Hope Through Healing Hands

On the Pediatrics Ward: Learning in Sri Lanka

Thu, 26 Jan 2012 12:00:01 EST

Holly Stump
Duke University
Physicians Assistant
Galle, Sri Lanka

We arrived on the pediatrics ward this Monday, a little less naive and much less shell-shocked. I had grown accustomed to hearing only the whirring of ceiling fans, barking dogs, and the quiet chatter of Sinhalese in place of the traditional mind-numbing beeps and alarms of our medical equipment. I was pleased to see protective screening over the open air hallways, to keep the children from tumbling two stories, and to keep out the birds. It was surprising to see the number of children waiting to be evaluated for possible admission. Nearly all the beds were full, and it seemed as though they were in the habit of converting previous storage closets, consultant lounges, and any available space into treatment areas. The need for even more space remains evident.

We were greeted by Dr. Jayantha, the department head, and were quickly incorporated into rounds. My incredible learning experience began the moment we arrived at the first patient. Rapid fire questions regarding minute details about pneumonia. "Inspect this X-ray, what do you see? What organisms cause the X-ray to appear this way? How do you know? Are you certain? Why is this child's pneumonia not caused by Klebsiella?" As the only visiting students on the ward, we were not spared! He is a fantastic educator and we were soaking in every piece of information. The ward was full of interesting cases. Kawasaki disease, meningitis, dengue fever, juvenile rheumatoid arthritis, osteogenesis imperfecta, just to name a few. About 25% of our patients that day were hospitalized due to new occurrences or relapses of nephrotic syndrome. Dr. Jayantha explained the incidence is very high here, mostly caused by minimal change in his younger patients. He calls them his "nephrotics" and he holds a special renal clinic for these patients every Wednesday morning, which we attended. Collectively, we saw nearly 50 patients that Wednesday morning with some variation of this syndrome. He has spearheaded a study on his nephrotics over the past 15 years. It will certainly be an interesting read once his results are published.

Regretfully, Friday was our last day on the Peds ward. We were benefited from phenomenal teaching by a handful of consultants who were intent on actively involving their students during rounds. "Palpate this child's skull, Holly. What do you find?" "An open fontanelle sir," I responded. "Quickly, in your notebook, write down 3 reasons you may find an open fontanelle in children over the age of 18 months" he demanded. Apparently noting the oppressive heat in the ward, and the obvious sweat forming on my face, he continued, "Quickly, and then we will go snowboarding!" Snowboarding? "I'll take it," I said. "Too slow," was his response. Then he erupted in laughter, gave me a pat on the back and moved on to the next patient. This kind of rousing I was familiar with!

The opportunity to go into the community and provide antenatal care, well child checks, and give immunizations was extended to us by Dr. de Silva in the Department of Community Health. We had been waiting for this! We boarded the bus with 20 medical students from the University of Ruhuna Faculty of Medicine and set out towards a primarily Muslim clinic in Gintota, about 10km from Galle. 10km came and went, then 20km, maybe 30km. There was much discussion between the bus driver, the spotter, and the instructor in charge of this outing. I didn't need to speak Sinhalese to understand that we were lost! When we finally made it to the road leading to the clinic, the bus was unable to fit, so we walked the final 2km. We walked through tiny villages, past small shops, and many people who hadn't seen many (or any) fair skinned, light haired women walk past their homes. They were curious, and came off of their porches to watch where our journey would end. It ended at a clinic at the top of a hill, which was closed! A cyclone had badly damaged the structure three weeks prior. We now had to make the trek back down the hill, into the Muslim town, where we were shuttled by a community doctor to the temporary location at a school. 35 moms-to-be and 35 children were seen that day. Although cramped in their temporary clinic, their system worked well.

We visited a Sinhalese clinic a different day this week, which strictly provided antenatal care. We found this to be just as efficiently run, with roughly 60 mothers receiving exams. I was amazed at how integral a role the midwife plays in prenatal care in the villages. She performs all exams, including albumin and blood sugar checks, fundal height measurements, and even listens for fetal heart sounds through a pinard stethoscope! A "pinard" is a cone shaped instrument made of wood, plastic or aluminum, with a second cone at the top through which you are to listen. The fundus and the baby's head are palpated, pressure is placed at the top of the fundus, and the pinard is placed approximately over the baby's left shoulder. The provider then places their ear on the top side of the pinard and listens closely (very closely) for fetal heart sounds. Warning: The aforementioned technique may read as an easy procedure; however, after being spoiled by dopplers and fetal ultrasound, this takes much practice and a well trained ear!

I read somewhere that Sri Lanka has been called the "gem" of the Indian Ocean. It is most definitely unique. The people, the food, the language, the landscape, the culture, all novelties to me. Every day is an adventure here, and I am cherishing every one.

Casualty Day: Karapitiya Hospital in Sri Lanka

Thu, 26 Jan 2012 12:00:01 EST

Tracy Curtis
Duke University
Physicians Assistant
Galle, Sri Lanka

After a long journey to the other side of the globe, I was finally in Sri Lanka. It was 1:00 am when I landed then I arrived at my lodging at 4:00am. I had 4 hours to sleep and be ready to work! When I woke up to monkeys howling and playing in the trees 20 feet away, I knew I would like this place.

I was excited and nervous to start my global health rotation at Karapitiya Teaching Hospital. Despite the fact that the University of Ruhuna Faculty of Medicine is conducted in English, there is still quite the language barrier with the Sri Lankan version of English and the amount of slang that we unknowingly use. Even the everyday medical language and abbreviations varies between the U.S. and Sri Lanka. I wasn't sure how this would pan out when I arrived on the medicine ward.

Three of us are here in Sri Lanka from the Duke Physician Assistant Program. Since Duke University and the University of Ruhuna Faculty of Medicine have an established relationship in medicine and research, many of the professors and researchers were very welcoming to us. We met with Professor Ariyananda, the Senior Professor of Medicine, and he was quite excited to bring us to Grand Rounds and introduce us to his faculty and fellow consultants before we got started the next day.

The next day, we began clinical activities on the women's internal medicine ward, where we spent the week. We met with the Senior Registrar (similar to our Chief Resident) and she hurried us to the first patient to begin morning rounds. It was definitely intimidating on the first day while rounding with their equivalent of residents and attending.

After a few days, I was able to understand how the ward works to admit patients, complete investigations and diagnostic assessments and carry out a treatment plan. There are many similarities, but a greater number of differences between the U.S. and the Sri Lankan inpatient wards. The overall appearance of the ward and staff, the admitting process itself, and the types of illness and their treatment protocols are notably unique.

When I first walked onto ward 11, I noticed there were more patients than beds, with some patients lining up with their belongings on the floor or with a make-shift mattress on the ground in the hallway. Some privacy is maintained with green curtain that can be drawn to a close, though this greatly reduces the air circulation and increases the already hot temperatures found on the ward.

Another distinct difference between the U.S. and Sri Lankan hospitals is the admitting process. Patients can only be admitted to a ward on Casualty Day. While casualty typically means trauma or catastrophic event, here in Karapitiya Hospital, it simply means acute care. Each ward has its own Casualty Day, rotating every 5 days, so on any given day there is at least one medicine ward holding a Casualty Day. It's quite obvious which ward is having their day because the hallway outside the ward is lined with sick people waiting their turn to speak to a House Officer (intern). Because Sri Lanka has a public health system, and Karapitiya is a public teaching hospital, patients are first seen at their local community health clinic or rural hospital and if their illness is deemed to be beyond the capabilities of the small hospital or clinic, they are referred to the teaching hospital. The patient brings their diagnosis card to the House Officer- a laminated square paper with their personal identification information, their chief complaint, lab work if done, and treatment to date. The House Officer is the first to speak to the patient; they do a complete history and determine if they need to be examined or treated outpatient. If they are in need of an exam, they proceed to the line for the single admitting bed where the Junior House Office and/or Senior Registrar (residents) examine the patient. They will determine whether the patient gets assigned a bed or follows up with outpatient treatment. Unless the patients’ illnesses warrants a longer stay, most patients are typically released to outpatient care after 4 days- just in time for the next Casualty Day.

When admitted to the hospital, patients must bring their own medical record, clothing, toiletries, pillow and blankets. The hospital only provides one pillow case and one blanket which are typically used to cover the bed. Visitors are only allowed between 1-5pm, though one person is allowed to stay at all times.

Needless to say, patients who get admitted here are very ill. We have seen many patients with Dengue and Typhoid fever, severe heart murmurs, and strokes. Many of these illnesses are quite advanced at the time of initial evaluation. There was one patient who had such a loud heart murmur that it took me a minute to realize that it was her mitral valve making all that noise and not her breath sounds! I've never heard such a loud, distinct murmur in my training. When I felt for her apical pulse, it was as though her heart was punching my hand through her ribs. Thankfully, the patients here are accustomed to medical learners examining and questioning them every day, so it was nothing new for me to listen and palpate myself. In fact, these patients have a crew of consultants, house officers, registrars, medical students and nurses rounding on them daily.

Another interesting difference that struck me was the absence of beeping monitors and other technology on the wards. Vitals are obtained manually at regular intervals and charted on a paper above the patient's bed. There were no oxygen tanks hooked up for the COPD patients, no controls to adjust the hospital bed for comfort and certainly no television sets. The physicians and students are heavily reliant upon their physical exam skills. It was impressive how well these physicians could hear breath and heart sounds with all the background noise and conversations amongst providers. I hope I will be able to acquire this same level of competency in my physical exam!

I can already tell that I will learn a great deal here in Sri Lanka, both culturally and medically. I'm grateful to have already seen so many tropical diseases that are rare or non-existent in my hometown. This will certainly prove beneficial for future international aid work. Also, learning about the public health system and adapting to the difference in technology will allow me to be a better global practitioner. In the next few weeks, my colleagues and I will also participate in pediatrics, OB/Gyn, community medicine and surgery. There will be many interesting patients and experiences to come!

In the Operating Theatre: Kijabe Hospital

Sun, 22 Jan 2012 12:00:01 EST

Joseph Schlesinger
Resident
Kijabe, Kenya
Vanderbilt International Anesthesia

We arrived safely in Nairobi and stayed at the Mennonite Guest House. The next morning we ate breakfast with missionaries from all over the world in different stages of their calling around Africa. Kijabe’s reputation is well known and they wished as well as we were picked up and driven to Kijabe via a road that had terrible slums juxtaposed with sweeping views of the Rift Valley.

We toured the hospital and got settled in our lodging for the month and got sign-out from the ICU as one of us was on-call the first night. It took adjusting to drugs and equipment that were foreign to us. All of the patients did well overnight leading into our first day in the operating rooms, or “theatres,” as they are called.

The staff comprises one MD anesthesiologist and in our case, two anesthesia residents, missionary and local surgeons, surgery residents, KRNA (the Kenyan version of a CRNA), and anesthesia students. Patients present with late-stage disease, terrible trauma, and for obstetric emergencies without previous prenatal care. One could take care of a neonate with a tracheoesophageal fistula followed by a patient after a road traffic accident followed by a C-section. The steep learning curve of anesthesia is addressed with intense didactics combined with a sick and varied patient population. The KRNAs and students do a great job. However, there is not insignificant morbidity.

I had the pleasure to oversee a few operating rooms, help the KRNAs and students perfect there neuraxial anesthesia techniques, discuss pharmacology and physiology, and teach them approaches to regional anesthesia that they have not seen before. The way they gather around and pay attention exhibiting their willingness to learn is refreshing.

After the first day, we brought two heavy suitcases of medical supplies to the anesthesia workroom as most of the equipment is donated. It caused me to step back and realize the amount of equipment we use in America and how we take many things for granted at our institution.

Everyone at Kijabe has been extremely welcoming and the missionary spirit of providing excellent medical care in the midst of educating the local medical staff is encouraging for the future. All of this paired with the beautiful land, delicious food and chai, and local wildlife seen on our weekend hikes prepare us for a busy week next week in the operating theatre.

Appendectomies in a New Light: Poverty and Surgery in Kenya

Tue, 03 Jan 2012 12:00:01 EST

Matt Landman
Resident
Kijabe, Kenya
Vanderbilt International Anesthesia

(Photo: Matt Hansen and Kenyan Colleague)

I've probably done more than 30 appendectomies so far during my general surgical residency. For all the times I've taken care of someone with appendicitis, rarely, if ever, has the thought that they might die from the illness crossed my mind. Indeed, some of these patients were quite sick; but once they presented to medical attention, we could get them through their illness. Many of these patients were young which help in their recovery.

My first week in Kenya changed my history with this nearly ubiquitous American surgical disease. We took care of a 20 year old male who presented to an outside facility with appendicitis of about two weeks duration. While he didn't have a CT scan to review, I'm sure his appendix was perforated. He, appropriately, underwent an open appendectomy by these physicians. Unfortunately, he required another operation shortly thereafter necessitating resection of the right side of his colon (the part of the colon to which the appendix is attached). He was discharged from that hospital and presented to Kijabe Hospital with stool leaking from his wound. The connection of his intestine had completely broken down, likely result of weeks of malnutrition and intra-abdominal infection. We performed additional operations to resect the damaged colon but the insult was too great. He died during my second weekend in Kijabe.

There I was, presented with a 20 year old, previously healthy man who died of an illness I’d not ever known in my short professional career to be fatal (although I think it's important to note that there is still a generation of American surgeons who certainly understand death secondary to appendicitis). Admittedly, appendicitis is much less common in Kenya, but nevertheless, his death was a tangible reminder to me of how the lack of medical resources and access to healthcare can truly affect patient outcomes. I’m not sure what kept this young man from presenting to medical attention sooner, it was probably a combination of lack of financial resources, poor access to care and cultural limitations, but had he presented earlier, he would have likely survived.

This, and other, experiences in Kijabe changed my view of global health. It’s so much more than just doing operations or treating patients in a hospital or clinic. Where the real efforts are being made and continue to be made is in creating a system in which patients get open access and timely care for both acute and chronic disease. Surely, as long as there is poverty, this will be difficult. However, if healthcare professionals of the caliber I interacted with in Kijabe continue to commit time and resources to a needy people, the outlook continues to look bright.

Investing in Health and Security

Thu, 15 Dec 2011 12:00:01 EST

By: Bill Frist

Politico
December 15, 2011 12:03 AM EST

While Congress remains deadlocked in fiscal debates, American families are holding their own budget negotiations. How much can we spend this year on gifts for the children, home projects or even food for the holidays? Congress and families alike are tightening their belts, cutting costs and planning ahead.

This week, Congress is to vote on a drastic reduction of foreign assistance. While most Americans shy away from the language of foreign aid, polls show that despite continuing economic problems, more than half all Americans support funding for health, including education and emergency relief, in developing nations.

On World AIDS Day, President Barack Obama, joined by former Presidents George W. Bush and Bill Clinton, spoke about the global commitment to end HIV/AIDS by 2015 and recommitted the U.S. effort to do so. He announced new targets to combat the pandemic — including providing anti-retroviral drugs to more than 1.5 million pregnant women with HIV over the next two years.

Obama received a sustained standing ovation when he announced his administration has set a goal to get six million people with HIV on anti-retroviral treatment by the end of 2013.

These are worthy targets to celebrate. But to achieve it, we must have the support of Congress. Continued investment in the fight to end global AIDS is more than an investment in the lives of families and communities in developing nations — it is an investment in security, diplomacy and our moral image worldwide. It uses health as a currency for peace.

Millions of lives are at stake — literally. Under the current budget cuts, more than.4 million people will likely lack mosquito nets, a cheap way to prevent malaria. More than 900,000 children will lack access to vaccinations for measles, tetanus and pertussis. These numbers are staggering, but real.

Yet, as with any good investment, there is need for accountability, transparency and results. The Millennium Challenge Corporation is a good example of promoting aid effectiveness from “input to impact.” There is mutual responsibility for both donor and recipient to achieve the goals agreed on — an expectation that the recipient take ownership, as a partner, of both the aid and its implementation. Washington should and does require seeing results in practice.

For example, one of the best investments is providing access to clean, safe water. Every $1 invested in safe drinking water and sanitation, according to the U.N. Development Program, produces an $8 return in costs averted and productivity gained. Children are healthier, girls can go back to school and women can begin to work again.

A Millennium Challenge Account compact funding package for El Salvador now invests nearly $24 million to provide access to potable water systems and sanitation services to benefit 90,000 people in the country’s poorest region. This money creates healthier and more economically sound communities with something as basic as clean water.

More than 68 percent of Americans in a recent holiday poll said that because of the economy, we should be committed to charity this year more than ever before. With Americans reaching deep into their pockets to fill the coffers of red-hatted Santas on street corners or offering plates at houses of worship, Congress should follow their constituents’ leadership as they consider foreign assistance this week.

This holiday season, let’s recommit to investing in global health and development in the parts of the world that need our assistance the most. Foreign aid is less than 1 percent of our national budget, so cutting it would have a miniscule effect on our deficit reduction.

But it means the world to a mother whose child’s life we will save.

For the hope of greater peace on earth, investments in health and security could be the best bargain in town.

Former Sen. Bill Frist, a doctor, served as Senate majority leader. He is the chairman of Hope Through Healing Hands, a nonprofit charity that promotes using health as a currency for peace.

A Decade of Progress on AIDS

Thu, 01 Dec 2011 12:00:01 EST

By BONO
New York Times

I’LL tell you the worst part about it, for me.

It was the look in their eyes when the nurses gave them the diagnosis — H.I.V.-positive — then said there was no treatment. I saw no anger in their expression. No protest. If anything, just a sort of acquiescence.

The anger came from the nurses, who knew there really was a treatment — just not for poor people in poor countries. They saw the absurdity in the fact that an accident of geography would deny their patients the two little pills a day that could save their lives.

This was less than a decade ago. And all of us who witnessed these dedicated African workers issuing death sentence after death sentence still feel fury and shame. AIDS set off an almost existential crisis in the West. It forced us to ask ourselves the big, uncomfortable questions, like whether capitalism, which invented the global village and kept it well stocked with stuff, could also create global solutions. Whether we were interested in charity... or justice.

The wanton loss of so many lives in Africa offended the very idea of America: the idea that everyone is created equal and that your destiny is your own to make. By the late 1990s, AIDS campaigners in the United States and around the world teamed up with scientists and doctors to insist that someone — anyone — put the fire out. The odds against this were as extreme as the numbers: in 2002, two million people were dying of AIDS and more than three million were newly infected with H.I.V. Around 50,000 people in the sub-Saharan region had access to treatment.

Yet today, here we are, talking seriously about the “end” of this global epidemic. There are now 6.6 million people on life-saving AIDS medicine. But still too many are being infected. New research proves that early antiretroviral treatment, especially for pregnant women, in combination with male circumcision, will slash the rate of new H.I.V. cases by up to 60 percent. This is the tipping point we have been campaigning for. We’re nearly there.

How did we get here? America led. I mean really led.

The United States performed the greatest act of heroism since it jumped into World War II. When the history books are written, they will show that millions of people owe their lives to the Yankee tax dollar, to just a fraction of an aid budget that is itself less than 1 percent of the federal budget.

For me, a fan and a pest of America, it’s a tale of strange bedfellows: the gay community, evangelicals and scruffy student activists in a weird sort of harmony; military men calling AIDS in Africa a national security issue; the likes of Nancy Pelosi, Barbara Lee and John Kerry in lock step with Bill Frist and Rick Santorum; Jesse Helms, teary-eyed, arriving by walker to pledge support from the right; the big man, Patrick Leahy, offering to punch out a cranky Congressional appropriator; Jeffrey Sachs, George Soros and Bill Gates, backing the Global Fund to Fight AIDS, Tuberculosis and Malaria; Rupert Murdoch (yes, him) offering the covers of the News Corporation.

Also: a conservative president, George W. Bush, leading the largest ever response to the pandemic; the same Mr. Bush banging his desk when I complained that the drugs weren’t getting there fast enough, me apologizing to Mr. Bush when they did; Bill Clinton, arm-twisting drug companies to drop their prices; Hillary Rodham Clinton, making it policy to eradicate the transmission of H.I.V. from mother to child; President Obama, who is expected to make a game changing announcement this World AIDS Day to finish what his predecessors started — the beginning of the end of AIDS.

And then there were the everyday, every-stripe Americans. Like a tattooed trucker I met off I-80 in Iowa who, when he heard how many African truck drivers were infected with H.I.V., told me he’d go and drive the pills there himself.

Thanks to them, America led. Really led.

This was smart power. Genius, really. In 2007, 8 out of the 10 countries in the world that viewed the United States most fondly were African. And it can’t be a bad thing for America to have friends on a continent that is close to half Muslim and that, by 2025, will surpass China in population.

Activists are a funny lot. When the world suddenly starts marching in step with us, we just point out with (self-)righteous indignation all that remains to be done. But on this World AIDS Day I would like you to stop and consider what America has achieved in this war to defend lives lived far away and sacred principles held closer to home.

The moonshot, I know, is a tired metaphor; I’ve exhausted it myself. But America’s boldest leap of faith is worth recalling. And the thing is, as I see it, the Eagle hasn’t landed yet. Budget cuts ... partisan divisions ... these put the outcome in jeopardy just as the science falls into place. To get this far and not plant your flag would be one of the greatest accidental evils of this recession.

Bono is the lead singer of the band U2 and a founder of the advocacy group ONE and the (Product)RED campaign.

An Impatient Optimist

Thu, 01 Dec 2011 12:00:01 EST

An Impatient Optimist's View of HIV
by SENATOR WILLIAM H FRIST MD

Impatient Optimists: The Bill and Melinda Gates Foundation

In 1981, I was a surgeon in training at Massachusetts General Hospital in Boston. I still remember the day we learned about a strange, new, deadly infection that presented on the West Coast. A little over a year later, we learned it was caused by a virus transmitted in the blood, a vital fact for a doctor performing surgery every day.

As I watched the epidemic grow from a handful of cases to a few hundred to several million, I also witnessed the cases grow in biblical proportions in less developed nations, namely across Africa. While I served in the Senate, I volunteered on annual mission trips to do surgery in villages ravaged by civil war. In these forgotten corners of the world, I witnessed how HIV was hollowing out societies.

Drawing on these firsthand experiences, as the Senate Majority Leader I encouraged and supported both the PEPFAR program and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The Global Fund, a multilateral institution with the U.S. as the leading contributor, leverages $2 for every single dollar given, all to combat this trilogy of diseases that disproportionately attack children and young adults in the poorest nations on the planet.

The remarkable news is that millions of lives have been saved by these investments. Thanks to the Global Fund, over 3.2 million people living with HIV are on lifesaving treatment.

I am proud to have been part of a government whose leadership, acting on behalf of the American people, has led the world and literally saved the lives of millions of people globally.

In 2008, I co-chaired the ONE Campaign’s ONE Vote ’08 Campaign. We brought a delegation of Republicans and Democrats to Rwanda to see firsthand the good work being done by the funding of the Global Fund, PEPFAR, and the President’s Malaria Initiative.

In Eastern Rwanda we visited the inspiring Rwinkwavu Clinic, run by Dr. Paul Farmer’s Partners in Health. With 110 beds and eight health centers, this clinic provides essential medicines, supplies, and equipment and recruits, trains, and retains staff to ensure a sustainable infrastructure for the future.

But without Global Fund funding, the Rwinkwavu Clinic could not provide health care services to the people of Rwanda. This is true for so many organizations and clinics worldwide.

And it’s unfortunate that even though we see investments pay off, lives saved, and economies grow, the Global Fund was forced to cancel its round 11 funding. This means clinics like Rwinkawvu will only be able to support those currently on HIV treatment and not add any new patients. This is alarming because in low-income countries half of people living with HIV are not receiving treatment.

At a time when our own economy is faltering, and our national debt is growing unacceptably, we have to tighten our belts. To do so, we need to decide where we make smart investments and where we do not.

The fact is that the American people spend less than one-quarter of 1% of our federal budget on global health and fighting global epidemics like HIV, tuberculosis, and malaria. With this little sliver of the pie, the Global Fund’s return on investment means more sustainable economies, less global instability, and healthier families. For less than a penny to the dollar spent on all foreign aid, we are investing in the lives of children, mothers, and our own national security.

On the horizon is excellent news for HIV. New evidence suggests male circumcision, microbicides, and quicker AIDS treatment will markedly decrease the disease. Combined with known prevention methods like condoms and nevirapine, we are on the right track to substantially halt the growth of HIV/AIDS.

I’m an optimist, an impatient optimist. We will win the war on HIV, tuberculosis, and malaria. Our investments have worked. The end is in sight. We just have to be smart enough to continue to invest wisely, using health as a currency for peace around the world.

The Cost of Healthcare in Rural Kenya

Mon, 28 Nov 2011 12:00:01 EST

Matt Landman
Resident
Kijabe, Kenya
Vanderbilt International Surgery

(Photo: Matt Landman at left)

It’s now been one full week since my arrival in Kijabe, Kenya. Simply speaking, to understand everything I’ve seen and experienced in the past week will take months of careful thought and reflection. I’ve seen the shackling consequences of poverty, the natural history of surgical disease more advanced than I’d ever seen before, a lack of medical resources, and the list goes on; but, overshadowing all of this, I’ve seen the good several committed people can do at one place in time to positively affect patients and their families for a lifetime.

My first full day in the hospital was spent in the general surgery clinic. I use the description “general surgery” but in reality, if forced to label it back at my home institution in the U.S. it would be better described as the general surgery - urologic surgery- otolaryngology -surgical oncology -endocrine surgery -thoracic surgery –vascular surgery-wound care-palliative care clinic.

I never imagined a more unique conglomeration of surgical diseases coming through the door in a single day. While the pathology was interesting (and inspiring to hit the books to expand my surgical knowledge) I was most struck by what each procedure meant for the patient—particularly the financial toll. Instead of flashing an insurance card and putting down a small copayment, each patient (and many times their family) was required to produce a down payment for the recommended procedure. If they required a cholecystectomy it would be x-amount of Kenyan shillings. If they required a colonoscopy it would be y-shillings. Quite foreign to me (and most in the US) was the readily available price tag, if you will, for each procedure (I should note that the payment system was different for emergency cases). That price tag allowed me to clearly see the financial sacrifice, relatively extreme in some cases, made by patients and their families to improve (or simply maintain) their health.

I often wonder what would happen to Americans if we were put in a similar situation. Would we still spend most of our healthcare dollars at the end of life? Would we be doing radical resections with small chances of cure? Would emergency rooms still be overcrowded? What would I give up in order to pay for me or my family’s medical care? While I’m not sure of the answers, I know that many Americans, as I’ve seen these Kenyans do countless times this week, would step back and evaluate their priorities and healthcare need.

The knowledge of these costs has another effect. Physicians are forced to understand their healthcare consumption. I certainly have been more cognizant here of what each laboratory test, imaging procedure or recommended operation would mean for my patients and have tapered my practice and recommendations to be cost-conscious while maintaining medical effectiveness. Seeing the results of our operations and care here, I’m confronted with excellent results that don’t necessarily correspond to the amount spent on each case.

It’s been a week and I’ve learned quite a bit, both medically and professionally. I look forward to the coming weeks for more experiences in which I can look back and evaluate my role in this place and in surgery as a whole globally and in the U.S.

Russian Delegation's Visit Builds Knowledge, Trust

Mon, 14 Nov 2011 12:00:01 EST

The Tennessean

by Bill Frist

Russian-U.S. relations are complicated and, at times, trying. But since we share a commitment to improve the health of our citizens, there is much we can learn through dialogue and collaboration. And there is no better place to do so than Tennessee, the heart of health-service delivery innovation.

Even at the height of the Cold War, U.S. and Russian scientists collaborated closely to eradicate polio and smallpox. Similar collaboration can lead to mutual benefit for today’s shared challenges, chronic disease and obesity, with a byproduct of improved diplomacy. Collaborations on health-service delivery in Tennessee between Russian and U.S. doctors are a powerful example of health diplomacy and a valuable currency for trust and understanding.

Russia has more doctors, health-care workers and hospitals than most countries, but standards remain variable. Prime Minister Vladimir Putin has committed $16 billion over two years to bolster working conditions, training, and national electronic health records with a promise to trim bureaucracy.

The Washington-based Open World Leadership Center invited 30 health professionals from Kirov State, Russia, to come to the U. S., specifically to Tennessee, to study and explore financing, organization and delivery of health infrastructure and services.

The Russian delegation spent a day in Washington to better understand how health policy is formulated at the federal level and to visit the National Institutes of Health. They then came to Tennessee for a week, spending time in Memphis, focusing on research, and in Knoxville, focusing on rural health delivery.

The visit culminated in Nashville, where they observed firsthand our $70 billion global health-care industry. Hosts Nashville Health Care Council and Hope Through Healing Hands welcomed the travelers to the “Silicon Valley” of health care.

Industry leaders citywide opened their doors with sessions on medical simulation at Vanderbilt and HIV research by Meharry. The group also received an inside look at the public health sector’s progress on making communities healthier from state Health Commissioner Dr. John Dreyzehner, Nashville Mayor Karl Dean and Metro Public Health Director Dr. Bill Paul. The day concluded with global disease-management leader Healthways, and focused on the company’s work to improve well-being through prevention.

Most valuable, however, was the opportunity to hear what the delegates found most applicable to their home. Among them were the development of IT for unified e-records, logistics for emergency services, and the great benefit of community volunteerism.

As the U.S. and Russia attempt to address growing health demands, we have much to learn from each other. Collaboration, using health as a currency for peace, will mean healthier societies, better diplomacy and improved bilateral relationships between our nations.

Sen. William H. Frist is a nationally recognized heart and lung transplant surgeon and former majority leader in the U.S. Senate.

Frist Hosts Russian Health Delegates

Fri, 04 Nov 2011 12:00:01 EST

Nashville Business Journal
by Chris Silva, Staff Reporter

Former Tennessee Sen. Bill Frist was at the Hermitage Hotel this morning with about 30 Russian physicians and a cadre of Nashville’s health care and business leaders to promote global unity and attempt to solve public health and behavioral issues that lead to chronic diseases.

Frist said Russia faces many of the same health care dilemmas as Middle Tennessee.

“We do have the best health service infrastructure here in Middle Tennessee, so why not share it with the global community – a oneness of mankind?” said Frist, who prompted Sen. Lamar Alexander to send a request to Open World Leadership Center to host the health exchange. “Out of our commitment to global health, democracy, being the best in the health service delivery and using health as a currency for peace, we had the conference today. It will be a foundation for future exchanges.”

The Russian visitors started out with a tour of Vanderbilt University Medical Center this morning and listened to a presentation from an expert from Meharry Medical College on HIV/AIDS research.

Ralph Schulz, president of the Nashville Area Chamber of Commerce, was on hand, as was Mayor Karl Dean.

“I am concerned most about this issue of obesity,” Dean said. “It’s going to be a battle that will be won or lost in the Southeast.”

Today’s events were hosted by the Nashville Health Care Council and Hope Through Healing Hands.

Pediatric Anesthesia in Kijabe Hospital

Fri, 04 Nov 2011 12:00:01 EST

by Allison Greening

Vanderbilt International Anesthesia

Kibaje, Kenya

I arrived in Kijabe, Kenya with two other senior anesthesia residents from Vanderbilt midday Sat Oct 29^th, after departing Nashville Thursday Oct 27^th, flying overnight to London, and then all day to Nairobi. We spent the night in the Mennonite Guest House in Nairobi, where we met several missionaries coming and going to and from various parts of east Africa, and then were driven up to Kijabe the next morning.

We had been scheduled to travel Monday Oct 24^th, but were delayed with security concerns due to the Kenyan army invading Somalia in response to recent kidnappings in northern Kenya, and threats of Al-Shabaab retaliation in Nairobi for a few days. Effectively this means we’ve missed a week, but three weeks are better than none! One of the first things we noticed about the place is its utopian feel. Justin, one of the other residents, referred to it as a “summer camp” feel. It seems funny to think of any sort of terror attack happening here, in an idyllic small town mostly made up of missionaries who either work at the hospital or international school, but evidently someone has thought of it, as it’s surprisingly secure.

We spent the weekend getting settled in, and then started in the operating rooms on Monday. I have an interest in pediatric anesthesia, so have been running the pediatric room, though my compadres have been doing lots of regional anesthesia with the new ultrasound donated to the hospital recently from Vanderbilt and Dr. Randy Malchow. (1^st photo) We’ve also been involved in a couple of airway cases, using the brand new glidescope, all of which has drawn quite an audience! (2^nd photo below) I’ve done some amazing pediatric cases; the two that stand out the most were an open thoracotomy to repair a patent ductus arteriosus (PDA) in a 15 kg, 7 year old boy who was an achondroplastic dwarf, and a debridement of a severe, 48 hour old burn to the face of a 3year old boy.

The first case was a pretty big deal, basically minor heart surgery in a third world country, and I was the experienced one in the room, with both a Kenyan nurse anesthetist and a Kenyan nurse anesthetist student helping. A few aspects of the case amazed me, especially how well we did with so much less than we do in the states, and even more so, how well the boy did after having such a major, and painful, surgery. Kenyans are tough!

The burn case was very memorable as well, and also good teaching for the nurse anesthetist and student. The boy also happened to have muscular dystrophy, which presented its own anesthetic challenges, on top of those unique to burns, such as not being able to use certain drugs, and potentially having trouble breathing for the patient after putting him to sleep. The burn patient, like the PDA patient, looked great the next day. There’s even quite a lot to be learned from a fairly basic case like we did today, when just a few minor speed bumps along the way became important teaching points! I should be clear though, that I am not the only one doing the teaching!! I have learned quite a bit, and already in the first week had experiences that will rival any that I’ll get during my pediatric anesthesia fellowship next year!

TASO Launches House of Hope! Funding by World of Hope

Wed, 02 Nov 2011 12:00:01 EST

TASO sets another milestone: Launches a House of Hope for persons affected by HIV and AIDS in Uganda.

As 2011 draws to an end, The AIDS Support Organisation (TASO) is elated to record yet another milestone in restoring hope to people affected by HIV and AIDs pandemic in Uganda. The organization, with support from her development partners and friends, has completed the construction of a multi-million complex, named House of Hope.

The attractive building, located at Plot 10 Windsor Loop, Kampala, was officially opened on 16^th of September 2011 in a grand ceremony presided by Hon. Princess Kabakumba Masiko, Minister of Presidency, who represented H.E Yoweri Kaguta Museveni, President of the Republic of Uganda.

The colorful event was attended by over 400 guests including members of the diplomatic community, representatives of development partners, Ministry of Health, Uganda AIDS Commission, leaders of various local and international AIDs Support Organisations and other civil society organizations, TASO governance bodies, TASO founder members, management and staff and above all, the gallant clients living with HIV.

In her remarks to launch the House of Hope, Hon. Masiko appreciated TASO for the innovativeness in the fight against the AIDS pandemic and for standing tall in the country and the world over in providing hope to people living with HIV. She pledged continued support to TASO and other stakeholders from the Government of Uganda.

The vision of the House of Hope was conceived as one of those strategies of sustaining provision and quality of HIV prevention, care support and treatment services to the TASO clients. Faced with the challenge of a growing number of clients seeking services especially following the initiation of ART programme, the available physical space and related resources at the Mulago Service Centre, which also housed the TASO Headquarters, were increasingly becoming inadequate. Therefore a need to decongest the facility at Mulago became more apparent and had to be addressed.

The management of TASO, with the approval of the Board of Trustees (BOT) then decided to construct a building to house the TASO Headquarters with additional space for generating resources for continued innovations and work in the provision of services to the clients and HIV prevention interventions.

The construction of the building commenced in November 2005 with the laying of the foundation stone in a ceremony officiated by Dr. Sam Okware, a prominent HIV activists and then a Director at the Ministry of Health.

The initial funding for the House of Hope project was provided by the World of Hope Foundation, USA. This funding followed a visit to TASO by a US Senator Bill Frist in 2005. During that visit, Senator Frist, a medical doctor, was taken around and briefed about TASOs work by the then TASO Executive Director(ED), Dr. Alex Coutinho and Dr. Matovu, then BOT Chairperson and Member of Parliament. Senator Frist was deeply touched by the great work TASO was doing in preventing HIV infection, restoring hope and improving the quality of life of individuals, families and communities affected by HIV infection and disease.

On going back to the US, Senator Bill Frist, M.D. nominated TASO to The World of Hope Foundation to be considered as one of the recipients of funds left over from former US President Bush’s election campaign. His nomination of TASO was accepted and gratefully, a generous contribution of US $500,000 was given to TASO, out of which about US $ 350,000 went into the House of Hope project.

The House of Hope project is one of the biggest projects that the current ED, Mr. Robert Ochai inherited when he assumed office. Together with his team, he raised additional funding from TASO friends from near and far, including the Board of Trustees, Staff, Subscriber Members and Clients, to complete this dream of a symbol of hope for TASO clients and friends. TASO pays great tribute to all the friends who contributed to make this big dream a reality.

Speaking at the opening ceremony, Mr. Micheal A Strong, the PEPFAR Coordinator, US Mission Kampala, Uganda, noted that the House of Hope is an investment for people living with HIV and will generate revenue for TASO for years to come to sustain the excellent work on HIV and AIDS prevention, care and support. He urged all organizations to emulate TASOs example of looking outside our narrow boxes to find creative ways to fund and sustain the efforts to improve the health of all Ugandans. On their part, the ED, Mr. Robert Ochai and the Immediate former ED, Dr Alex Coutinho, noted that TASO‘s commitment to preventing HIV infection, restoring hope and improving the quality of life of persons, families and communities affected by HIV infection and disease, has resulted into the organization taking up a pioneering pace setter role in the fight against HIV and AIDS in the country and the region. From the enviable milestones recorded over the years, the name TASO has now come to be synonymous with any initiatives in HIV prevention, care, support and treatment in Uganda.

The House of Hope is a modern facility, complete with a 400 seater conference facility/board room and a parking yard of over 30 vehicles. The facility also has a wall of memory of over 100,000 departed TASO clients. TASO is pleased to posses this facility on behalf of everybody involved in the fight against the HIV pandemic and especially the gallant clients who have given HIV a face. There is hope and together we shall fight on to defeat HIV so we can, one day, reach our vision of “A world without HIV”.

Russian Delegation in Knoxville and Memphis: November 2

Wed, 02 Nov 2011 12:00:01 EST

by Jenny Eaton Dyer, Ph.D.

Both Friend Force of Knoxville and Friend Force of Memphis are hosting the Russian delegates this week, including today.

The Russian delegates in Knoxville will be meeting with governmental officials Mayor Daniel Brown as well as Judge Tom Varlan today. They will be briefed on the bluegrass music of Appalachia at the Knoxville Visitor's Center, and their afternoon will be spent visiting with Cherokee Health Systems. This evening, the North Rotary Club of Knoxville will host the Russian delegates for dinner.

In Memphis, the delegates will meet with the Memphis Medical Society as well as with the University of Memphis. At the University, there will be round table discussions regarding healthcare delivery in Russia and the United States among other presentations.

Russian Delegation in Knoxville and Memphis: November 1

Tue, 01 Nov 2011 12:00:01 EST

by Jenny Eaton Dyer, Ph.D.

In following the meetings and events of the Russian delegation learning from Tennessee's wealth of health care corporations, universities, and institutions, we will share their schedule throughout the week.

Today, Tuesday, November 1, the delegates visiting Knoxville have spent the morning at Pellissippi State Community College touring the Nursing Department. This afternoon, they toured the UT Hospital and had a quick photo at the Rachmaninoff statue in World’s Fair Park. Afterwards, they will visit the Knoxville Museum of Art and learn about their Mobile Meals program for the elderly.

In Memphis, the other delegates met this morning at the Christ Community Health Services. This organization is a faith-based network of medical and dental clinics supplemented by a range of community outreach activities. CCHS serves a primarily low-income minority population that does not have the resources to obtain care elsewhere. For lunch, they visited the Caritas Village. And, this afternoon, they visited the Assisi Foundation of Memphis for a presentation and discussion on current health care reform initiatives and then the Hope and Healing Center to learn about their wellness and fitness program for a low-income population.

Kijabe: An Island of Hope in a Country of Medical Need

Tue, 01 Nov 2011 12:00:01 EST

by Walter Schratt
Vanderbilt Department of Surgery
Kijabe, Kenya

I arrived at the beginning of September for my first time in Africa. I really did not know what to expect but after 2 weeks I am really deeply impressed. Kijabe hospital is a medical center in Kenya where people get medical treatment at a high level for a reasonable price. The doctors are well trained – mostly in America and Australia, the residents, house and medical officers are highly motivated, have abundant basic medical knowledge, and, on top of that, they receive a detailed and profound training in their specialties that will prepare them for their challenges in the smaller community hospitals. Politics just has to make sure that they stay here in Africa to serve their countries and their people after they are finished with their training.

Same for the nursing staff. The nurses are competent, helpful, motivated. A substantial number of nurses who are trained here are hired at the big and prestigious hospitals in Nairobi – unfortunately for the Kijabe hospital but also an expression of the quality of training they receive at Kijabe hospital.

The African people are friendly, open and very patient and generally happy. Imagine 100 people in surgical clinic, first come first serve, waiting from 9 am to be seen at 3 pm – no complaints, still happy to be seen after a 6 h wait. Those people deserve our help despite political uncertainties. The fellow doctors who work here full time on their missionary dedication deserve our full recognition and support. I am lucky to be here. I am looking forward to the rest of my stay and hopefully I will be back some time.

Open World Program Hosts Russian Delegates: D.C. and Tennessee

Mon, 31 Oct 2011 12:00:01 EST

In May 2007, Dr. William H. Frist co-led a Center for Strategic and International Studies (CSIS) delegation to Russia to participate in the first St. Petersburg State University Forum on Global Health. The forum explored bi-national cooperation in health and health care delivery, including the exploration of establishing a public health initiative in Russia.

At the conclusion of the trip, Senator Frist published the paper: “Improving Russian-U.S. Collaboration on Health” (Washington Quarterly, 30:4, 2007, pp. 7-17) which focused on how Russia and the U.S., in a time fraught with tension, could work together to solve public health issues in terms of policy, behavioral change, and chronic disease. Both could emerge as better, healthier, more viable countries, with health partnerships strengthening diplomatic relations.

Senator Frist, a trustee at CSIS, was instrumental in establishing the Global Health Policy Center, and he served on the advisory board of the Commission for Smart Global Health Policy. This commission created the report, “A Healthier, Safer, and More Prosperous World,” as the product of a year’s worth of study of the long-term U.S. strategic approach to global health. Dr. Frist, in addition, serves as a co-chair of the Eurasia Health Project as a part of the CSIS Russia and Eurasia Program.

Initiation of the idea of receiving a Russian delegation of high level physicians in Tennessee began with a discussion among Russian and American experts in global health at CSIS in May 2009. Co-chaired by Senator William Frist, former Majority Leader of the U.S. Senate and CSIS Trustee, and Dr. Nikolai Gerasimenko, First Vice Chair of the Russian Duma’s Committee on Health Protection, the panel weighed new ideas for future Russian-U.S. joint initiatives and generated considerable shared excitement. CSIS Senior Associate Judyth Twigg played the lead role in conceptualizing and coordinating the session. Approximately twenty additional experts on U.S.-Russian collaboration on health, representing government, academia, and the private sector, contributed significantly to these discussions, which amounted to a brainstorming session for a blueprint for strategic bi-national collaboration on health.

Dr. Andrew C. Kuchins, Director and Senior Fellow, CSIS Russia and Eurasia Program, and Dr. Judyth Twygg have been part of this effort to bring Russians to the U.S. from the beginning. On January 31, 2011 the CSIS Russia and Eurasia Program hosted a conference as part of the Eurasia Health Project entitled, "Sharing Health: U.S.-Russian Collaboration in the Health Sector.” Dr. Nikolai Gerasimenko, a long-standing member of the Russian parliament and former chair of its health committee, served as the Russian Co-Chair along with Senator Bill Frist from the U.S. This meeting, which discussed U.S. and Russian efforts in health sector reform, promotion of healthy lifestyles, and regional-level efforts at health reform, was intended to generate momentum toward meaningful communication and collaboration between the two countries at both the governmental and non-governmental levels. Senator Frist’s article, “What the Doctor Orders” (Foreign Policy, 9/11/09) highlights the key findings and conclusions of this conference.

While serving in the U.S. Senate, Dr. Frist worked alongside Alaska Senator Ted Stevens and Librarian of Congress James H. Billington to establish the Open World Program by an act of Congress in 2000. The Open World Leadership Center conducts the first and only international exchange agency in the U.S. Legislative Branch and, as such, has enabled more than 16,500 current and future leaders from Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Ukraine, Tajikistan, and Turkmenistan to meaningfully engage and interact with Members of Congress, Congressional staff, and thousands of other Americans, many of whom are the delegates’ direct professional counterparts. Senator Frist served on the board of Open World from 2003 to 2010.

Prompted by Senator Bill Frist, M.D., Senator Lamar Alexander sent a request to James Billington, Chairman of the Board of Open World Leadership Center, to host a health exchange with Russian health professionals in the state of Tennessee. Dr. Billington responded in a Letter to Senator Alexander with enthusiasm:

“Having hosted nearly 400 Georgian, Kyrgyzstani, Russian, Ukrainian, and Uzbekistani participants—including health leaders—in Tennessee, Open World has an excellent statewide network of local host organizations and host families there. I am confident that, working with Senator Frist and his staff, you and your staff, and CSIS, Open World can carry out an exceptionally strong program on health care that will benefit both the Russian delegates and the participating Tennesseans.”

Open World agreed to provide nominations for the Russian delegates, and the Open World Moscow staff worked with the Administration of Kirov Region with approval of Governor Nikita Belykh.

High rates of communicable and chronic diseases, outdated medical equipment and facilities, and inadequate health care financing have contributed to a health care crisis in Russia. Open World provides grants for a Health Care Provision to address the issues relating to the delivery of services for patients with communicable or non-communicable diseases as well as at-risk individuals. Open World hopes that the outcome of this exchange is a medical partnership between the State of Tennessee and the Kirov Region.

Senator Frist has assisted directly in the organization of the statewide effort to place the Russian physicians in programs across Tennessee consistent with their interests in rural health, academic medicine, information technology, and health service delivery.

Senator Frist has had a longstanding commitment to “using health as a currency for peace.” Health care partnerships and exchanges of information provide powerful and robust contributions to diplomatic relations between the peoples of two countries. Such health diplomacy contributes to better understanding among nations and leads to dialogue in other spheres of human and government interaction. “Health as a currency for peace” allows individuals to be a part of missions greater than themselves and provides a way for America to begin to think about a long-term vision for building bridges of trust around the world, in both G8 nations as well as developing ones. Building Russian-U.S. collaboration in health care will benefit the foreign and public diplomacy of our nations and a better quality of life for the citizens of both nations.

Last week, the Russian delegates arrived and spent time with the Center for Strategic and International Studies, Kaiser Family Foundation, and National Institutes for Health in Washington, D.C. For the weekend, the delegates separated into two groups to tour both Knoxville and Memphis, Tennessee. In Knoxville, the delegates enjoyed a football game and other festivities and today they will visit De Royal Industries. In Memphis, the delegates visited St. Jude Children's Hospital, the National Civil Rights Museum and Beale Street over the weekend. Today, they will tour the Shelby County Health Department and Le Bonheur Children's Hospital. We are excited to host these health professionals in the State of Tennessee!

We will keep you apprised daily of their activities this week.

Lessons Learned in Kijabe

Wed, 12 Oct 2011 12:00:01 EST

by Sina Iranmanesh
Vanderbilt Department of Surgery, Resident
Kijabe, Kenya

No doubt, working at Kijabe is a once-in-a-lifetime experience. Upon setting foot on the dirt road leading to the hospital, I knew I would face many hurdles over the next four weeks as a general surgery resident. Over time, I appreciated subtle clues and changes in each patient’s physical exam to help guide the management of their care without relying on further information.

Lesson number two: I could no longer practice medicine ignoring the financial burden of my treatment plan. Practicing cost-conscious medicine was not just beneficial on a global sense, but specifically affected each family suffering from an economic crisis. Even worse, many treatment options (i.e., chemotherapy, radiation therapy, referrals to specialists) were physically or financially inaccessible by our patient population. For example, unlike women in the U.S. who had the option of a lumpectomy with radiation for breast cancer, our patients in Kijabe underwent a mastectomy because they could not afford radiation. I spent time counseling a young woman on her treatment options after removal of a large tumor from her thigh. I recommended radiation therapy to reduce the chance of the tumor returning, though she decided against it after discovering how much it would cost her. Such encounters were unfortunately fairly common.

In contrast to the philosophy of utilizing single-use, individually wrapped, and disposable equipment in Western operating rooms, Kijabe’s mantra of maximizing its very limited resources proved surprisingly effective. With the exception of our gloves, every piece of equipment used in the operating room (especially those labeled as ‘single-use’) had been routinely sterilized over and over again. I can only wonder what impact we can have on the US Healthcare Crisis if we learned a few lessons from Kijabe...

Kijabe is renowned for its level of care and medical education. As such, it is home to a number of visiting physicians of all levels of training. I felt fortunate to have encountered a number of these missionary physicians. My one-month commitment to work in an African hospital paled in comparison to individuals (and their families) who offered years of devotion. Working alongside such individuals was inspiring to say the least. I am grateful for the opportunity to experience medicine from a different angle, and the lessons I learned along the way.

Former U.S. Senator, Surgeon receives NBAA's 2011 Humanitarian Award

Mon, 10 Oct 2011 12:00:01 EST

Bill Frist Flies Missions Worldwide to Help Those in Need

Contact: Dan Hubbard, (202) 783-9360, dhubbard@nbaa.org

Washington, DC, August 22, 2011 – Esteemed doctor, pilot and former U.S. Senate Majority Leader Bill Frist has been awarded the National Business Aviation Association’s (NBAA’s) 2011 Al Ueltschi Award for Humanitarian Leadership in recognition of his life-saving efforts worldwide, and the importance of business aviation to those endeavors.

An accomplished medical researcher and heart transplant surgeon, Dr. Frist was elected to the Senate representing Tennessee in 1994, the first practicing physician elected to the lawmaking body since 1928. During his two terms in office, Frist rose to the majority leader position faster than any previous senator while spearheading efforts to improve medical access for Americans and others worldwide, notably leading on bills like the Medicare Modernization Act and the passage of the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR combats the spread of disease in resource-limited areas worldwide, and since its passage has provided life-saving anti-retroviral drug treatments to over 3.2 million people and counseling, testing and education to over 33 million to help prevent new infections. This ambitious program is often credited with saving a generation of Africans.

A true citizen-legislator, Frist has continued his regular medical mission trips worldwide since his retirement from the Senate in 2007. Frist – a pilot since the age of 16 and holder of multi-engine, commercial and instrument ratings – has consistently relied on aviation and his own piloting skills to expand his life-long commitment to healing to areas around the globe.

From using aviation night after night to personally transport hearts during his time-sensitive transplant procedures, to piloting planes throughout war-torn Sudan to perform surgery, Frist credits aviation as a powerful instrument for healing. Within days of the levees breaking in New Orleans after Hurricane Katrina, he flew his plane to care for those stranded. In flooded Bangladesh, he relied on floatplanes to ferry needed personnel and supplies on behalf of Save the Children and Samaritan’s Purse, and in 2010, he immediately flew to Haiti to perform surgery in the aftermath of the earthquake in Haiti.

“Bill Frist has combined his skill as an aviator with his expertise in medicine to reach people in need of life-saving treatment at home and all over the world,” said NBAA President and CEO Ed Bolen. “From piloting his own aircraft throughout Sudan to give surgical care, to using aviation to reach and treat victims days after the devastating earthquake in Haiti, the senator and doctor truly ‘walks the walk’ in assisting those most in need of help. He exemplifies the humanitarian spirit that’s always been a part of business aviation, and we are honored to recognize his pioneering work with this award.”

In his 2009 book Heart to Serve: The Passion to Bring Health, Hope, and Healing, Frist wrote about his belief that medicine unites the world in its common goal for peace. "People don't usually go to war against someone who helped save their children," he wrote. "While the world often sees America's tougher side...when people see America's more compassionate, humanitarian side, the barriers come down, and peace becomes a viable possibility."

Established in 2006, NBAA’s Al Ueltschi Award for Humanitarian Leadership recognizes the spirit of service demonstrated by humanitarian leaders within the business aviation community. The award is named for Albert L. Ueltschi, who was instrumental in the development of ORBIS, an international non-profit organization dedicated to preventing blindness and saving sight.

The award will be presented to Frist at the Opening General Session for NBAA’s 64th Annual Meeting & Convention (NBAA2011) in Las Vegas, scheduled for 8:30 a.m. on Monday, October 10, 2011. The full Convention will be held Monday, October 10 through Wednesday, October 12.

Past recipients of the Al Ueltschi Award for Humanitarian Leadership include Cessna Aircraft Company (2006), the Veterans Airlift Command (2007), Corporate Angel Network (2008), and the Civil Air Patrol (2009). Last year, the Association honored humanitarians throughout the business aviation community for their efforts in providing relief efforts following the earthquake that devastated Haiti in January 2010.

# # #

Founded in 1947 and based in Washington, DC, the National Business Aviation Association (NBAA) is the leading organization for companies that rely on general aviation aircraft to help make their businesses more efficient, productive and successful. The Association represents more than 8,000 companies and provides more than 100 products and services to the business aviation community, including the NBAA Annual Meeting & Convention, the world's largest civil aviation trade show. Learn more about NBAA at www.nbaa.org.

Members of the media may receive NBAA Press Releases immediately via e-mail. To subscribe to the NBAA Press Release e-mail list, submit the online form at www.nbaa.org/news/pr/subscribe.

Video: Senator Frist wins NBAA 2011 Humanitarian Award!

Mon, 10 Oct 2011 12:00:01 EST

Last Stops!: Closing down Water=Hope

Sat, 01 Oct 2011 12:00:01 EST

by Brande Jackson

After working with over 100 volunteers and getting 5000 new supporters for clean water initiatives, Water = Hope wrapped up another fun summer with the Brad Paisley H2O tour!

Our last weekend started out in rainy Philadelphia, where we were still able to have a great night - Philly was one of our best stops on the 2010 tour! - thanks to a hard working volunteer team that braved the elements to talk to fans and build support. We could not have done it without them!

The next day the tour stopped in Bristow, VA, outside of Washington DC. We were joined by a repeat volunteer, Ashley, who brought along her sister this time around, as well as a hardworking (and very funny!) father-daughter team, and two high school friends who were accompanied by mom. Our team did great, talking to hundreds of fans about the importance of clean water; in fact, two of our volunteers signed up over 300 people all on their own, a very impressive feat. And, for the first time in a looooong time, we had a show with no rain, a change we were very grateful for!

Raleigh was the final stop of the tour this year, and we were excited to wrap things up with a big volunteer crew of 10, including about five volunteers who were joining us for the second year in a row. They worked hard to help us end the tour on a great note.

All in all, it was an amazing summer full of incredible volunteers, supportive fans, and lots of love from the Brad Paisley crew. At the end of the day, going out on tour with an artist is really about the chance to use music as a connecting force, and we were reminded time and time again this summer of the compassionate nature of the country community. We are excited to see how many lives are impacted by the work of our volunteers and supporters from this summer!