Let the Games Begin

Today was the first of our orientation sessions for the participants in the CARING Survey. We had over 20 volunteer interpreters join our HBI team for 3-hours of training. We went over the survey instrument, talked about the schedule for the project and went over the interpreters responsibilities within the framework of the project.

The interpreters are fantastic. Think about it . . . they took a Saturday morning out of what little free-time they have, and came to a training session on confidentiality, privacy and informed consent. They had many great questions and a variety of great input we can use for future survey research projects.

The nursing student team from the University of North Carolina will arrive in Arequipa tomorrow (Sunday). We will hit the ground running with an all day orientation to the Mission of Alto Cayma, the specifics of the research project and some general information about Peru and the Peruvian healthcare system. Then, on Wednesday the group starts day one of data collection.

Our plan is to collect data in a variety of geographic settlements within the Alto Cayma area. We hope that the variety in data collection settings will give us a more thorough “picture” of the needs of the people living in this area. The goals behind this survey project are to better define the needs of the communities and to empirically develop interventions and projects that most appropriately address their needs.

Stay tuned to the HBI Blogspot for updates on this project and information regarding publication of the data sets from the survey.

My Friend Willliam

Boy did it rain last night. The sort of rain that comes along only every so often. The sort of rain that has people stop whatever they are doing and stare through their windows in disbelief. The sort of rain that causes damage and flooding.

The rain really got me thinking about all of the people living in the “Jovencitos” (a term used to describe the squatter or invasion communities that encircle many of the urban centers in Latin America). Their floors are dirt and their roofs are woven mats. The rain for them is much more than a simple inconvenience.

Look, I am from Portland – we know rain; and the rain that came down over a short 5-hour period last night was amazing. This morning on my run I saw makeshift dams that people built with ciliar rocks (compressed volcanic ash that is quarrierd close to the surface in and around the Arequipa area; this is the etiology of the famous "White City") and dirt to divert the water from flooding their homes. The streets all around our area are caked with mud and dirt. The dirt roads that lead to the poorest settlement communities have been distorted from the channels of water that developed in the middle of the by-ways.

The rain really got me thinking about a young friend of mine living in a Jovencito in Lima. William, not his real name, is one of the lucky ones – sort of. He and his family live in the back of a restaurant high in the hills. Their floor is concrete and the roof that protects them from the elements is a finely placed corrugated structure. They never have to worry about the rain.

“I have a small ‘problemo’ that happens 4-5 times every day at school,” William told me. William’s “problem” has significantly altered his life. His problem has caused an otherwise shy 12-year old boy to retreat into isolation. His problem is taking a significant toll on his emotional and mental development.

William was born with hydrocephalus or “water on the brain” (it is actually a build up of CSF - but much folklore surrounds the idea of "water" accumulation). The developing world knows its fair share of hydrocephaly cases; and for the most part, has initiated the necessary resources to adequately deal with the population of patients afflicted with the condition.

When William was very young a shunt was place in his head that would drain the fluid into his abdomen. The procedure is not without risk, but a fairly common procedure none-the-less. When William was a bit older he had another surgery to replace the original shunt – this is where his “problemo” started.

As best I can tell from talking with William’s mother and examining the young boy – this second procedure brought a myriad of complications. The complication that most affects William (and an issue he refers to as his “problemo”) is born out of a problem with a tiny nerve. During William’s second procedure the nerve that helps him control his bladder function and his anal sphincter was cut. This seemingly minor issue has led to fecal and urinary incontinence.

“I can handle the ‘problemo’ – it is just the smell. I am really embarrassed for the smell.”

William wears protective undergarments. He told me that we can go through up to 10 pair of “protection” per day. He always fears that time at school when he runs out of “protection.” He fears the inevitable attention and ridicule that comes.

His family is very poor – and although they work to ensure that William has enough “protection” to attend school, he never has enough.

HBI is working with the Anglican Church to develop a nursing care coordinator position. We envision a position that will train a person that will be available to advocate for William’s needs, help with care enrollment for Ines, and work to connect the dots of care for many of the fragile children living in desperate poverty in the Pueblos Jovenes of Lima.

Please keep William in your thoughts, your prayers, your meditations, your good intentions. Please help us to let William know that he is not alone.

I can't catch my breath!

A few months back I Blogged (See: Lima - The City that Never Sleeps) about a woman and her family who have been crippled by a number of tradegies. Her name is Margaretia and her story is one of thousands of similarly tragic stories about poverty and a lack of access to resources.

On Saturday we visited Margaretia and her four children. The drive up to the community where she lives is on broken roads and past crumbling houses. She is 42-years old, but has been trapped in the body of a woman many years her senior. She is barely able to catch her breath - and has been confined to the familys small shack of a home for most of the last 2-years. Afraid to stress the tubing that is her life-line and her connection to a tank of oxygen.

The floor of their home (like that of many of their neighbors) is dirt. The new walls that provide protection from the elements were a recent donaiton from the Anglican Church - along with a new corrugated roof to protect them from the sun. In the past they have depended upon woven ratan mats and a plastic cover to protect them from the cold and wind of the exposed sand hills.

The day we arrived - Margareita was sitting in her chair in the first room of the home gasping for breath. She had been to the hospital the day before and the doctors told her that it would be best to place her into the hospital until she could regain her strength and "normalize" (not that she is ever able to completely breathe normally) her breaths. She refused - "what would I do with my children?"

Her frail body is strained by the increased metabolic demand to fight for breath. She seems almost defeated by the challnege of working so hard to keep air in her lungs. Yet, she continues to comfort her two small children and mentor the two older adolescents. She knows that one day their lives will be dramatically changed; for one day (perhaps soon) she will no longer be able to fight the fight she needs to in order to breath.

The lives of the people living in the peri-urban squatter communites of Lima are filled with stories like Margarieta - and the work to bring compassion and justice to these forgotten individuals must go on. HBI is working in collaboraiton with the Anglican Church of Peru to create a "saftey net" to help coordinate care, collaborate resources and develop hope for the thousands of people who suffer in silence. People like Margareita and her beautiful children.

Thank you for continuing to support the work of HBI and our many in-country parnters. Please consider Margareita and her family in your thoughts and prayers. Together we can make a difference - and together we can change the world, one person at a time!

Creating Community

It is such an honor to be asked into the home of a friend and be treated with respect and admiration. It is even more amazing to be welcomed into the home of a person you hardly know and become the guest of honor. Such was the case for our team in Lima at the recent Baptismal services for one of the special people to HBI.

As is the tradition in Peru, when a child is to begin an important phase of their life or accept an important transition – two people are jointly selected to act as the “Padrino’s” for that child. The Padrino (Godfather and Godmother) is a special person in a child’s life – as they act as a confidant, a mentor and a supportive influence . . . not too mention they provide the financial support that is a customary responsibility (as many people who request Padrino’s for their children are without the financial means to be able to put on the parties or the events that are customary for the occasions).

Reverend Patricia Blanchard and I were asked to be the Padrino’s for a beautiful young girl who is part of a special program operated in collaboration with HBI and the Anglican Church of Peru. Ines is a four year-old child with a debilitating skin condition that leaves her in near constant pain. Pain that often left her unable to walk and writhing with every bite full of food. We all knew this sad truth, and our goal for this special day with Ines was to shower her with love and affection.

The ceremony was absolutely beautiful. Ines was fully in her element all decked out in her new Baptismal outfit. The pink bows in her hair made her look like a little doll that had been pulled right off the shelf. The service was a full mass and involved a group of about 30 neighbors and well wishers who had all come on this Saturday afternoon to honor a young lady whose life has been anything but simple or easy.

Standing in the thatched roof church with its uneven dirt floor – made the experience even more impacting. Here, in one of the poorest Pueblo Jovenes in Lima, was a true expression of the power of love. We collectively were united in our hope for this beautiful little girl – and the promise of a future that was relinquished of suffering.

Following the ceremony our team was invited to the home of the Ines’ family. There, we were treated to an amazing meal straight from the earth. The meal was an ancient tradition from the Sierra called “Pachamanca,” or offering to the earth god. The banquet, a bounty of yuca, corn, legumes, potatoes and every type of sweet potato you could ever think of – was extracted from an open pit dug into the earth and covered with rocks that had been heated in a searing fire.

Buried in the center of the pit was a large pot filled with chicken and herbs. This was a meal like no other. The food was carefully removed from its terrestrial oven and lovingly served to our “team of honor” plate by plate –

no, make that . . . heaping plate by heaping plate. We were humbled by the generosity and care that this extremely impoverished family put into creating a truly memorable celebration for their cherished daughter.

It is an amazing experience and a great honor to be a part of the life of such a beautiful little child. By the end of our incredible meal we all felt a collective sense of tremendous gratitude for a family that sacrificed so much.

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.