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

February 13, 2014

The morning started with an exciting Skype call to Paul Ferraro, the Chairman of the FLC U.S. Board of Directors.

After the call, the students learned more physical rehabilitation concepts today. They were taught how to use assistive devices for walking and how they can be made out of simple materials found around their villages. Adong, one of the local FLC staff, whipped up a pair of crutches made from bamboo, and two different sizes of canes from trees found right here at the training facilities. I am not sure what is more amazing, the fact that he made all the above in a single afternoon or that he did it all with only his machete!

Just like students in the USA, the Barefoot Doctor students initially had trouble with the concept of using a single crutch or cane on the opposite side of the injury but they seemed to understand way after hands on practice. Everyone had a lot of fun practicing and playing with the homemade assistive devices.

Dr. Alice Astone continued by talking about traumatic brain injuries and spinal cord injuries.

Dr. Nilson asked several questions on important information on a variety of diseases. As we suspected the students’ version of the book is not as up to date as ours so they needed to write in several important details. After polling the patients it was discovered that 19 of the 21 students need a tetanus shot.  We are attempting to get the tetanus vaccines for the students so they will be protected against this disease and to have them practice on each other how to give injections.

Nurse Holly

In the afternoon Holly taught the students how to measure and give medicine. She added to the book teaching by talking about the “9 rights” of medication administration in nursing that are taught at the hospital were she works. They are: the right patient, the right medicine, right dose, the right route, the right frequency and duration, the right reason, the right to refuse treatment, the right to be educated about treatment, and the right documentation.

Nurse Betty 

It has been another successful day here at FLC.

Rick, Alice, and Lindsey

Splints, bones, and hop-alongs Feb. 12, 2014

In the morning Dr. Alice Astone and Dr. Susan McDowell discussed differentiating between tissues: muscle vs. ligament. After Lunch, Dr. Nilson discussed how the wealth of a country directly correlates to the life expectancy of its people and their quality of life. Nurse Holly reviewed the morning lesson of “how to move a patient…safely” and how to keep a patient comfortable, clean them and their linens, and how to monitor them closely.  

Dr. Alice discussed the importance of looking at the whole patient for a complete diagnosis. Both she and Dr. Susan taught the importance of knowing when a patient is in distress, and when diagnosing, the importance of knowing the who, what, when, and where of the injury. They also discussed pain, both how it is “tricky” and “can fool you into thinking that something hurts when it is actually something else”, and how it is important to keep injured patients from overusing their injured part. The concepts of RICE was also discussed. RICE stands for rest, ice, compression, elevation. 

How to make a sling

Courtesy of Adang’s woodworking skills, the students also got the privilege of learning how to use crutches and canes. 

Adang and the crutches that he made for us

Dr. Alice taught them how to decide proper height and how to tell if the patient needs only one crutch or if they need two. Dr. Susan discussed fractures: how to care for them and how long to wait before they are considered “healed”. Her saying was “think like a dog…if it hurts to much, don’t use it!” The students learned that some weight on the injured bone is good, but too much will reinjure it.
Alice and Lindsey

Learning RICE

That's a wrap!

Today class continued with orthopedic issues. First Dr. Susan McDowell completed her lecture from the day before with various issues including fracture healing and arthritis.  Arthritis is always a hot topic. The audience response system was used to find the location of most common joint complaints of people in the students’ villages. It was a little surprising to find out that the knee joint was on the top of the list, followed closely by back pain and then hand pain. We all anticipated back pain to be number one.

We were taken back when one of the students asked if it was possible to restore function to one of his patients with a gunshot wound to the shoulder. This Barefoot Doctor student works in a refuge camp for internationally displaced people near the Burma-China border. He did not say and we did not ask the how the man was shot. Everyone stayed focused on the medical question and the basic answer that we gave him was that we need more information, but we will show him how to properly evaluate and treat this patient.

After lunch, Dr. Alice Astone and Rick Astone gave the students each their own battery free, crank operated head lamp. Dr. Alice then lectured and demonstrated the range of mobility, and limitations, of the human body, and how we can increase its’ functional range. To prove her point, she had all of the students lean back in their chairs and then try and stand up without using their hands. For comparison, she then had them all sit on the edge of their chairs and stand up. Some of our translators were so amazed at the concepts that she presented, they had to try it for themselves.

SAM splints and ACE bandange

  Dr. Alice Astone and Dr. Susan McDowell also taught the students how to properly splint parts of the body with SAM splints and ACE bandage. The students grasped the concepts very quickly, and by the end of the session today, they knew how to splint, wrap, check and make sure they didn’t splint their patient’s body part too tightly, and how to make a sling. They used Rick Astone as a model for their splinting and wrapping techniques. Receiving their splint wraps and elastic bandages was one of the many highlights of the day for the 

students.

Alice, Rick, and Lindsey