August 19, 2007
By Dr. Julio Sotelo

[NOTE: Dr. Sotelo is a physician with Direct Relief partner Peruvian American Medical Society and chairman of their Missions Committee.]

I was in Lima the 19th of August, returning from Abancay when Mariel Pineda for APCU invited me to collaborate on a trip to Southern Peru to visit the earthquake victims.  The Civil Defense Institute (INDECI) was stationed in Pisco, the most damaged town.

There have been many donations of medicine, food and other things from many countries.  I saw planes from Colombia, Brazil, the United States and Spain, which left at any moment of the day without interruption.  I helped organize the donations and register them in the computer.

The Commandant, Carlos Barandiaran, who is in charge of the base, offered me a flight to Pisco.  I immediately accepted and flew down with the Colombian Air Force with 15 other people on top of a shipment of Gloria milk cartons.  In Pisco, James Atkins of INDECI was in charge.  He assigned me to Angel Montesinos to help me inspect the town, the hospital and the emergency room.

We took a 20 minute drive to the town of Pisco in a MINSA truck.  During the drive I saw that at least 50% of the brick houses were destroyed and those that were still standing could not be used for the risk that they might collapse.  Due to this, many people are in the streets, some underneath plastic.  I saw no tents.  The driver and my companions advised me not to travel with the windows down and to lock the car door because in the past few days people had been approaching vehicles looking for water and food.  No one approached us this time.  All the streets were filled with people.  There was no water or plumbing, nor were any restaurants or hotels open.  All the stores were closed and many streets were impassable due to the debris.  There were no taxis or buses. 

We arrived at the hospital, which was completely destroyed.  A taxi driver told me that, a few days ago, a group from NBC reported seeing bodies lying in the debris with a stench in the air.  I did not see or smell this, only people wearing masks.  I was told a group of Spanish volunteers had removed the bodies.  No one could tell me if survivors were found after the earthquake among the rubble.  The emergency wing was recently finished and was to be inaugurated the week of the earthquake and it had to be used as the only site to attend to the people with head injuries, broken bones, and anxiety attacks.

After the hurt were stabilized, they were helicoptered to Lima.  Dr. Rosa Vicuna was in charge of the hospital wing.  There were five doctors working in shifts of 12 hours, leaving between two and three doctors in charge of the emergency wing. Dr. Vicuna said that the center had four stretchers, that they needed a well equipped ambulance, first aid supplies, and antibiotics.  I reiterate the need for an ambulance.  It was relatively calm in the emergency wing, with patients in stretchers.  There were coffins on top of each other in the entrance.  I estimate that there were about 100 coffins.

Dr. Vicuna said that the volunteer Cuban doctors had coordinated 34 shelters in the town.  She asked me that no blood be sent to the emergency wing because there was no way to store it.

It seemed that all the emergencies had been attended to in the first few days following the earthquake that occurred on Wednesday, August 22 at 6pm. The differences between the destroyed hospital and the intact emergency wing is a reflection on the differences between some of the houses in the town being completely destroyed and others left untouched.  Civil engineer Lourde Gomez of the INDECI explained to me that this occurred partly to the subsoil in Pisco and to the faulty construction by many people, who did not follow the building codes, instead building “a la criolla”—on their own.  The poorest people suffered the most.

The base of operations is located in the Pisco airport, which is receiving flights from Lima day and night.  There are free flights to Lima but the waiting list is very long.  The nights are cold.  Many families with children were going to Lima, but the majority of the population does not have family or the means to leave the town.  It reminded me of New Orleans and Hurricane Katrina when many of the poor people could not evacuate the city due to similar reasons.

I ran into Carlos Vallejos Sologuen, the Minister of Health, who has been working in Pisco at the airport.  He offered me his driver to return to Lima, but the trip usually taking four hours, has extended to more than six due to road damage.

October, 2003
by Kelly Darnell, Program Officer (Asia, Middle East)

Situated on the northeastern coast of South America, Guyana is a sparsely populated country with just over 750,000 people. The population is primarily a mix of African, East Indian, and Amerindians. Although the country’s healthcare system has improved in recent years, many Guyanese, especially those living in the northern rainforest, still have very limited access to health care and suffer from high rates of communicable diseases and nutritional deficiencies. The health system has also been particularly hard hit by the “brain drain,” that has been occurring for decades as Guyanese doctors and nurses leave for better pay and working conditions in other countries.

For over 19 years, Direct Relief has been providing medical supplies to health facilities in Guyana. During my week-long assessment trip, I visited seven Direct Relief-supported hospitals, including our newest partner facility, the Moraikobai Hospital.

Kelly Darnell with Prime Minister Sam Hinds

After traveling three hours inland through the rainforest on Guyana’s Mahaicony River, I reached the village of Moraikobai. This remote community is where the majority of native Amerindians make their home. Most live in small villages of palm thatched huts and survive on subsistence agriculture, hunting, and fishing. The Amerindians have the highest rates of low birth weight babies, malaria, and malnourished children in the country. In addition, they suffer from acute respiratory illnesses and diarrheal-related diseases due to poor sanitation and lack of access to clean drinking water.

The majority of Guyana’s health facilities are located along the populated coast of the country, leaving the Amerindian communities in the interior with very little access to medical services. The Moraikobai Hospital is the primary healthcare facility for the Amerindian villages within 100 miles. The small four room hospital is staffed by three nurses, one Peace Corps volunteer, and a Medex named Thomas George who has a level of training between a nurse and a doctor. Assigned to the village a little over a year ago, Thomas has already created a community health committee, helped establish a clean source of drinking water, and worked to improve the level of services at the hospital through partnerships with organizations like Direct Relief and the Peace Corps. In December 2003, Direct Relief will supply Moraikobai with material assistance such as a new exam/delivery table, inpatient beds, minor surgical instruments, quinine to treat malaria, and antibiotics to treat upper-respiratory infections.

During the final days of my visit, I had a series of meetings with government officials, including First Lady Uma Jagdeo, Prime Minister Sam Hinds, Minister of Health Dr. Leslie Ramsammy, and Guyana Peace Corps Director Earle Brown, to discuss our future assistance to Guyana and ways in which we can reach out to more isolated health facilities like the Moraikobai Hospital.

Direct Relief program officer Dan Smith, who has more than twenty years of experience in Latin American aid, is traveling in Guatemala and Nicaragua in February to see the work of Direct Relief’s partners there firsthand. Nicaragua has only 37 physicians per 100,000 people, which is the lowest rate in Latin America (UNDP). According to the Pan American Health Organization, 75 percent of the population of Guatemala lives in conditions of poverty. The lack of easy access to clean water, and the improper handling of waste have led to high rates of disease and malnutrition, particularly in children.

February 24, 2007

My trip has entered its Guatemala leg, and I kicked it off with a visit to the Kaqchikel Medical Clinic. Dr. Ronaldo Similox was very excited about the first donation we sent in 2006 and commented to me that it helped their patient services in five ways:

• In their weekly medical outreaches to 25 surrounding communities;
• In their stationary clinic;
• Equipping their 40 health workers and 8 midwifes, who live in the communities, with basic patient examination equipment and supplies so that the residents will have access to basic health care between the medical outreaches;
• In specific medical outreach programs to pregnant women in the communities they serve;
• And in the training of new health educators and in the on-going medical education required of current health educators and midwifes.

In addition to providing health services, the clinic also has adopted three public primary schools and provides 400 children with books and basic school supplies, multivitamins, and they give the each school a nutritional drink containing wheat, soy, rye, corn, and oats, which the teachers and parents prepare and give to the kids daily in an effort to both encourage their attendance, to improve their ability to focus and concentrate, and to improve their self esteem.

February 22, 2007

The Asociación Pro Niños Quemados in Managua, Nicaragua (APROQUEN) addresses the pressing needs of children with severe burns. Their modern facility receives referrals from all over Central America, and offers plastic reconstructive surgery, psychological counseling for the entire family, and extensive rehabilitation services. The above photo shows a young child playing, but in reality it is much more. The APROQUIN staff of professional physical therapists has a storehouse of play devices which stimulate the recovery of injured tissue and prevent the development of malformed limbs which occur after severe burns without proper exercise. In this case, the young girl is rehabilitating her burned legs, while also having fun.

APROQUIN also provides educational outreach to the community regarding safety around cooking fires and other potential burn dangers, as well as how to care for burns if they do occur. APROQUEN has a residence home on their site for parents who come from a long distance. Care and rehabilitation of a burned child is arduous and requires months or years of constant attention, so parents of burned children are given extensive instruction on home rehabilitation. No such inclusive treatment is provided by the government of Nicaragua. Product donor Johnson & Johnson provides Direct Relief with burn dressings and other needed materials that are sent to this facility.

I also had a chance today to visit another partner, La Escuela Primaria El Padul in Managua. This is a primary school started by members of a local church group in 1995 for the street kids in the area. It began as a small day care center in a private home and with years of hard work and the support of several foundations it evolved into a full primary school serving 400 children. The school is located in one of the poorest sectors of the city, where the parents can not afford to pay for the kid's school books and supplies, so the children roam the streets instead while their parents work.

At El Padul, the kids get free uniforms, books, and school supplies, and they are given two meals daily. The school pays the salaries of the teachers and staff, and has a small one-room medical clinic which, thanks to a volunteer physician, provides regular check-ups and basic medical consultations to both the students and their families. The school and clinic gives these impoverished children a chance to escape the circle of poverty into which they were born.

February 21, 2007

Tuesday was spent on the road in Nicaragua with Alvaro Pereira, director of the American Nicaraguan Foundation (ANF). Direct Relief has partnered with ANF for over 13 years providing Nicaragua with a variety of assistance, including children's antihistamines, high-calorie nutritional drinks, anti-diabetics, skin care products, and children's antibiotics. One of the sites we visited was the St. Francis of Assisi Clinic in Managua, a small urban clinic run by a group of concerned Nicaraguan women, and supported by products from Direct Relief’s ongoing assistance to ANF. The clinic sees about 100 patients per day, and has four physicians, a dental suite, and a small laboratory. The pharmacy lacks in some essential medicines, and the staff anxiously awaits the arrival of our next shipment, which will arrive in a couple of weeks.

This clinic serves many of the families that reside in (literally) and around the huge La Chureca city dump. These families make their meager living sorting trash into various bins and carrying it to various recyclers to be sold. School days last only a half day here, and those children lucky enough to attend primary school return in the afternoons to ply the piles of fetid trash in search of anything with value. It was explained to me that even though the living conditions are among the dirtiest and most unsafe in Nicaragua, at least they are with their mothers in the dump.

Unfortunately, most children ultimately resort to a life of crime and drugs in spite of educational and health opportunities available to them. The programs attempt to feed and educate the children and their families, while attempting to direct them towards a better life.

Logistics Coordinator Genny Bitter and Program Associate Rocio Cendejas are traveling in Grenada in January to assess the medical needs of Direct Relief partner Food For The Poor and evaluate prospective partners. They will be traveling with Grenada’s Minister of Health and a representative from Food For The Poor.

After Hurricane Ivan in 2004, 85 percent of all physical structures were either damaged or completely destroyed. As a priority, the two largest hospitals in Grenada underwent necessary repairs in order to continue to function. Direct Relief partners with Food For The Poor to donate medical material resources to Grenada for distribution to hospitals and clinics throughout the country.

Monday, January 22, 2007

Genny Bitter (center) and Rocio Cendejas (second from right) with staff from St. George’s General Hospital on the main island of Grenada.

The Minister of Health, the Honorary Ann David-Antoine, warmly greeted us this morning and helped us get a sense of the country’s present needs and activities. With the help of her staff our day’s itinerary was planned to begin at St. George’s General Hospital, situated on a hilltop overlooking St. George’s Harbor. This is the island’s main hospital with 200 beds and serves 40 to 50 outpatients each day. Benches lining the outdoor patio at the outpatient clinic were filled with men and women and the small surgery ward was fully occupied as well. The hospital is well staffed and has a small biotech department. The hospital’s pharmacy shelves appeared more full than anticipated. However, doctors and nurses alike clearly expressed the need for more equipment, supplies, and pharmaceuticals, particularly antibiotics. The hospital is also eager to see a cancer unit constructed.

Driving up Grenada’s lush hillsides, we next ventured onto the historic Richmond Hill to visit the Richmond Home for the Elderly, a government home housing 84 men and women. The small two-story barrack-style building rests atop the hill overlooking the bay, offering scenic views to an otherwise melancholy atmosphere. We visited the women’s room upstairs, a long rectangular hall filled with beds and speechless patients. There is a small separation at one end of the room that attempts to keep the mentally sick patients in their own living quarters. The house is in need of mattresses and personal care items, day gowns for the women to wear, and gloves for the staff.

Our journey to the eastern end of the island brought us to another home for the elderly, St. Martin’s. This house was completely destroyed by Hurricane Ivan, and only a portion of it has since been restored. Funded by the Catholic Church and through government assistance, this home cares for 40 individuals. We arrived at lunch time and entered into the main hall where two tables and side chairs accommodated the residents as they waited for their meals. St. Martin’s has small quaint rooms each with two beds. As at Richmond Home, the needs here include personal care items and improved infrastructure.

Continuing our path around the island, we next arrived at Princess Alice Hospital, a long rectangular building atop a hill overlooking Grenville, Grenada’s second largest city. The beauty of the thick vegetation and serenity of the cool breeze were very much offset by the condition of the infrastructure of Princess Alice Hospital. Another of Hurricane Ivan’s victims that was completely destroyed, the hospital is still in phase one of reconstruction with the entire female ward still fully under construction. As the hospital administrator stated, all is still make-shift here. Before the hurricane this was a 60-bed hospital, but present capacity is only at 20 beds. In general the hospital serves as one of the main centers for outpatient services for this part of the island and sees 1,000 patients each month. After any disaster or road accident, which have increased with the development of better roads, people make Princess Alice their first stop for stabilization rather than risking the 40 minute drive on curvy road to St. George’s General Hospital.

Finally, after heading north and before winding down the western coast of Grenada, we visited Cadrona Home for the Aged. Another government home, this small residence was nestled in the hills and houses 25 residents. Here we met with the Director for the Elderly for the Ministry of Social Development. He explained the great need that exists for services for the elderly. The 12 homes for seniors on the island do not meet the pressing needs. He also shared his plans to begin new projects such as a Meals on Wheels project and to foster a social service system that provides extensive in-house care. After this last visit, we followed the coast back to St. George’s, watching school children in uniforms walking home along the narrow roadsides and encountering Grenadian rush-hour traffic, the bustle and activity of St. George’s marking the end of this first day in Grenada. Tomorrow will take us to meet the Prime Minister, and to visit orphanages and schools.

From left to right: Rocio Cendejas, Grenadian Prime Minister Dr. Keith Mitchell, and Genny Bitter

Wednesday, January 24, 2007

Having been in Grenada for only 24 hours did not keep us from meeting the Prime Minister, Dr. Keith Mitchell this morning. Accompanied by Cliff Feldman of Food For The Poor, we were able to have a short visit at his office. He expressed his gratitude for the assistance we have contributed to Grenada and asked that we continue to think of his country in the future.

While still in the offices of the ministry, we sat down for a television interview with Allan Campbell of the Government Services Information. Mr. Campbell focused the conversation on the work of Direct Relief International and Food For The Poor in Grenada and asked each of us to comment on our impressions of the country and of our goals and mission while here. These goals include assessing the current health needs of the country, in particular those of the two large hospitals – St. George’s General Hospital and Princess Alice Hospital - in order to be able to direct focused support to address these needs.

Thursday - January 25, 2007

Yesterday afternoon we visited two schools – Wesley College Secondary School and St. George’s Methodist School.  Each school has restored its infrastructure after Hurricane Ivan and has a student body of over 400 students.  The majority of the needs of these schools include educational materials, furnishings, and books.  As far as health concerns, both schools would be well served by first aid materials and basic supplies to furnish a nurse station as currently no such commodities are available.

In general, Grenada appears to be well in the recovery process after Hurricane Ivan.  There are many construction projects throughout the island, the biggest of which appears to be the construction of the new cricket stadium in preparation for the Cricket World Cup hosted by the East Caribbean Islands that begins in March of 2007.  Although these projects have generated many jobs, local Grenadines informed us that prices for goods have risen considerably since Hurricane Ivan and that many Guyanese are being recruited for these construction jobs, meaning that the expanse of employment opportunities are not solely to the benefit of locals.

Dr. Joseph Cherubin with bed and equipment donated by Direct Relief International

Friday, January 26, 2007

A 90 minute boat ride from St. George’s inner harbor, known as the Carenage, took us to Carriacou Island.  The entire island, only 13 square miles, constitutes one of Grenada’s seven districts.  While in Carriacou we were accompanied by Ms. Susan Peter, a social worker with the Ministry of Social Development.  We visited Princess Royale Hospital, a small 32 bed hospital serving the island with out-patient and in-patient services.  Hurricane Ivan’s destruction has left the hospital in less than optimal conditions with repairs diverting resources away from efforts to improve patient services.  Presently, there is no maternity ward, and no operating theatre.  The male and female wards and the small out-patient clinic are the main areas of operation supported by one medical doctor and approximately 8 nurses.  The hospital staff expressed the need for equipment and provided us with detailed requests.

While in Carriacou we also visited the Windward Medical Health Station, one of several small clinics located within smaller communities throughout the island.  These stations provide free health services to all patients.  Such services include immunizations and basic lab tests, and out-patient care.  These health stations and the three hospitals on Grenada and Carriacou are linked under the system of health care supported by the Grenadine Ministry of Health.  Over the past six years, Direct Relief International has provided over $14 million of medical aid that was distributed amongst three hospitals and various health stations in Grenada.

This evening, we met with the Minister of Health again and she informed us that in 2005 and 2006 Grenada had achieved 100% childhood immunization.  All Grenadine children must have their immunization card complete before attending school and the Ministry of Health ensures that these important vaccinations are provided free of charge.

Monday, January 29, 2007

Leaving the Windward Islands and traveling northwest, Genny and I arrived in Santo Domingo, Dominican Republic this afternoon.  Awaiting us at the airport was Dr. Joseph Cherubin, Executive Director of the Movimiento Socio Cultural Para Los Trabajadores Haitianos (MOSCTHA).  Driving to the northern end of the city, we arrived at the newly constructed Centro de Salud Integral, a five story 15 bed hospital that provides lab services, including HIV testing, general medicine, nutrition, counseling, dermatology, internal medicine, pediatric, and dental services.  

MOSCTHA was founded in January 1985 by a group of immigrant Haitians in the Dominican Republic.  MOSCTHA does not discriminate on the basis of race, political affiliation, religion, sex, or nationality.  The mission of this non-profit organization is to improve the quality of life and respect the human rights of immigrant Haitians and their families and other impoverished populations through the implementation of community development projects and programs.

The work of MOSCTHA includes creating greater access to health services for immigrant Haitians and impoverished sectors of all regions of the Dominican Republic and the Bateyes in Haiti. Their hospital is open five days a week, and sometimes even on the weekends.  They also operate a mobile medical van to bring services into the communities around the hospital.   In addition, MOSCTHA offers educational seminars in conjunction with the Department of Education, actively calls for and strives to foster the respect of human rights for Haitian immigrants, and sponsors community development projects such as micro credit schemes and water and sanitation projects.

The new hospital is the culmination of Dr. Cherubin and MOSCTHA’s commitment and dedication over the last twenty-two years.  Direct Relief provided 15 beds that are now furnishing the exam rooms and in-patient ward, six exam tables, lab equipment and supplies, and a range of pharmaceuticals supplying the hospital’s pharmacy.  Dr. Cherubin expressed his sincere appreciation for this support from Direct Relief and stated that without our donation, the new hospital would not be in its present state of operation.

Tuesday, January 30, 2007

This morning we drove into the heart of Santo Domingo . Turning off a small city street, we pulled into the Cruz Jiminian Foundation Hospital to meet Dr. Cruz Jiminian. Unlike most medical centers and hospitals in Santo Domingo , Dr. Jiminian’s medical center is not located in a medical niche of the city. Instead it is located in a poor residential region isolated from any other medical clinic or hospital.

With a staff of over 100, the hospital is in constant activity. The patients treated at this hospital come from the most impoverished sectors of Santo Domingo seeking care that they would not be able to receive free of charge or at a very reduced cost elsewhere in the country.

As we stood in the driveway waiting for Dr. Jiminian to meet us, it was apparent that this hospital served a large population and was the main source of care for the surrounding community. People were constantly moving in and out of the hospital, and there was a recognizable sense of urgency around the building. Dr. Jiminian greeted us quickly and took us to a large courtyard, packed with elderly citizens, families, and school children, where a 95-year-old woman was being honored for her contribution to the improvement of human rights of impoverished communities in the Dominican Republic . Direct Relief and Food for the Poor were also recognized at this event for the donations of pharmaceuticals, nutritional supplements, and medical supplies given to the hospital.

Dr. Jiminian is well known in the Dominican Republic for the incredible contribution he makes to his community. A very energetic and charismatic man, he does the work of 10 people at once. His hospital provides free or reduced cost services to working populations, in particular providing corrective surgeries for children born with deformities. He told us later he performs two to three such surgeries for cleft pallets and external growths each day. He also has a feeding program for the elderly which provides meals for up to 200 people, which he personally overseas. His hospital also provides free TB, lab, and immunization services.

Dr. Cruz Jiminian at the Cruz Jiminian Foundation Hospital

Wednesday, January 31, 2007

Under the direction of Social Services of the Dominican Republic, Genny, Cliff Feldman of Food for the Poor, and I met with 12 doctors from all over the Dominican Republic, three Dominican Senators, and representatives of other local humanitarian organizations in offices at the National Congress in Santo Domingo. The doctors who were present all work in public hospitals in communities of high need. Of particular importance to everyone present were the social and health issues of the frontier, the communities along the Haitian border. Each doctor expressed the extremely critical needs that exist for health services, basic goods like food, clothing, water, and social services for the bateyes, or sugar cultivating communities, along the border.

This meeting was a wonderful opportunity to bring together various sectors involved in the improvement of the health and well-being of at-risk communities in the Dominican Republic and Haiti to establish better relationships and clearly lay the logistical foundations of the work we do together.

The Dominican representatives closed the meeting resolved to establish a committee to focus on the coordination of donations from Direct Relief International and Food for the Poor. We left the meeting with a better understanding of the biggest health needs and concerns in the Dominican Republic and amongst the batey communities that will help us gear our support to the region.

Thursday, February 1, 2007

On our final day in the Dominican Republic , we drove to La Romana, a city in the eastern part of the country. Driving down the coast, the houses and building became smaller and more rustic the farther we drove from Santo Domingo . La Romana is a relatively large city, whose streets are filled with motoconchos, or motorbike taxis that often transport whole families.

We first visited Hogar de los Niños, a large daycare center and school. As we stepped through the gates and entered the inner yard, the sounds of screaming and laughing children filled our ears. This center felt like an oasis among the poverty and stress of the city outside. Over 1,500 children are cared for and attend school at Hogar each day. In addition to a crib room with over 100 cribs, a large dining room, a bathing room, and classrooms for pre-school, elementary, junior high, and 9th and 10th grades, the center also has a full dental clinic and a medical clinic with a full-time pediatrician.

All the children we saw, from infants to young adolescents, appeared cheerful and healthy. With a staff of over 200, each child has adequate attention and care. In addition to the work in the center, Hogar also has a mobile dental van that goes into the 16 bateyes in the community to provide dental care for families, and on Tuesday and Thursdays 60 children from the bateyes are bused into Hogar for full dental care. The center also has a computer lab, classes for the deaf, mute and blind, and is constructing a public library.

The incredible work of this home is one that the staff and founders hope will be emulated elsewhere in the country. The majority of the children at Hogar are children of Haitian immigrants working in the Free Trade Zone and the sugar cane fields. There are many more communities of migrant workers throughout the Dominican Republic that are in need of education and basic care that Hogar is providing to the children they serve. Children arrive at Hogar as early as six in the morning and are bathed twice a day, fed three times a day, clothed, provided with medical and dental care, and education during the course of the entire day until six in the evening when the center closes.

Direct Relief has provided Hogar with multivitamins, antibiotics, analgesics, antiparasitic medicines, and first aid supplies to strengthen their clinic's ability to address many of the pressing health issues affecting some of the poorest children of the Dominican Republic .

Leaving Hogar, we drove across the city to the Dr. Francisco A. Gonzalvo Hospital, a public 135-bed hospital. We met the medical director, assistant director, and pharmacist of the hospital to assess their greatest pharmaceutical and medical supply needs. The hospital serves about 220 emergency patients every day, most of which come in with injuries suffered on the road, but also include work-related injuries. The hospital serves as a teaching hospital and offers a wide range of services including surgery, pediatric, gynecology, general medicine, ophthalmic, orthopedic, urology, radiation, and HIV/AIDS treatment.

Although there are other hospitals in the city, Hospital Dr. Francisco A. Gonzalvo provides more than 70 percent of the public services in the region of La Romana. As at Hogar, the great majority of patients seeking service at this hospital are from Haitian migrant communities. Direct Relief has provided one donation of pharmaceuticals and medical supplies to this hospital through Food for the Poor. This visit served to provide us with more information about the hospital, and the pharmacy department in particular, so that we can create a more concrete list of needs.

October 2006
by Beth Pitton, Corporate and Foundation Relations Director

Women for Direct Relief, a support group comprised of community member supporters and members of the board embarked on a trip to El Salvador to help distribute high-dose vitamin A tablets to children in rural areas. We visited FUDEM, a partner organization Direct Relief has worked with since 2000, providing them with ophthalmic sutures, eye antibiotics, and other eye medicines worth over $4 million.

Direct Relief has collaborated with Leiner Health Products to provide high-dose capsules of vitamin A over a three-year period to El Salvador 's FUDEM to distribute through their clinic systems in the country's poorest regions.

Under the partnership, Leiner will provide high-dose tablets of vitamin A that Direct Relief will deliver to FUDEM's eye clinics in El Salvador. FUDEM has an extensive mobile medical/visual program that I’ll see on Thursday. Through this program FUDEM will provide 63,000 dosages of vitamin A for El Salvadoran children once every six months for three years.

According to a USAID-funded national survey (ESANES), one out of every three children under five years of age in El Salvador is vitamin A deficient. Vitamin A Deficiency (VAD) is the most common global cause of preventable blindness in children worldwide and leads to increased morbidity and risk of mortality.

Tuesday - Izalco, El Salvador

The Women for Direct Relief arrived in matching orange t-shirts ready to put yesterday’s training into practice as part of FUDEM’s eye care campaign.  But first we were led to an auditorium full of people, decorated with streamers and large bunches of pink, yellow, and orange balloons.  The mayor, the physician who runs the health center at the school, representatives of the Ministries of Health and Education, as well as a representative of the National Guard were each called up to sit on stage, as were Nancy Walker Koppelman as representative of our group, and Nina Palomo, President of FUDEM.

After each dignitary said a few words the room stood for the Salvadoran National Anthem.  A talented band of horns played several other songs too, including the old Sinatra favorite, “My Way.”  Trip member Kate Firestone was offered the microphone and sang a phrase of the song before a surprised and appreciative crowd.  After this very special opening ceremony we were taken to our respective stations to begin work.

More than 720 people of all ages received eye screenings, examinations, and when diagnosed, either a new pair of glasses on the spot (170 received reading glasses, 30 others prescription glasses), a prescription to be filled within the next few weeks, or an appointment for follow-up service.  In addition, each child up to five years of age received a high-dose Vitamin A capsule and tablet of the antiparasitic medication albendazole.

Everyone seemed dressed for a special occasion; older women wore dresses and fine ruffled aprons with layer upon layer of lace; girls wore their best dresses and shoes and men wore button-down shirts and nice slacks.  And perhaps it was a special occasion as more than twenty Direct Relief volunteers and FUDEM staff spent the day in their town providing eye care free of charge to families living on an average of $1,200 a year.

Dorothy Largay, Kate Firestone, and Dr. Ayesha Shaikh (an OB/GYN in practice in Santa Barbara), worked at the first station where preliminary visual acuity screening took place, directing people to cover one eye and read the letters from a chart.  Ayisha was surprised at how many people simply could not see.  In one group, three out of five did not make it past the second row of large letters.  Sherry Villanueva, our group’s intrepid interpreter and photographer, observed that as the day progressed she began to appreciate how many layers of problems the families faced – the obvious vision problems being simply the top layer.

Many people had rotting or missing teeth – untreated oral infections can lead to other serious health problems, including heart disease as people age.  After one troublesome screening the mother explained that her child has cerebral palsy.  When asked if she could take him to the FUDEM clinic for further eye exams she explained that she could not afford the 55 cents it would cost to take the bus to San Salvador.  Sherry offered to give her the 55 cents.  The distraught mother explained that she has six other children she could not leave at home alone.  Without a husband, without funds, her young son seemed to be without hope for improved health.

All Sherry could do was give the boy a Beanie Baby in hopes of comforting them both. When the boy gave Sherry a kiss, the mother began to cry.

The third stage was, thankfully, managed by competent and professional FUDEM staff, where comprehensive examinations took place.

Rita Moya and Mer James worked at the fourth station where the eyeglass prescriptions were prepared. With a stock of the most common lenses ready and only minor adjustments required, most people were able to walk away with their new pair of glasses within minutes of receiving their exam.  A man who received a pair of reading glasses immediately sat down, pulled out a newspaper, and read it with a big smile on his face.  How long had it been since he last read a paper?

Marisa Grimes worked at the vitamin A and albendazole distribution station.  In the privileged place of meeting all of the youngest children, Marisa was particularly charmed by them – and struck by how different their lives are than those of her own children.

Jamie Gumins and Nancy Walker Koppelman worked at the final station where gifts of personal care packs were given out to each family that participated in the eye campaign.  This was the place, not surprisingly, where the action seemed most anticipated; a group of boys with shy smiles lined the far wall waiting curiously for what might be about to happen as we set out the boxes of packs.  Nancy chatted and laughed with the children, and by mid-day took one lively local woman up on her offer to help with crowd control.  Jamie let three little girls put colorful Band-Aids on her arms for practice after explaining how to use them.

A man walked in the room with a purpose, but did not show the slip of paper authorizing his receipt of a gift.  With his son in his arms he reached out and shook each of their hands, said, simply, “Gracias,” and instructed his little boy to do the same.  The boy smiled, shook their hands, and offered his word of thanks.  The man’s gesture seemed to reveal much beyond gratitude; honor, pride, and responsibility to provide important lessons for his young boy.

Our reward for a full day of eye campaigning was a visit to a Mayan cave further out in the lush green environs of Sonsonate District.  We walked in to the opening of a cave formed by lava from a volcano that erupted hundreds of years ago.  In this dark place the Mayans carried out rituals to honor the four elements of air, water, earth, and fire.  The Women for Direct Relief were privileged to witness a demonstration of this ceremony, which is said to cleanse and rejuvenate the spirit.

Wednesday - Isla Tarajeram, El Salvador

A thirty-minute bus ride from our hotel in San Salvador took us to a port village where we met a local man that was home visiting from North Carolina, where he has lived for twenty years working as a chef at a Chinese restaurant.  After a wait of about half an hour we set out for the island on a boat comfortably seating all of the Women for Direct Relief and two FUDEM staff members.  Our new friend and other townsmen kindly helped us into the boat and we were off.

It was a beautiful, bright morning that found us bumping along the bay toward Tarajera.  The boat ride was about another twenty minutes, which took us past resort islands with large homes, anchored sail boats and yachts, and the Hotel del Sol where, we were told, people come from all over the world to stay.

There are an estimated 5,000 inhabitants on Tarajera.  This was the first FUDEM eye campaign to be held here, and people came from all over the island, as well as from many neighboring islands.  Some people traveled two hours by boat or canoe.  Through another well-organized (and exhausting) campaign day, the women and FUDEM saw a total of 680 people and provided 120 people with new eyeglasses.  At the end of the day we were treated to ceviche, compliments of the mayor, brought all the way from the Hotel del Sol.

In comparison to the people seen yesterday at Izalco, the populations of the islands seemed healthier; the results of the eye exams revealed fewer eye and vision problems, the condition of people’s teeth were better, and people looked well nourished.  It would seem that their better health is attributable to a diet that includes fresh fish.  One predominant health problem, however, is parasites due to the practice of eating contaminated clams.

The populations of the islands were also younger than that of Izalco.  Senior women dominated the eye campaign at Izalco, while today there were more men in general, and more women of childbearing age and middle age.  The children of the islands seemed livelier, less passive and shy.

Today, in addition to the eye exams, Ayesha Shaikh provided free “toma de citología” (the Spanish phrase for a Pap smear) for 15 women.  Ayesha was pleasantly surprised at how well-informed and healthy she found the women.  She was also surprised to learn that many of the women practiced birth control using Depo-Provera, which requires a visit to the doctor every two months.  She said it is especially impressive knowing how difficult it is to get women in Santa Barbara to faithfully make their Depo appointments.  The average number of pregnancies among the women Ayesha saw was four – with one having had 10 while in surprisingly excellent condition (she had had a hysterectomy).

Sherry Villanueva, our intrepid photographer, had the opportunity to speak with several women who had had only one child.  We later learned that the local doctor, who works with the Ministry of Health, has a close collaborative relationship with the local priest.  The priest, demonstrating progressiveness in extreme contrast to most clergy in Latin America, actually encourages birth control and participates in home visits with the physician to promote health among the families they both serve.

Another evident difference in the two population groups was the incidence of strabismus, a condition causing crossed eyes.  This genetic condition was evident in at least 15 children in Izalco while only one child was seen with the condition on the island.

The women found today’s campaign quite a bit easier than yesterday’s, as they fell into the routine of their stage assignments (even though some alternated to work a new stage), and developed a greater coherence as a group and as a team with the dedicated FUDEM staff.

Though the homes on the island were constructed of simple wooden sticks and thatched roofs – and dirt floors – the women felt that the poverty seemed less severe than they had imagined because the island folks were so much healthier in comparison to people they had met in their other travels in the developing world.

And yet, the isolation, illiteracy, and structural poverty were certainly real and very much evident.  It was a privilege to have the opportunity to bring eye examinations to the people of Tarajera Island and its neighbors, many of whom received ophthalmic service for the very first time.

Thursday - Candelaria, El Salvador

The location of each of the previous campaigns was the local school of a remote, rural community.  The location of today’s campaign was a beautiful retreat center overlooking Lago Ilapango in a semi-urban setting.  Majestic and serene, the view belied the poverty surrounding it – though it did seem less severe than the poverty of the communities of Izalco and Isla Tasajera, perhaps due to its greater accessibility to building materials and other consumer goods.

An estimated 300 people received free vision screenings, high-dose vitamin A, and antiparasitic medications.  Dr. Shaikh provided another 25 women with free Pap smears as well.  Unfortunately, the women seen today presented many more complications, including four who required referral to the local clinic.  The Ministry of Health also provided free TB and tetanus shots to the campaign participants today, which demonstrates another instance of excellent collaboration on the part of FUDEM with the local MoH officials.

Overall, the Women have been extremely impressed with the professionalism, efficiency, and dedication of the FUDEM staff, particularly to Rural Outreach team responsible for the eye campaigns.  The campaigns themselves become community events that bring local officials, the Ministry of Health and other government departments, as well as community leaders and volunteers such as local health promoters together to serve people of on a completely nondiscriminatory basis.

September 2006
by Jason Kravitz, Communications Director

Direct Relief has provided over $40 million (wholesale) in medical material assistance to El Salvador since 1965, focusing on improving the quality of life by bringing critically needed medicines and supplies to local healthcare providers.

As the Communications Director of Direct Relief International, I visited El Salvador in September to launch a vitamin A initiative with our local partner organization, FUDEM (salud y vision). Direct Relief has partnered with FUDEM since 2000, providing them with ophthalmic sutures, eye antibiotics, and other eye medicines worth over $4 million.
 
Direct Relief has collaborated with Leiner Health Products to provide high-dose capsules of vitamin A over a three-year period to El Salvador 's FUDEM to distribute through their clinic systems in the country's poorest regions.

Under the partnership, Leiner will provide high-dose tablets of vitamin A that Direct Relief will deliver to FUDEM's eye clinics in El Salvador. FUDEM has an extensive mobile medical/visual program that I’ll see on Thursday. Through this program FUDEM will provide 63,000 dosages of vitamin A for El Salvadoran children once every six months for three years.

According to a USAID-funded national survey (ESANES), one out of every three children under five years of age in El Salvador is vitamin A deficient. Vitamin A Deficiency (VAD) is the most common global cause of preventable blindness in children worldwide and leads to increased morbidity and risk of mortality.

Tuesday

FUDEM provides vision care services to the poor population for minimal cost. In a given day they see over 350 patients in their main clinic in San Salvador. The newly constructed facility appears to be in pristine condition and it looks just any large optometrists’ office in the United States.

Over 65 percent of adult population in the urban areas of El Salvador is without access to vision care, while over 85 percent of the population in rural areas does not have access. FUDEM was founded 15 years ago to combat the lack of vision care services. The organization now has 12 ophthalmologists and 6 optometrists who provide services to over 105,000 patients in 2005. In 2006, the average daily patient rate is up to 350 patients per day in their San Salvador eye clinic.

They provide glasses to their patients either at a minimal fee or for free. Over 75 percent of their patients pay less than $3 for services. FUDEM also provides free eye surgery to cure cataracts, strabismus, and other vision abnormalities. I had the opportunity to witness a strabismus-corrective surgery on an eight year old.

Wednesday

In 2002, FUDEM expanded its medical services to provide dental care for its patients. Direct Relief has provided extensive support for their dental operation including dental equipment, supplies, and basic materials. FUDEM’s Dental Director, Dr. José Pedro Cedillo, with Direct Relief’s contributions (gloves, facemasks, gowns, drills, etc.) they have been able to expand their program to see 35-50 patients per day. Similar to a dentist visit in the United States, a patient will leave with a free toothbrush and floss provided by one of Direct Relief’s medical manufacturer donors. According to Dr. Cedillo, “only university dental programs have this type of dental product quantities.”

Thursday

I traveled with the FUDEM staff to witness the eye care campaign in a school in the town of Alegría (happiness), Department of Usulután to witness the vitamin A distribution. FUDEM has an incredibly efficient operation where they provide an eye exam, new eyeglasses (if needed), and then the children are given the vitamin A tablet. The entire community came out to participate. At the end of the day over 600 children received vitamin A thanks to Leiner’s donation.

Brett Williams, Disaster Coordinator and Senior Program Officer, Dan Smith traveled in Honduras and Nicaragua in April and May to identify new partners and follow-up with existing partners in these countries where over 50% of the population lives in poverty.

May 10, 2006

Roughly 80% of the population in Nicaragua is living on less than $2 a day, which is one of the highest percentages in Latin America. Yet, in the heart of the country, amidst a desert of poverty and destitute families, is the Consuelo Buitrago Women's Association (AMUCOBU). This center is located in the Walter Ferrety barrio of Managua, Nicaragua, one of the poorest and most dangerous human settlements in the country. Over half of the 5,000 residents are under the age of 15 as a result of the country’s protracted and violent civil war. The AMUCOBU clinic is the only medical facility located within this settlement, and in addition to providing primary health care it also offers health education, psychological services, and vocational training. The clinic sees about 500 patients per month, most of which are children and mothers. They also perform pre- and post-natal checkups and consultations. The director, Esmeralda Lorente, like nearly all the other 30 individuals at the center, was born in the barrio and continues to be a resident. Dona Esmeralda is a respected leader in the community, and is often called upon for other tasks, for example, during my visit she was sharing her home with a woman who had no place to go after her husband had left her with their newborn who had been diagnosed with encephalitis.

Direct Relief has donated antibiotics, analgesics, patient examination equipment, multivitamins, first aid supplies, disinfectants, educational posters, and minor surgical instruments. These materials have helped provide the tools which are so desperately needed by the staff of the AMUCOBU clinic to improve the lives and the health of the people of Nicaragua. Thanks to the assistance of Direct Relief International, Dona Esmeralda and her associates are providing a service that the government of Nicaragua is unable to provide.

For over 40 years, Direct Relief has provided medicine and supplies to all levels of the health care system in Honduras. Direct Relief has partnered with the largest public hospitals in the nation (Hospital Escuela and Hospital San Felipe) to the smallest urban and rural health centers (Honduran Health Exchange, The Garifuna Emergency Committee, Project Global Village, and The Dr. Polo Lindo Clinic).

April 24, 2006

As of February 28 the president of Honduras declared a state of emergency due to a shortage of medicine in the nation’s hospitals. There were reports that hospitals, clinics, and rural health posts had a minimal amount of medicine at their locations. The recently elected president just six months after his narrow victory is attempting to solve this problem. In a meeting this morning Direct Relief’s Senior Program Officer Dan Smith (who has worked with Direct Relief’s partners in Latin America for 18 years) spoke with Dr. Alphonso Pons, assistant to the president, and Dr. Guillermo Zelaya, the General Director of National Hospital Networks and Services for the Ministry of Health about the emergency. According to Dr. Zelaya this acute shortage of essential medicines has created a complex two-part problem.

The people who are getting sick in the rural areas and towns that would normally receive treatment at a rural health center called a Cesar (Centro de Salud Rural) are being sent home empty handed. These sick rural people are thus coming into the city because their local clinic has completely run out of medicine and supplies. This has created an exodus of rural poor traveling to the city seeking medical attention. The extra patients who would normally be treated in their local village, now reside in the waiting rooms of the cities larger hospitals. The situation has led to a severe overcrowding of the regional and national hospitals. The overcapacity has become so bad that people have started to sleep on benches or on the hallway floors in the hospitals.

The increased amount of patients has put a serious strain on the current fixed medical staff in the cities. According to Dr. Zaleya, “this strain has caused our specialist who is the country’s only pediatric oncologist to spend 75% of his time seeing patients with diarrhea and skin infection." In order to help alleviate the problem the government is focusing on infusing the rural health centers with supplies and medicine.

Honduran Health Exchange (HHE):

Honduran Health Exchange has focused on serving the population that has been left out of society: the rural poor, torture victims, current inmates, and all of their families. They have two clinics in Tegucigalpa that serve the barrios and prison inmates’ families. HHE also has a team of committed traveling doctors called the Medical Brigade who travel into the country side and provide health care to around 50 villages throughout the country, as well as frequenting Honduras’ prisons in order to provide health care for those who have been left out of the general system. Dr. Juan Almendares who was formerly the dean of faculty and president of the National University of Honduras, Tegucigalpa, founded this unique organization. He has received a number of awards for his incredible work, one being the Barbara Chester Award from the World Health Organization.

Direct Relief has partnered with this extraordinary organization for over seven years and three presidents.

April 20, 2006

Today we went to Hospital San Felipe, which is a government-run facility located in Honduras’ capital, Tegucigalpa. The hospital averages 2,000 patient visits daily, the cost of each visit is 1 limpera or $0.06. It is the only facility in Honduras that can provide cobalt therapy for cancer, thus it has become the country’s leading cancer hospital.

The hospital provides educational programs to help people detect the onset of cancer (especially breast cancer) by conducting self-examinations. In the past, Direct Relief International and the Rotary Club of Bishop California have helped to build a pediatric ward and a large water tank that allows the entire hospital to have potable water. Direct Relief has also furnished baby cribs and other pediatric specific equipment to outfit the new ward.

Tomorrow we will be visiting the largest hospital in Honduras and also a recipient of recent Direct Relief aid, Hospital Escuela. We will then meet with a Honduras non-governmental organization (NGO) called the Honduran Health Exchange.

Brett has been representing Direct Relief among a group sponsored by PQMD to test a pilot program to obtain exact GPS coordinates of each partner supported health facility in Honduras. This will allow for a more coordinated effort among our colleague organizations and medical manufacture donors to be able to pinpoint the exact location of the closest health facility during a time of disaster.