News travels fast in small rural communities, and the word about the women's clinic is quickly getting around. Women from the community women's groups have been bringing their sisters, daughters and neighbors. Each patient exam has been taking about an hour, as it includes a full history and physical. The appointment also includes an explanation of female anatomy, how a Pap smear is preformed, and how it is used to check for the changes caused by human-papilloma virus (HPV) which can cause cervical cancer. Many of the patients have never had a pelvic exam or Pap smear so teaching has become a large part of every appointment.

Primeros Pasos's mission includes increasing education about methods of disease prevention. Though it is common practice that Guatemalans only come to the clinic once already very ill, Primeros Pasos women's education program is doing a great job promoting wellness and annual check-ups. Some patients have come in for symptoms of anemia related to heavy and irregular menstrual bleeding, however many healthy feeling women have come in specifically for their Pap smear and annual physical. Currently, the Primeros Pasos clinic has the ability to process a handful of laboratory tests in house. Unfortunately, the Pap smear is not one of them. Where as many of Primeros Pasos volunteers are being trained to identify intestinal parasites from stool samples, or run different blood tests, a Pap smear slide must be read by a trained cytopathologist. Therefore, the Pap smears are being processed at a lab in the city of Xela. Once a week I take my bundle of Pap smears to the lab in the city. Each Pap smear costs 25 Quetzales, which is about the equivalent of three American dollars.  It's amazing how three dollars can make such a difference in the lives of these women.

Cervical Cancer has been the hot topic the last two weeks. Rightfully so, as it deserves a lot more attention than it ever gets. In the United States, we almost never hear of deaths from cervical cancer because we have so many methods of early detection already in place. However, according to the American Cancer Society global cancer statistics report (2002), cervical cancer is the second most common cancer among women worldwide. In select countries, such as Guatemala, cervical cancer ranks even higher as the number one cancer among women with a reported rate of less than 10% of women receiving regular screening (Ministry of Public Health and Social Aid of Guatemala, 2003). Many myths and misconceptions about cervical cancer exist in the rural communities. The last two weeks I have helped teach phase two of the women's education curriculum, which focuses on women's health issues such as uterine, ovarian and cervical cancer. In the past many, most women have lumped all the aforementioned together as the same "women's cancer" that is rarely spoken about due to fear and stigma. Through the women's education program, the myths around cervical cancer are slowly being unraveled and addressed.

The patients are not the only ones inquiring about cervical cancer. The buzz among the Guatemalan medical students prompted a lunch lecture dedicated specifically to the topic. Upon request, I will now be running a weekly lunch lecture on the essentials of obstetrics and gynecology. The new group of medical students is inquisitive and hard-working. They have already made huge leaps and bounds in their time at the clinic. I am working closely with the two female medical students to teach them to perform women's health exams. It is very culturally taboo for females to be treated by male healthcare providers for any issues related to women's health or pregnancy. So although I am foreign, my presence is accepted because I am female. Each day I hope to slowly build my patients' trust, which is the biggest thing that you can ask for as a foreigner in the Valley of Palajunoj, in a country like Guatemala that is still feeling the aftermath and distrust of a 36 year civil war.

For More Photos, Go to:



1) Nyamata Internal Nursing Hospital Staff

2) Nyamata Hospital


It is hard to believe it has only been two weeks since I arrived in Rwanda. I landed late Thursday evening and was taken directly to the Nyamata hospital guest house where I will stay the next three months. I started work in the hospital the next day at 7:30 am and I have been busy ever since.


The Nyamata hospital is a public hospital serving the people of the Buresera district in Rwanda. The patients are generally from the surrounding villages and do not have much money. The services are not expensive, but the patients have to pay for everything before they are treated. For example, if they need to have an intravenous line (IV) put in so they can receive IV fluids and it is not an emergency, they have to send someone to the pharmacy to buy the IV and all the equipment before it is done. Yesterday, when I asked the staff why a patient had not had an IV started yet, they told me the patient’s family had gone home to sell a goat to get the needed money.  


The hospital offers much more than I had expected. Inpatient units of the hospital include surgery, post surgery care, maternity, obstetrics and gynecology, pediatrics, emergency care, internal medicine, and mental health. They also have several rooms designated for isolating patients with severe cases of TB. On site services include a pharmacy, out-patient consulting, physical services, imaging, laboratories, a dentist and an optometrist. There are also consultation offices for HIV and tuberculosis (TB) and a voluntary HIV testing center.


I am spending my first month working as a Registered Nurse in the internal medicine unit. After this first month I will start working as a family nurse practitioner in the outpatient area and in the community. Working as a nurse is a great way to learn the common illnesses, the skills of the staff, and the challenges they face here. Every morning I see patients with the physicians and am able to discuss the problems and treatments of the people I care for. I spend the rest of the day working with the nurses. The nurses are well trained and we spend the day exchanging techniques and caring for the patients. There are usually 40-45 patients in our area with only two nurses taking care of them on each shift.


Although there are a full range of services resources are limited. For example, there are a total of 170 beds in the hospital and they seem to run at near capacity. Patients stay in rooms together, with as many as 11 per room with the beds spaced only two feet apart. They sometimes lack some basic equipment. Last week we were unable to find a working nasal cannula in order to deliver oxygen to a patient who desperately needed it. Fortunately, as in the case of the cannula, the staff are accustom to working under these conditions and are often able to fix broken equipment or find another way.


Patient illnesses vary, but there seems to be some common trends. Acute cases of malaria, TB, HIV, and hepatitis are all common. Gastrointestinal problems, caused by parasites and bacteria, are present in the majority of the patients. Pneumonia and severe anemia are also common problems. Parasites that cause internal bleeding and malnutrition seem to be the reason for 90% of the anemia. It’s tragic that people are dying from things so easy to fix.


I have been there long enough to have seen many patents sent home healthy after having arrived in critical condition. For example, one elderly woman with severe malaria was brought in from one of the nearby villages. She had a severe fever and anemia and was unconscious, and going into shock. I was not sure if she could survive. However, she after receiving anti-malaria medications and a few blood transfusions she started improving. A couple of days ago she walked into the nurses’ station, smiling and full of energy. She had come to thank the nurses and say goodbye. I cannot express how good this made me feel.


Of course not everyone gets better. Although there is a full range of services the limited resources has an impact. We seem to lose a few patients a week. It is heart-breaking to see someone die when you know how to help them but the medications, manpower, and equipment needed are not available.


It is not always easy to work in the hospital but I am grateful for this opportunity. I am helping people who are in desperate need while gaining invaluable experience. I don’t know what else someone could ask for.  



3) Looking at Blood Smears





Taking Care of Newborns: From Kijabe Hospital, Kenya


        Pretty sure I have fleas.  Jim found these two little guys buried deep in my hair and wriggling up itches everywhere.  Now I learn that the previous neonatologist had also acquired some type of stow-away and so would not sit on the mom's beds or wear his white coat thru maternity.  But what am I to do?   The mom's wait longingly as I speak to the woman in front of them.  The want attention for their babies and for their concerns.  They delight when the blond mazungu doctor hugs them and stops to visit. Maybe if I were here long term it would be different, but for just six weeks, though its not very lady like - I guess I'll have fleas.

         Don't be mislead...I am not that cool about having fleas.  The first night we discovered them I must have combed 1 pound of Ultrathon repellent thru my hair.   I then got three "999" pages to maternity for worrisome deliveries.  Yup, there I was resuscitating babies with my deet drenched head.  I can't wait to hear what the Samali women have named me, something like "sour smelling doctor."

          Most of the on call pediatric emergencies are in the delivery room which has verified my decision to specialize in neonatology.  For the most part, a sick newborn in the delivery room does not stress me out in the same way that it bothers non-neonatal physicians.   I am working hard to teach the general interns here how to be calm and act even when the babies are tiny or need to be intubated.   My soap box has ben intubating babies who need to have meconium (first baby stool) removed from their tracheas prior to resuscitation.  The interns know tracheal suctioning needs to be done, but they are terrified.  So if a baby is floppy, not breathing, and covered in meconium the interns have been stat paging the pediatrician and then just waiting: intern shaking, child dying.  Now we review the steps at every delivery that I go to with them and we prepare.  If the child needs suctioning it is up to the intern to be the baby's doctor and I am there for support.   Jim says I am like a duck - above water smoothly floating along, underneath my webbed toes are spinning out prayer.

            During the night of three stat delivery pages, I had my first death in the delivery room.  The hospital is downhill from our apartment so I was pretty swift to respond to the call, but the baby was a still birth.  The intern briefly tried to resuscitate him, but then made the decision that the child was truly gone.  When I walked in there was a blue baby on the bed warmer with the end of scrub bottoms covering his face.  His mom was silent, stretched out toward him, blinking in disbelief. It was awful.  I went to consol her, but quickly realized this was not the time for a rich white woman whose fat, healthy baby sleeps at home to become involved.  I left quietly.

            I remember passing the guard on the walk home.  My mind was busy trying to figure out what I am doing here.  I am suppose to be a teacher.  I didn't teach anything.  Of course, that would have been inappropriate but why was I suppose to be there at all?  At home where my family slept, I wondered and waited for the next page.  I did finally realize, my intern had made the decision to let the baby "go" on his own - How advanced?  How intimidating?  So I called him and told him he did the right thing.  I told him that in my country we frequently get babies who didn't have a heart rate for 30 minutes but no physician was brave enough to stop.  I reminded him that saving the body once the person has gone is not triumphant.  Learning when to stop is not easy and is almost never clear, but is essential.  I told Jeremy I was proud of him and he was grateful (quiet and Kenyan, but grateful).

Quetzaltenango, Guatemala

The past two weeks have been an absolute whirlwind. After overnighting in Antigua I took a small bus for five hours up the winding mountains into the western highlands, finally arriving in Quetzaltenango. Quetzaltenango was and still is a principle center of Maya Ki'che and is often referred to by its Ki'che name Xelaju and abbreviated to Xela. Xela is a large city seemingly disconnected from the surrounding cities but by small winding dirt roads which the revamped and repainted yellow school buses ride along. Most women in the city still dress in traditional Mayan clothing, which becomes even more prevalent as you head out into the country side. Every morning we take the unmarked school bus from the bus stop at the Calvario Church into the mountains of Tierra Colorada Baja. Outside the church, venders sell flowers freshly cut from the mountains and beans and eggs out of street charts.

Now is the perfect time for me to be at the Primeros Pasos clinic, as many exciting changes are going on around me. Originally a pediatric clinic, the Healthy Schools Program is one of Primeros Pasos largest components. Health educators go out into the local community schools and teach about prevention of infection and communicable disease. By participating in this program, the children receive free healthcare at the clinic. For the schools that are too far from the clinic, Primeros Pasos has a mobile clinic which runs at the end of the school year. The end of the Guatemalan school year is now approaching so we have been hiking into the mountains with backpacks full of medications and medical equipment. As we are about to hit a lull in pediatric consults, all focus is on the new women's clinic.

The women's clinic will run in conjunction with the women's groups that have recently started up in the community. Similarly to the Healthy Schools program, women that participate in the women's group will receive free care. The objective is for patient to invest in their healthcare through commitment to health education. In the afternoons we have been hiking into the mountains to teach the women's groups and to talk about the new women's clinic. The women's education group has three phases: The first phase focuses on nutrition, hygiene and traditional medicine. The second phase focuses specifically on women's healthcare topics such as cervical, endometrial, and breast cancer, pap smears and self breast exams, pregnancy and prenatal care, menstruation and menopause. The last phase focuses on self esteem and leadership. In this phase, the women have a choice to start a community wellness project or to become a health educator. We are hoping to find the next group of women's health educators from this group. Each day of the week is a different women's group meeting in a different community, all in different phases of the program. The women at the women's group range in age from teens to grandmothers. Most women bring along their children, tied onto their back and over their shoulder with a traditional woven clothe. The first groups are entering the third phase; it will be very exciting to see these women become leaders. You can easily tell the difference between the timid participants of groups in phase one as compared to the outspoken individuals starting phase three, who eagerly ask me inquisitive health questions and willingly discuss women's issues.

On the first day of my clinic orientation I already had a patient. I had been told that many mothers had been asking for help when they brought in their children, but I had not anticipated for things to happen so quickly. Unfortunately, all the clinic supplies were still in the apartment, so I did the best I could with what I had.  I guess you can say the women's clinic unofficially opened the first day and officially opened two days later and I have had at least one patient every day since.  A new group of medical students have just started their rotation at the clinic. Two of the six medical students are females and I will be training them in the basics of obstetrics and gynecology in the primary care setting. It will be exciting to see them grow into the role of provider over the course of their eight week rotation. I can already tell that everyday will be a new adventure.

Next Big Nashville: How Can Artists Help

October 9, 2009, 11am

Country Music Hall of Fame, Ford Theatre

by Jenny Eaton Dyer


Today, Charlie Peacock moderated a panel on How Artists Can Help Charities, especially given the current economic climate -- when money is tighter than ever. Panelists included Billy Cerveny, Brite Revolution; Kenny Alphin, Love Everybody; Jenny Dyer, Hope Through Healing Hands; Andrea Howat, Hanson’s Walk/Tom’s Shoes; Derek Webb, Blood:Water Mission; and Barrett Ward, Mocha Club.

Having worked with artists for years at DATA/ONE on how to promote awareness, education, and advocacy to their fanbase, I offered a few practical steps that they can take to get started:

  1. MATERIALS: Set up lit/materials at merchandise tab or booth.
  2. SIGN UP SHEETS: Sign people up to on sheets at merch table or booth Get their emails/addresses.
  3. PSA: Before or between sets, show a 2-3 min PSA
  4. SHOUTOUT: Before or between sets, commit to doing a "Shout out" for 1-2 min about importance of global poverty, health, education, etc.
  5. TEXT MESSAGE: You can get a text message service so that you can direct fans during show to "text" in to capture their emails on the spot - but there are costs involved.
  6. PASS A BUCKET: You could "pass  buckets" and ask for $1 during a show.
  7. PRESS KITS/INTERVIEWS: Mention in your press kits and interviews that you encourage fans to lend their voice to the fight against global AIDS and poverty in Africa.
  8. Wear  t-shirt/sticker, etc. on stage during show.
  9. Promote  on website w link/logo.
  10. Email blast: send email to fans encouraging them to sign up.
  11. Put  info in your CD/DVD liner notes driving them to website.
  12. Continue to promote and connect fans to website Twitter and Facebook.

Educate, Activate, Motivate, Celebrate is a catchy phrase to remember on the method of promoting awareness, galvanizing action, and sustaining interest among your constituency.

I also encourage local artists to check out our new Global Health Coalition. Consider supporting a local group doing global efforts.

Artists hold a prophetic voice in society, standing at the margins, speaking truth and perspective. One voice can change the world.

Let us know if we can be a resource to you: [email protected].

Global Health Leader Amelia Wood arrived a couple weeks back at Kijabe with her husband Jim and baby Josiah. She is serving as a neontologist there, bolstering health care delivery and training.

We have now been in Kijabe a full week. We arrived to homemade zucchini bread and an invitation to watch "So you think you can dance" from the wonderful Davis family (our neighbors just below in the Sitaplex guest house). Not having a TV at home, we were way less in the know than some of the long term missionaries here. Kijabe is like summer camp for doctors. And although there may be some sacrifices in being in Africa (like broccoli free of aphids) our overwhelming sentiment is, "man, don't we feel at home!" 

We have made many good friends in the short time since we arrived, including a missionary couple who are living our dream. Mark and Sue Newton have been in Kijabe for 12 years and they are so authentic and enjoyable that they make missionary life seem easy. Mark is a pediatric anesthesiologist who spends 10 weeks working at Vanderbilt every year and the rest of their time is at Kijabe. They have a welcoming home, wonderful children, and a black lab named Moshi. Their lives are busy, but they have graciously had us over twice in the first week - of course, one of those times we arrived un-invited! But they didn't seem to mind. It has been great to listen to them and realize that some of our hopes could in fact become realities.

PRAISE THE LORD, Jim and I found an angelic nanny named Helen who I will cry to leave. She makes it possible to work in peace knowing that our sweet Josiah is cheerfully smacking around our home under her watch. I am only working until lunch time (plus taking call) which is good because everything takes longer in Africa. It is a slow walk with Josiah on my hip to the dukkas (pronounced doo-kus = produce vendors); then bleaching the vegetables is another considerable speed bump once we get home! I actually really love hanging my own laundry out on the line (although it does mean you can't leave the job unfinished until tomorrow).

So as for our "test run" here at Kijabe....I'd say we love it. Where else could a country-boy practice pediatric surgery and his wife practice academic neonatology while their children run through the country-side?

The people here are smiley and energetic. The children are beautiful, just like everywhere. I work in the "nursery" which is an absurd understatement for the degree of illnesses managed in the small, overly heated room crammed with sick infants. We pile in as one big mass of white coats to begin rounds while the nurses sing praise songs in the next room for morning devotionals. Their singing sounds like a dream or the soundtrack to a Francis Ford Coppola film. In the nursery, the mothers all gather round to listen to our discussions as we move from baby to baby. There is no HIPPA so they support each other when things aren't going well and consol one another's babies when they are crying. Mostly, it is a type of sweet interdependence and community lost in the ultra-private and sterile US. Sometimes however, it is a cacophony of cultures-a yelling match in varied languages with beeping incubator alarms and empty infusion pumps filling in any moments of silence. The Somali women are particularly prone to finger wagging and loud refusals to suggested medical plans. I sometimes struggle to teach amidst all the hot commotion.

I usually round with my friend Stephany Hawk, who was my co-resident at Vanderbilt and is now doing a two-year stint as the pediatrician at Kijabe. Together we are training African residents in pediatrics during our daily discussions of patients in the nursery. I have also been asked to lecture at Grand Rounds for the missionary physicians -- pediatricians and family docs. Because I have had the privilege to train under Susan Niermeyer, an international expert in the care of newborns at high-altitude (Kijabe is 2000 feet higher than Denver), I plan to teach about the special challenges of caring for infants transitioning from fetal to post-natal circulation at high altitude. I will also be giving lectures in basic neonatology to the nurses who do much of the bedside care and are pivotal to keeping these babies alive. I am already attached to them, and I often need their hugs on the way out the door each day-neonatology in rural Kenya is sometimes very difficult.

Our biggest limitation to sick newborn care is the lack of total parenteral nutrition. We have many pre-term babies as well as several infants with inadequate intestinal length due to operations, who would all receive TPN in the States. At Kijabe we manage them by feeding at the earliest opportunity and praying for a miracle. It is the best thing available. We can sometimes get lipids (a component of TPN) to add to their IV fluids, and there are rumors of amino-acids, but I have yet to see any-I don't really believe they exist in Kenya. So we do the best we can with what we have.

We see a lot of death and pray that we are communicating Christ's love to these moms by caring for their children who would otherwise be forgotten. This morning, I barely left the bedside of a dying child, whose mother insisted that he was already dead-as evidenced by the ventilator breathing for the baby. The baby is not dead, but he probably will be soon. With all of the challenges and obstacles, it can be difficult to persevere at times.

Still, we do see some miracles. We have two former 29-week preterm infants who are thriving and have graduated into what American neonatologists call "feeder-growers". My favorite is baby James. He is almost ready to ‘hatch' from his incubator. Another baby I love is baby Joseph-a term newborn we admitted for sepsis. I told his father (‘Babba Joseph' as the Kenyans refer to a child's father) that he should expect Joseph not just to survive but to be a normal child. I told him that Joseph will play football (soccer) with his brothers one day. Babba Jospeh smiled broadly and declared "This is a good prophecy." Indeed, I agree.

Life is simple, hard, and lovely.


 Baby James

September 30, 2009

by Jenny Eaton Dyer, Ph.D.

Last night we had a really fantastic Global Health Gathering at the Frist home. Welcoming all Nonprofits who were dedicated to Global Health issues (or Millennium Development Goals) in Tennessee, we had an array of groups who attended who had traveled from as far away as Johnson City or Memphis.

These great groups, all who have joined the Tennessee Global Health Coalition, provide aid and service around the world. They provide beds, shoes, education and clean water for the world's poorest. Some offer leadership training, mental health services and a haven for child soldiers. We have groups who fight trafficking in all forms, and we have groups who train community health workers to provide better health care in forgotten corners of the world.

To be in a room with these heroes and learn from and about their great work was so encouraging for everyone.

Big Kenny ( and his beautiful wife, Christiev, came ( and shared their latest experience in the Sudan. He played his new song, "Forgiveness" with a collage of photos from the trip. His gift is storytelling, and he's out to change the world.

Lewis Lavine, president of Center for Nonprofit Management (, joined us to offer his organization as a resource for the nonprofit groups.

And, Senator Frist shared his story of getting involved in global health policy, the commitment to saving lives in medicine and politics, and the trajectory of Hope Through Healing Hands' Global Health Coalition for Tennessee.

Everyone enjoyed Moe's burritos and guacamole, and I think all left realizing that Tennessee indeed has a robust global health community of works that can and will be showcased. After a "speed-dating" for nonprofits ice-breaker (Kenny said it was louder in the Frist's hall last night than in a good bar!), we prompted small group discussion for these groups to think on ways to work together.

We are excited to see what the future holds for these amazing groups and partnerships.

 Courtesy of Jena Nardella: From left -- Senator Frist, Jenny Dyer, Sten Vermund, Big Kenny Alphin


 Frist Basement Hallway: "Nonprofit Speed-Dating"











Frist Basement: Small Group Discussion--Africa Group

A UMNS Feature
By Tim Tanton*
September 25, 2009

Dr. Bill Frist was flying low in a Cessna Caravan above the treetops in southern Sudan, an area routinely bombed by government forces during the country’s ongoing civil war.

The year was 1998. Frist, a U.S. senator, was entering Sudan surreptitiously as part of a medical mission sponsored by Samaritan’s Purse. Sudan had no diplomatic relations with the United States, which had identified the African country as a sponsor of terrorism.

In the remote Liu area, Frist flew over a site where bombing had claimed a rural hospital.

“It had been destroyed,” he recalls. “There was fighting all around.” However, his team was able to work in a makeshift clinic.

“I came back the next year, the fighting had stopped,” Frist, 57, says. “I came back the next year, and there was a little tiny village, maybe a hundred … huts there. And then I came back the next year, and all of a sudden the church, which had been bombed, was blossoming. There was a school there. There was a hospital there. Nobody was fighting.

“So then I said that, basically, there is something to this – that medicine or health is a currency for peace,” he says.

That idea became the foundation for his global health nonprofit, Hope Through Healing Hands. For the surgeon and former U.S. Senate majority leader, health care has a role to play in building communities – and building peace.

“You don’t go to war with somebody who has just saved the life of your child,” he explains.


September 24, 2009

Senator Frist was the Commitments Presenter in an Infrastructure Breakout Sessions Seminar: Infrastructure of Recover: Good Jobs and Smart Growth.

Global recession has slowed private sector investment and caused rampant job loss. In response, governments around the world are investing in economic recovery though forward-looking public works projects. This new generation of infrastructure investments -- from broadband networks to transit systems to clean energy technology -- is laying the ground word for global deployment of advanced technology and private sector innovation. The response to to the economic crisis has set the stage for a new generation of smarter infrastructure empowered by better use of information and more efficient use of resources. Outdated development patterns are being "leap-frogged." This session provides an opportunity to reflect on progress one year into the economic crisis and to examine the relationship between the public and private sectors.

Frist announcing Commitments.

September 23, 2009

P&G Dinner: The Procter & Gamble Company (NYSE:PG) honored partnerships that have helped the company achieve three life-saving commitments at their "Live, Learn and Thrive" Awards event. Held at a VIP reception in conjunction with the 2009 Clinton Global Initiative (CGI) in New York City, the Awards recognize partners CARE, PSI, UNICEF and World Vision for their help in improving the lives of more than 40 million children, by providing vaccines and safe drinking water to help those in need.

Senator Bill Frist was one of four who presented awards to the partners. While there, we took several photos featured below.

Sheraton NY Hotel and Towers, Avenue Restaurant

 Frist giving interview prior to award beginning on importance of clean water at global level.

Frist chatting with Hans Bender, P&G VP External Relations Global Household Care--Note PUR Packet and PUR Product produced by P&G













Frist chatting with Rich Stearns, President of World Vision (awardee) and his wife Renee Stearns.











Frist visiting with Fellow Awarder Actor Dania Ramirez
















President William J. Clinton and P&G Vice-Chair of Global Household Care, Dimitri Panayotopoulos wrapping up the evening, celebrating the launch of new commitments.



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