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Excellence in Healthcare Medical Bulletin

Nuestros Pequeños Hermanos™ International

May- August 2011

Message from the Medical Services Executive Director Greetings from Santo Domingo, Summer is the season we all love and it is a good mid-year time to reflect on our work and analyze what didn’t go as expected, what brought us joy from a job well done and what we still have to accomplish. Summer is also a time to give thanks, now more than ever, to all the unconditional benefactors and supporters, who despite the economic turbulences, keep supporting the children of NPH and believe in the mission and Father’s Wasson legacy. NPH couldn’t do its job without them! There is no greater tragedy than when a child suffers or dies from a disease that could have been easily prevented, thus we would like to sincerely thank Friends of the Orphans, USA for responding to our call for improving the immunization status of our children. I would also like to thank, on behalf of the health departments, all the offices in Europe and the USA for: • Funding the medicines needed in our local pharmacies which gives the opportunity to NPH doctors to have a correct and adequate formulary to treat the most frequent and common conditions that occur in the NPH clinics • Recent shipping of corrective glasses for Dominican Republic, Haiti and Guatemala • Educational and diagnosis material • Wonderful volunteers they select and propose to work in the NPH clinics • Emotional and financial support for very complicated and specific medical cases NPH medical services work hand in hand with a group of specialty health professionals, who share their skills, professional advice and network with Medical Services in order to be able to provide the best care possible. After returning from a trip visiting NPH Haiti about a year ago, Dr. Roger Mercade made it possible to save

NPH Dominican Republic, Casa Santa Ana, summer courses.

the lives of two children from the Dominican Republic suffering from a congenital heart condition that could not be treated in their own country because of the lack of specialists and equipment. Thank very much Dr. Mercade for your professionalism, support, enthusiasm, energy and good job. And thank you to Hospital San Joan de Deu and Cuidam Foundation for taking care of the surgery, accommodations and tickets from Dominican Republic to Barcelona - Catalunya/Spain. I recently got a phone call from the Dominican Republic that we have been expecting for more than one year. At the time of the call, the Dominican Republic along with Haiti were under the heavy tropical storm Emily, with severe rains and flooding and power outages making any type of transportation that much more difficult. The reason for such an urgent call was that Dr. Pilar Silverman and Brenda. there was a kidney available matching Brenda’s genetic profile. After a lot of uncertainty and deliberation by the surgeons’ team, they reached the conclusion that Brenda would be a good recipient. The surgery, the only lasting solution to her declining health status, has been a huge step forward for Brenda’s life expectancy and future as a young woman. No more dialysis 3-4 days a week, no more rigorous strict and limited diet to keep her alive due to her ESDR (End stage renal disease) caused by a FSGS (Focal segmental glomerulosclerosis). I will always remember August 3, 2011 as the day Brenda received a kidney, kindly donated by a family who lost a loved one. In the spirit of solidarity, however, their desire was to give life.

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We all wish Brenda a quick recovery and hope to see her soon in our DR home for convalescence, and in a few months to travel back to her beloved home country Nicaragua as soon as the doctors release her. The path to giving hope and treatment to Brenda would have not been possible without the professionalism, kindness, compassion, love, solidarity and courage expressed by Dr. Sandra Rodriguez, chair of the Dominican Nephrology Association, and her team at Antonio Musa Hospital in San Pedro de Macoris. Lastly, I want to express my gratitude to a couple of anonymous heroes, working behind the scene with the medical services team. They are and have been working day and night with pequeños suffering from extreme terminal chronic medical conditions. Working with them granted us (MS) to be able to fill the gap and disparity in healthcare among poor and rich countries. Thanks a million to all on behalf of the NPHI Medical Services team. With you we are working together to improve the health of thousands of children in the countries where NPH has homes. As Father Wasson once asked, “Who will care for my children?” There are many generous people helping to fulfill his call. Dr. Pilar Silverman, Executive Director of NPHI Medical Services

Dr. Corinna Lawrenz - A new member of our team. Giving back a smile to a sick child, comforting the ones who unfortunately will have to deal with a chronic condition for life, educating and teaching how to live a healthy life, advocating for the basic right to be healthy and have access to healthcare–this is all part of the mission of an NPH physician. I am pleased to introduce the newest member of the NPHI Medical Services team, Dr. Corinna Dr. Corinna Lawrenz with a patient. Lawrenz. She will be working as the new regional medical coordinator for NPH Mexico. Dr. Lawrenz worked as a volunteer doctor at our NPH home in Guatemala in 2010-11. She showed extraordinary empathy with the NPH philosophy and worked very well with the NPHI Medical Services team. She is a native of Germany, which is also where she graduated from medical school with a specialty in pediatrics. She began her work with us on August 15th. Dr. Susan Haverkamp, her predecessor, will continue working with the Medical Services team as a special advisor as well as Dr. Lawrenz’s mentor for the first weeks. Please welcome Dr. Lawrenz to NPHI Medical Service team. She can be reached at: Dr. Pilar Silverman, Executive Director of NPHI Medical Services

Manuel from NPH Mexico.

NPH Mexico With two clinics and almost 800 children, the local medical team is kept quite busy. During the first semester of 2011, Manuel, a 12-yearold boy, like many of our children, suffered the abandonment of his parents. His grandmother took care of him and his sister until she found NPH. Manuel presented high blood pressure when the doctor at the clinic performed the wellchild exam. Manuel was sent to the hospital for further studies and was confirmed with a diagnosis of aortic coarctation in a severe stage. In April Manuel underwent surgery at the Instituto Nacional de Cardiología and a catheter stent was inserted. The treatment was funded by “Fundación Derechos de la Infancia A.C.,” to whom we are very grateful. Currently he is in very good shape and doing all his regular activities, waiting for his follow up check up in February 2012 and excited to start middle school soon. Projects executed during the second quarter of 2011: • Vaccination for Hepatitis A and SR in both homes, Casa San Salvador and Casa Buen Senor • PPD (Tuberculosis testing) – donated by Tecvamen S.A de C.V • Full medical, immunization, screening for TB and dental check up to all children from Ciudad de los Niños (Matamoros) who visited Casa San Salvador during celebration days • Prevention of addiction and anti-doping testing • Well-child visit and new-child medical checkups – which continue to keep the daily schedule of the clinic full Dr. Azucena Hernandez, NPH physician - México

“At any time God can do a miracle… miracle…. St. Damien Pediatric Hospital, Haiti

Moving a Mountain - Josue’s disturbing defeat and a victory for humanity. Sometimes the misery one encounters when working in Haiti is beyond words. There is no right vocabulary to describe the desperation and pain in the eyes of the mothers of some of our pediatric patients at the NPH St. Damien Hospital in Port-auPrince. Alain Gervais, long-term NPH volunteer in Haiti, knows this firsthand. After several previous volunteer commitments in our programs, Alain has been involved in the construction and operations at the St. Philomena Rehydration Center and St. Luke Disaster Hospital, following Haiti’s January 2010 earthquake.

investigated. While the NPH attorneys in Haiti worked hard to gather all necessary documents for a visa application, Alain and others were busy recording and sending Josué’s medical history abroad. Days went by and with every hour Elvita’s desperation grew. Nevertheless, she wouldn’t give up hope. She simply refused to accept that there should be no help for her baby and was willing to fight to the end. Finally NPH Haiti received the desired notice that the charity team of the Mayo Clinic Minnesota (US) had generously accepted Alain’s treatment request for Josué. Within days, Josué, his mother Elvita and Alain were ready to jump on a plane and head towards the United States. What had seemed to be unthinkable only a few weeks before became a reality. Against all odds Alain indeed had moved a mountain for Josué.

In early April 2011, Alain was struck by the accidental encounter with 10-monthold Josué and his caring mother Elvita. Josué had already undergone two operations at a different hospital in which the surgeons tried to remove a terrible defacing tumor growing on his forehead that affected one of his eyes. Sadly, shortly after their arrival and When the tumor grew back for the when additional medical exams had third time, his mother Elvita decided been performed, it was determined to seek help at St. Damien and was that the cancer growth had advanced desperate when she learned that our to a stage where even the highly doctors were hesitant to initiate curative specialized experts of the Mayo clinic Alain with Elvita and Josué. treatment for her child due to the advanced were no longer able to rescue Josué. stage of the cancerous growth and their Palliative treatment was started and, upon limited treatment opportunities. Confronted with a limited Elvita’s request, she and her son returned to Haiti. Josué died on number of hospitalization beds and scarce resources as well June 26th 2011 under the loving care of his family. Alain, who as an overwhelming number of pediatric patients, even NPH had further accompanied the family, shared their grief but was physicians sometimes are forced to make difficult decisions. relieved to report that Josué was able to die with dignity and that Elvita was finally ready to accept his fate. The inspiring example After Alain learned about Elvita’s situation he immediately knew of love and care Elvita had shown for her son had culminated it was up to him to advocate for Josué – and he did exactly into a remarkable acknowledgment of her gratitude for the that. In the following days and weeks Alain worked day and magnificent solidarity her family had experienced: “Now I know night in order to possibly save Josué’s life. Josué was admitted we can‘t do anything, that’s life, it’s only in God’s hands now, to St. Damien and despite the excellent care provided by our so let’s keep on praying. At any time God can do a miracle… doctors and nurses it quickly became evident that Josué needed anyway, I’m so glad to have seen so many people loving Josué treatment abroad. Everybody knew that the timeframe to make and trying to do all they could to save him. All that you [Alain] that happen was very short. and these people did for us is written forever in golden letters in Within days Alain arranged for Josué’s birth certificate and my heart.” passport, and in close cooperation with NPHI Executive Medical Director Dr. Pilar Silverman, treatment opportunities Jan Weber, RN, MPH. Regional Medical Coordinator, Haiti and the in the Dominican Republic, and across Europe and the US were Dominican Republic.

Enuresis, a common problem among our children. Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Generally bed-wetting before age six or seven isn’t cause for concern. At this age, nighttime bladder control simply may not be established. At NPH we identified more than 247 kids with this problem and it has been a priority for the health departments to, among other reasons, improve self-esteem, personal health, personal hygiene and avoid bullying. These are some of the benefits we expect from intervention when it is necessary.

Educating and informing the caregivers about enuresis is a must for them to understand and support our intervention. They receive training on how to fill a registration form and calendar, mark times for an alarm clock to operate, how the wet alarm works, to support and supervise the child in not taking excess amount of liquids at night as well as how to maintain an emotional and supportive attitude when they have to wake up in the middle of the night.

The program has three phases: evaluation, intervention and follow-up. The basic interventions NPHI Medical Services are a bed wetting alarm and developed general guidelines for behavior therapy support when the homes to tackle the problem. Children from NPH Peru. there is resistance to treatment In some homes the project is and other psychological problems. coordinated by the local physician The bed wetting alarm acts as a reminder for the child and makes and in other homes by the clinic psychologist. him/her more conscientious and aware when it is time to go to the bathroom. We still need to reinforce understanding of the At NPH Peru we started the enuresis program in 2010, when a problem, the importance of early intervention and teamwork to 13-year-old boy and a 9-year-old girl were wetting their beds quite be able to reach a 100% success. frequently despite the support of their caregivers. At this point a joint team decided to take over the problem and look for an Licenciada Brigida Mata, NPH Peru-psychologist interdisciplinary approach and solution.

New Hope in Bolivia A new family recently arrived at the NPH home in Bolivia. The oldest sister of the family is named Lizzi. She had a traumatic injury when she was two years old that resulted in her loosing her right eye. She is now almost 15 years old and has had to live a life with just a hollow area in the eye socket where the actual eyeball should be. She is a very shy and timid girl after having to live so long with such an obvious and fairly shocking injury. Lizzi has dealt with chronic infections of the eye socket that have never been properly treated. When she came to the home, one of our first goals was to figure out how to get her a prosthetic eye. With the help of the Bolivian NPH medical team and the national director we had her seen by various specialists and worked out a plan. After being properly treated for the infection, she was fitted with a temporary prosthetic eye to help stretch out the socket in preparation for a more permanent solution. It was a fairly time consuming process but she now has a more permanent prosthetic. It has greatly helped her to increase her self-esteem and live a more normal teenage life. Lizzi smiles for her school photo.

Darren Blue, RN Regional Medical Coordinator for Bolivia, PerĂş, Honduras and El Salvador.

Dental Healthcare at NPH Nicaragua We are fortunate to have had the Swiss dentist Saskia and her team return to the home in NPH Nicaragua. They stayed for over one month to attend to the dental needs of the children. Dr. Corinna Lawrenz at NPH Guatemala.

Preparing our Children for Adolescence Besides providing an all-over medical primary care in our clinics, another fundamental goal is to realize primary prevention and health education with the intention to teach our children a responsible, healthy and reflected life-style.

Working with local staff, they performed more than 300 annual check-ups and gave recommendations for medical follow-ups for specific children. The team also gave various educational presentations to the children regarding oral healthcare.

Saskia and colleague at NPH Nicaragua.

NPH Nicaragua and the medical team would like to express our gratitude for the valuable and generous service, and commitment to our home. Marta Garate, RN. Regional Medical Coordinator Nicaragua & Guatemala

When talking about sexual education it is hard to determine whose concern is this difficult and sometimes uncomfortable task: Teachers? Caregivers? Doctors? Psychologists? In Guatemala we rose to this challenge with an interdisciplinary collaboration between different departments. For each of the sections where our children live together with their peers, tíos and tías (caregivers), our counselor and the clinic staff developed and presented individual programs appropriate for the age, gender and level of maturity of the children. Issues were the anatomy of the sexual organs, adolescent years, changes of body and mind, etc. In addition, the school department of “Orientation” designed a complex lecture series, on “Responsible Youth” is highlighted every month from a different point of view for our 300 local and community students. In collaboration with our psychologists, social workers and religious education teachers, we designed age-appropriate workshops for all grades with themes about puberty and personal hygiene, STDs (sexually transmissible diseases), anatomy, adolescence, values, etc. Most of our children listened to our talks very attentively and many of them took an active part in the discussions. We recognize the importance of good communication, exchange and collaboration between the different departments in our homes, including all members of our family, with the aim to provide the best education, health care and spiritual formation for our children. Corinna Lawrenz, MD. Regional Medical Coordinator México

Children walking to school at NPH Honduras.

Hand in Hand with Aid for Aids In the country of Honduras HIV/AIDS has been a problem of epic proportion for many years. There is evidence all over the country of this horrible disease. One of the major ways of transmission is from mother to child, which if appropriate precautions are taken, can be prevented 99% of the time. We deal with this daily at NPH Honduras. There are over 20 children who suffer from this disease. Most of the children are involved in a governmental program that supplies them with their medications. When a child with HIV/AIDS does not get proper treatment or does not follow the strict medication regimen properly, he/she can become resistant to the first line of antiretroviral therapeutic drugs. When this happens, he/she needs second-generation medications. These medications are very expensive and not provided by the government. At NPH Honduras there are three children who need the second-generation antiretroviral therapy. For each child the medication costs around $1,000 a month. So for all three children we were spending approximately $36,000 a year on medication alone. We have been looking for an organization or donor who could help us with these expenses. Thanks to the hard work of Dr. Pilar Silverman we came into contact with an organization called Aid for Aids. After presenting the three cases and communicating our needs and desires, Aid for Aids has committed to supplying the three children with their second-generation antiretroviral therapy. It was a huge victory for everyone and we are very happy to have the support of Aid for Aids. Darren Blue, RN Regional Medical Coordinator for Bolivia, Peru, Honduras and El Salvador

Brenda’s Challenging Journey: living and coping with a chronic illness. In 1982, the London based professor of sociology Michael Bury was the first to describe the incidence of a chronic illness as a biographical disruption and thus, as a critical brake in the life of the affected. Chronic illnesses appear as a fundamental and irreversible change in people’s lives. They separate current reality from the past and undermine and destroy images of selfperception as well as the ideas of a future life one might have had connected to them. Chronic illnesses that occur during adolescence or young adulthood are perceived as an existential thread with the potential to throw a whole personality into crisis. Furthermore, unlike acute diseases – which are characterized by their temporality – the onset of a chronic illness often is the starting point of a (potentially) lifelong patient-career. The course of a chronic illness can be described as an unstable progression of frequent ups and downs. The social life and daily routines and activities of the affected person are overthrown by the careneeds of the chronic illness and have to be readjusted constantly and according to the developments of the health status. More than 20% of the overall pediatric population in all the NPH homes are living with chronic health conditions of various natures. Considering the socioeconomic misery and often disturbing social histories of loss, neglect and struggle for survival that the majority of our pequeños experienced prior to their admission to NPH, the number can be interpreted as being surprisingly low. The realization that, to use professor Bury’s language, those children might have experienced already two biographical disruptions – characterized by the loss of their biological family and the onset or diagnosis of their chronic illness – reminds us of the enormous efforts children and NPH homes have to make in order to cope with past and recent challenges. Brenda, a 20-year-old Nicaraguan pequeña who lives in our Dominican Republic home because of access to better treatment opportunities than in her home country, for years has been facing and defeating the challenge of living with a chronic illness. Her potentially terminal kidney disease demands her adherence to a strict diet and causes her dependency on dialyses three times a week. Among many other factors, these might be the most visible differences between her life and the life of her healthy NPH brothers and sisters. However, beyond the visible surface these illness-related duties have much deeper implications for Brenda’s daily life. Brenda spends a large portion of her time at the dialyses department connected

Brenda having lunch at the NPH home in the DR.

to lifesaving machines while her brothers and sisters are attending school. When sitting for hours next to the dialyses machines, Brenda does textile work and has plenty of time to interact with other patients. The latter helps her to cope with her fate and raises hope whenever one of her fellow patients receives a kidney transplant. At the same time, it continually reminds her of her situation and raises fears when she or one of her ‘dialysis friends’ experiences a medical crisis. In such moments she is forced to question her future and she faces great risk of demoralization. Brenda’s efforts to routinize her daily life are often undermined by the unforeseeable duration of her dialysis appointments due to limited availability of machines. Furthermore, the frequent ups and downs of her health condition often necessitate specialist consultations and a subsequent adaptation of her schedule. Unlike her brothers and sisters who happily enjoy the meals prepared by the NPH kitchen, Brenda, along with the support of her caregiver, needs to prepare her own salt-free diet – a not always welcomed but necessary duty for a teenage girl, which helps to strengthen her responsibility and illnessacceptance. The side effects of Brenda’s dialysis and medication regime are, among others, high blood pressure, frequent headaches, psychological and physical exhaustion as well as hormonal changes. The latter can provoke mood swings, which further exhaust Brenda and sometimes turn into a challenge for her caregivers, supervisors and peers. Brenda misses her friends and family in Nicaragua, but at the same time enjoys the company of her Dominican brothers and sisters, as well as the excellent hospitality and care provided by our Dominican home and the home’s medical facilities. It is this kind of ambiguity that characterizes her everyday life in general and her emotions in particular – a phenomenon that can be described as typical for the life of those affected by a chronic illness. Generally, adolescence and young adulthood are a challenging time. Youth are expected to take over responsibilities – may they be household chores, personal education or taking care of younger children – in exchange for developing freedom and independence for making their own decisions, having a private mobile phone, hanging out with friends or maybe even engaging in a first loving relationship. It becomes even more challenging when due to a chronic health condition, expectations can’t be met by the patient and his or her freedom must be limited to avoid health risks and further complications. These are situations that are likely to trigger misunderstandings and often leave patients and caregivers uncertain about their roles.

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Thomas and Vern Secret NPH task force for special operations.

Brenda with her friends in the DR home.

In the Dominican Republic Brenda receives counseling by our home psychologist and the child caregivers are supervised and supported by the home director and the NPHI Family Service representative. Both help to cope with the described challenges and to deal with the interplay of ups and downs, frustration and hope. In her rare leisure time Brenda loves to sit in the park to chat with her friends. She is a talented drawer and loves to read. At night she enjoys playing cards, monopoly and other board games as well as watching the beloved Dominican telenovelas with her closest peer friends Alejandra and Yolanda. This is the time when Brenda dreams herself away from the daily struggles into a buoyant life of glamour, wealth and good health.

Many rumors are still circulating within the extended NPH volunteer community regarding the outstanding weekend-retreats the Conaway family, namely Mary Sue, Vern and their son Thomas, provided throughout the 1990s to the volunteers who served in the NPH Mexico home. Based in Mexico City, the Conaways generously invited volunteers to spend their weekends in their family home and the concomitant rest, change and treats were highly appreciated.

Thomas and Vern Conaway.

The Conaways stayed in touch with the NPH family even when Mary Sue’s job commitment moved them away from Mexico and after various stations, to the Dominican Republic (DR). While Mary Sue, who appears to pull the strings behind the scene, served as an important advisor on immigration issues to the NPHI Medical Services team in the recent years, Thomas and Vern formed a secret NPH task force for special operations with a wide range of activity. Whether it was in the aftermath of the January 12th earthquake in Haiti, where they tirelessly worked on the ground and guarded countless transports with lifesaving supplies from the DR across the border, or as patrons of the newly created cancer program for pediatric patients from Haiti in our Dominican Home, the NPH family can always rely on them. In the most recent weeks and months Thomas and Vern have been an outstanding support to the NPHI Medical Services team and with regard to the treatment of one of our chronically ill Haitian pequeñas who had to visit the DR for better treatment options.

The NPHI Medical Services team is proud to accompany Brenda on her long and burdensome journey towards the desired kidney transplant. Together we are grateful for the support provided by our generous donors. We hope Brenda maintains the necessary strength and patience she needs to defeat setbacks and to keep her admirable spirit up!

Covered with a tourist-style camouflage the two appear innocent but develop their full potential with the raising complexity level of their respective tasks. As a former air force member, Vern uses his widespread contacts and logistical skills to benefit the children. Thomas, while having special needs himself, knows how to point out the care needs of the sick and uses his communication talents to turn a stressful situation or a tense encounter into a joyful experience for everybody. Together they won’t stop until the best available medical specialists and treatment options for our children are tracked down. The Medical Services team says cheers and thanks to Mary Sue and our two task force agents, Vern and Thomas. We are grateful for their committed support!

Jan Weber, RN, MPH. Regional Medical Coordinator, Haiti and the Dominican Republic.

Jan Weber, RN, MPH. Regional Medical Coordinator, Haiti and the Dominican Republic.

Welcome Dr. Ramos to NPH Honduras

Dr. Ramos in the internal clinic at NPH Honduras.

NPH Honduras has an internal clinic that serves the children of the home and an external clinic that serves the community. Recently, Dr. Mario Antonio Ramos joined our local team to help with the growing demands of each clinic. Dr. Ramos is a native of Tegucigalpa, Honduras with over 20 years of medical experience. Dr. Ramos has worked extensively with children and people at-risk. He is very passionate about helping marginalized populations. Some of his work experience includes working with street children, people in jail and Doctors without Borders. He has been a wonderful asset to the medical team of NPH Honduras. Dr. Ramos mentioned that he once met an former pequeño from NPH Honduras who was working as a successful schoolteacher. It was very influential for him to see the long-term successes that happen at NPH. His dedication and big heart for serving others is very much appreciated! Darren Blue, RN. Regional Medical Coordinator for Bolivia, Perú, Honduras and El Salvador.

Dr. Guni Celebrates her 10th NPH Anniversary in the Dominican Republic and Haiti Retired German pediatric neurologist Dr. Sirgune Piorreck recently celebrated her 10-year involvement with NPH on an extended visit to our Dominican Republic and Haiti homes. As one of our central guest-speakers Dr. Piorreck – referred to as “Doctora Guni” by our children and staff – arrived at Casa Santa Ana in the Dominican Republic in late March and joined the preparation efforts for the annual NPHI medical workshop, which took place between April 4th and 8th 2011 (see January-April issue of the Medical Bulletin). Dr. Pilar Silverman and Marta Garate with Dr. Guni.

From October 2001 to January 2002, Dr. Guni made her first trip to our Honduras home following an invitation from NPHI Family Services Director Reinhart Köhler. At that time Reinhart was the National Director of NPH Honduras, and had identified consulting needs in regards to the care of the Honduran pequeños with special needs. Dr. Guni was happy to meet the challenge and after her first self-financed trip signed up as a voluntary senior consultant at the German Senior Expert Service (SES), an organization funded by a private-public partnership. Since then Dr. Guni has been a committed and reliable senior advisor for the NPHI Medical Services team, either from home or on her various SESfunded visits to our NPH clinics in Honduras (2003, 2004, 2007, 2008), El Salvador and Guatemala (2008) as well as in Haiti and Dominican Republic (2010). On her most recent trip Dr. Guni served as a workshop lecturer covering a wide range of topics which included the following: Intersections and differences of neurology, psychiatry and psychology; autism; use of psychopharmacological drugs in NPH homes; epilepsy and attention deficit disorder. She also presented on neurological examination methods to use in primary healthcare settings where advanced technology is not available. The healthcare staff that participated from all of our nine homes took advantage of Dr. Guni’s comprehensive professional experience. Through the course of many fruitful case discussions between the staff and the senior expert a wide range of challenging care and treatment issues were tackled. Due to her deep knowledge of the NPH population with neurological needs and her awareness of the often limited treatment opportunities in our host countries, Dr. Guni’s realistic advice takes those challenges into consideration and Dr. Guni in the Dominican Republic home. often becomes a vital base for the treatment planning of our local staff. Following the workshop she further trained our local Dominican psychologist and in close cooperation with our local health care team and volunteer-therapists examined and diagnosed a significant number of children. Subsequently she visited our homes in Haiti – St. Helene, the Father Wasson Angels of Light program, St. Louis and St. Anne. In the name of our children and staff, the NPHI Medical Services team expresses its gratitude for Dr. Guni’s dedication and profound support. We are looking forward to celebrating her 20th NPH anniversary 10 years from now! Jan Weber, RN, MPH. Regional Medical Coordinator, Haiti and the Dominican Republic.

Important days to remember. World Health Organization. SEPTEMBER 8 International Day to eradicate illiteracy 10 World Day to prevent suicide 21 International Day for Peace 25 World Heart Day

OCTOBER 10 World Mental Health Day 13 World Vision Day 16 World Food Day 15 Global Hand Washing Day

NOVEMBER 14 World Diabetes Day 16 International Day for Tolerance 17 World COPD Day 20 Universal Children’s Day

NPHI Excellence in Healthcare

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

by: Monica Ger y, NPHI Information Officer