DENTAL REPORT:

IRADJ SOOUDI, DMD, VOLUNTEER

A dental chair and unit as well as many small pieces of equipment and10 medium size boxes of dental supplies was shipped to Granada prior to our arrival.

4 high speed hand pieces belong to the dental clinic that I had brought back to Birmingham last year for repair were returned to the clinic.

I took 2 high speed as well as a slow speed in this trip and left it there for use.

I was assisted by 2 young dentist who also did a great job as for the dental services and Translators. They were:

Dr.Tamara Carolina Arouz  Garoa

Dr.Karla Lucia Chavez.

Clinic Staff:

Dr. Noel Lopez

Dr.Ivania Mendez Bermudez.

Delmidel Rosario Murrilo (dental assistant).

GASTROENTEROLOGY,

ROGER CARLISLE, MD.  VISITING VOLUNTEER

I was training Dr. Audry Sanchez, and did consultations for Dr. Rosenberg Duarte and Dr. Gillermo Gomez.

On February 7 I did 5 endoscopies , one esophageal banding and one esophageal dilation.

In the afternoons I worked in the Alabama Granada Clinica seeing a total of 46 patients

On February  8 while training Dr. Audry Sanchez, who is learning to do endoscopy, I saw 3 cases of upper GI bleeding, 2 cases of GI bleeding, one rectal mass, 2 cases of LLQ pain, and 3 cases of epigastric pain.  They did 7 upper endoscopies and 2 colonoscopies.

February 9  while training Dr. Sanchez and Dr. Roberto Balladares, they did 6 endoscopies, one colonoscopy  and one flex for cancer screening.  They had 2 cases of esophageal varices and one hiatus hernia and one hemtemesis.

February 10, while training Dr. Sanchez,  they did 5 endoscopy cases.  They had 5 cases of acid reflux esophagitis, one colonoscopy case for GI bleeding.

February 11 there were major problems.  The power failed and caused the monitors to turn off and on 30x per minute for 20 minutes. Power surges knocked out both monitors.  They lost two hours.    They were able to do 4 cases, 2 endoscopies and 2 colonoscopies. Much time was spent with Dr. Sanchez.  He returned to the states with 2 broken endoscopes and one broken colonoscope.  After returning I reported an email that told me the monitors had been repaired.  However, I do not recommend taking more equipment before surge protectors are provided.

OBSTETRICS AND GYNECOLOGY FEBRUARY 2011 REPORT,

SIREESHA REDDY, M.D., LEADER, CHIEF OF GENERAL GYNECOLOGY, UNIVERSITY OF ROCHESTER, DANIELLE PATTERSON, M.D., UROGYNECOLOGIST U. OF MASSACHUSSETTS,  CYNTHIA BRENNAN, RN,BSN, ROBOTICS DIRECTOR BROOKWOOD HOSPITAL BIRMINGHAM,ALABAMA, ELISE SIMONS, M.D., FOURTH YEAR OB/GYN RESIDENT  UNIVERSITY OF ROCHESTER AND BEGINNING FELLOWSHIP STANDFORD UNIVERSITY, PALO ALTO, CALIFORNIA

The team’s major goal was to establish a relationship with the Nicaraguan ob/gyn’s at the Hospital Amistad Japon Hospital, participate in surgeries and see patients in the clinic.  The team brought medications (a few examples: oral contraceptive pills, hormonal therapy, urogynecology medications, oral  and topical antibiotics, injectable anesthetics (local), pain medications (mostly NSAIDS), injectable steroids, potassium hydroxide solution, trichloracetic acid).  Team also brought urinary slings, pessaries, biopsy instruments, syringes, needles, surgical instruments (scalpels, scissors, forceps, keyes punch biopsy, vaginal assisted vacuum suction devices, surgical drapes, lap pads, bovie pads.

This year we participated in surgical cases with the Nicaraguan obstetrician and gynecologists.  We had the pleasure of beginning a relationship with DR. ERIKHA CASTILLO, the chief of the gynecology division of the Hospital Amistad Japon Nicaragua.  The procedures included cesarean sections, vacuum assisted vaginal deliveries, tubal ligations and total vaginal hysterectomy with anterior and posterior colporrhaphy.  The remainder of the time was spent in clinic seeing patients.  We also participated in cases with DRS. HERNANDEZ AND QUIJANO.  They were very open to suggestions.  We were able to teach them the use of vacuum assisted devices on vaginal deliveries and on cesarean deliveries. 

We were able to see, perform a preoperative evaluation on a patient and take her to the operating room to perform a colpocleisis.  Dr. Patterson performed this surgery with the assistance and interpretation by Ericka Gingerich, one of the RNs from Birmingham.

This year we saw patients in Christ the Healer clinic that is managed by ADELA LACAYO AND THELMA CHAMORA, our Nicaraguan volunteers and interpreters and limited experience at the Hospital Amistad Japon Nicaragua.  Our experience in the clinic was such that patients were evaluated for routine gyn care and specific gyn complaints.  APPROXIMATELY 175 PATIENTS WERE SEEN.  We diagnosed incidental pregnancies, urinary incontinence, UTIs, PID, pelvic prolapse, depression, chronic renal insufficiency, menopausal symptoms, vaginitis, uterine fibroids, ovarian cysts, and dysmenorrhea.  

Our goal for the following year will be to arrive a week earlier, emphasis on surgical aspects of patient care and continue routine care as well.  We were able to confirm the commitment with the medical director of the Hospital de Japon and will continue the planning throughout this year.

Ernesto Quijano Lesage14 de febrero de 2011 a las 20:56 On Facebook

hola Dra Patterson gracias por acompañarnos en las cirugias, con su habilidad se miraba todo facil, las pacientes evolucionaron muy bien, esperamos el proximo año nos acompañe aviseme con tiempo para buscar mas casos que nos permitan aprender de usted e intercambiar experiencias. A mi me gusta un poco mas la laparoscopia y estoy viendo donde la estudio pero no soy nada bueno con el ingles entrare en una escuela a aprenderlo primero o estudiare en un pais de habla español como mexico, españa o cuba. Bueno cuidese la esperamos pronto.Dr Ernesto Quijano.

OPHTHALMOLOGY

MICHAEL CALLAHAN, MD,   LEADER

JOHN PARKER, MD, MARK DRABKIN, MD

ANESTHESIA

JAMES RUDULPH, MD, JERALD CLANTON, MD

WILLIAM HOOGLAND, CRNA

ERICA GINGERICH, RN TRANSLATOR, LAURA CANTERA, TRANSLATOR

LYNN GUZMAN, DID ALL EYE MEASUREMENTS

ON SATURDAY 150 CLINIC CASES WERE SEEN, MONDAY THROUGH FRIDAY ABOUT 100 WERE SEEN

A total of 56 surgeries were done.

Dr. Callahan did 10 strabismus,  Dr. Parker did 5 cornea transplants, the remainder of 41 procedures were cataract surgeries.  Dr. Drabkin worked in teaching Dr. Johana Ramirez, the Nicaraguan Ophthalmologist. Under his tutelage, Dr. Ramirez did 9 cataract surgeries.  There was also one (1)amniotic membrane. 

ORTHOPAEDICS

MICHAEL BRAGER, MD

ELIE KHOURY, MD

Orthopedics performed 6 surgeries at HOSPITAL AMISTED JAPON NICARAGUA  and MILITARY HOSPITAL.  We visited CALDERON HOSPITAL in Managua with equipment donations and observed surgery. Saw clinic patients at HOSPITAL AMISTED JAPON NICARAGUA.
TRIMED donated a complete wrist fracture fixation set.
ST MARY MERCY hospital donated a large Assortment of orthopaedic instruments and equipment.
SYNTHES donated a large assortment of orthopedic fracture/ trauma implants

PEDIATRICS LED BY BONNIE MATTHEWS, MD. AND  BRYANT BENSON, MD.

 SUSIE BENSON, BSN. JANET REEVES, FNP

LAVERNE RAMSEY TRIAGE, LINDA KUSH, ADELA LACAYO, TRANSLATOR,

JACQUELYN MORALES, TRANSLATOR

WE EXAMINED 313 BABIES AND YOUNG CHILDREN with a variety of pediatric illnesses ranging from upper respiratory infections, viral gastroenteritis, asthma exacerbations, and various bacterial infections (otitis media, folliculitis/cellulitis, etc).  As always, we saw plenty of dental caries, intestinal parasitic infections, anemia, and malnutrition (all preventable but prevalent in countries with poor health care).  The greatest medication needs in the pediatric clinic are for medications that are in forms that children are able to take (i.e. solutions) such as antibiotics, antiparasitics, acetaminophen and ibuprofen, multivitamins and iron. Lots of Scabies, Impetigo, Bronchiolitis, colds, tinea/ringworm and such. Tons of toys and vitamins were handed out. Toothbrushes and toothpaste are also popular with the children and are greatly needed. 

We also worked with Alma, a medical student from Managua, who helped translate for us all week.  

RETINOLOGY , CENTRO NACIONAL DE OFTHAMLOGIA (CENAO)

DR. RICHARD FEIST, LEADER

During our week Dr. Rob Mason, Claudia Ayala, and I worked with the hospital director Dr. Francisca Rivas attending doctors Renee Pilartes and Edward Guerrero and the ophthalmology residents. We participated in 16 vitrectomy surgeries and brought supplies including 6 tanks of gas for post operative tamponade, 12 bottles of heavy liquid  12 bottles  of silicone oil for intraoperative use in retinal detachment repair, and 50 doses of avastin a medicine used for circulatory diseases if the retina.  In addition our group supplied a full Spanish language set of the reference texts used by residents studying for board certification - a vital part of any ophthalmology residency program's teaching resources that had not been available before.

Richard Feist

SUMMARY REPORT ON REPAIR WORK IN JAPON HOSPITAL AND ESTELI CITY HOSPITAL

In general this year MEDICAL mission was quite successful. Technicians in the hospital are very helpful and very cooperative.

 (ABI YILDIRIM/DICK ECHOLS, Hospital AmistadJapon Nicaragual) Stationery high pressure and temperature steam autoclave door control and PLC control maintenance:
Autoclave unit was reported defect. Autoclaves main loading door was not opening. Even the door was closed,  the LCD command unit display of the autoclave unit was showing that the door is not closed. Luckily,  we had service manual of the unit and we could consult it about possible problem sources. One of the door micro-switch was loose and micro switch setting was out of range.  Micro switch is readjusted and securely reassembled. Main PLC controller connections are checked, interface cable between PLC and LCD command unit is secured. After that, autoclave unit turned on and reset. PROBLEM IS SOLVED.

(Abi Yildirim, Japon Hospital)

EKG: MAC VU-Marquette  : Electrode interface box was bad. REPAIR WAS NOT POSSIBLE.

 (Abi Yildirim, Japon Hospital)

1HDI-5000 Philips Ultrasound Imager: Main power supply control board was bad. Board is repaired. All ultrasound imaging functions  tested. EQUIPMENT IS GOOD CONDITION, however, a user manual would be very useful for further maintenance and appropriate operation and use.

 (Abi Yildirim, Japon Hospital)

Orthodontist chair vacuum micro-switch: . Manual toggle-switch leads were corroded. Leads are cleaned and re-soldered.  AIR MOTOR TUBING IS REPLACED.
 (ABI YILDIRIM/DICK ECHOLS, Japon Hospital)

Siemens X-Ray machine film loading cassette:

2X-Ray machine film loading cassette timing belt was broken and operation was stopped.  We have used ordinary fiber reinforced plastics packaging strip to make a temporary timing-belt (see photo) . We have split the belt about 5 mm wide and cut it right length. Assembled as it was before.  Mean time an original timing belt has been ordered.

(Abi Yildirim, Japon Hospital)

3EKG MAC 8 : An EKG was not functional due to power supply and quick entry dial. We have repaired the power supply.  The quick entry dial (a digital encoder switch)  was damaged and repair was not possible.  First we have repaired the power supply and then eliminated the encoder switch (quick entry dial). Since the keyboard was sufficient to entry an control the EKG functions, the EKG was functional.

 (Dick Echols, Japon Hospital)

Air compressor cable and 110V-Plug is replaced. Condensation water in the tank is drained.
 Abi Yildirim , Managua VOSH Clinic- Edger (Friday, 11^th February,  2011)

10Glass edger (Supore LE-300) was not working due to misalignment of the calibration micro-switch. In addition, lens holder that was used was not this edger apparatus. Micro-switch is adjusted and couple of lens are cut to see the progress. About the lens holder assembly, the local responsible person is informed.

 Abi Yildirim , Esteli, local Hospital : X-Ray Unit. (Monday, 14^th February 2011/ Tuesday, 15^th February 2011)

1A clinical X-Ray machine (GE-Stenoscope)was broken over one and half years. User manual as well as service manual was not available. I was consulted about normal operation of the unit. After that I have talked local engineer who was responsible for technical service and support for Esteli hospital. I have localized multiple problems in various places on the electronic boards. REPAIR TOOK TWO DAYS, BASIC X-RAY IMAGING FUNCTION IS RESTORED. HOWEVER, IMAGING DISPLAY (CRT-MONITOR) WAS OUT OF CALIBRATION AND IMAGE WAS A BIT DISTORTED. I HAVE RECOMMENDED TO USE ORDINARY COMPOSITE VIDEO MONITOR UNTIL THE ORIGINAL MONITOR WILL BE CALIBRATED.

Repair work by Bill Goggans and Larry Clanton

1. repaired washer and drier at Alabama Granada Clinica. 
2. Sterilizer in Dr Callahan's OR.
3. Sterilizer in Dr Parker's OR.
4. keratometer in Ophthalmology clinic.
5. Instrument table in Ophthalmology clinic.
6. Slitlamp microscope in same clinic.
7. OB ultrasound in repair shop. (Assisted Abi with this repair)
8. lensometer in Ophthalmology clinic.
 9.Slitlamp (another) in same clinic.
10. Installed autorefractor in upstairs clinic for Optometrist and Opticians.
11.Installed new slitlamp in Ophthalmology clinic.
12.Installed new table for above slitlamp.
13.Installed new autolensometer in clinic.
14.repaired/adjusted direct ophthalmoscope for Dr Ramirez.
15.Installed new chart projector in Ophthalmology clinic.

Larry also worked on the ultrasound and washer and drier with me. He also repaired the front door at the Alabama clinic and installed an industrial drier at the nursing home.  He assisted Abi and Dick on a large sterilizer at the hospital.

VOSH OPTOMETRY REPORT RESPECTFULLY SUBMITTED BY LEADER, GREG KANE, OD

As the the VOSH Southeast clinics coordinator, I am pleased to offer our report....Our basic team from .Florida was composed of 4 persons, myself, GREG KANE OD(ST AUGUSTINE), JERRY POTTS (retired optician) our dispensing leader, his wife ROBIN POTTS MD,(family practice jax), and our youth leader SANDY DENARDIS from OCALA...We were joined by DRA ALEJANDRA NARVAEZ and her 4 optometry students from UNICIT, and ProVision clinic in MANAGUA, which is supported by VOSH INTERNATIONAL...the students were most helpful in that they all took turns on auto refraction,refractions,and dispensing of eyeglasses...we enjoyed working with them to improve their eyecare skills and knowledge...their names are WALTER..GEMA...TANIA and GRACE...all were hard working kids  and performed well. WE ENCOUNTERED 767 PATIENTS AND DISPENSED AROUND 800 PAIRS OF EYEGLASSES,INCLUDING BIFOCALS,MINUS SPHERES AND READING GLASSES...all provided  by VOSH INT...VOSH SOUTHEAST , AND MYSELF..I  received a large quantity of various types of eye drops from ALCON medical mission , which were used by  the surgery group, and in our clinics...the artificial tears were like gold to everyone in this dry /dusty  country....Future missions like this will be done with a per patient fee of $3-4 to help cover the cost of goods used.and to weed out those persons that really dont need to be there. Also a big part of our group ABI YILDIRIM AND DICK ECHOLS are bio-engineers from BIRMINGHAM who came to FIX anything and everything they could...    Also aiding our mission were various locals such as SERGIO ROMERO our translator and transporter from ESTELLI...JUAN RODRIGUES LACAYO from GRANADA our good friend and translator/transporter without whom we   could not function at full tilt!  next, we had 2 nurses each day that ran visual acuities and did blood pressures on those over 40, one of which was VLADIMIR BARRIOS' MOM...VLADIMIR is also a local..a former clinic mgr from GUATEMALAS VOSH CLINIC...VLADI also helped us as translator and clinic structure organizer..he was a BIG help to us..Finally we had an expat American now living in Granada and his beautiful wife(Keith and Nancy Knight)Nancy was our Jeffa del puerta...that means she ran our clinic entry doors...along with several local American Legionaire members who helped us carry our vast quantities of glasses and equipment around Granada...the lady who ran the 2nd floor library in the HOSPITAL AMISTAD JAPON NICARAGUA was a dear person and did much to help us every day!! her name was Flo..Our (BRIGADA)...referred 5 cases of extreme hypertension to the Alabama Granada Clinica, removed 2 foreign bodies, and discovered(sadly) a brain tumor in a 2 year old female, which I promptly referred downstairs to ophthalmology and then Dr. Vargas ran with that one. VOSH mission statement is to provide sustainable eyecare to countries like Nicaragua  and we seek 20/20 for all:  by the year 2020.  I want to thank everyone who helped in our endeavors and hope that Granada is a better place now that 800 can see better!......

ALL VIDEOGRAPHY DONE BY

PROFESSIONAL VIDEOGRAPHER

OUR GRATITUDE:

AND A SPECIAL THANK YOU TO ALL 2011 VOLUNTEERS

FROM: ALABAMA, CALIFORNIA, FLORIDA, MASSACHUSETTS, MICHIGAN, NORTH AND SOUTH CAROLINA, NEW YORK AND NICARAGUA.

YOU BRING YOUR SKILLS, PAY YOUR OWN EXPENSES AND WORK IN SOMETIMES FRUSTRATING SITUATIONS TO HELP THE POOR IN NICARAGUA.

TO ABBOTT  and  CHERYL WILLIAMS, WHO WORK WEEKS IN ADVANCE OF OUR TRIP and  WHO MANAGED ALABAMA GRANADA CLINICά 2011 TO MAKE OUR

“MISSION POSSIBLE”.

SPECIAL THANKS ALSO TO ALL OF OUR FINANCIAL SUPPORTERS, FOR YOUR DONATIONS

YOU  HAVE MADE IT POSSIBLE FOR OUR ANNUAL TRIPS TO BRING MEDICAL ASSISTANCE TO THE POOR OF NICARAGUA.  YOU HAVE GIVEN US THE MEANS TO ACQUIRE, RESTORE AND EQUIP THE ALABAMA-GRANADA CLINIC WHERE TWO NICARAGUAN DOCTORS, ARE PAID TO SEE PATIENTS HALF A DAY WEEKLY MONDAY THROUGH FRIDAY.

CORPORATIONS DONATING EQUIPMENT AND SUPPLIES

TO:  MEDTRONIC FOR THE DONATION OF 10  PACEMAKERS AND ACCESSORIES.

BIOTRONIK DONATED 6 PACEMAKER SYSTEMS AND ONE PACEMAKER PROGRAMMER

BIOSENSE WEBSTER DONATED ABLATION (8-1-) AND EP CATHETERS (10-12)

SAINT JUDE DONATED 5 SYSTEMS (5 PACERS AND 10 LEADS)  3 WERE USED OTHERS WERE RETURNED TO US AFTER THE GROUPS LEFT.

BIOSENSE WEBSTER, ST. JUDE A-FIB DIVISION, K ,MEDTRONIC, BIOTRONIC, GE AND BOSTON SCIENTIFIC ALL HAD REPRESENTATIVES PRESENT FOR PROCEDURES

FOR CARDIAC SUPPLIES

TO: ALCON LABORATORIES WHO KINDLY DONATED INTRAOCULAR LENSES, AND ACCOMPANYING SUPPLIES:   VITRECTOMY PACKS, BSS, VITREORETINAL FORCEPS, VITREORETINAL SCISSORS, BACKFLUSH BRUSHES, SILICONE OIL, PERFLUOROCARBON LIQUID, ESSENTIALLY ALL SURGICAL SUPPLIES. ALCON HAS AIDED OUR EFFORTS FOR 12 YEARS.  RETINA CONSULTANTS OF ALABAMA CONTRIBUTED AVASTINE MEDICATION FOR MEDICAL RETINA TREATMENTS. EQUIPMENT AND MEDICINES WERE ALSO SUPPLIED BY: ALLERGAN, MAP INTERNATIONAL AMERICARES, CYNACON-OCUSOFT, TRIMED, ST.MARY MERCY, SYNTHES: (ORTHOPAEDIC SUPPLIES)

TO:  DR. WILLIAM HOLCOMB FROM CULLMAN, ALABAMA, WHO DONATED AUTOREFRACTOR, SLIT LAMP, INSTRUMENT TABLLE, AUTOLENSOMETER INDIRECT OPHTHALMOSCOPE.

DR. ROB MASON DONATED TWO LAPTOPS AND A TWENTY FIVE DIOPTER LENS

TO BROOKWOOD MEDICAL CENTER AND CALLAHAN EYE FOUNDATION HOSPITAL FOR YOUR PRESENT AND PAST SUPPORT.

TO: ALABAMA EYE BANK FOR DONATION OF  CORNEAS.

TO: NATIONAL CENTER OF OPHTHALMOLOGY (CENAO) DIRECTOR DR. FRANCISCA RIVAS AND

DR. ABRAHAM DELGADO

TO: NATIONAL CENTER OF CARDIOLOGY,

DIRECTOR, DR. NELSON SALAZAR

TO: HOSPITAL AMISTAD JAPON-NICARAGUA

YELBA LOGO,  MD:      DIRECTOR

JOSE SANTOS MEZA, MD:    DEPUTY DIRECTOR

TO: MILITARY HOSPITAL

DIRECTOR, DR RENE DARCE

DR HUGO ARGUELLOS,  DEPUTY DIRECTOR

CERTAINLY OUR THANKS ALWAYS TO:

SRA, FÁTIMA LACAYO de SÁENZ AND HER HUSBAND JAIME SAENZ.  HE IS ALWAYS CHECKING ON THE WELFARE OF ALABAMA GRANADA CLINIC,

TO:  CECILIA BURGOS, MANAGER OF AGC,

OLIVIA SANCHEZ, OUR RECEPTIONIST and MARVIN FAJARDO, PHARMACIST