We arrived at the small medical clinic in Petit Trou de Nippes about five hours after we left Port-au-Prince that morning. The distance is only 75 miles but the unpaved roads, traffic, and small lakes and rivers we had to drive through to get there made the drive long. Halfway through the trip my Haitian colleague Catherine asked me if I felt like I was in a blender with all the jostling of the Land Cruiser we were driving in. We just pretended we were getting expensive lower-back massages the whole way.
Like the other clinics I’ve visited on this trip, this is the only one serving the 25,000 people who live in the area. Unfortunately, this small government clinic does not have a doctor, because he left for a training course in Port-au-Prince and they fear he’s not coming back due to the poor pay he’s receiving. A young but committed first-year resident who just graduated from medical school last year is now running the clinic. I asked her if she felt ready to be running a medical clinic just one year out of school. Before she answered yes, she hesitated and looked around at the two nurses, social worker, administrator, pharmacist, and lab technician who were sitting on the bench across from her waiting to hear what she’d say. It seemed like she wanted to reassure them that she could do it.
Like the doctor on the island of La Tortue who asked for a better boat to get his patients across the ocean to the larger hospital, the doctor at this clinic also asked for better transport. However, she needed it to get women into her clinic to deliver their babies. The only “ambulance” the clinic has is two broken-down motorcycles, but they wouldn’t want to transport pregnant women on motorcycles even if they were working. They went on to say that pregnant women usually come in on horseback, are carried in a chair, or lying on a door while their neighbors carry them like pallbearers.
Lack is a common theme. For example, nearly 100 doctors and more than a thousand nurses get their degrees every year in Haiti, but low salaries often drive them away from the country. While plenty of doctors and nurses are trained every year, many rural areas are left without the staff to care for their people.
A relatively small amount of money can solve the clinics’ problems, ones they’ve been dealing with for years. The doctor on the island of Ile-a-Vache asked if we could fix the leaky roof in his exam room so when it rained he and his patients wouldn’t get wet anymore. The doctor on the island of La Tortue needed $1,000 to dig a well so he could put running water in his hospital. The doctor in Petite Trou de Nippes said her dream would be to have an actual ambulance, but she’d be happy if they could have gurneys or stretchers so women wouldn’t have to be carried in on doors. The medical director of Beraca Hospital wants a sterilizer so wouldn’t have to disinfect instruments in a pot of boiling water on the stovetop. The nurse on Ile-a-Vache needs a raise from $300 a month to $350 a month because her parents spent all their money to send her to school and now she’s responsible for taking care of her three siblings. And the administrator in Nippes, who was extremely proud to show me the professional patient records and filing system he keeps, said he needed a new desk because the one he’s using is just a piece of plywood sitting on two oil drums. This man was working for almost no pay (and often goes months without even getting a paycheck) yet took pride in his work. He needs a real desk.
The Haitian doctor I was traveling with, who had worked in the U.S. for the last 30 years, promised to personally pay the $1,000 for the well, because of the thought of working in a hospital without running water was unbearable.
I take comfort in the fact that I work for an organization that can respond many of these requests and has a plan to help improve the health of mothers and babies in Haiti. We’re providing pre- and post-natal incentive kits for women who come to the health facility for treatment and delivery, upgrading medical equipment needed for safe deliveries, providing 5,000 rapid HIV tests to test mothers who enroll in the Prevention of Mother to Child Transmission (PMTCT) program, and providing ongoing education for traditional birth attendants. We’re targeting eight health centers strategically located in eight of the ten departments (or states) in Haiti, reaching 563,889 people, including almost 16,000 pregnant women over the course of the next year.
Sometimes it feels like we’re scratching the surface. But it still gives me hope.
]]>Drawing from his own experience as a father-to-be, Direct Relief's emergency response manager finds new meaning in maternal-child health initiatives in Haiti.
By Andrew MacCalla
Haiti, April 15, 2011
Halfway through my trip to Haiti this week, my wife sent me an email saying that if our baby was born today, he would have a 90 percent chance of survival. I found that incredible, given that Melissa just entered the third trimester of her pregnancy last week. Obviously, we hope that we won’t have to worry about an early delivery, but it is comforting to know that if our baby had to be born now, he’d likely be just fine.
The day she sent me that message I was visiting a hospital Direct Relief is supporting in Marchand Dessalines, a town named after one of Haiti’s first leaders after its independence from France, about two-and-a half-hours north of Port-au-Prince in the Artibonite mountains. I learned from Dr. Fequirere, the young Haitian obstetrician/gynecologist who works at the hospital, that if a child is born in Haiti at the start of the third trimester it would have practically no chance of survival.
Haiti has the highest maternal and infant mortality rate in Latin America and the Caribbean. Pregnancy and its complications have become the leading cause of death and disabilities among women of childbearing age. Out of every 100,000 births, 630 women die giving birth. Roughly 77 percent of Haitian mothers give birth at home, and nearly 100 babies out of 1,000 die during their first year of life. The thought of my wife giving birth in what is now a typical home in Haiti--a battered tent or tarp without running water or sanitation--makes me queasy.
Since the earthquake, Direct Relief has focused on addressing immediate medical needs. We’ve supplied wound dressings, sutures, and wheelchairs after the earthquake; IV solutions, oral rehydration, and antibiotics after the cholera outbreak; and bleach, soap, shampoo, and toothpaste to address the poor hygienic conditions in the camps.
Now, 15 months after the earthquake and seven months since the outbreak of cholera, Direct Relief is taking a step back to focus on the ongoing medical issues facing the country. The one that takes my breath away is the number of women and babies who die unnecessarily every year in childbirth.
The eight hospitals Direct Relief is supporting throughout the country (all with trained doctors, nurses, and midwives), will ideally become centers of excellence in Haiti with new equipment and supplies to save more lives and encourage more women to come in for prenatal care. Over 50 percent of women in Haiti don’t ever see a doctor before they give birth—partially because of the state of the medical facilities.
Our plan takes a four-pronged approach:
Dr. Fequirere at the hospital in Marchand Dessalines told me that they deliver about 80 babies each month, 10 of whom will die. While the hospital is staffed with five well-trained doctors, 18 nurses, and an anesthesiologist, it lacks the material resources to save these babies. There is no blood bank in the hospital. Often they don’t have the medications needed to treat the women, and they don’t have any incubators, let alone a neonatal intensive care unit to deal with premature deliveries. The doctor said the hospital must refer pre-term labor cases to a hospital over an hour away. The road between the hospitals is impossibly bumpy and winding, and the woman is transported in the back of a truck. Imagine any woman in your life--your wife, mother, daughter, or sister--having to endure that journey.
Bringing life into the world should not be a death sentence. We have the technology and knowledge to treat babies who are born three months (or more) early.
Sometimes it takes a personal experience, or the ability to put yourself in someone else’s shoes, to relate to these issues that affect so many people on our planet. Now that I my wife and I have a baby on the way and know what care pregnant women receive in the United States, I’m shocked by what most women in Haiti go through in bringing a new life into the world. Direct Relief is going to help change that for nearly one million women in Haiti. I’m glad I can be a part of it.
]]>Kingstown, St. Vincent
May 5, 2010
I am so impressed with the health system implemented in this tiny country. There are 39 health centers which offer basic primary care services; these centers are regional and are no more than three miles apart. There are five district hospitals in addition to Milton Cato Hospital, which is the largest and acts as the referral facility. The Ministry of Health is in the process of opening three polyclinics to ease the pressure on the emergency room and trauma center at Milton Cato (visibly labeled as “Fresh Wounds”).
Milton Cato Hospital offers a wide range of services including surgeries, lab tests, radiology, dental, ophthalmology, maternity, and geriatrics. It is equipped with three operating theaters, but it is by no means a state-of-the-art facility. These are the tropics, so things are rusty and dilapidated but the services the hospital provides are consistent. The fact that there is always a radiologist available impressed me when so many facilities only offer part-time access to such services.
Another unique component of the hospital is its commitment to and treatment of asthma patients, which is how Direct Relief first came to know the facility. The hospital holds an asthma clinic once a week where the staff can see returning patients--mostly children--and adjust their medication if necessary. In the emergency area, there’s a bench with built-in nebulizer stations where patients can sit and receive treatment when having a respiratory attack.
Mr. Emmanuel Jones is a trained nurse and pharmacy technician who now manages the inventory system at the Central Stores. He showed me how he logs and distributes our product and pointed out our supplies in the hospital. From his nursing perspective, he knows how desperate they can become for hospital necessities, so he works very hard to get the goods out swiftly and accurately. Our donations not only go to Milton Cato, directly across the street from the main Central Store, but they are delivered to all of the hospitals and health centers as needed, so we are really helping to equip the entire country. Emmanuel also showed me in their log records that they were down to just five IV sets when our donation was received, boosting the stock to more than 2,000.
What I like best about Direct Relief’s relationship with St. Vincent and the Grenadines is that we are the primary source of medical donations for them, they know the quality of our goods on a personal level, and our donations have literally saved lives and also enabled them to use their budget for drugs for chronic conditions--diabetes and hypertension are widespread here. Allowing people to have piped water in their homes is a good thing but also took away daily exercise. The shift away from backyard farms to eating more convenient refined foods has clearly contributed as well.
From the clerks in the Medical Stores to the nurses to the Ministry level, all were deeply grateful for our relationship and are eager to continue. I am leaving here very proud of our work and have seen direct results of the quality donations we provide...and with a list of what they'd like to see in the future.
]]>
Working in Port-au-Prince to facilitate logistics in Haiti and help our partners there, Brett Williams took this photo at St. Damien Hospital, a pediatric facility that has been treating a large number of adults and children injured in the January 12 earthquake. “The staff is treating patients under tarps,” Williams reported today. “They had so many patients the only place they could treat them was in the courtyard.”
]]>Listen to a radio interview with Brett Williams from Haiti, broadcast this morning on KGO-AM, San Francisco
January 18, 2010 - 2 pm
Direct Relief staff members Brett Williams and Nate Brock are in Haiti coordinating logistics and relief efforts there. Williams' comments from Port-au-Prince follow:
We have been able to organize the piles of medical supplies for the tent hospital that has been established in two large tents at the UN compound, where dozens of volunteer physicians from the States and several from France are working nonstop. Staff from the University of Miami, and a team from New Jersey were among the many who had been at it for days – sleeping onsite on crates.
Sunday evening, patients with serious injuries, including open compound fractures, were still arriving to be seen for the first time.
As we work to organize the resources already here, we are receiving site level assessments and reports from our partner health facilities – all of them are draining supplies fast and need replenishment. The in-country logistics for distribution, essentially from the airport outward, are pinched. We are focusing on the medical-supply channels, but food, water, fuel, patient transport, and every other type of transport and distribution function also is urgent.
Former President Clinton is here today, and we were with him at the hospital in Port-au-Prince. We have connected with Partners in Health and will work together to assist St. Damien Children’s Hospital. The pre-positioned emergency medical supplies we provided to St. Damien months ago in anticipation of an emergency (which we thought would be a hurricane), was a good call. But they need more, as do other partners, just to keep up.
We have been able to organize the piles of medical supplies for the tent hospital that has been established in two large tents at the UN compound, where dozens of volunteer physicians from the States and several from France are working nonstop. Staff from the University of Miami and a team from New Jersey were among the many who had been at it for days – sleeping on-site on crates.
Sunday evening, patients with serious injuries, including open compound fractures, were still arriving to be seen for the first time.
As we work to organize the resources already here, we are receiving site level assessments and reports from our partner health facilities – all of them are draining supplies fast and need replenishment. The incountry logistics for distribution, essentially from the airport outward, are pinched. We are focusing on the medical-supply channels, but food, water, fuel, patient transport, and every other type of transport and distribution function also is urgent.
President Clinton is here today, and we were with him at the hospital in Port-au-Prince (right). We have connected with Partners in Health and will work together to assist St. Damien Children’s Hospital. The pre-positioned emergency medical supplies we provided to St. Damien months ago in anticipation of an emergency (which we thought would be a hurricane), was a good call. But they need more, as do other partners, just to keep up.
March 24, 2008
On Haiti’s northern coast there has been a spike in premature births—a trend you wouldn’t immediately attribute to the storms that struck six months earlier. Those disasters are long forgotten by everyone except those still struggling with their lasting effects.
Haiti’s northern departments are the country’s poorest and most vulnerable, where about 75 percent of people live on less than $2 a day. The northern departments are dependent on commodities from the capital, Port-au-Prince, and are linked by one low-lying road on the coast that passes through Gonaives. It repeatedly bears the brunt of hurricane damage.
In St. Louis du Nord, we visited North West Haiti Christian Mission’s Birthing Center, which averages about 85 births a month. The clinic receives nutritional products from Abbott, which are critical for these mothers and babies.
At the clinic we met Rose Cardene. Rose had recently given birth to a beautiful baby boy, Standley, days before we arrived. Standley was premature, born weighing less than 3 pounds.
Premature birth is increasingly common in northern Haiti, where a food crisis lead to violent protests last spring and hurricane damage to crops caused the price of food to skyrocket. This left adequate nutrition out of reach for many pregnant women, placing additional stress on their already stressed bodies. Donated nutritional products become a lifeline for these women and their babies to be.
Adding insult to injury, aid delivery was severely hampered following last year’s four consecutive storms in as many weeks that killed more than 800 people, causing massive flooding and damage in their wake. With roads and bridges completely washed out, people in the north were forced to fend for themselves.
Now, in late March, a full month before the start of the rainy season, daily rains are making people in the north very nervous; memories of last year’s storms are all too vivid. It’s hard to image life in rural Haiti getting harder than it already is, but all you need to do is add water.
We are here planning our Hurricane Module distribution for the 2009 season, which will include Haiti. Clearly the need here is great.
Last year, hurricane modules were prepositioned in Texas, Louisiana, Mississippi, and Alabama in the U.S., and in Jamaica and the Dominican Republic in the Caribbean. The modules contain essential antibiotics; nutritional products for children and adults; oral rehydration solutions; and supplies for wound-care and water purification, all selected to help local healthcare providers meet the surge of additional patients while also caring for existing patients.
Having these modules in place before hurricane season starts will help protect vulnerable populations like pregnant women and their babies should a hurricane strike. Nutritional products give premature babies a chance at survival, despite challenging circumstances.
Direct Relief provided more than $2.3 million (wholesale) in aid to Haiti following last year’s hurricanes. The organization is committed to providing essential medicines and nutritional supplies as long as needed following an emergency—because pregnancy doesn’t stop for hurricanes.
Wednesday, March 18, 2009
We got on the road early this morning to avoid the daily traffic jam that so painfully congests Port-au-Prince, Haiti’s capital. Port-au-Prince is a sprawling city of winding roads, green foothills, and shanty towns along what must have once been a beautiful coastline. As Haitians move from rural areas to the capital in search of work and a more prosperous life, the true poverty of this nation becomes apparent. Although the numbers are different in each district, roughly 80 percent of Haiti’s population lives on less that $2 a day.
The slums, such as the infamous Cite Soleil, are bursting at the seams with people and the byproducts of human life. Rivers that empty into the sea have become collections of every kind of plastic imaginable, and with the slightest rain the streets are a soggy collection of trash and mud. Our car slips through the streets of Carrefour, another downtrodden district south of Port-au-Prince, as we try to avoid the lively collection of vendors selling sodas, fried plantains, charcoal, and used clothes on our journey south.
We are heading along Haiti’s southern arm to the city of Petite Riviere de Nippes, where a very determined group has built the Visitation Clinic. As the name suggests, the hope is to have visiting doctors come and share their expertise with the Haitian staff, building the knowledge base of local doctors, providing specialized services, and helping to expand the services the clinic can provide.
Arriving from the U.S. more than 10 years ago, a group of volunteers from the Parish Twining Program, which connects parishes from the U.S. with those in the Caribbean, visited Petite Riviere. They soon realized the immense need for health services, and under the leadership of one volunteer, Teresa Patterson, a foundation was created to help address the problem. The Visitation Foundation was born; regular trips of medical professionals to Petite Riviere were established with the goal of building a permanent clinic run by a Haitian medical staff and available five days a week all year long.
For the past five years, Direct Relief has supported the efforts of the Visitation Foundation with donated medicine and medical supplies hand-carried to Haiti during medical missions. More recently, with the clinic fully functioning, Direct Relief has provided the first of many large-scale donations of specifically requested products.
After a bumpy four-hour journey along dirt and semi-paved roads, we arrived to see the beautiful clinic perched on a hill above the town. The clinic was completed in January 2008 and has already seen over 15,000 patients. When we arrived, the waiting area was full of people, mostly women and children, who start lining up for service at 4:30 a.m. The medical staff is usually able to treat 80 or 90 people a day, and is on-call 24 hours in case of an emergency.
The Visitation Clinic has another unique quality: It’s 100 percent sustainable. The clinic is powered by solar panels on the roof and thus saves a massive amount of money on energy costs and the use of fossil fuels to operate generators. It also has a backup generator in case of an emergency.
Its remote location brings the challenge of referring patients with specialized needs. The clinic has worked very hard to establish relationships with specialists throughout the south and as far as Port-au-Prince, creating a billing service that allows patients to be seen elsewhere without having to pay on the spot because the Visitation Clinic pays the bill at a later date. The Foundation’s long-term goals include building a full hospital on their five acres of fenced land to keep up with expanding patient needs and to avoid having to refer patients to health facilities in Port-au-Prince.
After a short walk to the center of town with the clinic administrator, it’s obvious to us that the community supports the clinic’s work. We were unable to get 100 feet from the gate of the clinic without kids and parents offering their hellos and kids wanting to hold hands and walk with us. By the time we returned to the clinic, it looked as if a small parade had taken place. The clinic has brought healthcare to Petite Riviere, but also hope.
The journey to the Visitation Clinic made us extremely proud to know that the long-term commitment Direct Relief has to helping the people who just need a little boost pays off. The hard work is done by those on the ground, and we feel grateful to be a part of such a wonderful program. The project has grown into one of the best we have seen in Haiti and is completely run by Haitians with the exception of one staff member. Access to health services has been improved in Petite Riviere de Nippes and the goal of equal access to health services for everyone—no matter where you are born—is a little closer.
]]>[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.
]]>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.
]]>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 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
.jpg "Nicaragua 2007 - 1")
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.
.jpg "Nicaragua 2007 - 2")
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.
]]>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.
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| 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.
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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.
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| 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.
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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.
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| 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.
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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.
]]>Dan Smith, Senior Program Officer and Rose Shuman, Corporate and Foundation Relations Manager. traveled to the Dominican Republic and to Haiti July 2 through July 11th of this year. The purpose of their trip was to follow-up on Direct Relief's emergency relief shipments delivered to the victims of the flooding which occurred there. They were accompanied by Ana Fuentes, a Santa Barbara based professional photographer.
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| MOSCTHA's direct health care component is centered on its mobile medical van, shown here with Dominican physician Dr. Alba Nunez distributing much-needed medicines to the Haitian refugees in the city of Jimani, in the Dominican Republic. MOSCTHA is one of several Dominican organizations which assist this displaced population of Haitian families which receives only incomplete and sporadic government support. |
These poor living conditions, combined with the deforested terrain particularly on the Haiti side, help explain the nearly 2500 people killed and the tens of thousands of Haitians and Dominicans who were left homeless and jobless from these devastating rains. Direct Relief's first emergency shipment to this effected area was air freighted on June 4 and consisted of 4400 pounds of antibiotics, analgesics, first aid supplies, multivitamins, dermatological agents, and personal care items and included two Johnson & Johnson disaster modules containing first aid materials and other primary care medicines.
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| At the office of the Social Cultural Movement for Haitian Workers (MOSCTHA), a Direct Relief partner in the Dominican Republic, DRI-donated pharmaceuticals and supplies are loaded up for delivery to the border town of Font Verettes, Haiti, which was almost completely destroyed by the recent flood. |
Haiti is considered the poorest country in the Western Hemisphere by the United Nations Development Program. Most of Haiti speaks Creole, which is a mix of French and other native Haitian and African languages. Its predominantly Black population is culturally distinct from other Caribbean nations, and the extreme degree of poverty and current disorganization of the government have worked to create significant impediments for outside aid groups wishing to support the Haitian people.
The Mouviman Peyizan Papay (the Papay Peasant Movement, PMM) is a 31-year-old peasant organization located near the city of Hinche on the Central Plateau of Haiti. This group operates a small rural clinic which serves approximately 30,000 people, and it also oversees 20 rural health outposts located throughout the region. The PMM also provides technical support in agronomy, empowerment, clean water, permaculture, micro-enterprise endeavors, and they provide midwife training and workshops. In Haiti, between 70 and 90% of all births are done at home, the majority of these being performed by midwifes as there are 11,000 midwifes and only 700 OB-GYNs in all of Haiti, whose total population is over 8 million.
As a new partner for Direct Relief, the Papay Clinic will be receiving a series of medial donations the first of which is scheduled to leave the Direct Relief processing facility this fall.
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Nicaragua is a country of five million people. The annual per capita expenditure on healthcare in Nicaragua is $18. This compared to $4,881 in the U.S. The average income per family in Nicaragua per month is $40. The unemployment rate in Nicaragua is 30%, compared to an average rate of 5.6% in the U.S. in 2004.
From April 25 through 27, 2004, staff members, Genevieve Bitter and Beth Pitton, visited one of Direct Relief's primary partners in Nicaragua, the American-Nicaraguan Foundation (ANF). Direct Relief International has worked with ANF for ten years. Today, we are helping them to serve 112 health facilities and hospitals with contributions of pharmaceuticals and medical supplies. Through the generous support of our corporate donors, Direct Relief International has provided ANF with an average of three (20 or 40 ft.) containers each year. In 2003 alone, we provided shipments valued between $1.2 million and $2.7 million wholesale per container.
In Nicaragua there are three types of health facilities: Hospitals, Health Centers, and Dispensarios or Health Outposts. We assessed five ANF partner facilities in Nicaragua's capital city, Managua, and the country's cultural capital, León who have directly benefited from Direct Relief International's assistance. Our host, Executive Director of ANF, Alvaro Periera, also enabled us to make brief visits to two other ANF partners, examine the warehouse operations of ANF's headquarters, and arranged an interview with Nicaragua's Minister of Health, Dr. Jose Antonio Alvarado.
Much of what we know of the prevalent health conditions in Nicaragua, and indeed in impoverished countries throughout the world, were confirmed by the health professionals with whom we spoke: malnutrition, parasites, diarrhea, and various infections among children; respiratory and heart conditions, hypertension and skin conditions among adults; and arthritis among women due to a lifestyle of strenuous physical labor. Cancer, especially cervical and breast Cancer, and Diabetes are growing problems. Seasonal outbreaks of Malaria and Dengue Fever are other health challenges. A successful national vaccination program has had a positive impact, as have Direct Relief International's product donations on the ability of health professionals to address the health problems of the patients they serve.
King Pharmaceuticals' donated antibiotic, Lorabid was mentioned several times by the medical professionals we met. We were told Pfizer's donated Lubriderm "is gold" to people suffering from skin conditions. And one clinic was happy to have Den-Mat's donated Rembrandt toothpaste to provide to patients as part of their newly added dental health program.
Direct Relief will continue to provide assistance to ANF as we are able, and as the needs in Nicaragua persist. We will continue to work hard to provide antibiotics, pain medication, and nutritional supplements. Children's medicines are in great demand, and though they are rarely donated, we will seek them out. On a future trip, we would like to visit facilities on the country's more isolated Eastern coast. These facilities receive almost no other outside assistance than that which they receive from ANF and Direct Relief International.
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| A mother and her newborn daughter await their consultation |
ISPTR was founded in 1982 by Roxanne Kremer, a zoologist and leading expert on the Amazon pink river dolphin.The organization is comprised of a team of volunteer naturalists who work to protect the flora and fauna of the world ’s largest remaining tropical rainforest.ISPTR establishes forest reserves and wildlife sanctuaries,initiates conservation programs,creates awareness of the consequences of deforestation and habitat destruction,and works to shape positive environmental attitudes with local education programs and eco-tourism.Their 346-acre base camp,which serves as both research facility and jungle lodge,is respected throughout the area for its focus on rainforest conservation.It has also become known as a place for indigenous populations to receive assistance with healthcare and other needs.
Amerindians identify strongly with their tribal heritage and customs even though much of their oral history and spiritual beliefs have been lost. "They come from a whole other strength and are the true gardeners of the rainforest," says Kremer when talking about the 400 or so indigenous tribes that still populate the Amazon Basin. Many of the remaining tribes are very small,with a large percentage numbering less than 1,000 people. Like native people in many areas of the world, these jungle populations are experiencing a significant decline in living conditions and worsening health statistics as the modern world impinges on their homelands. The Achuar, Huambisa,and Ahuaruna tribes are a few of the tribes living along the Yarapa and nearby rivers that have grown to rely on the ISPTR clinic and outreach program for health care, especially when their traditional treatments do not alleviate acute or chronic problems.
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| Community Health Worker Orlando Treating Patients in Nuevo Jerusalem |
As part of ISPTR ’s medical outreach program,we carried an assortment of medical supplies to nearby villages to hold clinics and to share with community health workers.One afternoon,after hiking for two hours in knee- deep mud,we arrived in the Achuar community of Neuvo Jerusalem. Situated on the banks of the Rio Tamuayo, this Indian community of approximately 200 was founded in the late 1980s by an Achuar shaman who had moved south from the Ecuadorian border with his family and other villagers. We were greeted with smiles and kisses from the women and children,many of whom had previously received treatment at the ISPTR clinic. "Regalo,regalo," (Spanish for gift) the women exclaimed as they presented me with handmade baskets and pieces of jewelry made from jungle fi bers and seeds. I found their warmth and gratitude extremely touching.
That afternoon the clinic nurse saw 38 people with a wide array of problems: respiratory infections, anemia,malnutrition, diarrhea,dehydration, parasites,fungal infections,skin rashes, conjunctivitis,aches and pains associated with physical labor, and machete wounds. Most of these conditions could be treated with Direct Relief ’s donations of adult and pediatric antibiotics,nutritional supplements, oral rehydration salts,antiparasitics,topical antifungals,anti-infective and cortisone creams, ophthalmic drops,analgesics,and fi rst aid supplies. A supply of medical goods was left behind for Orlando,Neuvo Jerusalem ’s community health worker,who is trained to diagnose and treat many of the villagers' routine complaints. Direct Relief ’s continued support of this community has resulted in a healthier population,which has doubled in the last eight years.
For more than a decade,Direct Relief International has collaborated with ISPTR to strengthen the health of indigenous populations who face enormous challenges as they attempt to preserve their traditional customs,habitat,and lifestyle within the ever-changing social,political, and economic contexts of the modern world. Since the clinic was established,Direct Relief has provided medical goods valued at more than $1 million (wholesale value)so that ISPTR can stock this clinic and share supplies with community health workers,health facilities,and orphanages in Peru ’s Amazon Basin.
Susan Fowler has been with Direct Relief International since 1987 and is currently serving as Director of Programs.Fowler received a M.A. in international health in 1986.She is a multiple Rotary International Paul Harris Fellow,a recipient of the Diwaliben Charitable Trust Award for Humanitarian Service,and a former Board Member of the Vitamin Angel Alliance and the Friends of Tibetan Women ’s Association.
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