Cure Kits Opened and Distributed

Dr. Bjorn Nilson reports that the Cure Kits purchased by Frontier Labourerers for Christ were opened yesterday and distributed to the students.  There were very excited to receive them, and we know the supplies in them will be a great blessing!

Here you can see the Barefoot Doctors and Dr. Nawrocki from Texas unpacking the Cure Kits, each containing approximately $2,000 worth of vital medical supplies.  Frontier Labourers for Christ U.S. donated $200 each for the kits and coordinated the entire endeavor. Another ministry, Project Cure, gathered and boxed the materials and sent them to Seattle.    Boeing and Thai Air cooperated to send them to Chang Mai free of charge. 

Here at the Kalnin Learning Center, volunteers Dr. Nawrocki, Dr. Janet Warren and RN Anita Terry (both from Toronto sponsored by Samaritan’s Purse, Canada) are instructing 19 Barefoot Doctors in the use of the Cure Kits.   As you know, this group of Barefoot Doctors come from seven different mountain tribes in some of the most remote areas in Myanmar, where these supplies are desperately needed.  Each kit, weighing 50 pounds, will be carried back to their individual villages, many in the outer reaches of the Himalayas.   Supplies not used by the Barefoot Doctors will be shared with the local health centers that often go without the bare essentials.

Dr. Nilson also gave his heartfelt thanks to all of the volunteers who come at their own expense to help our students.   Some of these teachers have already come three or four times. We are also grateful for the participation of many medical professionals from Samaritan’s Purse who have come this year.  We thank God for all of our partners.

Thank you for your prayers and for reading our blog.

Jon

Friday-Quiz and BBQ

BBQ- Cooking with real wood.

Well, it was an information-packed morning with Dr. Nawrocki discussing the disease processes of rabies, tetanus, meningitis, brucellosis, and leprosy. The students learned how to identify these, conditions, what causes them and how they should be treated. In some cases all the Barefoot Drs can do is help transport the patient to the nearest health center even if that means walking for days to get there.

Dr. Nawrocki teaching.

One of the students had seen a leprosy colony in Burma! He stated there are several hundred people with leprosy in that area. Fortunately, they are receiving treatment from a large organization. Leprosy can be effectively treated with modern medicine but it is shocking to us to hear there is that many leprosy cases in Burma.

After lunch, Dr. Jeff discussed bites; both animal and human and how the bacteria in bites can be very dangerous. The instructors learned that 7 students know someone who has been bitten by a snake, and 4 of the students have been stung by a scorpion (“gin-chem-ya”). Dr. Jeff instructed in the treatment of new vs old wounds, assessing for signs of infection, and about allergic reactions like anaphylaxis. 

Quiz review using the ARS(audience response system)

The week closed with a quiz and robust review. The students are given the opportunity to discuss and argue their points and sometimes they are given credit. The point is to get them thinking and really understanding the subject matter.

There was a lot of confusion about how to treat a snake bite. It took us a wile to figure out that the student’s book has the outdated treatment for snake bite recommending to cut it and suck out the poison. The most recent recommendation is to clean the wounds and bandage it with and elastic bandage. More recent studies find that the cutting adds to the risk of infection and the sucking on the wound does not help get the poison out. Since their book said one thing and we another we gave them credit for both answers but made sure the wrote down the most recent recommendation.

Students at BBQ

Singing at BBQ

Friday evening ended with a big BBQ, something very rare for the students.  It was a time of fun and fellowship for all. The students said goodbye to Alice and Rick Astone and Dr. Jeff Kornelson. It is always and emotional and special time of mutual thankfulness.

Some of the instructors tried Chin Lo, a sport kicking a ball and no hands. There was also great food and of course some singing

Instructors practicing Chin Lo

Thank you,

Rick and Alice Astone

"Guk Guk" and "Squeak Squeaks"

Practicing CPR

Dr. Jeff started the morning off with discussing first aid and CPR.

Triangle bandaging lab.

The students reviewed the steps of assessment and got to practice on a CPR model. Many of the students found it difficult to inflate the chest the first few times during practice. There was also a lab on bandaging and slings. This included a real life demonstration of wrapping an ankle to decrease swelling. The students observed the effectiveness of proper wrapping on one of the instructors swollen foot. One of her ankles was ACE wrapped to show how compression can limit and decrease swelling; many were surprised to see about a 1-inch difference in circumference.

Practicing Ace wrapping. 

In the afternoon, Dr. Nawrocki reviewed the life cycle of a mosquito and its role in the spread of malaria. He also discussed insecticide and medication resistance.

Dr. Bjorn Nilson started review of the log book data we collected. This gives us in depth information on how many patients each student treated, what diagnosis, what drugs, and how many of each the used individually and collectively. There was a long discussion on Malaria and the use of Artesinate. There were only 3 students who do not have Malaria in their areas. Surprisingly the students did not use as much Artesinate for Malaria as was expected. We are still trying to understand exactly why. 

Presenting case with many cuts from "traditional" med.

 The afternoon finished off with a student case presented by Ram Bo Kin. His patient had chest pain and his breathing sounded funny. We all got a good laugh at the description of the breath sounds as “guk guk” and “squeak squeaks.” Not exactly the medical terms we use for breath sounds in the west but very descriptive. The patient received treatment from a “traditional healer” by making many small cuts along the trunk with a razor.  Even our western doctors had trouble identifying what looked like a strange rash but was really this “traditional healer’s” treatment. Ram Bo Kin reported the patient told him this “traditional treatment” helped his pain a little bit, which made for a good opportunity to reinforce the placebo effect. However, the patient needed Ram Bo Kims help because he still had a high temperature and pain. Through a thorough history and physical, the class came to realize this patient had pneumonia. Ram Bo Kin had treated him appropriately and the patient improved! This example reinforces the need for the Barefoot doctors and this training.

Thank you for your support,

Rick 

Wednesday-Psych and Rehab

Role playing of psych issues. 

Dr. Janet and Anita started the day off with mental health and drug addition. These are important issues with the increased reports of drug use and psychological trauma from conflict zones. We know at least 5 of the students know of people with land mine injuries in the last year.  Two of the students reported suicide in their villages. They actually made this serious topic more fun by having other instructors role play psychological disorders. Attached is a picture of Anita acting out Manic Depressive disorder. There were lots of questions about mood disorders, and addiction.

Anita acting manic/depressive

Dr. Bjorn reviewed a student case with a photograph from this past year. It was a 98 year-old woman with what appeared to be cancer on her face. She had a 12 year history of this slowly progressing problem that has now progressed to the point seen in the attached picture. She lived only 2 miles away from a health center but has never gone because see was afraid, believed it would cost too much, and did not think they would help her. The class went through a full history and physical to decide what the probable cause was and how she should be treated concluding that at this point there is not much they can do for her.

Student case-women with face cancer

Then it was on to therapy review and practical cases. The class collectively with Rick and Alice assessed two students with back pain and one translator with knee pain. Two of the three improved with stretching exercises and it was a great real life example of how they can apply Physical Therapy principles to improve the quality of life of the people. One of the student examples of back pain was brought on by picking rice. This is a very common activity and problem in this part of the world. The patient responded very well to extension exercise. We discovered the belief that drinking a lot of water can cure joint pain; the students learned that hydration is always good but it won’t fix a movement problem or poor posture.

Until tomorrow,

Rick Astone

Medicine and Injections

Students practicing injections

Dr. Janet Warren and Anita Terry lead the teaching today. They covered many topics including medication use, when to use and not use medicine, natural remedies, injections, and the scientific method. Nine of the students have given injections over the last year. It is preferable for the students to prevent serious illness or use oral medication rather than injections but sometimes it is necessary to give an injection. One of the objectives this year is to deepen their understanding of medicine and make sure they are using medicine in the most appropriate manner. 

Anita Terry showing injections on watermelon rind. 

We collected the data from the student patient logbooks and will be reporting out on this as the class goes on. On the subject of medicine, it is interesting to know that collectively the 19 Barefoot Dr students used Paracetamol (Acetaminophen or Tylenol) the most with 529 doses and Mebendazole for worms as a close second at 457 times. The third most used medication was Amoxicillin with 398 doses used in the last year. This indicates the students treated a lot of serious infections and intestinal worms in addition to less serious ailments.

The scientific method is a difficult concept but important. This is the basis for all western science. It means knowing and proving something works verses using superstition to treat the sick. The students seem to understand this concept now, even though it is not something they commonly grow up with.

Thank you for following our reports,

Rick

Dr. Janet Warren teaching Barefoot Dr students.

P.T. and Rehab

Dr. Alice Astone teaching P.T. and rehab. 

 day began with Dr. Alice Astone reviewing tissue function and assistive devices. The students then learned about variations of assistive devices for special circumstances, like when a patient cannot use one arm. Videos of patients post stroke were helpful to visualize paralysis and spasticity, associated compensations, and how to help someone regain function. We also looked at cerebral palsy, abnormal muscle tone and the necessity for proper positioning to prevent bedsores. Splinting and orthotics were new concepts as well as decreased bone density with non-weight bearing.  The class stated universally that people with strokes and cerebral palsy do not receive any help traditionally; they might learn how to do things again on their own with no assistance. We discussed rehabilitation vs compensation with conditions that plateau in function or conditions that will not recover like spinal cord injuries. The key to treatment for this population is to help them to help themselves. We learned that 16 of the students had seen people with strokes and 7 children with Cerebral Palsy type symptoms in the last year.

Alice teaching about CP with Timothy translating

Then it was on to infant and early child development. The class found it funny that Rick was a big baby on this topic, literally. He was the model in this exercise as Alice helped him learn new movements in the progression of development.

For orthopedics, we looked at arthritis, sprain/strain/tears, knee pain, and back pain. We discussed the relationship between posture and tissue stress with a live example of lumbar disc herniation with a Ziploc of water between two books. Slinky toys made for demonstration of tissue stretching with prolonged positioning; several students said they had seen joint stiffness after casting for a fracture. We talked through specific examples step-by-step according to a general P.T. assessment. This included an ankle sprain while playing Ta Craw (like soccer over a volleyball net), back pain from picking rice, knee pain from arthritis, and back pain from poor posture. The students asked great questions, including how to tell the difference between a movement problem and an organ problem (back pain vs kidney). 

students during stress break song.

As a stress relief one of the students made up a song involving a back message. Everyone seemed to enjoy this mini break activity. 

Thank you for your support,

Rick and Alice Astone

Students during message song

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