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Excellence in Healthcare Medical Bulletin

Nuestros Pequeùos Hermanos™ International

September - December 2010

Message from the Executive Director If someone asks me how was 2010 for the NPHI Medical Services department, I would say: it was intense, it sped by, with a lot of exiting projects going on. 2010 also brought a lot of sadness sometimes, and great happiness other times. Sadness for the children we lost despite all the efforts, for the natural disasters affecting our homes and surroundings. Happiness, because the NPH medical staff from all the homes had been able to improve and save many lives among our children and nearby communities. Despite all the preventative measures put into place, our home in Haiti, St. Anne, regrettably had their first death from the cholera epidemic. Another seven children have been treated as well. Please see more on page 5. I want to take the opportunity to thank all the medical staff in the homes, the regional medical coordinator and all the medical advisors supporting NPH health department around the world in order to improve the healthcare and thus the health of the NPH children. Wishing to all of you a healthy and peaceful 2011. Dr. Pilar Silverman, Executive Director of NPHI Medical Services

2011 Medical Services Workshop is April 4-8th at the NPH DR home.

Saint Helene in Haiti Starts Art Therapy Program NPH/NPFS Home in Haiti, continuously tries to improve the care for its infancy population. I am thrilled to report about our new Art Therapy program that was launched by Liz Lawne (Ireland) in August 2010 and supported by Gena Heraty, Director of the Special Needs Program of NPFS Haiti. Due to security issues we couldn’t place many volunteers in Haiti for several years which caused a great gap in the therapeutic care available at St. Helene. Liz is making a great effort to close the gap and it is a wonderful pleasure to see our children enjoying her daily art therapy classes. Not only that many of them make enormous progress from one week to the other, even more impressive is the treasure of hidden talents among the kids that is now being brought to light. The art activities are supplemented by occupational therapist Stefanie Hauser (Austria) who started her service in October 2010. Stefanie supports our children on an individual basis by offering them intensive therapy contributing to the development of their cognitive and motor skills. While other teachers might have a hard time to attract their pupils, our therapists are being awaited every morning by their children and are escorted to their classrooms. NPHI Medical Services would like to thank all former and recent volunteers within the medical field for your support, commitment, discipline, hard work and willingness to impose many personal privations in order to bring relief and quality therapeutic care to the children of NPH/NPFS. You are making an incredible difference! Jan Weber, Regional Medical Coordinator, Dominican Republic & Haiti

Yudelkis has a New Life We discovered Yudelkis’s heart condition and confirmed the prognosis with her cardiologist about a year ago. We realized the fact that she might not reach the age of twenty. Immediately a cardiac catheterization was arranged to find out if she would be candidate for surgery. She was! The Medical Services team, right away, started to consult and look for options with experts around the world. I would like to point out that no hospital in the Dominican Republic has the technology to perform such surgery, though they have good heart surgeons. Finally by mid September 2010, we received the good news that a renowned heart surgeon in Spain, Dr. Caralps, and his team at the hospital “Clinica Quiron” in Barcelona were willing to help Yudelkis by doing the lifesaving surgery On September 24 everything was ready, we even found a sponsor, Banco Dominicano del Progreso for the airplane tickets, and Yudelkis traveled to Spain with a volunteer, Kristina Cavit – DR Home Correspondent- who offered to be her “big sister ” for those days in Spain. Yudelkis and Kristina, as they reported, were treated like queens. During the pre-surgery days and recovery they stayed in the home of Dr. Mercade and Mrs. Mercade, the key persons along with NPH Spain able to make all the arrangements with the surgeons. The open heart surgery lasted almost seven hours, all of us were praying for the good outcome and finally the call arrived: “Yudelkis was in the intensive care room and everything during the surgery went fine as planned.” They spent a few more weeks in Spain to monitor the results of the surgery, returning little by little to her daily routines and enjoying the tourist sites of the city of Barcelona. One month later after the surgery, the heart specialist gave her the permission to come back to her country. Everybody at the home was expecting her and excited to see her, and what she would look like. She was happy, she had put on several pounds and now she is already back at school. We are grateful to all the people involved who made this lifesaving intervention possible. Further more, the hospital and its staff and directors were so impressed about the work NPH is doing that they desire, and promise to keep helping NPH with any child who might need surgery. The case touched so many hearts that are willing to help NPH, including the creation in NPH Spain of a project called, “Operacion Yudelkis”. This project will help support any other child when we cannot find proper treatment in his/her country; not only suffering from congenital heart conditions but also from any other medical specialty. Dr. Pilar Silverman, Executive Director of NPHI Medical Services

Manuel turned 18! It is hard to see the once spirited Manuel, now laying in a hospital bed in Santa Ana receiving intravenous antibiotics, internal feedings and supplemental oxygen through his tracheostomy. Manuel has had a rough time over the last two years. Suffering from a variety of illnesses that include dengue fever, septic shock and repeated cases of pneumonia. Currently he is in the hospital Centro Medico Jabes in the city of Santa Ana getting treatment for a pneumonia infection. He has been in and out of the hospital and the Casa for the last two years. The good news is throughout this time he has been provided with the best care available. He has an around the clock nurses that attend to his everyday needs. As well as the Doctor that works at the Casa he is seen by an intensive care Dr. at the hospital and the Casa. Staff and friends from his NPH family regularly visit Manuel when he is in Santa Ana as well as his one brother that is attending High School in the town. Manuel has a Mother and Stepfather that live in the southern region of El Salvador. Once every 3-4months, when they have enough money to travel, they come to visit with Manuel. We hope that Manuel will be back in the Casa for his 18th birthday on December 12th. When people at the Casa de NPH El Salvador talk about Manuel, they recount stories of a young man eager to help others, who still had the gentle innocence of childhood in his spirit before his illnesses manifested. On a recent visit to the Hospital with Father Ron, Manuel shook with emotion on hearing the Fathers voice and receiving a blessing from him. On his last birthday Manuel was so filled with emotion that tears rolled down his cheeks. We hope that this year he will feel the same overwhelming power of Love and Affection from his family at NPH El Salvador. Darren Blue, Regional Medical Coordinator, Peru, Bolivia, Honduras &El Salvador

Haiti - Medical Checkups and Dental Screenings for Angels of Light and St. Helene Children Disregarding the threatening Cholera epidemic, pediatric nurse practitioner Susan Moylan and her husband pediatric physician Dr. James Reeder from Chicago (USA) headed down to Haiti at the end of October. Their mission: Supporting our local doctor and nurse carrying out the initial medical checkups for the 160 displaced/ orphaned children living in the temporary homes of the NPFS Angels of Light program. Within only four days all the kids were screened, the findings were documented, follow up recommendations were made, and treatment was initiated where necessary. Simultaneously and with the support of St. Helene volunteerclinic-assistant Lisette Echterling (RN – USA), who came down the mountains to join and support the team, medical charts for all the kids were created and Body Mass Index data was collected. Rapid-HIV, Tuberculosis skin tests, and treatment for parasites were applied to all boys and girls living in St. Louis (children ages six to seventeen years) and St. Anne (children under the age of five years), as the temporary homes are locally known. Luckily no major and/ or unexpected findings were made and only a small number of children will need long term medical care.

Coincidentally with the conduction of the initial checkups for the Angels of Light children, our long term supporters pediatric dentist Dr. Ron Pruhs and his wife Ronni, as well as registered nurse Chris Cattani arrived to carry out the annual dental screenings for the almost 600 children living in our four sites: St. Louis, St. Anne, St. Helene Orphanage, and Kay Christine – home for our children with special needs. For many of the children in the Angels of Light programs, it was the children’s first encounter with a dentist in their life. The dental team was surly recognized and warmly welcomed by the children and staff of the St. Helene Orphanage where they have been taking care of the dental needs of our children for last the 20 years. The work that was accomplished is greatly appreciated! The impact it will have on our children here in the future is invaluable, and we are very, very grateful for the incessant work and the dedication of Sue, Jim, Ron, Ronni and Chris. Mesi Anpil! Jan Weber, Regional Medical Coordinator - Dominican Republic & Haiti

New Faces: Welcome to the new physician and local health coordinator for NPH Guatemala. Dr. Pedro Arnulfo Sacahuí Reyes started a month ago in Clinica San Andres, NPH Guatemala as a full time doctor and local health coordinator. Dr. Sacahuí was born in Guatemala and studied his professional career in Cuba, Facultad Calixto García Iñiguez . He will be responsible for the integral health of all the kids in San Andres and Chimaltenango where the high school and universities students live. On September 21st 2010 registered nurse Lisette Echterling from Indiana (USA) started her new position as our first Volunteer Clinic Assistant Nurse at St. Helene in the Haitian Mountains. Lisette brings along a lot of experience from her former work in a Trauma Hospital in Chicago as well a load of cultural awareness she gained during several mission trips to Haiti in the recent years. When participating in the relief efforts at our St. Damien pediatric hospital as a short term volunteer after the January 12th earthquake, she found out about the vacant position at St. Helene and was quick to apply. Lisette didn’t lose much time getting into her new job and became an essential part of our clinic and great support for our children and staff within a couple of days! Welcome to the Team Lisette – we are glad to have you with us!

NPH Medical Services gives Annie permission to take a break The Medical Services team says thanks and bye for now to our dear friend and colleague Annie Kautza! Annie joined the Medical Services Teams as the responsible Regional Medical Coordinator for Honduras, Peru, El Salvador and Bolivia for almost three years after she had volunteered as a nurse in 2005 and 2007 in our Honduran home. Annie’s commitment to the children of NPH, her endurance and professionalism are outstanding, and though she only left us a couple of weeks ago, she already is badly missed. All Members of the Medical Services Team are grateful that we had the chance to work with you and become friends with you Annie. We are sure that you will continue your success story while attending the Master Program in International Health in Berlin/Germany. We wish you all the best and hope to have you back on board in the near future!

Continuing Education

Moving to the Mainland in Nicaragua

During 2010, El Salvador took very seriously the health education program. El Refugio Clinic’s administrative presented several topics in health education to caregivers, staff and children, aiming to teach which diseases someone will get without appropriate personal hygiene to keep our bodies healthy.

During the first week of December, all the children and some employees will be moving from Ometepe island to Casa Padre Wasson in Nandeime near to Jinotepe.

The most important topics were: washing hands, personal hygiene, Scabies and Mycosis. Dra. Yesenia Vargas, lead the training and all caregivers and children asked a lot of questions. After implementing such easy measures, Dra. Yesenia reported a decrease in the number of children affected by scabies and parasites. A consultant nutritionist has also provided training to caregivers, cooks and year of service teenagers working in the kitchen. Different types of diets, how to prepare a balanced meal and basics on nutrition were among the topics. The goal of this training was to eradicate obesity and under weight status of the children. Furthermore the dentist gave training on dental diseases, how to properly brush teeth and dental brush techniques. Caregivers were also trained to monitor the children while brushing their teeth for a more effective outcome. The nursing staff, as well as the other members of the health department, were able to develop some projects and teach the caregivers how to act when minor emergencies occurs as well as how to measure the temperature in case of fever. Katia Guzmán, Administrative –Clinica El Refugio, NPH El Salvador

In Casa Padre Wasson there are already roughly 70 older children who are studying high school. These young men and women moved a year ago to start their school year in centers near to the new home. The change of moving from the house, that most of them have been living in since their entrance to NPH, causes anxiety and discomfort. This is a normal event for the children who will experience the unknown and various changes in how life will be at their new home. Psychological preparation has helped to make the change less painful and reduce the level of distress among the children. The young men and women, who already moved a year ago, have been back to the island several times to explain the daily routines and how they feel living in Casa Padre Wasson. These events have shown the children that with the move they will continue with their regular schedule and daily activities. The children also have some worries because of several changes in the staff, caregivers, nurses and others. For some staff members to go every day to Jinotepe means long travel hours and they could not commit to continue working for NPH. At the same time as some staff left, other were hired. Once the moving is completed, it will be very important to monitor changes in behavior, performance at school, and other situations that can occur due to the recent changes. Marta Garate, Regional Medical Coordinator Nicaragua & Guatemala

Dental Healthcare at NPH Guatemala Thanks to the partnership between University of San Carlos and NPH Guatemala, the was able to start a pilot project in dental healthcare. The university placed a dentist who needed to complete a year of community service before getting full credentials and licensed. The name of the position is EPS which means supervised professional practice. The first EPS has already finished his service. His name is Carlos and this is his testimony. “During my months at NPH, I learned more than I expected to teach. I learned to observe, to listen to others and to understand. I learned to give smiles and get a hug in exchange. I learned not to leave a grain of rice on the plate and pray to God for the ones who are not so lucky as I am.” Finally I understood a famous sentence that any mother says to her children, “I love all of you the same”. I forgot the prejudices according to social economic levels, physical appearance, strength and weaknesses, all of which are labels society puts on us, identifying and marginalizing us. I was fortunate enough to be part of this incredible project; despite leaving part of my heart in the home, I left with a sea of satisfaction. I left my internship very happy because I was able to apply and put into practice all I learned during my entire life, not only in the university but also with life skills.” Dr. Pilar Silverman, Executive Director of NPHI Medical Services

NPHS Haiti St. Philomena Rehydration Center As of the 2nd week of December, we have served close to 900 people in our St. Philomena Rehydration Center. There are 16 large tents that can accommodate 15 patients each and a two-table nurses’ station. Usually, eight tents are in use, giving time to sanitize the others before being put into use again. Most are staffed with one nurse, a “tech” - a specially trained lay person who helps with IVs and all other tasks, and one or two doctors who care for several tents each. The two pediatric tents usually have at least one doctor and three or four nurses between them. Most patients have a family member with them who also help. With enough IV fluids and oral serum, most patients regain enough health to go home with oral salt and glucose preparation in two or three days. Unfortunately, some come too late, too dehydrated to be revived. Of course the hardest to see are the babies and young children. As you can imagine, starting an IV on a dehydrated baby is extremely difficult. We often have to use inter osseous fluids, even with some adults. This requires using a drill to place a line into the bone marrow where the fluids can be absorbed. Of course without the fluids, they will die, so this has to be done to save them. We also have many patients who suffer from other diseases, such as diabetes, heart disease, kidney disease, all of which are acutely impacted by the disease and at times also by the treatment. It is such a fine line since many times the patient cannot give an accurate history and of course we are a field hospital and are equipped to treat very little other than cholera. We have no lab or x-ray, and a limited selection of medicines. Of course no hospital will admit a patient with cholera because of the high chance of contamination.

When a patient dies at our center, if the family wishes or there if there is no family, their body is taken to our chapel and a funeral mass is said the next morning. We cover their body bag with a cloth decorated with a cross or holy picture, and place flowers on top. After the Mass they are cremated at our own crematorium. The city morgue does not take bodies of those who have died from cholera. When someone dies at home or is found dead on the street, their body is taken to a designated center and they are buried in a mass grave. Yesterday it was my sad duty and privilege to carry to our chapel the little body of an eight month old baby whose mother died of cholera a few days ago and whose twin is still a patient in our center. We placed her in one of the tiny coffins that some of our local men make out of paper mache - so small next to the bodies of two women who were there also. And yet, we have a death rate of less than 2% here - quite amazing given the circumstances. But knowing the 2% is no easier than knowing a larger percentage. There is a strong camaraderie among the workers and volunteers here - as there has to be. Everyone works hard - sometimes up to 16 hours a day. We are all very aware of how cautious we must be when we walk to the center, though it is only two blocks down one road. It is harder to get supplies and food since the unrest. Imagine a diaper shortage when we have 30 babies with diarrhea and many adults who cannot walk to the port-a-potties. Though each patient has a cot side bucket - literally - to use for vomiting and diarrhea until they can walk, sometimes even that is not do-able. We have a dedicated “sanitation staff” who are responsible for emptying and cleaning buckets, washing cots, emptying trash, laundering sheets. The port-a-potties are cleaned out weekly with difficulty because the people put trash in them also which clogs up the pump. It is really difficult to describe to you what is takes to plan, set up, run, light, plumb a cholera field hospital. I hope his brief description paints at least an outline in your minds. Patricia Wheeler, RN and Volunteer Medical Coordinator, NPFS Haiti

Good News from Bolivia Zeneide Gutierrez is one of those kids that can light up an entire room with her smile. She is a ten year-old girl in the house in Bolivia. She has a medical condition called Craniosynostosis. When she was very young her some of the sutures in her skull fused together and did not allow for proper brain growth. To fix this problem she had surgery at 9 months of age. They cut open her skull, then wired it back together with enough leeway to allow the brain to grow. Besides having an abnormal head circumference there were no long-term effects on her physical or mental health. Unfortunately over the last few months one of the ends of the wire that was used in her skull started to penetrate her skin through the left temporal region. It was not painful for her, but it was aesthetically cumbersome and presented a portal for infection. After various consults at a respected hospital in the big city of Santa Cruz, it was decided that the best option would be to have a surgical procedure done. On November 3rd she was taken to the hospital, and stayed the night with a caregiver and was prepared for surgery the next day. The procedure was performed around noon on November 4th. They made a large incision on her scalp where there was hair (so not to leave a very noticeable scar), pealed back her scalp, and removed the protruding wire. The procedure went as planned, without complication. She stayed three more days in the hospital receiving antibiotics and wound care. She was accompanied the entire time by various people from the Casa in Bolivia. She returned to the home on November 7th in good spirits. Thanks to the help of the Dr. Graciela Teran, and the support of all the staff at NPH Bolivia, Zeneide is healthy and with a brilliant smile full of self-esteem once again. Darren Blue, Regional Medical Coordinator, Peru, Bolivia, Honduras & El Salvador

Striving for Excellence in Therapeutic Care With great pleasure I take the opportunity to report about the outstanding work being conducted by our international Volunteer Therapists in our Dominican home. With the arrival of three new volunteers in the recent months we were able to not only continue but even extend the therapeutic programs and care that have been implemented in our Dominican home Santa Ana within the last three years. Starting in September physiotherapist Allison Clarc (United States) was handed over the physiotherapy program that was introduced in 2008 by Austrian volunteer Nina Holiczki and continued throughout 2009 and early 2010 by Nicki Blazynski (Germany), who tirelessly served our kids for more than one year and even came back after a short vacation in order to ensure the continuity of the program. Due to the sometimes small number of applications and yet the great need for professional and experienced volunteer therapists in the majority of our homes we couldn’t prevent a small time gap between Nikki’s departure and Allison’s arrival. Allison s arrival and activities were anticipated not only by those in charge of medical care but first and foremost by the kids who are now once more enjoying their daily therapies and the accompanying sweet taste of individual attention. Also continued is the Occupational Therapy program that was launched by Occupational Therapist Katharina Brehm (Germany). After she started in September 2009 and with the support of the Santa Ana maintenance department Katharina managed to set up a state of the art therapy room within one month. Occupational therapist Judith Janssen (Germany) now carries on the hard work and therapeutic strategy implemented by her predecessor. The benefit is proven by the incredible progress so many children make when attending the therapy classes and also evidenced in the individual progress reports prepared for each child. With the constant training and the use of a wide range of therapy methods and materials many children are able to improve their

concentration skills, learn the alphabet, distinguish between colors, count numbers, write their names and advance their fine motor skills. These achievements immediately influence the daily life of our children and have long term impacts for those who have a hard time in the regular schooling system by providing a taste of success and a boost of self-esteem. The therapeutic care in Santa Ana has been further strengthened by the arrival of Occupational Therapist Julie Poulin (Canada). Julie brings a lot of professional experience and keeps herself busy by supervising the activities, care and daily schedules of Casa San Mathias, our home for handicapped and special needs kids. She gives individual training to them and strives to share her professional knowledge with our local staff in order to achieve as much sustainability and transfer of knowledge as possible. NPH Dominican Republic and NPHI Medical Services are glad that with the newly arrived volunteers we again found the right-minded set of people and the necessary support, professionalism and dedication to meet the therapeutic needs of our children. With the arrival of Speech Therapist Janine Lütkereinke (Germany) in January 2011 the therapeutic team in Santa Ana will be completed and ready to provide excellent and holistic therapeutic care for the children in need at NPH Dominican Republic. Jan Weber, Regional Medical Coordinator, Haiti & Dominican Republic

NPHI Excellence in Healthcare For more information contact: Pilar Silverman at: psilverman @

Design by: Monica Ger y, NPHI Information Officer