PARTNER FOR SURGERY
President’s Midyear Review - 2008
The Partner for Surgery (PfS) Midyear Review is intended to recap major events of the first six months of 2008 and identify anticipated events during the latter half of the year expected to have a major impact on our mission.
Mission: Our mission remains the same. Partner for Surgery is the bridge between impoverished Mayan populations living in rural Guatemalan villages and surgical teams who want to help those without means but lack the infrastructure to do so. PfS locates and educates prospective patients using local managers, community youth, radio programs, and community meetings. We bring medical teams to rural communities to triage patient’s medical and surgical needs and later escort surgical candidates to the hospital, provide care during the surgical experience, and assist with post operative recovery. All PfS patients are asked to contribute what they can toward payment of their surgical expenses – most importantly to maintain their dignity in the process. Most of our patients have never seen a doctor and have no easy access to any type of medical care. Our mission includes empowering rural communities to promote local volunteerism.
Triage Activities: One year ago the typical triage mission of four days ended with approximately 80 to 100 patients referred for some type of surgical intervention. Since last September the number referred has continuously increased with last April having an amazing 250 referred. Many factors are most likely responsible but some of the most important are the intensive use of rural radio four weeks before the triage, use of past patients giving testimonies, site selection and greater name recognition of PfS within the communities. This increased number of referrals resulting in an increased backlog of waiting patients allowed us to dedicate the May triage to evaluating a new outreach activity – screening and treatment for pre-cervical cancer lesions. As will be discussed later in this report, the success of this screening justified including it in our future general triage activities starting next September. It is our anticipation that the expanded triage activities will attract additional women with surgical needs and will require us to intensify our search for surgical teams with whom we can collaborate.
Rural Youth: In 2006 we began a pilot project to enlist rural youth to assist our local area managers in their respective communities. This was a big success and we realized that we had been overlooking the youth as a local resource for our mission. In the spring of this year we began another pilot project that empowers youth to help their communities through the use of rural radio programs. The project will explore the use of weekly radio programs focused primarily on health topics of interest to the community and to provide Partner for Surgery related information to patients and the communities. Our intent is to evaluate the use of various live program formats where each week youth in several communities use cell phones to call in to the station. In this way questions can be asked of special program guests and the answers heard by listeners in all the communities with coverage. Many other community information and participation activities are possible with suitable training for the youth. Formal training has already been given to a youth group in Cubulco, Baja Verapaz, an Achi speaking area. By the end of August an Ixil speaking youth group in Cotzal, El Quiche will be trained in how to plan a program, use a computer to produce the program and to practice speaking during a live program format. The metrics of success are the increase in community participation in the Partner for Surgery triage and the increase in number of patients joining with our area managers to go to the surgical sites. We are also currently looking for youth interested in this type of community activity in several Kekchi speaking areas of the department of Alta Verapaz. In all of these locations Partner for Surgery subsidizes the effort with the necessary equipment, software, training and program sponsorship while the youth volunteer their time. In recent discussions with the Peace Corps director in Guatemala, concerning renewal of our Memorandum of Understanding, she indicated this youth project would be a very appropriate secondary project for volunteers in addition to their translating activities.
Surgical Capacity: At the primary surgical site where we bring PfS patients, the Franciscan surgical center in Antigua, there is little opportunity to increase our patient quotas. Therefore, we have continued looking for other sites hosting surgical teams. Already in 2008 at five other more rural sites we have been able to provide an additional 91 patients with surgical care. Working at diverse locations is more time consuming and expensive for PfS compared to more intensive use of one or two sites. For this reason, expansion of Centro de Salud Barbara (CSB) in San Juan Sacatepequez to include a surgical center for PfS patients still remains our focus for significant increases in opportunities for surgical care. The container of surgical equipment provided by Rotary International for CSB has arrived in Guatemala and facility modifications to support volunteer surgical teams has begun. In addition, construction has begun next to CSB on a facility that will provide food and housing for the PfS patients and their family members during the week of surgery. Financing CSB modifications is provided by Fundacion Chusita and of the patient housing facility by Compañero en Salud, both Guatemalan charities with whom PfS collaborates. If CSB construction work is completed by September, the first team to use the CSB surgical site will arrive in November.
Rural Medical Tests: As part of our effort to encourage more women and children to come to our rural triage early this year we initiated a pilot project to offer women pre-cancer screening and if lesions are present the immediate treatment. This effort is called VIA and Cryotherapy and follows the recommendations resulting from extensive clinical studies in Africa and Asia. We have put together a strong collaborative effort using Guatemalan Ministry of Health nurses who receive a week of training from the U.S. nonprofit Faith in Practice. Our first team of three began receiving additional clinical training and monitoring last May by a volunteer gynecologist who was a member of the Partner for Surgery triage team. During our May triage organized specifically to sort out how best to include the screening and treatment in the normal triage events, 522 women were evaluated. Of this number less than half had ever had a pap smear and of those that did less than half knew the result. None of the women were told they had a pre-cancerous condition whereas during our screening two percent required treatment indicating possible problems with executing the Pap smear process. Based on our early success, the Ministry of Health would like to expand this collaboration and our goal is to prepare to train an additional 10 nurses who would then carry out the screening and treatment in health centers when they are not working at Partner for Surgery triage activities.
Management: On July 22 Dan Olson completed his year as our Director of Rural Development. Dan had a very successful year with Partner for Surgery, having made great strides in strengthening our roots in the rural communities and dramatically increased the number of patients triaged during medical missions. We are proud to say that based on his experience with Partner in Surgery he made the decision to go on to medical school. Daniel Cable began his training on May 1 with Dan Olson and became the Director of Rural Development when Dan Olson returned to the US. Daniel was a Peace Corps volunteer in Guatemala, including an assignment as a trainer, before he returned to the US. In addition to community development efforts and medical mission leadership, Daniel is leading the new youth radio project and the cervical cancer screening and treatment project. Joanna Wessels continues as our Director of Programs doing a fantastic job managing all the patients who are receiving surgery.
Restructuring of Activities in Guatemala: Prior to August first, all Guatemalans who worked for PfS received compensation directly from PfS and the van and motorcycle were owned by PfS. This situation created two major problems---first, there was no Guatemalan charity that had the PfS mission and had an established presence that could be used as a recipient of Guatemalan funds, and secondly, labor and liability issues were directly the responsibility of PfS. As of August 1, an independent Guatemalan charity, Asociacion Compañero para Cirugia (ACPC), took responsibility for all Guatemalans who work with PfS and for the ownership of the vehicles previously with PfS. In the future, when PfS recruited surgical teams go to the CSB surgical site, they will also be the responsibility of ACPC.
Board of Directors: Dr. Joseph Giordano, Professor and Chairman of the Department of Surgery at George Washington University, joined our board in July. We are fortunate to be able to add his expertise to the board and we look forward to his leadership in helping PfS expand its mission among the most impoverished in Guatemala.
Closing: During the three triage weeks remaining in 2008 we anticipate providing 2,500 with medical care of which at least 400 will require surgical care and will be added to our assistance program. Everywhere in Guatemala it is evident that a rapid increase in the cost of transportation and the items for sale in the community markets has occurred. This situation impacts PfS directly in the amount of financial assistance needed for each patient to go to the hospital site and in PfS costs associated with our community development efforts. For people in rural Guatemala, like the PfS patients who are subsistence farmers or day laborers, there is no increase in income to compensate for the inflation and we expect that for many even the local travel to our triage sites will be too expensive. We look forward to our new project that empowers youth to help their communities through rural radio programs and to our collaboration with the Ministry of Health in reducing the incidence of cervical cancer.
Frank Peterson
August 2, 2008
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