Andrew Morrow is a Timmy student chapter alum from Indiana University and a former Virtu Project team leader. Since graduating last May 2012, he has has served as the Timmy Nonprofit Management Fellow and most recently, as the interim Programs Coordinator. He plans to pursue his medical degree at the IU School of Medicine in the fall, and will continue to be a part of the Timmy-Indianapolis staff through June. This blog shares one of his recent conversations with Timmy Global Health’s “Medicine Woman,” Becky Lomax-Sumner, who helps to manage our Medical Supply Warehouse.

Becky Lomax-Sumner, one of Timmy Global Health’s Medicine Women, is busy. She is in charge of half of Timmy’s medicine procurement and redistribution–a component of Timmy’s work that distributed approximately $2.6 million worth of medicines in 2012. Officially joining the team in 2001, Becky has been volunteering at Timmy since its infancy. While the scale of Timmy’s work has grown by leaps and bounds over the years—requiring more and more oversight—Becky’s commitment has been unwavering. As a small tribute to her dozen years with Timmy, I thought I’d catch up with her, ask her a few questions, and share her Timmy story with everyone just in time for National Volunteer Week (April 21-27, 2013).

Last week, Becky and I met up around lunchtime at Timmy’s headquarters near downtown Indianapolis and walked across the street to Subway—a frequent staff lunch spot.

Before taking my first bite, I thought I’d start with the basics: “So, where are you from?” I asked.

“Rockville,” she responded. Rockville, Indiana is a small town in Parke County on the western side of the state. It’s more widely known as the “Covered Bridge Capital of the World” and home to Turkey Run Sate Park. Anyone who knows Becky knows that she’s an avid bird watcher (or birder). She confirmed that her time growing up in Rockville influenced her love of the outdoors.

I moved onto questions about her high school experiences, and then college. She graduated from Purdue University with a degree in microbiology. Her love of science and work in labs led her to a master’s level program at the University of Chicago. From there, she moved onto hospital work in Indiana and Illinois, leading laboratory projects that primarily focused on infectious disease. For clinical microbiologists like Becky, there’s not much patient contact in the lab. For that reason, she told me, she enjoyed the extra interaction she was able to have with students and patients on Timmy’s medical trips.

Becky was quick to point out that her role with Timmy coincides perfectly with her personal and professional interests—She gets to work in health and medicine while also working alongside energetic college students and knowledgeable medical professionals. She emphasized that working with Timmy students has always been one of the best parts of her position.

Next question, a question I’ve always been personally curious about: “How’d you meet Dr. Chuck?” I asked.

“I called up Scott Keller (Timmy’s former Executive Director),” she explained. In early 2001, Becky wanted to volunteer with pediatric patients, and she had heard about the Timmy Foundation, which at the time was highly-focused on helping underserved children abroad. “Scott asked me, ‘Do you want to be in charge of our donated medicines?’” Clearly the answer was a resolute yes!

Becky was hired on the spot and was immediately tasked with the responsibility of sorting all of Timmy’s medicines—which were crammed into Dr. Chuck’s garage in Zionsville.

“I was sorting meds in Chuck’s garage one day, and a man who I didn’t recognize walked in,” Becky recalled. “The man asked who I was. And I told him I’m the woman in charge of all the medicines. Who are you?’”

“Dr. Chuck Dietzen,” he responded.

Even though Becky’s introduction to Timmy, its founder, and her new position were unorthodox to say the least, she has always been a dependable and “go-to” volunteer. Becky entered the Timmy community at a time when change was a constant. Nearly every year after she started, the organization relocated the medical warehouse. In addition to Chuck’s garage, Becky and Susie (Timmy’s other medicine woman) have worked out of a warehouse at Shadeland and 55th, Eagle Creek’s airport hanger, and a building on the west side of Indianapolis near I-465. Becky laughs when she recalls working out of one space in particular—the basement in Glendale Mall! Each of these “warehouses” were spaces donated by board members or connections that Dr. Chuck had made.

For Becky, the turning point in Timmy’s 16-year history was in 2005 when Timmy moved into its current building near downtown Indianapolis. Becky rolls her eyes whenever she remembers the chaos she used to endure on mornings when 5 or 6 medical teams would leave from the old buildings on the same day. The new building—and her new pharmacy—were much bigger, and would allow for organizational growth – which soon came.

“What was your most memorable Timmy trip?” I asked. Becky has traveled 19 times to Timmy’s partner organizations in Guatemala and Jamaica. She has a lot of stories to choose from.

Without hesitation though, she recalled a story from her second trip to Guatemala in 2008. The story involves a midwife named Doña Ana – who is both a community leader and a liaison between Timmy, its partner organization Pop-Wuj in Xela, and Timmy’s patient population in a rural Guatemalan community. At that time, Timmy had three infant incubators sitting in the medical warehouse that had been donated by St. Vincent Hospital. Becky decided to try to get one of those incubators to Guatemala for Doña Ana.

A close friend of Becky’s, Doug Moore, was gracious enough to donate a flight to Guatemala in his private jet so that she could travel with the incubator and a plane-full of other supplies for Doña Ana. Becky was all smiles as she explained how the situation had unfolded. Today, the incubator is still at Doña Ana’s clinic in Guatemala, and is one of just three incubators in the entire city of Xela. Becky keeps a picture of herself and Doña Ana hanging prominently over her desk in the basement pharmacy in Timmy’s warehouse—a constant reminder of that meaningful trip.

Our lunchtime chat flew by, and in no time at all came to a close. But as we moved back towards headquarters, Becky and I kept the conversation going.

She was anxious to talk about Susie, Timmy’s other Medicine Woman. Together, the two Medicine Women spend hundreds of hours each year organizing medicines in Timmy’s warehouse. They enjoy the camaraderie and the friendship, and have learned a great deal from each other over the years.

Back inside headquarters, Becky headed downstairs to her pharmacy where she is already making arrangements for the next round of Timmy medical trips in May. Despite having volunteered with Timmy for over 12 years, Becky tackles her projects in the medical warehouse with the spirit and energy of someone who’s volunteering with Timmy for the first time—and she says, “You think 12 years is a long time? I’m just getting started!”

Jose Vazquez is Timmy Global Health’s new Medical Programs Coordinator in Monte Cristi, Dominican Republic. He is from Yakima, a small town in the eastern part of Washington State.  Jose graduated with a B.A. in Public Health and a minor in Classical Studies from the University of Washington-Seattle in June 2011.  At the UW, he had the opportunity to study abroad in Rome, Greece and Sierra Leone. Little known facts:  He played trumpet for the UW-Husky Marching Band, sang bass for the Gospel choir, and served as vice-president for his fraternity, Kappa Alpha Order. This blog post is an introduction to Jose and an overview of his plans for Timmy’s programming in the D.R.

I’ve recently completed 18 months of service as a U.S. Peace Corps volunteer. I originally sought out placement as a volunteer to extend what I had witnessed and felt while studying abroad in Sierra Leone. Though I only lived in a tribal village for three weeks, it was enough to categorize need, yet also experience the vitality and the potential of the community. It was a time in which I found a rawness within me that I hadn’t felt before—having to strip myself of my lifestyle in the U.S. and submerge myself into something unknown and thrilling at the same time. Simply, my inspiration to join Peace Corps was wanting the opportunity to live somewhere totally different, delve myself into a new culture, and come back to the states with a perspective that would allow me to feel more ‘complete,’ for a lack of a better word.

My experience in the D.R. has been all of that and so much more. Joining Peace Corps has provided me with an opportunity to live in an environment completely different from the one I had in the states—delving into music, food and culture has been so fun! In this placement I’ve also been able to apply concepts that I learned as an undergrad to my work, especially as they pertain to disease transmission, treatment, and prevention.

The first project site that I was stationed at with Peace Corps was in Pimentel, Duarte Province.  My primary projects revolved around working with youth and women’s groups with health sector initiatives to prevent the contraction of HIV and advocate about teen pregnancy and mother/infant health. In December 2012, group leaders and I graduated a total of six youth groups and four women’s groups in the above topics.  Some of the featured group work that we used were an HIV-themed play for World AIDS Day that received PEPFAR Funding with the youth groups and income generation projects with the women’s groups.

Within the past months, I’ve phased out my projects in Pimentel, and have taken on a new Medical Project Coordinator position with Timmy Global Health in Monte Cristi. It’s been living in Monte Cristi for about four weeks, but it was a three-month transition process.  I owe a ton to Alyson Davidson, who was the first Timmy volunteer in the DR, and whose position I’ll be taking over.  I spent a week on her couch as she showed me the ropes in clinic visits, medical trip organization, and life in the new town in general. She’ll be leaving the D.R. soon to attend medical school back in the sate, and I hope I’ll be able to fill her shoes and help to build upon what she’s initiated.

Before I go into more of my own story, I should share some more details about Timmy’s partner organization in the Dominican Republic: Banelino. Banelino is a fair trade banana cooperative that ships primarily to European markets. For every box of bananas that Banelino ships, it receives $1 USD.  The monies received are then collected and shifted to Banelino’s social programs—one of which includes health services. Banelino’s health program has been in full force since 2002, and is nearing its one-year anniversary as a partner of Timmy Global Health. Banelino’s health program currently serves a total of 11 communities, in both the provinces of Monte Cristi and Valverde, reaching both cooperative workers and community members.  Banelino’s health team includes two doctors, one nurse, and a team of about 15 health promoters that help to provide primary care services, a vaccination program, trainings for health promoters in health related topics, and even an ambulance for emergency transport.

Two of the five communities that we serve in the Monte Cristi area have a predominant Haitian population. Haitian families migrate to the D.R. to work mostly in agriculture. In Monte Cristi, agriculture is predominantly focused on banana production.  All of the communities that Timmy/Banelino operate in are very marginalized due to their rural location, as well as poor road conditions and other logistical challenges that limit access to health services. Our Haitian patients are further marginalized due to language and cultural barriers that they face.

Recently, Alyson and I have started a photo campaign to help us manage the medical records of our Haitian patients. The task has involved two full days of work in predominantly Haitian-migrant communities where we’ve discarded duplicate folders, and in their place, have taken pictures to match faces with each available patient record. We intend that this effort will allow a more efficient way of sorting through the records when it comes to weekly medical clinics as well as Timmy medical trips. A challenge to this new record-management system however, is the reality of migration patters. On one of the site visit days, our translator informed us that about 18 Haitians had left for Haiti on the same day! This poses the challenge of not knowing who these patients were, and thus, leaving a portion of the picture project finished until they (hopefully) return. Regardless, 108 pictures have been developed and placed in records, and we’re still counting! We consider this a great success.

In addition to the photo project, Alyson and I are also collaborating on strengthening the current patient referral system.  During clinic days and during Timmy’s primary care medical trips, some patients are referred for advanced care or testing. Timmy takes charge of the financial aspect of the project, and Banelino helps to coordinate the logistics for referring the patients to specialized clinics in Monte Cristi and throughout the country. We intend for the referral program to continue to grow as we take on new patients, and we believe that through it, Timmy and Banelino will be able to promote a greater sense of sustainability with the complete provision of health services to our patients.

It was August 2012 when I arrived to Monte Cristi for the first time.  I’d never participate in a medical trip before (with Timmy Global Health or otherwise), and I looked forward to translating for what was, at the time, just the second medical trip Timmy had coordinated with Banelino. I could never have imagined that just a few months later, I would be interviewing for the MPC position, as well as taking the lead on these programs as of March 2013!  The trek thus far has been very exciting.  I’m still getting a gauge for what this role will fully entail, but regardless, I’m stoked for what will come. And I’m thrilled to be a part of this Timmy-Banelino partnership, all in the spirit of a Peace Corps volunteer.

Muz Ahmed was working as a software engineer at Microsoft in Seattle when he caught the travel bug and wanted to get away (temporarily) to experience other places and cultures. In November 2012, he traveled to Tena, Ecuador with the Microsoft Medical Team and decided to stay! For nearly 6 months he has been working as a long-term volunteer in the Amazon Basin, combining his passions for health and technology to help revolutionize Timmy’s work via an electronic medical record system. This is Part 1 of a 3 Part Series about TimmyCare.

Abstract

TimmyCare is a web-based EMR developed in-house for Timmy Global Health. It’s truly amazing, and best of all, it requires ZERO paper. Paper is the enemy. If TimmyCare was a person, it would be a vegan. It would have dreadlocks, and eat only broccoli (that it planted itself). It would plant trees in its spare time and it would also run for president and win…But then turn the job down because it wasn’t involved enough. It would also eat lots of avocados.

Inception

TimmyCare’s inception began during a medical trip in November 2011 that took a group of doctors and a team of volunteers from Microsoft (Seattle, WA) to Tena, Ecuador. Upon observing how the clinic was run, a group of the volunteers (to their utter dismay) attempted to write a software program to store the data collected by the paper patient-intake forms. Written during (and mainly after) clinic hours, powered by an antique generator that supplied both power and carcinogens, on a single machine that would barely serve as a paperweight at Microsoft, TimmyCare v0 was born.

It succeeded in its objective to store the data collected on the paper forms, but not much else. After running for the few remaining clinic days, it was apparent that TimmyCare was not scalable. Charting hundreds of patient intakes on a single machine proved to be far too time consuming, and usually resulted in degenerative neurological disorders. Nevertheless—aside from the brain hemorrhaging that ensued from its use—TimmyCare had the potential to not only make Timmy’s clinics more efficient, but also to give Timmy insight into its data, something previously impossible.

Henceforth was born the EMR that would need to run in real time during clinic—often in remote locations that lacked Internet, power, and sometimes even shelter from the elements. The software would have to run fast enough to allow Timmy to see upwards of a hundred patients a day, be intuitive enough for medical and student volunteers to learn on the fly, advanced enough to justify the investment and development effort, and cost nearly nothing.

Version 1.0

Version 1.0 of TimmyCare began with a complete re-write in Redmond, WA by two software engineers who were on the initial 2011 medical trip. The verb “re-write” does a great disservice to the actual act that was performed as code was purged and memories were repressed… The focus was on digitizing the paper intake forms, schematizing a database that would allow for extensibility, and allowing the software to run on as many machines as possible, simultaneously. Since all of the machines used in Timmy’s clinics would be donations (and therefor older than time itself), the program couldn’t make any assumptions about the hardware it was running on.

Given those requirements, the clouds parted and it became clear that we should run TimmyCare as a website! A website would enable nearly any hardware asset to access the system, provided it had a browser. The website model inherently facilitated simultaneous processing of a patient, something paper—to its total and utter disappointment—would not allow. As a website, scaling TimmyCare to work with more devices, clinics, and providers was rather trivial, and destroyed zero rainforests in the process.

Fast forward 1 year to November 2012: the new version was deployed once again in Tena, Ecuador. A server and router were donated, along with 8 archaic laptops (each weighing slightly less than a car), and 5 inexpensive tablets, which turned on just over 40% of the time. The data collected from the v0 offering which was still running in Tena, was migrated to the new schematized database. Each clinic day, hosted in a remote village deep within the rainforest, was transformed into a mini datacenter. Bushes were burned, grounds were cleared, and Wi-Fi networks were broadcasted. No one was hurt, directly.

To our dismay, there were many issues with the software in that deployment. It was slow, its uptime wasn’t very high, and it wasn’t intuitive for the doctors or nurses. In its defense, the students loved it—but they don’t save lives (yet), so it doesn’t matter what they think really. Each night, team TimmyCare would assemble with the medical professionals and take notes as they bashed the software without restraint. Then we would make our immediate changes, which were deployed and tested the next day in clinic.

The Aftermath

By the end of that medical trip, TimmyCare was far more stable, hardly crashed at all, and was finally beginning to please the doctors, all the while making the Triage and Pharmacy stations the fastest they had ever operated!

 The main objective was close to complete by this point: Timmy Global Health was finally able to harvest data from its medical trips, and the EMR-enabled clinic was actually running faster than it had with paper patient-intake forms. (The reader is encouraged to re-read that last sentence multiple times).

At this point, the question of whether TimmyCare is actually being useful is still not answered, but we’ve at least overcome the question of it being usable! To answer the usefulness question, TimmyCare version 2.0 needs to demonstrate value added. So for now, it’s back to the lab again! More updates to come soon.

Zach Wright is Timmy student alum from Butler University and is currently working as a long-term volunteer in Tena, Ecuador. For nearly 9 months, he’s volunteered alongside Timmy’s international staff, helping to coordinate short-term medical trips to the Amazon Basin, managing chronic care patients, assisting referral patients in need of advanced care, and piloting Timmy’s new EMR system—TimmyCare. He’ll be pursuing his medical degree at the Marion University School of Osteopathic Medicine in Fall 2013. This blog highlights some of the challenges that arise in chronic care management for patients with difficult diagnoses in developing countries. (Click here to read an earlier blog post from Zach Wright.)

Timmy Global Health (Timmy) has developed a knack for overcoming obstacles on the ground. Whether these barriers to health derive from logistical, financial, or other potential challenges, Timmy’s staff is well equipped to solve issues related to getting our patients the critical treatments they need. One of the biggest challenges that Timmy—and every other international medical aid & relief organization—face is providing continuity of care. While short-term medical trips provide valuable services to many patients (i.e. disbursement of vitamins, anti-parasitic meds, health education, etc.), patients with chronic diseases require a much more intricate and sustainable health system. Many of Timmy’s chronic patients rely on daily medications, and in the absence of Timmy’s primary care clinics, their prescribed treatments are costly and difficult to come by.

I have witnessed these challenges time and again through my work with Timmy. One of the most recent scenarios took place during the January 2013 DePauw University medical trip to the Napo Province, where our Timmy physicians encountered two complex neurological patients—Michael and Alberto—both diagnosed with Parkinson’s disease. Managing chronic treatment plans for patients with hypertension and diabetes is challenging enough in the Amazon Basin, but this disease takes it to another level.

Parkinson’s disease is a chronic, degenerative neurological disease that can present in several forms, and is caused by a loss of dopamine cells in the substancia nigra—a specific region of the midbrain. The loss of the dopamine cells in the midbrain causes a certain movement disorder with rigidity, tremors (shaking), an unstable gait, and a loss of muscle control called akinesia. Although there is no present cure for Parkinson’s disease, dopamine and dopamine agonists are typically used to improve the symptoms. In the western world, new therapeutic strategies such as deep brain stimulation (electro stimulator inserted by surgery in the brain) are common, and costs for treatment average out to be an affordable $30 USD per month.

Dr. Katharina Stengl—an Austrian Neurologist who recently served as a long-term Timmy volunteer—treated Michael and Alberto when they arrived at Timmy’s primary care clinics in the communities of Tamia Urku and San Rafael, respectively. (Click Here to read a blog post from Dr. Stengl). Although neither patient had ever been diagnosed with Parkinson’s disease, nor received dopamine or any other treatments, they both presented with the classical clinical symptoms of idiopathic Parkinson`s syndrome (rigor, tremor and severe akinesia). And both experienced an onset of the disease within the last 4 years. Due to multiple years without treatment, the disease had progressed at an alarming rate for Michael and Alberto. Sadly, Alberto was hospitalized on the same day that he came to clinic, due to severe dysphagia that had caused weight loss and an inability to swallow.

After seeing both patients in Timmy’s clinics, Dr. Stengl referred them to the Stadler Richter Hospital in Archidona, so that she could start their treatments and oversee their progress. Before their follow-up appointments, she had diligently requested specific neurological medications, but unfortunately the meds did not arrive. Dr. Stengal’s time as a long-term volunteer with Timmy Global Health came to a close before she could oversee treatment for these patients. Without another neurologist on staff at Stadler-Richter Hospital to monitor Alberto and Michael’s Parkinson’s treatment, they would have to travel to another Timmy referral destination, Tierra Nueva in Quito.

But the search for a proper care facility for Alberto and Michael encountered another obstacle. As Timmy staff and partners arranged the logistical details for their trip to Quito, we quickly discovered that Tierra Nueva no longer had a neurologist on staff either. After searching high and low for another option, someone finally suggested that we reach out to a former Tierra Nueva neurologist, Dr. Michael Andrade, who now works in public health clinics in other parts of Quito.

Dr. Andrade agreed to schedule a consult for both Alberto and Michael.  Finally, nearly a month and a half after Dr. Stengl initially saw them on the January brigade, they arrived in Quito for their referral. Dr. Andrade assessed both patients, ordered blood labs, and ran tests. The patients had to return to their homes in the Amazon Basin while the tests and labs were processed, and then made a second trip to Quito a few days later to receive the results and begin their medical treatment. Upon their return, Dr. Andrade explained to each patient their medical situation, confirming both diagnoses of Parkinson’s disease, and outlining a treatment plan moving forward. He prescribed medications for each patient, which Timmy Global Health purchased immediately after leaving the clinic.

In order to monitor Alberto and Michael’s treatment and progress, both patients scheduled a second follow-up appointment at Dr. Andrade’s Quito clinic for late April. By the end of February, just a few days after the start of their treatments, both patients were becoming accustomed to their new meds and showed signs of improvement. They will continue to receive treatment and monthly follow-up services from Dr. Andrade, and Timmy Global Health will continue to work with Dr. Andrade for other neurological cases in the future.

Alberto and Michael’s stories show Timmy Global Health’s level of dedication and persistence. Staff members in Ecuador spent nearly 2 months attempting to locate a reliable neurologist and despite many obstacles, they refused to give up—making every effort to ensure that Alberto and Michael had access to the care they needed. But for Timmy Staff members, this story is the rule, not the exception. Timmy is dedicated to its communities and its patients—we’ve made a commitment and a promise to them. We are determined to get results for our patients and we are willing to find solutions, no matter where we have to go or how hard we have to look. And this “never-give-up” mentality is making a difference, one patient at a time.

Maria Alatorre is a junior, pursuing her Bachelor’s of Science degree in Biology at Indiana University. She is also an active member of the IU Timmy student chapter, and was awarded a scholarship from the Hank Benjamin Student Travel Scholarship Fund for her participation in the March 2013 Medical Trip to Xela, Guatemala. This blog post shares an inside look at her day-to-day experiences.

This marks my third year as a member of the IU Timmy Global Health student chapter, and my second time volunteering on a medical trip to Guatemala during my Spring Break. My first trip was a true eye-opening experience—I had never been in such close proximity to severe poverty and education disparities, yet such pure happiness. Within 24 hours of arriving in Guatemala, I came to realize that I wasn’t necessarily there to change peoples’ lives. Instead—the people I met were going to change mine.

The year after my first Timmy trip was an eventful one. I developed as a person, shedding this bad habit, picking up that new one—making new friends, and shamelessly learning their stories and creating my own. I struggled through my pre-med course work and forced myself to honestly re-evaluate my own ambitions. Ultimately, I decided to become a nurse practitioner, a career I believe is much better suited to my life goals. During that time, I also went back to my hometown in Mexico—to visit my grandmother, cousins, aunts, and uncles—for the first time in 15 years. While there, my experiences from my Timmy trip to Guatemala replayed in my mind, and I marveled at the parallels in my emotions while in both countries. Never have I felt as happy as when I am in Guatemala and Mexico.

I think all these events and realizations leading up to my second trip had a significant influence on my perspective as I took off for Guatemala for the second time. It may be blunt of me to say, but I no longer felt like an outsider—like I was only a Timmy student going to Guatemala for just one week. Instead, the second time around, it felt as if I was supposed to be there—not as a “savior” or anything self-centered like that, but as if this trip was just a natural chapter in my life story. Throughout the trip, I never ceased to be amazed by how much more my mind expanded and my heart grew. I learned so much from last year’s trip that it was difficult to imagine that I would gain anything more the second time around—but I did. And I believe, most of all, that shows how much more living I need to do.

With this blog post, I would like to share with you—Timmy’s network—what exactly Timmy students do on these trips. Below is a day-by-day account of our week of clinic, and the weekends before and after. Each story is unique, of course, and my views and thoughts do not reflect those of my fellow Timmy members. However, I hope that this will give you a better understanding of why so many people have a special place in their hearts for this organization, and why so many people proudly proclaim, “I am Timmy.”

Click the links below or scroll down for daily reflections.

Saturday, March 9

Sunday, March 10

Monday, March 11

Tuesday, March 12

Wednesday, March 13

Thursday, March 14

Friday, March 15

Saturday, March 16 & Sunday, March 17

Back in the US

Saturday, March 9

We arrived in Guatemala City, and took a short drive to the beautiful Antigua, a touristy hot spot with houses so gorgeous, the words “La Bella Casa” are painted on their walls. The streets are made of cobblestones, the churches are ornate and breathtaking on the inside and out, and flowers, delicate and bright, cling to the trees and bushes. In Antigua, our “Team” of medical professional volunteers, students, and Timmy’s Medical Programs Coordinator were all introduced to each other for the first time. We spent a long part of that night on the roof of our hotel, staring up into the endless sky. I considered about the week ahead, prayed that we would do more good than harm, and felt energized by the excitement of it all. And I thought—amazing how the moon, the stars, the clouds, the sun are the same no matter where you are.

Sunday, March 10

A group of us woke up early to walk around Antigua. Everything was calm and quiet as we roamed the town. We came across a pick-up soccer game, saw a pack of wild dogs, and greeted a group of men starting their morning ritual. When we came back for breakfast, I took a quick picture with “Flat Stephanie.” For a class project, my little cousin made me a paper doll version of her so that she could spend a week in someone else’s life. Having Flat Stephanie around proved to be very interesting…

After a yummy breakfast of pancakes, black beans, tortillas, fried plantains, fruit, and café con leche, we set out to sightsee once again before heading to Quetzaltenango (Xela). As we wound up the mountainside, we passed chicken buses, green trees, and fields that looked like quilted patches of tilled soil and plants. When we arrived in Xela, I saw the familiar “Cristo Vive” sign in the distance, and memories of last year’s trip flooded my mind. After lugging our suitcases to our rooms, we explored our home for the week. We saw a procession for Semana Santa, smelled delicious churros and pupusas from the vendors at the market, and simply admired the architecture of the buildings and churches. That night, Dr. Ronny Alvarado—from Timmy’s partner organization Pop Wuj—gave us what I personally call his “famous cultural competency talk.” Just as I was affected by his words last year, his sincere speech compelled me to do what I can, when I can, with what I can.

“We believe in making miracles”, Dr. Ronny told us. “Pop Wuj is a miracle, Timmy is a miracle, and the partnership is a miracle.” These words remind me that I don’t have to wait until the moment is right, or when I have all the resources necessary, or when I am in the right place to help someone—this moment is all I have and all I need to take action.

Monday, March 11

First day of clinics! We traveled to Concepcion Chiquirichapa. I translated for Dr. Bercovitz, a phenomenal man and doctor. From the beginning of the week started, it was clear that the medical professionals all had a deep passion for healthcare and serving patients. They were all a pleasure to meet and get to know. Dr. Bercovitz absolutely loved working with all his patients, and was adamant in learning a few Spanish phrases to help his patients feel more comfortable. He took pictures with the patients that touched his heart the most, including a very healthy and fit ninety year old man! His instinct as a human and as a doctor were remarkable. He picked up on a young female patient’s depression almost right away. As soon as Dr. Bercovitz asked her if she was sad, she started to cry, and told us her sister had passed away from cancer the year before, after losing a two-year battle. Besides teaching me the importance of listening to patients’ silent words, Dr. Bercovitz also taught me how to write prescriptions shorthand, how to listen to heartbeats and lungs, and how to examine eyes and ears.

All in all, it was a successful clinic day. Our cultural activity for the evening was delicious! We went to Chocolate Doña Pancha, a five-generation, family-owned chocolate factory. Doña Pancha told us about the history of chocolate, the process of making it from cocoa beans, and even the health benefits! We dipped tropical fruits into a rich chocolate fountain, drank the best hot chocolate of my life, and poured the chocolate fondue into peach yogurt. Then we were let loose to buy any and all products. Aside from all the chocolate goodness at Doña Pancha’s, this experience is vivid in my mind because I met a young girl—about 14 or 15 years old—who worked in the chocolatería. She was attentive, sweet, and had a great sense of humor. As we shared jokes and teased each other, she reminded me so much of my own cousins, bubbly and personable. I remember looking at her and noticing the differences between her and the young patient with depression from earlier. But I was also struck by the similarities. I knew they were both facing struggles of their own—medical, personal, or emotional—and that they both had dreams they wanted to accomplish. I knew because I was that age once—we all were. As I left the chocolatería, I said a small prayer for her that she may live the life she desires, safe and happy.

Tuesday, March 12

Today, we went to Xeabaj, where the clinics were held in the community’s school building, with a big courtyard for playing soccer and basketball in the center. Xeabaj was an interesting community and many of the citizens’ first language is Quiché, rather than Spanish. Therefore, a local woman named Laura and I teamed up to translate for Dr. Hobbes. From the little kids at the fluoride station, I learned how to say “hello and “thank you very much”! But for everything else, I relied on Laura.

Three events from this day stick out in my mind. First, we saw a tiny patient, a five-month-old baby who weighed only 5.5 pounds! He had a beautiful little face, sweet and smiling. Dr. Hobbes, a pediatrician, could not believe that he weighed so little, and had me reweigh him. So there I was, taking the clothes off this little baby, trying to soothe him so that he wouldn’t roll off the scale. It was quite the experience! What was truly remarkable, however, was their determination—Dr. Hobbes’ determination to let the mother know she had to start feeding her baby solid foods immediately, and the mother’s subsequent determination to put the baby on a nutrition program. We spent about 30 minutes with them, as opposed to the average 10-15 minute check up. Dr. Hobbes kept saying, “He could die if something isn’t done! His development could be impaired…” She spoke with such passion the baby could have been her very own child, and I was very moved by that. I realize that healthcare providers can’t always personalize their patients’ cases because it’s not healthy for the physician. But what if—for fifteen or twenty minutes of the appointment—we did as Dr. Hobbes, and viewed our patients as our friends or family? We could give patients a voice, like the one Dr. Hobbes gave that baby.

The second event that made this day special was playing soccer and basketball with the children. On last year’s trip, I was so focused on translating and doing what little I could to ensure the patients were receiving accurate medical attention that I overlooked opportunities to connect with patients on a personal level. I didn’t take the time to interact with the children, to play ball, or color with them, or get to know them better. I didn’t give myself that gift last year, but I vowed that for this year, I would make my experience more personable, and would try to connect with all the people I encountered, not just Timmy’s patients. And it was an incredible experience.

The final event occurred after we were all packed up and ready to go. I wanted to take a picture with Laura—my translation partner—because I admire her, and wanted something to remember her by. She’s such a strong woman—a single mother of seven, knowledgeable about nutrition, and home remedies for sicknesses. It was amazing to watch her interact with the women, to see her explain the treatment each one received and why it was important they take their vitamins and medications. Laura had very valuable qualities that I wish I had: she knew both the language and culture of the patients, so she knew how to most effectively communicate with the patients. She knew how to break down the medical lingo so that they would understand, how to have them take charge of their own healthcare, and how to answer all their questions. Furthermore, they were comfortable sharing information with her, which allowed Dr. Hobbes to diagnosis a more accurate treatment plan. After taking our picture, and thanking her, she told me, “You will always have a special place in my heart.” It is these people and these moments that I keep in my heart, drawing on them when I need motivation and reminders of what I wish to do in this world. 

That night, we went to Trama Textiles, an organization run by widows of the soldiers of Guatemala’s Civil War. They showed us how they back-strap weave threads into beautiful scarves, bags, hammocks, journal covers, hats, headbands and more. We met two women that were a part of the organization; one was the president of Trama. She was happy to see us, and thanked Timmy for its continued support. I was grateful to witness how they had turned their tragic loss into something positive and educational for everyone in the community.

Wednesday, March 13

I woke up Wednesday with sore muscles from the soccer game—just a reminder of my promise to make more personal connections! Our third day of clinic was in Pujujil, a community whose local government works hard to serve its people. The mayor was present, as well as volunteer translators. Like Xeabaj, many of the citizens’ spoke little Spanish. In Pujujil, the common language was Mam. I worked with Dr. Newell, an ENT specialist: ears, nose and throat. He let me look into patients’ ears to see the difference between healthy and infected ears, and listen to heartbeats and lungs. I started noticing trends in the medical ailments of the people: arthritis, gastritis, blood pressure, and diabetes.

In many cases, a likely cause of the arthritis was years of pushing, pulling, and lifting in everyday work, such as farming, tending to the livestock, cooking, washing, and other general housework. During our lunch break, we saw a very elderly man walking up a hill, carrying a grand pile of wood, strapped to his head and back, and I immediately understood. On the other hand, the gastritis, high blood pressure, and diabetes were probably due to poor nutrition, a lack of access to purified water, and other factors.

While Dr. Newell was seeing a young mother, her two children and her nephew, Dr. Chuck—the founder of Timmy Global Health—came from his own station and showed the boys magic tricks. That image of the delighted children, their eyes huge and shining, their smiles toothy and wide, will always stay with me. It was pure joy—I wasn’t even watching the magic tricks anymore, I was watching their expressions! We finished early that day, as many of the community members were attending the funeral of a young man. We saw the procession as they walked by, and heard their songs and their cries of sorrow.

On this day, I was also able to meet and play with the children. A fellow IU Timmy member and I brought out coloring books and crayons, and sat outside with the children. I loved seeing the look of pride on their faces when we praised their work and their joy when we told them they could keep their pictures and take them home. I also recognized a couple of girls that I met on last year’s brigade, and in that moment, I was so proud to be a part of Timmy Global Health—because I saw just how sustainable this organization is. For the entire year that’s passed since I last saw these girls, they had vitamins and access to medical attention. They had an opportunity to grow up healthy, and to thrive.

Thursday, March 14

Today we had the opportunity to visit Doña Ana—a midwife who has helped bring 16,000 babies into this world! Doña Ana opens up her own home to the women and families of Buena Vista and other surrounding communities, giving them access to healthcare. Her whole life is dedicated to the well being of others!

On this day, I translated for Dr. Judy, a sweet and inspirational doctor. After her children were grown, she enrolled in medical school and practiced as a doctor for ten years! She has a compassionate bedside manner, introducing herself in Spanish to all the patients, which I could tell they appreciated that. There was one woman in particular who reminded me of my mom and grandmother. She was so grateful, and thanked and hugged us multiple times. Another special patient that day was Andy, a small child with cerebral palsy. I didn’t get to meet him, but many of my fellow Timmy members, including my roommate, were deeply touched by his story, and shared it with me. He and his family traveled from three in the morning to Doña’s house. My roommate told me that was the day she finally felt as if she was making a difference, and that this trip was making a difference in her own life. She was amazed at how much Andy understood, at his ability to interact with people, and his eagerness to try Dr. Chuck’s magic tricks! She said, “Any ideas I had about children with disabilities were shattered today.”

On this day, I was also reunited with Maria and her beautiful little girl (also named Maria). I met them both last year when Maria and I double-teamed to translate for Dr. Obeime—a Timmy board member and medical volunteer. I was so happy to see her! Her little girl is in first grade now, and she told me she really likes school. Again, just like that day at Doña Pancha’s, I pictured this little girl’s future.

That night, we had a delicious and laidback burrito dinner at Pop Wuj, and met some of the Pop Wuj students enrolled in the clinic’s Spanish program. It was our last night in Xela, a bittersweet night. Our week was drawing to a close, and we soon had to return to school, to responsibility, to our “ordinary” lives. We had a reflection that night, and talked about how the people of Guatemala had forever touched our lives, and how we were now motivated to keep living the mission of Timmy Global Health: to use our passion and talents to empower others and ourselves to engage in health disparities.

We also brainstormed possible improvements to the organization and medical brigade. For example, Anne, a nurse, brought up the fact that many of our patients do not speak or read Spanish, so while they may understand how to take the medications while at the clinic, they may forget once they get home. She suggested using a picture system instead. We also discussed the idea of making posters or sheets to share information about nutrition and zoonosis to the patients while they wait for their prescriptions to be filled. I enjoyed this reflection, as it helped to put the purpose of our work into perspective, and also helped me sort my feelings. I walked out to the roof that night, to admire the stars and moon, the mountains in the distance, the “Cristo Vive” sign, the cross on top of the church, to hear the laughter and voices of people, the sounds of cars and motorcycles, and the faint music of the salsa club. I closed my eyes and let my heart take it in.

Friday, March 15

Our last clinic day was in Xela, at the Pop Wuj clinic. Knowing this was our last walk to the clinic, I relished the smells of the cooking food, the sight of the students rushing to school in their red and blue uniforms, the sounds of the trucks carrying fresh lettuce heads, the rocks under my feet. I looked down my favorite street, a hill so steep I wanted nothing more than to ride a bike from the top to the bottom. (I’ll go back one day to do just that.)

I translated for Dr. Chuck that day, and a fellow Timmy shadowed him as well. We asked him why he became a pediatrician, and how he knew medicine was the “right” career for him. It was nothing short of incredible to work with the very man who started an organization that has changed countless lives, and all for the better. We saw patients of all ages, young, old, and in between. One of my favorite cases was that of an elderly couple. They walked in together, and shared a couple of diseases: high blood pressure and diabetes. It was clear they were a team: they helped each other remember when they had last taken their medicine, scolded each other when one was not paying full attention to Dr. Chuck, and read each other’s treatment plans to make sure they understood what each was taking.

When Dr. Chuck told them to limit their sugar and salt intake, and exercise to lose a few pounds, they nodded their heads and thanked him profusely. As they walked out, the man told my Timmy mate and I, “Gracias, doctoras.” I smiled and said, “No, we’re not doctors.” He smiled and replied, “Not yet.” The truth of his words both terrified and excited me. One day, very soon, we will switch roles with the next generation, and we will be the ones with stethoscopes around our necks, teaching them how listen for healthy hearts.

That day, we had no cultural activity. We boarded the buses and Don Juan, our bus driver, arranged out suitcases on top of the van. We bade one last farewell to Xela—to moments lived, to patients seen, to people met, and to experiences had—and set on our way to Panajachel.

Saturday, March 16 and Sunday, March 17

The next morning, I walked out to the balcony connected directly to the room, and was overwhelmed by the beauty of Panajachel. I remembered a poster from our very first hotel in Antigua that stated, “Guatemala: Una exageración de naturaleza.” (Guatemala: an exaggeration of nature) There was a mountain to my right and left, a volcano by the lake right in front of me, red tut-tuts creaking by, and a man selling extra-fresh goat’s milk—straight from the goat itself!

We had the whole day to explore this gorgeous town. A group of us went on a pleasant boat ride, and as the wind rushed through my hair, the cool water covered my hand, and I felt so free! We passed by simple yet grand houses and hotels built on and among the very mountains. The whole landscape deserved to be put in a traveler’s magazine, so that its beauty could be appreciated worldwide. When we came back to shore, I went with a small group to a restaurant named Bombay Café. Here, I got to see more of Dr. Chuck’s genuine kindness. First, a young boy came in, asking if anyone wanted a shoeshine. Dr. Chuck gave him some money and told him to shine an elderly man’s shoes—someone local that deserved a shoeshine. Then two different boys came in, and Dr. Chuck and the rest of the med professionals gave them a plate of food that had barely been touched. Their actions demonstrated to me that being kind is a way of life, not counted actions that we do to fulfill our “good deed quota.”

Later, I walked around looking at everything the vendors had to offer. There were so many things that I wanted to take home with me—leather and cloth purses, jewelry, headbands, bracelets, t-shirts, hats, and more. But most of all, I wanted to take that feeling of pure contentment home with me. I wanted to bottle up a little bit of Panajachel’s magic and beauty and take it with me, and spray a little onto my life every once in a while. Saturday night, we all stepped onto our hotel’s roof. We had a small discussion, where we learned we had been able to treat around five hundred patients throughout the week! I felt pride again, and such thanksgiving to be surrounded by those amazing individuals, who had no idea just how incredible they are, and how much they marked my life. When it was over, we headed inside, to pack for our journey back to the United States, a world so different yet so similar to the Guatemala we came to love.

Back in the US

Now that I am back in Bloomington, I find myself thinking about Guatemala, Timmy, and my life. For my cousins’ Flat Stephanie project, I had to write about our adventures together and as I wrote the letter, I got more and more excited. My cousin’s classmates will read this, and learn about other children in the world—they will dream about new places and adventures, they will learn about Timmy and what college enables you to do, they will travel the world without even leaving their desks! And as I write each word now, I realize that global medicine will be a part of my life forever, because I cannot imagine it otherwise.

I wish everyone could have this experience. It has changed my perspective on healthcare and on life. It’s allowed me to see first-hand that true joy comes not from material things but from other people’s joy, and finding purpose in one’s life. Thank you, Timmy, for everything.

Craig Matthews is a physicians assistant working in emergency response in Stuttgart, Germany. He has volunteered as a medical provider in Timmy’s clinics in Tena, Ecuador for three years, and just returned from a January trip with the Ball State team. After providing care to some of the country’s most isolated communities, Craig plans to return to the Amazon Basin for a fourth trip in November 2013. This blog post shares a culmination of his stories and experiences. 

It did not take too much research for me to find Timmy Global Health and realize the quality of their humanitarian work that is offered in Ecuador. As cliché as it may sound, the reason why I ventured into a medical career was to be able to use my strengths to help less fortunate people than myself and to improve the quality of life of people who have little or no access to basic healthcare. On March 2^nd, 2013, I was fortunate enough to participate in my third Timmy medical trip—and my second working with the Ball State University students, who have a special place in my heart, as I completed my first Timmy trip with them back in 2012. The students are highly motivated and caring and show a lot of interest in learning and developing their skills and shaping their futures. Together we spent 7 days providing medical care in Tena, Ecuador.

My journey to Tena was long and began in Frankfurt, Germany. After two stops in the Dominican Republic and Panama City, my flight finally landed in Quito, the capital of Ecuador. An exciting bus journey winded through green mountains giving me the feeling of life and energy. Along the road, local people were seen with livestock, carrying wood or simply walking with their families to reach the small villages and communities that they live in. With happy and loving expressions on their faces, the children waved as we drove past.

We reached what I like to call “base camp” after having spending the time in the bus getting to know other medical professionals and students. It is always interesting to meet so many people, all with different backgrounds and cultures. Our accommodation was basic, clean, and managed by very friendly and helpful staff. The first evening we enjoyed a welcome dinner, which comprised of local culinary specialties. After a group discussion in the evening and a short meeting for the medical professionals, the pharmacists and the students began to prepare the medications for the first clinic day. In Tena we serve two sites per day and so we are, as medical professionals, divided into two teams for each day. Although we were all tired, the students organized and managed to prepare the clinic materials for day one.

Our first day took my best friend Shawn Hake (PA-C ) and I, to a small island community. In order to reach the island we had a bus journey into the Amazon rain forest, which then brought us to a river. We transferred all our equipment and medication to small canoes and set sail for a short journey across the water to the island community. The island community received us with welcoming smiles and the various teams made up of registered nurses, pharmacists and students set up clinic. The varieties of patients we see bring with them a variety of illnesses—which make it interesting for us as medical professionals and also sometimes very challenging.

The patients lined up and waited patiently to be seen by us. I had visited this island on the first two brigades that I had been on and it made it exciting to see familiar faces, and very gratifying when the patients recognized me. I completed 3 small surgical procedures and supplied intravenous rehydration therapy to a number of patients. The language barrier was successfully overcome with very competent translators ensuring that our patients felt comfortable. As the patient lines became shorter, the first day of clinic drew to an end.

Our return journey was filled with exchanging of experiences and the need for a cool shower. The joining up of the two teams back at base camp was exciting as it gave us the opportunity to hear about the other site’s experiences. The evenings were spent enjoying local food and sometimes a relaxing walk around the small town of Misahalli. The town’s inhabitants included small friendly monkeys who made it necessary for us to keep our cameras and wallets safe and tucked away! The coordination of our clinics were managed by August Longino—Timmy’s staff member on the ground in the Amazon Basin. August is a young man with incredible management and organization skills. He has established a solid trust with the local communities, and is very knowledgeable and sensitive to the needs of patients that we treat.

The 4 days of clinic brought with them new and exciting experiences and remained very challenging emotionally and physically. We managed to achieve a lot as a team despite our limited resources and time. The lack of resources and diagnostic possibility’s certainly sharpened my medical skills and brought me “back to basics.” It was a true cultural and medical learning experience. My heart remains in Tena, Ecuador and the Amazon basin and I look forward to my next trip in November 2013.

Victoria Oliva is a sophomore studying Anthropology and Community Health at Tufts University. She is also one of the first recipients of a travel grant from Timmy’s new Student Travel Support Fund, an initiative of the Hank Benjamin Memorial Scholarship program. In January 2013, Victoria joined a team of her peers from the Tufts Timmy chapter and a group of medical professionals to spend a week providing healthcare services to the underserved communities surrounding Xela, Guatemala.

When I heard about the Timmy Global Health chapter at Tufts and its work in Xela, Guatemala, I was intrigued. As an anthropology and community health major and the daughter of a Guatemalan immigrant, I was especially excited by the opportunity to work with and learn from others in a clinical setting in Guatemala’s rural indigenous communities.

Before traveling to Xela with Tufts Timmy Global Health, I had already been to Guatemala quite a few times to visit friends and family and had seen firsthand the extreme social inequities present within the country. These experiences forced me to recognize the many opportunities I had been given, just by virtue of being born in the U.S. For me, this relative privilege created a social obligation to effect positive change in the lives of others, both domestically and abroad. Tufts’ Timmy Medical Trip offered me a wonderful opportunity to bring together this commitment to social justice with my interest in public health – and in my father’s native country!

Once in Guatemala, our medical team spent each day setting up a clinic in a different rural community. We were each assigned jobs on a rotating basis – interpreting for doctors, assisting in the pharmacy, or working in the triage station. I most enjoyed interpreting, as this gave me the opportunity to speak with patients for lengthy periods of time. Through this process, I had the privilege to enter their world and learn about their conception of life, pain, and illness. This experience exposed to me the power of the clinical consult beyond its medical value.

Of course, I served as an interpreter only for the English-speaking doctors from the U.S., not for the Guatemalan doctors who were also part of our team. I wondered how patients’ interactions with the Guatemalan doctors might have differed from their interactions with the doctors from the U.S. Having grown up hearing from my father about the U.S.’s brutal imperialist actions towards Guatemala in the 1980s, I considered how this history might affect patients’ perspectives and perceptions. Did patients regard the U.S. doctors as powerful and all-knowing, or as untrustworthy? How did this view affect their interactions with them? What are the implications of international politics for the work of international health workers?

When our trip came to a close, our medical team left with renewed excitement about continuing the fight for global health equity, as well as empathy for the various Guatemalan patients we had met. As we headed back to Tufts we also shared a certain level of frustration, stemming from the limitations of our resources and time.

Since our return from Guatemala, our Tufts Timmy Global Health chapter has carried with us the memories from our trip as a source of inspiration and motivation. Our Executive Board recently established a shadowing program between the Boston medical professionals and the Timmy chapter members. We also held a university-wide Timmy Dodgeball Tournament, through which we raised over $600 that will help to support the patients Timmy treats in Guatemala. As we continue with the semester, we intend to organize more fundraisers and more campus-wide health equity advocacy activities to support Timmy’s local and international programs.

On a personal level, I remain committed to my pursuit of a future career in international public health. I hope that one day, I will have the opportunity to return to Guatemala—to learn more about how the mobile clinics operate throughout the country, how the community health workers impact patients’ lives, and what healthcare services are like when medical teams are not present.

For now, however, I am deeply grateful to Timmy Global Health and the Hank Benjamin Memorial Scholarship for allowing me to share in this experience.

Katharina Stengl and Goetz-Christian Melloh are Austro-German doctors who specialize in Urology and Neurology. Both served as medical professional volunteers with Timmy in the Amazon Basin from fall 2012-winter 2013. This blog is a summary of their experiences—both personal and professional. Through their work as long-term volunteers with Timmy, they experienced global health disparities firsthand, and took an active role in expanding access to healthcare to some of the Amazon Basin’s most underserved patients.

Before deciding to join Timmy Global Health as medical professionals, both of us had been working for some years as medical assistants at one of Europe’s biggest university teaching hospitals—Charité – Universitaetsmedizin Berlin. We were used to working with highly specialized diagnostic and therapeutic techniques. Talking to each other, both of us realized that we have shared a growing interest in humanitarian work and an urge to help underserved people ever since we had been in med school. Conscious of the contrast to high-tech university medicine we wanted to go back to basic medical examination and primary care. Unfortunately, it was not easy to find a placement in a humanitarian project for both of us because we wanted to work together as a couple and share the experience. After a lot of research, we were grateful to finally connect with Timmy Global Health—who offered us the opportunity to work and volunteer together. In the spring of 2012 we had applied as long-term volunteers at Timmy´s medical site in the Amazon Basin of Ecuador. Working closely with Timmy’s medical team coordinator in Tena, August Longino, we started our humanitarian mission that autumn.

We were transported directly from Germany´s capital and melting pot, Berlin, to the heart of the Ecuadorian jungle—Tena, situated in the Oriente province. At first, both of us struggled with the jungle´s humidity, the different kinds of huge insects and, of course, with the situation of the patients we encountered in the region. We quickly realized the harsh contrast to Germany´s western-style medicine. Certainly, both of us had expected a lack of hygiene, of diagnostic and therapeutic aid, but in the end, we had to admit that the patients in Oriente were far worse off than we thought they would be.

Working with Antony Hidalgo, the Director of the Jose Maria Velasco Ibarra Public Regional Hospital, we started our humanitarian project by accompanying the local Ecuadorian doctors on their everyday internal medicine ward rounds. After getting more comfortable with our Spanish, we got to know the most frequent diseases of the region—which included a large number of gastro-intestinal infections, pneumonia, malnutrition, and other diseases frequent in developing countries (tuberculosis, dengue-fever, snake bites, and self-induced intoxication with barbasco and organophosphates). Learning about how to diagnose and treat these different diseases was challenging, but the hardest part of our work at the public hospital was encountering a completely foreign patient mentality.

We had to learn to respect their ancient beliefs in the power of the Shamans—which were and are still the natural healers of the communities. And we had to accept their fear of western medicine and their overall preoccupation of not having enough money to pay for the treatments we recommended. This was especially difficult, as many of the inhabitants of the poorer communities in the Oriente could not afford the costs of expensive hospital stays and treatments with their daily incomes of about one US dollar.  In many cases, if patients had to see specialists, they usually had to travel at least five hours to Quito. For the majority of them, this was nowhere near an affordable option. Combined with their cultural backgrounds, anxiety to enter a big city like Ecuador´s capital, and lack of access to the expensive medications recommended for treating urological and neurological problems, providing care to these patients was sometimes just impossible.

In the afternoons both of us established our neurological and urological consultations in the private Stadler Richter Hospital—in the nearby small town of Archidona. There was a high medical demand for consults, especially in neurological treatment for diseases like Parkinson´s and epilepsy. Facing the fate of chronically ill patients, like the many neurological patients we saw through our consults, we felt miserable to learn that coverage for their daily medication does not yet exist within the Ecuadorian health system. We were so grateful to learn that Timmy Global Health organized and financed the treatment of our patients suffering from Parkinson´s disease and epilepsy.

During one of our first weeks in the Amazon Basin, a Timmy Global Health supported hernia repair team came to serve the community (Read more about this trip in a post by Andrew Morrow). Within a week´s time five surgeons operated on more than 60 patients suffering from different kinds of hernias (inguinal, umbilical and scrotal). Christian enjoyed working with the American and Italian surgeons and was thrilled to be able to improve his surgical knowledge. In the meanwhile he was eager doing ward rounds on the common surgical ward of Tena´s public hospital, too, where he got to know its chief surgeon Dr. Llamuca. He could assist in the operating room, especially when it came to urological questions like prostate-excision etc. and tried to help out wherever a hand was needed.

In December and January we joined Timmy’s primary care medical teams that came to the region to provide healthcare to the very remote communities of the Oriente, some of which could only be reached by foot or travelling by boat along the Rio Napo. We really enjoyed these mobile clinic days, visiting every day another community, working together with other Timmy doctors, and teaching and supporting the Timmy student volunteers (which were not all pre-med students, though showed eager interest in public health). They did a great job and showed respect to the patients. I was able to treat approximately 30 to 40 patients a day, sometimes the whole family with a bunch of 7-8 children. The patients presented with a broad spectrum of diseases from common flu symptoms to severe pneumonia, malnutrition of the children due to parasites, skin infections like fungus or impetigo, and also severe cases of epilepsy, Parkinson´s disease, birth abnormalities or genitourinary malformation. Thanks to the service provided by Timmy Global Health, complicated cases like these could be referred to specialized hospitals in Quito.

Looking back at our time in the Amazon Basin, I can say it was a truly unique experience that we had. Working with Timmy Global Health consisted of so many different kinds of work: ward rounds, operating rooms, mobile medical clinics…but above all getting to know the people of Ecuador. We enjoyed getting in touch with the indigenous populations living in their small, remote communities surrounded by wilderness, and supplying them with urgently needed healthcare options. We both can finally say that this kind of humanitarian work was not only a donation to the Ecuadorian people; but it was also a great benefit for us! Thank you!

Derek Sprunger is an undergraduate senior majoring in economics and math at Indiana University–Bloomington. He served as President of The Virtu Project in 2012. The Virtu Project is an organization run by 35 students in the Liberal Arts and Management Program at Indiana University–Bloomington. Virtu operates a mock investment fund with private investors who ultimately contribute directly to Timmy Global Health based on the performance of Virtu’s fund. Throughout the past five years, Virtu’s investment fund has been responsible for raising approximately $45,000 in unrestricted contributions for Timmy.

The first time I heard about The Virtu Project, it sounded like the ideal opportunity for me. I was a freshman economics student at IU Bloomington with a particular interest in financial markets. So after hearing about a student-run organization that manages its own mock investment fund, I knew I had to get involved. I thought that hands-on learning in investments would help propel me to the career I sought. Virtu’s mission is two-fold: to educate its members about investing and to use that expertise with a philanthropic objective. I thought the former was my calling, but the latter turned out to be far more rewarding.

When I first started at Virtu, I learned the basics of investing from the group’s elder members. As part of our self-educating mission, I read and discussed with my peers Benjamin Graham’s The Intelligent Investor, which Warren Buffett has called “by far the best book on investing ever written.” Afterwards I served as a group expert on equities in the technology and financial services sectors. My investing education has been both considerable and hands-on, but this was only part of my Virtu experience.

My next role led me to focus on the philanthropic side of the project by attracting investors to the Virtu fund. It also brought me closer to Timmy. This new position allowed me to gain a deep appreciation for the work of both Timmy and Virtu. While I had not expected this when I joined Virtu, my new role fed a passion for benevolence which I inherited from a very young age.

I come from a charitable family with a certain disposition for global health improvement. My grandfather and his parents served as medical professionals in India for significant portions of their lives. Growing up and hearing their stories made me wonder how I could ever match the magnanimity of my elders. Fortunately, working with Virtu has given me the chance to begin a lifelong journey to do just that.

I have had the great privilege of serving as a leader in Virtu for about two years. Many things have surprised and challenged me while serving in various leadership positions. I learned a considerable amount of soft skills which cannot be appropriately encompassed in the classroom: how to lead, manage, and motivate are foremost among them. Without a doubt, I will carry these skills developed with Virtu to my career. But I must say that the best part about my experience was working with passionate people. These people were both Virtu members – curious and motivated individuals in their own right – and the Timmy staff, who exhibited a lot of trust by treating me as a peer.

I have been continually amazed by the respect the Timmy staff shows for the young investors that comprise The Virtu Project. It has been through this support system that I have come to understand why Timmy and Virtu are such excellent partners. The competencies of the organizations simply match so well. Virtu’s desire to learn and Timmy’s dedication to inspiring the next generation of professionals form a great team.

As a senior now with only a few months separating me from graduation, I can say that my time with Virtu has been one of my most transformative college experiences. I am indebted to all who have worked with me, and I am excited for the bright future which I believe is in store for both Timmy Global Health and The Virtu Project.

Dr. Michael Blood is a Family Practitioner working in Crawfordsville, IN. For years, he and his team of medical professionals have worked tirelessly to provide access to healthcare to many underserved communities in Haiti. In January 2013, his team partnered up with the Boise State Timmy chapter to provide medical services to a new region–Monte Cristi–which lies just along the northwestern border of Haiti and the Dominican Republic. Below are some of his observations of the highs and lows of providing services to this region.

Baseball is truly the national sport in the Dominican Republic. The central feature of each batey—the rural communities that Timmy serves outside the larger town of Monte Cristi—is a baseball field, complete with backstop and dugouts, and some with rubber-tire seats. The young men practice very hard, while the older men invest much of their time coaching. During my January medical trip, some of our Timmy team jumped in for a game or two. Barbi and Amber (two Timmy volunteers) raised the bar for the gringos when they went up to bat. They really showed what the ladies could do—as both are avid softball players!

On one of my first days in the DR, we visited a batey called Isabel, and saw about 150 total patients. The day was full of highs and lows. Barbi was able to perform 24 ultrasounds with the machine loaned to us by Sonosite—a rare tool for trips to these communities, many of which lack any source of electricity for powering high-level testing machines. We also did several surgeries, and treated a wide variety of sometimes-complex illnesses. In this same community, we also saw three insulin dependent juvenile diabetics and were able to give them insulin and steps to improve their regimen.

None were even remotely well controlled—the list of challenges to managing this disease in a developing country goes on and on. These patients either have no knowledge of or no access to the resources they need to check their blood sugars; they have no refrigeration for the insulin that’s critical to keeping them healthy; and they cannot afford to buy adequate amounts of insulin in the first place. We hope to help them as they follow up with Dr. Miguel Garcia, but we will need to find a source for insulin for them after what we brought runs out. My day in Isabel was a true reminder that we take so much for granted in the US…

In another one of the bateys we visited, we set up our pharmacy in an old bus that, despite the fact that it no longer runs, works surprisingly well as a distribution center! We called it the “Magic Bus” after the old song by the Who. The docs set up clinic in a school building next-door, seeing and treating patients in classrooms. One of my personal high-points on this day was simply giving a pair of sunglasses to a blind man. And then seeing the smile on his face.

We were also able to do an ECG on a man with chest pain using a fully charged laptop and a remotely operated special program. Another patient, a man with a neurogenic (non-functioning) bladder from a spinal surgery, came to us with symptoms from a chronic indwelling catheter in his bladder. He didn’t have any bags to collect the urine.  It was such a simple, but powerful solution when we were able to give him a leg bag and a new cane, and antibiotics for his ever-present urinary infection.  We also made an asthma spacer device out of an old Tums bottle for a young man who needed assistance with his inhaler. We call that MacGyver medicine!

Perhaps the most interesting moment in clinic that week was when Dr. Keith Baird treated a soldier who insisted on keeping his automatic weapon over his shoulder. Jose, one of the Peace Corps translators volunteering with Timmy for the week, asked if it was loaded, as it was aimed at his foot. The patient replied…It was loaded! But they were assured there was not a round in the chamber. That night we had a show at the hotel with local Dominican music and dancing. The dancers made everyone participate, including myself, which was not a pretty sight. But it was a lot of fun. The music reminded me of Louisiana bayou music with the accordions and saxophones.

Dionissi Aliprantis is a Research Associate at the Inter-University Institute for Research and Development (INURED) in Port-au-Prince, Haiti.  The research discussed in this blog post was conducted with support from the Inter-American Development Bank. In the years before he began working for the INURED, Dionissi worked with Dr. Chuck to help found one of Timmy Global Health’s first student chapters at Indiana University. As a Timmy alum he is a shining example of how Timmy students continue to engage in research, service and development in the movement to end health disparities–even after they graduate.

Most of the choices we make imply tradeoffs between competing objectives we hold.  Consider a seemingly innocuous choice I face every day – the temperature at which to set my thermostat. I want to be comfortable in my apartment (at least enough so to write my Timmy blog post!), but my physical comfort is not the only thing affected by my choice. On the positive side, increasing the temperature will lead me to pay a higher heating bill, which helps provide jobs to those operating the power plant, and contributes to my city’s tax base for things like roads and schools. But on the negative side, increasing the temperature will lead me to pay a higher heating bill, which comes out of my paycheck. And since my heat comes from a coal-fired power plant, heating my apartment contributes to global warming and increases cancer and asthma rates in my city.

Ultimately, my choice will weigh my physical comfort against the other effects from heating my apartment. If schools will close without the tax revenue from my heating bill, I might be convinced to crank up the heat. But if CO_2 emissions are wrecking the planet, it might make more sense for me to put on a sweater during the winter months. Knowing the precise tradeoffs my choice represents will help me to make a better decision.

Now, if you work with Timmy, it may be old news that many of your everyday choices have these kinds of tradeoffs, and you may have already spent a lot of time thinking about those tradeoffs you are willing to accept in your own life. I’m writing this blog post not just about these individual-level choices, but about a very specific group-level choice we might face: If we were to intervene to help communities in rural Haiti gain access to safe water, what strategy or approach should we adopt (“We” can be a lot of people – Timmy, the Haitian government or a Haitian NGO, etc.)?   To be even more specific, I am thinking about two particular approaches to improving access to safe water in rural Haiti.  The standard approach is to drill wells and give all community members access to them, and the community-based approach is to drill wells only after training community members to manage the wells for themselves.

To aid those working to provide water in rural Haiti in making better decisions, I have done some research to try to characterize the precise tradeoff made when choosing between these two types of interventions.  The strength of the standard approach is that it provides water for all community members when wells are functioning, but its weakness is that its wells aren’t always functioning.  The strengths of the community-based approach are that wells tend to function better under this approach, and that it can help build political institutions. The main weakness of the community-based approach is that it might limit access to water for the very poorest members of a community.

After thinking about these tradeoffs for a couple of years, I now believe the community-based approach is a hands-down, clear improvement over the standard approach. But I didn’t always think this way. In fact, when I began my project in the summer of 2010, I actually had very strong views in favor of the standard approach. The main reason is that I am interested in improving the outcomes of the poor, and there is research showing that programs similar to the community-based approach for well maintenance can hurt access of the very poorest community members. Well-known examples in economics are studies of two programs, one designed to distribute de-worming drugs to school children, the other to distribute Insecticide-Treated Bed Nets (ITNs) to combat malaria. It was shown that when participants were charged even the most modest user fees for these programs, participation dropped dramatically as compared to programs with free distribution. 

So when I met Neil Van Dine in Haiti and heard him describe the management program for wells he and his organization had developed, it all sounded very well and good to me except one detail: After his group has helped to organize a community, those communities almost always decide to charge for access to their wells. I could tell Neil was working hard to improve the situation in Haiti, and I could tell he had the best of intentions. But there are a lot of people working in Haiti today with good intentions, and if you are to judge a tree by its fruit, well… looking at Haiti today, I would simply have to conclude that good intentions aren’t enough.  The community-based approach seemed to offer some advantages, but I initially thought the tradeoff in terms of access for the poor was too high to justify the approach.

Two things changed my mind. First, I listened to Neil tell me about his experience working on development projects in rural Haiti.  Neil has been involved in these types of projects since the 1980s, and he and his colleagues didn’t just arrive at the community-based approach because they were trying to make money or restrict access of the poor. I realized there is a case for user fees in some contexts, especially when it comes to maintaining infrastructure.

In the case of water infrastructure, Neil told me about lessons he had learned the hard way. He told me about the water system he had worked to construct together with over 500 unpaid community volunteers per day over the course of a summer.  It sounded like a religious experience – so much goodwill, so much hard work for the good of the community. But because no institutional structure was established to maintain the system after it was constructed, it quickly fell into disrepair.  All of that goodwill and hard work, and in the end the community still didn’t have access to safe water.

He told me about a realization he had while traveling to the US. He noticed that after all the progress he thought his organization had made, he would leave for a few weeks, and everything would fall apart. Wells would stop working, and things would be right back at square one. After an honest look in the mirror, he came to conclude that even after his organization had worked in communities, they were still dependent on outsiders for access to safe water. The community-based approach was developed around the idea of doing something different, an intervention that would leave communities more self-sufficient than before. 

Briefly, Haiti Outreach’s community-based approach is designed around the end goals of organizing communities to make collective decisions, and then helping to train community members in making those decisions a reality. HO works with the local government to establish a committee whose members will oversee the operations and maintenance of the well, making sure that at least $5 are deposited in the well’s bank account each month.  These committees have a variety of responsibilities, and HO requires that they have a series of public meetings to ensure the dissemination of information and transparency in their operation. If the committee is functioning properly, HO will drill or refurbish the community’s well and build a shelter around it (I discuss these issues in greater detail, including exactly how HO experimented their way onto their current approach, in Section 3 of my paper.)

The second thing that changed my mind was looking at the evidence.  Although the standard approach provides water to all, including the poorest, since communities do not manage the wells for themselves, they tend to break down relatively often. As a result, the provision of water is relatively sporadic. Remember that while the community-based approach solves this problem by providing water more consistently, the tradeoff is that it might exclude the poorest members of the community due to the user fees it charges. In my research paper I developed a way to quantify this tradeoff, and I collected data and crunched the numbers in order to do so. The baseline results I got were determined under assumptions strongly favorable to the standard approach. According to these results, in order to prefer the standard approach over the community-based approach you would have to be willing to trade the provision of A LOT of water to the average rural Haitian in exchange for providing water to the poorest.

One of the strong assumptions of these baseline results is that the only reason community members don’t subscribe to a well is because they can’t afford the user fees. But this assumption is quite unrealistic. First of all, by the standards of rural Haiti, the subscription fees aren’t exorbitant (typically about 50 cents per month), and committees can grant discounts to families too poor to afford the full price. This is supported by the fact that 64 percent of households in the median well’s community were subscribers.  Second, there are all kinds of other reasons families might not subscribe. They might prefer to get water from a river if they live near one, or they might simply choose to buy it elsewhere. They might also be jealous of those on the committee, and want the project to fail.  Once you relax this assumption to something more realistic about the access denied to the poor through user fees, the tradeoff is no longer even close. To prefer the standard approach, you would need to essentially ONLY care about the very poorest in communities, being close to indifferent to whether anyone else has access to safe water.

Now I take this as really strong evidence that my initial concerns were misplaced, but this is not yet the end of the story (I know it’s a long post, sorry…). We have gotten to this point, and I have yet to say anything about Haitian history, which is amazing, because it is amazing. It is important to recognize Haiti’s role in the development of the Western hemisphere, with particular attention as an American on the Louisiana Purchase. Thinking as a citizen of the world, it is important to recognize what Haiti has done for freedom.  After it gained independence, Haiti supported groups like Simon Bolivar and his troops, and even the Greek Revolution, with weapons, troops, and other resources. Haiti gave only one condition for its support:  whatever new countries those groups started, they had to abolish slavery there. How can you not want to jump in to support that cause?

The reason I bring up Haitian history here is because so far I have only spoken in terms of water (This is also the focus of my research paper.), but Haiti currently being the poorest country in the Western hemisphere is not unrelated to it also being the first free country in the Western hemisphere. Given this history, I think it can be easy for people to focus on Haiti’s history and to see Haitians as victims. It is easy to see that Haiti is still paying a heavy price today for standing up for freedom at a time when it wasn’t acceptable to the world’s powers. I don’t want to minimize this point, because there is no question the past is silenced way too often when people talk about Haiti. But I think there is an opposing danger in focusing on this too much, because Haitians are much more than just victims. Just because Haiti has suffered from problems beyond its control, it does not mean that Haitians do not have the capacity to make positive changes in their lives. However much we might blame the current situation on history, it doesn’t change the fact that the problem we have inherited is ours; we have to find a way to address it. Focusing so much on Haiti’s history has at times taken my focus away from finding solutions, and I think others have fallen into this mentality as well.

Just like Jacques Roumain’s classic “Masters of the Dew,” I think Haiti Outreach’s work is in the end about much more than just water. It is about realizing the problem is ours, and that we have the power to actually do something about it. From its years of experience, Haiti Outreach now views its work as helping to make communities responsible for moving themselves forward. Once communities become collectively responsible, projects become more effective. This realization has become so deep that Neil is now spending most of his time to initiate a group called Develop Haiti, which is about creating this sense of responsibility on a broader scale than water alone. Develop Haiti’s goal is to create programs that help people realize their language, attitude, and actions have a direct impact on the quality of life they lead.

What does any of this have to do with Haiti becoming a “developed” country?  One big problem Haiti has inherited from its history is that it is a country where social and political institutions have had little room to grow (One illustrative example Dr. Chuck and I like to cite:  Papa Doc Duvalier was so paranoid about any potential leaders threatening his power that he even disbanded the Boy Scouts! Click Here for details). As a result, there is a clear need for building local capacity and institutions to move from simply providing relief in Haiti to actually helping the country to develop. I think the work done by Haiti Outreach and Develop Haiti is THE precise work that has to be done in order for it to be possible to build local capacity and local institutions. From my experience, I think a focus on building physical infrastructure alone, whether used to provide water or for any other purpose, can distract from this even more fundamental work of building the social infrastructure that is ultimately necessary for the long-term development of Haiti.

Alright, you have finally reached the end!  But before I go, I should say a few words about my connection to Timmy.  It just so turns out that I became interested in Haiti after I went on a Timmy trip there in March of 2000. I think my case is a clear example of the seeds Timmy trips can plant in students. After our experience in Haiti, some friends and I started bugging Dr. Chuck until he would let us hang out in his clinic with him. Eventually I became involved with the group that got the IU chapter going, and in so doing I got to spend some time in Ecuador, Honduras, and at CHAMP Camp. Our group at Indiana was really lucky – not only did we have great support from people at Timmy (Chuck, Scott, Darrell, Jess, and others), but we were also at IU, which was filled with people who had the vision to support us (people at the Honors College, the IU Foundation, as well as alumni and individual faculty members). And I would like to think we had a pretty cool group of students working together, too.

I have been extremely impressed both with the overall direction Timmy is taking and with the current Timmy students I have met – they all seem to be well-rounded and thinking about the right issues. If I had any advice for students involved with Timmy, it would be to keep at it even when things are tough, and to remember that Timmy is a vehicle for creating the kind of world we want not only in terms of global health, but also in the most basic terms of how we interact with each other here in the US and all around the world.

DISCLAIMER:  The author is a Research Associate at the Inter-University Institute for Research and Development (INURED) in Port-au-Prince, Haiti.  The research discussed here was conducted with support from the Inter-American Development Bank, and was conducted while the author was on leave from the Federal Reserve Bank of Cleveland.  The views stated here are those of the author alone, and do not represent the views of Haiti Outreach, Develop Haiti, INURED, the Inter-American Development Bank, the Federal Reserve Bank of Cleveland, or the Board of Governors of the Federal Reserve System.

If you are interested in studying in Haiti, I would strongly recommend you study with the Haiti Today program run by the Haitian Studies Association at the University of Massachusetts Boston.

Two quick links on Haitian history:

http://www.youtube.com/watch?v=5A_o-nU5s2U&feature=g-u-u

http://www.pbs.org/programs/egalite-for-all/

And a short list of other organizations doing great work in Haiti includes

Haiti Outreach         

Develop Haiti

Zafen

Fonkoze

Fokal

INURED

Haiti Corps

Partners in Progress

Haiti 2015

The Lambi Fund  

EarthSpark International

Partners in Health

The Peasant Association of Fondwa

Scott Pegg is an Associate Professor of Political Science at the IUPUI School of Liberal Arts. Beyond research and teaching, Scott is Chairman of the International Friends Committee of Bebor Nursery and Primary School in Rivers State, Nigeria, where he–working in collaboration with Timmy Global Health– is actively raising money to build nursery and primary schools in two rural villages in the Niger Delta. What follows is an open letter from Scott recapping the challenges and growth of  work in this region of Nigeria.

Dear Friends and Supporters of Bebor Model Nursery/Primary School,

Let me take this opportunity to give you a few brief updates on our school project and a somewhat more extended update on Bariala, the nursery 1 female student with polio who is in a wheelchair at our school in Bodo (spoiler alert: it starts sad but ends good!)

First, my heartfelt thanks to everyone who voted for Timmy Global Health at the American Giving Awards. They finished in 3rd place and will receive $250,000 from Chase for doing so.  Bebor supporters were just a small part of their winning coalition, but we brought votes from IUPUI, Turkey, Nigeria, all over America and who knows where else! It was a real charge seeing Matt and Chuck accept the award on NBC.

It was a cold day on the campus of Ball State University in Muncie, IN when I attended a dinner hosted by the pre-med club and featuring Dr. Chuck Dietzen. To be completely honest, I didn’t know anything about the Timmy Foundation (as Timmy Global Health was called then) and mostly went for the free food. But I left that night changed. I was on the edge of my seat the entire time, listening intently to Dr. Chuck, hanging on his every word.

In fact, I felt so compelled by his presentation that, when the dinner was over, I called my parents and told them I would be traveling on a medical mission trip. I didn’t know when or where, but I knew in my heart that it would happen. That desire catapulted me to start a student chapter of Timmy Global Health at Ball State. In our first year, the chapter was too small to have it’s own medical team, so we joined Purdue University for their annual medical trip to Ecuador. By our second year, however, we were able to take an entire Ball State Timmy team back to the same site.

During one of those trips to Ecuador I encountered a little girl that was complaining about headaches every day after school. After she was examined by one of Timmy’s medical professionals, it was determined that she needed glasses. Now—I don’t remember the exact chain of events, but somehow we were able to provide her with a pair of glasses that met her prescription needs, and the look on her face was priceless.  As I mentioned, when I first heard about Timmy, I was at a pre-med club meeting…so I was clearly thinking about medical school before any involvement with the organization. But at that moment, when that little girl looked up at me and could see me clearly for probably the first time in her entire life, I was truly inspired to look at all of my options. I researched several different opportunities in the medical field and Optometry just seemed to stick with me.  So I went on to get my Doctor of Optometry degree from Indiana University.

After graduating, I decided it was time to give back to one of the reasons I went into medicine, and specifically Optometry, to begin with…Timmy Global Health.  This past August I had the incredible experience of traveling to the Dominican Republic as a Timmy healthcare provider, to provide eye care and glasses to those in need.  It was a first for me to be on a Timmy trip as part of the actual practicing medical team, rather than as a student volunteer. And it was also a first for Timmy—the first time the organization was able to offer prescription glasses and eye care services to it’s newest adopted communities in Monte Cristi. Overall I would say the medical trip exceeded my expectations! During the trip, I was able to consult with 115 patients, collaborate on diagnoses with an ophthalmologist that was also volunteering on the medical team, and help Timmy provide 83 pairs of prescription lenses.

My journey with Timmy has now come full circle, as it has for a number of other Timmy student alums that went on to medical school, nursing school, or maybe even to get their optometry degrees like myself. I look forward to offering continued service in any shape that may take form and will forever treasure my memories of working with Timmy Global Health.

When volunteers come on Timmy medical trips, they are immediately greeted by a Timmy staff member, and work closely with Timmy staff throughout the week. As volunteers head home, many of them leave with the impression that we Timmy staff run all the programming that goes on here in-country. However, I’ll be the first to admit that nothing could be further from the truth. At each Timmy site there is a whole host of local staff, volunteers, and Timmy affiliates that make what we do possible. From drivers, to health promoters, to local doctors, to social workers, each of these incredible people work extremely hard to do the work that comes before and after Timmy’s medical trips.

This blog post is the first of many that I hope will help to shed some much deserved light on the important local staff and volunteers who help us expand access to thousands of underserved patients each year.

Elicio Grefa is an extremely important part of Timmy’s programming in the Amazon Basin region of Ecuador. He is an employee of Patronato de Amparo Social, one of Timmy’s international partner organizations. Elicio serves as one of Timmy’s critical liaisons and is our main contact with the local government. During medical trips, Patronato provides Timmy’s medical teams with the transportation we need to set up mobile clinics and helps us communicate with rural communities by providing Kichwa translators. Once the medical teams leave, Elicio helps me coordinate with the local government to help Timmy’s referral patients get the transportation and other logistical help they need to get to their appointments—whether they’re in the local hospital in Archidona or six hours away in Quito. 

Elicio also goes on house visits with me to check up on patients that have recently returned from the hospital. When one of Timmy’s doctors refers a patient to the Tierra Nueva Hospital in Quito, Elicio wakes up at 3 in the morning to ensure that that patient gets to his or her appointment at 9:30. When we explore new potential Timmy communities, Elicio is there to help me translate my Spanish into Kichwa so that local leaders understand our mission. In addition to all of this, Elicio is also the person that coordinates the pickup trucks and canoes that help Timmy’s medical teams get to work on time, and back again at night. He is indispensable before, during, and after Timmy’s medical trips.

Elicio is Kichwa, a member of the largest indigenous group in the Amazon basin. He is completely bilingual in Spanish and Kichwa, and knows a few words of English. He is 41 years old, and has a health family of 5 children ranging from 3 to 14—3 girls and 2 boys. His wife, Irene Quinobanda, works in a the local market, cooking and serving food from 6 am until 7 pm every day. Elicio has been working for Patronato in a variety of roles for 16 years, from rural construction worker to logistics manager, to his current position as community promoter. He has been elected president of two different communities—Canoayacu, the community where he was born and raised, has elected him 3 consecutive times. In addition to his incredible work with Timmy, he is much loved in the community for having done the legwork to build a bridge that connects the isolated community of Canoayacu to the larger town of Tena.

Elicio’s dedication to Timmy is truly admirable, and he is deeply invested in our work to expand access to healthcare. He is fond of saying that Timmy, unlike many government programs, provides our patients with a complete service, from daily vitamins to transportation to the hospital.

Situated in one of the most geologically active regions of the world, Guatemala is no stranger to earth tremors. Every few weeks, we experience these tremors (usually under a magnitude of 5.0 on the Richter scale) and most people here are used to them. They arise unexpectedly, pulse and shake for a few seconds, and are gone almost as quickly. It is extremely rare for these tremors to cause significant damage, if any damage at all.

On November 7th, Timmy and Pop Wuj’s staff were hard at work at a mobile clinic in Buena Vista—a community about 30 minutes away from the Pop Wuj clinic in Xela. At 10:35 AM, we felt a slight tremor. But, unlike the hundreds we’ve felt before, this one did not subside. Instead, it continued to grow, strengthening to a magnitude of 7.4. The ground vibrated so forcefully that everything in the cabinets and shelves fell to the ground—boxes of supplies, files full of records, and containers of medications spilled to the ground.  The earthquake lasted for a mere forty seconds, causing only minimal damage to our inventory in the clinic. But the destruction in communities closer to the epicenter was extensive.

The earthquake’s epicenter was just off the Guatemalan pacific coast, and the greatest damage was in the department of San Marcos—approximately thirty miles outside Quetzaltenango. 52 people were killed, most of them from San Marcos. In spite of this tragedy, authorities and community members were thankful that the tremor did not occur at night, which would have resulted in even more destruction.

The images in this blog post are from San Marcos, and show just how powerful forty seconds of ongoing tremors can be. Many of the houses share external features common in post-earthquake damage, such as deep cracks and holes, but the majority of them seemed to be cosmetically sound. However, one look inside shows the true colors of the damage, like a caved-in roof or worse. Many of these houses are currently condemned, and have peligro (danger) and demoler (demolish) written on them.

Despite the damages, however, it’s been clear to those of us working in the region that the earthquake’s power to destruct is no match for the Guatemalan community’s resilience. From the very first day of the earthquake through today, people working and volunteering with the Guatemalan Red Cross, military, or through independent efforts have rallied to provide food, water, and other living essentials to the people most affected by the earthquake.

While the active landscape of Guatemala brings it unparalleled beauty, it also possesses the high risk of natural disasters. In the last month, there have been a few aftershocks following the main earthquake, but we are happy to say that none of them have caused any significant damage. As rebuilding continues and business is back to normal for most Guatemalans, we are busy preparing for the new wave of medical teams that will be volunteering in Timmy’s clinics in 2013. And we are confident that their presence will continue to have a lasting effect on the health and wellbeing of all those we serve in the highland region.