by Emma Apatu
ETSU College of Public Health
American Samoa

Emma apatu co workers

Developing Strategies to Promote Healthy Diets to American Samoan Youth

Summer school is currently in full swing throughout American Samoa. In the morning time you will often see several school children walking or taking the bus to school with their backpacks on chatting with their friends and local street vendors selling fresh banana, taro, and bok choy to passersby.  By 9:00 many classes are in session with bright eyed students soaking in morning lessons. By mid-day students are offered a generous snack/lunch.  During break periods and afterschool, it is common to see students hanging out by the fales (a hut like structure).

Over the past two weeks, I have been actively working on a Healthy Food Assessment for school aged children in American Samoa.  The purpose of this assessment is to gather ideas from students, teachers, parents, and school administrators on how to promote healthy diets to American Samoa’s school aged children and information on school aged children’s access to healthy foods. With the assistance of two community liaisons, Sharon and Marie, from the American Samoa Land Grant office and the staff at the two local high schools, I have been able to conduct eight interviews. All of the interviews were conducted at one of two high schools, Fa’asao Marist private school which has approximately 200 students and Leone High school, a public school with an estimated 1,000 students.

Currently, I am transcribing and analyzing the transcripts and will be summarizing the findings that will go into a final report that will be submitted to Dr. Dan Aga who is the Chair of the American Samoan Food Policy Council.  In addition, to the interview information, I am also working on a school-based policy analysis to complement the interview findings.  

I am definitely learning a lot by being able to apply knowledge that I have learned in my doctoral program to a real world setting and by immersing myself in another culture.  

I am so proud to be here serving as a Frist Global Health Leader !

by Megan Quinn
ETSU College of Public Health
Munsieville, South Africa

Munsieville megan quinn

Over the past two weeks, I have had the opportunity to experience the beauty of South Africa, relish in the culture, and learn from the local people.   My colleague, Twanda Wadlington and I are based in the West Rand district of the Guateng province, specifically working in the Munsieville township.  We are both working with Project Hope United Kingdom’s “Thoughtful Path” program.

The Thoughtful Path program aims to engage and empower the community to create positive health and social change for the orphaned and vulnerable children in Munsieville.  The community, community based organizations, and the local government are typically involved in all aspects of the various projects associated with the Thoughtful Path.  That said, we have had the opportunity to meet with a variety of different community members and organizations during our time here.  

On Monday, June 20th, we were included in a meeting between the Thoughtful Path and Safe and Sound Learning.  Safe and Sound Learning focuses on raising the level of qualifications for early childhood development (ECD) teachers and has played an integral role in training several of the teachers in Munsieville.  Locally, ECD centers are called crèches and there are several throughout the Munsieville community.  Project Hope, in conjunction with Safe and Sound learning plan to train twenty crèches owners over the next few years.  Training of local crèches owners will provide positive change for the development of hundreds of young children.  In addition, we plan to work with Safe and Sound to establish a monitoring and evaluation program to document specific educational, health, and social indicators for the young children of Munsieville.  This process will be informed by assessing current methods that are utilized and accompanying Safe and Sound Learning staff on site visits of the Munsieville crèches.  Quality education and skills development in early childhood has proven to create better learners throughout the lifespan.  Additionally,  children who receive education and skills at a young age become healthier more productive adults, one of the overall aims of the Thoughtful Path.

Thursday, June 23rd served as the kick-off for a new youth service program on economic development.  Due to our work in the community, Project Hope was invited to attend the festival as honored guests.  The new program “One job per needy household for 100 days”  complements the existing National Youth Service program and aims to provide skills to youth to create economic development in the West Rand region.  Youth, in South Africa, defined at ages 18-35, and serves as one of the age categories with the highest levels of unemployment in South Africa.  Developing the skills of the youth in Munsieville will not only aid in economic development, but it will reduce crime rates and create a healthier community.  Several government officials from the West Rand district were present and provided inspirational speeches to the local youth.  The head of the Department of Infrastructure from the West Rand district commended the American youth that have come to their area, recognizing Twanda and me for our dedication to working in their district and making positive health changes in the Munsieville community.  Additionally, local youth dancers, performers, and scholars were highlighted during the program. 

We were able to truly experience just how compassionate and empowered the Munsieville community is on Friday, June 24th during the Thoughtful Path workshop.  The Thoughtful Path program consists of seven different “hubs”:  early childhood development, after school care, youth support and development, community strengthening, child/youth sports program, child rights and protection unit, and community based organization capacity building.  The leaders and key players of each of the hubs were invited to attend the workshop.  I was truly inspired by the genuine level of concern and compassion these individuals have for their community and the health of its citizens.  This group of individuals hold the key to making positive, sustainable changes in the lives of vulnerable children in the Munsieville. 

The workshop held several purposes: to inform and update the community regarding specific projects, to train the leaders about the monitoring and evaluation process, and to formally introduce the key stakeholders to Twanda and me.  Twanda and I were responsible for providing the monitoring and evaluation training.  The community members all possessed varying levels of education, so our main goal was to make sure everyone fully understood the key components of monitoring and evaluation.  Monitoring and evaluation are integral parts of the research process and can help to inform researchers if a program is successful or needs modification and where to allocate resources.  Specifically, Project Hope aims be able to generalize the Munsieville model to other similar communities around the world.  This goal will not be achieved if monitoring and evaluation processes are not integrated into programming. 

Twenty-two community leaders attended the workshop and learned the key components of monitoring and evaluation.  The training included an overview of data and data collection, monitoring, and evaluation.  Local, health-related examples were utilized to provide a practical component of the training.  Further, community leaders were divided into their hubs to apply their learning to programs specific to their projects.  Training the community leaders serves as one of the best ways to reach the most people in the Munsieville community.  As we have seen in our short time here, the community leaders play an integral role in engaging the community and providing successful programs.

This week has proved to be extremely successful, especially opening the doors of communication and collaboration with the community leaders.  I look forward to continuing to serving this dynamic community and improving the overall health status of its citizens.     

by Katie Baker
ETSU College of Public Health
Appalchia/ASPIRE Scholar

My internship with the Tennessee Cancer Coalition (TC2) is going very, very well!  I have made significant progress on the skin cancer prevention toolkit through consultation with experts in the TC2 – Jackson region, the TC2 Skin Cancer Resource Committee Chair from Knoxville, and one of my local supervisors who represents the American Cancer Society.  I will be contacting a melanoma survivor from Appalachia as well as a local high school health educator in the coming days in an effort to incorporate their input and experiences into the program as well.  Additionally, we will be adding another sun safety awareness event to our schedule.  On July 16th, we will provide no-cost educational materials and sun protection aids (i.e., visors, SPF 15 sunscreen, etc.) to those participating in health screenings during the Johnson City Farmers’ Market.

TC2 Summit on Cancer in Tennessee

June 16th & 17th, 2011

Franklin, Tennessee

As a part of my internship experience, I was invited to attend TC2’s 2011 Summit on Cancer in Tennessee which brought together researchers and academicians, physicians, nurses and other allied health professionals, cancer registrars, employers, health education and outreach professionals, community organizations, legislators, patient navigators, grassroots advocates and volunteers, and cancer survivors to focus on transforming the latest knowledge into strategies that communities, institutions, businesses, and individuals can employ to reduce the cancer burden in our state. 

I attended several interesting sessions, which I will describe below, and I even won first place in the Student Poster Competition for my poster titled, “Skin Cancer Prevention in Young Women: Evaluating a Measure of Pathological Tanning.”  The poster highlighted the prevalence of indoor tanning dependence and abuse among a sample of college undergraduates as determined by the Structured Interview for Tanning Abuse and Dependence (SITAD).

Pre-Conference Melanoma Workshop

When reviewing the Summit program, I was thrilled to see a pre-conference workshop on skin cancer.  During this session, we heard from Tara Bankes, a pathology assistant with Knoxville Dermatopathology Laboratory (KDL), Dr. Roy King, a dermatologist with KDL, and Richard Boland, a melanoma survivor. 

From Tara, I learned that 90% of skin cancer cases are caused by UV radiation and that 1 in 5 people (1 in 3 Caucasians) will be diagnosed with some form of skin cancer during their lives.  She also pointed out that melanoma, the deadliest form of skin cancer, is most common among 25- to 29-year-old females.  She took us through the ABCDs of melanoma detection, which stand for: Asymmetry, Border Irregularity, Color, and Diameter, adding an E to the acronym, which stands for Evolving.  Dermatologists believe the “evolution” of moles may be the most tell-tale sign of melanoma development and tell patients to pay particular attention to any changes in size, shape, color, elevation, bleeding, itching or crusting.  Tara stressed the importance of skin cancer prevention with the message to COVER UP YOUR SKIN with SPF 30 sunscreen and lip balm, hats, sunglasses, and umbrellas and to limit sun exposure between the hours of 10:00 AM and 4:00 PM.  She also emphasized that sufficient levels of Vitamin D can be acquired by spending just 15 minutes in the midday sun, and that sunless tanning products (i.e., spray-on tanning, self-applied lotions and creams) are the way to go for people desiring a tan.

Dr. King shared his work on the development of a melanoma database for Knox County.  He and his team have compiled over 6,000 cases from the area and have come to several conclusions:

  • From 1998-2007, there was an 82% increase in the incidence of invasive melanoma.
  • Melanoma incidence is 46.8% higher in 20- to 29-year-old females when compared to males in the same age group (likely attributable to tanning beds).
  • There are more tanning facilities per capita in Knox County than in almost any other city in the country, and the prevalence of tanning among middle schoolers there is 15%.

HPV Vaccination in Appalachia

I also attended a session during which two  ETSU professors presented their work on HPV Vaccination in Appalachia.  Dr. Sadie Hutson of the ETSU College of Nursing and Dr. Kelly Dorgan of ETSU’s Department of Communications reported on their study in a presentation titled, “Beliefs and Knowledge of HPV and Cervical Cancer in Appalachia.”  Here, I learned that Appalachian women face an excessive cancer mortality risk and that 18- to 24-year-olds in this region are surprisingly unaware of HPV.  Drs. Hutson and Dorgan conducted interviews and focus groups in Northeast Tennessee and Southwest Virginia and came to the following conclusions:

  • Appalachian women face an HPV Vaccination Protection Dilemma, where they perceive two types of “threats”: 1) unknown side effects that potentially outweigh the benefits of avoiding cancer; and 2) non-vaccination and the acquisition of cervical cancer.
  • Limited knowledge, skepticism with regard to HPV vaccine commercials, and confusing risk all interplay to keep Appalachian women locked in the protection dilemma.
  • Appalachian women often operate in “spheres of silence,” meaning that HPV and the HPV vaccine are not discussed by (1) providers and/or (2) the community.

by Shana Gillette

Cinci water equals hope

When Brande asked me to fill in for the Water = Hope Campaign, I couldn't have been happier. Having heard about the organization from her, I know it was an outreach effort really committed to making a difference in both the U.S. and abroad.

Coming primarily from a corporate event marketing background, I'm accustom to having a 'sell' at the events I manage.  This time the 'sell' was easy - Everyone Everywhere should have access to clean drinking water.  Period.  Done.    

Day one in Cincinnati was a blast.  Kyle & Danielle were just about the cutest couple ever and we couldn't have asked for better volunteers.  Danielle, the first of 3 volunteers currently in nursing school who came out to help us this weekend was also 7 months pregnant so the fact that they were so eager and happy to help, in the heat to boot, was even that much more awesome.  We got lots of signatures and donations for the rad looking 'Water=Hope' t-shirts, and had a great time admiring everyone dressed up in their cowboy boots and hats. 

Day two in St Louis started off with a bang, literally.  At about 11 a.m., with ominous skies looming, we received word that severe thunderstorms were on the way and a tornado had touched down somewhere nearby.  Thankfully the Paisley crew came quickly with sandbags, helping to secure the tent and belongings before everyone took shelter backstage to wait it out.  The winds were high and the rain came sideways knocking over one of our bins of t-shirts and posters but the tent survived and thanks to a dryer at the venue, we were good as new by days end. 

Erica, yet another nursing student, came out just in time to help dry everything off and truly did the work of three volunteers, getting tons of signatures to let our leaders know what an important issue this is and raising money for the cause.  With more storms in the forecast, we opted to break down a little earlier and she was invaluable helping to put everything away and just as excited as she'd been earlier in the day to help set it up.  It was truly great to meet someone like Erica and so many others so enthusiastic about supporting Water = Hope.  Once folks heard Brad supports the work we're doing, they were hooked. 

The irony of the name 'Water=Hope' didn't escape anyone as we arrived in Indianapolis on the third day to discover more rain.  Fortunately, this time it cleared up and we had a great day talking to folks about helping others around the world get access to clean water.  Sli (also in nursing school), and Jason finally broke thru traffic and got in just in time to talk to a few of the tailgaters before they came in to enjoy the show.  Having also worked Bonnaroo with Brande a couple weeks before, they noted that it seemed to be a lot easier to talk to folks about the campaign and to donate money there.  To that I say, 'C'mon Brad Paisley fans - let's show em that country fans care too!' 

Sli & Jason worked their tails off, even helping to organize all the shirts we had to dry from the storm the day before.  Lots of folks came up to the tent to ask what it was all about.  We even met one woman *pictured in red foam hat and pink shirt holding 'i helped build a well' sign* who's son actually helped to build one of those wells for real!  

In addition, four more high school student volunteers who'd helped out the year before, came back again and walked all over the venue getting yet more signatures  and introducing people to the campaign.  It was another great day for Water = Hope and it couldn't have happened without the great work of all the volunteers!  

We've got more shows coming up!  If you want to volunteer, you'll not only be working for a fantastic cause, you'll get to see a free Brad Paisley show too.  It's true!  Scroll up and check out our Volunteer page to apply.

Thanks so much to the Paisley family and all the volunteers for making this an awesome weekend!  See you in July!!       

 

by Brande Jackson

We are very proud to be back out with Brad Paisley on his H20 Tour again this year. Our first stops in Virginia Beach, Hartford and Cleveland were a hug success; we talked to lots and lots of country fans about the importance of clean water. As always, we were impressed by how engaged fans were in our project, and how eager they were to help. Our first three shows were a big success, and we are very excited about the remaining dates over the course of the summer. 

Like last year, we are also using our work with Brad to provide unique volunteer opportunities for those interested in this issue. By volunteering, you are not only contributing to your community (and getting a free Brad Paisley show as a thank you!) but demonstrating first hand the idea that a ‘small drop can make a big ripple’! To learn more about volunteering and to get signed up, visit:

http://www.waterequalshope.org/volunteer 

We also made a stop at Bonnaroo Music and Arts Festival this year as well. We were joined by a stellar team of 7 volunteers: Slidana, Jason, Jeff, Sarah, Krystina, Ralph and Audoin. Our team worked very hard in the infamous Bonnaroo dust and sun to educate Bonnaroo fans about why clean water is so important, and what role they can play in bringing it to those who lack it. By the end of the dusty weekend, we had talked to over to 500 Bonnaroo attendees about this important issue, and raised money that will go towards a new well building project - something Bonnaroo fans can be very proud of! 

In the months ahead, we’ll be making stops in Texas, Darien Lakes, Chicago, Tampa, DC, Philly and many other cities. We’re always looking for some volunteer support; visit the Water = Hope website to learn more.

 

 

by Jenny Eaton Dyer, Ph.D.

WHF and Sten 6.13.11

Last night, Hope Through Healing Hands and the Vanderbilt Institute for Global Health partnered hosting a meeting with the members of the Tennessee Global Health Coalition (TGHC). Doctors, academicians, nonprofit leaders, faith leaders, and private sector leaders alike joined together representing over 80 different organizations to discuss their work in global health and ways in which we could all work together better. 

Senator Bill Frist, MD and Sten Vermund, MD PhD both spoke to the members encouraging the building of relationships and partnerships between NGOs, universities, and the private sector. Both shared successful examples of how working together, pooling together resources, knowledge, and expertise, can save lives. 

Breaking out the guests among topics such as Haiti, South America, Africa, Orphan Care, Emergency Relief, or Medical Mission, the members had the opportunity to get to know one another and learn more about one another’s organizations with shared interests. 

To close the evening, we discussed how the TGHC might better serve the global health community of individual organizations. Suggestions included more meetings per year, a breakout of topical meetings, better portal for communication among members, better marketing of the TGHC as a whole and its members, and aid with grant writing, among others. 

As a hub for the coalition, HTHH will work on these recommendations and convene another meeting in the near future! Many thanks to all who participated, and a special thanks to our co-host, the Vanderbilt Institute for Global Health.

by Emma Apatu
ETSU College of Public Health
American Samoa

emma apatu american samoa 1

Photo: Dr. Aga, (preceptor; Emma Apatu, Kasie Richards (East Tennessee State DrPH candidate); Aufa'i Areta, Associate Director/Acting Extension Program Coordinator)

Talofa (greetings)!  I arrived in American Samoa almost a week ago, and have fallen in love with the Samoan culture.  I have found the people to be very friendly, the fresh foods are delicious, and the oceanic and mountainous views to be postcard worthy.

 I have also been fascinated by the beauty of the traditional Samoan garb.   It is very common to find men wearing Lava Lavas which is a cloth like wrap skirt, and the women to be clad in beautifully printed dresses complimented by a flower in their hair.

 As I witness the beauty of this island, I have also taken note of the obesity problem.   It baffles me to see people of an island that has a plethora of nutritious food to have one of the world’s highest obesity rates.

The World Health Organization attributes American Samoan’s obesity problem on the fact that a great number of the people have stopped eating traditional foods and have adapted diets rich in processed foods.  A few days ago, I talked to some of the local people, and they also agree that a great part of the obesity problem is due to poor diet choices. 

Today I met with my field experience preceptors Dr. Aga and Aufa'I  Areta, at the American Samoan community college.  The meeting today was very productive and Kasie and I will meet with Dr. Aga and Aufa’I Areta who is the Associate Director/Acting Extension Program Coordinator later this week to finalize the scope of our community based Food and Nutrition project. 

I am looking forward to next upcoming weeks!   

June 8, 2011

In Case You Missed It...

The Tennessean

More than one-fifth of preschool children are overweight or obese. That’s 20 percent of kids 5 years old and younger who are already on track for chronic health problems such as cancer, type 2 diabetes and heart disease before their first day of kindergarten.

That’s more than 4 million toddlers already queued up for health issues that will last them a lifetime. And of the heaviest youngsters — those who are obese — more than 160,000 live in Tennessee.

Our state’s and our nation’s obesity epidemic is well-documented, and childhood obesity continues to be an appropriate focus. We are learning more and more how nutrition and exercise at the very earliest stages of life can have a dramatic impact on our bodies as we age.

If the body mass index (or BMI, the ratio of height to weight that is typically used to determine a healthy weight) increases too soon or too rapidly for a young child — as young as 3 years old — research shows that child has a much higher risk of obesity later in life.

In short, too much fat produced too early sets the stage for a battle against obesity that will last a lifetime. Before most kids can add 1 plus 1 and get 2, their bodies are learning that being overweight is a way of life.

To start our children in life along this path is simply unacceptable.

There are plenty of statistics to cite, from economic — nearly $150 billion per year is being spent nationally to treat obesity-related medical conditions — to national security — more than 25 percent of all Americans ages 17-24 are unqualified for military service because they are too heavy. But those statistics shouldn’t be necessary.

Being overweight doesn’t necessarily equate to low self-esteem or an inability to achieve, but we cannot intentionally start toddlers out with a predisposition to type 2 diabetes and cancer and heart disease and expect things to be easier for them.

The next 15 years are going to be hard enough; we don’t need to make things any more difficult.

Solving the problem, however, is more complex; there is no silver bullet. Private- and public-sector leaders all have a critical role to play.

Several mayors from across the country recently pledged to do more for those in early child-care education settings in their cities. Many private-sector companies are helping to curb this epidemic, too. Specifically, a recent commitment from the planet’s largest retailers and food and beverage manufacturers to reduce calories in their products by 1.5 trillion by 2015 is laudable.

Parents, get kids moving

Parents also play a role. That’s why we’re calling on everyone to get our youngest kids more physically active. Whether that’s taking a walk or playing a game, it’s just as important for the 3-year-old in your life as it is for the 33-year-old in your life (or, in my case, older still). Cut out the sugar-sweetened beverages for kids under 5 and look to low-fat or nonfat milk for kids over 2 years old.

Equally, the private sector needs to continue to step up. Parents don’t need more complexity and more costs; they need more answers and easier ways to provide a healthy lifestyle for their kids. We need the private sector to make healthy choices as easy and as economical as possible.

We’re asking private industry to better serve their customers and communities by helping them access healthier products. This allows kids to have healthy childhoods. We can do better.

For a nation that prides itself on opportunity, we owe our youngest and most vulnerable at least that: the pledge to ensure their future is as healthy as possible.

And that means starting right from the beginning.

The Honorable William H. Frist, M.D., is vice chairman of the Partnership for a Healthier America, an organization working with the private sector to solve the nation’s childhood obesity crisis.

by Katie Baker
ETSU College of Public Health
Appalchia/ASPIRE Scholar

Sun Safety booth Katie Baker

Let me begin by introducing myself – I’m Katie Baker, a second year doctoral student in Community Health attending East Tennessee State University’s College of Public Health.  I was recently selected as a recipient of the 2011 ASPIRE Appalachia Scholarship and, as such, will be completing my summer field experience with the Tennessee Cancer Coalition, a state-wide organization focused on reducing cancer incidence, mortality, and morbidity and improving the quality of life for those affected by cancer in Tennessee.  This experience could not have been better suited for me, as I have received intensive training in skin cancer prevention throughout my time at ETSU. 

Objectives 

After meeting with my preceptor and local supervisors, I have developed several objectives for my summer field experience.  My objectives are as follows: 

  • Assist in planning sun safety awareness and outreach activities for local events, including the Blue Plum Festival in Johnson City, Tennessee (June 3 & 4)and FunFest in Kingsport, Tennessee (July 15-23).
  • Develop an evidence-based skin cancer prevention toolkit designed specifically for high-school aged adolescents by performing rigorous literature searches informed by evidence-based principles, consulting with experts in the field, and facilitating discussions among local public health professionals with experience in this topic and target population.  The toolkit will serve as a packaged program ideal for dissemination to each of the eight county Health Councils in the Appalachian Northeast Tennessee region.   Health educators and interested volunteers throughout the state will also have access to the toolkit, with the goal of educating every high school student in the state of Tennessee on the dangers of skin cancer and effective ways to prevent the disease. 

Sun Safety at the Blue Plum Festival, Johnson City, TN

June 3 – 4, 2011 

The Blue Plum Festival, spanning two full days of 90+ degree heat and cloudless skies, provided me with the perfect opportunity for sun safety outreach in my community.  For this event, the Tennessee Cancer Coalition, along with the American Cancer Society, provided no-cost educational materials and sun protection aids (i.e., SPF 15 sunscreen; visors; bracelets made from UV beads) to be distributed by members of the Washington County (TN) Health Council from a booth in Majestic Park in downtown Johnson City.  Strategically situated between the food venders on Market Street and the arts and crafts vendors on Main Street, our booth was a popular stop for festival goers, especially children.  Many approached the booth, at least initially, because they wanted a bracelet made with UV beads – small beads that change color once they have been exposed to sunlight.  However, once they received our message that the beads changing color indicates that they should apply sunscreen, many of them took the opportunity to apply the sunscreen we provided, and quite a few walked away wearing a Tennessee Cancer Coalition visor as well.  Overall, this experience was a wonderful glimpse into the “real world” of health promotion.  I was able to meet and interact with the Director of the Washington County Health Council, public health professionals working for the Washington County Health Department, and community members impacted by skin cancer – all of whom served as a reminder that I truly love the field of public health and that skin cancer prevention is becoming an increasingly important area of research and public outreach. Thank you to “Love Everybody” for making this experience possible through your scholarship support.

by Shannon Langston
Department of Emergency Medicine
Vanderbilt Medical Center
Georgetown, Guyana

langston baby 1

It usually comes to me in a super market, sometimes Wal-Mart.  This time, it was in a Chili’s restaurant in Miami International Airport.  I was returning from 6 weeks in Guyana and the bustling airport led me to seek refuge in a restaurant.  The burger I ordered, with a thick slab of bacon, nearly overcame me with emotion.  It wasn’t that it was such an incredible burger. It was my reflection, the contrast, of the place I often take for granted and the place I was returning from.   The excess we have become accustomed to.  Something so simple as a good burger is not obtainable everywhere.  Many things aren’t. 

The Emergency Department at GPHC, Georgetown Public Hospital Corporation, the country’s tertiary care facility, is busy.  It sees about 70,000 patients per year.  The House Officers and Residents work tirelessly to sort the truly ill from the baseline chronic disease present in the population.  I spent the majority of my time consulting on patients, standing at the bedside, and teaching the Emergency Medicine Residents and House Staff alike on the care of acute and chronic illness.  Often, as I went through the differential diagnosis of the patient, I would realize, we might never discover the exact cause of the patient’s illness.  Many of the diagnostic tests so easy to obtain here, are simply not available.  Blood cultures, to determine the infectious bacteria of a septic patient, aren’t easy to obtain.  A CT scan of the head, often ordered to excess in the US, is expensive for the population of Guyana, sometimes costing a months salary for a test that may be negative or have little impact on a patients’ subsequent care. Cardiac enzymes, used to diagnose heart attacks, aren’t readily available.  And, even if they were, neither is a catheterization lab.  I had to ask myself often where to draw the line between teaching good care and teaching appropriate care. 

The patients presenting to the emergency department in Guyana are often complex.  In addition to the ills that face patients in the US, tropical disease such as Malaria, Dengue, and Typhoid are present, complicating the clinical picture.  One child in particular nearly died from something so simple as touching a caterpillar, the most toxic known.  TB was a common complaint and is seen daily at GPHC, often in advanced stages.  At times it seemed as if the taxi drivers are actually aiming for the children as they make their way to school, so common is their appearance in the trauma bay with broken bones and head injuries.  Those injured in the interior, the jungle, often have to endure many hours over rough inland roads, or a choppy river, to reach the hospital.  I was often surprised by their survival and endurance of what must be agony, only to be gracious for the care provided.  Those intubated in the emergency department are ventilated by hand until a ventilator can be found in the ICU, sometimes hours later.  The nurses often take turns ventilating with few complaints. 

As I choked down my burger, I thought back to the infant with meningitis, gasping for air.  There was no spinal needle for children that would allow a lumbar puncture.   Despite aggressive treatment and antibiotics, the baby succumbed, as did another a few days later.  I recalled the young lady that presented with mild confusion and fevers.  In a matter of a few hours she was unresponsive with a dangerously low blood pressure.  I spent hours at her beside with the residents, struggling to keep her alive, without the rapid tests that would give me the cause.  One resident intubated and another started a central line.  Fluids, antibiotics, and multiple drips were started.   A lumbar puncture and an ultrasound were performed.  We wracked our brains to discover the missing piece of information that would keep her alive, a diagnosis that fit.  Her husband, whom I kept updated, was brought into the room.  I told him she was gravely ill, and would not likely survive.  I encouraged him to talk to her and say anything he wanted.  He whispered into her ear and kissed her on her cheek before walking away, sobbing.  Our efforts were not enough.  She died a short time later. 

Despite the challenges and material limitations, the physicians are eager to learn.  Suggestions to improve care are readily embraced by residents and management and solutions are sought to overcome an often challenging work environment.  In my short time there, through the work of many people, I was able to secure a readily available supply of much needed blood for trauma patients.  A resident is now teaching the calculated administration of vasopressors to other interns and sharing new knowledge to improve patient care for the local population.  By saving patients that would have died just a few years ago, they are learning to be hopeful as they provide compassionate care.   These things, it seems, are available everywhere

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