Friday, February 19, 2010

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.

Tuesday, February 16, 2010

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

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

Saturday, November 14, 2009

Life you just can’t make up…

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

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…

Friday, November 13, 2009

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…

Friday, April 10, 2009

Pens for Peace

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.