by Senator Bill Frist, M.D.

If you are a health professional, what can you do to influence global health? How can you get involved in health care around the world? What does health diplomacy mean?

This short video serves as an introduction to a lecture on health diplomacy and global health for those who currently serve in medicine in the United States. We invite you to watch and let us know what you think.

Hope Through Healing Hands Announces The Water=Hope Campaign’s Continued Partnership with The Brad Paisley H2O II: Wetter & Wilder World Tour

Nashville, TN --Today on World Water Day, a day to draw attention to the one out of eight people around the world who lacks access to safe drinking water, Hope Through Healing Hands (HTHH) announces The Water=Hope Campaign's continued partnership with CMA Entertainer of the Year Brad Paisley and his H2O II: Wetter & Wilder World Tour presented by Chevy.

Hope Through Healing Hands (HTHH) is excited to partner again with the Brad Paisley's H2O Tour in 2011 with a campaign for clean, safe water. The Water=Hope Campaign will promote awareness and advocacy for safe water, adequate sanitation, and improved hygiene, especially in low-income countries. At each U.S. show, HTHH will have a booth to distribute literature and encourage people to learn more about how they can get involved. Prior to the show, fans will have the opportunity to text "H2O" to 25383 to donate $10 to support clean water initiatives around the globe.

Last year, HTHH built three wells in Liberia, Uganda, and Ethiopia and installed water purification systems in homes lacking access to water in Appalachia. This year, we hope to build more wells and service more homes for families to have clean, safe water at home and around the world.

H2O II: Wetter & Wilder World Tour will bring back the very popular and fan favorite "Water World Plaza," turning every city into a water festival. Focal point in the Plaza area will be the "Water World Plaza Stage" featuring emerging new stars Brent Anderson, Edens Edge and Sunny Sweeney. Special guests on the tour will be Blake Shelton and Jerrod Niemann. The tour extravaganza will open each day at 4:00pm with music starting at 5:00pm. In addition to the music stage there will be multiple water-themed activities – including a Chevy H2O FLW fishing simulator, dunking booth, slip n slide, The Water=Hope Campaign booth and more.

For concert date volunteer opportunities with The Water=Hope Campaign, visit www.WaterEqualsHope.com/volunteer.

About Hope Through Healing Hands:

Hope Through Healing Hands is a Nashville-based 501(c) (3) that promotes improved quality of life for citizens and communities around the world using health as a currency for peace. HTHH supports health students and residents to do service and training in underserved clinics around the world. For more information, go to www.HopeThroughHealingHands.org.

About Brad Paisley:

CMA Entertainer of the Year and Grand Ole Opry member Brad Paisley is a consummate singer, songwriter, guitarist and entertainer, which has earned him three GRAMMY's, 14 Country Music Association Awards and 13 Academy of Country Music Awards. He has 18 #1 singles and has released nine critically acclaimed studio albums, the most recent Hits Alive which is a two disc release of original studio hits as well as live performances from concerts. Paisley's innovative and entertaining H20 World Tour played to over 879,000 fans in 2010 and placed #1 country tour for attendance by Pollstar. Paisley's current single "This Is Country Music" is the title track from his next album which will be in-stores May 24.

H2O II: Wetter & Wilder World Tour dates:

*Paisley only shows.

**Paisley, Shelton, Niemann only

*** Paisley, Shelton, Niemann and Darius Rucker

May 28 Heinz Field Pittsburgh, PA ***

June 3 Virginia Beach Amphitheatre Virginia Beach, VA

June 4 Comcast Theatre Hartford, CT

June 11 Progressive Field Cleveland, OH

June 16 Riverbend Music Center Cincinnati, OH

June 17 Verizon Wireless Amphitheatre St. Louis, MO

June 18 Verizon Wireless Music Center Indianapolis, IN

June 24 Wild West Arena-Nebraskaland Days North Platte, NE**

June 25 Tuttle Creek State Park Manhattan, KS**

July 2 Lavell Edwards Stadium Provo, UT*

July 15 PNC Band Arts Center Holmdel, NJ

July 16 Comcast Center Boston, MA

July 17 Scarborough Downs Scarborough, ME

July 22 Toyota Pavilion Scranton, PA

July 23 Darien Lakes PAC Darien Lakes, NY

July 30 Pizza Hut Park Frisco, TX

August 4 WE Fest Detroit Lakes, MN**

August 6 First Midwest Bank Amphitheatre Chicago, IL

August 7 Columbus Crew Stadium Columbus, OH

August 17 O2 Arena London, UK*

August 19 Olympia Theatre Dublin, IRE*

August 24 Cirkus Stockholm, SWE*

August 26 Spektrum Oslo, NOR*

August 27 Lisebergshallen Goteburg, SWE*

August 28 Forum Copenhagen, DEN*

September 9 1-800-ASK-GARY Amphitheatre Tampa, FL

September 10 Cruzan Amphitheatre West Palm Beach, FL

September 23 Susquehanna Bank Center Philadelphia, PA

September 24 Jiffy Lube Live Washington, DC

September 25 Time Warner Cable Music Pavilion Raleigh, NC

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Contact: Jenny Dyer

615-386-0045

bechtel and patient

I have learned a lot from my time in Guyana. It is amazing to see how long patients will wait patiently to be seen. Crowded onto benches for hours just waiting their turn.

The "asthma room" as it is termed is one of my favorite areas of A&E. Patients magically appear there from the waiting room and are started on breathing treatments. All doctors have heard the term "all that wheezes is not asthma." So daily I would make my way through the group placed in the asthma room searching for the one who didn't have asthma but some other process. I found one elderly lady in heart failure and another baby who had a murmur and heart issue as well. Largely though the asthma room works as it gets those who need breathing treatments quickly the medicine they need. Teaching the residents at GPHC to be cautious about those other kind of wheezers was enjoyable and they will be on the lookout in the future as well.

Sadly I saw a few deaths this month including a few being pediatric. Death is much more accepted, as resources aren't as abundant here like they are in the US. I also saw some patients persevere and do well with diseases and ailments I would never have expected people to survive let alone be functional with. There is a saying here that "God is Guyanese." Essentially these people are looked after by a higher power. One man who was stabbed in the belly made it to the our A&E a full day after his wounds from deep inside the interior of Guyana after a trek through the jungle to a landing strip and then by plane to Georgetown. He remarkably ended up doing ok after surgery to his intestines.

The team working here is amazing. They all are very friendly and dedicated. We had young man come in shot in the abdomen one evening. We quickly had the whole staff helping to resuscitate and care for him. He was taken to the OR in record time but succumbed to his injuries as the bullet had hit the great vessels as well as the liver. He had the best chance to survive due to their quick action and the surgeons being ready as well. Unfortunately where he was shot he wouldn't have lived even at the best US trauma center either.

I did a grand rounds type talk to the Emergency Medicine residents, staff nurses and other doctors on one day. They don't have any Neurologists in the country and I saw many, many seizures of all sorts of etiologies. So after a week of seeing what they had to treat seizures and the kinds that were coming in. I lectured on strategies to manage the seizures using their pharmacological armamentarium. The power of course went out in the room I was lecturing in so it became more of a discussion and me using my computer and its battery as the projector wouldn't work. Overall though it was a great experience and the nurses and doctors were very interactive.

I also did lots of bedside teaching. Many of the doctors in the ED itself are relatively new and have just completed medical school training mostly in either Guyana or Cuba. They are eager to learn and fun to work with. They routinely stop me and ask questions about what I would do with different patient presentations. I would definitely like to return here some day.

cook baby E

These last two weeks at Kijabe I've been working on the pediatric service. I've worked on a fabulous team in pediatrics. My main "partner in crime" is a Kenyan clinical officer who loves kids and has a tremendous fund of knowledge and experience. Between the two of us, we see all the patients every morning in preparation for team rounds, write their daily notes and orders, and see outpatient pediatric consultations and admit patients in the afternoon. Everyday we go on rounds with a short-term family practice volunteer doctor from the US with years of experience, and a brilliant Kenyan pediatrician who trained at the top national hospital in Kenya.

Although I didn't spend much time in the nursery, I also interact with the nursery team: an amazing American pediatrician who has spent the last 15 years working in rural Uganda and a pediatric resident from India with an incredible bedside manner. We round with a nutritionist or a nutrition intern who not only provide great plans in how to get our babies gaining weight, but also spend a lot of time with families, often informally serving as ad hoc social workers/counselors. One of the best aspects about working at Kijabe has been the diversity and richness of the people I get to work with and learn from everyday.

I've had an amazing range of patients from the "bread-and-butter" babies with bronchiolitis and viral gastroenteritis that are fairly easy to admit and care for, to some really sick little babies with multiple serious medical problems and some surgical conditions I may not see twice in my lifetime. These are the ones that you really get to know and worry about. One in particular is Baby E. He's a 7 month old baby who came to the hospital about a week before I started on pediatrics in a coma, severely dehydrated and really sick. My first day, he had just transferred back to our pediatric ward from the ICU and his condition was still tenuous. Baby E is Massai, one of the most traditional people groups in Kenya; his family lives in fairly remote part of Kenya and eeks out a living through raising cows. I cannot even begin to imagine what it is like for his mother to be in the hospital, a day's travel away from her 8 other children for 3 weeks, she definitely had her moments of discouragement, but at the same time she displayed incredible graciousness and generosity to me as her "baby's doctor."

One morning when I came to examine Baby E she said, "I want to give you a Massai blessing," reached out her hand and gently slid a vibrant beaded Massai bracelet onto mine. Baby E was still in the hospital when I left and to be honest, I don't know his long-term prognosis, he has devastating neurologic sequelae. We were very honest with his family about the extent of the damage and that we did not know how much he would recover in the long-term. I internally struggled in caring for baby E with the tension between providing the standard of care for this individual patient and taking into account the tremendous financial and social burden on this family, especially when the ultimate outcome was so uncertain. By advocating that baby E stays in the hospital to get the oxygen and nutrition support to give him the best possible chance of recovery, what am I doing to the 8 other children this family has at home? Their mother is not with them to care for them or feed them and they are accumulating a hospital bill that is possibly even more than a year of this family's average income. These are impossible dilemmas and it was easy to become discouraged. At the same time, I had to keep reminding myself that despite the hardship for the family he is my patient and my greatest obligation is to do what is best for him.

My final afternoon at the hospital I had a glimmer of hope for baby E. I saw a three year old girl in the outpatient pediatric clinic who had been severely ill at 5 months of age with tremendous neurologic damage but who was now not only still living, but was thriving; she had some muscle weakness on one side of her body but she was a happy, playful three-year old . I hope and pray that this will be true for baby E.

Despite the numerous challenges in the US health care system and the fact that I have taken care of many patients in America without insurance and with tremendous needs, my time in Kenya has been the time of greatest personal awareness (and anguish) of the limited resources of my individual patients and the impact on their care. I have learned good lessons about being creative and ways to reduce waste; I have also had more personal heartache over my patient's dilemmas that I hope will shape the contributions to individual and population level care I have in the future.

Senator Bill Frist, M.D. is board member of the Kaiser Family Foundation.

The Kaiser Family Foundation has released a collection of new resources examining global health and HIV/AIDS funding in the Obama Administration’s budget plan for fiscal year 2012.

On global health, a new fact sheet breaks down the $9.8 billion in the budget request for the Administration’s Global Health Initiative (GHI), a proposed six-year, $63 billion effort to develop a comprehensive U.S. government strategy for global health. The fact sheet reviews proposed funding for the initiative, including breakouts by program area (HIV/AIDS, malaria, etc.) and by agency, including trend data where available.  It also examines support for the President’s Emergency Plan for AIDS Relief (PEPFAR).  The Foundation also has updated its Global Health Budget Tracker to reflect the President’s proposed fiscal year 2012 budget; the tracker will be updated to reflect changes as Congress considers and acts on global health appropriations.

A second fact sheet examines the $28.3 billion in proposed funding for HIV/AIDS programs both within the U.S. and overseas.   On the domestic side, the fact sheet breaks out support for programs that provide health care, drugs and other services to people with HIV or AIDS, as well as prevention and research funding.  The global budget examines spending for HIV/AIDS through bi-lateral and multi-lateral efforts.

In addition, the Foundation has updated the relevant Kaiser Slides charts to reflect the President’s budget proposal.  The charts can be downloaded for use in presentations or slide decks.

The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information and analysis on health issues.

I've spent my first 2 weeks at Kijabe Hospital working on the internal medicine team of the men's ward. Inpatient medicine at a tertiary care hospital is a quite a change of pace from rural primary care at Lwala. We have more diagnostic and treatment abilities, but also "sicker" patients. The variety in what I've seen has been tremendous – everything from the "bread and butter" medicine cases I see in the US like COPD, CHF, and diabetes but also lots of infectious diseases (HIV/AIDS, TB infections in every manifestation (brain, lung, abdomen), meningitis). I've taken care of men as old as late 80s and as young as 15 (the cut-off for pediatrics here is 12). I work on a team with a medical officer intern (equivalent of an intern in the US), a clinical officer (equivalent of a nurse practicioner/physician's assistant), along with two family practitioners that come on attending rounds with us once a day and are there for "back-up" if we need it. Besides my amazing patients, my favorite thing about Kijabe is the people I work with. The medical intern and clinical officer on my team are really bright, hardworking, and compassionate Kenyan women; they have tons of experience, especially with physical diagnosis skills and they're a pleasure to work with. The hospital always seems to be at or above capacity, basically our 80-bed men's ward almost always has beds in the hallway. The wards are fairly public with 10 beds in a room. The advantage is that many times when I get stuck with language I have a built in interpreter in the bed next door, or if I'm trying to gauge the progress of one of my patients a brain infection and altered mental status, his neighbors will chime in and tell me how he's doing. They often times really look out for each other. Yet this "built-in" community does also bring the challenge of maintaining confidentiality and privacy for patients; for example when a patient is newly diagnosed with HIV, they often have not yet decided to disclose their infection to their family, much less the stranger in the bed next door.

A few firsts for me this month:

-Being the one to share with a previously healthy 51-year old police officer that he has advanced cancer, follow him and his wife through 10-days in the hospital while stabilizing him from acute kidney failure only to have him pass away while traveling to the national hospital for chemotherapy

-Performing my first lumbar puncture (and second, and third)

-Seeing my first case of rheumatoid lung, TB pericarditis, HIV cardiomyopathy, cryptococcal meningitis, thyrotoxicosis, among others....

Sometimes the limitations in terms of nursing staff, diagnostics, or therapies are frustrating. At the same time, I'm amazed by how much can be done, and how often patients and their families fill the gap in care. Once a week all of the hospital staff gather for a chapel service and I've found this time to be important. It's a time when titles don't matter, when the lab tech and a nursing student may be leading the singing, and we're all just there to renew strength and hope when we reach our own limits.


badger kenyaLate one evening about 4 months ago, Josephine, a 31 year old Kenyan female, was riding home from a long day of work on the back of a motorcycle. An oncoming vehicle swerved directly in front of her to pass another vehicle. As the motorcycle swerved to avoid a collision she was thrown to the ground, severely fracturing her right ankle. She was taken to the hospital, where she underwent surgical repair of the ankle. Following the operation, she continued to have pain and weakness, to the point that she could not bear weight and had to walk with a crutch. After a repeat evaluation, she was referred to Kijabe Hospital, in Kijabe, Kenya, for ankle fusion.

Kijabe hospital, a mission hospital located an hour northwest of the capital city Nairobi, has a vast number of medical missionaries from all over the world serving the residents of the area and training locals in the practice of medicine and surgery. One of these missionaries, Dr. Mark Newton, is the only full time anesthesiologist in the region, and runs a training program for Kenyan Registered Nurse Anesthetists. The hospital, which is one of the most respected mission hospitals in the country, relies on donations of time, financial support, and supplies in order to maintain an exceptionally high quality of care. One such donation came approximately one year ago, in the form of a state-of-the-art ultrasound machine used specifically for the practice of regional anesthesia (peripheral nerve blockade). Ultrasound guided regional anesthesia is an advancement that is relatively new in the United States, and unheard of in East Africa. Though the overall resources and supplies in Kijabe are slim, hundreds of patients have benefited from improved post-operative pain control with the practice of peripheral nerve blockade, which involves injecting local anesthetics around large nerves of the arms and legs causing a portion of the limb to become numb. A single injection can last 15-20 hours, during which time it can provide complete pain relief following a surgical procedure. When the local anesthetic effect subsides, patients begin taking intravenous or oral pain relievers to control their pain.

Josephine, as mentioned above, had a severely injured ankle and was to undergo a very painful surgical procedure. We were readily equipped to provide excellent pain relief for her for 15-20 hours with an ultrasound guided peripheral nerve block, but we knew that when the block wore off she would still be in severe pain. Luckily, some supplies had just been donated to the hospital by Dr. Randy Malchow from Vanderbilt University Medical Center, including some peripheral nerve catheters, which allow the anesthesiologist to leave a catheter near a nerve and either attach it to a pump for a continuous local anesthetic infusion or give repeat daily injections through it while the patient remains in the hospital. Peripheral nerve catheter placement is an advanced form of regional anesthesia - many medical centers and university hospitals in the U.S. have yet to develop such programs - but through generous donations even a remote hospital in Kijabe, Kenya has the ability to provide this service in special situations, such as Josephine's. The decision was made to place a popliteal sciatic nerve catheter, which was done just prior to her going to the operating room. She then underwent operative fusion of her ankle. Following surgery, her ankle was completely numb and she had no pain. She was smiling from ear to ear because she remembered having terrible pain after her previous surgery. The following morning, her ankle remained numb, and she continued to have no pain. She was surprised at how well the nerve block continued to work. Later that day, she began to feel the numbness subsiding, and started to feel some gradually increasing pain in her ankle. A second dose of local anesthetic was injected through the nerve catheter that was taped to her leg and her ankle again became numb, with her pain disappearing completely. The nerve catheter remained in for 3 days following surgery, during which time she recieved one daily dose of local anesthetic and remained very comfortable, always smiling and thanking us for helping her. When the catheter was removed on post-operative day 3 and the numbness resolved, her pain was only mild and was able to be controlled well with oral pain pills. She was extremely satisfied with her experience.

It is amazing to realize that medical advances have progressed to the point that patients are able to undergo normally very painful surgical procedures with only minimal pain. What is even more amazing is that through incredible generosity by so many individuals these advances are able to be shared with patients like Josephine, living in a remote location such as Kijabe, Kenya.

See how the Clinton Bush Haiti Fund's grant to Inveneo is empowering rural and underserved communities in Haiti with information and communications technologies.

Their grant will accelerate the development of sustainable, high-speed wireless broadband connectivity to 20 population centers in six rural regions across Haiti, which will in turn stimulate economic growth and support decentralization of the country. Inveneo works with several Haitian ISPs to deliver training programs that will prepare its partners to manage and take full responsibility for the network. Inveneo also provides training programs for Haitian Information and Communication Technology (ICT) entrepreneurs.

Visit www.ClintonBushHaitiFund.org to get involved.

See how the Clinton Bush Haiti Fund's grant to YouthBuild International, partnering with IDEJEN, will put young people back to work in Haiti and give them the skills necessary to rebuild their country.

The centers will serve at-risk youth (ages 16--28) by providing them with vocational training in construction and leadership skills for the future. The grant will also be used to provide a two-to-one match of trainees' savings contributions, support leadership training for the Build Back Better Youth Corps. The program also provides six months of follow-up support as trainees seek viable employment opportunities or pursue self-employment.

The first training center, JENKA, was built in Leogane, the epicenter of the earthquake where nearly 90 percent of the buildings were destroyed. This first of 12 centers is where the project's local implementing partner IDEJEN (Haitian Out of School Livelyhood Initiative) is now recruiting staff and students.

Clinton Bush Haiti Fund money enabled YouthBuild to get construction underway quickly while other projects in Haiti have stalled due to funding delays.

Visit www.ClintonBushHaitiFund.org to get involved.

See how money from the Clinton Bush Haiti Fund has provided sales and marketing support for local artisans.

Their funds also helped these local business people rebuild their workshops, damaged during the earthquake. Through our support, artisans were able to complete their order to Macy's for its exclusive "Heart of Haiti" collection, inspired by the courage and culture of the Haitian people.

Clinton Bush Haiti Fund's recent loan to Fairwinds Trading, will expand this support to artisans in three additional communities and increase employment opportunities for Haitians — particularly women. This could sustain the employment of 740 artisans and artisan managers and provide secondary employment for 185 additional individuals.

Follow-up orders from Macy's could provide income to support 4,544 individuals.

Visit www.ClintonBushHaitiFund.org to get involved.

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