Wednesday, December 5, 2012

Volunteer Reflections...

It’s been an amazing year! 

It goes without saying that we couldn’t have done it without all the wonderful volunteers who gave their time, talents, and resources so selflessly to make this year’s missions possible. In 2012, PULSE global health teams set out to 4 corners of the world. Upon their return, these were their reflections...

I was privileged to be asked to join the PULSE mission to Nepal in March this year. This mission involved teaching pediatric trained physicians to provide critical care services to children in Nepal. Although there are many very well trained pediatricians in Nepal, there are very few pediatricians who can provide lifesaving services to children who are critically ill.

I was both thrilled and apprehensive at the prospect of being part of the mission. But once we arrived in Kathmandu I was made to feel comfortable by their 
friendship towards us and eagerness to learn from us. The group of trainees that we interacted with came from different regions of Nepal, and represented various health care systems in Nepal. 

The enthusiasm demonstrated by the people we trained was tremendous. They were keen to learn and worked very hard to achieve skills that they could use in their day-to-day work caring for the children of Nepal.

I feel that this mission had a significant effect on me. It has made me think of the global health care issues facing children all over the world and the contributions I can make.

It has made me think of ways I can influence others in my profession to contribute towards health care for children in the rest of the world. I am grateful to PULSE for providing this opportunity and hope they will consider including me in their future missions.


At the end of the mission, I felt that the five days I had spent in Nepal had been the most fulfilling and satisfying experience 
of my professional life.

Suresh Havalad, MD, is Associate Professor of Pediatrics at the Chicago Medical School, North Chicago, IL and Division Director of Pediatric Critical Care Medicine at Advocate Lutheran General Children’s Hospital in Park Ridge, Illinois, USA

*To join our global health teams in 2013, please send an application request to or fill an online application and click to register your annual subscription.We look forward to working with you!

Sunday, March 18, 2012

The price of critical care

The practice of intensive care medicine is intuitively associated with the use of sophisticated and expensive machines.  In this context, the availability of such services would only be reserved for resource rich places.

A pediatric intensive care specialist returned to the United States after a two week mission in a field hospital in Haiti. Troubled by what he saw,    he shared his views with a prominent figure in the critical care medicine community on how to develop a better system of critical care for the children of Haiti.  The critical care expert replied "...the focus should be on clean water and vaccination."

Think about this, as long as there are hospitals, critically ill patients will exist, regardless of access to intensive care services. The same is true in resource limited countries.  The availability of technology or limitless resources does not define critical care medicine.  The larger questions to answer are: What is the appropriate level of intensive care that is applicable to a particular region?  What aspect of intensive care should be and can be delivered?  How do we prioritize the delivery of such services?

The advantages of critical care education of health care professionals in resource limited areas has many advantages: It enhances the perception of needs from the community, improves preventive measures and primary care efforts, boosts the confidence of health care professionals and dramatically decreases their "failure to rescue".  Training providers in the delivery of a higher acuity will improve the overall quality of care.  Curriculum developers need to think about  the opportunities for candidates to become versatile in both resource-rich and resource-poor settings. "A liberal is a person who believes that water can be made to run uphill.  A conservative is someone who believes everybody should pay for his own water.  I'm somewhere in between:  I believe water should be free, but that water flows downhill."   Theodore H. White.

To the question recently posed on our social media site "Is Intensive medical care for children in low-resource countries is dependent on technology that is relatively expensive (breathing machines, monitors) compared to preventive measures (vaccination , clean water)"  it is encouraging to know that the majority (53%) believe that it was equally important or not dependent at all.


Sunday, November 13, 2011

Are Children in Low-income Countries, Better-off if Modern-Western Health Care Were Brought to Them?

The results are in! PULSE values the participation of all who answered, followed and wrote their comments in support of an opinion on this issue. The majority of opinions (66.9% voted yes) in the latest poll (unscientific) posted on fb by PULSE is overwhelmingly in support of the obvious, an apparent conclusion that hardly needs to be stated. 

Indeed, the infant mortality is alarmingly higher in low-income countries in contrast to the good fortune of affluent nations.  However, there is great value in acknowledging the voice of descent (20.6% of responders voted no).  A simple transposition of modern health care supposedly negates the valuable local traditions that prevent diseases and cure the sick and injured. These traditions in some instances have long pre-dated modern health care.

According to Garth Osborn and Patricia Ohmans[1] "Promoting western style health care as the only alternative to local beliefs and practices can be the surest way of killing a project before it gets started.  Many of the most effective global health projects have blended approaches and beliefs rather than trying to replace them.”

Acacia Xanthophloea: 
Roots used for treatment of stomach ache, 
bark for treatment of fevers and eye complaints.
Settlers eronously associated  the tree with 
Malaria.  The tree grows in swampy areas
where mosquitoes can thrive.

Do you still believe that most people in developing countries want and need modern western health care?

[1] Book: G. Osborn, P. Ohmans, Finding Work in Global Health, Health Advocates Press, 2005, "Top ten global health myths".  This book is promoted as a practical guide by the president and CEO of the global Health Council, Nils Daulaires, MD, MPH as "This is a terrific place to start". 

Review Poll Results or Weigh in Here...

Saturday, October 1, 2011

PULSE A Global Health Agent

Year One Anniversary Statement

During the last decades, the world has woken up to realize that we live in a global economy.  After the bust of the housing bubble, no one can ignore the fact that the greed of investors coupled with the naiveté in chasing the American dream of owning a home was at the origin of the global financial meltdown of 2008.  More recently, the debt woes of a lesser economy in Greece is threatening the return to another recession.

The healthcare sector in the US seems to be the go-to area for securing a job during this time of uncertainty and high unemployment.  Without going into the details of healthcare reform and the threat of repealing Obamacare, the landscape is ever-changing while stakeholders are poised to minimize their losses in an era    where super-capitalism is the only winning option.  Yes, it is a changing world and the international health  community must find ways to secure a better future.  We think of a global economy; likewise, health care must not be less regarded.

Global health work is no longer an issue of humanitarian missions or just a token for social corporate responsibility.  A rebuilding nation, Liberia, has found new meaning in the commitment to social contract by investing in universal health care for liberians.  Since then, the Liberian government has gained the trust of international support [1].  No longer should we be satisfied, counting a list of accomplished international missions. but rather direct the energy towards accomplishing the healthcare related millennium development Goals (MDG) launched by the UN more than 20 years ago.  Some measure of successes has been reached but much more needs to be done. 

PULSE, a group of global health-minded individuals adopted these concept goals and aligned themselves to play their role for a ‘healthier future in a changing world’, particularly in low income-countries.  PULSEans take the challenge of the UN to end poverty in 2015 with the Millenium Development Goals (MDG). Of the eight, we embrace goal #4 [Child Health] as a global health initiative, believing that we can make a difference by addressing health inequalities, increasing access to healthcare, forming partnerships with multiple sectors, building and strengthening local capacity and promoting sustainability.  Here are some of the bold efforts in which you can join our mission to make this goal achievable.

Saturday, June 4, 2011

Worlds of Medicine

She was an aged woman, in the dusk of her life. She lived all her life in a small village, away from the bustle and hustle of the major city, though the city was only half an hour away from the village center. She took pride in her livelihood, having raised her children with almost no income, and grown her own food and tendered to the livestock she had.

Being away from the city or village center also meant being away from health care. She first noticed a blister on her right hand, which she cleaned whenever she remembered. She went on with her daily chores, and the issues of life that consumed her. But the area of blistering did not go away. In fact, over weeks, it grew ferociously and her hand was becoming non-functional. There were fields to be tended to, children to be fed, clothes to be washed, goats to be milked; and on went the list of things to be done.

Until one day she realized that she was in grave danger of losing the hand that had fed her family. She made the journey to the small village clinic. The nurse took one look at the hand, and told her that it was too far gone- the hand would be amputated. Her right hand.

But being in the city center did not mean that adequate medical care was available to you, as a young mother found out at the country’s premier medical center. Her child had been born without event, and he had been growing well until he was a few months old. Suddenly, he seemed not to be able to feed well, and he would turn a dark shade whenever he exerted himself. She brought him to the hospital, only to be told her beloved son had a heart malformation that would need open heart surgery, the kind that could not be performed in the country. He would have to get to a neighboring country with that capability so she applied for a passport for him to travel. As she walked into the pediatric ward from the immigration department, she noted that the bed her son had laid in was empty; and instantly she knew. He was gone. The weight of her loss hit her as she slumped to the floor. Children were not supposed to die.

But she was not the only mother that was covered in sorrow. There was wailing from a mother who had lost her child to Cryptococcal meningitis and full blown AIDS. Yet another child lost their life to tuberculosis. It seemed that death resided here, and life did not peek its face in that ward often enough.

While preserving life is a task essential to the medical staff’s purpose. Success at this task however, seemed elusive, for various reasons. To begin with, the facility they worked in lacked so much. There was very little for monitoring patients. The patient in heart or respiratory failure could deteriorate over hours, and seem to die suddenly because predicting catastrophic events was challenging. There are no isolation rooms. Patients with tuberculosis and cancer were on the same ward, and infectious diseases roamed rampant, passed on freely from child to child. Equipment was lacking (no positive pressure ventilation bags at every bedside) and very few oxygen sources in the ward.
As a trainee in Pediatric Critical Care, caring for the sick and dying child became my area of expertise. Children here in America are not allowed to die without a fight for their lives- no matter what the disease process or their prognosis. The lives of children are preserved with the help of accessible monitoring, machinery, medications, resources and trained personnel. Even the most dire of circumstances is addressed with a flurry of medical attempts in the face of futility. There is no life too insignificant. It is a system that is constantly seeking new and innovative ways to predict changes in the medical status of patients, and improve ways to manage disease. There is a wealth of medical therapy, progressive research and evidence-based medicine by which we base our medical practice on. Our patients get the privilege of para-medical services such as Child Life Specialists, Physiotherapists, Nutritionists, and Social Workers… And so on the list goes.
When compared to the affluence of Western Medicine, the paucity of such services in the Developing World is alarming, even discouraging. Many commodities that we take fore granted as standard of care in the Western World, are yet to be instated in the Developing World. Education is perhaps the first step in moving towards improving outcomes for acutely ill children, addressing cultural biases that diminish the the value of children, and then on to assessment, treatment and management of the sick child. Basic and Pediatric Advanced Life Support strategies are vital to optimal survival in the management of pediatric conditions, and with increased awareness of these strategies, great strides can be made towards improving pediatric health care in the Developing World. Lastly, by incorporating adaptable technologies to sustain the advancement of medical care.
However the myriad of complex and exorbitant machinery available to the West are not what is necessary, but sturdy and indispensable accessories to sound professional medical judgment that aid in accurate diagnosis and patient treatment. There is no substitute for access to medical care; patients need to be able to get to where they can receive advanced care for any effective improvement in outcomes. We have much to learn from pediatric medical practice in the developing world, and vice versa. Only the sharing of knowledge and a partnership of minds and technology between our worlds can do wonders to improve the lives of children.

 Unami Mulale, M.D. is a Pediatric Intensivist in the Greater New York Area who is passionate about seeing the lives of children changed for the better both through improved medical care and social justice.

Sunday, April 17, 2011

PULSE Reaches Out To A Small Town in Rural Kenya...

In March 2011, we visited the Bishop Kioko Catholic hospital in Machakos, Kenya. Our objective in Machakos was to formalize a commitment between PULSE and the hospital to develop it's pediatric services to include a newly established Newborn Nursery and Neonatal Unit, as well as a Pediatric Intensive Care Unit. These new services will offer advanced medical care for acute and critically-ill children who need emergent treatment. We envision a Neonatal Unit which is capable of caring for well newborns and premature babies who need monitoring, special nursing care, and breathing support to allow their tiny lungs to heal and mature. This mission trip allowed me to reflect on my hometown's history, which is not without setbacks and challenges, and tiny victories. 

Machakos District is located in the Eastern province of Kenya, just 68 km (42 mi) southeast of Nairobi.  Machakos or Masaku, as it is named after an Akamba Chief, is predominantly home to the Akamba people and was the first administrative capital for the British colony before Kenya’s capital was moved to Nairobi in 1889, because Machakos was bypassed by the Kenya-Uganda railway. The climate is semi-arid and the terrain is hilly, with patches of stark green cliffs 
and maize-covered hills that rise everywhere. 

The people depend heavily on small scale agriculture for subsistence however, the area has been hard hit by drought and famine for several years.  Historically, the Akamba have learned to weather their terrain through utilizing very scanty amounts of rain to farm by small-scale terracing and irrigation techniques learned by Akamba soldiers sent to fight in India during World War II. They successfully turned around the food situation that it came to be known as the “Machakos Miracle”. 

Machakos has a rich culture of arts and crafts and is home to Wamunyu, the birthplace of the modern Kamba-carving industry. It is unlikely that a tourist has ever left Kenya without a souvenir carved piece that has come to be synonymous with Kenyan art.  At Wamunyu, it is believed that about 3000 workmen and women, and sometimes children, participate in the self-help and cooperative carver’s society that create this world famous art. However the existence of a middleman in selling their products has prevented 
the carver societies from establishing sustainable wealth.

Machakos is also home to the longest serving Catholic Bishop, the late Bishop Urbanus Joseph Kioko. Bishop Kioko began a life of service in the Catholic priesthood in 1961,became an ordained bishop in 1973, and passed away on March 2, 2008 leaving behind a rich legacy of service to the Kenyan people. He was known as an activist for peace, and lived a life of simplicity and humility. The naming of the hospital pays tribute to man of God, and a man of service who was affectionately known as the "People's Bishop."

The Hospital is a 125 bed facility which currently operates at 60 % of capacity, offering 24 hr outpatient and inpatient services which includes a pediatric ward, labor and delivery ward, and antenatal services. It warmed our hearts to receive smiles from many pediatric patients who were recovering well from their illnesses and close to discharge. However, there are two sides to any coin and we were struck by the children who required advanced care (in a small burn unit) but could not receive it due to lack of equipment, specialist pediatric consultation and limited finances. The hospital’s modern appeal and pristine maintenance uplifted us. The hospital staff clearly take pride in their facilities and aspire to provide excellent service to the surrounding community. 

We listened to candid accounts of their experience with sick, premature infants delivered at the hospital, who often times are transferred without the accompanying mother to not-so-nearby facilities. It may be a short ambulance ride to the more technologically advanced facility, however for the technologically-dependent baby, it is often too far and too late in getting there. There are simple methods to avoid this transfer and we believe through training medical and nursing staff to be Neonatal Resuscitation Providers according to internationally accepted guidelines, and equipping them with patient monitoring and equipment for neonatal resuscitation, and the Bubble CPAP system which is a low tech, cost effective device which provides  non invasive respiratory support to premature infants,  we could provide babies with otherwise dire circumstances a fighting chance at survival, within close proximity of their mothers for nursing and bonding.

We anticipate the installation of computer equipment to support a telemedicine system which will allow Pediatric Intensivists who are PULSE volunteers within the United States to lend their expertise in real-time consultation with local physicians and nurses on-location in Machakos in managing critically-ill infants and children.

PULSE team with Bishop M. Kivuva
The history of Machakos and it’s people is one of resilience and self –help in overcoming obstacles, creativity and ingenuity. We believe that under the leadership and guidance of the Bishop of Machakos, collaboration with hospital administration and able staff, we can create a pediatric unit that will cater to the acute healthcare needs of children in the region, and dramatically improve outcomes. 

Here's how you can help. With your donation will we equip the hospital with the necessary equipment to begin helping babies breathe a little easier, and continue to train physicians and nurses in caring for those children with critical illness.


Saturday, January 29, 2011

A Heartfelt Message to Volunteers to Haiti, One Year after Haiti's Devastating Earthquake

We are in January 2011. While the devastating earthquake of January 12, 2010 is already one year old, the enormous task of  reconstruction has not yet started. Until this moment, signs of improvement are very little.

Most of the homeless are still living under tents here and there in the open spaces. The deposed families are waiting for jobs to be rehabilitated in the society with dignity.

Health care is poorly taken care of. Many parents died as a result of the earthquake. Orphaned children and youth are waiting for helping hands. Many are sick, hungry, handicapped, disabled physically and mentally.

The living conditions of the victims of January 12, 2010 is a public scandal and a shame for all Haitians. The basic needs of the people need to be met as soon as possible to avoid future calamities. What can be done for a better living? There is still so much work to be done. 

First, Leadership and team work are essential to face this challenge. It is to be hoped that in the very near future in a combined effort of the Haitian people and the international community a solution can be found to improve the living conditions for the victims of January 12, 2010. 

Allow me to propose a list of recommendations to the international helping hands and volunteers. 
  1. Listen to the voice of the needy
  2. Recognize the capacity and the dignity of the local Haitians 
  3. Pay attention to ideas coming from the experiences of the local staff 
  4. Pay attention to the individual differences between the nationals
  5. Transfer your skill and technology, but avoid creating culture shock by misunderstanding their expertise
  6. Control with accuracy all equipment, materials and resources brought for the realization of your goal
  7. Canalize with efficacy all national and international forces in order to reach your goals
  8. Foster a positive attitude with your interventions
  9. Be guided by your vision in each step of the implementation of your plan 
  10. Develop faith in the accomplishment of your mission. 

Saint-Louis Pierre, Pastor
SDA Haitian Union Mission
Director, Publishing Ministries
President, Commission of Coordination of Plans and Projects