With your support, Hope Through Healing Hands has been able to raise over $420,000 to help those impacted by the Russian invasion into Ukraine

Last spring, Hope Through Healing Hands helped facilitate 85 pallets of needed medical supplies, which were picked up on March 19, 2022 by a Polish Air Force cargo plane at Berry Field in Nashville and flown directly to Poland, where they were received by the First Lady of Poland Agata Kornhauser-Duda and distributed throughout eastern Poland and Ukraine. The remaining supplies were picked up by the nonprofit Samaritan’s Purse at the end of March and flown into Poland for delivery throughout eastern Poland and Ukraine.

Receipt of medical supplies from Tennessee by the First Lady of Poland and Polish government.Receipt of medical supplies from Tennessee by the First Lady of Poland and Polish government.

In addition, Hope Through Healing Hands has partnered in supporting the on-the-ground work of Samaritan’s Purse and the International Rescue Committee (IRC).  Samaritan’s Purse is a nondenominational Christian nonprofit organization that has helped meet needs of people who are victims of war, poverty, natural disasters, disease, and famine since 1970, and HTHH has a nearly two-decade history of collaborating with the nonprofit on medical mission trips and aid initiatives. 

Since the very beginning of the conflict, Samaritan’s Purse has been deploying disaster relief teams, medical facilities, and vast amounts of supplies to the region with the aim of saving lives and relieving suffering among Ukrainian families. From March to mid-June of 2022, the nonprofit established a 58-bed emergency field hospital in Lviv (which treated up to 100 patients a day in its emergency room and conducted up to 10 surgeries a day in its operating room), and established two additional emergency clinics in southern and central Ukraine. (Your support enabled us to get funding to Samaritan’s Purse in the immediate days after they first opened their field hospital).

This fall, they stood up an emergency field hospital in a newly liberated area to provide much needed medical care. Through their medical supply airlift program, they have supplied 115 Ukrainian hospitals with critical needs including pharmaceuticals and bandages. And by working through a large network of 2,000 local church partners, have distributed 102 million pounds of food, over 23,000 blankets and 44,000 solar lights, and produced 31 million liters of clean water.

 Samaritan's Purse field hospital in UkraineSamaritan’s Purse field hospital in Ukraine.

The International Rescue Committee, a nonprofit that has a nearly 90-year history of responding to the world’s worst humanitarian crises, also received support from HTHH for their Ukraine efforts. The IRC has been working to ensure people affected by the war in Ukraine are able to meet their immediate and basic needs with safety and dignity by providing emergency cash assistance to conflict-affected individuals, and distributing survival essentials, such as hygiene kits, dignity kits for women and adolescent girls, kits with learning and healing materials for children, and household or shelter items, as well as provide housing support for over 3,500 affected families.

The IRC has offices in 5 cities and works both directly and with local partners to provide humanitarian assistance to people living in the east and south of the country, where fighting is currently the heaviest, the temperatures will drop lowest this winter, and the needs are most dire. They are actively implementing activities in 10 oblasts (aka provinces) with a winter distribution program to help families, which Hope Through Healing Hands has helped support.

In December, at the request of the Ukraine Ministry of Health, our chair and founder Senator Bill Frist facilitated an observership for a multidisciplinary team of Ukrainian transplant physicians at the Vanderbilt Transplant Center, the busiest heart transplant center in the world (which Frist originally founded in 1989). Hope Through Healing Hands helped sponsor the Ukrainian physicians’ travel to Nashville, where they learned from Vanderbilt physicians how to improve outcomes in their nascent heart transplant program, and how to set up a lung transplant program in their nation (where only a single case of lung transplantation has occurred). These doctors have been performing surgeries by flashlight or limited generator power, treating a surge of wounded soldiers, and routinely find themselves sleeping in the hospital for days – often with their own family members serving on the front lines or being separated for long months with their children having evacuated to other nations.

Senator and Tracy Frist meeting with Ukraine transplant teamUkrainian physicians meet with Senator Bill and Tracy Frist at their home in Franklin, TN.

Senator Frist shared of the learning exchange, “We were able to start and create a world-leading Transplant Center at Vanderbilt over three decades ago because we learned from other centers of excellence. This week, Vanderbilt shared with our Ukrainian counterparts the cutting-edge medicine of our nation, so they can stand up their own best-in-class program thousands of miles away in the midst of unfathomable circumstances.”

You can read more about the Ukrainian transplant team's experience in this three-part series in the Nashville Business Journal entitled, "Operating in Darkness": 

Finally, Hope Through Healing Hands is directly aiding Ukrainian refugees resettling in Middle Tennessee.  Two families who left everything behind to flee to the U.S. have received direct support from HTHH to begin rebuilding their lives here in Nashville. We’ve also provided grant funding to the Nashville International Center for Empowerment, the largest refugee and immigrant resettlement organization in Middle Tennessee, to support the economic, linguistic, and civic integration of Ukrainian refugees, removing barriers to employment, housing, transportation, education, and other needs.

We will continue to support humanitarian aid efforts in Ukraine in 2023, and are investigating partnerships to provide direct aid on the ground with the relationships we’ve developed with the Ukrainian transplant surgical team, and through other humanitarian organizations.

We are immensely grateful to and humbled by our donor community who responded overwhelmingly to meet the needs of the Ukrainian people in unimaginable crisis.

To continue to support our efforts in Ukraine, visit: https://www.hopethroughhealinghands.org/donate

You can also mail a check to:  

Hope Through Healing Hands, P.O. Box 158554, Nashville, TN 37215

Welcome back! After meeting with the leadership of all the IRBs, we decided to have a four-part series with the members. The first session began with introducing the current institutional review board structure in Liberia by the Regulatory Compliance and Ethics Manager of the John F. Kennedy Medical Center, Kokulo Franklin. After having written a thesis on the ins and outs of the Liberian IRB structure, Kokulo laid out an excellent potential national plan for the organization of the IRBs.

After Kokulo’s presentation, I presented the results from the needs assessment that we had conducted previously. I began my presentation by outlining the purpose of the needs assessment, which was to provide an up-to-date analysis of the strengths and needs of Liberia’s current research ethics review infrastructure. I then moved onto discussing the makeup of each IRB and the standardized protocol documents that each IRB had or did not have. From there, I discussed the demographics of the committee members and what they wanted to learn. For example, the top three research and research ethics topics that members wanted to know more about were ethical principles in research, international guidelines in research, and research with vulnerable populations (children, prisoners, etc.)

I closed the presentation by discussing essential points that will guide how we structure the rest of the sessions with the committee members. It was a fantastic experience getting to present my findings to all the IRBs. I wanted to create an engaging presentation, so there were times where I stopped and asked questions of the members. These conversations become valuable because I learned more about each participant as well as what the IRBs needed. Below are pictures of my presentation!

In the next session with the members, we will be discussing informed consent and how to work with vulnerable populations.

Noor Ali blog2

Hello! My name is Noor Ali, and I am now a second-year Master's in Public Health candidate on the Global Health Track! My practicum experience is helping to build institutional review board capacity in Liberia. I am working alongside Dr. Troy Moon, Dr. Elizabeth Heitman, and Dr. Marie Martin. This project was funded through the USAID PEER Liberia project and serves to provide an up-to-date analysis of the strengths and needs of Liberia's current research ethics review infrastructure, including evaluation of organizational processes, human resources, as well as relevant laws and policies in ethical research within Liberia's biomedical research institutions as seen by committee members.

My work started at the beginning of January when I was tasked to evaluate data and create a needs assessment report, which laid the foundation for our work. From there, we set up meetings with our Liberian colleagues to discuss our path forward. There are currently three established IRBs within Liberia and two that are new. After our discussion with our colleagues, the team decided to create a two-part training session. The first part was going to be with the leadership of each IRBs. Dr. Moon traveled to Liberia while the rest of us joined in virtually for the two-day conference with the administration. Below are pictures of that event. 

I have enjoyed working with our Liberian colleagues and look forward to working with them in the future. After the conference with the leadership, we will have a four-part session with the members of the IRBs and discuss critical steps forward. On day one of the member's conference, I will present the needs assessment results.

Statement for the Record Submitted to the U.S. Senate Committee on Foreign Relations Hearing: "COVID-19 And U.S. International Pandemic Preparedness, Prevention, And Response: Additional Perspectives" 

June 30, 2020

Senator Bill Frist, MD

Chairman Risch, Ranking Member Menendez, and other Members of the Committee, I am pleased to be given the opportunity to provide the Committee with my thoughts on global health security. I served for years, and I am grateful that you are taking up this critical topic.

Health is perhaps the most unlikely of topics to rise to the very top of our national interests globally and for consideration before the Committee. Because the ability of other countries to prepare for and respond to outbreaks directly affects our own health security, the pandemic compels us to rethink how we approach development assistance, cooperation, innovation, and international organizations. We now understand that the parts of the government over which the Committee has authority and oversight are not simply for development and diplomacy, but for our national security.

In 2005, as Senate Majority Leader, I gave a series of speeches regarding the necessity of preparing for a pandemic, proposing a six-part readiness plan. We were not prepared then, and while we made some progress, we were not prepared when it arrived this year. We are learning hard lessons, but important lessons about how to organize our government and prioritize our effort, and I am pleased to be able to contribute to that effort.

On December 8, 2005 at the National Press Club, I said, “A viral pandemic is no longer a question of if, but a question of when. We know— depending upon the virulence of the strain that strikes and our capacity to respond—that the ensuing death toll could be devastating.”1

My 2005 remarks were not a prediction, but a warning based on historical and medical facts. Awareness of the threat made it into popular imagination then, but it has escaped political will until now. Remarkably, the requirements are the same 15 years on because the threat is the same. Now is the time to put into motion for the next pandemic what we’re learning from the COVID-19 crisis.

Global Health Security and Domestic Health Security are One in the Same

The first great policy challenge is to point out the dangerous distinction often drawn between global health security and domestic health security. The distinction has contributed to our vulnerability. Our health security depends on the ability of all countries to detect, report on, and respond to outbreaks. Shared vulnerability requires a shared defense. That defense is only as strong as the weakest link.

While not necessarily intuitive, a huge part of effective infectious disease surveillance is maintaining federal support of global health. The next zoonotic disease transmitted from animals to humans will likely come out of Asia or Africa. The ability of developing nations to detect, track and contain a novel virus will be inextricably tied to the capacity of their own public health infrastructure, something that is vitally dependent on U.S. support. And their willingness to mutually share that critical infectious disease surveillance information and allow our scientists to reliably participate in its interpretation will depend on the integrity and trust of our diplomatic relationships.
Our national health, when it comes to recurrent deadly viruses and pandemics, depends on global health. While COVID-19 needs a “whole of government” approach that considers and coordinates both domestic and international response needs, it is exceptionally challenging to operationalize as the domestic–international divide is so fundamental to our laws and government and engrained in practice and thinking. The Federal Government is not structured in a way that allows for essential planning and coordination across accounts, departments, agencies, and authorities. Significant gaps exist between and among the collection of mandates of departments and agencies, and those mandates do not in the aggregate provide a capacity that is up to the job.

To ensure a comprehensive federal approach to global health security, Congress's fractured global health jurisdiction (which spans at least 10 different committee and subcommittee structures across both chambers) should be rectified by the establishment of separate bipartisan special committees or formal working groups that provide a coordinating, overarching vision for the regular committees of jurisdiction.
Additionally, the White House Office of Management and Budget should establish a senior staff role to ensure consistency of health security funding and management decisions across all agencies and accounts—domestic and international—as the George W. Bush administration did effectively.

Health Defense Funding is More Than Foreign Aid

Another challenge on the global side – the core business of this Committee – is that the programs necessary to address U.S. global vulnerability and threats are treated as foreign aid instead of strategic health defense investments. We have relied on emergency supplementals and ad hoc organizational structures. Observing closely for the past 25 years, I conclude – like our armed service defense – we must have predictable, consistent base funding for our public health security programs. We must remind ourselves that development assistance is actually a real national security imperative and not simply a so-called “soft power” instrument of subtle persuasion or a humanitarian imperative. Health security is national security, so let’s treat it as such.

We typically commit about one percent of federal resources to international assistance, but in our COVID-19 emergency packages, only one-tenth of one percent of funds have gone to help low- and middle-income countries in their COVID fight. We must recognize containing COVID globally is essential to halting its spread in the U.S., particularly as we begin to reopen our country for travel and business. (Indeed, New Zealand had just announced the eradication of COVID-19 when two infected U.K. travelers potentially reintroduced the virus, coming in contact with as many as 320 people.)

We cannot close our borders until a vaccine is developed and all 300 million Americans are inoculated. Nor can we completely shut down our economy and livelihoods. So, while protecting our own people is first and foremost, supporting global response efforts are essential to keeping Americans safe.

Viruses are indifferent to a country’s borders. Our response must be global as well as domestic.

Federal Incentives, Private Sector Innovation, and a Vaccine

One of the main thrusts of my 2005 preparedness plan was that the challenge requires much more than simply the public sector alone, and we must summon the creative force, ingenuity, and entrepreneurial spirit that we are known for an that brought us to victory in the Second World War. The role of our private sector and industry is essential to success.

But the powerful commercial markets that incentivize and drive innovation do not naturally exist for an unknown threat or in other instances where need does not provide actual demand due to poverty. Those areas are where our most acute vulnerability lurks. Addressing that vulnerability requires that the government create through policy and incentives the demand for innovations and the environment and playing field to foster it.

For example, Project BioShield when it was enacted in 2004 was intentionally an advance 10year appropriation, established to allow the government to guarantee a market for chemical, biological, radiological, and nuclear (CBRN) medical countermeasures. But since 2014, there hasn’t been an advance appropriation, and instead it is reliant on the annual appropriations cycle. That doesn’t send a powerful message to the private sector.

Additionally, we must recognize when it comes to competing global interests, it is not a zerosum situation. Today, exactly as I said in 2005, we simply do not have the domestic pharmaceutical manufacturing capacity in this country necessary to cover our own needs. The greater the capacity to produce a vaccine globally, the better off we are. Access must be addressed proactively before it is a politically explosive as well as economically and ethically catastrophic. While the World Health Organization Access to COVID-19 Tools (ACT) Accelerator has little chance of really corralling every player to share “equitably” before meeting their own needs, participation or cooperation now will at least be the point on which countries will judge one another. China will exploit the hole in U.S. engagement in at least two ways: providing products and access directly to countries and by pressing the idea that the global rules-based, capital system is the cause of any vaccine access failure. We should consider constructive ways to engage globally to counter this narrative, including participating in the Coalition for Epidemic Preparedness Innovations.

Learning from the Past – PEPFAR

Finally, I would offer that the United States has so much at hand to deploy in this effort, and we’ve made progress in ways that we don’t fully appreciate. For about two decades now, with the leadership and support of the Senate, we have led on a global health effort that has truly changed the course of history. We undertook this effort for reasons of moral conviction, charity, and of value for money and proven effectiveness among our foreign assistance programs.

The President’s Emergency Plan for AIDS Relief (PEPFAR) program provides an exceptional example of strategic health diplomacy. The theory of strategic health diplomacy is that investments in health programs have the potential not only to have extraordinary positive impacts on health, but also to advance key strategic and foreign policy objectives. And without question, this humanitarian effort has yielded incalculable diplomatic and development dividends that were never assumed or contemplated. Created in 2003 by President George W. Bush and a bipartisan group of legislators I helped lead, PEPFAR has prevented millions of deaths, including 2.7 million averted infections to children at birth, and now supports almost 16 million people with lifesaving treatment.

At its peak, HIV/AIDS was killing three million people each year – more than died in the entire Korean and Vietnam Wars combined. PEPFAR is the single largest commitment any one country has ever made to combat a disease. PEPFAR’s effects beyond public health is a topic I sought to understand as part of my work with the Bipartisan Policy Center (BPC). Our research indicates that the 2014 – 2015 Ebola outbreak in PEPFAR countries was mitigated by the health system capacity developed significantly through PEPFAR funding, including such practical tools as improved laboratory capacity that allowed for quicker diagnoses, and on-the-ground human resources better equipped to surveil, report on, and respond to a public health crisis.

Our 2018 BPC report, which I co-authored with Senator Daschle, calls on Congress to continue in the vein of PEPFAR the same dedication and effort to global health security. PEPFAR demonstrates both the essential role of American leadership in health, but also that the reasons for doing so extend far beyond what might be the original focus. We found that countries with higher PEPFAR investment have: had greater growth in worker productivity and economic development than other countries; experienced greater improvements in World Bank indicators of governance, including government effectiveness, regulatory quality, and rule of law; and had improved perceptions of the United States, which strengthens government-to-government relationships and builds the capacity for U.S. ambassadors to address other, more contentious issues.

With respect to the current pandemic, in our most recent Bipartisan Policy Center report we call on Congress to allocate additional funding to the next supplemental package to support vulnerable countries around the world. We recognize the critical importance of the funding and effort of the Federal Government thus far, but we believe that – given the continued trajectory of the pandemic – those resources are not enough to adequately build capacity and support vulnerable countries around the world.

Contagious threats cannot be treated like are exceptional, rare events. Simple facts of globalization and increasing population will increase frequency and perhaps severity of epidemic and pandemic threats. The good news is that we can invest in domestic health security capacity, multilateral health security capacity, and our ongoing global health programs for mutually reinforcing benefits.

One of the most vexing and problematic factors in our lack of preparedness is the cycle of hype and fizzle regarding pandemics. The worst predictions don’t come to pass. But the fact that you cannot prove what didn’t happen or quantify what our investments and preparedness prevented, creates a sense that our response was necessarily an over-reaction. This cycle trains us to weigh the threat less each time. We must not fall prey to that mindset again. Now is the time to act.

1) Read the full 2005 remarks here: https://www.forbes.com/sites/billfrist/2020/05/06/we-failed-to-act-on-pandemic-preparedness-after-sars--we-cannot-make-that-same-mistake-again/#46118a4e6281

I’ve been in Kijabe a little over three weeks. Yesterday I attended a special morbidity and mortality conference wherein we reviewed the preventable death of an orthopedic trauma patient. I was peripherally involved in his care and of course have repeatedly questioned myself about whether or not I could have should have predicted picked up on followed up on any number of details that were put together only too close to the time of his death. I sat through the discussion partially numb while so many glaring systems issues that contributed to this outcome reached out and slapped me in the face.
Quality improvement work is so cut and dried when presented as an academic topic – root cause analyses, PDSA cycles, systems-level reflection following carefully laid-out evidenced-based models with neat acronyms. But the sensitive nature of debriefing a bad outcome and preventing future similar ones is always messy. It takes more than an hour, and hinges on mutual respect and established relationships. I’ve been struck by the willingness of the staff here at Kijabe Hospital to discuss bad outcomes openly and often. It’s necessary. Complications happen everywhere, but talking about them is the first step.
Next week I return to Vanderbilt. Some of the resources I most look forward to include:
  1. Ubiquity of dressing supplies – no need to ask patients to purchase each piece of gauze from the pharmacy before dressing their wounds in clinic or the ward
  2. Medical receptionists – to avoid the frustrating experience of locating patients in the gray areas between the ER, outpatient clinics, waiting areas, and hospital wards without an up-to-date directory of patient location
  3. A serviceable EMR
  4. WiFi – for ready access to UpToDate, PubMed, society guidelines, etc.
  5. Nephrologists, gastroenterologists, interventional radiologists, all radiologists, psychiatrists, and all my other specialist friends not represented here
In contrast, things I will miss about my time in Kijabe:
  1. Teaching junior residents here
  2. A more relaxed surgical hierarchy
  3. The option of not pan-CT scanning every acute and elective surgical patient
  4. Reusable sterilized cloth drapes and gowns in the OR
  5. The simplicity of hanging IV fluids on a nail on the wall behind a patient’s bed
  6. Being a 5-minute walk from the hospital while on home call
  7. Taking time to greet everyone good morning before getting “down to business”
Health care is notoriously expensive in the U.S., but rarely in my general surgical training have my patients had to grapple so viscerally with the financial implications of their illnesses in the acute setting. In Kijabe, I see this play out daily. The pedestrian hit by a matatu who is so preoccupied with his emergency room bill that he is unable to concentrate on our physical exam to diagnose his pelvic fracture. The septic newly diagnosed diabetic man with a massive back abscess who spends the night in the clinic waiting room instead of upstairs in the ICU because he doesn’t yet have the deposit for his hospital admission fees. The fresh motorbike trauma patient with abdominal pain and potentially undiagnosed solid organ injury who leaves our ER against medical advice for another facility where she believes CT scans to be less expensive. The elderly woman with dysphagia and biopsy-proven esophageal cancer who delays getting a staging CT scan or endoscopic stent placement for months or even years while her family crowd-funds the next step in her care. Maybe my patients in the U.S. are making similar life-or-death decisions based on financial calculations, but it doesn’t happen in front of me.  
The National Health Insurance Fund (NHIF) started about 4 years ago to offer free insurance coverage to all Kenyan citizens. Kijabe Hospital fees are out of reach for >70% of the population, so NHIF coverage is critical to the hospital’s mission of caring for patients while remaining financially viable and sustainable. In recent weeks, NHIF abruptly stopped covering surgeries and maternity fees at mission hospitals across the country, including Kijabe. This crisis has translated into lower surgical case volumes, fewer training opportunities for my Kenyan resident counterparts (i.e., the next generation of surgeons in East Africa), and a growing number of patients not getting the operations they need in time. Watsi, an international crowd-funding platform, and Friends of Kijabe (https://friendsofkijabe.org/) are two ways people can help.
Costs affect patient outcomes in innumerable ways. Approximately 40% of breast cancer patients cared for at Kijabe are HER2+ and would receive a survival benefit from a targeted course of Herceptin therapy.  Yet at a cost of $27,000, this treatment is out of nearly everyone’s reach. For comparison, in the nearby city of Naivasha, most of the local population works for a company that produces fresh-cut roses for the European market. They make $70 per month. A recent Lancet Commission on global surgery determined that 25% of people who have a surgical procedure incur financial catastrophe as a result of seeking care – although this proportion is probably far higher in Kenya.  
For the past seven years, I have lived the daily luxury of not thinking about costs for 99.99% of my medical decisions. The luxury of doing the right thing for patients, regardless of cost implications or their ability to pay. Is this wrong?

Feeding the world

Nov 05 2018

Yet though we are living in the face of four historic famines right now with more than 20 million on the brink of starvation, there is a spark of light. Though complex, we do know how to address hunger, and we know how to end it.
Recent headlines have been filled with stories and images of parents being separated from their children by the U.S. government. This is not what our country represents.

In fact, 15 years ago, we enacted the President’s Emergency Plan For AIDS Relief, or PEPFAR, to do quite the opposite, and the program has gone on to save the lives of millions, keep families intact, and provide support for millions of orphans, vulnerable children and their caregivers. It represents the best of America, and we can be proud of the global legacy it has created.

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