Rotarians in Santarem, northern Brazil

Steven Winn Alexander in action in his administrator's office at the "Foundation of Hope". Steven organized the local logistics for my short 3 days visit to Santarem where he has now lived well over 20 years after having been around the world in places such as Brazil (several times starting as young volunteer with the Peace Corps), Vietnam (with USAID) and Alaska (as health administrator).

Steven has been a Rotarian for many years and he assisted the past years with the final reporting for the used funds from the Rotary International Foundation. Steven made most of the photos that I am using for these blog postings (that is why you suddenly see me so many times in the photos).

Steven picked me up at the Santarem airport last Tuesday together with Thiago Riker, the current Club President of the Santarem Rotary Club. They made sure that I was settled in a local hotel and in the evening picked me up for a "working" dinner with a number of fellow Rotarians:

Steven took me around the "Foundation of Hope" dental and medical clinics the next day (see one of the next posts). Mother & child care was wonderfully organized in this center...

Just to make sure the newly donated dental chairs were comfortable. I got out there quickly though when she reached for her equipment (I just had my 6 month check in Niagara in June....).

Another Rotarian, Getulio, took me around town a bit (here in front of the might Amazonas river) and then to two of the hospitals where Rotary had donated medical equipment (see the next post).

Bunch of "cool dudes" those Rotarians of all ages, eh....?

Rotary International donates medical equipment in Brazil

I visited a 200 bed hospital in the city of Santarem in the north of Brazil as part of a project evaluation mission for the Rotary International Foundation. A donation of about $400,000 was used to buy important X-ray machines and ultra-sound equipment in this under-serviced city and region. On the right of the photo is the General Manager of the hospital, a native from Santarem who had just returned to his home town in early 2014 after medical specialization and work in Sao Paulo. This hospital is the referral hospital of a region with about 1.2 million people. You can imagine how busy their emergency room is all the time 24/7. During our tour of the hospital I witnessed many motor accident patients; motor cycles are in these parts of the world more common than cars. If I already disliked motor cycles, I now even dislike them more....

While the first photo showed a mobile X-ray machine, here is one of the donated fixed station machines in a recently renovated room. You can see that our GD of the hospital is happy....

After the visit to this city hospital we drove an hour to a regional smaller hospital where Rotary also donated X-ray and ultra-sound equipment. During the drive we enjoyed some tropical rain....

In the back of the car my "three musketeers" of the day. On the left Getulio, the long-time Treasurer of the local Santarem Rotary Club who had overseen the good and transparent use of the funds from the Rotary Foundation (Getulio is a very fit 76 year old commercial shop owner and operator) and on the right Steven who had organized my visit and who had assisted in the final reporting of the use of the funds to the Rotary Foundation (Steven is an energetic 75 year old health care administrator who just like Getulio still works every day). Squeezed in the middle of these two "veterans" is Thiago who is the current Rotary of Santarem Club President with his 26 years of life experience....

We visited this smaller hospital during the afternoon when it is very quiet. The out-patient services are only offered (other than emergencies) during the morning because this hospital does not yet have enough budget to operate full days. They have a few patients staying overnight but longer term care would be transferred to the city of Santarem. While we were in the hospital the TV was on in the waiting room and we watched for a bit a friendly soccer ("futebol") game of the Brazilian team being hosted in Switzerland....

Also here the X-ray machines were in good shape after four years of use. Above the "fixed" machine and below the mobile unit. This hospital has only two trained X-ray technicians who each rotate between the morning services and the afternoon/evening/night stand-by for emergencies (compared to 12 technicians in the Santarem hospital who work between them a 24/7 service).

The technician showed me the daily activity book (not automated yet) which shows an average of about 10 patients per morning/day. Modest but essential services in a regional health center.

Social medical services in Brazilian Amazonas region

The "Foundation of Hope" in the city of Santarem in the State of Para in the north of Brazil fills a void for low income families in preventive health care with a clinic for dental care and a clinic for general health care (especially for mothers and smaller children). I visited them as part of the agenda during a project evaluation mission for the Rotary International Foundation.

The organization was started about 50 years ago by an American missionary medical doctor. They have grown into a very professional local NGO offering wonderful essential health services to low income families. Much of their external funding over the years has come from USAID, but they are reasonably self-sustaining because their clients/patients have to pay modest fees for the services.

This is an overview of their services including dental hygiene, immunizations, mother & child care consultancies, psychological assistance, and work safety consultancy. The "Projecto Quilombo" is the river boat project described in the previous post (they called the escaped slaves "Quilombos").

These are (most of) the members of the management team of the clinics which employs about 300 medical staff , technicians, administrators and support staff. The lady on the right is the operational manager and she was promoted to this position last year after several years work in the purchasing team (she has done lots of professional development and she just started a distance Master program in hospital management; great to see professional people in such local NGOs).

This is the reception of the dental clinic. Thanks to the Rotary donation 4 years ago the clinic could not only purchase about $200,000 in additional and new equipment but also a few computers to professionalize their patient administration system. Clean, professional and friendly atmosphere.

In the waiting room on the wall one can find a nice plaque with acknowledgement of the recent donations of the Rotary Clubs locally and internationally. Below with Steven Winn Alexander who is an American Brazilian, long time Rotarian and also consultant health administrator to the clinics.

Dental hygiene is so important for general public health. Nice to see the young fellow happy..

The American dentist Bill Chase has started this dental clinic many years ago, and he stills comes frequently as a visiting volunteer dentist to see how they further develop.

The waiting room of the medical clinic. Obviously well used....

The clinic has an impressive laboratory for in-house blood and urine tests (funded by USAID) with some state-of-the-art equipment. This makes treatment time and referral decisions much quicker.

 

The organization does a lot of active professional development with its staff. We bumped into a session on "safety in health care" with some of the staff and interns. The organization also does some modest outreach in the communities, and for that Rotary donated a VW minivan as well as a Toyota pick-up truck. The cars are well used and well maintained. I always have a warm feeling when I see these VW vans because I travelled with one of those in 1982 through the African Sahara and during my years with MSF in Maputo in 1988 and 1989 we also had one of these excellent workhorses...

Across the street the Foundation has started a technical college and an applied university with about 2,000 students currently (of whom about 1,300 study applied medical programs). In 2014 they will start even a Faculty of Medicines to locally start training MDs which will have a very positive impact on the future health care in this region of about 1.2 million people.

Medical relief in remote communities in the amazonas river

During the colonial and initial post-colonial times slaves who were brought over from Africa to Brazil to work on sugar and rubber plantations at times managed to escape. They settled in very remote small communities along the Amazonas river and even up till now the Brazilian health system (even though working hard to offer public health to all of the almost 200 million Brazilians) has not quite caught up with them. Organizations such as "Fundacao Esperanca" send some relief with medical teams and supplies of essential medicines. This organization sends 10 times per year (once per month other than in November and December when the tropical rains are too heavy) a small team of 10-12 volunteers up the river to three remote communities. There is always a medical doctor and a pharmacist on the team, but most of the others are medical and pharmacy students. They rent a boat for the week and bring kits of essential medicines to the communities where they train community members how to assess infections and diseases, and then how to administer medications. People from surrounding communities know the schedule and come to one of these three communities for the opportunity to get consultations and some primary health care.

The logistics of such a trip brought back lots of memories for me to my years with MSF (Doctors without Borders). All the work "behind the scenes" to get the kits ready for example:

 

This year an American volunteer was able to join the team. She is a pharmacology student.

A proud team doing wonderful medical outreach work and loving what they are doing!

Project travel logistics

Colombia is a country with many geographic and logistical challenges. It borders with Panama on the north-west, with Venezuela for a large part of its eastern borders, with Brazil in the south-east and with both Peru and Ecuador in the south. The country has a long coast in the north with the Atlantic Ocean and another long coast in the west with the Pacific Ocean. Above an amateur drawing of the shape of the country in which its 43 million people are widely distributed. The only area with a low population is the south-east corner of the country in the region of the amazon river delta.

For our project we work in two of the northern provinces ("departamentos"): Bolivar with as capital the coastal city of Cartagena, and Antioquia with as capital the mountain city of Medellin. In past blogs I have shown photos of both cities. From Bogota it is an hour and half flight to Cartagena. In this city SENA has three training centers (see previous blog posts) and from here they organize delivery of training as well in the southern part of the province. Let me try to picture how this works from a logistic  and travel perspective....

From Cartagena it is a 7 hour drive to the town of El Banco (which is located at the border of the provinces of Magdalena and Bolivar. When we visit our project target region we stay overnight in this town of El Banco and take the "chalupa" river boats to the municipality of Barranco de Loba.

It takes two hours in these river boats to Barranco and then another hour to one of the mining communities in that municipality called Minas de Santa Cruz.

I made a blog post about this community in February. There are people who work in Minas Santa Cruz and who go up and down to this community from El Banco every day in the river boat.

From El Banco we have to go 5 hours on another river boat to reach the second project target municipality of Santa Rosa del Sur. There are basically no roads in this huge delta of the mighty Magdalena river so the boats are the only option, unless you are independently wealthy and can charter small planes to fly you between the small airstrips of El Banco and Santa Rosa del Sur.

From Santa Rosa del Sur we take a river boat of 3 hours to reach the city of Barrancabermeja on the border of the provinces of Bolivar and Santander. If we only go to Santa Rosa del Sur, we can fly from Bogota to Barrancabermeja and then take the chalupa. Also in this area the roads are so bad that the chalupa is a better way to travel.

From Barrancabermeja it is a 3 hour drive over reasonable roads through a mountain range to the town of Puerto Berrio, where SENA has a regional mining & agriculture training center which also coordinates training program delivery in the two other project target municipalities of Remedios and Segovia. From Puerto Berrio you can take the road to those communities (about 5 hours). Puerto Berrio is about 3 hours driving from Medellin (a stunningly beautiful drive from the higher region of Puerto Berrio to the valley in which Medellin is located).

From Medellin there are three daily commercial flights with small planes to the airport of Otun from where it is just half an hour to both Segovia and Remedios. I have made blog posts about these mining communities in March. From Medellin there are also three daily flights to Cartagena and about 10 daily flights to Bogota.

This gives you a bit of an idea of what it takes to travel to our project communities in Colombia. At the end of August we will do a few of these visits again....

Back to working on gold

Our project in Colombia aims to increase the capacity of the national training organization SENA to reach out in remote areas of the country with applied education programs. In our specific project we will concentrate on training programs for small scale gold mining, small scale rural agriculture (in the same areas where the small scale gold mining takes place), water treatment and entrepreneurship (to transform existing informal small production units into formal businesses). One of the main problems in the small scale gold mining is the use of the chemical mercury (to get the gold away from the rocks). The way it is used is not only relatively inefficient (they get a maximum of about 40% of the potential gold from the rocks that way), but also a real threat for public health and the environment.

Above a statistic which shows that after the large countries of China and Indonesia, Colombia has a lot of contamination taking place through the use of mercury in gold mining. And if you realize that the gold mining in Colombia has barely began in seriousness, the threat is very real and large.

Our project "Education for Employment" (EFE) hopes to give an additional impulse to stimulate alternative uses of appropriate technology in Colombia for the small scale mining operations. SENA trains a lot of Colombians (about 7 million each year) with short courses of as little as 40 hours up to diploma programs of two years. They have not yet been able to do much in the sector of mineral mining, and our EFE program will launch an important increase in that activity.

The coming weeks we will have some visits of Canadian colleagues (for annual project steering committee meetings) and visits to our project target/pilot communities. During September and October we will have a call for expressions of interest to participate in this program for all the member institutions in Canada who are member of the ACCC (Association of Canadian Community Colleges), we will have a few special Canadian experts conducting workshops, and we will organize a workshop on "gender mainstreaming" by a Colombian expert. In November we hope to complete the selection of the Canadian colleges for the five sub-projects of our EFE program in Colombia, and then we can start in serious with the project/program implementation during 2014, 2015 and 2016.

Greetings from your friend and for-ever optimist. On we go. Step by step. Paso por paso....

Vacation back in Canada

The past two weeks I did some work in Canada plus enjoyed a week with our family in a cottage we always rent with the brother and sister of my wife Mary. With all the kids and others invited this place can host up to 20 something people. It is located on Cameron Lake near Fenelon Falls in Ontario (not far from Peterborough). We had wonderful weather and lots of fun on the water. On the photo is our daughter Hilary with her niece Fiona.

On Thursday this week back to Bogota with a busy agenda for the coming few months....