Rocío Posada: Getting Ready for Pampas Grande

(Submitted June 1, 2016) 

Our trip to Peru is nearly a month away and I am preparing myself for this experience. I have participated in other service learning trips like Habitat for Humanity and U of R’s Students Engaging & Enacting in Dialogue & Service (SEEDS). However, I am very excited to take what I have learned from past experiences and travel abroad to Pampas Grande. Peru is a country with a unique history and a rich culture, but like many countries it has a flawed healthcare system. Approximately, only 43 percent of people have one of the three main types of health insurance and a small pueblo like Pampas Grande does not always have access to medical facilities and treatments. PAN Peru has initiated healthcare and education programs and a partnership with RGHA in order to provide better health quality for its people in Pampas Grande. With that said, I am a bit nervous about being at more than 14,000 feet of altitude and getting out of my comfort zone in a new culture. I hope to use my native Spanish language skills to communicate with the people of Pampas and interpret for medical professionals. Most of all, I am ready to learn from the people by immersing myself in a completely different atmosphere and be part of this team of passionate professionals and undergraduates. 

In the SEEDS Trip 2016 in West Virginia students volunteered in McDowell County and learned about mountain top removal and environmental & health related issues.                                                                                           This is where we started our morning hike. 

In the Sophomore Scholars in Residence trip to San Diego and Tijuana, we studied immigration and U.S.-Mexico border relations. In this picture I am standing on the Tijuana Beach Border. 


Nicole Dambrosio: Pre-Trip Reflections

(Submitted June 9, 2016)

Our annual service trip to Peru is almost here! I am excited to be traveling to Pampas Grande this year to work with the community and learn more about the culture. RGHA has traveled to Pampas Grande for a number of years now and I’m hoping to help continue and expand the great projects already in place in the town. From the school programs to the greenhouses, I think together with the members of the town, we have made a great positive impact on the community. During meetings following up to the trip, we see pictures of life in Pampas Grande and hear stories of the past experiences of RGHA members. I’m excited to finally embark on this journey to see what will be in store for me upon arriving. I’m eager to go to Peru for the first time and not only help the community in any way, but hopefully learn from them as well.

I have worked as a medical assistant at a pediatric clinic in the United States so am eager to see how clinics are run in the community of Pampas Grande. I hope to use my Spanish speaking skills and EMT training to help in the clinic in the best way I can. I’m looking forward to spending time with the children at the schools as I spent four summers working at a summer camp with young children.

I can’t wait to meet everyone we will be working with and make new friends. I have only heard great positive things about the generous, loving, and caring community so I hope that I can help them as much I possibly can in return.

Nicole is an undergraduate student at the University of Richmond. This will be his first trip to Pampas Grande, Peru. 

Destini Teague: A summer of experience in healthcare

This summer, I am lucky enough to have two opportunities which allow me to experience healthcare in vastly different cultural and physical environments. During the weeks remaining before our trip to Peru, I have been working as an intern in the community health department of Children’s Medical Center in Dallas, TX. This department serves to assess environmental, social, and economic factors causing the most prominent public health issues in the Dallas-Fort Worth metroplex, and then develops programs and services in order to tackle those issues. In 2013, this department performed a Community Health Assessment to determine their future objectives. In this study, they found five areas that needed the most attention: access to care, prevention and management of chronic diseases, improved education and economic security indicators, expansion of public health infrastructure, and child advocacy and safety. I did some research, and it was interesting to compare these public health concerns to those in Peru.

Destini and her colleagues at Children's Medical Center in Dallas, TX.

According to the CDC Community Environmental Health Assessment in Peru, top public health issues include lack of basic services, contaminated food and water, and poor healthcare infrastructure. If you compare this list with the aforementioned survey of Dallas, you find that accessibility is a shared issue, but for different reasons. Lack of accessibility in Dallas usually means the child is uninsured and therefore cannot afford to receive preventive care, usually resulting in misuse of services provided in the Emergency Department. Lack of accessibility in Peru usually means that rural communities simply do not have the means to travel long distances required to receive basic care. It’s the same basic problem, but under largely different circumstances. It will be interesting to experience the necessity and impact of public health in these two areas.

I am so excited to travel to Pampas Grande, experience a new culture, and meet lots of new people. Two weeks is not a lengthy stay, but I am determined to squeeze in as much interaction, experience, and learning as I possibly can. I’m lucky to be traveling with such a knowledgeable crew, and I have high hopes for what we can accomplish during our short time in Peru. But as excited as I am to help in any way that I can, I do realize that our group is not the solution to all of this country’s problems. I think our role in global health is more like that of the first domino in the domino effect. We can give some momentum through education, supplies, and programs, but in the end, it’s only successful if the train of dominoes continues to fall without our push.

In conclusion, I have two personal goals for this trip. I just mentioned one of them: sustainability. I hope our projects offer progress beyond our two-week stay. The second, and most important in my opinion, is connection. Because as one of my favorite authors once said:

 “Most people need love and acceptance a lot more than they need advice.”

Bob Goff, Love Does: Discover a Secretly Incredible Life in an Ordinary World

 

Destini is an undergraduate at the University of Richmond. She will visit Pampas Grande, Peru for the first time with RGHA in just a few days.

 

Community Health Assessment of 2013 in Dallas:

https://www.childrens.com/keeping-families-healthy/child-advocacy/current-issues

 

Community Environmental Health Assessment in Peru:

http://www.cdc.gov/nceh/ehs/Docs/Factsheets/Community_Environmental_Health_Assessment_in_Peru.pdf

Getting Excited for the Trip to Peru

By KJ Josloff

Our service trip to Peru is rapidly approaching, and I’m becoming more excited by the day. This is a great opportunity to work with community members in Pampas Grande, and I’m eager to learn more about the culture there. I’m looking forward to meeting and getting to know people in Pampas Grande and working alongside them to build upon the great community programs that they have already established. 

In any case, I'm really getting excited to use my particular skills and traits to make a positive impact during the service trip. I hope to use my EMT training to lend a hand in the clinic, and I'm really looking forward to interacting with the children in the different villages we will visit. Spending 3 summers teaching kids from ages 4 to 10 all different kinds of sports has been a great experience, and I'm really excited to take those skills to Peru, though I'm not sure how well my Spanish will hold up. I'll be using these next few weeks to brush up on my Spanish for sure, and probably my soccer skills as well. 

KJ at summer camp with a camper

I’m counting the days until the trip starts up, and I can’t wait to meet the people we’ll be working with. Although, truth be told, I have a feeling we’ll gain more from them than they will gain from us. 

KJ is an undergraduate student at the University of Richmond. This will be his first trip to Pampas Grande, Peru. 

Natalie Brown: Looking forward to a new service experience

Each week I’m becoming more and more excited for this service trip to Pampas Grande, especially after learning about the community’s healthcare system and the projects we will work on to help the people there. I’ve seen the powerpoints and the pictures depicting life in Pampas Grande and heard stories, and now I’m feeling eager to finally arrive there and see it all for myself. I’m eager to embark on my first trip to South America, to continue practicing my Spanish, to make new friends, to interact with the people in the community and support them in any way possible, and hopefully in return, learn from them.

The last time I participated in a service trip was for Habitat for Humanity in Miami, where we helped build, paint, and tile a house for a single mother and her three kids. I loved how equally rewarding the experience was for both myself and for the mother, and to have a similar or even more rewarding experience in Peru seemed like an amazing opportunity. I have always wanted to travel abroad for some sort of service trip, and I’m thankful for having the chance to work together with such a diverse group of undergraduates, graduates, and healthcare professionals.

Natalie painting a house for Habitat for Humanity in Miami, FL

Natalie's Habitat for Humanity service group

It’s difficult for me to feel passionate about one particular issue that RGHA will tackle in Pampas Grande since I haven’t attended the trip yet and am uncertain of the role I will play in the various projects we will work on. However, I do know one thing. While I was able to help make a substantial, if not lifelong, impact on somebody’s life when building a house through Habitat for Humanity, I know that I may not exactly have the chance to in Peru. It’s not feasible to provide lifelong supplies of medications and care to this community, but it is possible to make some sort of impact. I think it’s important to realize going into the trip that though there are some issues that cannot be fixed or eliminated in a short two-week period, there are improvements and impacts that can be made in the short term, and that will make a difference.

Natalie Brown is an undergraduate student at the University of Richmond. She will visit Peru with RGHA for the first time this June. 

Greenhouse for a High Altitude Peruvian Village

https://www.crowdrise.com/GreenhouseforaHighAltitudePeruvianVillage/fundraiser/siddharthadante

We are looking to raise money to fund the construction of greenhouses in Pampas Grande, Peru.

Pampas Grande is located at an altitude 12,500 feet in the Peruvian Andes Mountains.  With limited infrastructure, water, and advanced farming techniques, residents of Pampas Grande are unable to grow their own vegetables and maintain a healthy diet.  

This greenhouse will provide crucial, sustainable, and healthy nourishment for a number of high-altitude communities where traditional farming is falling short. The Richmond Global Health Alliance built the first greenhouse in 2011 in Pampas Grande. Working with local residents we have built an additional 6 greenhouses over the past 3 years.  The greenhouses have been incredibly productive, allowing the residents to grow and eat their own vegetables for free!  Between 2013 and 2014 the following vegetables have been harvested: 280 lettuces, 200 beets, 50 radishes, 200 pickles, 30 cabbages, 20 kg. of peppers, 10 kg. of tomatoes, 10 packages of cilantro, and 30 zucchinis.

The new greenhouses we are raising money would be located in new towns within the Pampas Grande District.  We would provide all the funds for the greenhouse and work with the local residents on construction of the greenhouse.   
*$1,000 or more- Pay for the greenhouse singlehandedly! Have the greenhouse dedicated in your name with official documentation and photo of team and school provided.
*$400 or more- Pay for the tarp needed to cover the greenhouse! A framed picture of the greenhouse with the RGHA team and school will also be sent as a token of our appreciation.
*$100 or more- Pay for a bundle of vegetables to be planted! A handmade item from our journey in Peru will be mailed as a thank you.
*$25 or more- A handwritten thank you note from us to you!

We are volunteering with the Richmond Global Health Alliance (RGHA). RGHA is incorporated as a non-profit business in Virginia, but is not yet an IRS approved 501c3. Teams from RGHA have traveled to Peru for the last 7 years and the Greenhouse project is exciting and growing.

To learn more about the Richmond Global Health Alliance and our work, please visit our website athttp://richmondglobalhealthalliance.org/ or ‘like’ us on Facebook at https://www.facebook.com/RichmondGHA

My trip to Peru: An experience that I will never forget

By Maggie Byrne


In the summer of 2014, I traveled to the mountains of Peru.  It was an amazing experience that I will never forget.  I traveled with the Richmond Global Health Alliance or RGHA.   It was really fun even though I spoke absolutely no Spanish whatsoever.  We traveled to the small town of Pampas Grande and did many projects including, building greenhouses, providing free medical clinics, spending time with the local children, and doing crafts in their library.  It was really fun to experience a whole different culture, have fun with the kids, see the beautiful landscape and just generally help the town of Pampas Grande and the surrounding villages.

            The culture of Peru is very different from what I am used to in America.  Everyone that I met in Peru was very nice.  Everyone greeted me with a hug even if I had just met them.  This type of greeting was very different from the usual handshake that I am used to in America.  They were also very welcoming and invited us into their homes with open arms.  They always made us something to eat and made sure that we were never hungry.  They were extremely nice to us and that is something that I will never forget.

One of Maggie's favorite photos from her morning hike

            The children were really sweet and it was fun to hang out with them.  I went to the school and did a couple of projects with them, which were amazing.  They were eager to learn the English lessons that I taught using flashcards I had brought with me.  The children taught us how to play some of their games, which were a blast.  One memory that I will never forget happened at their playground.  There were two or three kids on the monkey bars and I started tickling them until they fell off.  I had no idea what I was getting into.  The kids loved it and got back on so I would tickle them again.  Kids were popping out of nowhere to join the game!  It was crazy!  They reminded me of my dog Daisy and her endless energy, because they never got tired and I could not wear them out.  When I tried to stop and go play tag with some other kids, the ones on the monkey bars kept calling my name, Señorita Maggie, Señorita Maggie.  Their was no escaping, so I just kept tickling.  It was really fun and I think I connected with the kids. 

            One day we woke up early and went on a hike.  Going on a hike at 12,000 feet was not the easiest thing to do, but it was really fun.  We hiked on a path for a little while before we reached the top.  The view was amazing!  The mountains stretched for miles and the morning fog covered them like a blanket.  As I looked down, the clouds and sky looked like the ocean.  It was beautiful!


            We did a bunch of projects in Pampas and the surrounding villages.  We built a greenhouse which involved everyone pitching in.  We also visited a greenhouse that RGHA had built in the past, and saw all of the plants that were being grown for the community. It was incredible to see what a big difference RGHA had already made.  Every experience, from the landscape, to the culture, to interacting with the children, was an something that I will never forget.  I hope that I can come back one day and see once again see the impact our small group has had on the lives of the people.


Maggie is the daughter of RGHA co-founder, board member, and legal team director Sean Byrne. She traveled to Peru for the first time this summer.

Pippa Carey: Reflections on my Time in Peru

Shortly after I returned from spending my summer with RGHA in Pampas Grande I began my study abroad experience in Copenhagen, Denmark. It was such a drastic change to go from working in an area where quality health care is extremely limited to a welfare state, where all citizens have access to health care that goes far beyond basic needs. While in Copenhagen, I studied public health from a global perspective, and it has made me reflect even further on my time in Peru.

RGHA Student Leader Pippa Carey, in Copenhagen, Denmark, where she studied abroad last semester

The majority of my time in Pampas was spent working in the clinic and on various projects such as the sunscreen project with children either at the school or the library. There were also green houses built and a dental project. Although we have not solidified all of the projects to dedicate our time to each year, we try to meet the needs of the community. Before going in with rigid ideas of what is needed we must ask them what it is that they believe will benefit them the most. As an organization, we must also strive to create sustainable projects that carry on even when we leave. When serving a community, you don’t want to have them remain completely dependent on the support of one week’s stay. Rather, you must help create projects and initiatives that locals can take over and spearhead for the rest of the year. This creates a beneficial partnership.

Pippa and VCU medical student Niyant Jain observing Dr. Erika Soria Leiva in the dental clinic in Pampas Grande, Peru.

During my time in Pampas, I also realized how important is for organizations like RGHA to maintain their relationships with the communities we work in. That means our interactions with the locals must not be limited to the few weeks each summer we are physically present in Pampas but must continue all year round through constant communication and development, even when we are thousands of miles apart.

The trip that I went on was the 4th year that RGHA has gone to Peru. It shows the people in Pampas Grande how dedicated the organization is to serving their community and builds their trust in the organization. Commitment is essential if trips like the one to Pampas are to ever succeed. The number of people visiting the clinic surpassed any previous year. The committed volunteers return each year to help more who have heard about the good work of the organization.  However, commitment does not automatically equal success. When something doesn’t go as planned, it means making the effort to create a change that benefits everyone, and trynig again. In Pampas, that could mean trying a new system when registering patients at the clinic or scratching one program entirely for one that may be more useful. It’s a commitment to trying to get it right.

Commitment and teamwork also go hand in hand. Everyone on the team has to dedicate themselves to give their best and be willing to do whatever job comes their way. This means that no job is too small or insignificant, whether it’s playing with a child while his mother is being examined by the physician or organizing supplies for the school projects. I have seen all of these characteristics with the groups I worked with in Pampas and they inspired me to do the same.

Finally, discovering something to be passionate about is truly a priceless experience, and developing that passion requires commitment, patience and the cultivation of experiences to provide new perspectives on healthcare and service work. All of these things describe my experience with RGHA. My time in Pampas was truly a life changing one that allowed me to see healthcare in a new way and reinforced my future career goals of working in global health. As a new assistant student director of RGHA, I am excited to help plan the upcoming summer trip and continue collaborating with HOMBRE and PAN Peru to serve the Pampas community.

Congratulations to our new Student Directors!

Mentorship and service education is an essential part of our work as the Richmond Global Health Alliance, and involving students in every aspect of our operations is essential.

We are proud to announce that Meredith Walsh will be serving as our Student Director. She will be joined by Pippa Carey and Abigail Burns.  All three students joined us for our 2013 trip to Pampas Grande and will be an integral part of our team as we grow RGHA and prepare for our 2014 trip.

The University of Richmond Student team travelling to Pampas Grande with PAN Peru, RGHA and Motif members.

Meredith Walsh – Senior – University of Richmond

Meredith is an active student on the University of Richmond campus with leadership roles in the Westhampton College, Global Health and Human Rights Club, and Delta Delta Delta Sorority. She is fluent in Spanish and has shown her interest in global health while not only working with RGHA but also with the World Pediatric Project and Midwives for Haiti. 

Pippa Carey (left) and Meredith Walsh (right) at a café in Cuzco, Peru.

Pippa Carey – Junior – University of Richmond

Pippa is a Health Care and Society major and Chemistry and Spanish minor from Nassau, Bahamas.  She is currently studying abroad in Denmark and has previously studied in Spain.  She serves as the President of the West Indian Lynk and participated in the Sophomore Scholar in Residence Program in Children’s Health working with Dancing Classrooms, Inc. for her capstone project. 

Abby Burns (left) and Meredith Walsh (right) in Cuzco, Peru.

Abby Burns – Junior – University of Richmond


Abby is a Healthcare and Society major and Biology and Spanish minor from Massachussets.  She's an athlete, regularly playing soccer and ice hockey.  At the University of Richmond, she is a Spider Key Society Tour Guide and orientation adviser.  She is currently studying abroad this semester in Spain where her fluency in Spanish is likely thriving.  

Emily Peron: What I've Learned

When I moved from Pittsburgh to Richmond last summer to join the faculty at the VCU School of Pharmacy, I thought I knew my role. I was a practicing pharmacist, educator, and researcher with a passion for working with older adults wherever they reside. Little did I know that I would soon find myself working with older adults in Pampas Grande, Peru, thousands of feet above sea level and thousands of feet from my new hometown.

Becoming a part of the Richmond Global Health Alliance originally stemmed from my involvement with student pharmacists who were traveling to the Dominican Republic, Honduras, and Peru as part of VCU’s HOMBRE organization (formerly the Honduras Outreach Medical Brigada Relief Effort). As a first-year faculty member, I was not sure if the opportunity to travel internationally for work would present itself again in this way. So, I picked a country, signed up, and showed up. And I learned a few things along the way…


Dr. Emily Peron and Max Stinehour organizing donated medications in the Pampas Grande clinic.

1.      It’s important to show up. One of the most valuable things RGHA does for the people of Pampas Grande is show up. Year after year, residents can count on a team from the Richmond area to live in Pampas Grande, participate in local cultural events, and see hundreds of patients in a week’s time. Although student participants often change from year to year, trip leaders are dedicated individuals who the residents of Pampas Grande have come to know and respect. And, with the help of PAN Peru and local community health workers, the work that we do during these annual medical brigades is able to be maintained and even enhanced over the course of the rest of the year.

2.      Being present is a powerful thing. There is no question that our days in Pampas Grande are busy. One group may be building a greenhouse while another is distributing sunscreen to children with chapped faces and yet another is trying to see all the patients in clinic before darkness sets in. When you are thousands of miles from home and connecting to the internet is the farthest thing from your mind (in part because it’s next to impossible), it’s amazing how present you are in whatever activity is happening at the moment. Mornings spent walking from home to the kitchen to the clinic, afternoons spent dancing and singing at local festivals, nights spent eating and talking over dinner, and especially hours spent seeing patients in the clinic setting, are times spent engaged in the present, listening to and learning from others, and truly focusing on what is important.

3.      Quality healthcare is quality healthcare, and everyone deserves quality healthcare. Although I could probably use more eloquent terms, this statement gets to the heart of what RGHA strives to do. As providers in the clinic in Pampas Grande, we do our best to provide the same care – the same assessments, the same treatments, the same quality of healthcare – as we would to patients in the Richmond area. From a pharmacy standpoint, we travel with a wide range of brand and generic medications purchased from reputable suppliers. Medications arrive in Pampas Grande unopened and with expiration dates that will not come to pass for many months. Evidence-based medical practices are followed, and patients do not get medications without a prescription. Detailed notes are written, and records are kept for years to come. Treating the clinic in Pampas Grande as though it is any other clinic in the Richmond area is a key to the successful engagement of RGHA within the community and a key to ensuring that all patients receive the same quality healthcare we have come to know and expect in the United States.

4.      Committing to a cause can change your life. Leaving Peru, “committed” is the word I would use to describe how I was feeling. It is also the word I would use to describe my colleagues who dedicate their time, energy, and money to HOMBRE, RGHA, PAN Peru, and so many other organizations that work to bring quality healthcare to people everywhere. The individuals who have worked to make the annual trip from Richmond to Pampas Grande a reality are truly extraordinary and committed human beings. They are the kind of people you want in your corner, and they are people I am proud with whom to work year-round to make our two-week trip happen every summer. 
     
I cannot adequately thank RGHA, HOMBRE, PAN Peru, VCU, and all of the individuals with whom I have worked  over the past year. I was looking forward to our 2014 trip the day I returned to American soil this summer, and I look forward to many, many more summers spent in Pampas Grande.

- Emily



Dr. Emily Peron is an assistant professor at the VCU School of Pharmacy in the Department of Pharmacotherapy & Outcomes Science. She is a board member of both RGHA and HOMBRE. 
        






Sean McKenna on HOMBRE and RGHA

The physicians and nurses and support teams here at the VCU Medical Center are engaged in an array of amazing international medical efforts around the world and throughout the year.  RGHA is truly proud to be a part of this group of people— and joining the HOMBRE team has really had a terrific impact on our work and on the work that I see us doing in the future. This year the HOMBRE team is led by Dr Mark Ryan from Family Medicine and includes two different programs in Honduras (Norte and Pineras), a trip to the Dominican Republic and our trip to Peru.  The VCUMC programs are not limited to these opportunities but for now those are the only programs that are included in “HOMBRE.”

HOMBRE used to stand for Honduras Outreach Medical Brigada Relief Effort, as the program began in Honduras. Since growing to include several other Latin American destinations we are planning to adjust the name and will most likely change Honduras to Healthcare.  Peru brings some great new opportunities and ideas to this group- not only are we the only South American destination but we can also share our incredible experiences with our in-country partners, Pan Peru, and can offer unique perspectives by integrating with already established medical efforts in Pampas Grande and rounding at several Peruvian hospitals.  As the newbies in the group, the challenge is to make sure we bring as much to the table as they have to offer us, which will be a great goal for us to set for ourselves. These guys really have it down and the experience they offer their students is really terrific. By working with them, and by building from their models, I know that our medical student experience will be even better than it already is—which I think is saying a lot.

RGHA and HOMBRE team members at a hospital in Huaraz, Peru (Summer 2013). Photo courtesy of Ranya Abi-Falah (M2, VCU School of Medicine). 

The HOMBRE program just recently completed its selection process, and we now have the names of the medical students and pharmacy student (all first years) that will be joining us in June.  RGHA is very excited to welcome these individuals to the team and will have them write some blog entries over the coming weeks: Kara Keefe, Jackie Britz, Jason Barnes, Sherna Sheth and Sarah Nowalk. These students, along with the students assigned to the other locations, will begin Saturday morning classes in January (1-2/month I think) that will prepare them for the opportunities and challenges of international medical mission work.  Hopefully many of our RGHA team members will be able to attend these classes as well— we are welcome, but it all depends on schedules.

The RGHA team will be busy over the coming months preparing these new students for the trip in June. Soon we will know the names of our UR students as well and will start dividing up the teams into work groups for the different efforts. Hopefully we will be able to get the new medical/pharmacy students up to speed fast and then have them take on leadership roles on different projects. Our trip will run from June 15 to the end of the month, and many of us will hopefully be able to head to Cuzco following those 2 weeks. Dr Mayes has been able to put together some terrific opportunities for our team to participate in his summer study class and to benefit from some of his long-standing connections he has made in nurtured. I for one am definitely hoping that I will finally get to experience Machu Picchu.  Everyone asks and I always have to report that even though I have been to Peru for 7 years now, I have never made it to Cuzco or to the most famous destination in South America.

For now I will leave you with 2 HOMBRE links and will hopefully be posting again soon on our progress and plans.

Gracias,

Sean





Dr. Sean McKenna is an Assistant Professor in the Division of Pediatrics at VCU Medical Center. He serves as Chair of RGHA and is a member of the HOMBRE board. He has been visiting Pampas Grande since 2007. 

Sid Dante Explores RGHA Mission, Vision, and Principles


Sean Byrne, Sid Dante, and Sean McKenna at the dedication of a greenhouse behind the secondary school in Pampas Grande, Peru.


Three years into our existence as the Richmond Global Health Alliance, it is worth reviewing our original mission statement and principles.  Each was written with specific intentions, and this blog post will not only explain our initial thoughts but serve as a review of our initial principles as we embark on a strategic planning process led by Mary Grace Apostoli.

Mission Statement:

To support, financially and logistically, the global health and international service efforts by faculty, students and alumni of the University of Richmond and Virginia Commonwealth University.

We opted for a broad mission statement when we started for myriad reasons.  First, we had built a successful team through our return visits to Pampas Grande, Peru but we know that our team was special and could do more.  By not tying our mission specifically to Peru, we allowed ourselves the ability to build and grow even though organizationally we knew we were committed to our work in Pampas Grande for the near future.   Second, one of the roadblocks and frustrations we faced when we started was finding non-profit and administrative support for our project as it transformed from a experiential undergraduate trip to a global health mission.  As we grow, we hope to be available to other groups and projects that are establishing and help them while also learning from their experiences and results.  Finally, we bridge the City of Richmond as one of the few projects that involves the campuses of both VCU and U of R and we wish to further cement our relationship with both schools.

Principles:


        We are committed in assisting those currently engaged in global health and in encouraging the development of the next generation of global health leaders.  We will involve participants of all experience levels and work to recruit those new to aid, development, and international efforts.

The first part of this principle builds on our hope and goal to eventually be able to support other groups and projects.  However, the second part is why this principle is listed first.  Our project from its inception involved students and was the result of a group of students wishing to help.  As our group has become more professional and increased our capabilities, we have kept students as central to our leadership.  There are multiple opportunities for mentored work and we have two student positions on our Board of Directors designed to offer a practical experience.  Moreover, recruiting both students and those new to aid, development and international efforts not only provides a valuable and novel education experience to those participants but also helps our group.  In areas where those of us who have returned to Pampas for many years may have made excuses for our failure to meet challenges or provide services, those new to aid and to our project bring a fresh perspective.  This leads to new ideas or novel suggestions, but more often it is their enthusiasm that is infectious and keeps those of us in leadership motivated. 

       We desire diversity in thought, ideas and action.  We will not discriminate based on sex, race, religion, creed, or sexual orientation when selecting our partners in global health.  We will not have discriminatory preconditions for our services nor will we engage in proselytizing during our work.

Our non-discriminatory statement is standard and broad but it is fundamentally important to us to have many different views and thoughts.  This leads to creative ways to solve problems and different approaches to the same conflict.  But it not only lets our projects to succeed, it allows us to learn from the other strengths.  In our leadership team we have included physicians and lawyers – two groups that are often portrayed as antagonistic, but in our work we have seen the fruits of collaboration due to different areas of expertise.  In the last part of this principle is a commitment that we will seek to help all and avoid preconditions to our service.  We do not have expectations of those who we try to help.  We will not expect them to sign on to our belief system or meet our cultural norms.   This is important – we are foreigners and outsiders where we work and we embrace the idea that our educational experience outweighs the services we provide.  As outsiders, we will try and learn from those we serve and allow them to learn from us. 

      We believe in the dignity of all human beings.  We will present our work realistically, avoid exploitative imagery and advertising, and maintain an appropriate standard of care across all our activities.  We will seek to strengthen communities with sustainable solutions and not burden them with frivolous requirements.

Our goal is to serve but we must respect those we serve.  Images of children are often used to tweak heart strings and increase fundraising, but these images can be exploitative if staged or designed to highlight aspects of poverty.  Additionally, this means maintaining the privacy of our patients and avoiding photography in clinic even if it means that showcasing our work with patients becomes more difficult.  This also is central to our teaching.  We discuss photography and the perils of disaster tourism with our students and ask them to consider their social media posts. Their trip is not help or save but is instead to learn. 

Maintaining a reasonable standard of care is difficult on mission trips but there are areas and approaches we must take to meet that.  Though there are limitations to the care we can provide due to the medications or technology available, where we can, we must seek to provide the same quality care that we provide to patients in the United States. This means that we must aspire to higher quality care and seek to expand our capabilities every year. This can come in the form of refusing donations of well-intentioned but expired medications. However, at times we may use medications that have an expiration date if our research shows that there is no harm.  Our basic principle is that we would never offer or provide any care that we would not do in the United States.  If a medication or piece of equipment that is expired is something I would prescribe to a family member because the expiration date is arbitrarily placed by the local pharmacy (as is common on all prescriptions) or on equipment that is structurally safe, then we will use it.  However even if it’s the “best” that is offered, we must strive for more.  This means more of my time spent fundraising to buy quality medications and equipment rather than accepting cast-off donations.   


        We value the hard work of our volunteers and donors and the needs of those whom we serve.  We will strive to have minimal overhead to our work, a longitudinal commitment to the people and areas where we work, and an open and inviting culture to all our volunteers and supporters.

This is an organizational principle that has only strengthened as our programming has grown.  Thus far, we are volunteers with professionals and students and the majority of our fundraising comes from our family and friends.  As we continue, we may be able to attract additional sources of funding but we must do it in a responsible manner.  Expansion of our programs or missions will be based on need and not based on our desire to travel more.  This requires us to commit to our projects not only during our mission trip but also throughout the year.  We build projects with many years in mind but also seek to do it in a way that builds the capacity of the town.  Finally, we have to recognize that we will not always succeed.  Having a multi-year commitment allows us to fail but also gives us the ability to change.  To do so, we have to have a culture that allows open and honest discussion and include all in our decision-making process. We have a board but all of our meetings are open and everyone is invited.  In fact, we invite all new volunteers or interested supporters to our meetings to see how we work and to actively participate.  

      We recognize our limits in time, ability and ideas.  We will seek collaborations with other groups, learn from the successes and failures of previous projects, and seek oversight and guidance.   We will regularly debrief our efforts and submit to critical reviews from our partners and experts.

Finally, we end with an expression intended to demonstrate humility.  We may be led by professionals such as doctors, lawyers and pharmacists and our short time has allowed us to develop some small measure of expertise in our work, but we know that much of what we are trying to enact has been done before.  Our goal is not to go it alone or build our organization but to learn and do our best.  This also means that we have to regularly review our own work and debrief and it means that periodically we have to revisit our mission and goals. 

Vision:


We envision a stable, adaptable and supportive organization that will provide a longitudinal commitment to sustainable projects in international communities.

Our vision follows above.  We seek to be stable so our commitment is long-term, try to be adaptable so that we recognize our successes and failures and work to be supportive in not only our service but also to our volunteers and students.  Being such an organization means that we can meet the objective of sustainability.

Reading and reviewing this mission statement, I continue to be excited for our strategic planning process.  But looking back at our mission statement and our efforts since our founding in 2011 is that we do meet each of this principles as we try to achieve our vision.  As a young group, we still have much to do to see if we become the organization we wish to be, but I believe we can and will.  

-Sid Dante


Sid Dante is a graduate of VCU School of Medicine and is now in his second year of residency at the University of Chicago. Sid has been traveling to Pampas Grande since 2010 and is a member of the RGHA board.

Project Spotlight: Water Sanitation

A preliminary study by the district health post identified many common contaminants in Pampas Grande's water supply. The problem is further compounded by the recent cut in government funding for chlorination of Pampas Grande's reservoir. For this project, we plan to conduct a formal assessment of the water supply in Pampas and its surrounding towns as well as administer a survey to determine where residents obtain water. As a gift to the town and Mayor, we will then provide the chlorine required to sanitize the reservoir.




The estimated cost for this project is $500, which includes water testing kits and chlorine. If you would like to help fund this project, you can go to our website, richmondglobalhealthalliance.org, and make a donation via Paypal. Since all RGHA volunteers have paid for personal travel, food, and lodging expenses, 100% of your donation will go to this and other peojects.

T-minus three days and counting until the medical team leaves for Pampas!

Project Spotlight: Skin Care


Our longest standing project seeks to treat and prevent the extensive damage that high altitude and sun exposure cause- especially to the sensitive skin of the face. For those children interested in participating, we provide sunscreen and education on skin health/safety. Contacts in the community follow up with the participants to track their progress and report their findings to us for future planning.

The estimated cost for this project is $300, which includes the cost of sunscreen. Please help us with this project by donating via Paypal on our website, richmondglobalhealthalliance.org.One-hundred percent of your donation will go to project expenses.


For more information on our skin project and the issue of skin damage in Peru, see this post, which we published early last year: High Altitude and Healthy Skin: A Public Health Concern.

Project Spotlight: Children's Program

A primary goal of the Children's Program is to encourage children to express their creativity through various forms of media and to become comfortable using the resources available in the library. During the 2012 trip, RGHA volunteers, led by RGHA Student Leader Ari Prinzbach, worked with children in the Pampas Grande library on a number of creative arts projects. One activity involved making spiders out of pom poms, googly eyes, and pipe cleaners (Go Spiders!). Also, the Peruvian rock band, Motif, led a workshop on music basics and playing the recorder.  







For the 2013 trip, the Children's Program is looking to implement new, exciting ways to encourage children to express their creativity through crafts, photography, and music. Additionally,  the Program will host an English class for children. Stay tuned for photos from the upcoming trip! 

Project Spotlight: Women's Health Initiative


RGHA's Women’s Health Initiative focuses on both clinical and community-based programs for women in and around the service area of Pampas Grande, Peru. Julie Armistead, a nurse practitioner who joined RGHA in 2010, is the main clinician for the Women’s Health Initiative. During each trip to Pampas Grande, Julie provides her patients with primary gynecological care, including pelvic exams, pregnancy tests, and well-woman visits. Julie and the rest of the Women’s Health Initiative team are working to provide the Pampas Grande clinic’s year-round staff with an improved and sustainable clinical environment for women’s health practice. For instance, the Women’s Health Initiative donated a microscope to the Pampas Grande clinic in 2010. Additionally, each year, the Women’s Health Initiative restocks the Pampas Grande clinic’s pharmacy with common gynecological medicines.



In 2012 with the Women’s Health Survey, the Women’s Health Initiative spearheaded an effort to gather information for future evidence-supported community-based programming. The survey was administered to thirty anonymous female volunteers who visited the clinic to receive services during RGHA’s medical campaign. Questions ascertained demographic, maternal health, reproductive health, and family/home information from survey participants.




Although the survey sample size was too small to yield any significant associations between variables (such as education level and contraception use), the descriptive data provided useful information about the female patient population. For instance, most of the female patients that visit the clinic during RGHA’s medical campaign travel over two hours by foot to receive clinical services. This indicates a need for a transportation system so that patients (particularly those who are pregnant, with children, or in poor health) can travel more easily to and from the health post. 

This year, the Women's Health Initiative is planning to implement a number of small group workshops and trainings for women, teachers, and other interested community members. The trainings will include information and activities regarding sexual and reproductive health, goal planning, and leadership. 


 

Board Member Perspective: MaryGrace


A Little About Me

My name is MaryGrace Apostoli, and I currently work as a Senior Analyst for a health care consulting firm. My job is to uncover and disseminate industry best practices to support nursing executives around the world in addressing strategic and operational management challenges. Outside of my paid work, I volunteer serving as a Board Member with the Richmond Global Health Alliance, a group with which I have been involved since my early undergraduate days at University of Richmond. As a member of this group, I look to expand my knowledge of the field through every learning opportunity I can get my hands on.

This past weekend, I had the privilege of attending Unite for Sight’s Global Health and Innovation Conference, at which 2,200 professionals and students from all 50 states and more than 55 countries convened to exchange ideas related to global health equity and social entrepreneurship.

As a recent graduate (I am allowed to say that until I’m like, 30, right?) and an ‘outsider’ from a publicly-traded company, I admittedly felt intimidated to be in the company of incredibly influential people in the field, such as Al Sommer and Jeffrey Sachs. I was equally intimidated by the young Masters in Public Health candidates, who were frantically waving their hands in the front row of a lecture, eager to stump the presenters with complex questions and spout theoretical knowledge of program models and systems integration and all of those lofty terms we so often use to complicate relatively simple concepts.

I’ve never been one to frantically wave my hand in the front of any lecture, and as a non-MPH, many of the theoretical concepts sailed right over my head. But I did want to do my part in facilitating knowledge exchange by sharing some lessons that I took away from this weekend with all of you.

So here it is – my first ever blog post.


Food for Thought from the Unite for Sight Global Health and Innovation Conference

The majority of speakers spent a lot of time rallying around a few critical themes that are relatively well-known and well-demonstrated in the field of global public health. It was very interesting to discuss how you convert theory into action in a lot of these areas (promoting self-actualization over providing handouts, empowering the community you work with to drive forward your priorities, focusing on prevention and health promotion over curative medicine, etc.) – but in general, these are relatively well-accepted truths for those who study, dabble in or have made a living out of this kind of work.

My most valued ‘takeaways,’ however, were in the areas where there was some friction; where thoughts and perspectives were a bit less harmonious.

In a session on social businesses, we heard from a spirited Chief Executive Officer of an international fair trade coffee company who challenged the intense focus on ‘scalability’ in the global health and social entrepreneurship community. He told several stories to demonstrate his point, including one about how his organization paid for the education of a young daughter of a farmer in the coffee cooperative he worked with in order to save her from being sold into sex slavery in Saudi Arabia. Perhaps from a dollars and cents standpoint, that was not the most sound or most scalable investment he could have made. But because he cannot do that for every young woman at risk for being sold into domestic servitude, did that mean he shouldn’t do it for the one?

A similar story is told about Dr. Paul Farmer in Tracy Kidder’s famous book, Mountains Beyond Mountains. Kidder tells the story of how Dr. Farmer’s non-profit organization, Partners in Health, spent a large sum of money to fly a young boy with an advanced tumor from Haiti up to Chicago to get very expensive surgery that was ultimately unsuccessful. The young boy died, and many criticized Dr. Farmer for spending so many resources on just one person when it could have done so much good for so many people.

So the question raised by both of these stories, and the one the speaker at the conference challenged us with is: How do you weigh breadth of impact with depth of impact?

Breadth vs. Depth of Impact: Where do you draw the line?

Throughout the conference, nearly every non-profit or NGO representative, every researcher or clinician, and the majority of social entrepreneurs, would get up in front of the group and discuss the model for their projects or their business, the outcomes they’ve achieved and how they have already (or how they plan to) take that model “to scale.” This is both to accommodate growth and maximize return on future investment.

Resources are scarce, and “rationing” is a reality that we all have to live with. That is undoubtedly true across the board –the health care systems and hospitals of even our most economically developed countries face these kinds of ethical decisions every day. Showing maximum impact for minimum investment is prized in a world where resources are limited and there is a lot of work to be done.

Perhaps most importantly of all, having tangible data to “show for” your efforts is critical to proving responsible use of previously invested resources, as well as to attracting additional resources. As a person who spends her time studying and advising on operational efficiency, this way of thinking makes perfect sense to me. I like numbers, and I like evidence, and in their absence, I tend to be a bit of a skeptic.

So having a concrete vision for maximizing impact and appropriately scaling efforts are simply basic principles of good financial stewardship. How could these values ever be seen as anything but utterly responsible and entirely positive?

Can the pendulum swing too far?

Ordinarily, I’d argue that they can’t be seen as anything but positive. And for the most part, these are important principles to adhere to. The discourse initiated at the conference, however, made me question whether or not we are all at risk for taking this commitment to a bit too far. There is a fine balance to be struck, and we need to be wary of letting good financial stewardship impede justice.

Dr. Farmer has a quote that I particularly like: The idea that some lives matter less is at the root of all that is wrong with the world.” If you really stop and think about it, he is exactly right. We let injustices and great disparities persist because – whether explicitly or implicitly – we believe that some lives are more valuable than others.

To return to the stories referenced earlier, if, for example (and God forbid), it were my sister who was being sold into sex slavery or my brother who was suffering from a tumor, I would walk through fire to get them the help they needed with no thought of financial stewardship. In fact, I can only imagine the choice words I’d have reserved for anyone who dared to raise those issues with me in a time of crisis. But that’s because, to me, the ‘return’ on an investment in the life of my sister or brother would be something I could never quantify or run a cost effectiveness analysis on. Their value is priceless.

Dr. Farmer sent that Haitian boy up to Chicago because, quite simply, it’s what he would have done for his own son. Resources were available to get this child what he needed to have a shot at survival, and Dr. Farmer gave them to him because it was the right thing to do for the patient – for the person – in front of him.

I don’t think we all naturally think that way – most of us, whether we’d like to admit it or not, don’t believe that all lives are equally valuable. But perhaps we should.

A Personal Perspective

So thinking about it now, that question of - “is this investment worth it for one person? Or 10 people, or 15?” – while in general is totally economically rational thinking, is making me a little uneasy. I cannot help but think, what if all the people who helped me along the way had thought that way? My parents who raised me, often times each working multiple jobs to ensure I had every opportunity and privilege in the world at my fingertips. The countless donors to the University of Richmond who funded my college education. The coaches, teachers and friends who encouraged and supported me along the way, always pushing me to be the best I could be. What if they had all decided to evaluate the return on their investments in me, and they had decided they weren’t worth it? Where would I be today?

We Value Your Support

They say, “it takes a village to raise a child.” This was certainly true for me.

We, as the Richmond Global Health Alliance, in close partnership with Pan Peru, are privileged to be just a small part of the village helping to raise Pampas’s children. And while our sphere of influence, at present, may be geographically small, our impact deepens with every passing year as more resources – human, financial and otherwise – are added to our efforts and our relationship with the people of Pampas grows stronger.

To conclude, I will just offer a sincere and welcome invitation to each of you reading to join us by sharing your time, talent or treasure with the Richmond Global Health Alliance. If you’d like more information on our organization or are interested in donating, please email us at richmondgha@gmail.com or feel free to email me personally at mgapostoli@gmail.com.

Thanks for reading!

World AIDS Day: Remember, Support, Learn

According to the World Health Organization, more than 60 million people have been infected with HIV, and over 30 million people have died of AIDS since the beginning of the HIV/AIDS epidemic in the early 1980s (WHO, 2012). Today, it is estimated that 34 million people are living with HIV, most of whom do not know they are infected with the virus (WHO, 2012). Developing countries, particularly those in Africa, carry the burden of HIV prevalence, as shown in the figure below (WHO, 2009).



This Saturday, December 1, marked the twenty-fourth annual World AIDS Day. This day is designated to unite and remember those who have died of HIV/AIDS, support people living with the virus, and increase awareness of effective HIV/AIDS prevention and treatment. In recognition of World AIDS Day, the Richmond Global Health Alliance would like to acknowledge organizations that employ this spirit in their daily work.

Fan Free Clinic
Richmond, Virginia

Since 1970, Fan Free Clinic has provided free health care to those in the Richmond area who have limited access to care. In the 1980s, Fan Free Clinic spearheaded the state's first community-based HIV/AIDS outreach program and remains a leader among local HIV/AIDS advocacy and health organizations today. They provide free testing, education, and support groups, and are at the forefront of spreading HIV/AIDS awareness in the Richmond community. Last year on World AIDS Day, the Fan Free Clinic organized RVA Remembers, a community-wide campaign that received national media attention. At 12p.m. on December 1, 2011, four-hundred red umbrellas opened in the shape of a red ribbon to symbolize remembrance of the victims of HIV/AIDS and to commit to HIV/AIDS education and prevention.

Here is a video of RVA Remembers 2011: 



VCU HIV/AIDS Center
Richmond, Virginia

The VCU HIV/AIDS Center provides clinical, research, educational, and support activities throughout the state of Virginia. Their services reach a number of diverse audiences, including individuals living with HIV/AIDS, medical providers (physicians, pharmacists, nurses, psychologists/psychiatrists, dentists, etc.), social workers, substance abuse professionals, and case managers. The overall goal of the VCU HIV/AIDS center is to prevent the spread of HIV and improve the lives of those living with HIV/AIDS. 

TED

TED is a world-wide nonprofit organization that is dedicated to "ideas worth spreading." Essentially, the organization gathers thinkers and doers from all over the world to share their ideas in a talk lasting 30 minutes or less. TED then posts videos of the talks on its website, which are available to the general public at no cost. TED has hosted a number of talks on HIV/AIDS prevention, treatment, and impact from individuals in a variety of academic and professional fields-- from photography, law, and economics, to biochemistry, psychology, and epidemiology. Some of our favorites are below. 

Elizabeth Pisani
Sex, Drugs, and HIV-- let's get rational



Shereen El-Feki
 HIV -- how to fight an epidemic of bad laws



Hans Rosling on HIV: New facts and stunning data visuals 




Cited sources: 
World Health Organization. (2012). Global health observatory: HIV/AIDS. Retrieved from http://www.who.int/gho/hiv/en/index.html.

World Health Organization. (2009). Global health observatory map gallery: HIV/AIDS. Retrieved from http://gamapserver.who.int/mapLibrary/app/searchResults.aspx. 


Update: 2013 Trip

This summer, RGHA will launch outreach efforts in Pampas Grande and Cusco, Peru. The RGHA team will travel to Pampas Grande in mid-June, where we will spend a week carrying out our medical and social projects (clinic, pediatrics, women's health, dental, joint pain, emergency medicine, music, art, community health workers, and greenhouse). We will then travel to Cusco, where we will stay at a hostel that supports a local children's clinic. RGHAers will be able to volunteer at the clinic and a nearby orphanage. These new plans (in contrast to our past spring break trips) allow us to spend a longer time in Peru and to extend our outreach to health and social advocacy organizations in Cusco.

Partnerships with VCU School of Medicine's HOMBRE ,University of Richmond professor Dr. Rick Mayes, and the University of Richmond School of Law's Tara Casey have made these plans possible. First, HOMBRE has recruited three first-year medical students and one first-year pharmacy student from VCU to join us on our trip. We hope to provide these students meaningful, hands-on public health learning. Second, the University of Richmond undergraduates' time in Pampas Grande will be supplemented by Dr. Mayes's public health policy class and further volunteer work in Cusco, for which they will receive academic credit. And last, Tara Casey has helped us recruit a law student for social justice efforts in Pampas Grande and Cusco.

We are excited about the plans for the 2013 trip and will continue to work to promote our mission, vision, and goals. More updates to come!


Cusco's Plaza de Armas (photo by Blair Armistead, 2009) 

"Othering" and Global Health

The act of "othering" involves identifying an individual or group of individuals as different from oneself or from the mainstream. Discourse on othering is ubiquitous in global health, as international health efforts (by definition) involve communication and cooperation among different cultural groups. Othering becomes problematic in any context (especially health) when it leads to the marginilization of any particular group through the introduction of a power dynamic. In other words, when people who are "othered" become inferior to those who are othering, disasterous outcomes can occur.

In their book, Stories in the Time of Cholera: Racial Profiling During a Medical Nightmare, Charles Briggs and Clara Mantini-Briggs discuss how othering facilitated a cholera epidemic among people living in the Orinoco Delta in eastern Venezuela. While the authors present examples of blatant racism and the exertion of power and superiority over people living in this region, the accounts of othering by well-intending public health officials and aid workers are particularly startling. Without being completely conscious of the outcomes of their words or actions, many people who were fully dedicated to assuaging the epidemic actually facilitated it by connecting cholera to culture. In doing so, they shifted the blame from factors such as lack of access to care and inadequate plumbing systems to the people who contracted the disease themselves.




Briggs and Mantini-Briggs present a strong case for the significance of critical thought and consideration of the outcomes of othering when working with people different than ourselves. As the late Dr. Edward Said described in his concept of Orientalism, people often other automatically, making it easy to introduce a power dynamic in the process.





While it might not be beneficial (or even possible) to eliminate othering, it is essential for people providing services to be aware of any power dynamic introduced during the process of othering. As Briggs, Mantini-Briggs, and Said describe, doing otherwise could lead to marginalizing people, even where explicitly unintended.