In This Issue:
• The "Virtual Curbside:" Internet-Based Assistance Program on Its Way
• RVPC Expands into Perinatal Medicine
• Welcome Third Year Pediatric Residents!
• "Baby Steps"—Rewards and Frustrations in the First Year of the RVPC
• Honduras San Francisco Consul General Congratulates Global Healing
• Volunteer Doctors This Year to Date
• Other Volunteers and Partners This Year
• Creating a “Pediatric Fellowship” at the RVPC for Honduran Physicians
• We Are Looking for a Treasurer
• Calling for Volunteer Pediatricians and Pediatric Residents!
• Would You Like to Contribute?

The RVPC is teaming with Children’s Hospital & Research Center at Oakland to open an internet-based assistance program! Through the “Virtual Curbside,” the RVPC will be able to discuss complicated patients on a daily basis via a dedicated web-based station established in the Emergency Department of Children’s Hospital. Global Healing has brought broadband internet to the Public Hospital; with this connection the RVPC can now transmit high-resolution digital images, real-time video conference via web-cam, and easily telephone the U.S. with voice-over technology. The dedicated station at Children’s Hospital will allow rapid access to second opinions and consultations with pediatricians and pediatric sub-specialists in Oakland. In addition to the Oakland consultants, we have a large group of volunteer subspecialists from throughout the San Francisco Bay Area, including UC San Francisco, Stanford University, and Kaiser. Thanks to you all! We look forward to your active involvement as the “Virtual Curbside” becomes reality!

As the RVPC grows, our role is extending outside of the pediatric clinic itself, into inpatient consultation, newborn resuscitation, and, most recently, perinatal obstetric care. Dr. Mark Jacobs, Chief of Obstetrics and Gynecology at Marin General Hospital in California, recently volunteered at the Public Hospital through the RVPC. Advocating the concept of family centered care (especially important in an impoverished environment with a history of paternal non-involvement), Dr. Jacobs conducted the first delivery witnessed by the father in the public hospital’s history! The father’s face of fear turning to joy (pictured here) was a priceless image to all—hopefully, this precedent will allow for more Roatán fathers to be a part of the biggest day in their children’s lives!

Dr. Jacobs also worked together with the local obstetrician, helping to educate on improved simple medical management of mothers near delivery (especially those who were preterm). In addition, Dr. Jacobs brought a portable hand-held ultrasound machine with him to better assess mothers-to-be. This technology was of tremendous use—not only for the typical newborn screen, but for helping to reassure a “threatened” pregnancy, avoid a D&C on what was thought to be a spontaneous abortion (the fetus was healthy!), and much, much, more. Dr. Jacobs is working with the portable ultrasound’s manufacturer to obtain a similar model for the RVPC permanently. Our volunteers could train the local staff in its use, and, just as important, given its very small size, transport back to the U.S. for repairs and maintenance would be simple.

Through RVPC pediatricians and other physician volunteers, the health of Roatán improves in more ways than one!

"Being involved in a ‘grass roots’ program like Global Healing has enhanced my medical education more than any other rotation during residency."

Not only does the RVPC provide volunteer opportunities for pediatricians and associated medical staff, but it has now also been developed as an elective rotation for third-year pediatric residents, allowing our future pediatricians to contribute to medicine in the developing world early in their careers.

In February and March, we hosted our first resident—Dr. Ben Pecht. This rotation not only provided the children of Roatán much needed extra medical attention, but also provided Ben with an invaluable learning experience that he otherwise would not have had.

 

Each rotation at the RPVC is tremendously rewarding to our volunteers—and patients! However, our volunteer doctors have also experienced much frustration over the lack of medicine, equipment, and general medical training of the local staff—things that make a difference to a child’s life in the moment of urgency. Dr. Chris Longhurst and medical student Corie Keet experienced this first-hand when they tended to an 18 year-old patient in shock. Dr. Longhurst describes his experience in this e-mail he wrote at the time:

"When called by the local staff to the ward, Corie and I arrived to find a comatose, unresponsive, toxic looking patient with minimal respiratory effort. After the oxygen saturation machine we brought from the pediatric ward confirmed our patient was hypoxic, we began bag-mask ventilating him while two of the local resident physicians simply watched. Although I have developed reasonably competent resuscitation skills, this was the most pathetic code I have ever helped run… I was frustrated by the lack of response [of the local staff]… we had lost a pulse and were doing chest compressions, but [with the help of Anesthesia] did manage to intubate the kid and, with a little atropine, his rhythm resumed within a few minutes. Incredibly however, there is no working ventilator available [in the entire hospital] and the family TOOK TURNS BAG-MASK VENTILATING HIM ALL NIGHT!! Today he was flown to Tegucigalpa, but I don't have high hopes."

In response, January volunteer Dr. Dana Duncan also shared an experience with the loss a newborn baby who could have survived with the proper support available back home…

"I had a similar experience when I found a newborn with agonal respirations and no one was responding. I ran the resuscitation, got the heart rate back and realized there was no ventilator or even CPAP [simple positive pressure airway support] available. I tried to makeshift mask CPAP, but it didn't work, the baby died. It bothered me that this baby would not have died in another setting. I felt helpless and ineffective as a doctor without my fancy tools. But the reality is the Roatán Public Hospital is not yet ready for a ventilator. We are there to help get them to that point, [and progress has been made] but they are not there now. Ron (Global Healing engineer) went over all of the equipment, and he described a ventilator (that was previously donated). The tubing was chewed by rats and the knobs were rusted. It is not just about donating the machine. Nurses need to be trained (they now only take vitals once an 8 hour shift), there needs to be maintenance/upkeep of the machine, you need monitors, blood gas capabilities, ... Hopefully you are not discouraged by the immensity of the healthcare disparities between Stanford and Roatán, but are (instead) inspired to help diminish the gap."

All of our physician volunteers have been actively involved in local staff education through daily pediatric ward rounds and discussions of outpatient cases with selected staff. Director of Clinical Affairs Dr. Eric Scher has taken teaching one step further through hands-on training of basic newborn resuscitation skills. Dr. Scher is pictured here performing CPAP on a premature infant. Through his efforts over several hours, this child had a fighting chance to live! Even more important for the long-term, though, through such patients, the local staff are now themselves practicing resuscitation and CPAP techniques! [A Honduran nurse and a Honduran medical resident are shown here performing CPAP on two different newborns.]

Our volunteers continue to work hard, knowing that over time improvements will be made and many lives will be saved. As former RVPC volunteer Dr. Amy Kostishack would frequently say, “Baby steps….”

The Consul General of San Francisco recently expressed Honduras’ gratitude towards Global Healing and the RPVC:

The Consulate of Honduras in San Francisco, California, would like to thank Global Healing. Through the Roatán Volunteer Pediatric Clinic, they are able to contribute generously to our children’s health in Roatán Island. We thank each and every one of you for making possible this great project.

It is very fulfilling and quite rewarding to help people achieve their dreams. Global Healing’s clinic provides vital resources to support and strengthen Honduran families in Roatán Island, meet health needs of children, and help youth succeed and build healthier neighborhoods and communities in our country. We are glad and proud that Global Healing chose the Roatán community for their great volunteer work.

Best Regards,

Amalia Lardizabal de Hernandez

 

Here are the doctors and medical students who have volunteered since our last newsletter. With help of these doctors and others (see Others Who Have Lent a Helping Hand below), the number of patient visits at RVPC to date has reached over 1,500!

Dr. Dana Duncan - Dr. Duncan is a pediatrician at East Valley Clinic, part of the Santa Clara Valley Medical Center system, a Stanford University affiliate. Dr. Duncan finished her pediatric training at Lucile Packard Children’s Hospital at Stanford in 2001. She has long been interested in international medicine, and this was her first opportunity to work abroad. Dr. Duncan will be presenting an overview of her experience at Grand Rounds at Santa Clara Valley Medical Center in early July.

Dr. Arthur Lande (pictured below, to the left of star RVPC nurse Betty) – Dr. Lande is in his 20th year pediatric practice with the Kaiser Permanente Medical Group. He has previously volunteered abroad with Interplast and Los Medicos Voladores. He currently practices both inpatient and outpatient pediatrics at the Kaiser hospitals of Martinez and Walnut Creek, California. Dr. Lande is married to Jane Lande, also a pediatrician, and has three children. Here are a few words from Dr. Lande:

"In two weeks it seems I must have received more than I contributed, but I would hope to reverse this phenomenon on future trips. Given a presence on the island of barely six months (as of February 2004), the progress of the Global Healing effort is remarkable. The clinic is fully operational with running water, air conditioning, internet and stateside phone access. I believe one of the best testaments to its success is the fact that families are now frequently requesting to be seen by the Global Healing pediatricians. While there is considerable work to be done in the areas of hospital improvement, education, and public health, Global Healing is clearly established and in position to make a significant impact on health of island families."

Dr. Ben Pecht – Dr. Pecht is a third year pediatrics-medicine resident at the University of California San Diego Medical Center. He had the honor of being the first resident physician to rotate through the RVPC. (Ben is pictured to the right of nurse Betty; read about Ben’s experience in the resident section above.)

Dr. Chris Longhurst—Dr. Longhurst is a third year pediatric resident at Lucile Packard Children’s Hospital at Stanford. Dr. Longhurst was the second resident to rotate through the RVPC; he recently presented a summary of his rotation at a residents’ morning conference at Stanford. He has helped to expand our education and service into the nursery by initiating the practice of regular newborn discharge exams for the first time in the Public Hospital’s history. We hope to see these babies regularly through scheduled newborn and well child check-ups at the RVPC. We look forward to starting preventive medicine education from the very beginning!

Corinne Keet – Corie worked at the RVPC as a 4th year medical student from UCSF interested in international medicine. Her fluency in Spanish was of great assistance, not only for patient education, but also for local staff teaching. Corie was also involved in community outreach. Here she is pictured with Kenya, a premature infant who had been suffering from malnutrition. RVPC volunteers initially helped with inpatient tube feedings, followed by temporary outpatient care in “foster care” at a local resort. After a recent assessment by RVPC resident physician Dr. JB Long, Kenya is now feeding well with her mother at home! (Corie, good luck with residency next year at Johns Hopkins! Hope to see you back in Roatán again!)

Dr. Jennifer Beth Long—JB just finished a month long rotation at the RVPC. She is currently completing her residency in pediatrics at the University of Miami. JB did a fantastic job with both outpatients and inpatients. Her fluency in Spanish and wonderful demeanor were a plus for the patients—we have already received compliments on her job! JB also helped with the early trials of the “Virtual Curbside” program. We are very excited to extend our pool of physicians outside of California, and we look forward to further active participation from the South Florida community in the future!

Dr. Eric Scher—Our “Director of Clinical Affairs” has returned for his third rotation at the RVPC. Words cannot express the extent of Dr. Scher’s contributions to the success of the RVPC. Many of our volunteers have been able to work directly with him. Dr. Scher’s frequent visits have provided a face of continuity to the RVPC and have allowed new volunteers to make smoother transitions into their rotations. Dr. Scher’s activities this year have extended from outpatient care at the RVPC, to resuscitations in the Emergency Room and Delivery Room, to transport of patients and families to the children’s hospital in Tegucigalpa (a 14 hour trip by ferry and bus), to home visits in Roatán, to fundraisers on the island and in the Bay Area, and much, much, more. Thanks so much Eric!

In addition, the following individuals have made significant contributions to the operation of the RVPC:

Abby Lloyd & Carrie Aschendel – Abby, a third-year student at the University of California Boalt School of Law, and Carrie, a recent graduate of the University of Chicago, both have volunteered extensively in a variety of humanitarian projects. They recently spent a month in Roatán and thoroughly researched the hospital’s water supply and sewage problems. They also helped the RVPC overcome some of the Honduran legal hurdles on the road to long term success.

Charles Mouland – Charles owns a vacation rental complex in Half Moon Bay section of West End and is providing housing for our volunteers at a discounted rate.

Dian Lynn of Dian’s Garden of Good Eatin’ and Averyl of Casi Todo Books – Dian and Averyl presented the Taste of Roatán, an annual fundraiser featuring Dian’s fabulous cooking. As one of this year’s two beneficiaries, the RVPC and Public Hospital Roatán received over $1,600 to be put towards much needed equipment and repairs to help improve pediatric care in the hospital. Our first purchase was a refrigerator for the pediatric ward to allow mothers’ to store pump and store breast milk for their sick babies. Thank you Dian and Averyl!

Eric and Teresa Johnson – Eric and Teresa first came upon the RVPC as tourists exploring Roatán. Although not in medicine themselves, they were determined to find a way to help the children of the island. Returning home in South Florida, they established the Lordship Foundation, dedicated to raising support for children in need. Eric and Teresa recently returned to Roatán with a large donation of sandals, toothbrushes, infant formula, and other pediatric and infant supplies. Eric and Teresa are pictured here with Dr. Eric Scher.

Note the smiles on these two grateful children as they leave the RVPC with their first sandals and toothbrushes! (With a high rate of foot infections, sandals have a tremendous preventive impact; tooth decay is also a major concern—children typically “brush” their teeth with their fingers, if at all!) Thank you Eric and Teresa!

Global Healing and the RVPC are searching for Honduran physicians who are bright and energetic, AND have a desire to stay in Roatán. We propose creating a one year “pediatric fellowship” at the RVPC and Public Hospital Roatán for a Honduran physician interested in pediatrics. Our steady stream of volunteer pediatricians would work hand in hand with this Honduran doctor, improving his or her pediatric training over the course of one year. The Honduran “pediatric fellow” would provide another level of continuity in the clinic over this time. A Honduran physician would have a much better perspective of the infrastructure of the local medical system, and working together with the RVPC volunteers, could further improve the program’s impact on local children’s care.

This “fellowship” would be a great opportunity to improve pediatric care on Roatán on a continuing basis, and it would be a great symbol of partnership between Honduras, the Roatán community, and the United States (through our volunteers with Global Healing). We estimate that such a position (4 to 5 days a week in the clinic, pediatric ward, and newborn nursery) would require about $10,000 to $12,000 annually (100% going to the “fellow’s” salary support).

If you or your organization would be interested in supporting this fellowship, please contact either Director of Clinical Affairs Dr. Eric Scher (eschermd@aol.com) or Roatán Project Director Dr. Arup Roy-Burman (arup@Roatánclinic.org).

We are looking for a volunteer to work as Treasurer for Global Healing, the RVPC’s sponsoring non-profit. The anticipated time needed is 8-10 hrs./month. Responsibilities would include: paying monthly GH bills (approximately 5-7 bills/month); reconciling the two GH bank accounts monthly; maintaining records of bank statements and bills; preparing quarterly financial statements (automatically generated by the accounting software QuickBooks); and reporting annually (or semi-annually) at a GH board meeting. Initially, this volunteer would have to gain working knowledge of GH's three current medical programs. Additionally, the Treasurer would work with the firm Moss Adams in overseeing the Global Healing annual audit (2003 is complete and would begin tax year 2004 in April of 2005). Please remember GH is a relaxed organization and rarely is there any time pressure or constraints.

If you are interested in this position, we would love to hear from you!

Please contact GH President Cindy Basso Eaton at cindy@globalhealing.org

Are you a pediatrician or pediatric resident who would like to volunteer? We are taking applications now for both pediatricians and third year pediatric residents who would like to work at the RVPC. Ideal rotation length is four weeks, or more! There are still some positions open for this Summer!

MATCHING DONATION PROGRAM! A generous Bay Area couple has agreed to match all individual donations, dollar for dollar, throughout this Summer. Your contribution will help—and it will go twice as far!

The Roatán Volunteer Pediatric Clinic is a partnership between Global Healing and the Public Hospital Roatán, with approval and support of the Honduran Ministry of Health. The RVPC is located within the Public Hospital Roatán. It has been staffed nearly continuously by U.S. volunteer physicians since establishment in July 2003. The clinic is open to any and all children and has no religious or other special interest affiliation. Care is provided free of charge (patients only pay the Public Hospital the standard fee of about US $0.05). Global Healing has no paid staff—100% of donations to the RVPC go directly to the program.

Contact Information:

Sheila Jenkins, MD, and Arup Roy-Burman, MD
Global Healing
Email: arup@Roatánclinic.org
Website: www.Roatánclinic.org

If you are interested in contributing, please contact Global Healing through its website (www.globalhealing.org) or by phone at (925) 327-7889. You can also use our online donation form if you prefer. 100% of your contributions of cash, stock, or property is deductible from your federal and state taxes.

Global Healing is a 501(c)(3) nonprofit organization established to accomplish health care reform, through education, in areas of the world where modern health care is not available.