SUMMARY BLOG 2014

The Barefoot Dr. training program has come to a close for 2014. All the instructors have returned safely home and the students are well on their way. It was a very successful program that was able to cover the entire book “Where There Is No Doctor,” a week of CHE (Community Healthcare Education) training, and a wealth of additional knowledge from all the instructors.  In addition to medical skills they attended night classes on how to use computers and the internet. For many of the students it was the first time they had touched a computer, not to mention the internet. As Burma develops, computer skills may prove to be just as life changing as the medical skills.  The students also received a starter kit of medicine including many potentially life saving drugs. Their medical kits contain 23 of what we believe to be the most needed medicine in their areas, medical equipment such as stethoscopes and blood pressure cuffs, digital cameras and log books to record their work. They also received many other useful devices for the treatment of their patients and a backpack to carry it all. We fully expect that this group will save lives this first year. Not only by treating life threatening illness but also in knowing when to advise patient to make the long trek to the closest hospital and in preventative medicine. This program emphasizes that in the long run they will save many more lives by community healthcare development and preventative medicine than by simply treating those already sick. We cannot wait to see them all again next year and hear their stories!

Putting this program on is a team effort and it would not be successful without all those who support it locally and globally. Our trainers came from all around the world including multiple areas of the USA, Canada, Thailand, India, and New Zealand! The financial and equipment donors are from hundreds of individuals, a handful of churches, and a few medical companies around the world. Of course, the students came from all across Burma in some of the most remote and under-served areas left on the planet. They included many different ethnic groups all working together for a greater good. Their Christian belief in God gives them incredible dedication and drive to do this important work often times at great sacrifice to themselves and their families in the form of time, travel, and physical effort.

Fundraising is always stressful and this year it looked like there would not be enough to get it all done. However, as providence would have it, in the last week of the program some extra funds came in. They were just enough to complete the necessary tasks. It was far less than we had originally hoped for but thanks to some incredible cost saving efforts from our Thailand and Burma team, the program ended up fully funded!

The plans for the second year of this three-year program have already begun. A start date is set for mid January 2015. We hope to have enough funds to include the very necessary dental extraction training in the next class. Please pray for the success of the Barefoot Dr. students in the field and for next year’s program.

Thank you all for support in so many different ways and may God Bless you.

Rick Astone

Picture from Feb 20th, 2014 the day Alice and I returned home. The students are holding badges they received as gifts and some of the instructors are wearing the tribal ties they received from the students. 

March 6, 2014- Cooks, Cookies, and Class

     Today the students finished presenting their chapters and medicines to the class. Dr. Nilson also reviewed medicines today in preparation for the final exam tomorrow. He demonstrated for the students how to use Google to find interesting pictures that showed different medical conditions. He also showed them a picture of a eucalyptus tree. All of the students recognized the tree, and learned how to use its leaves to treat cold symptoms. We also spent some time reviewing for the final exam that will be given tomorrow. 

     This morning we weighed all of the students before breakfast, and they have all gained weight! In Myanmar, they usually only eat one to two meals per day and their diet is lacking in protein and other essential nutrients.   While they have been here, they have received three meals a day, and have gained weight.  All of the meals here have been very healthy and very tasty.  (We did have ice cream bars one day and some yummy cookies yesterday though).   We try to use every opportunity to teach so we used their weight gain while eating healthy as a great teaching tool.  We revisited the chapter on nutrition and reviewed the necessary nutrients for physical health and the weakened state of health with poor nutrition.  We compared it with their spiritual food, as well.

     At lunch today the class president shared a few words of thanks to all the instructors and requested that they all return for the next two years.  The Physicians were each presented with ties made in north Myanmar.  Lindsey and  Gayle were given a purse and woven basket, respectively.

Dr. Nilson receiving his Burmese tie and wall hanging

Dr. Nawrocki with his gifts from the students

Dr. Jim Buie and his wife Gayle Buie with their gifts from the students

     During the afternoon, the team took the opportunity to thank the cooks by giving them a night off and to prepare a special spaghetti dinner for the students.  They kept asking if it was American food – didn't know how to explain it was Italian/ American.    They do understand pizza!  We feasted on spaghetti with rice noodles, tossed salad, sourdough garlic bread and Coca Cola.   Dinner was topped off with Lindsey’s no bake chocolate oatmeal cookies. In most Thai homes, there is no oven and “no bake” was our only option.   

 
 We had trouble keeping the cooks out of the kitchen, but mainly because they were so interested in how we were making the food.    Wish you could have seen them chow down!  We wrapped up the evening with a few games  and singing, then off they went to study for their exam.  

March 5, 2014 Skin amiss and what if

     This morning, Dr. and Mrs. Buie taught the students basic dermatology. Dr. Nilson also got to imput as well. We discovered that the students see a lot of goiter and rashes. Some of the issues discussed were chicken pox and scabies. We are amazed that they do not see much, if any, leprosy. The problem is not on the skin, but the symptoms are, so the students learned how to keep others from being infected. we also learned that they do see a lot of burns. Part of that problem is that they cook on an open fire, so if they lose their balance, or trip, they fall into the fire.

     After lunch, Dr. Nilson asked them an important question… “What if?”. He asked if they were given $100 USA dollars, what would they do to improve their community? All of the students had very ambitious ideas. One of the groups wanted to create the first bathrooms in their village to help control the waste and create sanitation. Yes, I did just say that they wanted to bring the first toilets to their villages.

Lindsey

March 4, 2014 - Presentations and Translations

     Today was full of student presentations. The students, even the few shy ones, stood before the class and individually taught the class about the medicine they were assigned to learn about, or the chapter they were assigned to present to the class in preparation for the final exam on Friday. With Dr. Nilson’s input, a few of the students bravely presented their chapter to the class. The women were definitely more reserved about the project than the men. Part of their reserve is due to the culture. In Mynamar, women are not on equal social standing with the men.

     Lindsey and Bjorn made miniature quizzes on the audience response system for each presentation. To our chagrin, the translators, Timothy and Abraham, laughed at some of the misspelled words that Lindsey missed when imputing the questions into the system. We, yet again, helped the students develop the critical thinking and reasoning skills that are required to be a good barefoot doctor by only guiding them in the correct direction when they answered incorrectly. After a while, they would figure out who, among them, was answering incorrectly, and use the same reasoning skills to persuade their fellow classmates to understand the information, and change their answer to the correct one.

     We were very interested to understand the value of the audience response system (ARS). During one of the presentations, one of the students said that the drug she researched could cause both constipation and diarrhea. The instructors were all confused until one of the translator read the Burmese textbook’s section on the drug, and started laughing! The translators of the book wrote that the drug could cause both symptoms, and we would have never known if we hadn’t used the ARS system.

Lindsey

Lindsey and Bjorn working the ARS system

March 3, 2014- But WHY?

     Today was an interesting day. This morning Dr. Nawrocki continued his discussion on serious illnesses and how to prevent them. This afternoon, we reviewed the test from Friday to see how much material the students retained over the weekend. We were surprised at the range of knowledge remembered. Using the audience response system to record their answers and receive live feedback, and we refused to tell them what the right answer and helped them develop the critical thinking skills required in order to become a good barefoot doctor. We asked them “why” a lot. “Why is that the correct answer” and questions similar to that. It took them a while to understand that we wanted them to think. In Myanmar, they are given correct answers to repeat back to the instructor. They are not taught to analyze the material presented. In order for them to reach a diagnosis, they will have to do more than guess. They will have to observe the patient's symptoms and analyze the data they collect from the symptoms in order to provide the correct treatment. We also had the opportunity to continue with the student presentations of medicine, the project that keeps being mentioned where each student studies a medicine that they will be carrying in Myanmar, and presents it to the class.
Lindsey

Dr. Nilson and Dr. Nawrocki teaching

Feburary 28, 2014

     This morning, Dr. Nilson continued his discussion on sicknesses and illnesses of children. His discussion included malnutrition, rashes, scabies, and ringworm and their respective treatments. The students learned a lot from him. We learned that they see a lot of scabies and even more malnutrition. The Maringa tree was discussed yet again because of its highly nutritional properties. The students say that they have easy access to this tree. Listening to their stories about sick children and the hunger that they see was very enlightening to the teachers.
We learned that they will maybe get two meals per day, and it usually only consists of rice and something green. They do not eat much meat because it is very expensive, and most of the people cannot afford the luxury of having meat even once per day. It makes me realize, as an American, how blessed we are in the western world. We have meat, and three meals per day. These students do not. It has been interesting watching them as they have been here. They are so thrilled to have three meals per day. They are thankful for everything that they are given, or can learn.
Also, we learned that when a person gets sick, they do not give them food while they are ill. The thought behind it is "they are sick, and the food will make them worse". They learned about how to treat these people, and how to enlighten the other people in their villages. The students were very surprised when we explained that food (nutrition) is important to make people well.

Dr. Nilson discussing digestion and malnutrition

     In the afternoon, the students took the fourth exam. When reviewing it, Dr. Nilson had them discuss the test questions among themselves if they got the answer wrong. Through discussion amongst themselves, they eventually came to the correct answer. Teaching them this way is important because it teaches them to self-learn and ask questions of each other. We ended the week with a time of worship, which is something to behold. The students worship God wholeheartedly and focused only on Him.
Lindsey

Worship time at the end of the day!

February 27, 2014

     Today was day two of Dr. Nawrocki’s lecture on serious medical conditions and illnesses that need special treatment. This morning, his discussion included illnesses such as Malaria and Dengue fever. He had the opportunity to discuss with the students the importance of preventative medicine. Dr. Nilson interjected with information about pre-treated mosquito nets, and told the students that if Malaria is prevalent in their village, that these nets are a low cost way to prevent Malaria. They do not have 100% success with malaria prevention, but these nets prevent many cases of Malaria.

    Thursday afternoon Dr. Buie tackled The Urinary and Reproductive Systems.   The students were understandably uncomfortable with the topic, particularly in mixed company.  In their culture, sexuality is rarely discussed openly among the Christian villagers and never between men and women.  Not until recently have schools begun to teach human sexuality.  When some of our team visited a Christian village outside of Chiang Mai a few weeks ago, they noted that men and women even sleep on opposite sides of their houses.

     Dr. Jim presented the anatomy and physiology in a direct and professional manner, putting them at ease.  He explained that they would encounter patients with sexually transmitted diseases and breast cancer.  He reminded them that as health care workers they have a responsibility to educate the people and they would need to become comfortable with uncomfortable topics.  HIV is prevalent in Myanmar and they will definitely be asked to see patients with complications associated with it. They need to teach about the dangers and health issues of unprotected sex.

Lindsey and Gayle

Feb. 26, 2014

     Dr. Nawrocki started this morning with teaching about infectious diseases: how to identify, know their symptoms, and treat them. He discussed diseases that the students will face regularly: tuberculosis, pneumonia, diarrhea, and HIV/AIDS. He also lectured on some less common diseases that they could see such as rabies, syphilis, and tetanus. Part of the lecture this morning was about identifying and treating these diseases as quickly as possible. He also discussed bedside manner and about how important empathy is when treating a patient.  The students were fascinated at the different medial techniques that he presented in order to save a patient’s life.

     After lunch, we had the privilege of reviewing some of the student’s pictures that they have taken with their new cameras. Dr. Nilson critiqued them to teach them how to improve their pictures. Their technological skill impressed us all. Some more of the students also presented what they learned on the medicine assignment that was mentioned in a prior post. Each student was assigned a different medicine to study and present to the class. As usual, the day ended with a song.

February 25, 2014

     Today was Dr. Nawrocki’s first day of teaching. The students welcomed him warmly, and listened intently to his lectures. He discussed chapter twenty-two in the student’s textbook, Where There is No Doctor. It was all about the health and care of elderly people. The students were saying that some of the most common complaints of the elderly people in their villages is arthritis and back pain.  The arthritis is a side effect of aging, but the back pain is more than likely caused by the long days that they spend in the rice fields, bent over, planting, caring for, and harvesting rice.  

     After lunch, Dr. Nilson used the audience response system to present demographic questions to better understand their situation both individually and as a group. The results were very revealing. Most of the students had six or more siblings. Two of the students had nine or more brothers and sisters. When we asked them how far it was to the nearest clinic, some of them only had a half a day walk. Four of them lived over twenty miles away from the nearest clinic, and they could only get there by walking. A few of the students lived over three days walking distance away from the nearest health clinic. These clinics sometimes only have nurses, they are not guaranteed to even have a doctor at the clinic. The student that lives the farthest away is over fifty miles from the nearest clinic among another twenty to thirty villages, all dispersed in the otherwise inaccessible Himalayas. She will be the only health worker in that area.  

     Also today, courtesy of a generous donor, we had the privilege of giving each of the students their own camera to take pictures of medical issues that they face, and bring them back to us so that we can better understand their situation and the medical problems that they face.

Lindsey and Bjorn 

Food for Thought

     We are beginning the last two weeks of our Barefoot Doctor School.  Today, Dr. Bjorn Nilson introduced the students to Dr. Joe Nawrocki , a Family Practitioner and Emergency Room physician from Texas.  Dr. Nawrocki has used his medical skills to help people throughout the world in countries such as Myanmar, the Philippines, and Ghana. 

Dr. Nilson introducing Dr. Nawrocki

     The morning started with presentations on their drug assignment.  Over the weekend, each student researched a drug that they will be using in Myanmar, and were given the opportunity to present what they learned to the class, peer to peer learning. Their report included what the drug is used for, its dosage and administration, and all potential side effects of each drug.  It was a challenge for them, but they all did a great job.

Measuring the digestive system

     Gayle Buie, RN, walked the students through a short course in nutrition during the afternoon.  She discussed the process of digestion, and the students used twine to measure the length of the digestive system, a whopping 25 feet!

      Gayle also covered necessary nutrients to the human body, and briefly talked about diseases and conditions caused by poor nutrition.  Dr. Jim Buie and Gayle served a snack that included all of the basic food groups and asked the students to identify which food belonged to which group as they enjoyed the food.
     It was very interesting to learn about the student's nutrition in Myanmar. For example, they only eat two meals a day. And when they eat, there is limited meat because it is very expensive, they have to slaughter an animal for there to be meat, and there is no refrigeration to store the excess meat. Also, they have little to no dairy. Their main staple is rice because it is easy to grow, easy to store, and easy to cook. It is also the cheapest calorie they can produce per acre.

Gayle and Lindsey

The Miracle of Birth Feb. 21, 2014

This morning was very enlightening for our students. For the first part of the day, Nurse Holly discussed asthma and breathing problems from her knowledge and personal experience. The students had lots of questions for her. Nurse Betty then discussed the birthing process and contraceptive measures, everything from abstinence to birth control. Some of our male students were shocked that we would discuss this with them, but Betty quickly explained to them that as Barefoot Doctors they needed to know what to do if they ever faced the situation of a woman giving birth. This did not make them much more comfortable, but helped them understand why they needed to learn about birthing and pregnancy.  After lunch, there was a photo op with the nurses and students as the nurses, Holly and Betty, were leaving that evening. The students took their third quiz before the end of the day. A good game of "Ta Pae", after class, ended another successful week. 
Lindsey

the students playing "Ta Pae" at the end of the day

Feb. 20, 2014

Thursday of week three is already finished. It is amazing how time flies when you are busy. Today started with a discussion on skin and skin diseases. Dr. David Brumwell and Cyril Thomas, PA, created an artificial abscess for the students to examine and for them to “treat”. The students had the opportunity for them to observe the surgical procedure to drain the abscess. Melanoma and cellulitis were also discussed. They stressed the importance of hygiene to maintain a healthy body. Infections such as thrush, or rotting teeth and gums are preventable. Without caring for the body, it will not do well.  Neurological problems were also lectured on this morning:  strokes, seizures, and lower neurological problems were talked about. Dr. Brumwell and Cyril also discussed common problems, such as shingles, and how to treat them.

After lunch, the students gave a heartfelt farewell to Cyril and his family, Rick and Alice, and David Brumwell, giving them each a gift, and a sincere wish to have them back next year. 

Rick & Cyril wearing their "Longyi" traditional Burmese wear for men.

When class reconvened, Cyril discussed part of the chapter on the male reproductive system, including some common problems in the male reproductive system. He asked if any of the students had seen bear attack victims, and all but a few raised their hands. He reinforced his point about the seriousness of open wounds. He also reviewed the protocol for abscesses: warm treatment, wound opening, cleaning, sealing. 

He also showed the students pictures of different open wounds, and made sure that the students understood that they must use clean bandaging material. He reviewed open compound fractures and open wounds, and the proper way to treat them.

Rick, Alice, and Lindsey

Poking, Prodding, and Melon Dropping Feb. 19, 2014

Today Dr. David Brumwell and Cyril Thomas, PA, started the morning with patient assessments. They picked a volunteer from the students. They sat the student on the examination table, and questioned him about his “illness”, using the experience to teach all of the students how to ask the proper questions to reach a correct diagnosis. They also taught the students how to document patient cases and do physical examinations. Dr. Brumwell told the students “It’s always good to listen to a patient’s heart. That way you know what normal feels or sounds like. Then you will know what abnormal feels or sounds like.” The students learned about needle safety, as well as how to draw and calculate the proper amount of medication. 

Rick teaching about needle safety

They also learned how to find the correct place to administer an injection. Each student practiced their technique on an orange. 

Cyril guiding the student's hand

Giving injections was such an exciting topic that the kitchen staff joined in, and even the chef practiced injecting an orange!

One of the cooks injecting an orange

Later in the afternoon, all of the doctors and nurses reviewed the morning’s material. Then the students practiced administering injections on each other in groups; this served as a teaching experience as well as an opportunity to receive protection against tetanus for those who wanted it. Ten of the twenty-one students had never had a tetanus shot and eight of them had not had a buster in over ten years. Tetanus is a nightmarish disease if you get it and usually deadly. There is evidence that even one tetanus injection is enough to protect someone. If you get tetanus, it slowly causes the muscle in the body to spasm until you get lockjaw, your muscle spasm to the point of breaking your own ribs and you slowly suffocate. The instructors went on to explain needle gauges, how to identify them and which size is appropriate for different situations.

We also had the opportunity to teach them about motorcycle safety and helmets. Cyril, his son Peter, and Dr. Brumwell performed a dramatic skit about a motorcycle crash that caused brain damage and loss of consciousness. 

The students learned the steps of triage examination, how to stabilize the neck, and how to identify brain damage. The instructors explained that brain injuries due to motorcycle accidents can usually be prevented by wearing a helmet. This concept was illustrated by dropping two watermelons on the ground. One melon was protected in a helmet, and one was not. The one in the helmet survived unscathed, but the unprotected melon made splattered all over the floor; the students gasped with surprise. Cyril pushed through the crowd as if to “save” the melon after it splattered, but instead picked up a piece of the “brain” and revisited the idea of helmets for prevention. 

Rick, Alice, and Lindsey

Helmet safety demonstration

The unfortunate melon that was dropped without a helmet

Malaria Clinic and Emergency Med.

Mr. Dawnga teaching about blood tests for malaria.

Mr. Dawnga continued teaching the students about the malaria clinics he helps to set up (Zo Clinics). Some of the students were not fully convinced that the blood test for malaria was the best way to diagnose malaria. Dawnga used the example that for Christians the Bible is the best diagnostic tool for spiritual health and the blood test is the best diagnostic tool for malaria. He went on to say that the Barefoot Doctors are the bridge between the experts and the common people. It may not be practical for these students to use microscopes in the field but

Student blood smears drying in the sun.

they need to know about it so they can be a good advocate and educator of the villagers.

Rapid Diagnosis Kit for Malaria.

Fortunately, there is a simple test called the “Rapid Diagnosis Kit” for malaria. It just takes a drop of blood and costs about $1.50; the class practiced on one other performing a finger prick. The students learned about 2 types of malaria and how to tell the difference between malaria and other conditions based on the patient’s signs and symptoms. Dr. Cyril emphasized that best thing we can do for disease is to prevent it.

In the Afternoon we answered written questions from the students. There were some great questions and it was really helpful for us to focus in on areas of interest for them.  The questions revealed not only cultural beliefs but also common advice by medical doctors in their area. The class got a comprehensive review of tooth decay, its cause and development into abscesses as well as the spread of infection. They learned that sometimes it is better to remove a tooth than to leave an infected tooth.  After that our ER doctors, Dr. David Brumwell and Cyril Thomas PA, took over the teaching. This is always exciting and interactive for the students as you can see by the pictures. They covered chocking emergencies and protecting the spinal cord after a motorcycle accident. The difficult subject of teaching about the different kinds of germs was also addressed including viruses, bacteria, and intestinal parasites. It is difficult to grasp the concepts of why certain medicines are used or not used if you do not understand the different types of germs.

Dr. David Brumwell and Cyril Thomas PA teaching.

Does "Coining" cure malaria?

This afternoon the malaria clinics discussion continued. One of the students thought he had malaria so the blood test that we learned about earlier was performed on him. It turns out he did not have malaria but he over generalized flu like symptoms and just assumed he had malaria. This is very typical of the mind set they Barefoot Dr. will run across in the villages and is a good reminder to us we have a long way to go in this program. 

Example of "Coining"

The students still commonly use “traditional medicine” techniques passed down from old Chinese superstition. You can see in the picture on this page this student also tried a home remedy common in Burma. This is a good example of “coining” where a coin is scrapped across the skin in lines until it causes mild red colored bruising. The philosophy of this program is not to stop such practices unless it is dangerous or harmful. In stead we try and educate the students on what we know scientifically but we try not to impose our opinions or change their culture.

Later, nurse Betty discussed epilepsy, pneumonia, the use of antibiotics, seizures, and dental hygiene.   Betty also explained the dangers of medicine and how sometimes drugs that are used for good can also be harmful. Then she was discussing dental hygiene and we passed out toothbrushes and toothpaste to each student donated by an anonymous donor.

Students get toothbrushes

 

Malaria Clinics

Mr. Dawngaliana Zongte

  We started a new week with a new instructor, Mr. Dawngaliana Zongte ( Dawnga for short), who taught the students about malaria clinics he founded throughout Asia and Africa. Dawnga calls the clinics “Zo Clinics” and they have a proven track record of decreasing deaths due to malaria in areas where they have been set up. As part of the training Dawnga teaches the students to identify malaria using a microscope and a “Rapid Diagnosis Test Kit” for malaria. These are the only ways to truly diagnose malaria. Dr. Nilson pulled some interesting statistics from the World Health Organization (WHO) about the malaria deaths in Myanmar. There is a 15% mortality rate in Children under 5 yrs old in Myanmar and ½ of those are due to malaria! Malaria is a huge problem for Myanmar and these students. Some basic knowledge on malaria will save lives.

Students looking at malaria slide in microscopes.

Friday 2/14/14

Dr. Alice helping a student with a crutch down some stairs

Friday was a very good day. The morning started with a hike up the mountain near FLC for Timothy, Abraham, Susan, Rick, Alice, and Lindsey. The view of the sunrise from the top was amazing.
The students got a chance to use their new knowledge about assistive devices. They practiced going up and down stairs with crutches and canes. Dr. Susan McDowell wrapped up her last day with a lecture on the eye. 

Dr. Susan lecturing on the eye

After lunch, the students presented Dr. Susan with a farewell gift to thank her for traveling all this way to teach them this valuable medical knowledge.  

The afternoon consisted of review of class material, and the weekly test. The students have officially mastered using the ARS (audience response system), and have improved their grades since the first test.

In reviewing back and neck pain as it relates to position, we noticed some confusion. We called on one of the students that had neck pain. He did not know why he had pain but noticed he had pain when he was reading or working on the computer for a long time. We asked to see how he read and he picked up his book while sitting in the chair at the table. His position was not bad but when we asked more questions he revealed that he does not read at a table or even in a chair. He reads sitting on the floor fully flexed forward. We asked him to demonstrate exactly how he reads and the cause of his neck pain was obvious (See picture). This was a great example for the class and for us westerners not to assume we know how they do things in their villages.

Friday night, we took the students into Chiang Mai to the night market. It was the first time most of them have seen a big city. We all crammed into two songtaews (yellow trucks). A couple of the boys who got to stand on the back got off at the red lights, looked around, and hopped back on when the light turned green! When we got to the night market, they all looked around amazed! Timothy’s family donated noodles from their booth so that each student got the full experience of the night market. On the way home, some of the students fell asleep on the way back. We had fun taking their pictures and laughing together.

Rick, Alice, and Lindsey