Greetings from the Medical Services Team,

When you read this message, 2012 will be over. During the past year the worldwide economic turbulence has been impacting the ability to provide quality services in all levels of NPH, including medical services. NPH has had to make cuts in staff, services and projects. Nevertheless the seeds planted for the last three years by structuring the NPH healthcare system, training doctors and nurses, developing tools and policies had been crucial as not to go backwards in detriment of the quality services that the clinics provide.

Together, the local staff and the NPHI Medical Service team strives to provide the best quality services measurable by international standards. The results are obvious, we don’t have “emergency outbreaks”, there are less children sick as consequence of being infested by parasites or other preventable infections of the digestive system. Thanks to water and sanitation improvements in the homes, health education and hygiene, we are still on track with our goals.

Despite the financial challenges and struggle NPH is facing, especially in our homes, keeping the children healthy is our priority since it is the pillar for a child to be able to do well in school, be happy and energetic, and take advantage of the opportunities they find living in the NPH family. A sick child who doesn’t feel well, isn’t able to take advantage of attending school, to be able to learn, as well as socialize, which are essential for children to develop toward a healthy adulthood.

Dr. Pilar Silverman, Executive Director of NPHI Medical Services

Excellence in Healthcare Medical BulletinSeptember-December 2012

Nuestros Pequeños Hermanos™ International

NPH El Salvador

Message from the Executive Director Joint Efforts for the Wellbeing of the Children

The NPHI medical services team wants to take the opportunity to express one more time our gratitude for the invaluable support from two partners.

Aid for Aids and Miami Baptist Hospital Outreach program for all their support for the HIV+ children living in our NPH homes. Aid for Aids donates annually antiretroviral medication with a value of more than $40,000.

Miami Baptist Hospital performs resistance testing for HIV medical cases presenting failure to the treatment they are taking. Resistance testing is a valuable tool that allow us to find the correct antiretroviral once the first line of treatment according to international standards fails.

NPHI Medical Services Team

The prognosis is worse if the disease occurs at an older age and if several joints are affected. Over 50% of patients continue with active disease after 10 years. Some sequels are joint destruction and functional limitation, which may have implications for the social, educational or vocational life.

The aim of drug therapy is to quickly and effectively treat inflammation, to reduce pain and physical disability by preventing joint destruction.

In recent years the treatment of JIA has changed. Although the classical anti-inflammatory therapy (NSAR, corticosteroids) - which still is part of the treatment - the emphasis is now on other drugs that influence disease progression (Methotrexate, and new immunomodulators).

It is essential from the beginning to make sure interdisciplinary care, by complementing pharmaceutical treatment, including physical therapy, occupational therapy and psychological and pedagogical therapy. The goal is to ensure a physical and psychosocial development without difficulties and a life as normal as possible. It is always easier to prevent than to treat complications.

In NPH we have several children suffering from JIA. One child, Carmen (name change) is 16-years-old, and is living in NPH Nicaragua. She was diagnosed nine years earlier with polyarticular juvenil idiopathic arthritis. Last year the rheumatologist prescribed Methotrexate, which she took for 1.5 years. A few months ago, she had a relapse including nearly all joints. Her treatment was changed to Infliximab, made by an artificial antibody that modifies the immune response.

Additionally physical therapy helps in order to maintain mobility in the joints and to avoid pain. Carmen receives physiotherapy three times a week in the clinic with a volunteer from Germany. The local doctor coordinates and oversees her treatment. She also has appointments with a rheumatologist, an orthopedist and an ophthalmologist at the public hospital. Appointments in public hospitals are free. Also most of the tests - laboratory, ultrasound, x-rays - luckily are free. Infliximab treatment is $8,500 annually.

Carmen lives a normal life, like any other child in NPH, thanks to an

interdisciplinary and appropriate treatment of her disease and the support of all of you who make it possible to receive the best treatment available.

Corinna Lawrenz, MD, RMC México & Marta Garate RN, and RMC Nicaragua & Guatemala.

Talking About Juvenile

Idiopathic Arthritis (JIA)

Juvenile idiopathic arthritis (formerly

known as juvenile rheumatoid arthritis)

is the most common rheumatic disease

in childhood. It is one of the most

disturbing chronic diseases in children

and adolescents because of the

chronicity and the huge impact on the

affected patient’s lives.

Haiti, St. Helene: Improving drinking water Kenscoff

In October 2012, NPH Haiti initiated a huge step to improve the water safety in St. Helene. For several years we had been

doing partial solutions but it was the time to look for a lasting one.

“This was a puzzle, because supposedly there were several water treatment technologies in place to purify water for drinking and cooking. So during planning phase of the project, NPH staff were clearly eager for a rapid solution”, said Karun Koernig, Head of Operations for the Water is Right Foundation.

Vern Conaway reported, “On October 14, thanks be to God, Karun Koernig, the Head of Operations of the Water is Right Foundation (an organization based in Germany) arrived safely in Port-au-Prince and had no problems clearing customs with the water filter system that he was bringing for St. Helene. After a meeting with the house director and a review of the

current water filtration systems on the grounds of St. Helene a plan to improve the water conditions was laid out. Everyone involved in this effort - and in particular, Cassagnol Foste, Janvier, Jean Tony, Karun, and a couple of other maintenance men / water truck drivers - did an outstanding job of coming together to get the job done. Everyone played a key role in getting this project underway and completed in the one week period we had available to us. Karun obviously deserves a great deal of the credit. Not only was he not afraid to jump in and work hard but given the fact that this was his very first visit to Haiti he acted like he was an old pro at dealing with the many problems that we were faced with. He’s a team player who really led by example. And he refused to buy into the standard line that “Nothing is easy in Haiti”. He made it look easy! And of course, thank you to NPH/Germany and Jan Weber for making this happen.God bless you all!”

Vern Conaway, Special Projects for NPH Dominican and NPH Haiti

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Haiti, St. Helene: New Full-time Doctor Joins the Team

On October 2012, Dr. Ernesto Garcia joined the St. Helene healthcare team in order to have a physician’s presence in the home and carry out the NPHI healthcare program. Dr. Garcia graduated from medical school in Cuba and worked in different positions in the Dominican Republic and Haiti. He has broad experience in primary health care and pediatrics as well as emergency care, public health and preventive medicine. We all welcome Dr. Ernesto Garcia.

Dr. Pilar Silverman, Executive Director of NPHI Medical Services

Home Updates

Home Updates Continued...

El Salvador and Nicaragua: Onsite Professional Nursing Training

During the months of September and October, the nurses from the NPH clinics in El Salvador and Nicaragua had the privilege to have an onsite training by a licensed nurse and professor, Lic. Maria Jose Camacho, from the University of Nursing from Murcia, Spain.

The topics covered were theoretic and practical and were chosen by the nurses and local doctors. Some of the topics covered were advanced CPR, how to act in front of a injured patient, hemorrhages, sutures, patient mobilization, treatment of ulcers, knowing the effects of the medicines given to the children, urinary catheter, personal hygiene and washing hands before performing a medical intervention, oxygen and how it works, nursing roles and self-esteem. In Nicaragua, the trainer also had time to visit and work with the “Buen Samaritano” project and with Father Alberto in a drug prevention outreach project.

The nurses were excited to have this opportunity for learning new skills and self-improvement. We would like to take this opportunity to sincerely thank Lic. Maria Jose for such priceless support.

Dr. Pilar Silverman, Executive Director of NPHI Medical Services

Nicaragua: Eyeglasses for Our Children

In 2012, NPH initiated a “Vision project” proposed by the Hundt’s. It started in January in NPH Honduras where more than 100 patients were examined and received their prescription glasses without cost. While in Honduras the Hundt family and their eye doctors and ophthalmologist friends trained staff members to perform the vision exams with the auto refractor, a device donated by them. During 2012 more brand new made prescription glasses were sent to Honduras as well as to Nicaragua. Immediate plans for this project in 2013 are to go to the NPH homes in Mexico and hopefully to Guatemala where vision/eye problems are one of the most frequent causes for consultation with the doctor.

Healthy eyes and good vision play a critical role in how children learn. Vision and eye problems during childhood may cause developmental delays. During early years is when children develop the visual abilities that they will need in school for their life.

Dr. Pilar Silverman, Executive Director of NPHI Medical Services

Clinic Needs Though our clinics are quite well equipped, there is always a need to acquire new minor equipment to ensure a quality standards framework.Sphygmomanometers, stethoscopes, thermometers, stadiometers, printers and even computers get out-dated, worn out and old. Here is a needs list from our clinics.

Bolivia: Updated formulary book in Spanish, stadiometer and pediatric sphygmomanometer

Haiti: Stadiometer and French formulary book

Dominican Republic: Psychology test material

Nicaragua: Sphygmomanometer adult and pediatric

Honduras: Stadiometer

Peru: Flash light and neurology test material

(continued next page)

NPHI Excellence in HealthcareFor more information contact: Dr. Pilar Silverman at: psilverman@nph.org, Design by: Monica Gery, NPHI Information Officer

Importance of First Aid Training

The Medical Services team assists in finding local training through hospitals or other facilities. In (home here) First Aid training was performed by a local firefighter squad. The goal was to provide basic first aid interventions and to highlight in which situations the patient needs urgent medical assistance.The training also raised awareness among non-healthcare staff about the importance of early intervention when there is an injury. Other training topics were: choking, bone fractures, wounds, fainting and basic CPR.

NPHI Medical Services Team

Visiting Medical Brigades

Medical brigade teams are more than welcomed to provide services supporting our local doctors or surrounding communities. The purpose of medical and dental brigades within NPH homes is to provide service to the NPH children respecting the NPH HEALTHCARE POLICY, which includes an application process that may vary depending on the country and other important requirements. The Brigade Policy is available upon request or when the application to work in any NPH home is submitted to the Local Healthcare Coordinator of the country and to the Medical Services team.

The aim for NPH homes to accept medical and dental brigades is to provide services that build on and add value to the services the NPH clinics provide.

The goal is to work together with the local doctor, dentist or ophthalmologist, in such a way that follow-up care may be provided by the local healthcare staff after the team leaves. To ensure efficient follow-up, NPH requires a report to be turned in no later than 15 days after the completion of a visit.

There is a list of preferred activities including: Well child visits, Educational and preventive activities, local staff training. Dental hygiene Routine dental checkups and cavity treatment, Ophthalmologic checkups, ENT screening, or specialists for infectious disease, neurology, gastroenterology, orthopedics, etc.

NPHI Medical Services Team

“Health is a state of complete harmony of the body, mind and spirit. When one is free from physical disabilities and mental distractions, the gates of the soul open.” ~B.K.S. Iyengar