June 7, 2010

by Beth O'Connell
Cygera, Rwanda
East Tennessee State University: College of Public Health

Beth Oconnell 1

Hand Washing and Community Health Education

The hand washing campaign has continued with 78 high school students participating.

I was given a very challenging task of educating high school students at the local Kiruhura Christian College on health topics. This proved to be a challenge because of the language barrier and lack of resources- the students had no text books and there is a very limited supply of pens, paper, and chalk.   Nonetheless, the task was accomplished successfully and  I was asked to teach during Biology for the Senior 3, Senior 4A, Senior 4B, and Senior 5 classes.   In these classes students range in age from 15 to 38 years of age.   Biology class meets for two hours per week, one hour on Tuesdays, and one on Wednesdays. I chose to teach the Germ Theory of Disease with hand washing during the first two classes.  To evaluate understanding and effectiveness, they took a quiz whereby six of the eight students scored perfectly, and two answered three out of five questions correctly.   I believe that the students understood the topic well and their incorrect answers were due to language barrier.  

The second week, I taught the same students about HIV/AIDS. This discussion included general information including how HIV is transmitted  and ways to prevent transmission.

Because of attending an organizational meeting in Kigali on June 2, I have not given the HIV quiz yet. I plan to do so during next week’s class. I was pleased that the students asked many questions and I plan to continue teaching about HIV/ AIDS next week.  Handouts and quizzes were kept simple due to language and cultural barriers.   Also, printing resources are limited so materials were limited to one page or less.  

For the General Paper classes, I asked each student to choose from a list of health concerns in the community, or to propose a health related topic of their own.   The list provided included Malaria; HIV/AIDS; hand washing and hygiene; clean water; food contamination, and community safety. They were to include definition of the problem, causes of the problem, importance, how to prevent the problem, and any personal experience they have had with the problem.   These classes meet for two hours per week, but it is common in Rwanda for students to be absent frequently.   I left materials with the teacher of each class to give to absent students. These students were required to take quizzes and turn in assignments the following class.

Despite these challenges, I  anticipate excellent results from these classes.  These students are the future of Rwanda  and educating them on health will improve the health of the community for years to come.  I also expect a ripple effect as the student share their knowledge with their family and friends outside of school. I have no means of assessing this ripple effect, only the assessments of the individual student’s knowledge after each education session. These assessments are the quizzes given in the biology class and the essays written in the general paper class. I plan to continue teaching on health topics in the school.

Bio-sand Water Filtration

On June 4, the Rwandese Health and Environment Project Initiative (RHEPI), installed five bio-sand water filters and educated those who would be using it on proper use. At the advice of RHEPI representative James Rubakisibo, three filters were installed at the Faith and Hope Children’s Home, one at the girls boarding quarters at the Kiruhura Christian College, and one in the school cafeteria. 

There are currently thirty girls and no boys at the school’s boarding quarters.    I am happy to report that all the students will now be able to drink clean water at lunch due to these filter systems.  Installation of these filters is the product of my research, contacting filter providers and on-going communication since December 2009.  This began with researching types of filters with  Bio-sand filters removing 95-99% of bacterial, viral, and protozoan contaminants. If you are interested,  you can learn more at http://www.biosandfilter.org/biosandfilter/index.php/item/301.

While bio-sand filtration is not very effective in removing chemical contaminants, the primary concern in the community of Cyegera is microbes.  Bio-sand filters are very simple to use and require little maintenance and for these reasons seemed the best choice for this community.  I then began contacting organizations that build bio-sand filters; CAWST of Canada responded to my request for information with clarification to determine if bio-sand filters were truly the best option for Cyegera.

Once they were satisfied, they referred me to RHEPI and  James Rubakisibo. James and I discussed pricing, when the filters would be available for the instillation, education, and other details of a contract.

The filters require one month of daily feeding before the bio-layer is completely functioning. RHEPI provided education about bio-sand filters prior to installation to those who would use them.  Staff of both the school and children’s home assisted in the installation so that they have an understanding of how the filters function.  Unsafe water has been a serious problem in this area, and I look forward to seeing a reduction in water-related illness at the school and children’s home.

Other  activities

In addition to the health education and water filtration, I have been busy with community and organizational events.   As mentioned, I went with the site administrator, to a meeting in Kigali. The meeting was a strategy and information-sharing meeting among administrators of various sites. I also participated in a government mandated community work day.  These work days occur the last Saturday of every month. This work day was spent breaking ground for an additional building at the local school. 


I have reached 259 participants in my hand washing education campaign; my original goal was 300 participants so I am well on my way to meeting this objective.  I met my objective concerning environmental analysis and interventions during the first week and described in my May 25 report. I have also educated a total of 112 students on several of the major health concerns of the community.

I have met the objective of installing five bio-sand water filters and will continue to look for opportunities to expand these objectives as most have already been achived.  

Please view the chart below for a  summary of the work the Hope Through Healing Hands Foundation and the Niswonger Foundation are helping make possible in Rwanda.




Intervention/ Education



# of participants or people affected 

May 25-26



Germ Theory Education






May 26



Hand washing






May 26



Topics of Concern in Community Health






May 27



Topics of Concern in Community Health






May 29



Community work day






May 30



Prenatal vitamin education






May 31



Topics of Concern in Community Health






May 31



Hand washing education


(class S4A)







June 1



HIV/AIDS Education






June 2



Organizational meeting






June 3



Hand washing education


(class S5)







June 4



Bio-sand Water Filter Installation and Education (Children’s Home)






June 4



Bio-sand Education (Girl Boarding Students)






June 4



Bio-sand Water Filter Installation and Education (School Cafeteria)






June 7



Topics of Concern in Community Health






Daily since June 4



Bio-sand Water Filter Feeding






Daily since May 19



Meal logs for future analysis







June 7, 2010


by Tom Daschle and Bill Frist

It is staggering to consider the myriad changes since we each entered Congress. Things like cell phones and the Internet were straight out of a science-fiction movie then. Now, our grandchildren are so technologically connected by Facebook and MySpace that a schoolchild in Rwanda can check in with a pen pal in South Dakota or Tennessee in seconds.

Life’s frenetic pace and growing global interdependence have had a profound impact on the way America must engage with the world.

Our greatest threats are no longer from another country, as was the case during the Cold War. Today, they are as likely to come from infectious diseases, failed states, economic despair, nonstate actors and terrorism — issues that cannot be addressed through military might alone.

This requires a new approach, drawing on a renewed commitment to development and diplomacy — as well as our military strength.

America’s military is still the world’s finest, but it must be matched by equally agile and robust diplomatic arms if we are to remain safe and secure.

We agree with Defense Secretary Robert Gates, who said about the war on terror: “We cannot kill or capture our way to victory.” Smart development investment translates to fewer U.S. boots on the ground.

What we must do is use our full complement of powers — defense, development and diplomacy — to help troubled nations build stable governments and address the needs of their people; not just for food, water and shelter but also for health, education and the opportunity to learn marketable skills.

To do this, we have to invest in our future by bolstering the nation’s international affairs budget. This is something the two of us — and Democrats and Republicans as a whole — agree on.

As the military does its job in stabilizing troubled states, vigorous humanitarian and diplomacy efforts can ensure that we build a lasting peace by strengthening communities and governments, reinforcing the foundations for growth and opportunity and neutralizing those who wish our country harm.

Our foreign assistance dollars pay strong dividends economically, as well. Americans’ security and prosperity are tied to the security and prosperity of people around the globe. In the past 40 years, trade has tripled and U.S. exports account for approximately one out of every five American jobs. 

Today, developing countries represent 40 percent of U.S. exports. Programs supported by the international affairs budget increase economic opportunities, promote our business interests around the world and create U.S. jobs through increased exports.

While helping the world’s poor brings the United States national security and economic benefits, it also demonstrates our commitment to alleviating poverty. Both of us have traveled many times to developing nations — not just as elected officials but also in our personal capacities to work with international charities and deliver humanitarian aid.

We know the value of American generosity and have witnessed the remarkable difference public and private aid can make in people’s lives.

Whether it’s a Peace Corps volunteer introducing a local farmer to a new crop that is more nutritious and marketable, or a women’s group receiving a small loan to start a basket-weaving business to provide for their families, America spreads a message to the people of the world that we are a valuable partner — and friend. Aid works. And it works best by putting tools in the hands of others to build their own better tomorrow.

Republicans and Democrats have long worked together to make a difference in the world through humanitarian efforts, and those investments have paid off. In the past 50 years, child deaths worldwide have been reduced by more than half; polio has been nearly eradicated.

Former President George W. Bush created the President’s Emergency Plan for AIDS Relief with bipartisan support — and millions of people in Africa are alive today as a result.

President Barack Obama is working with Republicans and Democrats in Congress to implement his plan to address global hunger and food security and to emphasize maternal and child health through the Global Health Initiative.

The international affairs budget is now before Congress, and we were gratified to see a growing consensus on its importance.

In recent months, 247 members of Congress — Democrats and Republicans — wrote the president to urge an increase in his fiscal year 2011 request. As we support robust investment in our tools of smart power, we also welcome executive branch and congressional initiatives to modernize those tools to ensure accountability, be responsive to in-country needs and achieve the impact our interest and ideals require.

We realize the deficit is soaring and money is tight in Washington. Few know better than the two of us that the budget is a balancing act of limited resources and many worthy priorities.

While we have disagreed in the past on what priorities should be, we see eye to eye on why rebuilding our civilian-led tools of development and diplomacy is important.

For a small fraction of slightly more than 1 percent of the federal budget, our investment in helping others to help themselves overseas is one of the most cost-effective ways our government can keep us both safe and prosperous.

South Dakota Democrat Tom Daschle served as Senate majority leader from 2001 to 2003. Tennessee Republican Bill Frist served as Senate majority leader from 2003 to 2007. Both are advisers to the U.S. Global Leadership Coalition.

© 2010 Capitol News Company, LLC

by Brittany Cannon
Roatan, Honduras
East Tennessee State University: College of Public Health

brittany cannon photo 2

My first week in Roatan, Honduras  has been was quite an eye opening and educational experience.

The first day there I met with a dentist to discuss a dental hygiene educational program and I discovered there was basically "no such thing" as preventative measures regarding dental health here. As with many other countries, dental health is of no concern to the people.  If you have to choose between eating rice for a couple of days or having your teeth cleaned, you would most likely pick eating.

A significant dental health issue among the children here is maintenance of of their primary molars. I didn't know the significance of the primary molar until our meeting with the local dentist. The primary molar basically sets the stage for a young person’s entire mouth.  A child usually gets his/her first molars six years of age. Well, because preventative dental health measures have not been taught many of the children's teeth have severe decay including their primary molars. When the decay becomes very severe, the solution is to pull the tooth. Although this is a temporary fix for the child in terms of alleviating the pain, it poses huge problems for the child’s permanent teeth development and future dental health. The primary molar is actually an adult tooth and if it gets pulled it will cause the child’s other teeth to become very crowded and grow in incorrectly.

Our job is to gather data on the local school children to quantify the severity of decay in each child’s mouth and report whether the primary molar had been extracted. This data will hopefully aid the dentist in receiving a grant to help address this problem.

Before we collected the data in each classroom we did a dental hygiene educational class. We taught the children why it is important to brush their teeth and why good dental hygiene was important to their overall health.  After teaching them the basics of dental health we gave them all tooth brushes. This was one of the most rewarding things I have ever done because when they received their tooth brush  they acted like we had handed them a magical toy.  They were so excited to show us how they were going to brush their teeth. I really felt this was definitely worth while!

Over the four day period of going into schools we educated 385 children on how to brush their teeth and taught them why they should. They were very eager to learn and it was obvious that they had not received even basic training on this important aspect of health. A lot of the children asked for tooth brushes for their parents!  Hopefully we made an impact and my biggest hope is that with the knowledge we provided them they will continue to brush and one day it will become a cultural norm here.


June 2, 2010

by Beth O'Connell
East Tennessee State University: College of Public Health
Cygera, Rwanda

Upon my arrival to the Cygera Faith and Hope Children’s Home  I discussed the problems and what could be done about them with my preceptor, Elizabeth Nzakizwanimana, who the nurse for the children’s home, Ernest Batera, the administrator of the children’s home and the local church’s pastor, and John Mary Bemeyimana, the headmaster of the school.

Environmental Illnesses: Malaria and Spider-Bites

The immediate need  presented to me was environment-related illnesses.  Two children were recovering from malaria and several had spider bites.  Spider bites can be dangerous if incurred from a poisonous spider.   Malaria can be life threatening, and mosquitoes can spread other dangerous illnesses as well. Therefore, my first objective quickly became analyzing and addressing environmental hazards at the children’s home and adjacent school. 

My environmental analysis revealed both broad problems and some more addressable problems. Those that I was able to address included the pest problems, which I tackled in several ways. First , we placed screen over the windows to avoid insects coming into the children’s bedrooms.  Second, we sprayed a pesticide barrier around the homes and nearby school to detour insects.  So that these interventions would be continued after I leave, I asked the home administrator to assist me. He helped me place the screens, dilute the pesticide concentrate appropriately, and helped spray it.  Third, I placed fly traps in the homes, reducing the chance of fly-related food contamination, and conjunctivitis, which is often caused by flies. During my assessment,  I questioned staff about the presence of lice and bed bugs. They denied their presence and said they were currently preventing these problems by washing bed linens regularly and keeping the children’s hair short. I explained the use of the lice treatment materials and gave to them for future use.


Sanitation is another environmental problem. There is a lack of a garbage system and the outhouses used at the children’s home were incredibly dirty. One of the caretakers explained that they scrubbed them out weekly, along with the floors of the homes.  I provided scrub brushes I had brought with me and suggested that the outhouses be cleaned twice a week to avoid fecal-related infectious disease.

The entire community has no publicly provided means of garbage disposal; therefore, they simply throw it on the ground, or give it to children to play with.  The children’s home has a small composting system, but the community as a whole does not. This problem is much greater than I can address during the time I will be here and requires government cooperation and funding.

Climate-related Problems

Climate related problems include extremes in temperature with a vast difference between day and night.   Some of the children and I have been sick with head and chest colds probably due to the cold nights.  The local people call this illness “grape” and told me that I had it because I drank a cold Fanta (a soft drink soda) the day before I got sick!  This explanation prompted me to educate them on the correct cause of colds and was to prevent them.  Another climate related problem is lack of consistent rain fall. Like many equatorial locations, Cygera has a rainy season and a dry season. In order to manage water supply, the children’s home has two rain water storage tanks which collect from the two roofs. I have suggested to Hope 2.2.1. that purchasing more storage tanks would allow the home to use rain water only throughout the dry season, rather than resorting to using a local stream, which is highly contaminated. In the future, it would also be beneficial to install rain water collection at the school and any home that have metal roofs. The problem of unclean water will be addressed in the next update.

Hand Washing Campaign

I have also begun my hand washing campaign. I first taught the children at the Faith and Hope Children’s home as well as the caregivers and cooks.  I did this by simply discussing the steps recommended by the Centers for Disease Control and Prevention with some minor changes for cultural effectiveness, such as singing “Jesus Loves Me” instead of “Happy Birthday” as the guide for how long it takes for an effective hand washing.  I then prepared a handout and posted it on the hand washing station and also demonstrated the technique at a hand washing station outside of the homes. 

Additional hygiene education involved a Coleman solar camp shower which is more effective in prevention of infectious diseases than their current use of a bucket of water. I am still persuading the adults that it is better to bathe this way for full coverage and with warm water.  I have purchased soap for the home, because the soap they were using was actually for laundry. They used it because it was cheaper.   I was given permission to teach hand washing and give soap and handouts to the congregation after church on Sunday. In this class, we discussed the proper way to wash hands and when we should wash our hands to prevent infection and disease. The people asked questions and showed interest. The outcome of the hand washing campaign will be determined by observation at the children’s home and school over the next nine weeks. Members of the church class will simply be asked in coming services if they have been washing their hands at appropriate times and with correct technique.

Dental Hygiene

I have begun working on dental hygiene by providing the children with toothpaste, toothbrushes, and dental floss to aid in prevention of dental diseases.  I also began the nutritional portion of my objectives. I created an excel spreadsheet for tracking the daily intake of the adults and children at the Faith and Hope Children’s Home and have documented all meals since my arrival.

June 2, 2010

by Katie Skelton
East Tennessee State University: College of Public Health

katie skelton peru 2

Welcome to Urubamba, located in the ancient Inca’s Sacred Valley in the heart of Peru.  The local culture is permeated with Andean traditions as natives wear traditional clothing and live in Adobe homes.  Although the personal sense community is strong, the need for Public Health services remains vast.

Since arriving in Urubamba, I have been working on a health assessment of the Collanes-Pillary community, located approximately 20 minutes from Urubamba.  This community is in desperate need of much help.  They face many barriers that have prohibited them from obtaining optimal healthcare.  Many of the natives are not educated, do not speak Spanish, and have little to no income each month.  Our health assessment, containing 26 questions, will enable us understand the needs and wants of the community at hand.

Thankfully, my coursework at ETSU has greatly prepared me for the challenges I face here in Peru.  I have learned how to create a first-class survey, assess communities, and have gained the ability to develop and conduct a tailored, health intervention. These skills will be of great use to impact the health status of the local community.

Upon completion of my first two weeks in Peru, I have assessed ninety different families.  While each family is different, many of the same issues are consistent from household to household.  The area is lacking in clean water, the homes do not have sewers, health education is sparse, and gender equality is not present.  Over the next 6 weeks, the health assessments will be used to develop several specific health interventions that will best fit the community’s needs.  I will continue to work each day to help the local community defeat the barriers they face and obtain the needed healthcare they need and deserve.

Thank you Hope Through Healing Hands Foundation and Niswonger Foundation for making this incredible opportunity possible.


June 1, 2010

by Brande Jackson, Lokahi

water=hope st. louis 1 water=hope kansas city

Hope Through Healing Hands and Water = Hope were back out on the road with Brad Paisley this past weekend, making stops in Kansas City and St. Louis.

As always, we were joined by some amazing volunteers along the way. Jacqueline and Troy are a couple that live in Kansas City who are active volunteers in their community. They helped us have a great night, talking to fans about the campaign and getting many of their fellow KC residents involved! Our Kansas City set up was pretty fun; the ‘water world’ where our booth is situated each show was on a closed street outside of the Sprint Center in downtown KC, and we also had a table set up inside the arena as well. Kansas City also featured the debut of our PSA, which was exciting to see!

In St. Louis, we were joined by Mira, Kelley, Holly and Jeremy. They all know each other from high school, and it was the first time most of them had volunteered with a campaign like Water = Hope. They did an incredible job, working non-stop in what was by far the hottest day to hit St. Louis in a long time! Our St. Louis volunteer crew helped us have our best day yet on the tour, signing up hundreds of new supporters for Water = Hope and getting lots of fans to text to donate. 

As always, we were able to talk to lots and lots of fans about clean water issues as well. We were particularly impressed by how many young people in St. Louis told us about studying these issues in college, high school, or even middle school, and who in turn were eager to join the campaign. We are excited to start working with our new base of supporters in Missouri in the months to come!


The tour continues into more of the midwest this week as well; we’ll be in Toledo, Indianapolis and Cincinnati this week. Next week will see stops in Detroit and Pittsburgh. To join us, just visit http://waterequalshope.com/volunteer/


You can check out more photos from the tour (and tag yourself if you are in one of them!) on our Facebook page: http://www.facebook.com/hopethroughhealinghands



Brad Paisley's H20 World Tour Gets Senatorial Support

by Donna Hughes

The Boot

May 26, 2010

Brad Paisley's new H20 World Tour not only points out the fun aspects of water, but it also draws attention to the serious side of it as well. Brad partnered with the organization Hope Through Healing Hands to help raise funds and to bring awareness to the fact that millions of people around the world do not have access to safe drinking water.

How he came across the safe water initiative was nearly by accident. "I've become friends with [Senator] Bill Frist, and Bill and I went to Washington, D.C., to the Alfalfa Dinner," Brad explains to The Boot. "He took me as a guest to see and meet all these guys. It was the most insane room I've ever been in. Colin Powell comes up and says hello, and then he's talking to [California Sen.] Dianne Feinstein, and then there's [Mississippi Governor] Haley Barbour 'Hey Haley Barbour. How've you been?' I played an event for him. Then you've got [Vice President] Joe Biden."

"And everybody you see is walking around in this place," Brad continues. "On the airplane, [Sen. Frist] was asking about things that were going on, and I told him about that we were going to have the H20 tour and if he knew of any charities. And he said, 'Absolutely. Through the one I'm involved with.' He said it's the biggest problem in the world. It gets overshadowed by disease. It gets overshadowed by natural disasters and everything else -- the largest killer of both children, and I think people in general, is unclean water. I think one billion people are without it, or something like that. And his theory is this, 'If we can go in these places by digging a well or whatever, this is the biggest thing we could do for the world as the wealthiest nation.' So, we decided to pair that up and make that a part of the [tour] too, so we're not overlooking the fact that water is also very important as well as fun."

Senator Frist, his family and staff were on hand in Virginia Beach for the kickoff of the H20 tour. "It was so exciting to be there for the very first show," says the Tennessee senator, who helped to found Hope Through Healing Hands. "We have a great booth, and we signed up many interested activists and donors for this important campaign for clean water."

The show's headliner stopped by the booth to say hello and picked up one of the Water=Hope campaign t-shirts to help spread the word of the organization even further.

The next stop on Brad's H20 trek is in Kansas City, Mo., on Friday, May 28.


by Christian L. Gilbert, M.D. F.A.C.S.
Associate Medical Director
International Children's Heart Foundation

Olken Foncime May 2010

Olken Foncime, 2010

My wife and I were invited to attend a gathering sponsored by Hope through Healing Hands at Senator William Frist's home in Nashville. Towards the end of the evening I was approached about a child in Haiti, Olken Foncime, who was very sick with a heart defect. This was the end of September 2009 and in early October I was planning to leave for Dominican Republic for a two week mission and I offered I would be glad to help this child, however he would need to come to Santiago to be evaluated.

After a few emails and several back and forth conversations with Dr. Dorian, who by the way is the man of God who first identified this child, it was arranged for the boy to come to Santiago.

When he arrived we learned he had Tetralogy of Fallot and was profoundly cyanotic(blue) and would need some blood exchanges and a shunt procedure. All that went according to plan and he was released from the hospital in several days, much improved, see pictures below. Somehow I knew he would mean so much more than one child getting surgery and going home. His gentle spirit and captivating smile were contagious and all who met him instantly fell in love with him.

When tragedy struck on January 10, 2010 everyone was fearful he might have been injured or killed. Frantic email were sent out and after several anxious days we found out he was OK but the orphanage was severely damaged. Dr. Dorian traveled to Haiti after the earthquake to help with emergency relief and found him there and made arrangements for him to return to the states on a medical visa for his corrective procedure.

Out of all this an idea came forth, which I believe is from the Holy Spirit, that we needed to develop a program for Haitian children with heart defects. So here we are gathering ideas and looking for support for this project: To provide a place for 400 children over a period of five years and hopefully find a more permanent location for a cardiac institute in Haiti to care for these children closer to home.

Thankfully, we have on the island a place where children can receive advanced cardiac care in Santiago DR at Hospital Infantil Arturo Grullon. In fact, the hospital is about to break ground on a new pediatric cardiac institute specifically for children with heart disease. This will allow for the more immediate need to be met, however a more lasting solution needs to be developed. This will take more hard work and prayer and with His direction I believe we can find an answer.


1750 Madison Ave, Suite 500
Memphis, Tennessee 38104

May 24, 2010

by Jenny Dyer, Ph.D.

Brad Paisley and Bill Frist Photo 

In spite of the flooding of millions of dollars worth of the H2O tour instruments and equipment, the show still went on.

The Brad Paisley H2O World Tour began in Virginia Beach this Friday night, and critical reviews are saying it will spoil you for any other summer shows...and maybe even Disney World.

Hope Through Healing Hands has been honored to partner with the tour to promote awareness, advocacy, and philanthropy for clean, safe water initiatives around the world with our Water=Hope Campaign.

Senator Frist and his family, staff, and friends flew to Virginia Beach for the launch of the tour.

"It was so exciting to be there for the very first show. I'm proud to be partnered with the H2O tour and I'm proud of the hard work of all our Water=Hope Campaign volunteers. We have a great booth, and we signed up many interested activists and donors for this important campaign for clean water," says Frist.

Being in Virginia Beach, the volunteers talked with lots of fans that were current or retired members of the military, many of whom had seen the need for clean water around the world first hand and were eager to lend their support. 

We also got a lot of love from the Paisley crew - Brad himself came by and picked up a shirt from our booth, so keep an eye out for it to appear on stage sometime soon. The tour continues on, and we are looking forward to getting more and more people involved!

If you'd like to be a volunteer, sign up at www.waterequalshope.com/volunteer. We may be coming to a city near you soon!

University Teaching Hospital

Lusaka, Zambia


The two weeks I spent on the gynecology service were eye-opening and much less pleasurable than working on the maternity wards. On this service we were mostly giving bad news and taking care of chronically ill patients. Of the urgent cases, the majority presented with complaints of bleeding during the first trimester of pregnancy. At least half of these were spontaneous abortions (miscarriages), an average of 12 per 24 hour shift. These patients needed manual vacuum aspiration to empty the uterus of any retained products of conception. Amazingly, the women accepted the news gracefully and were cooperative with this method of treatment. Only their strength carried them through this painful procedure as analgesia was not given.

Unfortunately, a few of the women lost a significant amount of blood and fainted soon after the procedure. We scrambled to start intravenous fluids and manually monitor vital signs for quick resuscitation. We were always very concerned about blood loss knowing that the entire hospital had a critical shortage of blood available. For weeks most requests for blood transfusions were denied. Blood was only given for surgical cases since these patients were at highest risk for becoming acutely anemic.

I had the pleasure of visiting the Chongwe District Health Center, a rural health center outside of Lusaka. The clinic was very busy and ran as efficiently as possible with 1 physician working day shift, 1 clinical officer, 2 midwives, and 4 or 5 nurses. This center functions as a hospital and clinic, keeping patients who need close monitoring overnight as well as treating any acute cases that come day or night. On site is an antiretroviral clinic used for the care of people with HIV/AIDS, a women's clinic with equipment to perform cervical cancer screening, and men's and women's wards which are usually mixed due to an overflow of patients. Pediatric cases are also treated and kept overnight if necessary. The physician on duty treats a variety of illnesses, from malaria to strokes to burns. Emergent cases or those needing specialized care are stabilized and sent to University Teaching Hospital, some 45 kilometers away. All medical care is free, including medications and laboratory tests. In 2009 this clinic serviced over 17,000 patients.

The medical care in Zambia is adequate. The major shortcoming is manpower, a result of limited resources. I was grateful to be welcomed as member of the medical team, helping patients receive quality care in a timely fashion. The dedication of the medical staff and strength of patients will forever influence my attitude and actions throughout my medical career.

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