it's a small world - nursing across the borders part...
TRANSCRIPT
1
Itrsquos a Small WorldNursing Across the Borders
Itrsquos a Small WorldNursing Across the Borders
Cheryl Herrmann RN APN CCRN CCNS-CSCCMC
Cardiac Clinical Nurse SpecialistCherrmannverizonnet
wwwcherylherrmanncom
2
bull Speaker Disclosures
bull AACN Speaker Bureau
bull Cross County Education Speaker Bureau
2
Itrsquos a Small WorldhellipMidwest Illinois
Itrsquos a Small WorldhellipMidwest Illinois
Peoria
4
3
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
trainingndash Zacatecas
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
6
4
7
How far away is half way around the worldHow far away is half way around the world
bull 9500 flight miles to Medan Indonsesiabull 22 hours in the plane --- not counting
layoversbull 7 flights and a boat ride to base at Telo
Islandbull 12 hours time difference ndash crossed the
international date line Left home Saturday morning arrived in Medan on Monday morning and Telo on Tuesday morning
8
5
9
10
Do you have money in the bank
Do you have change in your wallet
Do you have spare change in a dish someplace
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
6
YOU are among the
TOP 8 of the worldrsquos wealthy
YOU are among the
TOP 8 of the worldrsquos wealthy
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
12
If you havehellipIf you havehellip
bull Food in the refrigerator
bull Clothes on your back
bull A roof over head
bull A place to sleep
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
7
You are more comfortable
than 75of the world
You are more comfortable
than 75of the world
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
14
Disparity of WealthDisparity of Wealth
bull Half the worldrsquos population lives on less than $250 per day
8
15
PovertyPoverty
bull Poverty is the most important factor associated with preventable death
bull Poverty is associated withndash Poor housingndash Unsafe drinking waterndash Inadequate sanitationndash Poor nutrition
16
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull 10 Million Children under the age of 5 die each yearndash Almost all these could survive with access to
simple and affordable interventions
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
9
17
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Cardiovascular Deaths are the leading causes of death in the worldndash At least 80 of deaths from premature CVD
and strokes could be prevented through bull healthy dietbull regular physical activity
bull avoiding the use of
tobacco
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
18
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull HIVAIDS is the leading cause of adult deaths in Africa
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
10
19
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Population aging is contributing to the rise in cancer and heart disease
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
20
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Lung cancer is the most common cause of death from cancer in the world
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
2
Itrsquos a Small WorldhellipMidwest Illinois
Itrsquos a Small WorldhellipMidwest Illinois
Peoria
4
3
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
trainingndash Zacatecas
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
6
4
7
How far away is half way around the worldHow far away is half way around the world
bull 9500 flight miles to Medan Indonsesiabull 22 hours in the plane --- not counting
layoversbull 7 flights and a boat ride to base at Telo
Islandbull 12 hours time difference ndash crossed the
international date line Left home Saturday morning arrived in Medan on Monday morning and Telo on Tuesday morning
8
5
9
10
Do you have money in the bank
Do you have change in your wallet
Do you have spare change in a dish someplace
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
6
YOU are among the
TOP 8 of the worldrsquos wealthy
YOU are among the
TOP 8 of the worldrsquos wealthy
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
12
If you havehellipIf you havehellip
bull Food in the refrigerator
bull Clothes on your back
bull A roof over head
bull A place to sleep
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
7
You are more comfortable
than 75of the world
You are more comfortable
than 75of the world
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
14
Disparity of WealthDisparity of Wealth
bull Half the worldrsquos population lives on less than $250 per day
8
15
PovertyPoverty
bull Poverty is the most important factor associated with preventable death
bull Poverty is associated withndash Poor housingndash Unsafe drinking waterndash Inadequate sanitationndash Poor nutrition
16
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull 10 Million Children under the age of 5 die each yearndash Almost all these could survive with access to
simple and affordable interventions
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
9
17
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Cardiovascular Deaths are the leading causes of death in the worldndash At least 80 of deaths from premature CVD
and strokes could be prevented through bull healthy dietbull regular physical activity
bull avoiding the use of
tobacco
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
18
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull HIVAIDS is the leading cause of adult deaths in Africa
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
10
19
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Population aging is contributing to the rise in cancer and heart disease
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
20
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Lung cancer is the most common cause of death from cancer in the world
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
3
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
trainingndash Zacatecas
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
6
4
7
How far away is half way around the worldHow far away is half way around the world
bull 9500 flight miles to Medan Indonsesiabull 22 hours in the plane --- not counting
layoversbull 7 flights and a boat ride to base at Telo
Islandbull 12 hours time difference ndash crossed the
international date line Left home Saturday morning arrived in Medan on Monday morning and Telo on Tuesday morning
8
5
9
10
Do you have money in the bank
Do you have change in your wallet
Do you have spare change in a dish someplace
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
6
YOU are among the
TOP 8 of the worldrsquos wealthy
YOU are among the
TOP 8 of the worldrsquos wealthy
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
12
If you havehellipIf you havehellip
bull Food in the refrigerator
bull Clothes on your back
bull A roof over head
bull A place to sleep
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
7
You are more comfortable
than 75of the world
You are more comfortable
than 75of the world
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
14
Disparity of WealthDisparity of Wealth
bull Half the worldrsquos population lives on less than $250 per day
8
15
PovertyPoverty
bull Poverty is the most important factor associated with preventable death
bull Poverty is associated withndash Poor housingndash Unsafe drinking waterndash Inadequate sanitationndash Poor nutrition
16
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull 10 Million Children under the age of 5 die each yearndash Almost all these could survive with access to
simple and affordable interventions
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
9
17
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Cardiovascular Deaths are the leading causes of death in the worldndash At least 80 of deaths from premature CVD
and strokes could be prevented through bull healthy dietbull regular physical activity
bull avoiding the use of
tobacco
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
18
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull HIVAIDS is the leading cause of adult deaths in Africa
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
10
19
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Population aging is contributing to the rise in cancer and heart disease
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
20
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Lung cancer is the most common cause of death from cancer in the world
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
4
7
How far away is half way around the worldHow far away is half way around the world
bull 9500 flight miles to Medan Indonsesiabull 22 hours in the plane --- not counting
layoversbull 7 flights and a boat ride to base at Telo
Islandbull 12 hours time difference ndash crossed the
international date line Left home Saturday morning arrived in Medan on Monday morning and Telo on Tuesday morning
8
5
9
10
Do you have money in the bank
Do you have change in your wallet
Do you have spare change in a dish someplace
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
6
YOU are among the
TOP 8 of the worldrsquos wealthy
YOU are among the
TOP 8 of the worldrsquos wealthy
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
12
If you havehellipIf you havehellip
bull Food in the refrigerator
bull Clothes on your back
bull A roof over head
bull A place to sleep
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
7
You are more comfortable
than 75of the world
You are more comfortable
than 75of the world
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
14
Disparity of WealthDisparity of Wealth
bull Half the worldrsquos population lives on less than $250 per day
8
15
PovertyPoverty
bull Poverty is the most important factor associated with preventable death
bull Poverty is associated withndash Poor housingndash Unsafe drinking waterndash Inadequate sanitationndash Poor nutrition
16
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull 10 Million Children under the age of 5 die each yearndash Almost all these could survive with access to
simple and affordable interventions
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
9
17
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Cardiovascular Deaths are the leading causes of death in the worldndash At least 80 of deaths from premature CVD
and strokes could be prevented through bull healthy dietbull regular physical activity
bull avoiding the use of
tobacco
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
18
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull HIVAIDS is the leading cause of adult deaths in Africa
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
10
19
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Population aging is contributing to the rise in cancer and heart disease
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
20
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Lung cancer is the most common cause of death from cancer in the world
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
5
9
10
Do you have money in the bank
Do you have change in your wallet
Do you have spare change in a dish someplace
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
6
YOU are among the
TOP 8 of the worldrsquos wealthy
YOU are among the
TOP 8 of the worldrsquos wealthy
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
12
If you havehellipIf you havehellip
bull Food in the refrigerator
bull Clothes on your back
bull A roof over head
bull A place to sleep
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
7
You are more comfortable
than 75of the world
You are more comfortable
than 75of the world
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
14
Disparity of WealthDisparity of Wealth
bull Half the worldrsquos population lives on less than $250 per day
8
15
PovertyPoverty
bull Poverty is the most important factor associated with preventable death
bull Poverty is associated withndash Poor housingndash Unsafe drinking waterndash Inadequate sanitationndash Poor nutrition
16
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull 10 Million Children under the age of 5 die each yearndash Almost all these could survive with access to
simple and affordable interventions
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
9
17
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Cardiovascular Deaths are the leading causes of death in the worldndash At least 80 of deaths from premature CVD
and strokes could be prevented through bull healthy dietbull regular physical activity
bull avoiding the use of
tobacco
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
18
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull HIVAIDS is the leading cause of adult deaths in Africa
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
10
19
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Population aging is contributing to the rise in cancer and heart disease
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
20
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Lung cancer is the most common cause of death from cancer in the world
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
6
YOU are among the
TOP 8 of the worldrsquos wealthy
YOU are among the
TOP 8 of the worldrsquos wealthy
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
12
If you havehellipIf you havehellip
bull Food in the refrigerator
bull Clothes on your back
bull A roof over head
bull A place to sleep
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
7
You are more comfortable
than 75of the world
You are more comfortable
than 75of the world
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
14
Disparity of WealthDisparity of Wealth
bull Half the worldrsquos population lives on less than $250 per day
8
15
PovertyPoverty
bull Poverty is the most important factor associated with preventable death
bull Poverty is associated withndash Poor housingndash Unsafe drinking waterndash Inadequate sanitationndash Poor nutrition
16
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull 10 Million Children under the age of 5 die each yearndash Almost all these could survive with access to
simple and affordable interventions
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
9
17
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Cardiovascular Deaths are the leading causes of death in the worldndash At least 80 of deaths from premature CVD
and strokes could be prevented through bull healthy dietbull regular physical activity
bull avoiding the use of
tobacco
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
18
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull HIVAIDS is the leading cause of adult deaths in Africa
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
10
19
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Population aging is contributing to the rise in cancer and heart disease
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
20
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Lung cancer is the most common cause of death from cancer in the world
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
7
You are more comfortable
than 75of the world
You are more comfortable
than 75of the world
Source 2005 Statistics State of the Village Report Original version by Donella H Meadows wwwodtorgpophtm
14
Disparity of WealthDisparity of Wealth
bull Half the worldrsquos population lives on less than $250 per day
8
15
PovertyPoverty
bull Poverty is the most important factor associated with preventable death
bull Poverty is associated withndash Poor housingndash Unsafe drinking waterndash Inadequate sanitationndash Poor nutrition
16
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull 10 Million Children under the age of 5 die each yearndash Almost all these could survive with access to
simple and affordable interventions
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
9
17
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Cardiovascular Deaths are the leading causes of death in the worldndash At least 80 of deaths from premature CVD
and strokes could be prevented through bull healthy dietbull regular physical activity
bull avoiding the use of
tobacco
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
18
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull HIVAIDS is the leading cause of adult deaths in Africa
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
10
19
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Population aging is contributing to the rise in cancer and heart disease
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
20
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Lung cancer is the most common cause of death from cancer in the world
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
8
15
PovertyPoverty
bull Poverty is the most important factor associated with preventable death
bull Poverty is associated withndash Poor housingndash Unsafe drinking waterndash Inadequate sanitationndash Poor nutrition
16
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull 10 Million Children under the age of 5 die each yearndash Almost all these could survive with access to
simple and affordable interventions
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
9
17
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Cardiovascular Deaths are the leading causes of death in the worldndash At least 80 of deaths from premature CVD
and strokes could be prevented through bull healthy dietbull regular physical activity
bull avoiding the use of
tobacco
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
18
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull HIVAIDS is the leading cause of adult deaths in Africa
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
10
19
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Population aging is contributing to the rise in cancer and heart disease
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
20
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Lung cancer is the most common cause of death from cancer in the world
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
9
17
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Cardiovascular Deaths are the leading causes of death in the worldndash At least 80 of deaths from premature CVD
and strokes could be prevented through bull healthy dietbull regular physical activity
bull avoiding the use of
tobacco
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
18
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull HIVAIDS is the leading cause of adult deaths in Africa
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
10
19
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Population aging is contributing to the rise in cancer and heart disease
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
20
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Lung cancer is the most common cause of death from cancer in the world
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
10
19
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Population aging is contributing to the rise in cancer and heart disease
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
20
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Lung cancer is the most common cause of death from cancer in the world
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
11
21
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Complications from pregnancy account for 15 of deaths in women of reproductive age worldwidendash More than half a million women die from preventable
complications during pregnancy and childbirth
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
22
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Mental disorders such as depression are among the 20 leading causes of disability worldwide
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
12
23
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Hearing loss vision problems and mental disorders are the most common causes of disability
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
24
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Road traffic injuries are expected to rise from ninth leading cause of death globally in 2004 to the fifth in 2020
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
13
25
10 Facts on the Global Burden of Disease10 Facts on the Global Burden of Disease
bull Under-nutrition is the underlying cause of death for at least 30 of all children under the age of 5
Source httpwwwwhointfeaturesfactfilesglobal_burdenenindexhtmlAccessed 11009
26
Deaths Under 5 YearsDeaths Under 5 Years
Most deaths India Nigeria China Pakistan DR Congo Ethiopia (50) Highest Mortality Rate Sierra Leone Niger Angola Afghanistan Liberia
Each dot represents 5000 deaths
Lancet Vol 361 June 28 2003
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
14
27
10 million children die each year before age 510 million children die each year before age 5
That is one every 3 seconds
28
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Neonatal (lt28d) 39 millionndash 24 severe infectionsndash 29 birth asphyxiandash 24 prematurityndash 7 tetanus
One every 3 secondshellip
CMAJ 2005 173(3)279-86
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
15
29
10 million children die each year before age 5That is one every 3 seconds
10 million children die each year before age 5That is one every 3 seconds
bull Pneumonia ndash 21 millionbull Diarrhea ndash 2 millionbull Malaria ndash 1 millionbull Malnutrition contributes
to 53 of deaths
One every 3 secondshellip
CMAJ 2005 173(3)279-86
30
Risk Factors for MortalityRisk Factors for Mortality
bull 88 of deaths from diarrhea ndash attributed to
inadequate water for hygiene
ndash unsafe water ingestion
ndash inaccessible sanitation
bull Being underweight confers additional risk of mortality from infectious diseases
Lancet Vol 361 June 28 2003
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
16
31
Risk Factors for MortalityRisk Factors for Mortality
bull Non-breast fed babies are 7xrsquos more like to die from diarrheapneumonia than breast fed
Lancet Vol 361 June 28 2003
32
United Nations Millennium Development Goals for 2015
United Nations Millennium Development Goals for 2015
bull Halving Poverty and Hungerbull Achieving Universal Primary
Education and Gender Equalitybull Reducing Child Mortality by 23bull Reducing Maternal Mortality by 34bull Reversing the Spread of HIVAIDSbull Halving the Proportion of People
Without Access to Safe Water
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
17
33
Focus Of RecommendationsFocus Of Recommendations
bull Newborn Health Carendash Skilled birth attendant prevention of HIV transmission
tetanus protection early postnatal visitbull Nutrition
ndash Exclusive breastfeeding complementary feedsbull Vaccination
ndash Measles DPT3 Hibbull Preventive Measures
ndash Clean water sanitation vitamin supplements chemically treated bednets
bull Case Managementndash Early appropriate oral rehydration therapy antibiotics
antimalarials
34
WHO recommends 20 docs amp 500 nurses100000 US256782 Burundi 051
Disparity of in Health Care Professionals
Indo MDs 0 ndash 25100000
Telo Islands Now = 330000Need 6 - 7
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
18
35
Can We HelpCan We Help
bull Yeshellipbull One way is with short term medical
missionsbull Share our experiences
ndash Mexicondash Indonesia
36
Challenges to for Medical MissionsChallenges to for Medical Missions
bull Diseases are different - Tropical diseases ndash Diseases of poverty - more appropriate
term
bull Medical Resources are minimalbull Cultural Context is differentbull Short term medical missions ndashhow
effective are theybull Nursing education is for high tech
society not a developing country
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
19
How to prepare to successfully serve in a developing country
How to prepare to successfully serve in a developing country
38
Health is the GoalhellipNot simply providing services
Health is the GoalhellipNot simply providing services
Health care goalsbull Nutritionbull Safe obstetric carebull Infectious disease preventionbull Trauma preventionbull Provision of medical care
Source INMED International Medicine 2007
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
20
39
First Evaluate YourselfFirst Evaluate Yourself
bull Why are you goingndash Is it to serve and help them or is it just to
fulfill an obligation
bull Characteristicsndash Willing to become part of their culture ---
food bathrooms sleepingndash Leave Type A personality at home
bull Other team members also need these qualities
40
Learn about Diseases of PovertyLearn about Diseases of Poverty
1 Institute for International Medicine wwwinmedus
bull Comninellis N INMED International Medicine Advanced Preparation for HealthProfessionals Kansas City MO Institute for International Medicine2007
bull INMED International Medicine course
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
21
41
Resource BooksResource Books
1 Burns AA Lovich R Maxwell J Shapiro K Where Women have no Doctor A Health Guide for Women Berkely CA Hesperian 1997 (wwwhesperianorg)
2 Werner D Thuman C Maxwell J Where There is no Doctor A Village Health Care Handbook 9th
ed Berkeley CA Hesperian2007 (wwwhesperianorg)
42
Recommended ReadingRecommended Reading
1 Correll G Twenty Tips to Live by When Serving on Short-term Missions Physician JulyAugust 200121-22
2 Roberts M Duffle Bag Medicine JAMA2006295(13)1491-1492
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
22
43
Understand the CultureUnderstand the Culture
44
American Characteristics that create conflict in developing countries
American Characteristics that create conflict in developing countries
bull Individualism Humility Conformity
bull Distrust of Authority Age or title entitles them respect
bull Individuality Emphasis on the nuclear family
Source INMED International Medicine 2007
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
23
45
TimeTime
bull Time is a commodity in the USndash Spend timendash Take timendash Waste time
bull Time in other countriesndash Pass time
46
TimeTime
bull Attempting to stick to a schedule will bring frustration
bull Punctuality -- tardiness is normbull Mantildeana
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
24
47
Culture and HealthCulture and Health
bull America Evidence Based Practicebull Developing Countries
ndash May have traditional and supernatural influences
ndash Traditional healers
48
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Treat everyone with respectbull Avoid attitudes of cultural
superioritybull Prioritize relationships
rather than projectsbull Ask if in doubtbull ldquoHelp me understand whyrdquobull A ldquoSmilerdquo is the universal
languagebull Kindness
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
25
49
Building Cross Cultural RelationshipsBuilding Cross Cultural Relationships
bull Create trust and communicate your sincerity and good will
bull Appreciate the unique characteristics of the new culture
bull Learn how to effectively function in the midst of them
bull Observe understand and adjust to the behavior of the them
bull Understand the Dorsquos and Donrsquots of the culture
50
Assess Community needs and resourcesAssess Community needs and resources
bull With each of our medical missions we will share how we assessed the community and the lessons learned
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
26
51
52
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
27
53
54
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
28
55
56
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
29
57
58
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
30
59
60
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
31
61
62
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
32
63
64
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
33
65
66
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
34
67
68
We have great aspirations for curing the ills of the worldrsquos poorhellip
We have great aspirations for curing the ills of the worldrsquos poorhellip
bull We can best impact by TEACHING them the basicsndash Wash your handsndash Eat fruits and vegetablesndash Good sanitation habitsndash Brush your teeth
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
35
69
70
TeachingTeaching
bull May listen more to us --- as we are ldquoAmericansrdquo
bull Be careful of yourhabits --- Donrsquot eatcandy and we hand out candy
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
36
71
72
Tips to Minimize Culture ShockTips to Minimize Culture Shock
bull Know the goal of the journeybull Set realistic expectations
ndash ldquoWe set great aspirations for curing the ills of the worldrsquos poorhellip And set ourselves up to failrdquo
bull Anticipate the challenge and adventurebull Plan a light initial schedulebull Be prepared for new ideasbull Good humor is essential ndash laugh at yourselfbull Keep a journalbull Keep in contact with friends back home
ndash (Long term missions)
Source INMED International Medicine 2007
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
37
73
Tips to Minimize Cultural ShockTips to Minimize Cultural Shock
bull Learn about the host culture in advance
bull Get to know the national peoplebull Reject criticism bull Have an attitude of mercy and
lightheartedness
Source INMED International Medicine 2007
74
DebriefingDebriefing
bull What were my goals for this international experience
bull Were the goals met In what waysbull How could this experience have been
betterbull What have I learned about myself in the
processbull How will this experiencehellip
ndash Change my personal chacteracterndash My interaction with othersndash My lifersquos plans
Source INMED International Medicine 2007
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
38
75
Why we do medical missionsWhy we do medical missions
bull Opportunity to use nursing skills in a different culture
bull Serve others who are underservedbull Share Christbull Opportunity to travel to see
and experience anotherculture
International Experiencesbull Mexico Medical Missions
ndash Juarez and Creel ndash health prevention clinicndash Ixtlan ndash providing ambulance supplies and
training
bull Indonesiandash Partnership with MAP Internationalndash Mobile Medical Clinic via boat -- island to
island
As we have therefore opportunity let us do good unto all men eAs we have therefore opportunity let us do good unto all men especially unto them who specially unto them who are of the household of faithare of the household of faith Galatians 610Galatians 610
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
39
77
Itrsquos a Small Worldhellip Juarez MexicoItrsquos a Small Worldhellip Juarez Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
Zacatacas
78
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
40
79
80
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
41
81
82
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
42
83
84
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
43
85
86
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
44
87
88
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
45
89
90
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
46
91
92
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
47
Use local physiciansUse local physicians
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
48
95
96
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
49
97
98
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
50
99
100
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
51
101
102
800 ndash 1000 people per day
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
52
103
104
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
53
105
106
Remember QuantityldquoSolo Vitaminasrdquo
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
54
107
Name TagsT-shirtsUniform
108
Missions great for children
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
55
109
110
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
56
111
Juarez AssessmentJuarez Assessmentbull AMMAR groupndash asked for a medical teambull At the time we were inexperienced so did
not do a formal assessmenthellip Learned lots along the way
bull Walk around the community bull Visit homes and grocery storebull Did a survey on one of the early teams to
assess health practices and eating habitsbull Communicate with local physicians
regarding needs and how we can better serve
bull Goal of this mission To provide spiritual outreach via a medical mission
112
Juarez Lessons LearnedJuarez Lessons Learned
bull 30 + medical teamsbull Developed a relationship with local
church groupbull Feeding program School child
sponsorshipbull Have seen improvement in areas and
in education level of the colonibull Work with local physician and clinicbull TEACH TEACH TEACH
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
57
113
bull Remember the health of your team members
bull Water Boysbull Bottled Water
114
Juarez ChallengesJuarez Challenges
bull Would like to see better follow-up at local clinics --- difficulty getting MDs to stay committed
bull Difficulty learning health system as it is a short term mission
bull Border difficulties with suppliesbull ldquoDo we create beggarsrdquobull And yethellip We provide a screening
preventative and teaching clinic
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
58
115
17 years later 17 years later
bull Another opportunity to start medical clinics in new areas with a new missionary group - Isaiah 55 in Reynosa MX
Zacatecas Mexico
116
Triage ndash vital signs blood glucose amp teachingTriage ndash vital signs blood glucose amp teaching
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
59
117
118
Itrsquos a Small WorldhellipIxtlan MexicoItrsquos a Small WorldhellipIxtlan Mexico
JuarezMagdalena
Creel
IxtlanMexico City
El PasoNogales
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
60
119
120
Ixtlan 2003Ixtlan 2003
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
61
121
Ixtlan AssessmentIxtlan Assessmentbull PA living in community saw the needbull Email questionsbull Carlos had the vision ndash gave a good
assessmentbull Mexico regulations for ambulancebull Meet with Carlos to plan
122
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
62
123
124
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
63
125
126
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
64
127
128
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
65
129
130
Manikins and other suppliesAED
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
66
131
132
Ixtlan Lessons LearnedIxtlan Lessons Learned
bull CPR manikins and Spanish First Aid DVD videos great learning tools
bull Timehellip ldquoItrsquos Mexicohelliprdquo Need to be ready to teach when they are ready
bull Broken down vehiclesbull A short ambulance transport ends up
with 12 hour run and a sight seeing tour to a cathedral and a stop for burritos
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara
67
133
Medical mission resourcesMedical mission resources
bull Affordable CPR manikins wwwcprpromptcombull American Red Cross First Aid DVD ndash Spanish and English bull American Heart Association -- Spanish CPR and First Aid
materials httpahachanning-betecombull Hesperian Foundation Publications and resources for
community health ndash many including Where there is no Doctor books can be downloaded free wwwhesperianorg
bull International Aid --- Medical equipment and supplies wwwinternationalaidorg
bull International medicine course offered by Institute for International Medicine wwwinmedus
bull MAP International -- Medical Assistance Programs (medicines and supplies for medical teams) wwwmaporg
134
Ixtlan 2008Ixtlan 2008
Transporting a 1 kg (22 pound) premie 2 hours to Guadalajara