Friday- Hoopla

Student receiving representative gift of CURE kits

Friday was packed full of excitement. We started the day learning about how to take care of a sick person then stopped early to get ready for the “Goodwill Presentation Ceremony.” This was a big deal with a lot of hoopla to honor Thai Airways, the Boeing Company, and Project C.U.R.E. for their help in bringing medical supplies to the Barefoot Doctors program this year. With the support of donors, FLC was able to purchase 21 “Cure Kits” from Project C.U.R.E. at a discounted price. The kits have a lot of basic medical supplies that the Barefoot Doctors will need. They do not have any antibiotics or malarial medications, so those items will still need to be purchased for the students. However, the kits go a long way. As a good deed, Thai airlines agreed to transport the large boxes containing the kits from the USA to Chiang Mai, Thailand at no charge! This was made possible because of Thai Airway’s recent purchase of a new Boeing 787 Dreamliner that has space for the cargo during its delivery to Thai Airways from the USA. Thai Airways and Boeing sent officials to represent them and Thai Airways sent a lot of the local staff to support the event. Some local officials and villagers from the hill tribes also attended to demonstrate their support. The Barefoot Doctor students wore their best traditional outfits for this special occasion and it was an impressive site to see. It really made the collaboration of so many companies and people groups stand out. It was truly beautiful to see, visually, so many people from different backgrounds working together to help the less fortunate. Above all, the Barefoot Doctor students were praised for their dedication in learning and taking this knowledge to those who have little or no healthcare available.  We also had a chance to educate some of the Thai Airlines and Boeing officials on the program. They received a live projected demonstration from an iphone of the most skilled student placing sutures in a pig’s foot. We also showed them the ARS (Audience Response System). The students were polled to demonstrate teaching techniques and the true need for the program in real time.   It was a great time of mutually honoring each other, educating others on this program, and celebration.

Demonstration of suturing

After lunch, it was back to business as usual with the first quiz! After the quiz, we reviewed it together making it another teaching tool. The workday came to a close talking about “home cures.” It is always interesting to hear what types of things the students use in the villages. One student showed an herb that the villagers believe works well on snakebites. One of the western doctors educated us all that ginger has been proven to help with morning sickness in pregnant women.

At dinner the students said a tearful goodbye to Dr. Susan McDowell for her excellent teaching and heartfelt help with the program.

Students with at the ceremony 

It was a busy, exiting, and exhausting day but a great end to this first week of focused medical training.

Rick 

Thursday- Suture Lab

Students practicing suturing 

Thursday started with a 6:00 am hike up the mountain near the training center. The westerners had shoes and lights as we were lead by our translators. However, in the dark we lost the trail briefly. It was one of the students who caught up to us in his flip-flops that took the lead to get us back on the trial.

Timothy, Susan, Jeff, Abraham, Hkaw Taik on the mountain.

After that it was an exciting morning learning how to suture. Dr. Susan McDowell taught the students with foam sheets and then moved on to pig’s feet. This is always a favorite activity of the students. We are always impressed at how quickly they pick this skill up compared to medical students in the west. The students are very good with their hands and many of them know how to mend clothes. This may be why they learn this skill so well.   

Doctors teaching suturing wile being projected overhead. 

We finished up on the prenatal and childbirth chapter in the afternoon and took a few survey questions using the ARS (Audience Response System). We found out that it is farther for the villagers to walk to a health center than to walk to get a soda pop like coca cola.  This is not surprising but a sad statement of how things are developing all around the world. We also found out that the people have a low opinion of the health clinics regardless of how far away they are. The clinics are often not fully staffed, may have intermittent power, and prescribed medication can be expensive for the villagers. 

Dr. McDowell teaching suturing. 

Babies, Bibles, and Puppies

Wednesday 

Dr. Jeff Kornelsen teaching on pregnancy.

We felt the students needed a bit of encouragement today so Dr. Bjorn Nilson and I let them have it with both barrels. First I opened with an encouraging bible verse and Bjorn followed with a cute puppy video. If that does not lift your spirits I don’t know what will. The verse I opened with was Hebrews 10:23-25 and reads “Let us hold unswervingly to the hope we profess, for he who promised is faithful. And let us consider how we may spur one another on toward love and good deeds. Let us not give up meeting together, as some are in the habit of doing, but let us encourage one another- and all the more as you see the Day approaching.” Bjorn had a cute video of his dog Riley playing with their new puppy.  We added in a little motivational speech to encourage them to lift each other up, work together, enjoy the experience, and approach the day as children coming before Jesus. The students seemed a little down to us and that is to be expected after 3 weeks or more away from their homes. We reminded them that this is a life changing experience for them and for many people they will help because of this knowledge.

Women during a break out session

Fittingly, the subject for today was maternity care and childbirth. In general this is a happy subject. However, the students knew of 5 women who died from childbirth in the last year! One of the students told us about a woman who was having difficulty delivering so they correctly decided to transport her to the hospital. The journey took 4 days on foot! Miraculously they made it to the hospital and surgery was performed saving the mother. Sadly the baby did not make it.  

Dr. Jeff Kornelsen teaching

There were a lot of great questions and discussion for this important subject. Dr. Jeff Kornelsen was able to bring a baby and pelvic model to show how a baby is delivered. The model added to Dr. Kornelsen's lecture by providing the students an opportunity to do hands-on activity.

Student working with birthing model

This subject reminded many of the instructors and staff of Dushin, a student from our last graduating class. Dushin was from a very remote mountain village. We received word about 2 years after her graduation that she died in childbirth. With the nearest hospital over a week away on foot, and Dushin being the only trained medical worker in that area, there was no help for her when there was a problem. The thought of this still makes us emotional but illustrates the very real importance of this subject.

Dushin with Rick on graduation day 2012

Our hope and joy is that this education should help the students save lives.

Until tomorrow, 

Rick

Top 10 Orthopedic questions

Dr. Susan McDowell teaching with Timothy translating 

Tuesday the teaching started on orthopedic issues. Dr. Susan McDowell started out by asking the students what issues they have seen and what  questions they have related to orthopedics. Some of the answers may surprise you (Picture Attached). We were shocked to hear that about a quarter of the class have seen land mine injuries! Fortunately they did not see these injuries immediately after they occurred and they were usually only observers.   They also have seen gun shot injuries and wanted to know how they should treat them if needed. This indicates a significant increase in the number of these kinds of violent injuries compared to years past.

Top 10 List of student ortho questions. 

Here is a top 10 list:

·      Motor bike accident

·      Fall off cliff/ tree

·      Dislocations

·      Knife, cut injury

·      Landmines

·      Bullet wounds

·      Animal bite-bear

·      Hit by stone-rock fall

·      People fighting

·      Nail injuries.

Exam of student with crooked finger

Dislocations and sutures were discussed and students were used as real life examples.

The audience response system(ARS) system was used to start and collect the data from the patient log books. This is also used to talk about the different types of patients and start answering questions. We will report out on the findings as we get more data. Thank you for your interest in this important work
Rick Astone

Students getting used to suture equipment

First day of Focused Medical

Map pins of student locations

Student showing where is lives on the map

Monday started the focused medical training for the Barefoot Doctors Training 2015. The students have been here now for 3 weeks and have a great foundation laid for the intense medical portion of the course.  We started with introductions and had everyone pair up to introduce each other.  Everyone was to tell something of significance that happened over the last year. Along with this we had all the students and instructors place pins in a map showing where they live. This is a very fun and interesting activity that everyone enjoys. The students are spread across the country of Burma and represent many different tribal groups.

Ram Bo Kim

Ram Bo Kin had a fascinating but concerning report.  He lives near a town called Myintkyina. He was very busy this last year treating refugees that are in his area. There are 69 families that have been displaced from their homes due to fighting. He has treated 69 families spread out in his area. This could be between 300 – 500 people. The main issue he treated was the rampant diarrhea problem that was spreading quickly. He decided not to just treat the symptoms but to educate the refugees on hygiene and how to prevent the spread of diarrhea. By addressing the issue in this way he helped the entire affected population and very likely saved some lives. He would run himself ragged if he tried to treat the symptoms of 500 people living in a primitive environment and who undoubtedly continued to spread the infection and become infected again and again. This is a perfect example of what we are trying to teach the students. He did a great job! Another surprising detail was that this refugee camp is deep inside Burma and was totally unknown to most of us. Usually refugee camps are in neighboring countries.  

We also discussed the growing drug problem in the Shan state of Burma. Several of the students live in this state and we asked them to confirm some of the reports we had heard that up to 80% of the youth in this state have an increasing drug problem with Heroin. To our shock they confirmed this was the case. This is a mostly Christian area and fortunately the local churches are stepping up to try and address the problem. This is a complex issue, but many people there are being targeted and the drug problem is being forced on their area by outsiders. I expect this issue will come up later in the course and we will report more in depth at that time.

Getting new books

The students were issued there 2^nd textbook, the Burmese Border Guidelines. This is a much more technical and difficult book to read than their first textbook, but it includes more in-depth medical information.

The last thing we covered was defining our clear expectations for the course. The students also listed out what they expect to get out of the course.  Here is a list of some of the expectations we have of the students.

1.     Summarize the patient log books

2.     Students present reports on assigned chapters.

3.     Case presentations

4.     Explain pictures of patients

5.     Report on health official contacts that they were supposed to initiate since last class.

6.     Report on forming a health committee in their areas.

7.     Be able to send an email and look up a disease on the Internet.

Writing out objectives of the course

Final Day of CHE Training and Certificates!

Today's training started out with a focus on home visits and the factors that are instrumental in helping families adopt good health habits. They learned to praise the good practices they observe during the initial visits and, at the same time, use it to discretely notice unhealthy conditions and practices that may become the subject of future lessons. This lesson brought out the importance of asking 'open ended' questions to encourage more sharing and thus find out more of the family health history and situation. An emphasis was placed on building trust and encouraging a growing confidence that can lead to a willingness to change their behavior.

The next lesson covered the use of a 'baseline survey' to record the health conditions of the community so that progress can be measured as time passes. This information is valuable when evaluating the methods used to foster good health practices. There were two types of surveys introduced.

The afternoon started off with a lesson on using picture booklets especially as a follow up on health lessons given. The students discussed the advantages of using picture booklets and why they would enhance learning home treatment and prevention. An explanation was given as to the separate sections of the picture booklets and the important points of how to present the material.

Lastly, the students were asked to answer some evaluation questions of this week's training.  Some of the questions were: 1) Name one or two core values which you understand better now because of the training this week? 2) What new ideas did you gain this week? 3) What is something new that you gained from this training that you will do when you go back to your community? 4) What was most useful to you?

At the end of the day, certificates of completion were presented to each student in recognition of their participation and hard work as they discovered new principles, practiced new teaching methods and processed a lot of new material throughout the week - David Crist

Jung remarked how wonderful it has been to have David Crist and Joanna Geiger back for this CHE training. He noted, "They are spiritually mature, understand the culture, and are, most of all, humble servant leaders."  He also added his thanks to everyone for your support and prayers for this ministry and the students.

As Dr. Bjorn Nilson and Rick Astone arrive to continue the medical training of our students, look forward to more reports and updates on the Barefoot Doctor School.  Thanks for reading these posts, and thanks for your prayers.

Jon Ulm

Day Four of CHE Training

Today's training began with a review of the CHE core values. The review began with Pastor Jung sharing his experience in helping a northern Thailand village install a water system. He told the students that, because of his using the core values to guide him through the process of working with the village leadership, money and time was saved as well as a sustainable system of ongoing village run maintenance was established.

 The students were then asked to identify activities in the project that indicated one or more of the core values taking place. They were quick to point out the significance of the large amounts of time and effort Pastor Jung spend in building relationships with government and local leadership. They also pointed to the ownership the community expressed in the water system by the money, labor and their own resources they contributed. This review exercise underscored the core values through a real project and gave them a practical example of how they could put the core values to use in their own context.

The core values review led into a discussion about the importance of an invitation by those who need help and that it is crucial to the success of a project. They learned that an invitation was an indication of interest to improve and most likely would lead to positive change. They understood that an invitation from a family to have a Barefoot Doctor teach them about disease prevention was an indication that there would be a change in behaviors and the establishment of good health habits.

The afternoon sessions focused on the topics where health prevention could be taught in their communities. Their list was quite extensive but the most mentioned places were at church, schools, homes and mandatory community meetings called by community leaders. The point was then made that the main objective of teaching prevention was not information dissemination but changed behavior. One of the important conclusions made was that one of the most effective ways to encourage changed behavior is to build trust relationships where people know they are valued and loved - David Crist

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Bolu's Testimony.

Hello, my name is Bolu from Gumling Village, Nongmong District, northern Myanmar.  This is my second year CHE training with David and Joanna.  I must admit that I did not fully grasp the CHE principles or core values we learned last year and how these principles would fit with my role as a barefoot doctor.  But this year studying more with David and Joanna has widened my horizons.  Now I see how important these principles and CHE methods are as tools to change people's attitude. These methods will help mobilize them, get their cooperation, and help us to be better facilitators.  I want to thank David and Joanna for teaching and leading us patiently and for making our class lively every day.  Now I have a better idea how I can be a better barefoot doctor by using CHE principles.