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Excellence in Healthcare Medical Bulletin

Nuestros Pequeùos Hermanos™ International

January - April 2012

Over half a million (655, 000) people die from malaria each year, mostly children younger than five years old. NPH Haiti, St. Louis home receives mosquito nets.

Message from the Medical Services Executive Director In the mist of economic turbulence, the NPH community can stand quite grateful. We continue to make a difference in the lives of so many children, thanks to the support of the donors and tireless teams from the fundraising offices. For sure it is a challenging time; food and fuel prices are increasing but solidarity keeps us working and moving forward

and the Caribbean which leads to increased prevalence of chronic conditions such as anemia, neurological and psychiatric problems, creating a burden on the health system. Furthermore inadequate nutrition leads to the paradox of overweight and obesity, a silent epidemic. Obesity leads to chronic conditions in adulthood such as diabetes, heart problems and hypertension, all costing a lot of money.

I would like to give you just a glance on some of the health issues for the During the first semester of 2012, the NPHI first semester of 2012. Our focus this medical services team visited all the homes year is to reinforce public health issues: working hand by hand and supporting regular water testing to keep the water local staff, following up with the vaccines safe to drink, window and door screens project, medicine orders, obtaining medical to prevent mosquito bites, fumigation donations, and much more. All countries are of the surrounding of the homes and working within a frame work and blueprint increase hygiene awareness in the homes. to raise quality standards in healthcare for As simple as it sounds, people forget the wellbeing of the children. when life gets busy. When I saw in Bolivia that all the children line up in front of a Medical Services also had four brigades recently installed sink located in the front working in the external clinic and Dr. Pilar Silverman with children at NPH Mexico. of the dining hall, this made me very happy. surrounding communities of NPH Honduras Statistically less than 30% of the general population wash their and Nicaragua as well as supporting our local physicians to meet hands before meals or after going to the bathroom. their goals. NPH Honduras received priceless equipment to do eye exams for the children and community population. The first set Reviewing the homes menus is also an ongoing task for the local of glasses for all of those identified in need arrived by the end of doctor and regional medical coordinator. They analyze making February and all of them are wearing their glasses very proudly and sure there are enough proteins, fruits and vegetables as well as noticed a huge difference. Glasses are brand new and custom made vitamins. We cannot forget that for cultural reasons, nutrition with a ophthalmologist prescription, free of charge in Naples, in the NPH countries is different from where we originate, but Florida. it doesn’t exclude to reach a balanced and adequate diet for the Dr. Pilar Silverman, Executive Director of NPHI Medical Services children to growth and develop according to their age standards. Chronic malnutrition is a public health problem in Latin America

July 28 - Hepatitis Day Hepatitis is mostly a viral infection that causes inflammation of the liver. There are five main hepatitis viruses A, B, C, D and E. Hepatitis B and C lead to chronic disease in hundreds of millions of people worldwide and together are the most common cause of liver cirrhosis and cancer. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses are contaminated blood or blood products, invasive medical procedures using contaminated equipment and for Hepatitis B and some cases of Hepatitis C, transmission from mother to baby at birth, and also by sexual contact.

World Days The Pan American Health Organization and World Health Organization mark certain days throughout the year as a way to remember the effort on fighting such diseases, not yet curable:

Hepatitis A and E are typically caused by ingestion of contaminated food or water. The disease is closely associated with poor sanitation and a lack of personal hygiene habits, such as hand-washing. Improved sanitation and the Hepatitis A vaccine are the most effective ways to combat the disease. Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

April 25 World Malaria Day

Every one should be vaccinated against Hepatitis A and B virus. Unfortunately there is no vaccine for the other types. According to the WHO: • 1.4 millions of estimated cases of Hepatitis A occur every year • 2 billion people (estimated) worldwide have been infected with the Hepatitis B virus. Hepatitis B is preventable with a safe and effective vaccine. The hepatitis B virus is 50 to 100 times more infectious than HIV.

April 21-27 Immunization Week

• 130 million people at least are chronically infected with hepatitis C virus. No vaccine exists to prevent HCV infection, unlike those for hepatitis A and B virus. The risk of infection can be reduced by avoiding: unnecessary and unsafe injections; unsafe blood products; use of illicit drugs and sharing of injection equipment; unprotected sex with HCV-infected persons; sharing of sharp personal items that may be contaminated with infected blood; tattoos, piercings and acupuncture performed with contaminated equipment. • Hepatitis C patients infected should be vaccinated against hepatitis A and B to prevent co-infection and protect the liver We would like to bring awareness of this disease because our NPH clinics are exposed every day with patients being positive to hepatitis and also to advise all visitors in order to travel safely to get vaccinated against the Hepatitis A and B virus. Unfortunately there is no vaccine for Hepatitis C and others. Dr. Pilar Silverman, Executive Director of NPHI Medical Services

May 31 No Tobacco Day

Photos, right: Nurse Clorette from Haiti practices CPR training in Miacatlan. Below: Workshop training in Cuernavaca.

Red Zone Children: Striving to provide adequate care. Medical Workshop 2012 The fifth annual NPHI Medical Workshop took place in Cuernavaca, México, April 23th -27th. The core topic was “Emergencies in primary care.” Participants form all NPH countries; physicians nurses, assistants and volunteers attended the training sessions. Doctors from different hospitals in Mexico and with great expertise in ophthalmology, gynecology, surgery, cardiology, pediatrics and psychiatry, were some of the outstanding speakers providing training on emergencies and acute diseases on their respective specialties. A CPR training was held at the NPH Mexico home in Miacatlan with the rescue department of Cuernavaca. Each doctor and nurse had the chance to improve their skills in CPR for adults and children. One special guest speaker was Dr. Susan Haverkamp, who was part of the medical team and currently is a pediatric consultant for NPH, spoke about palliative care in children.

In addition to the academic, case discussion and training part of the workshop, the participants had the opportunity to visit the different NPH homes in Cuernavaca and Miacatlan. Overall the workshop was quite productive thanks to the active participation and support of the healthcare staff from the countries. Doctors and nurses came back to their home countries with new ideas, a new set of evidence based protocols, a psychiatric manual and a healthcare guide for all caregivers. Always in mind to improve and provide excellence in health care and integral care for all the children in NPH We are very grateful to the office staff and México directors as well as the México healthcare team and NPHI staff for their support organizing such an event. Marta Gárate, RN & Corinna Lawrenz MD, Regional Medical Coordinators for Guatemala, Nicaragua and México

Manuel continues to fight for his life. He remains stable with high quality care. His room at the NPH clinic is equipped as an intensive care room thanks to the donations of a feeding pump, heart monitor and oxygen concentrator. Despite Wendy’s prognosis and lung capacity, she attends school and enjoys spending time with her friends. Thanks to the donation of a portable oxygen concentrator, she is able to move around with a fair amount of independence. Brenda returned to her home country of Nicaragua after being away for two years. She was able to reunite with her father and spend one month with him. Brenda is now back at NPH and continues with her immunosuppressant treatment and medical check ups.

Home Updates Haiti: Donation of Mosquito Nets Thanks to the tireless effort of many people the Fr. Wasson Angels of Light program at NPH Haiti received a donation of more than 200 mosquito nets. As you can imagine we are very happy to be able to have our children sleeping under a mosquito net which is the most basic and cost effective tool to prevent high prevalent mosquito transmitted diseases dengue, malaria or filaria. Dr. Pilar Silverman, Executive Director of NPHI Medical Services

Bolivia: Hand Washing One of the easiest and most effective ways of preventing communicable disease is hand washing. It has recently been a huge focus of public health in countries all over the world. As part of the Medical Services team one of our goals is to encourage, provide for and educate in measures that can be used in disease prevention. At our home in Bolivia they are doing a great job with hand washing. Before each meal in the main dinning area, the children line up outside for prayers and announcements. Afterwards each child passes by and gets a squirt of soap and washes their hands at one of the four sinks before entering the dinning hall to eat. It is a great way to make sure children are washing their hands and it has helped keep the children healthy and happy. In all the homes of NPH, we try to provide soap and hand washing facilities that are easily accessible for the children so they are able to continually wash their hands and learn good hygiene habits. We also are reinforcing the importance of proper hygiene habits with the caregivers so that they can be examples to the children they care for. Diarrheal diseases, acute respiratory infections, intestinal worm and skin and eye infections are directly related to poor hygiene. There is evidence of the effectiveness of hand washing in reducing the incidence of these diseases. Darren Blue R.N., Regional Medical Coordinator

Nicaragua: Canadian Brigade A Medical Team of 32 Canadians travelled to NPH Nicaragua February 9th to 24th and stayed at the new visitors’ house at Casa Padre Wasson. The group included 3 Physicians, 1 Nurse Practitioner, 2 Nurse Leaders, 8 Registered Nurses, 1 Pharmacist, 1 Nutritionist, 3 massage therapists, 1 builder/carpenter and 13 helpers. According to the report submitted by Jean Aitcheson, RN, Medical Team Leader to NPH Nicaragua February 2012; The work of the team was to be two fold, examining the children at NPH for their annual physical check up and documentation, and medical outreach from NPH to the communities around the Home. Health and hygiene teaching was done including the importance of hand washing, dental brushing, drinking sufficient water in this hot climate, and the detriment of high salt and sugar intake. Each student had an eye test using the Snellen Chart, and a near vision card. All students received a new toothbrush and brushed their teeth with prophylactic paste. The outreach group completed eight days of medical clinics in seven different communities. The team travelled to Managua one day to assess and give care to the students in Managua, as well as the street children program. Each of the street children were able to choose a new pair of shoes. One day was set aside to do the immunization of students needing Hepatitis A and Hepatitis B. Another day was scheduled to assess and give care to any and all of the NPH employees and workers, similar to the routine as outlined for the children. Almost everyone was given near vision reading glasses. “Students at NPH seemed quite energetic and lively which would be an indication that they are getting enough calories and that for the most part their nutrition is adequate. The students seem to be quite active and most of them look lean, which will stand them in good stead as they age. There is a high incidence of adult onset diabetes in Nicaragua and there is certainly a genetic component to this. Diabetes and hypertension is a deadly combination and healthy eating and exercise will help the students of NPH receive healthy habits and avoid these diseases in later life,” said Elizabeth Denton, a Registered Nutritionist. Dr. Pilar Silverman, Executive Director of NPHI Medical Services

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Home Updates Continued... Mexico: Health program for caregivers This year as part of our AOP (Annual Operating Plan), with the support of our regional medical coordinator, Dr. Corinna Lawrenz, began a program called “Education for caregivers” in our Casa San Salvador home in Miacatlan, Mexico. This monthly program focuses on healthcare training for youths who are in their year of service. Topics are structured according to the needs and weaknesses observed in the care and attention of our children. The monthly program also includes a training at the school, targeting directly the children. The discussions in the school are the same topics addressed in the caregivers. With this strategy, both children and caregivers are in tune on the issues addressed. Thus, greater success in accomplishing the objectives is achieved. The program has had favorable results, as we have had good response from caregivers, making them aware about the basic medical care and key points or alarm signals, as they are the ones who pay the most attention to the children. Dr.. María de Lourdes Gamboa Espelosin, NPH Mexico

Honduras: Ophthalmology Center In January, NPH Honduras had the pleasure of hosting Ophthalmologist Richard and Sally VanBuskirk and Leo and MaryLou Hundt. Along with their vision expertise, they donated a computer-controlled auto-refractor machine, which is able to provide an objective measurement of a person’s refractive error and prescription for glasses in just a few clicks of a button. During the three days of consult, they tested the vision of over 200 NPH children, employees and their families, and people from the surrounding communities. Those diagnosed for glasses were able to pick out the frames they liked during their consultation. In addition, several year of service girls were trained in the use of the auto-refractor and fitting of the frames, so that this project can be sustainable in the future without an ophthalmologist present. When Dr. Richard and Sally returned to Naples, Florida, they graciously rushed to prepare the 107 pairs of glasses that were prescribed during the brigade so that they could be quickly sent back to Honduras. In February, 30 children from NPH Honduras received new glasses. For many, whom it was their first pair, their eyes were opened to a whole new world of better vision for the first time. Care was taken to make sure the glasses were properly fitted to each child’s face, and the importance of use and care of the glasses was reviewed with each child, teacher, and caregiver. As with any group of children, some are more excited to wear their glasses than others, but it is a process of adjustment (and fashion for the teenage girls). One of the youngest boys to receive glasses, Gerson, strutted around the home with a huge grin on his face, proudly showing off his metallic blue framed glasses to everyone he met for several weeks. Through this experience, it is evident that there is a huge need for ophthalmology services, especially within our surrounding communities where the majority of people cannot afford a vision consult, much less purchase overpriced glasses. Our hope at NPH is to be able to continue utilizing the autorefractor and personnel trained during this brigade to assure that all NPH children get their vision tested once a year, in addition to offering frequent outreach to the community. Heather Brooks, Volunteer RN

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Honduras and Nicaragua: Spanish Brigade For two weeks during the month of March, a team made by up of one internist, one pediatrician, three gynecologists and a psychologist, gave their time and expertise to provide medical care for the less fortunate in Honduras and Nicaragua. The Spanish brigade collaborated with the local doctors and also did amazing work at the community level, traveling to the remote communities. More than 170 consults of gynecology were performed as well as more than 50 gynecological sonograms thanks to an abandoned device that was discovered which was not being used. More than 60 psychiatric consults, 300 pediatric consultations as well as 300 prescription lenses where donated and health education was provided to the NPH population. The doctors from the brigade were surprised to witness the huge need for medical attention in the rural areas of both countries. They promised to return not only to care for patients but also to train health personnel and put to use or fix unused/ abandoned medical equipment. NPH Honduras and Nicaragua are very thankful to have had the opportunity and cooperation from these doctors working in renowned hospitals from Spain.

My experience at NPH When I knew it was time to start my Social Service in a surrounding community, my goal was to learn a lot from the experience and use it to grow as a human being. Thus I had the opportunity and I was fortunate to meet NPH. Although at first I was scared by the large number of people at NPH, I felt it was my chance to apply the knowledge acquired during my career. I learned about how to develop dietary guidelines for a specific population, but I never imagined that I would learn so much from them, that it would be such a challenge for me and I would leave footprints in NPH. Nevertheless, people I had the honor to get to know, especially the children, also left an indelible mark on me. I had the opportunity to see a commitment and a dedication of everyone who works as an employee or as a volunteer in NPH. I was surprised that a lot of people running NPH Mexico are former little brothers and sisters. This shows that they do it with all their heart and that the “Pequeños”, they are raising today, tomorrow will be successful persons and especially individuals with a big heart.

Guatemala: Wilmer A 20 year-old boy who when he was nine years old became quadriplegic due to a stray bullet while playing in the street with his brothers, has been confined to a wheelchair, striving to do things normal young people do. In February, thanks to his godmother, the offices if NPH Holland and Spain, Wilmer had the opportunity to travel to Spain to receive an intensive physical therapy program for his paralyzed body in order to gain independence and be able to fulfill his dream to attend university. As you can imagine, university in his country is not prepare for handicap people to move around. After three months of intensive training , he gained strength, skills and independence. Wilmer recently returned to NPH Guatemala with a chaperon provided by the Iberia airlines Foundation called “Mano a Mano”. Wilmer will continue with his physical therapy, recommended to him by the experts on spinal damage. In 2013, Wilmer will begin studying international business on a scholarship at a college in Antigua, Guatemala. Dr. Pilar Silverman, Executive Director of NPHI Medical Services

My work at the foundation was to analyze the food situation of the foundation to develop menus according to their needs. So I had to learn about the basic food consumed in the foundation which is basically produced by the members of the foundation -their participation promotes the harvest- about the food that is available in the region and about the Infrastructure available for food preparation or consumption. So, I prepared a cyclic menu of one month duration adapted to the nutritional status of the children in NPH. Although not followed exactly, it may serve as a guide for the persons responsible for the menus. I just want to thank NPH for giving me the opportunity to spend part of my Social Service with them and for filling me with experiences that will help me in my future career as well as in my personal life. Alejandra Yareli Mendoza García, student of nutrition Universidad Latinoamericana “Campus Ciencias de la Salud”

NPHI Excellence in Healthcare

For more information contact: Dr. Pilar Silverman at: psilverman @, Design

by: Monica Ger y, NPHI Information Officer