Pediatric HIV Elective in Malawi After missed flights, lost bags, and 3 days of travel I arrived in Lilongwe, the capital of Malawi, on a sunny morning during the rainy season.  The Baylor International Pediatric AIDS Initiative has a Clinical Center of Excellence in Lilongwe, an impressive pediatric HIV clinic staffed by Malawian clinical officers, nurses, social workers, pharmacists, research staff and a few American pediatricians. The clinic is adjacent to the massive government hospital, Kamuzu Central Hospital, which includes a pediatric emergency zone, high dependency unit, malnutrition ward, nursery, NICU, oncology ward, peds surgery ward, and several general peds wards. During my month in Malawi, I worked in HIV clinic, Kaposi’s sarcoma clinic, HIV Teen Club, cervical cancer screening clinic, inpatient peds wards, and in a rural northern region of the country on a community outreach and mentoring trip. My first day was spent in Kaposi’s sarcoma clinic where we saw children with oral KS, severe lymphedema, GI involvement, and HIV-negative KS. If children are fortunate enough to have access to the central government hospital in the capital, they are able to get chemotherapy for KS, and many do quite well. During my second week, I flew up north to Mzuzu with the mentorship team that works in rural health clinics to help strengthen pediatric HIV care. Some of the challenges addressed included HIV positive children lost to follow up, ARV stock outs, insufficient clinical staff, and dosing of pediatric ARV regimens.  At the local district hospital, we rounded in the ICU and used my VCMC ultrasound education (thank you Dr. Rutherford, Dr. David) to demonstrate evaluation of intravascular volume. This was particularly useful for our CHF patient who appeared to be in acute renal failure while the hospital had no serum chemistry available due to reagent stock outs and insufficient funds to purchase more. Back in Lilongwe during my third week, I worked alongside Malawian clinical officers in HIV clinic, learning the first-line and second-line ARV regimens, (there are no third-line options), malnutrition treatment guidelines, TB prophylaxis, and malaria prophylaxis for HIV positive kids.  During my week on the inpatient peds team, we had many interesting cases including a girl with cryptococcal meningitis, on fluconazole and ampho-B, who underwent frequent therapeutic lumbar punctures to relieve her headache and vomiting – all without local anesthesia since it is a fairly limited resource.  We started a cachectic 20 year old HIV positive woman with a BMI of 12 on TB treatment. She had chosen not to take her ARVs for the preceding 12 months because she had moved to live with her cousins and did not want them to know she was HIV positive.  We saw numerous cases of...

VGHP is partnering with Dr. Robert Skankey, a retired Obstetrician who has delivered over 3500 babies in Ventura and Ojai, and his Nomad Foundation in the Sahara Desert. The Nomad Foundation has started a clinic in Tamesna, which is located on the annual migration route of the local Nomads. The clinic has a midwife training program. One in seven women in Niger has a lifetime risk of death during childbirth. Midwives trained by Dr. Skankey have assisted at more than one hundred births since November of 2011 with no maternal mortality and no infant mortality of a child born alive. They are reporting to Tamensa clinic staff that is developing the first health statistics ever for this remote region. While vigorous and very committed, Dr. Skankey is 82 years old, and VGHP has committed to help him pass the torch to younger Ventura doctors. VGHP will recruit and fund OB/GYN’s to continue the work of training midwives at the Tamesna clinic. Donations Coming...

VGHP is partnering with Dr. Carlos O’Bryan, a 2011 graduate of the Ventura Family Medicine Residency, to assess needs in providing care to underserved peoples in Maneadero, Mexico. Maneadero is an agricultural community five miles South of Ensenada in Baja California. There is a strong migrant farm worker population, many of them Mixteco people from Oaxaca, Mexico. Dr. O’Bryan intends to provide care to Mixtec peoples as his life’s work. He presently practices at Las Islas Family Medical Clinic, a county-run facility in Oxnard which provides care to a mostly immigrant, and strongly Mixteco, population. Over the next five to ten years he intends to transition more of his practice to Maneadero, where fewer healthcare options exist. As an interim step to full time practice in Maneadero, Dr. O’Bryan and VGHP are partnering to conduct medical outreach and perhaps provide clinical care on a part time basis. The first step is medical outreach; ad-hoc provision of care to gain exposure and assess the needs in the community. If medical outreach activities indicate a need and a culturally appropriate fit, the mid-term goal is to start a clinic that is open on weekends, with Dr. O’Bryan serving as medical director and with rotating volunteer doctors from the Ventura community. Note: our first VGHP-sponsored rotation will take place February 16-17. Dr. Carlos O’Bryan (MD), Dr. James Appel (MD), and Dr. John Chung (DDS) will provide care at Casa Hogar, an orphanage for abused children in Maneadero.   Donations Coming...

VGHP is partnering with Dr. Zachary Self, a 2012 graduate of the Ventura Family Medicine Residency, to support his startup Clinica Medica Cristiana in Santo Tomas La Union, Guatemala. Santo Tomas is a city of 25,000 residents, mainly indigenous Mayan, with four satellite towns of 5,000 residents each. Dr. Self’s goal is to “live out a life of solidarity with the marginalized indigenous population of Guatemala” and to “provide our patients with a quality of care comparable to that found in more developed countries”. Dr. Self will provide care without regard to political affiliation, religious belief, ethnic identity, or ability to pay. VGHP has committed a grant to Dr. Self to help him procure medical equipment required for his clinic. VGHP intends to support the clinic with short-term rotations of volunteer doctors from Ventura beginning in late 2014. Donations Coming...

VGHP is partnering with Dr. James Appel, a 2003 graduate of the Ventura Family Medicine Residency, to provide specialist care in Moundou, Chad. Moundou is the second largest city in Chad with a population of over 500,000 including hinterlands. There are less than 20 doctors in Moundou (compared to 679 doctors in the city of Ventura with a population of 106,000), and most of those are in private for-profit practice serving those few residents who can afford private care. Moundou Adventist Hospital provides care without regard to political affiliation, religious belief, ethnic identity, or ability to pay. Dr. Appel started the hospital in 2011 after spending eight years at Berea Adventist Hospital in Chad. When Dr. Appel started in Berea, the hospital had not had a doctor for 15 years. Now there are three doctors, and Dr. Appel has moved to the city of Moundou to start his newest venture. Dr. Appel has requested short term rotations of specialists in Ophthalmology, Dentistry, Gynecology, Orthopedics, Plastic Surgery, and Urology. Donations Coming...