of orphans and other vulnerable children (OVC) in Tanzania. My supervisor is a co-chair on the task force and she usually hosts the meeting but I led the meeting in her absence.  The task force is in the process of developing national guidelines for quality improvement of OVC care as well as a household status tool to be used in assessing the household conditions of OVC. The discussion about the process of creating and revising the documents gave me insight into how national guidelines for development work are established and the relationship between governmental ministries and non-governmental organizations.

            I was also invited to the Implementing Partners Group meeting in my supervisor's absence. This monthly meeting is a chance for NGOs and CBOs operating in Tanzania to come together and share best practices and lessons learned. At the meeting we discussed everything from a recent trip to Egypt to share promising practices to progress made on incorporating children with disabilities into mainstream education. I had assumed, since most NGOs target specific issues and populations, that they work independently but the IPG meeting revealed the interconnectedness of Tanzania's NGO community. So many of the NGOs/CBOs rely on each other as partners in implementation that they seem more like a network than a group of independent organizations.

            My next field visit is currently scheduled for September. I will be heading to Iringa (one of Tanzania's colder regions) to visit beneficiaries and implementing partners. My co-workers have been warning me that I will need to purchase a heavy jacket! I'm enjoying getting to know my co-workers here in the office and partners at other organizations but I am looking forward to traveling to other parts of Tanzania and witnessing the impact of OVC programming in the field.

Senator Frist's first trip in Medical Missions was with Dr. Dick Furman and World Medical Missions, an affililate of Samaritan's Purse.

Samaritan's Purse has been doing good work in Sudan for some time. I thought it appropriate to highlight their work, in support of their continued efforts, here as we focus on Sudan this month.

Sudan: Samaritan's Purse

During decades of vicious civil war, more than 2 million people lost their lives and thousands of communities were destroyed. Samaritan's Purse has been helping the people of Sudan since 1997, by providing food, shelter, clean water, agriculture assistance, education, medical aid, and vocational training programs. In Darfur, we have fed 220,000 people who were forced from their homes by government-backed militias. In 2005, we launched a major church reconstruction project for Christians in South Sudan who suffered violent persecution.

For more CLICK HERE.

Franklin Graham called for a Day of Prayer for Sudan, August 1. He has requested prayers for the following:

• Omar Hassan Ahmad al-Bashir, President of Sudan

• Salva Kiir Mayardit, President of Southern Sudan

• A peaceful election in January

• The vote on independence for Southern Sudan in 2011

• Revival and prayer in local churches

• Lasting peace throughout Sudan

We welcome your comments.

Senator Frist has a forthcoming book that will release October 5: A Heart to Serve: A Passion to Bring Health, Hope, and Healing

In Chapter one, A Mission of Mercy, Frist shares his experience of flying into Lui, Sudan, under the radar, to perform surgery in a conflict zone. This experience was a foundational one which shaped his understanding and philosophy of health diplomacy and how offering health care can be a currency for peace around the world.



Don't forget to order your copy of the book on!



July 17, 2009

Dar Es Salaam, Tanzania

My first two weeks in the office at Africare in Dar es Salaam, Tanzania have been surprisingly busy. In fact, on my first day I was asked to accompany two co-workers on a five-day trip west to Dodoma. In Dodoma we met with representatives from the other partner organizations involved in the COPE project. We also had the opportunity to visit a household and evaluate the impact of the aspect of the COPE project designed to assist orphans and vulnerable children (OVC) households in generating income.

From Dodoma we drove three hours north to a small, rural town called Kondoa. It was pretty slow going since the roads were rough and rocky but when we got there we were escorted through the village to a specific household. Behind the house there was a small chicken coup with about six chickens and a pile of eggs. A community member explained that they would raise the chicks that would hatch from the eggs and sell them at the local market as a means of generating income.

The trip opened my eyes in more ways than one. Most of my time in Tanzania has been spent in major cities, so it was my first time visiting a village and seeing how people live in such a rural setting. Also, it was great to witness the direct impact of the program and to get an understanding for what kind of people the COPE project is serving.

Although I'm back in the office now, I enjoyed my time in the field and I'm looking forward to my next trip to Dodoma. I should be headed out there around August to administer a series of surveys designed to assess the impact COPE has had on the community it serves.

See where Krista is traveling -- Map of Tanzania: CLICK HERE


Project Hope

Jul 13 2009

We have made significant progress on the Munsieville Needs Assessment. After several drafts and two field tests, a final version of the survey was created. Our survey covers 11 topics that include health indicators such as housing, income, health behavior, and reproductive health. Our specific questions aim at health attitudes, general health knowledge and accessibility to health care and government services.

As we continue with the Munsieville Model, we must evaluate other settlements in the area for additional or alternative sites for Project Hope to establish programs. With the help of a local minister and director of a substance abuse center, Dave Gardner, another American, we have established contacts in Randfontein, a nearby city. We were introduced to Lucky, an eccentric Obama fanatic that is also the political representative of all of the informal settlements in one of the wards of the West Rand district.

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