Kim's Medweb CPO Blog

Honduras – The Opening of the Roy & Melanie Sanders Regional Medical Center, Concepcion, Honduras, February 17-22, 2010

2010-07-08T16:27:00.000-07:00

There are days and trips that can alter the course of your life, or at the least leave such an impression that you want to adapt and change – to become better, to make a difference, to give more than you thought possible and to change even what others may say you never can or never will.

My trip to Honduras, February 17-22 was one of those trips. It is perhaps for this reason that this blog entry has been so hard to write, and now comes (because it has to!) as I prepare to speak about our experience at the SIIM conference in Minneapolis, and the documentary of the trip premieres... (this brief documentary is available at http://www.itnonline.net/node/36993)

It is always a struggle to put into words the sights, sounds, smells, feelings and emotions that arise when you leave your comfort zone and go to a place that knows true need. How can you write about the people that you encounter that leave you humbled by their dedication and compassion for a people less fortunate, with no regard for personal or financial gain and do any justice at all to what they do and who they are? How do you write about the people you meet who you would expect, and quite frankly DESERVE, to be crying out in hopelessness and despair, but greet you instead with smiles, love and a desire to share?

The reality is – there are no words. So I’m simply going to write what I can and hope that as you read, you can dig deep down and imagine your most powerful moments – moments when you have been touched beyond belief by someone who took time to believe in you, to inspire you, or a memory and feeling so powerful that YOU were moved beyond words, and then read on with that feeling and perhaps together we can bring these oh-so surface-skimming words to life.

Life is really a circle and one thing leads to another. Chance encounters in one area often lead to profound opportunities in another if you are open to experiencing them. Such is the case with how Medweb got involved with Shoulder-to-Shoulder/Hombro a Hombro (S2S). It started with a chance meeting with a philanthropic-minded radiologist, Dr. Phillip Silberberg, at the Radiological Society of North America (RSNA) conference in November 2009. On January 14, Dr. Silberberg contacted us to ask if we would donate a PACS (Picture Archiving & Communications System) for the Roy y Melanie Sanders Regional Medical Clinic in Concepcion, Honduras – nearly 8-10 hours from the capital of Tegucigalpa (depending upon the roads) set to open on February 20th. We tend to get several inquires so at first it was just a “sure, we can do that using virtualPACS™, not an issue.” Done, next issue and back to Haiti relief and grant writing for Afghanistan and Pakistan – Or so I thought! Turns out, not with this group…

Impassioned and well-entrenched in the country for the past 20 years through grassroots volunteer efforts and a lot of “blood, sweat and tears,” I came to realize that this is no ordinary organization on any level. Their style of service and mission lead to a level of sustainability that is truly remarkable, and accordingly, they get results far beyond what their balance sheets say they can do. And so, a 5069 to Cincinnati Medical Center, virtualPACS for use in Honduras, and a plane ticket to Honduras for the final clinic set-up and grand opening later, and we were a part of this great effort.

Joining me in Honduras was an incredible team from S2S, as well as several other representatives from private organizations who Dr. Silberberg had also reached out to solicit donations for the clinic. To say that these individuals were amazing would be an understatement. Dedicated, sincere, knowledgeable and willing to pitch in anywhere – inspiring to the core.

Monte, our Senior Engineer, and a true genius was set to go with me, for as much as I would love to learn to be technical, I have just come to terms with the fact that I just am not. So instead I look up to and depend upon the true talents and genius of Medweb’s “Geek Power Corps” (or at least that’s what I’ll call them for now).
Upon landing in Tegucigalpa, however, I received a call from Monte that he had not been able to board the plane because his passport had been warped after he had gotten it wet during a philanthropic trip to Antigua the week before. Since getting to Concepcion would not be characterized as “easy”, there was really no way to get him there on time for the clinic opening in the next 36 hours. As a cold weight settled in my stomach, I sought to reassure the others that had traveled from near and far from this great assembled team that Suuurrreee... I can totally handle this. Absolutely under control. Ay yi yi.

Working on our side once we got to Concepcion, however, was the fact that the engineering machinations of a dedicated volunteer and all-around “MacGyver” of the highest order, Art Ranz, we had bandwidth. Hallelujah! I was saved! Monte was able to tunnel into the virtualPACS and set up the parameters needed, as well as help when some of the other partners needed assistance in integration. There IS a benefit to doing this all over the world – you learn to integrate and work with what you have under intense time pressures because lives are literally at stake. And

Monte really is one of the “best of the best.” He did things remotely that even folks on the ground could not make happen, for products that were not even ours, and literally worked around the clock to make it happen. Again, no words for the depth of respect and admiration I have for him! Good for me as well, was learning that I CAN do this and I know our stuff much better than I thought. It’s amazing what you realize and can do when you have to.

Realization #1: How Art managed to get the bandwidth he did, from a satellite at the price he got, should be recognized. While the solution needs more permanence (and some serious benefactors) it really shows the vision of what IS possible when people come together. Bandwidth does not have to be unattainable and it doesn’t have to be priced at blinding prices that aren’t sustainable, or place undue financial burden, in the long-term. Bandwidth = access to information and communications which means access to education, health, business opportunities and overall growth and stability. Calling all Power Geeks and philanthropic minded folks from the public and private sectors… Let’s find a way to get sustainable bandwidth here and in other places.

Realization #2 & Whole Bunch More: You can’t go into a place expecting to be “sustainable” right away. S2S has been “in country” for more than 20 years, and started with a single individual dedicated to making a difference – Dr. Jeffrey Heck – Founding Director of S2S. Dr. Heck’s legacy will last more than a lifetime, or even 3 or 4 lifetimes. His work, dedication and the dedication of his family is beyond inspiring. The model that S2S/HaH has built is ground-up. It incorporates a local organization that drives the day-to-day operations of the organization, and is focused and built on relationships with individuals. They also constantly strive to do more (build a clinic, build a school, provide supplies, support the local economy through job creation, etc. etc. etc.) S2S though is also realistic. They KNOW what can be done, what should be done, and how to get it done – and they know how to take it in stride when things go sideways, up and down or boomerang back and hit you over the head when you least expect it.

I was blessed to see the fruits of all their labor and love at this point. You could FEEL the energy as people poured in from all over the countryside to sit in the chairs and on the dirt hills surrounding the clinic. This was no ordinary day. The clinic opening represented more than just a medical center and that energy was palpable. The dream became a reality on that special day as the extraordinary efforts of so many were recognized, while still others who gave more than anyone thought possible stood quiet in the background – content to just FEEL the power of the place, without the need for recognition.

Concepcion, Honduras – this tiny impoverished area, neglected for so many years, now has a telemedicine and teleradiology program that rivals anything you will see anywhere – and at a price tag that is unbelievable – approaching zero cost to the organization (not including staff time). Donations from numerous private sector partners in addition to Medweb, public support (from the Honduran government), paid and volunteer leadership and effort at its finest, ongoing services and consultations from more than 20 medical institutions and universities throughout the U.S. – the impact is staggering. This is what you talk about in aid/humanitarian work – the dream you pursue and hope, but more often than not never achieve. THEY DID IT HERE. IT IS POSSIBLE. This is a MODEL for how to do it elsewhere, and best of all it is simple.

In saying this, I realize that I keep throwing the world “simple” around as if everything is easy. Let me make it clear that simple is not easy and simple does not mean that hard work is not involved. What it means is that sometimes we try to make things so horribly complex (guilty!) and think there is a magic bullet we just haven’t invented yet. The reality is hard work + dedication to the long haul + recognizing and seizing opportunities as they come + more hard work + more dedication + patience + attitude of love, compassion, and selflessness = Success. When people come together and feel a cause together, and commit to that cause – big or small – it will be resolved, change WILL happen. And it really is that simple.

I truly feel as if greatness was achieved in this corner of the world and beyond on this trip, and we were an ever-so-small piece of this. It was just that each small piece, each small contributor, led to a greater whole, better than any imagination or dream. And if it is achievable here, then it is achievable elsewhere – including war-torn and ravaged places such as Afghanistan, in countries ravaged by AIDS and famine in Africa, Asia and the Caribbean, to even places in the U.S. and Europe where poverty still exists (maybe not to the extent that we see in other areas – but there are still children who starve every day and we can do better).

We were privileged enough before we left to see the first two patients arrive at the clinic for treatment… The first was a 26 year-old male who had been injured in a motorcycle accident 9 months prior. Lucky to be alive, he had considerable pain and had lost the use of his left arm. Having heard about the clinic he and his family had traveled more than 10 hours overnight to get to the clinic – we were his last hope. He had been through a string of doctors who were not sure what to do. At first glance, it appeared that with some fundraising he could be sent to the U.S. for a “miracle surgery” to restore use of his arm. Using the portable X-ray donated by MinXray and the CR by iCRCo, the studies were sent through the Medweb virtualPACS to a neurospecialist in Miami. Unfortunately, sad news came back, and we were moved to tears as this man collapsed in his brother’s arms sobbing... Due to the length of time that had elapsed from the date of the accident, the recommendation was to amputate the arm above the elbow (which also meant that a prosthetic hand/arm would not be possible with current prosthetic technology). NEXT TIME we said though, it will not be the same here in this corner of the world… NEXT TIME, they will now have what they need to diagnose and treat – that is/was the positive. We may have been too late for him, but it will not be too late for someone else.

Our second case was a premature baby who had been born with a club foot. Lucky to have survived at all, they had been trying non-surgical options, such as casting to fix the foot, and really needed a true measure of the progress before contemplating surgical options that would strain the systems of this tiny infant. There were also concerns about other possible heart and organ defects and in addition to the x-ray on this precious little one, he was also given a pediatric ultrasound by volunteer ultrasound and PACS technicians/administrators from Kosair Children’s Hospital in Louisville, Kentucky. In this case, we had good news… no apparent defects AND the casting and current treatment strategy was working. One day, this little one would be running and playing and jumping just like all the others.

We really can do more. It is possible. It is attainable. And it’s not hard when we come together.

As most who know me know, one of my most favorite quotes and sources of inspiration is by Mother Teresa… “If you can’t feed a hundred people, then feed just one.” If all that can (and even many that think they can’t) “fed just one”, the waves would reverberate around the world, creating a sea of lasting change, health, prosperity and peace.

Making a difference in Haiti...

2010-02-19T08:23:00.000-08:00

Guest entry by Jeffrey Henry, Medweb Engineer in Port-a-Prince, Haiti (Tuesday, February 16, 2010)

I’m about to change someone’s world by printing them a 180 page X-ray user manual. He will be an X-ray tech the rest of his life, and probably be able to provide a much better home for his wife and child because of it.

In my not so humble opinion, this trip has been a resounding success. Ever since I set up the view station right next to the Medweb, the doctors have been running back and forth non stop from their patient to the PACS view station. It was awesome to see this. The Medweb PACS has truly helped people get their studies read in a timely fashion; it has enabled them to compare old X-rays to new ones, determine the rate at which people are healing, and decide if they can be discharged. I’m confident Medweb’s donation has helped reduce the length of time people are suffering, and has helped save some peoples lives.

I helped my new Haitian friend Fetner send all the old studies needed by the doctors one image at a time for review.

Before I leave, I am going to print out 1 copy of the Medweb plug-in user manual and staple it together and leave it near the View station for incoming doctors when I am not here. Come to think of it, I should train Fetner to train the Haitian docs. I love how things work out sometimes.

I definitely miss my home, friends and coworkers. If we are coming here on another trip, I will help make a drive to get donations. I cannot stress to you enough how much is needed here.

-Jeffery Henry

PACS up and running in Haiti!

2010-02-19T08:17:00.000-08:00

A Guest Entry from Jeffrey Henry, Medweb Engineer in Haiti (Monday, February 15, 2010)

The Univ. of Miami Medishare hospital has been running X-rays non-stop. I was able to get a view station set-up next the X-ray station in the adult tent. A local arrived who was trained in the machine and can take the X-rays and scan in the cartridges. The traffic here at the hospital has picked up. We are full; the massive rain last night caused schools to collapse and some people came in with major issues.

I have to say, the trip thru town was atrocious; the city is non-stop rubble with a lot of people living in tents made of bed sheets. The international response is everywhere, but at the same time, seemingly minimal. Every country with the capability to do so has sent something, but nothing comes close to the US presence.

I also got some great intel on how the medical efforts are going and where the needs are most vital and how this Medweb server in particular could be used most efficiently.

When I got back to the Miami Medishare facility, one of my laptops had been liberated and hooked up to a projector in the kids' tent to show a French version of Peter Pan. You just can't get "mad" though - these poor kids just tug at your heart and if a little bit of relief in a movie that tells them it's ok to not have to grow up overnight - then that's a part of why we are here, too. There is still another view station in this room. I will leave my tough book here with a user account for Medweb viewing and I will give the password to the docs who need it.

Tonight my to-do list is to send 37 studies from X-ray to PACS so they can compare priors and secure view station, setup near X-ray machine so the doctors can read NEAR the X-ray machine for faster reads.

As I was writing, I was interrupted by a doc who needed to read. Patient had a femur fracture that they patched up and put a cast on and were ready to discharge. They were very happy.

Our Hearts Go Out to Haiti: Medweb Team & Technology in Port-a-Prince

2010-02-16T23:48:00.000-08:00

The stories and images tug at our hearts. Today, news reports called the Haitian earthquake of January 2010 the worst natural disaster in world history - per capita, it has killed more people than the tragic Indonesian Tsumani of five years ago - which laid claim to the not-so-desirable title previously. As the media presence begins to wane, the need will go on for decades. For one of the world's poorest countries, recovery will be long and slow, but maybe, just maybe with enough help from the outside, we can help the people of Haiti to rebuild better, stronger and more resilient communities.

Jeff Henry, one of our engineers, is currently returning from a one week initial deployment and assessment in Haiti. While there he was touched, moved and saddened by all that he saw. His words are vivid, and as such, I invited him to do a guest blog. Here are his words regarding the Medweb PACS supporting University of Miami's/Medishare 240-bed Expeditionary Medical Facility (EMF) at the Port-a-Prince airport.

SATURDAY, FEB 13

Last night I got in and it was chaos. The airport here isn’t really functional; luckily the US military was there with hummers and big guns to keep people in line, literally. :-)

I was able to unload the servers from the plane myself. I asked, "Is there a conveyor belt at the airport?" The military guy laughed at me and told me that I was the conveyor belt. I was so pleased when I got the servers to my sleeping quarters, opened them up and found them to be fully intact.

As soon as I got here they needed an OB and delivered 2 babies last night. There are about 150 patients here with a support staff of about 50.

I went to all the [hospital compound] tents and saw their c-arm, X-ray machine and ultrasound. I am so glad that they all have Ethernet ports. The CT at Heart Check America sent fiber. I need to get both modalities networked, then get them sending to the Medweb. We have spools of cat6 to facilitate this.

If you wanted to send these people something useful, send boxes of carnation instant breakfast, you couldn’t send enough. A couple thousand packets should do.

We could use tablet computers to help doctors do their charts. A decent high speed scanner would be awesome for scanning in charts. We need a badge maker, we need to track patients, if we could get the barcode arm band things that would be a miracle.

Need more blankets, need more tents, need more sleeping mats and sleeping bags.
We could really, really use more mosquito nets. People are actually getting malaria around me, I am so glad I am on the malaria prevention pill.

Something that would be incredibly useful for the supply room and OR are NSF shelves, the big metal shelves you can buy at Costco for around 70 dollars.

We need a scale, a rectal thermometer, infinite fans, otoscope speculums, LFT (liver function test), troponin, B-natriuretic peptide. We need a DENGE test.

I got to sleep last night really late, I walked the grounds with Dave, head of logistics and a pastor handing out blankets and just helping anyone who looked like they needed it -- a family member of a patient sleeping on a bench outside a medical tent. We went and got blankets and water and tucked them in.

I met with Sam, head of IT here. He is 150% awesome. This guy lives excellence. We ran around looking for the best place to put the Medweb server. We chose the main ops tent, which is air conditioned and has good network infrastructure. We ran cat6 cable around the tent to their switch and put the Medweb out of the way on the floor. I installed it and setup a UPS for the Medweb and them to use.

I booted up the Medweb servers and logged in and checked the raids and everything is fine. So the Medweb is up, on their LAN.

I walked around with Sam and his coworker Eric who helped me run cat cable to the Medweb, analyzing their modalities and discussing how we are going to get them networked. Currently they are not networked.

They have an X-ray machine in the pediatric tent, it clearly has an Ethernet port and a super easy interface, I am confident it will be sending to the Medweb server in a couple of hours.

I got to walk into the OR while they were operating. I focused on the C-arm, they have two; one is turned on and plugged in. It has a dual monitor viewing station built on. I saw no Ethernet port, no way to network it. It did have a support contact number and serial number and all that good stuff, so I am merely going to call support, explain the situation and then hope they can assist me in getting this machine networked.

Then I walked over to their ultrasound, it looks like an awesome ultrasound, it has multiple different kinds of US devices, ones for gastro, ones for abdomen, ones I don’t even recognize. I also could not find a network port on that device, bit it also had the support number for the ultrasound and I will call them and ask them how to network it.

We are about to network the X-ray machine, it should be easy it is the closest machine to the Medweb server. It is in another tent, we may put another switch in there.

The c-arm and Ultrasound are on the other side of camp. They will be the biggest challenge. In my opinion, those devices are not as important to get hooked up with the Medweb because they are for more immediate need. I.E. they are literally in the O.R. they are used in a quick fashion like, for instance, if a patient is on the table, and they need a quick scan, they wheel over the C-arm and look inside the patient and then instantly make a diagnosis, rather than the X-ray which will have the studies sent.

I just got approached by a doctor asking to help make the X-ray machine itself work. I ran over there, having never inserted a cartridge before, I copied the support info, and then rebooted the WinXP side of the machine, no dice.

I called support. He told me to reboot the scanner part of the machine and that I needed a physical key to switch it, I ran and got the key and used it to reset the scanner device. It took forever to warm up and then it began working seamlessly.

There was literally a little girl on a table just waiting to be scanned. It’s hard to describe the feeling I got when everyone was relieved that the machine was scanning plates again and they could continue. That moment alone made this whole trip worth it for me. At the doctors’ request I called back the support guy and requested documentation, he emailed it to me and I am getting it printed out now. He also gave me verbal directions on configuring the X-ray to send to the Medweb. X-ray is up and sending, everything that gets accepted by the X-ray machine automatically sends to the Medweb server, the Medweb totally received it and it all works great. We are pumped! Everyone is shaking my hand. So awesome.

In the meantime I fixed a regular old printer for a nurse here. No big deal. They are keeping me busy and I love it. It’s great seeing people work together. The volunteers here just instantly work together on any problem until it’s fixed.

We need viewing stations. Send us the cheapest dell laptops with the widest screens. So, weak processors, minimal hard disk space and wide screens would be 100% awesome.

-- Jeffery Henry, Medweb

Life you just can’t make up…

2009-11-14T10:17:00.000-08:00

In addition to meetings and surveys and project analysis and set-up, we’ve also had quite a few adventures in the past 24 hours. Politics have stalled the bridge building process across the Kabul River to the Kuchi village that Sister City/Rotary/Mindtel have been assisting for the past few years, and so makeshift rafts (inner tubes with rope and some wood) are still the way to get across. The plan was to donate some rubber rafts to replace these and then head over for a visit. Reality, on the other hand… presented quite a different experience…

First, we got hung up on a rock in our SUV in the middle of the river. After 10 minutes of attempting to get the car off the rock, and realizing it wasn’t going to happen anytime soon, Dave decided to inflate the raft – on the roof of the car through the sunroof using the foot pump with his hands. Part of the crowd gathered on the near shore of the river came out to assist and try to push us off again – no luck so we got into the raft. (I have to say chivalry is not dead as Meggin and I were the first in, and we were oh-so-carefully handed into the raft – actually quite charming and we were grateful as the water temperature is near freezing.) With Dave and I paddling and Meggin carefully photo documenting we pushed ourselves off and over the rocks and through the rapids – trying to maintain some semblance of control and not tip over. I can only imagine what the picture of this looked like to the villagers! Thankfully, they are friends, and were just excited to have us make it over rather than laughing at us – although I REALLY need to learn Pashto because there was quite a lot of smiling and pointing as we climbed out of the raft – particularly by the boys. (They did, however, immediately jump into the raft (way more than it should really hold) and started paddling around. Albeit, one boy asked Dave – why’d you bring us this cheap thing? We need a wood bottom one. LOL. Point taken and sorry was the best luggage would allow!)

Due to the elapsed time and the pure spectacle we created, there was now quite a crowd gathered to welcome us. The kids know one word in English – “Picture”. With multiple cameras and willing “shooters” – they were in absolute heaven. They’ve become quite the little posers, I must say. Finally we had to begin the hike up to the village, and we did so to the chant of “Picture, Picture” the entire way. The kids are endearing and the parade up the hill with all their brightly colored clothes and beautiful, dirty faces was full of laughter.

Upon arrival at the village there were more pictures (naturally), and then Dave went to go talk to the elders about the situation with the wells. Meggin and I were surrounded as the women came out to talk to us (again, gotta learn Pashto…) and we were invited into one of the huts. While we sat on their carpet, we were surrounded by more than 30 women in children in a semi-circle around us (in a not large space I might add) they asked for our socks. After handing them over, however, a fight broke out among some of the children over the INDIVIDUAL socks, so the eldest woman gestured for us to take them back. So, now we are of course on a sock mission – among other things… For starters, the village has never seen a doctor or dentist. There seems to be some sort of spreading fungus on the kids and lice were literally jumping off their heads.

As we rejoined Dave and the men, and were invited in for chai, we learned that due to flooding they had lost their access to fresh water several months ago. As I drank my second cup of tea, not wanting to be rude as they generously gave us the only gift they had to offer – sugar, I was gently reminded by others in our party that the water we were drinking was the contaminated, barely filtered river water. I needed a stronger immune system anyway… As for them, it is just unacceptable and a complete travesty that they don’t have access to clean water. We found out that it is $500 to put in a new bore hole and give them access. Needless to say this WILL happen in the next couple of days.

This morning, our adventures continued as we made our way to the Public Health Hospital to add a more reliable relay for the sat comms hosted at the Taj and providing access to the hospital. Ryan is of course our comms/sat/tech guru (who is my hero as well after fixing my computer twice in as many days), but no way us non-techies (e.g. Meggin and I) were going to be left behind as we climbed to the top of the water tower. After admiring the FabFi antennas (Google it) at the top that have been providing the link to date, we stopped to look out at the view from this incredible vantage point – snow capped mountains surrounding the valley, bustling activity on the streets below… Tomorrow morning Pete and Ryan will return to complete the last step to get the antenna up and running. For now, as I sit at the Taj writing this, I am just thankful beyond words to be back here, for our friends new and old, for all we have accomplished, and simply for the day.

"Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it is the only thing that ever has." ~ Margaret Mead

2009-11-14T10:09:00.000-08:00

We arrived in Jalalabad three days ago and have managed to visit the three primary hospitals we had on our agenda. The Teaching Hospital (see entry below with the IV bags hanging from trees, etc.) was our first stop. I’m sad to say that not much (if anything) has changed in 6 months. The smells are still rancid and basic supplies (clean water, soap) are in short supply. As promised many months ago we had planned to fix their “broken” anesthesia machine. Turns out, that the machine had never been taken off the pallet (bolts rusted on) and by simply plugging it in – it worked. However, no one is trained to use it, so instead it sits there while they use a bag-valve mask (BVM) to administer anesthesia – which we might add is not constant and patients frequently wake up in the middle of surgery. In so many ways everything comes back to training and dedicated PEOPLE to make it happen – the technology and equipment pieces are the easy pieces. The human factor is the imperative as Dr. Dave Warner likes to say.

It’s so true. We have the potential resources and ability to install a large telemedicine network here, but there are basic training elements that are lacking and must be met first. So we draw up plans, revise them, and revise them again and again – trying to find a solution that can be sustainable in the long term even if we are not involved. Initially we’ll focus on training because there is such a vital need by establishing a Telemedicine and Medical Distance Education Center. We have a site, excitement about the idea, and it looks like the funding to make it happen within the next 6 months.

At the Jalalabad Public Hospital today, too, we saw a “friend” (no names) from our last trip here who recently was almost prey to a suicide bomber attack. We see a slight resignation in him now versus the near boundless energy from before the attack, the elections and political wrangling and change of the past several months, yet there still remains hope and a light in his eyes and a determined resolve to help his people.

All the kids tug at our hearts everyday as we see them in the halls of the hospitals and the banks of the river, but there was something equally powerful and moving sitting across the conference table today looking at this powerful man oh so humbly and graciously—with no pretension—express his appreciation for the fact that we came back, ask us to not leave and help him to help his people. We are humbled to be around such incredible people who do so much for little more than love. It is a lesson also in resilience – quitting is not on option…

Afghanistan Return - Fall 2009

2009-11-13T11:45:00.000-08:00

Compared with our last trip here to Afghanistan in March, which can only be described as a whirlwind, this trip, which began on November 6, has been at a totally different pace—Slower and quieter, but still powerful. A lot has changed in six months, and certainly the media has done a “great” job of sensationalizing some of the security and political issues, but there is still an amazing hope and energy that is palpable, and I would be sadly remiss if I didn’t mention it and try to convince others to feel it and care about it, too.

We spent several days in Kabul on this trip due to travel issues, but everything happens for a reason and I’m so happy we did. Having not spent much time in Kabul previously, it was a whole new adventure – from the tranquil serenity of our guest house to the bustling and crazy traffic that rivals anything LA or New York can throw at it – just add some donkey carts, bicycles and lanes that aren’t really lanes so much as “guidelines” – to the French restaurant tucked away off dirt side streets with good friends. At one point, we set out to pick up our air tickets from the UN travel office thinking it would be 45 minutes max roundtrip and over 3 hours later we had success. Little bit of lost driver time in there, too, but the upside was that we (Meggin & I) got to see parts of Kabul we’d never seen before. Also, got to ride in the back of the car (trunk really), as in true Afghan style, we crammed 8 people into a car meant for 5. All part of the adventure.

That’s kind of been the flow of this whole trip – start with a plan, have it change, redirect, etc. and go with it – which is often far better than the original plan. We were able to meet again with Afshar Hospital, which is now open and functioning – great to see the changes and the use of the facility. Our meeting was delayed by a couple of days as they prepared for and then conducted their first outreach clinic on the outskirts of town along the Jalalabad-Kabul road. They saw over 200 patients (men, women, children) in the space of 4 hours – impressive to say the least. We brought along a 3.5 MHz portable USB ultrasound, which we donated and they will use for their upcoming clinic this weekend and in the weeks that follow. While we were there, their IT Tech was able to load it onto one of their laptops (after first conducting a virus check of our ultrasound AND the laptop!), so it is ready to go and they were excited to use it. There is just such a great feeling about being able to give something that you KNOW will be put to good use and immediately.

Our next stop was the privately funded and run Acomet Hospital – associated with Kabul Medical University. Another great facility – and completely dedicated to a qualitative standard of care. They offer no patronage, rather services are provided on a first come-first serve (or urgent need) basis – period. The two brothers that run it are incredible. We’ve now had the good fortune to meet both, and their dedication (which includes living at the hospital), energy, and commitment to forward progress and quality are truly inspiring. As but one small example, in a couple of weeks the 64-slice CT (impressive technology) they ordered will arrive at the hospital. We were able to donate a Medweb server and get it up and running for their Radiology Department. After our return from Jalalabad, we’ll head back to the hospital and Meggin and Ryan will provide some additional training and ensure they know where to go for support.

As I sit here in the sun in Jalalabad reflecting back on the week, I just can’t help but smile. It’s REALLY good to be back here in Afghanistan.
Up next… Our Jalalabad adventures… including today’s planned excursion in a couple of hours which involves rafting across the Kabul River to visit the Kuchi village…

Pens for Peace

2009-04-10T21:08:00.000-07:00

Been awhile since I’ve been able to write an update, but now back in the U.S. – despite the strong desire to stay in Afghanistan longer. Looking forward to the return trips! I’m going to commit the next few weeks… maybe longer, because it will really take that long to document some of the great efforts and projects we saw in our short time in Afghanistan. We were only on the ground for 8 whirlwind days, but it’s incredible how many amazing people we met dedicated to making a positive difference in Afghanistan and beyond – and how exportable some of these ideas and projects are to other areas.

First up, I have to begin to tell the story of the Pens for Peace effort. We randomly got involved after some of the logistics got a little challenging… not that we’re a logistics company (at all), but you get a reputation for tenacity and getting it done, and add that “philanthropy” piece – and sometimes it catches up to you. So how did the program start? It started when Chris Corsten (at the time, a Captain in the US Army) first came through the streets of Nangarhar Province in 2005. Kids would line the streets and use a form of sign language to “sign” that they wanted the troops to give them pens and paper – they’d realized that the incoming forces had these “precious commodities” and a heart for the kids (who seriously couldn’t?). Chris happened to mention this to his mom back in his small hometown in Wisconsin. Before he knew it, his mom was shipping boxes of pens for Chris and other members of the military to distribute that she’d managed to pull together with her friends and others she engaged.

That continued for some time, and then a call from Chris to Bill McCready in Reno, NV following Chris’ participation in one of Bill’s online investment trainings took the “program” to the next level. One thing led to another in the conversation, and it turned out that Bill was also a veteran of the U.S. military, having done several tours in Vietnam. Bill, enroute to a Rotary meeting, mentioned “well if there is anything I/we can do…” (aha! Famous words – right?!) – And in that moment, Pens for Peace was born as Bill and the Reno Rotary Club kept a steady supply of pens flowing to Chris in Afghanistan.

Chris soon became known to the local children as “Captain Kalam”… meaning “Captain Pen” in Pashto, and as he would walk into his office or to the villages he would visit, they would hold out their hands and call out to him. Having witnessed the “entourage” that one can get as you walk through villages, I can only imagine the following he had and how each cry of Captain Kalam must’ve brought a smile to his face, as well as tugged at the heart strings.

About 9 months ago the program got a boost by the donation of two massive PALLETS of pens (equates to about 100,000 pens) in Reno, NV. As you can imagine, the financial costs and international shipping logistics of getting these into Afghanistan - and to Nangarhar in particular - were major challenges… not to mention the fact that it is generally always preferable to “buy in country” (or in affected areas) – money helps stimulate the local economy which can help spur additional development. After numerous dead-ends, the challenge was thrown out to us during a late night email exchange with Dave Warner, MD PhD (Mindtel, LLC) that went something like “Kim meet Chris, Ken and Bill… they have pens for kids… trouble getting them here… need in time for spring surge… do what you can… synergize at will.” This was of course following these news stories… As you can see, we had no choice:

ABC News Newsbroadcast (Video): http://www.youtube.com/watch?v=nGdk9JwZWzY;
ABC News Story (Text/Photos): http://abcnews.go.com/WN/popup?id=6639064

So we synergized : ) And after a few more dead ends, and visits to the High Sierra Industries Warehouse in Reno where the pens were (great organization as well that employees adults with disabilities… google it), and thanks to a donation from the Woodard Family Foundation in Eugene, OR (you really gotta love the Gamma Phi sorority connections and lifelong friends always willing to support your latest adventures and undertakings)… the pens are making their way into Afghanistan in a steady stream of 5 large APO (Army Post Office) boxes every few days (we figure they'll all be there by early May - there's 675 boxes total). I also managed to fit about 1,500+ pens into a bag as part of my checked luggage; of which we dropped ~700 of them at the La Jolla School for the girls there. The rest of that bag will likely end up in the hands of the kids at the villages by the Kabul River. All told, the pens averaged out to a very reasonable $.02/pen and are high quality that the kids love – which is the core mission. Photos to come soon.

One person, seeing a need, engaging others and making a positive impact. To some, pens may seem a small thing and something we take for granted, but sometimes it’s the smallest gestures that can make the biggest difference.

"Progress"

2009-04-03T08:07:00.000-07:00

Today we went to the Teaching Hospital associated with Nangarhar University – operated by the Ministry of Education (versus the Ministry of Health, as is the Public Hospital). Words cannot express the great tragedy of this place… this is not a rural hospital or clinic located in an unsecured area, where maybe you could understand and offer SOME explanation of the condition (of the TEACHING hospital no less); but instead it is located in the middle of Jalalabad, so there are no excuses in my humble opinion. We’ve seen some bad places in our travels, and this is by far one of the saddest stories. There were points at which I would have been hard pressed to speak, and Pete pushed us to get out of a few rooms a little more quickly for the same reason.

The 240-bed hospital sees more than 400-500 outpatients per day and handles 50-60 new admissions each day. I’m not sure if that includes the people sitting outside the hospital with IV bags hung from trees?

Each wing has a name plate that denotes the NGO or governmental agency (from all over the world) that have donated, and then later left the hospital, and its director, to try to continue to keep it funded and running… which is difficult to put it mildly and explains in a lot of ways the lack of affect we saw in his face – good people all over trying to make a difference and beaten down by a system that has failed them. The doctors and staff were recently (again) not paid for months and only just started to see some of their salary and pay come through… hence the tendency for all the private clinics.

There is no money for even cleaning supplies. As we walked into the pediatric ward, there was a pool of blood on the floor of the waiting room swarming with flies. 30 minutes later as we walked out someone was using a squeegee and bucket, of what we’ll at least hope was clean water, to wash it into the drain located in the middle of the ward entrance hallway, where a burqa-clad woman holding onto the hand of her barefoot toddler happened to be walking through at the same time.

I have to wonder (among so many other things) what message and “teaching” is really being done here – or can be done here at this time? We’ve certainly seen the possibilities elsewhere, and how a little can go a long way. Now it’s time to cut through the bureaucracy and make it happen. Lives are at stake in more ways than one.

Unbeknownst to us prior to our tour, this was the same hospital that was visited in 2006 by Dr. Dave Warner… I had seen the pictures and saw the piece aired on CBS News… you tell me, which pictures are from today and which are from 2006…. http://projects.mindtel.com/2006/0506.jbad-06/nu-hospital/

Like I said earlier, the children get me every time.

April 2, 2009

2009-04-03T07:40:00.000-07:00

So we’ve officially been on the road for a short 7 days now, yet it feels both as if a lifetime has gone by and also that it has flashed by in second, too – a mad whirlwind of meetings/site visits, chai (tea), equipment testing, new friends and new experiences. Today we visited the PRT (Provincial Reconstruction Team) to continue connecting all the dots. As we walked in, Sabaghul (age 3) and her father were talking with a local very talented doctor/cultural specialist Dr. X (not putting names in writing) and Capt. Millis, in charge of medical for the U.S. Army at the PRT. What a story this was, and I know we only got half of it… turns out that as Capt. Millis rotated in, he was asked to find this little 3 year-old girl with a heart defect (transposition of great vessels) that the previous rotation had encountered, but lost track of due to the movement of the family.

Well, they found her and were able to link her with the Gift of Life program out of New York, which is paying for her to have another surgery in the coming weeks in Peshawar. Not the original surgery as planned given that she is exceptionally small for her age (she looks to be the size of a 1-year old), but should grant her more time to get stronger. Post-surgical care will be done by the PRT-U.S. Army medical team. Yet another perfect example of how telemedicine can be used effectively to improve overall care and reduce complications, given that everyone would have the same records and information; however, this case will likely just need to stand as an example of the need and potential value, versus an actual case due to some of the political considerations.

After Sabaghul and her father left, we were able to get some additional ground truth on the healthcare system here, and it still keeps coming back to the same things no matter who we hear it from – the great need for additional training and education to build the local capability and capacity – especially in the rural areas where power is available for 1-2 hours/day. The tendency for “drop and run” as I’m going to call it, and no lasting support, REAL education and plan for sustainability on all the “donations of X,Y,Z”, is just staggering.

After that, it was back to the Fab Lab/Taj for Pete to set up the fixed satellite, which finally made it here from Kabul. Happy to report it is now installed, and getting great bandwidth that we can use to dedicate for medical comms. While he did that, I tagged along with Steve and Fary to the La Jolla School (named because of the Sister-City Sponsorship through Rotary) just on the outskirts of city proper. I’ve heard about the school for over 7 years and was excited to finally see it. Nearly 5,000 students grace the steps in 2 shifts – older boys in the morning; girls and younger boys in the afternoon. It does need some repairs following the October 2008 earthquake in Pakistan, which Steve and Fary carefully documented for action. We got to look in on some of the classes, and after a while again, the kids warmed up to us and expected us to go to each classroom. The vast majority of older girls still hurriedly pull their headscarves around themselves to shield themselves from the men as they enter the room. A smile and wave from Fary and I and they do seem to relax a bit – but only just. When it was just Fary and I in the computer lab with the girls, however, they were remarkably freer (but still reserved). Standing back and observing, I did notice that as Fary walked around to each workstation to see the work they were doing, and offered high praise, the next girls down the line, strove to do the same thing and elicit the same praise.

Jalalabad Adventures Continued... Ultrasound Training & Visit to the Kabul River

2009-04-01T11:42:00.000-07:00

So much for the “established program”!… day instead of great spontaneity, starting with an early call to Pete from Dr. Pardes, the Public Health Director for Nangarhar Province, asking that he come back to the Public Hospital by 10AM to demo the 3.5MhZ portable USB ultrasound that we brought along to a group of 20-30 doctors/staff. While there, they actually used the ultrasound to do a demo exam on a child who had been admitted for abdominal pain. Perhaps the greatest take-away though is the hunger and thirst for knowledge and training. That’s the lesson we’ve certainly learned in the past and want to repeat here in Afghanistan… LOCAL sustainability matters, and that boils down in so many ways to training and education.

Following the demo, a crew from the Taj/Fab Lab/Rotary/Synergy Strike Force “surged” to the local Kuchi village down by the Kabul River, where the building of a bridge across the river is in the works… project led and guided by the Jalalabad-San Diego Sister City program out of the La Jolla Golden Triangle Rotary Club (google it). It may be an engineering feat, but it’s a bridge of another sort too…

While the “adults” discussed the bridge and the opportunities/issues, the “kids” got to play… and play we did. Having had this project, among others in the area, in the works for a number of years, the kids are real camera hams – once they warm up. No girls down by the river, but a crowd of boys. It took a bit for them to warm up to Adriana (George Mason U. grad student in Stability Ops) and I, but once they did… wow. We were surrounded with requests for pictures with us, without us, and always, always… to show them the pictures. So much fun and we were laughing a lot. One little boy very much wanted me to take his picture with the notepad I was carrying… and he was adamant that the picture be just him (no small feat because the camera draws an instant crowd of posers). Again… a hunger and thirst for knowledge that we would do well to feed. Maybe medical school and career in telemedicine is in his future?

For a 30 second video from the Kabul River go to: http://www.youtube.com/watch?v=yDxBAlXSKGA

Free Rangin...

2009-03-31T09:53:00.000-07:00

Today was truly our first “Free Range” opportunity and what a day it was! We went to a brand new CHC (Comprehensive Healthcare Clinic) in the Kama District (VERY impressive 40 bed hospital built for $200,000 – WITH equipment), and a BHC (Basic Healthcare Clinic – no beds, almost “urgent care” like). Hard to describe in words both what we saw, heard, smelled – and the possibilities to truly make a difference. Could have done without riding in the UN ambulance (low profile unmarked Toyotas are really good), but all was safe and good and it did handle the crazy dirt roads to the BHC pretty effortlessly.

Then it was off to the market with Mahrab – total pro at negotiating the colorful busy streets packed with artisan crafts, shoes, food, men, women (most burqa clad), and children – you name it… pretty much there, as we shopped and made arrangements to have new shalwar kamiz’s made. It was so much fun… and almost exactly how I’d imagined it – only better and brighter.

We’re also starting to slowly, but surely (as much as you can in a few days at least), piece together the healthcare “puzzle” here. One of our key theories established prior to our trip was that it would be far better to link Jalalabad with Islamabad/Pindi in Pakistan than to Kabul (both are primarily Pashtun, whereas Kabul is predominantly Dari; many Afghans also seek care in Islamabad; and of course the relationships we established there over the past year as a result of our comms/telemed work there). Theory = PROVED – based on all our meetings and conversations over the past few days.

Over the next couple of days we’ll seek to make the introductions between our new Afghan friends and Dr. Zafar, Dr. Sadia and the rest of the team in Pakistan. Also hoping that we can help to orchestrate reciprocal trips between Jalalabad-Rawalpindi so that a) an operational highly successful telemedicine program can be witnessed by the teams of doctors here, and b) that leveraging the true expertise of Dr. Zafar and Dr. Sadia, a successful regional model can be established. I have a feeling that if all of these incredible people are able to meet, that magic will happen – especially if we can keep the bureaucrats out of it.

Up next… figuring out the best location for the telemed equipment… as of COB today, we are thinking the Fab Lab may be best location until we can arrange a return trip and do a little more training and support. There’s a whole lotta equipment (eagerly accepted) just sitting in boxes, in the basement, etc. of the hospitals here because the support and training infrastructure was not there before well-meaning (blank space - insert name) NGO, government agency, etc. left it. We don’t like repeating the mistakes of others (or our own for that matter)! We also just can’t pack it up now though… as we catalogued everything today on the pool table, we generated more than a little bit of excitement. Beginning to look like that in addition to a spontaneous school, that the Fab Lab may become the next clinic in JBad.

Tomorrow it’s back to the more “established” program, but really hoping not too established, because today was a really great day.

Kabul Happenings - Day 1

2009-03-29T06:23:00.000-07:00

A lot can really happen in 24 hours…so far in addition to surviving Kabul traffic (no small feat in of itself) due to local expertise and TRUE driving skill (us Southern Californians can learn a thing or two here!) … we narrowly missed children, bicycles, goats, sheep, and numerous other obstacles on our way around town, we’ve attended meetings and tours of hospitals and a local Rotary meeting...and have successfully made it to our home away from home for the next week in Jalalabad – and ALL our gear made it. But first about Kabul… what an experience in so many ways (broken down cab story upon request). While picking up some satellite gear purchased from Kabul Net, I was left in the car while Ishaq and Pete went to pay, and was immediately surrounded by children. They say they are professional beggars, so I shouldn’t cave and give, but professional or not I can only take so much of “Please Madam, Please Madam, Please” while I type on a blackberry worth more than most of these kids will see in a year. There’s the one precious little boy who kept throwing the Kleenex he was selling through the open window, the one who tapped on the window for a solid 5 minutes then started imitating a chicken and I just couldn’t help laughing, and the two little girls who chased after our car… I guess I’m just going to add that to the budget. Pete’s actually not much better, although his breaking point is the mothers holding their babies in the middle of the road.

Back to the purpose of our trip … get some “ground truth” on the healthcare “system” in Afghanistan and look for opportunities where telemedicine capabilities can be applied and leveraged. After visits to the soon-to-open privately funded Afshar Hospital and Acomet Hospital (affiliated with Kabul University) … the possibilities are endless – they are committed to healthcare, technology, education and building local capability and capacity, and have movers and shakers at the helm to put it mildly. Lot of synergy here and information to report.
Tomorrow, we’re off to meetings in Jalalabad… although on no particular schedule, because that’s the way it works.

One last quick bit… we were most honored on Saturday night to attend the Kabul Rotary Club meeting, where Dost Mohammad won the prestigious Rotary International Paul Harris Award for his dedicated leadership. More on Rotary and the work they’ve been doing here later (we owe all the smooth trip and connections to them for a start). If you’re interested in joining or providing support to the Kabul Rotary Club, contact Dost at domohammad@mtn.com.af.

Pictures: Picking up the sat dish; @ Acomet Hospital with Kathleen Rafiq and Dr. Goforth; @ Afshar Hospital with Dr. Goforth, Dr. Tim Fader and Dr. Nayeem.

What is Telemedicine & Next Up on the "Tour"?

2009-03-26T00:59:00.000-07:00

Telemedicine is broadly defined as the use of technology to support the delivery of medical care over geographic distance. The increasing availability of Internet connectivity and portable, low-cost laptops and medical devices make it possible for the developing world to benefit significantly from telemedicine, where it has the potential to increase access to healthcare in rural and remote areas; provide care to mobile or evacuated populations; and increase the efficiency of physicians in urban areas.

In the most common practice model, physicians (or other healthcare providers) carry a compact tele-clinic with them. When they encounter a patient who would benefit from a consultation with remotely located senior or specialist physicians, the tele-clinic equipment is used to collect and transmit relevant clinical information. The foundation of the tele-clinic is a laptop computer; medical devices that may be included in a tele-clinic include EKG, respirometers, and digital cameras equipped for a variety of uses, including ENT and dermatology photographs. Data collected from these devices is automatically included in a referral request, while clear, Web-based interfaces guide physicians in the collection and reporting of other clinical information, such as history and symptoms.

Next stop: Exploring Telemedicine Possibilities in Afghanistan... Estimated date of Arrival - March 28, 2009 (Kabul), March 29 (Jalalabad)...