Dear PHL supporters, 

As we do once a year in October, we would like to tell you what PHL and its colleagues have been up to over the past 12 months and to request your continued support of our efforts. As you know, the stated goals of Project Health for León are to promote improvement of medical care for the Nicaraguan people through education of health professionals, through the acquisition of appropriate medical technology and supplies to enable medical personnel to do what they need to do, and often to provide direct patient consultations and medical and surgical care, mostly in Nicaragua, but sometimes here in the United States.

 Let´s first look at the education efforts this year:

As our board member and colleague Dr. Bill Sullivan has done for many years, he once again through PHL twice brought 4^th year Nicaraguan surgical residents, along with intensive care physicians from the Rosales Hospital, to WakeMed Hospital in Raleigh for three week periods of observation of surgical and intensive care procedures. These physicians also visited surgeons and intensivists at the Pitt Memorial Hospital, the teaching institution of East Carolina University and the Brody School of Medicine, during their stays. Drs. Sullivan and  Osi Udekwu of WakeMed also led a group of  general and neurological surgeons to the Rosales Hospital in April, 2011, along with 2 University of North Carolina surgical and emergency room resident physicians, and they plan to return to León next month for another surgical mission. The interchange of U.S. and Nicaraguan surgical residents has been most beneficial to all concerned.

Board members Drs. John Rose and  Harry Adams took  6 East Carolina University 4^th year medical students to León in February, where they participated in clinics at the Rosales Hospital and outlying areas in the region. Adult cardiologists John Rose, Jimmy Locklear, and John Paar and pediatric cardiologist David Hannon, along with echo techs Wendy Barnhardt, Lucy Towner, and Marie Smith,  evaluated many cardiac patients and prioritized those who require surgical correction. Medical students from ECU and from the León medical school, as well as Rosales Hospital medical residents, were taught in these clinics.

In late August and early September, Drs. Rose, Hannon and  Paar  returned to León to evaluate approximately 300 cardiac patients, 9 of whom were operated upon during a 5 day period by Dr. Ted Koutlas and his team from East Carolina University. These patients required surgery to correct valvular disease caused by rheumatic fever, as well as congenital heart problems and, in one case, a patient with a cardiac tumor. A cardiology fellow from ECU accompanied Dr. Rose for a valuable teaching experience, with expectations of future involvement in our programs.

Dr. Jeff Brumfield, an electrophysiology cardiologist from Kentucky, went to León twice this year under the auspices of PHL to insert donated pacemakers into poor patients who otherwise would have had no hope of obtaining them.

You may recall that for several years PHL has been working with Rosales Hospital internist Dr. Carlos Espinoza, who now is in the midst of another internal medicine residency at the Pitt Memorial Hospital and who hopes to obtain a cardiology fellowship in this country, with his ultimate goal of returning to Nicaragua to set up a cardiology training program, after he obtains full North American boards in internal medicine and cardiology. This will then also enable him to continue bidirectional Nicaragua-U.S. training missions, hopefully over a long period of time.

PHL board member and ECU nursing school faculty person Donna Lake and her associates, with the full cooperation of their UNAN-León and Rosales Hospital nursing colleagues, continue to have teaching teleconferences from ECU to León, and, together with a new Canadian nurse educator, born in Nicaragua, are working to emphasize key basic education deemed needed by all concerned. Right now their chief emphasis is on improvement in sterile technique and proper sterilization of supplies.

As for our goal of acquisition of needed equipment and supplies, PHL has done the following this year:

We cooperated with our orthopedic colleagues from North Carolina (COAN), together with the Rotary Club of Clemmons, NC, in shipping a 40 ft. container to León in the spring of 2011. The PHL and COAN  contents included many valuable pieces of equipment and orthopedic, surgical, and cardiology supplies.

Because the Rosales Hospital budget for sustaining basic medical equipment is abysmally low, PHL again purchased reagents and membranes for autoanalyzers in the Rosales Hospital clinical lab, EKG paper for machines which we had donated, parts for x-ray machines, and other items. Our board has established a budget figure to help with this. Sustainability of donated equipment and  supplies is an ongoing challenge in Nicaragua,  due to multiple factors.  

PHL again contributed  towards  sustainability of the pediatric surgical program in Managua for correction of children´s congenital heart diseases, as part of our support of the efforts of Rosales Hospital pediatric cardiologist Dr. Nubia Berrios.

  As far as PHL provision of direct patient care, a patient with  multiple endocrine-related tumors was brought to WakeMed Hospital for brain surgery by Dr. Grant Buttram, who had previously gone to León with Dr. Sullivan. The same patient had multiple tumors of her pancreas, and eventually required total removal of that organ and of the spleen. She had previously had removal of both adrenal glands by a PHL group at the Rosales Hospital  15 years ago for tumors called pheochromocytomas, which were causing malignant hypertension. We greatly appreciated the generous contribution of gratis care by the hospital and by multiple surgeons and other consultants. Drs. Sullivan and Udekwu and their colleagues, in addition to their teaching activities for the Nicarguan residents in Raleigh and in León, operated upon many patients in León, and, as mentioned previously, cardiac surgery was performed by the PHL mission in September conducted by Dr. Koutlas and his associates.