Reflecting and Returning to Oakland

Editor’s note: Umma Amina, RN, is a nurse at Kaiser Permanente Oakland Medical Center. She volunteers with the Glens Falls Medical Mission Foundation, which since 1996 has served the needs of underrepresented populations in Guatemala. She returned to Guatemala this month and sent this dispatch on April 16.

The mission has ended, but the feeling of compassion, gratitude and healing lives on and I am forever grateful for the experiences this mission gives me.Umma1

Each year upon returning from Guatemala there is a slight culture shock that occurs. I walk into my closet and see an abundance of shoes. Why do I have five  pairs of black shoes and some of my patients in Guatemala have no shoes?

I turn on the faucet and have an abundance of water. Why do I have so much clean water and some of my patient’s in Guatemala have no access to clean water?

Umma2I walk into work at Kaiser Permanente in Oakland and have access to an abundance of medical equipment, medical technology and medical personnel who provide high quality medical care. This is why I go to Guatemala: because I am thankful and so blessed to live and be where I am that I feel compelled to help those who do not have access to medical care.

I look forward to Spring 2014 and more time with the beautiful people of Guatemala. Muchas Gracias for reading this blog…Umma3

” Yesterday is gone. Tomorrow has not yet come. We only have today. Let us begin.”
-Mother Teresa

Bananas, Boots, Blessings

Editor’s note: Umma Amina, RN, is a nurse at Kaiser Permanente Oakland Medical Center. She volunteers with the Glens Falls Medical Mission Foundation, which since 1996 has served the needs of underrepresented populations in Guatemala. She returned to Guatemala this month and sent this dispatch on April 16.

Midweek and we are seeing a minor epidemic of varicella from the people of Ojo

Two boys healing from chicken pox and ready to roll with their new cars

Two boys healing from chicken pox and ready to roll with their new cars.

de Agua. Most of the patients have healing or healed scabs, so for the team this is a good time to see them as they are no longer contagious. For the patients, this is a huge relief to know the worst is over with. All they require now is supportive care of the scabs with simple remedies such as hydro-cortisone ointment.

After seeing patients for their chickenpox issues and giving them medications for the next six months until the fall mission arrives, we slowly move our gaze to their feet to offer them a pair of shoes. Sometimes they will timidly ask for shoes. We take the patient back to the “Zapatos Corner,” where they shyly choose a pair of shoes for themselves and as many family members as they like.

After saying our goodbyes and handing them their medications and shoes, one

Dr. Robinson after treating a family and a very cute little girl looking at her new shoes

Dr. Robinson after treating a family and a very cute little girl looking at her new shoes.

sweet woman gifted us bananas from her farm in exchange for our services.  At this moment compassion, humility and gratitude transcended the barriers of race, religion, socioeconomic divide and nationality. A blessing emerges in this exchange. It’s remarkable for both our souls: For us to be able to provide western medical healing and for her to be able to provide us with a soul healing via experiencing the true nature of humanness through the qualities of compassion, humility and gratitude.

The bananas were delicious and a welcomed daily snack for me!

Special Thanks to my friend Saena for donating shoes and Doctors  Joanne and David Robinson for bringing themselves (for the past 9 years!) and the donated shoes to the clinic in Nueva Santa Rosa.

A little girl plays with her new doll

A little girl plays with her new doll

UmmaAmina3-3

Me and our gracious Guatemalan Volunteer Vincente.

Me and our gracious Guatemalan Volunteer Vincente.

In Jumaytepeque, a Community of Love and Compassion Seeks Access to Health Care

Editor’s note: Umma Amina, RN, is a nurse at Kaiser Permanente Oakland Medical Center. She volunteers with the Glens Falls Medical Mission Foundation, which since 1996 has served the needs of underrepresented populations in Guatemala. She returned to Guatemala this month and sent this dispatch on April 16.

Day two and we are working from 8:00 a.m. to 8:00 p.m.

Although the hours are long, the time is so worth the effort for the people of this Umma2area. We have seen everything from simple headaches due to working in the coffee plantations for long hours to rare congenital anomalies. What impresses me most is the capacity of love for one another in a community setting. One patient will bring her five children and the children of her neighbor from a volcanic village such as Jumaytepeque to be seen. Neighborly love goes such a long way when you bring your neighbors’ sick child to be seen as they are busy working.

I also had the privilege of meeting 100 year-old midwife who delivered nine babies this month in her volunteer position, and is expecting to deliver 10 more-Umma1-just this month. The spirit and dedication of these women impresses me so greatly as they have no financial gain from the births they attend, as they voluntarily fill this great need in their community out of love and compassion for their fellow humans.

Umma3

To Recognize National Doctors’ Day, An Interview with Hernando Garzon, MD

Saturday, March 30, is National Doctors’ Day. Since this blog was created to share our caregivers’ thoughts about their relief missions worldwide, it’s appropriate for National Doctors’ Day to recall the work many of them do abroad on their own time, serving populations after natural and manmade disasters.

One of the physicians who knows this work best is Hernando Garzon, MD. Dr.

Arif Seyal, MD, provides assistance to a mother and child.

Arif Seyal, MD, provides assistance to a mother and child.

Garzon is the director of Kaiser Permanente Global Health Programs, an emergency room physician at Kaiser Permanente Sacramento (Calif.) Medical Center, and the medical director of Sacramento County Emergency Medical Services.

Dr. Garzon was among the first physicians on the ground in Haiti following the 7.0 earthquake in January 2010 that left more than 220,000 dead. His initial dispatches from Port-au-Prince formed the basis of the “Dispatches From Haiti” blog, from which this blog is derived.

Dr. Garzon joined The Permanente Medical Group in 1992 and, three years later, was dispatched with a search and rescue team to the bombing of the Alfred R. Murrah Federal Building in Oklahoma City, in which 168 people were killed. Dr. Garzon’s relief missions have taken him from New Orleans (Hurricane Katrina) to Myanmar (Cyclone Nargis), and many places in between.

He sat down for this interview in late March, just weeks prior to departing for a mission to Central America. He talked about what Kaiser Permanente caregivers’ relief efforts abroad mean to both the populations served and the people of Kaiser Permanente who volunteer.

In your experience, what roles do doctors play in disaster relief efforts beyond providing medical care?

During relief efforts, people may come for medical attention and also ask, “Can you help me find my cousin?” or, “Can you help me find my sister?” In

Hernando Garzon, MD, helps out with relief efforts in Peru.

Hernando Garzon, MD, helps out with relief efforts in Peru.

the spirit of humanitarian relief, we do whatever we can. Frequently, we build contacts with not just the health care, but everything else. Depending on the organization we work with we get involved with other programs—water sanitation, distribution of non-food items, those sorts of things. We try to meet the other needs as well. Every disaster has been different.

During the earthquake in Pakistan in 2005, I felt very much like an ambassador for the United States. Pakistanis were shocked that we would come to help them. So we also serve a peace-building, ambassador-type of role.

What and when was your first disaster relief mission?

I joined Urban Search and Rescue when I started working for Kaiser Permanente. The first major deployment was the Oklahoma City bombing in April 1995. The search and rescue system had been designed to respond to earthquakes—we weren’t thinking at the time about terrorism, but it turned out that was the first response we did. I was very much a novice to the whole idea of disaster response to begin with. The thing that made Oklahoma hard for all of our rescuers was that it wasn’t a natural disaster, it was a man-made disaster. We tried to come to grips with what it would be like to go though the devastation. We were one of the first teams in before the sunset on that day. We spent essentially three weeks there going through the rubble.

What made you volunteer again?

I’ve certainly been to bigger events [than the Oklahoma City bombing], including 9/11 and evacuating New Orleans. But Oklahoma City has had the most impact on me. I realized then that we were serving a very vital function to help a community in crisis deal with the aftermath of the terrorist event and what an important role the Urban Search and Rescue system played.

 In your relief missions you often work side-by-side with physicians in host countries, and doctors from around the world. What have you learned from those experiences, both in the practice of medicine and as it regards our cultural differences?

It’s really fascinating. You can’t separate the cultural differences and the cultures they’re from and the practice of medicine. There’s definitely a kinship and a camaraderie when you’re there working alongside local health care providers.

Usually the American healthcare providers that come along for these events have so much more training than our international counterparts. They frequently look to us as the experts. We may have more years of residency training, but most of our people aren’t familiar with the environment they’re going into. We have less experience dealing with tropical disease. It’s usually a wonderful working relationship – they want to learn from us and work alongside us, and we learn from them.

What value do you think our caregivers bring back from relief missions abroad? Do you see your colleagues working differently or viewing the world differently after they return, and if so, how does that benefit their practice and Kaiser Permanente?

What each person takes away is really quite personal. I did exit interviews for all who went to Haiti. I was very surprised when I asked them how the experience was and the first 10 of 12 said it was life-changing. That was a universal experience for them.

For myself, it has changed not only the person I am but the way I do my work. I have a very different and deeper kind of compassion for my patients. I think it’s very much reaffirming for why we went into health care—to take care of people.

Editor’s note: While difficult to spotlight any single caregiver’s dispatches, we’ve gathered a few here that we think represent the spirit with which Dr. Garzon saluted his fellow Kaiser Permanente caregivers and their contributions:

Vivian Reyes, MD

Suzy Fitzgerald, MD

Mary Sue Carlson, MD

Jay Bachicha, MD

What is it like leaving a disaster relief site?

The thing that always defines the end of those missions is that it’s always very bittersweet and very surreal. I think on one level many of us—myself I know for certain—are ready to go home after we’ve worked two, three, four weeks 24/7 in the intensity of a disaster situation. We’re spent. We’re ready to rest and relax and see family again and have some elements of normalcy. But frequently it’s very hard to let go when you know the need is so great. As hard as we work as individuals, we’re still a drop in a much larger ocean.

Many of our volunteers have returned to Haiti. They’ve gone back to help in other ways after the earthquake. They’ve built upon the work they did there the first time.

Do you have any plans to volunteer abroad this year?

I’ve planned a trip to Honduras in April and May. I’m hoping to end up back in Burma at the end of the year. That will be my second trip in two years there.

Scales, Shoes and Smiles — Umma Amina, RN, Returns to Guatemala

  Editor’s note: Umma Amina, RN, is a nurse at Kaiser Permanente Oakland Medical Center. She volunteers with the Glens Falls Medical Mission Foundation, which since 1996 has served the needs of underrepresented populations in Guatemala. She is preparing to return to Guatemala this spring and provided this dispatch prior to her mission.

Looking forward to going back to Guatemala with the Glens Falls
Medical Mission. We will be starting IVs, eating warm tortillas, pulling rotten teeth, holding fresh babes, dispensing rehydration salts and reflecting.

We are a team of 40 doctors, nurses, interpreters and happy volunteers.
We see an average of 90 people per clinic per day in our five clinics:
general medicine, pediatrics, women’s, dentistry, and triage.

A scale is a major tool to diagnose general health.
In the past the towns of Cuilapa, Barbarena and Nueva Santa Rosa
population seemed healthier as they weigh the same or more.
In the poorer villages — Jumaytepeque, Cacoltapeque, Ojo de Agua, Monte
Verde — populations are usually not thriving as they have lost weight
and there are more cases of malnutrition in their babies and children.

As a rule of thumb we can tell who is poor, very poor and very, very
poor by looking at their feet; the condition of the their shoes if the
shoes fit, if a child is wearing his mother’s shoes or if they have bare
feet. Often they will borrow outfits or wear their nicest
clothes to see us.

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The smiles, gratitude and love we see from a poor barefoot
pregnant woman who is gifted a bag of baby clothes, or a child who is
given a gummy vitamin & toy, is priceless.

I am honored to be going back this spring to spend a week in the
company of such gracious beings.

Not Goodbye, but Until We Meet Again, Haiti

Editor’s note: This is Dinah Waldsmith Dittman’s fourth and final dispatch from Haiti, where she and Raymond J. Baxter, PhD, senior vice president for community benefit, health policy and research, traveled  for the opening of a new Ministry of Public Health and Population building in Port-au-Prince.

Tuesday, February 26, 2013

This is the day that we say farewell, or actually “Au Revoir” (“until we meet again” in French), to Haiti.

A few of the lasting impressions for me have been:

  • The graciousness of the Haitian people we’ve met; it’s clear that they are accustomed to working in community to get things done, and that good manners are important to them.
  • The bonds that people have with the place and its people, while in Haiti and coming/going in the airports, we saw many groups of volunteers and missionaries who have been making regular trips to Haiti to help in various ways (building houses, teaching children, providing health care in remote areas) as well as people who started coming after the earthquake and “got hooked on helping”, as one of them said.
  • The size of the challenge of prudently using the financial support that was pledged to Haiti from all around the world, when there are many competing needs and much to be agreed upon.
  • The importance of understanding the culture and the history when looking at the present. One of the CDC leaders, who has served in public health positions in many countries around the world, gave a brief history to those of us traveling in the van with him yesterday. The historical agreements that leaders of Haiti made with France, regarding ending slavery and breaking up plantations into small farms, shaped the current society, including some of the issues that Haitians struggle with.

I knew this before going to Haiti, but the trip reminded me….. We have much in common with each other. We discover more about the world and its people  if we are willing to let go of assumptions, be compassionate, and try to connect with each another.

Au revoir!

At Last: Opening a New Building for Health in Haiti

Monday, Feb. 25

This is the day we’ve been waiting for – when we get to meet the Minister of Public Health and Population and see the new building!

The day started bright and early and was on a fast-paced schedule throughout. We had a briefing from CDC Foundation staff at an outdoor buffet breakfast – even at 7 a.m., it’s warm in Haiti! I tried a local favorite of hot dark chocolate blended with coffee; it was delicious.

Well-briefed and well-fed, we boarded the vehicles with local drivers (a must for visitors, between the heavy traffic and the vague traffic rules, it’s best to leave the driving to the Haitians), and headed across town to the site of the new MSPP building.

We were welcomed by Dr. Florence Guillaume, a warm and gracious woman who is clearly deeply committed to improving access to care and the general health of the Haitian public.

She told us about her “promise to God” that she would do her job well and take care of the people. Already, she’s been making progress in maternal health and getting many more people into HIV-AIDS treatment and care. She talked about her plans to prevent cholera, a disease that showed up in Haiti after the earthquake and took many peoples’ lives. And she spoke at some length , along with partners from the CDC, about the work underway to assess and work on decreasing  violence against children in the country.

There was an official ceremony of the deed to the building being signed over to the Ministry, followed by giving her the keys to the building and cutting a big purple ribbon (she saved the bow to hang on the wall in her office). We had lots of photos, and I gave her a Kaiser Permanente tote bag (one of the colorful laminated fruit and veggie totes) that had a little bag inside it with a KP eco-friendly pen and pencil, a packet of sunscreen and a tube of lip balm, along with a  “Thrive” handheld fan – very useful in a tropical climate! We left a supply of these gifts for her to give the MSPP employees when they move into their new office space in a few weeks.

After that, we went for a tour, dedication and press conference to the Haiti National Laboratory, which is also housed in two modular buildings designed and built by the same company, Proteus On Demand, that built the MSPP building. Their buildings come equipped with furniture, mechanical and electrical systems, computer wiring and office furniture, which is a major advantage in these rebuilding situations.

The late afternoon was spent in briefings with CDC staff, bringing us up to date on the work that they are doing, partnering and providing technical assistance to the MSPP, and also in partnership with USAID and the United Nations. The people who work for CDC are really an impressive group; very smart and committed, and genuinely nice people who care about health around the world. It was clear that these folks enjoyed working with one another, weren’t put off by a challenge or a change in plans, and that they are in this work for the long haul.

The people of Haiti are industrious and resilient. We look forward to hearing about the progress that they are determined to make to improve their health and economic well-being in the years to come.