In This Issue:
• Letter from Our Director
• Honduran Physician Fellow Highlight: An Introduction to Dr. Charles Welcome and the Honduran Medical Education System
• Global Healing Coordinates Community Health Volunteer Training Programs
• Medications for Roatán
• A Letter from Our April 2006 Resident
• Meet Our Volunteers
• Special Thanks to Our Supporters
• Volunteering at the RVPC
• Would you like to Contribute?

This past year has brought so many wonderful volunteers through the RVPC. Global Healing is grateful for all of our volunteers' hard work. However, it is the children of Roatán who have truly benefited. As they leave the clinic, the smiles on the faces of mothers and fathers (and often the children, too), brings great joy to each and every volunteer. Now, nearly three years in existence, the RVPC is proud to have cared for newborns who now return to the clinic running around and chattering away. With each passing year, our role has expanded from simple urgent care to anticipatory guidance and well-child care, concepts that will, ultimately, make a long-term impact on the health of today's children and tomorrow's parents.

The RVPC would never have made it to this point were it not for the generous support (emotional, moral, and financial) of individuals like you. As most of you have not visited the Roatán clinic, we hope that the accompanying vignettes can help you better understand the impact of this program. For those of you interested in numbers, since opening its doors in the Summer of 2003, the RVPC has had over 8,650 patient visits. With increasing efficiency and regular staffing with attending and resident volunteers, together with the local Pediatric Fellow, the clinic can now see upwards of 30 patients per day. Furthermore, with a growing presence in the public hospital, Global Healing is initiating improvements in multiple departments, with the ultimate goal of significantly improved infrastructure and staff education, allowing a transition to local self-sufficiency. Global Healing has achieved such goals in the Republic of Georgia, and soon in Armenia, as well. We hope to add Roatán to this list of successes.

Sincerely,

Arup Roy-Burman, MD
Director, RVPC
Global Healing

We would like to extend a very special thank you to our Honduran physician fellow at the RVPC, Dr. Charles Welcome, for his hard work and dedication to the clinic. A native of Roatán, Dr. Charles began a fellowship in our clinic last June and has recently agreed to extend his fellowship another year, through June of 2007.

The RVPC's fellowship position supports one Honduran physician to work alongside our volunteer physicians and residents in the pediatric clinic. Central to our mission of sustainable medical outreach, eligibility for the fellowship position requires future plans to practice in Roatán. This ensures that our aid to the island extends beyond the reach of our outpatient clinic's day-to-day operations, enhancing our fellow's ability to care for his future pediatric patients on the island. The continuity provided by the Honduran fellow also helps the RVPC to emphasize prevention as well as healing. Developing a longer-term relationship with patients, the fellow is able to encourage regular check-ups (especially for infants) and to take the time to educate mothers and fathers about ways to prevent common illnesses.

Dr. Charles and the volunteer physicians at the RVPC enjoy exchanging stories of their medical training years, comparing and contrasting the two national systems. We highlight Charles background here to give insight into the medical education process in Honduras.

Born in his home in Coxen Hole, Dr. Charles attended elementary school in French Harbor while perfecting his English with a tutor in the evenings. After graduating the sixth grade, he continued his public school education at Colegio Jose Santos Guardiola in Coxen Hole for three years. Completing high school in La Ceiba (the closest mainland city to Roatán - a 2-hour ferry-ride away), Dr. Charles entered medical school in the capital city of Tegucigalpa at the Universidad Nacional Autonoma de Honduras at the age of 18.

Like at all Honduran medical schools, medical classes spanned over eight years, with the first two consisting of general education and the following six focusing on medicine. Discussions between Charles and Global Healing volunteers from the US revealed that the 5th and 6th years of Honduran medical school are similar to the 3rd and 4th year clinical rotations of American medical schools. The Honduran 7th year is similar to the American resident's internship year. Honduran students are assigned to hospitals throughout the country, spending three months each in gynecology, pediatrics, surgery, and internal medicine. Dr. Charles enjoyed direct contact with his supervising attending physicians in the San Pedro Sula hospital where he worked, as hospitals outside of the Tegucigalpa area do not have residency programs and interns are able to report directly to their attendings.

The eighth year, or "social service" year, is spent working as an attending physician at a government health center anywhere in the country, as decided by a match system similar to the American residency match. Dr. Charles spent a year in the town of Danli near the Nicaraguan border. Although his palate, accustomed to the rich varieties in the typical island diet, never quite adjusted to the restrictive local diet of tortillas and beans in Danli, the large pediatric population at the Centro Salud (about 70% of his patients) provided him with extensive pediatric training.

Hoping to complete a pediatrics residency in the near future (a three-year program offered only in Tegucigalpa and San Pedro Sula), Dr. Charles signed on with Global Healing to further his experience with pediatrics and expand his knowledge of treatment options and medical literature.

A note from Dr. Charles:

"I would like to extend my deepest thanks to every Global Healing volunteer I have had the pleasure of working with. The exchange of knowledge with the volunteer doctors is extremely beneficial to me, and I feel that we are able to complement each other well in our different perspectives and approaches to medical practice. The extensive experience with a pediatrics population is invaluable to me given my future plans to become a pediatrician in Roatán. The access I now have to online medical journals and hard copy medical literature in the clinic is also invaluable, as such resources are not readily available in most practice locations. I have found that a lot of the medicine we are taught here is based on Honduran programs and Honduran research. For example, studies on the management of TB in Honduras show that short-term treatment is the best option, and we have developed our national TB program along these lines. However, literature I have been reading from other sources suggests that long-term treatment might be better, and it is important to me to remain knowledgeable of current medical literature in order to practice medicine more effectively and to be as ready as I can be for my residency years. As my first year in the RVPC draws to an end, I am looking forward to my next year and am grateful for the experience, knowledge, and friendships I have gained through my work with Global Healing."

Dr. Charles with a patient in the pediatric ward.

La Colonia Community Health Volunteer Program
Promoting health awareness and education in local communities is a priority for the RVPC. At the request of concerned parents in the barrio of La Colonia, located approximately 10 kilometers from the public hospital in the town of Sandy Bay, Global Healing volunteer nurse Audra Katz worked from October 2005 through January 2006 to coordinate a community health volunteer training program. With the guidance and financial support of Dr. Richard Crespo, a professor of community health at Marshal University, Audra worked with Dr. Raymond Cherrington, a former RVPC physician fellow, to develop a curriculum for health volunteers on the most common health issues facing children under five years of age.

After ten weeks and eight 2 to 3-hour classes, eight community health volunteers graduated from the program on January 18, 2006. The volunteers have divided their community into eight zones and are responsible for all of the children 0-5 years old in their respective zones. In addition to monthly health status checks, which are compiled into reports for use by Dr. Raymond, the RVPC, and the public hospital, the volunteers are trained to educate parents about basic health care and disease prevention, to determine severity of illnesses, and to administer over-the-counter medications during non-clinic hours.

La Colonia 'Voluntarios de Salud' on graduation day with Dr. Richard Crespo, Dr. Raymond Cherrington, and Global Healing volunteer nurse Audra Katz

Flowers Bay Community Health Volunteer Program
Global Healing is coordinating a similar volunteer training program in the Flowers Bay community, located about five miles outside of Coxen Hole. Community members from this area came to our Global Healing volunteers with concern about the overwhelming levels of diabetes and hypertension in their community. Global Healing's Fulbright fellow, Jennifer Miller, and Eric Jung, RCPHI intern February through March of 2006, have taught volunteer training classes with Dr. Amanda Everett, the Flowers Bay Clinic physician, for two months. Volunteers are expected to graduate in June of 2006, and will monitor diabetes and hypertension cases in their zones much like La Colonia volunteers. Volunteers will focus on promoting behavior change in the areas of nutrition and exercise to control diabetes and hypertension.

Community health volunteer Cordelia Meza practices taking the blood pressure of fellow volunteer Janice Brooks with the help of Doctor Amanda Everett

It is sad to see that medicines often don't reach the patients who most need them . During a holiday in Honduras last year, Dr. Nora El Goulli, a London pharmacist specializing in drug procurement, visited the Roatán public hospital. The long lines of patients being turned away in front of empty shelves at the pharmacy was a heartbreaking sight. Small-scale medication donations brought with Global Healing volunteers has been unable to fill the gaps in medication supply that often span three months out of the year at the hospital. Such shortages force many patients to forego treatment, as prices at private pharmacies are often prohibitive. Nora decided to volunteer a few months of pharmaceutical consulting with Global Healing to help improve the situation. The few months turned into a year with the start of the ambitious "Medicines for Roatán" project.

Nora's preliminary report found that all public hospitals in Honduras depend on the central government for their medicines. Inefficiencies in the national drug procurement and distribution system result in chronic shortages in most regions. Roatán public hospital is chronically out of stock of basic medicines. Thus, children present with massive abscesses from living in unsanitary conditions or with severe respiratory infections, and there are no antibiotics to treat them with; diabetics die from insulin shortages.

But Roatán is a small island - there had to be simple a solution to sort out this problem! The first approach was to try to obtain drug donations from international health organisations, humanitarian agencies, and drug manufacturers. When insulin ran out in December 2005, Novo Nordisk, an insulin manufacturer, responded to our request by Fed-Exing a donation of a 6 week stock of insulin, which filled the gap until the hospital was able to re-stock. This saved up to 100 lives. But this was a rare example of a drug donation. 2005 was a year of major disasters, with the Indonesian tsunami, hurricane Katrina in the US, the earthquake in the Himalayas, famine in Niger, etc. Sadly, despite an acute crisis situation at the hospital in the aftermath of 3 hurricanes, without the benefit of media coverage, requests for Roatán did not receive much attention. A more sustainable, long-term solution was needed.

That solution is the "Medicines for Roatán" project. It involves setting up a Honduran non-profit organization called "Medicinas para Roatán", which will be charged with raising funds and procuring low-cost medicines from the suppliers to the World Health organisation. Orders will placed 3 times a year, and the medicines will be donated to the public and charitable clinics on the island, in proportion to the number of patients seen at each facility. The launch of the new organization is planned for January 2007.

We are now raising funds to procure the first year's stock of medicines. The target for 2007 is to raise $50,000, to cover the needs of all the public and charitable clinics on the island. We have found a professional fund-raiser willing to donate her services, and will train a small group of health workers in each step of the drug-procurement and distribution process. Our new Honduran NGO has the goal of becoming completely self-sufficient over the next few years, filling in the gaps in medication coverage on the island so that every patient will have access to the treatment that he or she needs.

Dear Global Healing,

I wanted to let you know what a phenomenal month I had during my rotation in Roatán. Charles was wonderful to work with, and I was able to spend two days with Peggy and Raymond in their clinic, which was also delightful. I would very much like to come back for two weeks next April as an attending.

I learned so much about the local community and their beliefs about medicine and health and was always struck by how strong the bonds of family and community are no matter where you are and under what circumstances you live. I felt so privileged to be able to enter into the lives of all the families I met, to earn such trust from them, and to try to help them with what I could offer. The experience of immersion in such a different environment is one that not only opened my eyes to other ways of thinking and living, but also gave me a new perspective on my home environment.

In a rather unanticipated way, the opportunity to spend a substantial amount of time in such a beautiful and remote location provided a much-needed way to reflect on my years in residency, and allowed me to gain some insight into myself and my career/life direction. The scuba diving I did provided a serenely meditative aspect and strengthened my powers of observation. And, perhaps most importantly, I met so many people who shared themselves with me, with such different life experiences and wisdom, many of whom have become lifelong friends.

It is encouraging to me that programs like this one and others are in place and driven by such inspiring people. Just about all of the locals and travelers I met during my stay expressed ardent support for our work. Roatán, in particular, seems to be a beloved location for many people, and it certainly has become one for me.

Thank you so much for this experience. It was by far the best of my residency and life-changing in so many ways.

Sincerely,

Jamie Lien
Pediatrics Resident, UCSD

Derya Caglar served as Attending from February through March, 2005. Derya previously worked at Children's Hospital Oakland and is now pursuing a Pediatric Emergency Medicine fellowship at Children's Hospital Los Angeles.

Wendy Zimerman was in Roatán February through March, 2005 as well. A fourth year medical student at Pennsylvania State at the time, she is now a pediatrics resident at Harbor-UCLA.

Marlene Rodriguez, a Children's Hospital Oakland resident in February of 2005, has now completed her residency and is currently working at a community clinic, serving a predominantly Spanish-speaking population in Oakland.

Natalie Ramos volunteered as the first RCPHI intern during February and March, 2005. Natalie is a fourth-year at Stanford University and will be a medical student at USC's Keck School of Medicine this fall. She co-directs the RCPHI Intenship with Jennifer Miller and provides technical support to Global Healing.

Anisha Patel, now chief resident in pediatrics at Lucile Packard Children's Hospital at Stanford, rotated through the RVPC in March and April, 2005.

Top Row from Left: Paula Roy-Burman, Celeste Allen, Phuong Khuu, Curtis Chan; Bottom Middle: Natalie Ramos

Phuong Khuu, a pediatrics resident at UCSF, volunteered in the RVPC in March and April, 2005, together with her husband Curtis Chan.

Curtis Chan served as attending in the RVPC March through April, 2005. A Fellow in General Pediatrics at UCSF, Curtis also works as a medical epidemiologist at the San Francisco Department of Public Health.

Celeste Allen, a pediatrics resident at Children's Hospital Oakland, rotated through the RVPC in March and April, 2005.

Paula Roy-Burman, now a medical student at USC's Keck School of Medicine, volunteered as the RCPHI intern in March and April, 2005. Delaying her return home, she coordinated a trip for eight patients to visit Hospital Loma de Luz in Balfate, a mainland coastal town, for audiology and ENT surgery consults.

Jaap Karsten, a seasoned international volunteer with extensive experience in Africa, made his first medical trip to the Caribbean, serving as attending in April 2005. Jaap is a pediatrician in the Netherlands and was our first volunteer from Europe.

Camille Scribner, a resident at Children's Hospital Oakland, participated in the program in April, 2005. Camille has now finished residency and will soon be starting a Fellowship in Pediatric Emergency Medicine at Children's Hospital Oakland.

Lisa Remaklas, a resident at Phoenix Children's Hospital, also rotated through the RVPC in April of 2005.

Arthur Lande returned to volunteer as attending in May of 2005. In his 22nd year of pediatric practice with the Kaiser Permanente Medical Group, he currently practices both inpatient and outpatient pediatrics at the Kaiser hospitals of Martinez and Walnut Creek, California. Besides his rotations at the RVPC, Dr. Lande has previously volunteered abroad with Interplast and Los Medicos Voladores.

Eli Sills, who rotated through the RVPC in May of 2005, completed his residency at Kaiser Hospital in Oakland.

Allyson Niece, also an RVPC resident in May of 2005, completed her residency at Tulane University.

Eileen Birmingham is a veteran of the RVPC, having served as attending in the RVPC on four separate occasions spanning from August to September of 2004, a return trip in November 2004, and subsequent trips in June and December of 2005. She most recently returned as the physician leader of a Global Healing administrative site visit in May 2006. Currently, she is preparing for a one-year trip to Uganda working with the Baylor Pediatric Aids Corps. Dr. Birmingham credits her experiences in Roatán as a major factor in her continued involvement with international service work.

Mollie Greves, a resident at the University of Washington, rotated through the RVPC in June of 2005.

Isabelle von Kohorn, a resident at UCSF, also volunteered in June of 2005.

Agnieszka Czechowitz, a fourth-year student at Stanford University during the time of her internship at the RVPC in June of 2005, will be attending Stanford Medical School this fall.

Katie Paul, a fourth-year student at Stanford University, volunteered as RCPHI intern from July through August of 2005. Katie compiled a report on the quality and availability of water in various communities surrounding the public hospital. She is currently obtaining a Masters in Public Health at the University of Washington.

Leonel Toledo, a pediatrician from New Jersey, served as an attending at the RVPC for three months from August through October, 2005. Leonel is currently considering at pediatric hospitalist position in Philadelphia and hopes to return to volunteer at the RVPC on an annual basis.

Alissa Chow, an undergraduate at Stanford University, volunteered as an RCPHI intern from August through September of 2005.

Courtney Jane Wusthoff, a resident from Children's Hospital Oakland, served from September through October, 2005. Courtney will finish her pediatric training this month and will begin a Fellowship in Child Neurology.

Jessica Harris volunteered as RCPHI intern September through October, 2005. A student at Stanford University, Jessica created a questionnaire to learn more about health and sanitation practices of parents with children under 5 years old in La Colonia to use as a guide for the health volunteer training program classes.

Reena Jethva, a resident at Children's Hospital of Pittsburg, worked in the RVPC in October of 2005.

Rodney Canete, who volunteered as resident in the RVPC in October of 2005, recently completed his residency at Mount Sinai in New York.

Nora El Goulli, a pharmacist from London, visited Roatán from October through December of 2005 and is now on the island again March through June of 2006 to establish a non-profit organization dedicated to providing a sustainable and consistent source of medication to the island. Her work is supported by the United Kingdom branch of Global Healing.

Ilena George, a fourth-year student at Stanford University, volunteered as RCPHI intern October through November of 2005.

Stephanie Doniger, a Fellow in Pediatric Emergency Medicine at UCSD, volunteered as attending physician in the RVPC in November of 2005. She will be returning to volunteer at the RVPC in 2006. Stephanie is also on the Advisory Board for Health Volunteers Overseas.

Kuldip Malhotra, a pediatric attending at the local hospital in Kitchener, Ontario, and faculty at MacMaster University in Hamilton, Ontario, volunteered in Roatán during November of 2005. Dr. Malhotra hopes to return to Roatán for additional volunteer work.

Thomas Bockle left New York, where he is completing his residency at Mt. Sinai, for a rotation in the RVPC November through December, 2005.

Alicia Cruz served as RCPHI intern November through December of 2005. A graduate of Stanford University, Alicia plans to pursue a career in nursing.

Ellen Tessler, Dr. Charles, Cynthia Lucero, & Natalie Chavez

Jennifer Miller is in Roatán from January through July of 2006 on a Fulbright Fellowship with Global Healing. Her projects include coordinating the RCPHI internship at the RVPC, contributing to the community volunteer programs in La Colonia and Flowers Bay, and conducting research on food insecurity and nutritional status in La Colonia. Graduating from Stanford University in December of 2005, Jennifer will be attending Stanford Medical School in the fall.

Brian Compton, a UCSF resident, completed his rotation in the RVPC in March of 2006.

Yen Lin Loh also served in the RVPC in March of 2006 as an elective in her residency program at the University of North Carolina.

Eric Jung, a third-year chemical engineering student at Stanford University, volunteered as RCPHI intern from January to March 2006. In addition to working for the RVPC, he helped conduct the training program for diabetes and hypertension community health volunteers in Flowers Bay. Working at the RVPC was Eric's first experience with international service work and he is excited about continued involvement with RCPHI and future such trips to new destinations.

Jamie Lien, a resident at UCSD, completed a rotation at the RVPC in April of 2006. Jamie will move on to a position as chief resident in pediatrics later this year.

We appreciate all of the help and support we have gotten from everyone. Including:

Greg & Noreen Basso
Dave & Dana Dornsife
Frederick Franks
Tamar Howson
Henry & Sonia Sohn

Dalina Trejo at Taca Airlines for assisting our volunteers with the transport of supplies to the clinic. Her help makes the trip much smoother.

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 Fall!

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.