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

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...

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!

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.

Afghanistan Return - Fall 2009

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…