sina iranmesh blog

No doubt, working at Kijabe is a once-in-a-lifetime experience.  Upon setting foot on the dirt road leading to the hospital, I knew I would face many hurdles over the next four weeks as a general surgery resident.   Over time, I appreciated subtle clues and changes in each patient’s physical exam to help guide the management of their care without relying on further information.

Lesson number two: I could no longer practice medicine ignoring the financial burden of my treatment plan.  Practicing cost-conscious medicine was not just beneficial on a global sense, but specifically affected each family suffering from an economic crisis.  Even worse, many treatment options (i.e., chemotherapy, radiation therapy, referrals to specialists) were physically or financially inaccessible by our patient population.  For example, unlike women in the U.S. who had the option of a lumpectomy with radiation for breast cancer, our patients in Kijabe underwent a mastectomy because they could not afford radiation. I spent time counseling a young woman on her treatment options after removal of a large tumor from her thigh. I recommended radiation therapy to reduce the chance of the tumor returning, though she decided against it after discovering how much it would cost her.  Such encounters were unfortunately fairly common.

In contrast to the philosophy of utilizing single-use, individually wrapped, and disposable equipment in Western operating rooms, Kijabe’s mantra of maximizing its very limited resources proved surprisingly effective. With the exception of our gloves, every piece of equipment used in the operating room (especially those labeled as ‘single-use’) had been routinely sterilized over and over again. I can only wonder what impact we can have on the US Healthcare Crisis if we learned a few lessons from Kijabe...

Kijabe is renowned for its level of care and medical education. As such, it is home to a number of visiting physicians of all levels of training. I felt fortunate to have encountered a number of these missionary physicians.  My one-month commitment to work in an African hospital paled in comparison to individuals (and their families) who offered years of devotion. Working alongside such individuals was inspiring to say the least.  I am grateful for the opportunity to experience medicine from a different angle, and the lessons I learned along the way.

 

Bill Frist Flies Missions Worldwide to Help Those in Need

Contact: Dan Hubbard, (202) 783-9360, [email protected]

Washington, DC, August 22, 2011 – Esteemed doctor, pilot and former U.S. Senate Majority Leader Bill Frist has been awarded the National Business Aviation Association’s (NBAA’s) 2011 Al Ueltschi Award for Humanitarian Leadership in recognition of his life-saving efforts worldwide, and the importance of business aviation to those endeavors.

An accomplished medical researcher and heart transplant surgeon, Dr. Frist was elected to the Senate representing Tennessee in 1994, the first practicing physician elected to the lawmaking body since 1928. During his two terms in office, Frist rose to the majority leader position faster than any previous senator while spearheading efforts to improve medical access for Americans and others worldwide, notably leading on bills like the Medicare Modernization Act and the passage of the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR combats the spread of disease in resource-limited areas worldwide, and since its passage has provided life-saving anti-retroviral drug treatments to over 3.2 million people and counseling, testing and education to over 33 million to help prevent new infections. This ambitious program is often credited with saving a generation of Africans.

A true citizen-legislator, Frist has continued his regular medical mission trips worldwide since his retirement from the Senate in 2007. Frist – a pilot since the age of 16 and holder of multi-engine, commercial and instrument ratings – has consistently relied on aviation and his own piloting skills to expand his life-long commitment to healing to areas around the globe.

From using aviation night after night to personally transport hearts during his time-sensitive transplant procedures, to piloting planes throughout war-torn Sudan to perform surgery, Frist credits aviation as a powerful instrument for healing. Within days of the levees breaking in New Orleans after Hurricane Katrina, he flew his plane to care for those stranded. In flooded Bangladesh, he relied on floatplanes to ferry needed personnel and supplies on behalf of Save the Children and Samaritan’s Purse, and in 2010, he immediately flew to Haiti to perform surgery in the aftermath of the earthquake in Haiti.

“Bill Frist has combined his skill as an aviator with his expertise in medicine to reach people in need of life-saving treatment at home and all over the world,” said NBAA President and CEO Ed Bolen. “From piloting his own aircraft throughout Sudan to give surgical care, to using aviation to reach and treat victims days after the devastating earthquake in Haiti, the senator and doctor truly ‘walks the walk’ in assisting those most in need of help. He exemplifies the humanitarian spirit that’s always been a part of business aviation, and we are honored to recognize his pioneering work with this award.”

In his 2009 book Heart to Serve: The Passion to Bring Health, Hope, and Healing, Frist wrote about his belief that medicine unites the world in its common goal for peace. "People don't usually go to war against someone who helped save their children," he wrote. "While the world often sees America's tougher side...when people see America's more compassionate, humanitarian side, the barriers come down, and peace becomes a viable possibility."

Established in 2006, NBAA’s Al Ueltschi Award for Humanitarian Leadership recognizes the spirit of service demonstrated by humanitarian leaders within the business aviation community. The award is named for Albert L. Ueltschi, who was instrumental in the development of ORBIS, an international non-profit organization dedicated to preventing blindness and saving sight.

The award will be presented to Frist at the Opening General Session for NBAA’s 64th Annual Meeting & Convention (NBAA2011) in Las Vegas, scheduled for 8:30 a.m. on Monday, October 10, 2011. The full Convention will be held Monday, October 10 through Wednesday, October 12.

Past recipients of the Al Ueltschi Award for Humanitarian Leadership include Cessna Aircraft Company (2006), the Veterans Airlift Command (2007), Corporate Angel Network (2008), and the Civil Air Patrol (2009). Last year, the Association honored humanitarians throughout the business aviation community for their efforts in providing relief efforts following the earthquake that devastated Haiti in January 2010.

# # #

Founded in 1947 and based in Washington, DC, the National Business Aviation Association (NBAA) is the leading organization for companies that rely on general aviation aircraft to help make their businesses more efficient, productive and successful. The Association represents more than 8,000 companies and provides more than 100 products and services to the business aviation community, including the NBAA Annual Meeting & Convention, the world's largest civil aviation trade show. Learn more about NBAA at www.nbaa.org.

Members of the media may receive NBAA Press Releases immediately via e-mail. To subscribe to the NBAA Press Release e-mail list, submit the online form at www.nbaa.org/news/pr/subscribe.

by Brande Jackson

last stop water hope

After working with over 100 volunteers and getting 5000 new supporters for clean water initiatives, Water = Hope wrapped up another fun summer with the Brad Paisley H2O tour!

Our last weekend started out in rainy Philadelphia, where we were still able to have a great night - Philly was one of our best stops on the 2010 tour! - thanks to a hard working volunteer team that braved the elements to talk to fans and build support. We could not have done it without them!

The next day the tour stopped in Bristow, VA, outside of Washington DC. We were joined by a repeat volunteer, Ashley, who brought along her sister this time around, as well as a  hardworking (and very funny!) father-daughter team, and two high school friends who were accompanied by mom. Our team did great, talking to hundreds of fans about the importance of clean water; in fact, two of our volunteers signed up over 300 people all on their own, a very impressive feat. And, for the first time in a looooong time, we had a show with no rain, a change we were very grateful for!

Raleigh was the final stop of the tour this year, and we were excited to wrap things up with a big volunteer crew of 10, including about five volunteers who were joining us for the second year in a row. They worked hard to help us end the tour on a great note.

All in all, it was an amazing summer full of incredible volunteers, supportive fans, and lots of love from the Brad Paisley crew. At the end of the day, going out on tour with an artist is really about the chance to use music as a connecting force, and we were reminded time and time again this summer of the compassionate nature of the country community.  We are excited to see how many lives are impacted by the work of our volunteers and supporters from this summer!

by Bill Frist

Wall Street Journal

Droughts happen. Famines ensue. Families are destroyed. You can't control Mother Nature. On a fact-finding mission to the border of Kenya and Somalia this month, I learned otherwise.

Traveling with Jill Biden, wife of Vice President Joe Biden, I knew going in that 12 million people in the Horn of Africa are at risk of starvation and death because of the worst drought in 60 years. Five regions in war-torn Somalia are experiencing famine, and 29,000 children in the region have died in the past three months. There is much Americans can do—immediately and inexpensively—to save lives and quickly reverse the current trajectory of catastrophe.

Mrs. Biden and I spent most of our time engaging refugees who emotionally recounted their painful, weeks-long treks through parched lands with little food and water, having no choice but to leave their husbands in war-torn Somalia, often losing a child or two along the way to dehydration or lung infection.

The extreme drought has destroyed crops and caused the death of 80% of the livestock. For most Somalis who live a pastoral lifestyle, these conditions amount to an American losing their home, job and all worldly possessions, with no food or water available to beg for or borrow.

At the Dadaab camp along the Kenya-Somalia border, more than 1,600 refugees arrived on the day of our visit, bringing the total past 50,000 for the past month. Designed for 90,000 people, the camp is swollen beyond capacity with 430,000. Another 45,000, typically malnourished with crippled immune systems, wait outside the camp with little water, no sanitation, minimal health care and only makeshift shelter.

The world community has increasingly responded to the crisis in the past few weeks, but the demand continues to outstrip what is provided. The central challenge is access: The famine is centered in lawless Somalia, which is dominated by the al Qaeda-affiliated terrorist group al Shabaab. Nongovernmental organizations find it dangerous to operate there, as 47 aid workers have been killed over the past two years and many others kidnapped.

Mrs. Biden and I witnessed an ongoing outbreak of measles in the Dadaab camp, including a new wave among refugees in their 20s. This observation suggests an unanticipated need to vaccinate older age groups. Few Somalis have been vaccinated before coming to the camps (al Shabaab discourages vaccinations, considering them a Western intervention to be shunned). In a crowded camp of almost half a million, a small measles outbreak can explode and lead to mass casualties. Vaccinations can stop this—and each costs only a dollar.

Then there's water. Its absence causes famine, and its unclean varieties cause diarrhea that is dehydrating and can be fatal. That and acute malnutrition are the big killers. But nutrient-supplied oral fluids can bring young, malnourished children back from the brink of death within a few hours.

All these health interventions are cheap and easy to administer. A dollar goes a long way toward saving lives in Africa.

Outside of immediate crisis relief, our past investments clearly are paying off. U.S.-supported early-warning networks identified the famine threat a year ago, allowing Kenya and Ethiopia to begin stockpiling food reserves and planning regional responses. The U.S. is working with the World Food Program and the United Nations to initiate innovative programs like food vouchers that reduce corruption and better distribute food. These programs encourage regional and private-sector solutions to shortages, with smoother flow of foodstuffs from more plentiful areas to drought-stricken ones.

In times of budget cuts, we must remember that, according to Oxfam International, emergency food relief during a famine costs seven times more than preventing a disaster to begin with. Hence U.S. efforts such as the multi-year, multi-agency Feed the Future program to stimulate research into making plants more nutritious and crops more drought-resistant.

With the chaotic economy dominating the news, it's easy to focus on ourselves rather than others so far away. But when we remember that we spend only a tiny fraction of one percent of our budget on developmental aid, that recent assistance is smarter and more targeted than in the past, and that our investments in the Horn of Africa alone have saved millions of lives, each of us can be proud of our past investments and supportive of their growth in the future.

What can we do as individuals who care? A good place to start is the list of aid organizations on the website of the U.S. Agency for International Development, www.usaid.gov.

Dr. Frist, a physician and former majority leader of the U.S. Senate, is chairman of Hope Though Healing Hands.

The Rugged Altruists

Aug 24 2011

by David Brooks

NYT Op-ed

Nairobi, Kenya

Many Americans go to the developing world to serve others. A smaller percentage actually end up being useful. Those that do have often climbed a moral ladder. They start out with certain virtues but then develop more tenacious ones.

The first virtue they possess is courage, the willingness to go off to a strange place. For example, Blair Miller was a student at the University of Virginia who decided she wanted to teach abroad. She Googled “teach abroad” and found a woman who had been teaching English in a remote town in South Korea and was looking for a replacement.

Miller soon found herself on a plane and eventually at a small airport in southern South Korea. There was no one there to greet her. Eventually, the airport closed and no one came to pick her up. A monk was the only other person around and eventually he, too, left and Miller was alone.

Finally, a van with two men rolled in and scooped her up. After a few months of struggle, she had a fantastic year at a Korean fishing village, the only Westerner for miles and miles. Now she travels around Kenya, Pakistan and India for the Acumen Fund, a sort of venture capital fund that invests in socially productive enterprises, like affordable housing and ambulance services.

The second virtue they develop is deference, the willingness to listen and learn from the moral and intellectual storehouses of the people you are trying to help.

Rye Barcott was a student at the University of North Carolina who spent a summer sharing a 10-by-10 shack in Kibera, the largest slum in Nairobi, Kenya. One night he awoke with diarrhea and stumbled to the public outhouse. He slid onto the cement floor and vomited as his bare body hit puddles of human waste.

He left his soiled pants outside the hut, but when he went to find them later they were gone. He was directed to another hut where a stick-thin girl, with missing clumps of hair, had the pants, scrubbed and folded, in her lap. Barcott said softly, “I’m grateful,” and asked her why she had cleaned them. “Because I can,” she replied. A week later, she died of AIDS and her body was taken in a wheelbarrow to a communal grave.

Over the next several years, Barcott served as an officer in the Marines in places like Iraq and created an inspiring organization called Carolina for Kibera, which offers health services and serves as a sort of boys and girls club for children in the slum.

The greatest and most essential virtue is thanklessness, the ability to keep serving even when there are no evident rewards — no fame, no admiration, no gratitude.

Stephen Letchford is a doctor working in Kijabe, Kenya. One night, years ago, when he was working at a hospital in Zambia, a man stole a colleague’s computer. Letchford drove the police down the single road leading from town. The police found the man carrying the computer and, in the course of the arrest, shot him in the abdomen.

They put the man in the back of the car and rushed him back to the hospital to save his life. Letchford pressed his wounds to stem the bleeding, using tattered garbage bags as surgical gloves. He had scraped his hands gardening that day and was now covered by the man’s blood.

They saved the thief’s life and discovered he was infected with H.I.V. For several days, Letchford and his family were not sure whether he had been infected by the man who robbed them. Their faith was tested. (They later learned that he was not infected.) When the man recovered, he showed no remorse, no gratitude; he just folded in on himself, cold and uncommunicative.

This final virtue is what makes service in the developing world not just an adventure, a spiritual experience or a cinematic moment. It represents a noncontingent commitment to a specific place and purpose.

As you talk to people involved in the foreign aid business — on the giving and the receiving ends — you are struck by how much disillusionment there is.

Very few nongovernmental organizations or multilateral efforts do good, many Kenyans say. They come and go, spending largely on themselves, creating dependency not growth. The government-to-government aid workers spend time at summit meetings negotiating protocols with each other.

But in odd places, away from the fashionableness, one does find people willing to embrace the perspectives and do the jobs the locals define — in businesses, where Westerners are providing advice about boring things like accounting; in hospitals where doctors, among many aggravations, try to listen to the symptoms the patients describe.

Susan Albright, a nurse working with disabled children in Kijabe, says, “Everything I’ve ever learned I put to use here.” Her husband, Leland Albright, a prominent neurosurgeon, says simply, “This is where God wants us to be.”

omo 2

Today started as usual with ward rounds, visiting my patients: Stephen, baba with DM and Mr. SO whom we operated on for appendicitis. I really feel sorry for Stephen’s dad.

Then we went to the OR where we had one scheduled surgery and one emergent ex-lap. The scheduled surgery was removal of a breast mass; turned out to be a chocolate cyst (grossly). I really enjoyed having scrubbed in. I started the IV line and first-assisted; also got to close the skin. I really do enjoy surgery especially on days like this when I feel competent; when the operation went well, when I closed skin properly, when I feel I helped the team help a patient. 

The second case was interesting. A man in his 60s/70s presented to the hospital after a road traffic accident in which he obtained rib fractures and perineal laceration. He also had an acute-appearing abdomen with left quadrant tenderness, hypoactive bowel sounds and free air on x-ray. We were concerned about stomach/small intestine perforation or splenic laceration. The interesting part of the story is that upon entering his abdomen, what we found was indeed a perforated viscus (small intestine) but there were surrounding adherent exudates to suggest bacterial perforation such as typhoid perforation, not due to trauma. His spleen and other internal organs were fine. We wonder if he was ill preceding his accident; I’d find out from him on rounds tomorrow

After the OR, went to physician conference where Dr. Aremu talked about the responsibilities of family physicians to their patients. There was a post-presentation announcement about ensuring patients pay their bills up-front especially in non-emergent cases. The thing is that this is a small town where many of our patients cannot afford the hospital bills; many go into debt as a result, but the hospital needs funds to run to be able to keep helping patients; there really is a need for a national/state-wide health insurance system.

Overall, I’ve had an excellent experience here in Ogbomoso. The physicians here do so much with very little. I admire the tradition of praying before every surgery and before every clinical encounter. There is obviously room for improvement, need for specialists such as pathologists, cardiologists and ICU physicians, and need for better diagnostic and monitoring equipment such as ECG monitors (there isn’t one even in the ICU) and CT scanners (especially given the volume of patients that present with head injuries). I think though that beyond the hospital and immediate control of hospital personnel, general road safety urgently needs to be addressed. Too many patients present with and die from otherwise preventable injuries secondary to road traffic accidents. Also urgent, is the need for a health insurance system as too many patients end up being turned away or under-treated due to inability to afford medical services.

 

Bill Frist: NPR Interview with Melissa Block

To listen, CLICK HERE.

Former Senator Bill Frist just came back from a fact finding-finding mission to the border of Kenya and Somalia. He and Jill Biden, the vice president's wife, visited the Dadaab camp, which was designed for 90,000 but its population of Somalian refugees has swollen to 430,000.

In an interview with NPR's Melissa Block, Frist threw out numbers. Lots of them that put the situation in the Horn of Africa in some perspective. He said: This is the worst drought in 60 years; 29,000 children under the age of five have died in the past 90 days; tens of thousands are dead; 12 million people are at risk of death; 42 percent of them die from starvation.

All of that is hard to visualize, but then Frist talks about the people he talked to at the camp.

"A family might be typically a woman who has four children, who has walked for 15, as many as 20 days to leave the area of famine and lawlessness and lack of aid... and walk across a desert, arriving many times missing one child, a child who died along the way," he said.

The children arrive at the camp malnourished or starving and what's amazing, he said, is that an inexpensive mix of water, sugar and nutrients will bring a child back to life.

Frist has seen human tragedy. He's been to Rwanda during the genocide and saw the 1980 famine in the horn of Africa. He's been to Chad, Darfur and Sudan but he says what strikes him about this particular crisis is that "the world is responding to the need itself but the need is increasing faster than the response."

"The simplicity with which this can be addressed... is not keeping up with increased demand," he said. "They're all human tragedies, but this one we can nip in the bud if we're more aggressive."

Melissa also asked some tough questions of Frist, the chairman of the non-profit Hope Though Healing Hands. She brought up the AP report that detailed that thousands of sacks of food aid were being stolen and asked what he would tell Americans, struggling through a bad economy.

"We spend less than half a percent of our budget on all of developmental aid. Not just responding to crisis but in all of developmental aid. So we don't spend nearly as much as people think," he said.

Frist admitted that this famine is a man-made crisis. The drought is bad but the political situation on the ground, the fact that Islamist militant group al Shabaab has not let aid flow in has made things worse.

"But it doesn't mean we give up," he said. "It means we stay on it. We do the best we can as the oneness of humanity gets translated by [non governmental organizations], by partnerships, by governments, by individuals who focus on it."

To read more, CLICK HERE.

By Jill Biden and Bill Frist

USA Today

WHF and Biden 8.8.11

This week, we traveled to Dagahaley refugee camp in Dadaab, Kenya, where hundreds of thousands of people have fled Somalia seeking to escape the worst famine in 60 years.

We met women and children who walked for weeks, often barefoot and with nothing but the clothes on their backs, desperate to find food and medical care. We heard the story of one mother who was too weak to carry both of her children, and made the wrenching choice to leave one behind on the road in hopes of saving the other. We learned of families who had arrived too late whose children became part of a devastating statistic: In the past three months alone, 29,000 children younger than 5 have died of starvation.

Fortunately, the international community has mobilized. Last year, the U.S. realized this potential for famine and worked with other countries to stockpile food and medical supplies in the region. We are now helping more than 4.6 million people.

Amid the devastation, we saw the impact of this aid. We saw inexpensive oral rehydration packs bring listless babies back to life. We saw children getting vitamins and vaccines that will stop the spread of deadly diseases throughout the camps.

Still, the scope of this crisis threatens to overwhelm the international response. Without lifesaving assistance, hundreds of thousands of people, most of them children, could die.

As governments and international organizations do their part, the rest of us can do ours. Just a few dollars can literally save a life. (Go to USAID.gov to see how you can help.)

Yet we must also confront the broader challenge of food insecurity that leaves so many people vulnerable to droughts like this one. That's why America has been helping nations such as Ethiopia and Kenya develop innovative and improved crops and irrigation methods, and new ways for farmers to market and transport their products. The goal of our aid is simple: to help create the conditions where such aid is no longer needed.

That, ultimately, is how we can help prevent the kind of suffering we see in Somalia today.

As we left one of the camps, a mother looked us in the eyes, surrounded by her four malnourished children, and asked us to please help save her family.

We all have the power to answer her plea.

Jill Biden is the wife of Vice President Biden. Bill Frist is a former Republican senator from Tennessee.

 

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