Our NPHI Medical Team and the home’s clinics are very grateful for the support of health brigades and senior experts. Their invaluable services assist not only our children, but support the staff, and the surrounding communities. 2013 has been a great year, with several key medical teams. Many teams return yearly and travel during their vacation to provide services for the less fortunate.

The purpose of medical / dental brigades within the NPH homes is to provide services to the children, staff and patients from the community, while respecting the NPHI Healthcare Policy. Medical and dental brigades should aim to provide services that build on and add value to the services that the NPH clinics provide. The goal is to work together with the local doctor, dentist or ophthalmologist in such a way that follow up care may be provided by the local health staff after the visit has ended.

Preferred activities and services provided by brigades:

• Dental check ups
• Eyes and vision check ups
• ENT screening
• Well child exams
• Local staff training
• First aid and CPR training
• Specialists in Infectology, Neurology, Orthopedics etc.

Appointments with selected children will be coordinated by the local doctor and healthcare coordinator.

Medical students are welcome and encouraged to participate in brigades, especially those with knowledge in public health, epidemiology, pharmacology, tropical medicine, etc. However, students may only work under supervision of the leader of the group or local doctor. They are not allowed to do anything independently that they would not be allowed to do in their own countries.

Each country has its own legislation and requirements to practice medicine. Medical teams should be aware and respectful of the country’s culture and norms. Tolerance, respect, open and receptive to understanding and appreciating different cultures.

Also it is mandatory to fill out an application at least two months prior the traveling.

To view the application, visit http://www.nph.org

To view a brigade story in Spanish visit: http://www.quiron.es/es/fundacion_quiron_ayuda_quiron_prensa

Contributed by Pilar Silverman, MD
NPHI Medical Director

Every December first, the world health community raises awareness on HIV/AIDS.

When I met Brenda for the first time back in 2006, she was 15-years-old. She was a teenage girl and like all the other girls in the home, mostly laughing and joking with her friends. You would not have realized that she had a severe kidney disease.

Two years later her health state worsened and she had to start with peritoneal dialysis. Due to several peritoneal infections, she had to change to hemodialysis some months later. These were hard times for Brenda. She had to be operated on several times because her catheter would not work. You can imagine that it is not easy for an 18-year-old girl to have a catheter at the jugular vein, where everyone can see she is in some kind of medical treatment. The hemodialysis did not only cause her psychological problems but also several infections. However, Brenda was strong and borne all these difficult situations. She did not give up and went on fighting, although she was aware of the fact that due to legal issues, she would not have the possibility to get a kidney transplant in Nicaragua.

After having searched in several countries abroad, the NPH International Medical Team managed to enroll Brenda into a donor program in the Dominican Republic. There it was: the chance for her to receive a new kidney and to release her from dialysis! Brenda packed her bags, left her Nicaraguan friends and family behind and moved to the NPH home in the Dominican Republic. She left and was full of hope – although she was aware that this chance could also fail.

Brenda survived several life-threatening infections in the Dominican Republic, but after one and a half years she received her new kidney! The smile on her face in the days after her transplant is hard to describe – she was shining.

Having received her kidney meant also having to say goodbye to the NPH family in the Dominican Republic that has accompanied her during these months. This goodbye was sad, but she loved her home country of Nicaragua and was happy to be back – alive and with a new kidney, not dependent on a dialysis machine anymore.

Mid-September of this year, her kidney was rejected by her body and we lost Brenda on October 12th. For everyone who has known and loved her and who has accompanied her during the past years, it was very hard to let her go. Many people had fought with her and had given their best to make her win this fight for her life.

In these situations we are aware again, that despite the fact we all give our best, the result of our work is not in our hands. However, in the end it is not the result of our work that makes it valuable, but the amount of love and devotion we put in it each day and each minute. I believe this love stays with the people we work for – also beyond death.

Contributed by Nina Ehrle

Senior Pharmacist Advisor, NPHI Medical Services

Dr. Pilar Silverman, second from left, with colleagues.

NPHI Director of Medical Services, Dr. Pilar Silverman, along with the local NPH Honduras health coordinator and local doctor, meet with the directors of the Honduras Pediatric HIV Clinic, which operates out of Hospital Esceula, in Tegucigalpa. Currently, the clinic has more than 200 children in the program, 24 of them from NPH Honduras. During the meeting, challenging cases were reviewed and a common strategy was developed to improve integral care for our pequeños.

The clinic gave us the news that our NPH children can now receive extended care at this clinic until the age of twenty-four. One of the challenges the clinic encountered was that when youths aged out of the program, many abandoned their treatment. Thus to improve and keep the adherence to medication (vital to keep patients out of health complications and get into AIDS status) they will keep youths under their care for longer, ensuring the patient understands the scope of the disease. The hospital also offers a support group. At NPH, we strive to reinforce the psychological support to enable children to understand the disease and to care for themselves, prevent stigma, or how to deal with it, and work with on their self-esteem.

NPH has been able to include several of the clinic’s patients, who needed second and third line of therapy, in the Aid for Aids program, a US based non-profits that help thousands of people living with HIV/AIDS around the world. Aid for Aids not only provides lifesaving antiretroviral drugs, but they have a group of dedicated professionals advising all of us in Honduras on challenging cases. Furthermore, NPH is the one who transports and distributes the medicines that Aid for Aids donates on a regular basis.

Honduras, along with Guatemala, according to UNAID, has more incidence of HIV/AIDS in Central America 0.7% (before 1.2%). If we compare with the Caribbean, the Dominican Republic has 0.5% and in Haiti 2.1%.

Overall the directors of the pediatric HIV team do a fantastic job in caring for their patients, not always with optimum conditions and resources. Despite the many challenges, the work that NPH has and is doing, is outstanding, taking into consideration that less than 20 years ago, children with HIV from birth didn’t reach the age of two.

Laura before and after.

Laura* was 11-years old when she and her two brothers arrived at NPH Guatemala in 2011. It was obvious that Laura had vision problems in her right eye due to mistreatment in her previous living environment. After treatment to try and save the eye, and consultation with an ophthalmologist, Laura’s eye was removed and a prosthetic eye was implanted. Now, two months after the surgery, we can see that it has been a great success for Laura physically as well as psychologically. Laura not only looks great with a big smile but you can see in her face that her self-esteem has improved. NPH goes to great lengths that all children receive quality medical care.

Contributed by Marta Garate RN, Regional Medical Coordinator Guatemala and Nicaragua 

*Name changed for privacy.

The clinic at NPH Guatemala has organized intensive health education sessions for the children. In charge of theses educational sessions are volunteers Jessica and Kira, a nurse and a clinical assistant. The sessions are developed by age and presented to about 20 children per group. The methodology that is used is very participative and involved the children.

Some of the themes that were presented were personal hygiene, oral hygiene, hand washing, which is especially important within our home due to easily spreading of germs.

We work to help all the children learn healthy habits. Health  education in school and in the home can capacitate the children to make good decisions about their lives  and help to obtain good habits for the rest of their lives.

 Contributed by Marta Garate RN, RMC Guatelama & Nicaragua

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The nurses in Guatemala recently had a full ten days of practical training by an experienced nurse from Spain.

The following feedback from the nurses was very positive.

Most interesting topic covered: oxygen therapy, intoxications, medication administration.

Most practical theme: cardiopulmonary resuscitation, sutures, pressure ulcers, bandaging, and burns.

Most interesting new theme: oxygen therapy.

Topics learned: cardiopulmonary resuscitation, sutures, treatment of ulcers and bandaging.

Ability to put into practice: sutures, treatment of ulcers, hemorrhaging, burns, medication administration, hydration, immobilization, bites and stings of animals, heimlich maneuver, convulsion crisis’, isolation, norms and allergies.

More transparency, less paperwork and administrative work. These are the main objectives for the introduction of the electronic medical records in the clinics of the NPH homes. The idea of this project had already existed before and was gradually became more concrete.

During the preparation time, with the great support of Jane Collova, a reference software was found and its customization started. Jane has plentiful experience in computer programming and systems and has been working for NPH for a long time.
Fortunately the office of NPH Germany obtained a grant from “Vodafone ” (cell phone company ) sponsoring a German specialist for one year. So it was decided to hire an expert in programming and training to travel to all the NPH homes and to train the clinic staff in the use of the new software.

After the application and interview process it was decided to hire Karlheinz Staymann, who fulfilled all the requirements for the position, having experience in training people in Latin America in different software and being highly motivated to carry out this new project and to collaborate with people in the NPH homes.

In early 2013 the project was finally started. In March, the medical team, Jane Collova and Karlheinz Staymann met in Mexico to customize the EMR software to the needs of the NPH clinics. The EMR (Electronic Medical Record) is a free software that normally doctors in the U.S. use to manage their private practices.

Subsequently, a tutorial was compiled and then the test phase was started. Between May and early July Karlheinz Staymann was in Mexico to introduce the system to the local medical team. Nowadays the system is applied in Mexico and used to document daily and external consultations, inventory, patients’ weight and height, vaccines etc., and Karlheinz is still traveling, currently in Dominican Republic and then Haiti.

One of the advantages of the system is the direct monitoring in case of medical problems with patients without the need of being “on-site”. Also reports can be drawn immediately at distance. Overall we hope to improve medical documentation in order to improve the health of our children, facilitate work and reduce the medical team’s travels.

Contributed by Dr. Corinna Lawrenz, Regional Medical Coordinator NPH Mexico

Más transparencia, menos papelería y trabajo administrativo. Estos son los principales objetivos de la introducción de los expedientes electrónicos médicos en las clínicas de las casas de NPH.

La idea de este proyecto ya había existido antes y poco a poco se fué volviendo más concreta.
Al principio se requirió de un tiempo de preparación, durante el cual con el gran apoyo de Jane Collova, se encontró un programa/software de referencia y se empezó con su adaptación. Jane es informática con mucha experiencia en programación de sistemas y tiene mucho tiempo siendo parte de NPH.

Afortunadamente la oficina de NPH Alemania obtuvo una beca por parte de “Vodafone” (compañía de celulares), con la cual se financiaría a un especialista por un año. Así se decidió contratar un experto en programación y capacitaciones para que viajara a todos los países donde existen casas de NPH para capacitar en el uso del nuevo programa a todos los trabajadores de las clínicas.

Después de un proceso de aplicaciones y entrevistas se decidió a contratar a Karlheinz Staymann, quien cubrió todos los requerimientos del puesto, teniendo experiencia en capacitar a gente de Latinoamérica en diferentes programas computacionales y además una sobresaliente motivación en llevar a cabo este nuevo proyecto y colaborar con la gente en todas las casas de NPH.

A principios de este año 2013 finalmente se comenzó con la realización. En marzo, el equipo de servicios médicos, Jane Collova y Karlheinz Staymann se reunieron en México para adaptar el programa EMR según las necesidades de las clínicas de NPH. El EMR (Electronic Medical Record) es un software gratuito que normalmente los médicos en Estados Unidos utilizan para la administración de sus consultorios privados.

De esta forma, se generó un manual y posteriormente se inició con la fase de prueba. Entre mayo y principios de julio Karlheinz Staymann estuvo en México para introducir el sistema a todo el personal médico. En la actualidad en México ya se usa el sistema para documentar consultas diarias, consultas externas, inventario, peso y talla, vacunas etc. y Karlheinz sigue viajando, por lo pronto se encuentra en Republica Dominicana/ Haití.

Algunas ventajas del sistema son que se puede controlar a distancia directamente si existen problemas en cuanto a los pacientes sin tener que estar personalmente en cada casa o pedir por reportes. En general esperamos poder mejorar la documentación médica con el fin de mejorar la salud de nuestros niños, facilitar el trabajo y disminuir viajes de parte del equipo de servicios médicos.

Contributed by Dr. Corinna Lawrenz, Regional Medical Coordinator NPH Mexico