Excellence in Healthcare Medical Bulletin - Friends of the Orphans

Excellence in Healthcare Medical BulletinJanuary - February 2010Nuestros Pequeños Hermanos InternationalCourtyard at St. Damien’s HospitalThe First Few Days - HaitiImmediately following the tragedy in Haiti, the Medical Servicesteam directed all their efforts and energy towards supportingFr. Rick and his local teams during the emergency phase. Sincethe first day following the earthquake we were able to be inHaiti assessing the needs for human resources and medicalsupplies and medicines. As we were waiting for the first team ofsurgeons to arrive from Italy, the first two days were exhaustingas we provided medical care, comfort and palliative treatmentto the hundreds of wounded patients of Saint Damien Hospital.It was a time of uncertainty in regards to how many of thoseprofoundly wounded patients would survive or if they wouldmake it through the surgery to savetheir life.I had the experience of working withthe Red Cross during hurricanes inFlorida; howevernothing couldhave preparedme for thetask at handin Haiti. Thefeeling ofdesperationand theimpotence of not being able to providethe care you would like to was affectingthe doctors working in the field, oppositeto what the Haitian patients werefeeling. They were grateful to God tobe alive, and they were grateful to usfor being there as we helped them inany capacity we possibly could duringthose early days. They gave us a truelesson of gratitude, faith, solidarity andstrength. They sang when they hadpain, and they comforted us whenthey saw our face of frustration.Despite the darkness during the first two days we saw somelight at the end of the tunnel. The Brazilian and Israeli Minusta(UN units) came to the hospital offering their services in theirfield hospital. They took care of several very urgent cases. Asa matter of fact, when they came we were in the x-ray roomreading the images of one ex-pequeño, which showed amultiple mandibular fracture, with the good fortune that theMinusta had a maxillofacial surgeon. They operated on him thesame day. I saw him a week after and he was doing well. Thiswas a sign that we at least were doing something well.This horrendous tragedy taughtus how fragile and fine the line isbetween life and death, dependingon where you are born. Countrieslike Haiti with such fragilegovernmental structures becomechaotic in the face of naturaldisasters. Despite all the efforts ofthousands of medical professionalsthe scarcity of medicines andmedical equipment during thefirst 72 hours of the emergencytook its toll on thousands of morelives. Tetanus, sepsis and other lifethreatening conditions were someof the most common complications physicians had to fight, ontop of the horrendous wounds they had to take care of.Now, two months after the tragedy, post traumatic stress is a bigconcern for a country in desperate need to be rebuilt in orderto move forward. Doctors who had been there for a while wantto come back to see the patients they left behind. Those doctorsstill have nightmares regarding the conditions they had to workin and the extreme decisions they had to make to save lives.They saved thousands of lives, but for them the loss of a singlelife that in their countries could be saved is a heavy weight theycarry on their shoulders.continued next page...

The path to recovery for Haiti will be long and painful. 20,000 young people, thefuture of Haiti, are now trying to survive following amputations or spinal cord injuries.Thousands of children have been left orphaned. The need for continuous care for thispopulation is a big concern.Public health issues remain a concern, and will be monitored for the coming weekswhile people are still living in temporary camps. Assurance of adequate sanitation willbe crucial in order to mitigate the risk of large-scale outbreaks of waterborne diseases.Food, safe water and shelter are the more urgent needs for Haitians to go back to alife as normal as possible.The NPHI Medical Service Team not only has been supporting Haiti in thefield but also has been able to raise, thanks to the incredible support of Dominicancorporations such Banco de Progreso and Fundacion Inicia, more than $120,000 incash (5.5 million pesos) and more than $20,000 in in-kind donations of water, foodand basic medicines, which were vital the first days before donations from USAor Europe were able to make it to the DR and Haiti. Some members of the teamcontinue to raise funds in their churches, through newspaper articles and televisionnews programs.Since the emergency phase is “officially over” the NPHI Medical Services team is backto its normal duties.Dr. Pilar Silverman, Executive Director of Medical ServicesTrust ObligesWhen looking back on the previousweeks and the latest events in Haiti,my participation in it still seemssurreal. Thank God during theemergency relief phase right afterthe earthquake hit Haiti we weretoo busy to stop and think aboutwhat we were facing. There still hasbeen no time to actually realize whathappened.I heard about the earthquake onJanuary 12th around 11pm throughan email that was sent by NPHIExecutive Medical Director Dr.Silverman right after her apartmentin the neighboring Dominican Republic stopped shaking. The message reached mein Austria where I happened to be for a short vacation. After a long night in front ofthe TV while exchanging emails seeking out any news from Haiti with the worldwideNPH community, I headed back to Germany in order to get prepared for my journeyto Haiti.Joined by German nurses Nunja Pilz and Heike Needham, I arrived in Haiti aboutone week after the quake. For three weeks we worked in different children and adultpost-op rooms of St. Damien. When Nunja and I started our first night shift a coupleof hours after we had arrived we were assigned to a room with about 19 patients– children, adults, men and women, some of them pregnant, all mixed up, laying onthe floor, on mattresses and improvised cots, very few had a bed. The rooms werecrowded because every patient had a family member to care for them day and night,as families didn’t want to leave their loved ones alone. Most families wouldn’t havehad a place to go anyway since their homes no longer existed.Haiti Relief Efforts…without leaving homeMany who spent time working in Haitidescribed being overwhelmed by the sights,sounds, sensations, and smells of the tragedy.I returned from a regularly scheduled visitto the NPH Mexico clinic two days beforethe earthquake in Haiti. Suddenly, insteadof writing updates on the chronically illchildren in Mexico, I found myself helpingto coordinate the international medicalvolunteer response at St. Damien’s. For me,the absence of those physical experienceswas perhaps the most surreal part ofmy efforts. I continued to shuttle my sonback and forth to his pre-school, and tosee pediatric patients with colds and earinfections at the inner-city health center inChicago, IL where I work three days a week.Before and after work, in the evenings and onweekends, I was at my computer… “skyping”with people on the ground at St. Damien’s,discussing adult patients with spinal cordinjuries and seizing infants with depressedskull fractures. I spoke by satellite phonewith the doctors at the University of Miamitent near the airport, I emailed with the headof the US emergency response team in theembassy at Port-au-Prince, I helped arrangethe evacuation of a couple of critically illpatients to the University of Michigan… and Ilooked for resources to send to the doctorsand staff caring for patients within Haiti.By a couple of days after the earthquake, itbecame clear that we needed to establisha system to deal with the outpouring ofsupport and desire to volunteer at ourhospital. At the request of NPHI staff andFather Rick, I worked with Vicky Medley ofFriends of the Orphans and Esther Kemmeof NPH Europe to establish a system forscreening and forwarding short term medicalvolunteer applications to NPHI Medical Teammembers working in the hospital in Haiti. Theoutpouring of support quickly overwhelmedthe infrastructure of St. Damien hospital, evenwith our small team stepping in to help…butwe are grateful to all who shared their time,energy, skills, supplies, and money…and alsoto those who tried to do so, but whose skillswe were not able to use!Now back to my regular responsibilities, I’llfinish up those reports for Mexico…butremain grateful that even without leaving myhome, I could be a part of the phenomenaloutpouring of support for our brothersand sisters in Haiti, and could connect withso many incredible and giving people whowere able to go and provide the care sobadly needed in the acute relief phase of ourresponse. Merci!Dr. Susan Haverkamp – Regional MedicalCoordinator Mexicocontinued next page...

At least 17 of the 19 patients in our roomwere amputated and had lost at leastone limb. The injured had pain andfevers through the hot and humid nightsof Port-au-Prince. We hurried to findand distribute the medications, tried tokeep the IVs running, and our patientsalive. After a few days, wounds becameinfected, and some patients suffered fromtetanus infections. Though we tried all wecould and treated them with antibiotics,immunoglobulin and morphine, not all ofthem made it.The unbelievable strength, hope and trustof our patients were what kept me going.Especially the children seemed to have nodoubt in us. Trust obliges. Many of the Haitian staff I have known for years, that sufferedthe loss of their homes and loved ones, trusted me. They expressed their feelings of beingoverwhelmed by some volunteers that had little international experience, especially in theface of disaster. However, overall, the Haitians truly appreciated the international volunteersthat came to support them during the disaster. I trusted my Haitian colleagues, mycolleagues of the NPHI Medical Services Team and all the former and current NPH/NPFSvolunteers that came down to help. We worked hard, calmly and efficiently. Their presencemade me feel so much more comfortable and secure. Thanks NPH family!ANNOUNCEMENT:Due to the Haiti earthquakethe NPHI Medical Workshopwas postponed as the EDMSannounced via email to thosedirectly involved. We are workingto reschedule the workshop forSeptember 2010, depending on theavailability of the guest experts.As soon as we receive theirconfirmation we will announce thedate of the workshop.Jan Weber, Regional Medical Coordinator Haiti & Dominican RepublicRight Place, Right Time and in the Right HandsDuring the three weeks I spent in the St. Damien Hospitalpharmacy I assisted a team of Haitian pharmacists and technicians,and our German pharmacist, Dagny Henning who knows thepharmacy well after having spent several months working thereduring 2009.Medications and medical equipmenthelp to save lives, if the right product isavailable in the right place, at the righttime, and in the right hands, a goal thatwas not always easy to fulfill these daysin Haiti. During the earthquake manystorage racks in the pharmacy fell andmedications became mixed up and werenot classified by names or indications inthe shelves anymore.Following the earthquake, many adultssought care at St. Damien’s. Thehospital’s pharmacy generally only stocksmedications from the World Health Organization’s EssentialDrug List for Children. The adult care created challenges, astheir conditions required treatments other than what is generallyavailable for the pediatric population of St. Damien. Furthermore,highly specialized health care professionals arrived from around theworld, who required specialized equipment and medications. Theoperating rooms immediately became orthopedic-focused, and amaternity ward that was created out of dire necessity. These arejust two examples of how the hospital quickly changed its usualfocus on pediatrics. As a consequence, not only the variety but alsothe quantity of the needed products, equipment and medicationsrose tremendously in a very short time.In order to meet the demands of the hospital, we receivedmany containers of in-kind donations that were provided fromdifferent institutions and organizations from all over the world.Incoming donations were screened, checked for adequate quality(expiration dates, sterility, etc.) and storedin adequate quantities according to thenecessity and urgency of the products.Equipment and medications that werereceived in extremely large quantitieswere distributed appropriately to otherhospitals and organizations in Haiti thatwere not as fortunate as we were toreceive such vital donations.The work in Haiti wasexhausting. However, I was given avery precious memory in these days, amemory that I will always hold in myheart. It was a gift to see the smile of my Haitian colleagues thatkept their positive attitudes despite all the personal tragedies, likelosses of family members, friends, beloved ones, the loss of homesand belongings, the smiles of the many children, smiling despite thefact that they had lost their arms or legs.These smiles are a very good medicine, too…Nina Ehrle, Regional Medical Coordinator Guatemala & Nicaragua

Volunteer CoordinationWhen people ask me “How wasHaiti?” the one word that comes tomind is “overwhelming”.A few days after the earthquake Ibegan working with Monica Geryand Susan Haverkamp, as we tried tofigure out how our team could assistin the relief efforts at St. Damien.Just days later, I arrived in Haitiwith the task of coordinating themedical teams coming to the hospital.Together with Phadoul, the HumanResources manager, and the MedicalDirectors of St. Damien, Dr. Arty and Dr. Narcise, Fr. Rickand Conan, we decided where the volunteers could behelpful to fill in the gaps where local staff wasn’t available.I then made assignments accordingly for all of the helpinghands to cover day and night shifts in the hospital, and tostaff the mobile clinics that went out into the city daily toprovide care to people that could not make it to the hospitalfor proper treatment. I was responsible for communicatingour needs to Esther Kemme, Susan Haverkamp and VickyMedley who were collecting applications from medicalpersonnel interested in going down. This was far from easy,as our needs were constantly changing.For about the first two weeks I was there, we did the bestwe could with what little staff we had to work with. Ournurses were providing care for up to 20 patients at times,and working over 12-hour shifts. They were constantlyrunning from room to room, looking for the neededmedications or supplies. They did all they could to makesure their patients weren’t in pain, that they got their neededantibiotics on time, and that post-surgical patients weregetting out of bed in order to prevent complications.Even though I myself wasn’t able to work in therole of a nurse due to the other responsibilitiesI had, I was so proud to see mycolleagues and fellow nursesworking so hard to bring comfortto the patients and their families.I’m pretty sure not a single oneof us came away from Haitiwithout having shed some tearsof frustration and desperation, butat the same time I know that fromour experiences working with thepeople of Haiti we came awaymuch stronger people. Phadoul,who worked day and night, findingtime to play in the courtyard to makethe children smile, Dr. Arty coming to care for the patientsduring her sabbatical year, the local staff working harddespite their personal situation, the international volunteers,and the hope in the eyes of the patients and their families…it was inspiring.Many of the volunteers that arrived were previous NPHvolunteers, not only from Haiti, but from the DominicanRepublic, Honduras, Mexico, Nicaragua and Peru. In theface of tragedy, family comes together. I’ve never felt astronger sense of family within NPH than I did while in Haiti.All of the support fromour donors, internationaloffices, volunteers, andeven the children in theother NPH homes that wereraising money to supporttheir Haitian brothers andsisters…it was amazing.Annie Kautza, RegionalMedical CoordinatorBolivia, El Salvador,Honduras, Peru

Updates from Our HomesMexicoDominican RepublicHaitiGuatemalaEl SalvadorHondurasBoliviaNicaraguaPeruBolivia:Childhood VisionProblemsThe majority of thecommon vision problemsthat can be correcteddepend on early detection,the acuteness of theproblem and on the age ofthe child. With prevention,serious problems in thefuture can be avoided. Aneye exam offers an effectivemeans of reaching theobjective of detection and early correction.We are continuing to perform the “well child checkups”,which includes a basic test of visual acuity, and as we havementioned previously this is a very useful tool to detectvisual problems early on. This will allow us to provide thechild with the appropriate treatment, offering our childrenquality health care. All of this is possible thanks to the helpof all of the people that are always supporting and watchingover the children of the NPH family.Dr. Ana Claudia Ayllon RiberaFamily Physician, NPH BoliviaWe recently detected some children with diminished visualacuity, and were able to take them to the ophthalmologistto determine their exact diagnosis and to get them theglasses they required. Some children needed glasses for thefirst time, and others just needed adjustments to the lensesthey already had.In our clinic we test visual acuity by using a Snellenchart. The chart presents the letter “E” pointing in variousdirections: with the lines pointing down or up, to the leftor to the right, and the child shows us which direction theletter “E” is pointing.The signs that a child might be presenting visual difficultiesare not always obvious, but they can include squintingor closing one eye when they read, excessive blinking orrubbing of the eyes, a cloudy appearance in the pupil ofthe eye, or frequent headaches. Being attentive to signalsof visual difficulties of the child may save the child frompresent and future problems.Vision problems, such as myopia or short-sightedness,hyperopia or farsightedness, astigmatism, and strabismus,if not treated within an appropriate timeframe, may resultin difficulties for the child. For example, it could lead tolearning difficulties if it is difficult or bothersome to read.The child may end up not wanting to read, and developnegative feelings towards the task.The child’s general activities may be affected as well, whichmay bother the child or make him or her feel sociallyrejected. For example, a child with uncorrected myopia thatplays basketball will have difficulties moving and shootingbaskets. This may end in the child not being well acceptedamong the other team members.Dominican Republic:Brenda’s Hope for a Kidney TransplantThe NPH family sticks together and supports each otheracross all borders - especially in difficult situations. In thepast two months NPH Dominican Republic was supportingthe NPH family and the St. Damien hospital in Haiti on alllevels, by organizing equipment, medications, water andfood and by providing transport for both volunteers anddonations to Haiti.Besides all this enormous support for the neighboringcountry, NPH Dominican Republic also provided caringsupport to Brenda from NPH Nicaragua, who had recentlymoved to the DR in the hope to receive a kidney transplant– a wish that was out of reach in her home countryNicaragua for lack of a national organ donor program.In Nicaragua, the second-poorest country in the Westernhemisphere after Haiti, resources are scarce and manyspecialized operations are not yet available.Having spent the past three months in Casa St. Ana, Brendais already integrated in the home and in the girls’ section‘San Esteban’ (see above picture).continued next page...

She receives hemodialysis three times a week in thehospital in San Pedro de Macorís, only ten minutes awayfrom the home. The shunt in her left arm has now beenfunctioning successfully for about one month, and thus thecatheter in her neck was able to be removed. The use ofthe new shunt and the removal of the catheter do not onlydelight Brenda for aesthetic reasons, but also improvesBrenda’s health care as her risk of acquiring infections issignificantly reduced now.We hope that Brenda will be on the national waiting listfor transplant within the next weeks and pray that she willsoon receive a donor kidney.Nina Ehrle, RMC Nicaragua and Guatemala & Jan Weber:RMC Dominican Republic and HaitiMexico: ClínicaBuen SamaritanoThe new year broughtmany changes tothe medical clinic atNPH Mexico. First,the clinic celebratednews that moving thepharmacy out of thearea where the nursestriage patients to asecure and dedicated area allowed us to pass our endof-yearinventory control audit with flying colors forthe first time ever. Congratulations to volunteer ClinicAssistant Dan Peck and nurse/Local Health CoordinatorFrancisca Palacios for their hard work and success in thisreorganization of the pharmacy.Second, in early February the clinic celebrated the arrivalof volunteer physical therapist Jeremy Sullivan. Jeremycomes to NPH from the Rehabilitation Institute of Chicago.Jeremy worked with the NPH Mexico projects coordinatorto purchase equipment for the therapy room with thesupport of a generous donation, and in a very short periodof time has gained the trust and acceptance of some ofthe clinic patients with chronic orthopedic needs. Wewelcome Jeremy, and are thrilled with the new service andequipment that we can offer to the patients at NPH Mexico.And lastly, at of the end of February, former pequeño Dr.Alejandro Zacarias has departed after five years as theleader of the medical department in Mexico. Dr. Zacariaswill be pursuing specialty training in Family Medicine.Wethank him for his efforts and wish him well in his furtherpursuits.We will look forward to introducing our new leadphysician in a future newsletter!Dr. Susan Haverkamp, Regional Medical CoordinatorMexicoHaiti: Dlo Pwóp – Clean WaterOne aspect of the efforts made to establish a state ofnormalcy is to get back to challenges that we have beenfacing even before the earthquake of January 12th. Oneof these continuing challenges was the potable watersituation at NPFS Haiti. More than three years ago thepartnering NGO International Action (www.haitiwater.org)provided us five free water filters – easy to recognize bytheir happily colored flags – and respective maintenanceservice on a regular basis. Therefore the potable watersupply had been stable and secure. The challengeinvolved was that our children still had to pick up thepotable water at the assigned taps in order to carry it totheir houses, which is no easy task given the fact that thechildren’s houses are spread all over hilly property.In a co-operational effort of International Action andNPFS Haiti a new agreement was made to supply all 19houses with water filters. International Action is installingthe filters while using material out of their stock and willcontinue to provide free service and maintenance in thefuture whereas NPFS only needs to add $640 to purchasesome missing materials.A respective intranet project was posted and will hopefullybe considered soon. On March 12th the InternationalAction engineers, led by Dalebrun Esther and joined bytheir visiting International Director, visited the orphanageand the first four houses were equipped with filters. Thekids are enjoying their direct access to the now potableand safe water. The children of NPFS Haiti say MERCIBEAUCOUP to International Action for their generosity,the excellent cooperation and their reliable service!Jan Weber, Regional Medical Coordinator Haiti &Dominican RepublicNPHI Excellence in HealthcareFor more information contact:Annie Kautza at: akautza@nph.orgDesign by: Monica Gery, NPHI Information Officer