HBI Team Peru

The HBI Team Peru campaign preparations are fully under way! Our team will be traveling in July this year and will be spending two-weeks in medical, dental and social outreach in a corridor of impoverished communities south of Lima and in the community of Alto Cayma in the District of Arequipa.

The purpose of the outreach campaign is twofold – (1) to provide support and collaboration to our in-country partner organizations who are delivering care and services to the marginalized of Peru everyday; and, (2) to create a lasting experience that can really re-shape our view of the world. HBI strongly believes in the power of "in-reach" and the goal of changing the way that we view the world as a vehicle for creating a ripple effect of change all around us.

In holding to the HBI philosophy of care - HBI ensures that all outreach projects have Peruvian physicians, nurses and dentists. HBI strongly believes that sustainability comes from empowering local initiatives and in helping to create opportunities for Peruvians to serve Peruvians.

Anyone interested in joining the team should check out the trip details on the HBI Website; or e-mail HBI directly at Info@HBInt.org

HBI - Updates from January and February

Arequipa Connect Conference – A New Coalition: The inaugural Health Bridges International and Medical Ministry International Arequipa Connect Conference was a huge success. Participants from over 25 agencies and organizations attended the 2-day event whose focus was the creation of collaborative coalition for sharing resources, ideas and expertise. The coalition that developed from the meeting, Groupo Connectado Arequipa (GCA)" convened their first formal meeting on 09 February 2009. The next steps for forming the coalition will be firmly in the domain of the newly developed GCA and will more than likely take shape in the next couple of months. HBI and MMI will continue to provide technical support with help in meeting facilitation and oversight in the development of an on-line communication tool (Mr. Daniel Bachhuber has graciously offered to spearhead this project); but the new coalition strongly belongs to its new member constituents.One thing is for certain - when you put a group of spirited, passionate and creative people into a room together for two days . . . GREAT things happen. Stay tuned to the HBI BlogSpot for ongoing updates about the new Groupo Connectado Arequipa coalition and their burgeoning process of development.HBI is proud to have partnered with MMI on this historic event. We look forward to future conferences that work to create bridges between groups and organizations bringing desperately needed health and social services to the poor.

Carabayllo Outreach Clinic: The January outreach and community assessment campaign in Carabayllo was an extension of our on-going work in the Jovencito of Valle Sagrado. The purpose of the outreach campaign to Carabayllo (in the Northern Cone district of Lima – a sprawling peri-urban slum of over 1.5 million) was not to deliver medical and dental care, but to support the development of a sustainable outreach project to the area through a collaboration with the Anglican Church of Peru’s non-governmental health care outreach program. The HBI team (made up of four physicians, one dentist, two dental students, two nurses and a social worker spent an afternoon surveying the needs of the community through an administered questionnaire and through observational evaluations obtained by the team during our small clinic outreach.

In just 5 hours of clinic, our team administered over 20 comprehensive surveys, attended to 87 patients seeking medical care and 18 patients for dental care. By the end of the next day, we had met with a representative from the Anglican Church of Peru to present the data we collected in our assessment survey. The numbers spoke for themselves - many of the respondents described incomes at less than 300 soles (approximately $100) per month; and this is for a family of 5. Additional data revealed the depth of poverty enveloping the community: of the 20 respondents not a single family has access to indoor plumbing or water, many of families described 6 or 7 day work weeks with 12-hour days for little more than 15 Soles ($5 USD), most of the families surveyed said that they knew “where” to get medical and dental care – but could not afford the cost of transport and prescription medications. The most revealing data we retrieved pointed to a barrier that few studies have discussed – transportation and cost of prescription medication.

The goal of HBI is to help develop a collaborative response to the extreme poverty of Carabayllo and to begin to build the bridges that will allow all of the children of Valle Sagrado the opportunities of education, healthcare, and the unlimited hopes of tomorrow. Through our partnership with the Anglican Church of Peru – we are well on our way to making this goal a reality.

University of North Carolina Wilmington CARE Research Study: In early March, HBI and UNCW will be partnering on a community assessment research study in the Alto Cayma communities. The Community Assessment of Resources and Healthcare Experiences (CARE) is a cross-sectional survey study was designed to evaluate healthcare access and utilization patterns as well as objective and subjective barriers to healthcare in a series of peri-urban squatter communities outside of Arequipa, Peru.

More specifically, the survey will gain information regarding perceived access to healthcare, awareness of area clinics and charity care resources, emergency department use, and perception of their own health, including medical, dental and mental health issues. The Institutional Review Board (IRB) approved survey will also evaluate participants’ feelings on the medical care and treatment they are provided. In gathering this information HBI and UNCW hope to better understand the behaviors of our study population, so we can, in response, craft interventions to provide the people of the Alto Cayma Communities with expanded and appropriate primary care. You can stay up to date on the progress of this study through the HBI BlogSpot.

Help from Affinity Health System: A team from Affinity Health System in Menasha, Wisconsin was recently (February) in Alto Cayma. HBI helped to organize the event coordinated by our own Dr. Bob Gehringer. The team, a group whose purpose was to act as an evaluation team, used their week-long stay to the fullest – visiting the mountains, incorporating into the various activities of the Mission and helping to conduct roundtable evaluations and focus groups.

The group came away from their experience with a number of wonderful ideas on how to enhance an on-going relationship between the staff of Affinity and the Mission of Alto Cayma. Future collaboration may include: helping to incorporate an Electronic Medical Records system into the Alto Cayma Clinic, bringing specialty care teams down to Arequipa to help training healthcare providers, and working to bring greater recognition and understanding of the needs of the people of Alto Cayma to the staff and consumers of the Affinity System.

Help Fund Alto Cayma Healthcare Conference and Training Symposium: In April HBI will be producing the Second Annual Alto Cayma Healthcare Conference and Training Symposium. This year’s event will include two separate tracks of training – one for physicians and one for nurses and mid-level providers.

The goal of the event is to help to train the care providers working with the poor of the Alto Cayma communities and to attract new Peruvian professionals interested in volunteering in the Alto Cayma Mission Clinic. Invitations will be sent out to 100 providers – making this year’s conference a significantly larger event. We are fortunate to have a team of seasoned presenters from the Affinity Health System and from the University of North Carolina nursing program. The emphasis on the Second Annual event will be teaching evidence based skills that can be applied in everyday patient care. If you would like to help fund this event click here to donate HBI website.

Team Peru 2009: The HBI Team Peru Outreach trip is in full swing to recruit team participants. Our team leaves for a 2-week campaign on June 30. If you are interested in joining the Team Peru trip – please get your applilcation in as soon as possible. The details for the trip are being arranged and there is a need for a definite count of participants.

A Great Loss

It is with great sadness that HBI reports the death of Mr. Paul McMahon.

Mr. McMahon was a former HBI Board Member and a strong supporter of our work with the poor and disenfranchised. Paul was a big supporter of the arts, an advocate for education and a true humanitarian. He will be greatly missed.

The staff and Board of Directors of Health Bridges International wishes to extend our sincere condolences to Mrs. McMahon and the McMahon children at this time of loss.

Our thoughts, prayers and well wishes go out the entire McMahon family.

And the work continues . . .

I am sitting in the Lima airport awaiting my return flight to the States. This is a flight I have made many times – and yet, I always feel a bit anxious about the trip. Perhaps my anxiety is born from the feelings I have leaving Peru and in the recognition that there is a great deal of work that needs to be done in preparation for my next trip.

This has been a really “full” trip – with the First Annual Arequipa Connect Conference, many meetings to plan an upcoming research project, preparations for the Second Annual Alto Cayma Healthcare Conference and Training Symposium (in April) and our outreach campaign to Carabayllo. Next week, a group from Affinity HMO in Appleton, Wisconsin will be visiting the Mission of Alto Cayma to work with Dr. Bob Gehringer and Nurse Karen Falkenstein to determine ways that the Mission Clinic and the Affinity group can establish a collaborative partnership to advance healthcare services to the people of Alto Cayma.

On Tuesday afternoon I flew back to Lima for a series of meetings with critical HBI in-country partners. These meetings are important to the on-going work of HBI as they help to establish the connections that make our work so valuable. In addition, the meetings afford a tremendous opportunity to brainstorm about future programs and projects.

Speaking of future projects - I am excited to get back to Portland to prepare for an important upcoming collaborative project in Arequipa with the University of North Carolina Wilmington School of Nursing. In early March, HBI and UNCW will be partnering on a community assessment research study to evaluate healthcare access, utilization and satisfaction amongst people of the Alto Cayma communities.

Our hope is that this Institutional Review Board (IRB) approved study will help to bring greater attention to the needs of impoverished peoples in the periurban communities of Alto Cayma and help to direct future interventions. HBI will be posting more information about this study in the coming weeks.

On a separate note - I have recently learned of a change in U.S. law that makes it easier for people to donate to non-governmental (U.S. 501 (c)(3) registered) organizations like HBI.

The U.S. Congress has passed legislation that allows those over 70 1/2 years of age to forgo their required minimum distribution for the calendar year 2009. They have also extended the legislation that allows those 70 1/2 years of age to make contributions directly to a charity. The benefit of giving from your IRA, is that you do not have to take the income on your 1040. This is a major benefit for those who use the standard deduction rather than itemizing. Should you wish to donate to HBI - please see our website for details: http://www.hbint.org/donate/money.php

As always, thank you for your support of HBI and our on-going work of serving the poor and building bridges for sustainable change.

Valle Sagrado Outreach - Photos

Photo: The Playground

Photo: A case conference

Photo: The walk home

Photo: Waiting for the doctors

Photo: Dental care

Photo: Dr. Juan - a true healer

Photo: Nurse Karen and friend

Photo Credits: All of the photos posted in this BlogSpot are courtesy of an HBI volunteer Daniel Bachhuber. Daniel is working in Peru through the month of March and will have frequent photographic updates posted to his Flicker site at: http://www.flickr.com/photos/danielbachhuber/

Daniel is an extremely talented young man with an amazing ability to capture the true essence of a situation in his photography. HBI is very proud to partner with Daniel on a variety of collaborative projects.

The Sacred Valley

What a great day! The day started as an uncertainty and quickly became a real meaningful experience for every member of the team.

After loading the bus in Miraflores (a toney neighborhood in Lima close to the coast and well known for the “gringo” amenities) we started the 2-plus hour drive to the community of Valle Sagrado in Carabayllo (and area that one of my close colleagues once described as “the end of the earth”).

Ironically, the community of Valle Sagrado is named after one of Peru’s most sacred and revered areas – the ancient and historic valley of ruins near Cusco. Once you get past the nomenclature reference – there is very little in common between the Sacred Valley of the Urubamba region (see: http://www.cusco-peru.org/cusco-surroundings-cusco-sacred-valley.shtml) and the Sacred Valley of Carabayllo.

Our “clinic” for the day was the home of Sra. Torribiya – a woman who has been a defacto community leader for the people living in extreme poverty of this region. Torribiya’s spirit and commitment to organizing a better “tomorrow” for her neighbors are inspiring. She never fails to greet our teams with a huge smile and a lovely sign (see photo).

After a quick, and very purposeful, set-up – we started to serve a sea of patients. The line seemed to grow and grow and grow. By the end of the first hour of clinic it was apparent that we would not be able to attend to the masses of patients awaiting our clinic providers. As such, we triaged the line and took a firm interest in providing the most comprehensive care possible to the patients we were able to serve.

As our goal behind this clinic was to evaluate the needs of the people in Valle Sagrado regarding their access and utilization to healthcare services – we were very focused on ensuring that our Peruvian nurse Raquel had an adequate environment to ask the detailed questions in our assessment survey. This “adequate environment” did not last long – as the droves of patients waiting to be seen pressed into the small clinic space.

Not one to be deterred, Raquel pressed forward and managed to complete almost 20 surveys (little did we know that each survey would take so much time to complete). However, by the time Raquel completed the last question on the second survey we all knew how important this information would be to the development of a comprehensive care plan for the community.

I write this BlogSpot update from the comfort of my first class bus seat as we embark on a 15-hour drive back to Arequipa. As such, I have not had a great deal of time to systematically review the data we gained in the survey – but, a cursory review has my jaw dropping. Many of the respondents described incomes at less than 300 soles (approximately $100) per month; and this is for a family of 5. Additional data revealed the depth of poverty enveloping the community: of the 20 respondents not a single family has access to indoor plumbing or water, many of families described 6 or 7 day work weeks with 12-hour days for little more than 15 Soles ($5 USD), most of the families surveyed said that they knew “where” to get medical and dental care – but could not afford the cost of transport and prescription medications. The most revealing data we retrieved pointed to a barrier that few studies have discussed – the opportunity cost of receiving care.

Raquel told me on our drive back from the clinic site to our hotel that she was very surprised at the number of people who were enrolled in the government’s SIS program (analogous to a Medicaid program for the lowest socioeconomic strata) who were unable to utilize the program due to the “cost” of missing work to attend a day long waiting game to try and get an appointment. She told me that person after person described the extreme hardship of not being able to utilize the services of the SIS program – because of the “costs” (time off work, transportation, etc.) of accessing care. By the end of our clinic day I felt that I had gained a sufficient enough understanding of the needs of the people of Valle Sagrado to help shape a proposal for expanded care delivery to one of our in-country partners.

You can only look into the eyes of child who is suffering from extreme poverty with significant empathy and deliberate intention. The pain and loneliness their eyes express speaks volumes to their needs. The goal of HBI is to help develop a collaborative response to the extreme poverty of Carabayllo and to begin to build the bridges that will allow all of the children of Valle Sagrado the opportunities of education, healthcare, and the unlimited hopes of tomorrow.

Stay tuned to this BlogSpot for more info regarding our collaborative work in the Sacred Valley of Carabayllo.

Be Flexible!

It does not seem to matter how much I travel to Peru – I have a hard time remembering that the best of any plans will often be changed.

Our team has just arrived to a hotel in Miraflores after a 14-hour bus ride from Arequipa. We are a bit sleep deprived and in desperate need of showers – but all and all, we are in really good spirits and excited for our outreach project to Carabayllo tomorrow.

That is until we were slapped in the face with a big dose of reality.

The purpose of our outreach campaign to Carabayllo (in the Northern Cone district of Lima – a sprawling peri-urban slum of over 1.5 million) is not to deliver medical and dental care, but to support the development of a sustainable outreach project to the area through a collaboration with the Anglican church of Peru’s non-governmental health care outreach program. We planned to spend the better part of 5-hours surveying the needs of the community through an administered questionnaire and through observational evaluations obtained by a team of Peruvian physicians and dentists during a small clinic outreach.

When we arrived at the hotel this afternoon we were told that there is a “political power struggle” going on in the area – and that it may be too dangerous for us to go. It seems that elections are going to take place in three of the small communities that make up the area know as Valle Segrado in Carabayllo. The officials seeking leadership positions are angry that “and America team” is coming down to make the official of another community “look good.” Through telephone conversation the leaders have alerted one of our in-country staff to this “issue” and requested that we not conduct the clinic.

Daniel Bueno Rojas, HBI’s in-country lawyer and “go-to-guy”, is traveling up to Carabayllo (a four hour round trip) to try and sort out the issues and help to smooth the way for our clinic in less than 16-hours. He seems to think that he can convince the powers that be - that everyone can “win” from the clinic and the community assessment. He is, however, concerned about the potential for violence if we show up for the clinic and we have not fully discussed our intentions with all of the elected/nominated officials.

His parting words to me as he left the hotel for Carabayllo were – “we will need to wait to decide yes or no for the clinic until around 11 pm tonight.” Alas, we are in a state of pause awaiting our next steps. Perhaps the most difficult aspect of this whole “waiting game” is that we need to get back on a bus for Arequipa tomorrow night for another 14-hours of transport.