May 2013 Newsletter  
Shoulder to Shoulder
Working Together With Our Communities and You
spacer.gif May 2013 
Vaccinating Thousands in Two Weeks

    Between April 22 and May 3, we vaccinated every scheduled child, elderly adult, and high risk individual for measles, rubella, diphtheria, pertussis (whooping cough), polio, pneumonia, rotavirus, hepatitis B, and Vitamin A.

    We are still compiling the final numbers for Concepción (pop: 10,758) and San Marcos de la Sierra (pop: 9,085). Here are our stats for the municipalities of Santa Lucia (pop: 5,527), San Antonio (pop: 5,606), and Magdalena (pop: 4,815):
• Vitamin A supplements - children four and under: 420
• Tetanus – 11 year olds: 327; other groups: 80
• Diphtheria, pertussis, tetanus, hepatitis B, influenza – under 12 months: 41
• Diphtheria, pertussis, tetanus boosters – 18 months: 11; four year olds: 33
• Measles, mumps, rubella – 12-23 month olds: 16
• Rotavirus – 28
• Pneumococcal – under 12 months: 41
• Polio – under 12 months: 52
• Tuberculosis  –  under 12 months: 18
    Pneumococcal vaccines were also provided for high-risk patients, including elderly, asthmatic, diabetic, hypertensives and patients with chronic pneumonia.

• High-risk aged 2-59: 625 scheduled, 637 reached (102%)
• Elderly aged 60 and over: 260 scheduled, 298 reached (115%)

    Overall, it was a very successful campaign, part of the national vaccination campaign. These vaccinations help prevent the spread of disease and ensure the continued health of our community members.

Brigade Update: Johns Hopkins
From Taking Call to Home Visits, They Did It All

    Led by Dr. Ed Zuroweste, Drs. Laurel Pellegrino, Lila Worden, Brett Wanamaker, three Johns Hopkins fourth-year residents, Dr. Mish Mizrahi, a family practice attending physician from UCLA, and Mike Piorunski, an Environmental and Occupational Health Program Associate with the Migrant Clinicians Network, the Johns Hopkins brigade spent two weeks immersed in the daily healthcare needs of the Santa Lucia area.

    Accompanied by our nurses and Social Service doctors, they visited some of our most remote clinics and communities. While some students attended patients in our traditional field clinics, others assisted with the vaccinations. Dr. Pellegrino, who will begin her Psychiatry residency in July, had the opportunity to see patients in her field at the Santa Lucia clinic. Brigade members conducted home visits and gave charlas, or health education talks, to hypertensive, diabetic, and pregnant patients. Both the students' and the audience's favorite tool, by far, was a sugar-filled zip-lock bag demonstrating the actual amount of sugar in one bottle of Coke.

    In their off-time, the brigade forded the Rio Torola, toured the La Esperanza hospital, and played a lot of Catchphrase. This group was open to experiencing everything from grunt work to taking night call and really went above and beyond in filling out our government paperwork. Thank you to Johns Hopkins and Dr. Zuroweste for your continued support, and for the brigade members' tireless efforts on the ground in Intibucá.

Helping Babies Breathe
Research Project Provides Essential Neonatal Resuscitation Education for Resource-Limited Environments
    For the last year, Kathryn Taylor (Ohio State B.S. ’12; Harvard M.D. ’17) has been training Shoulder to Shoulder’s physicians, nurses, and local midwives how to save babies’ lives. Based at our Santa Lucia clinic, Kathryn has trained and evaluated our staff for basic neonatal resuscitation techniques as part of a study of Helping Babies Breathe, a joint program of the WHO, Save the Children, and the American Academy of Pediatrics. She teaches a curriculum designed for developing countries in limited resource environments. 

    Approximately 23% of neonatal deaths worldwide are due to asphyxiation. Helping Babies Breathe was developed on the premise that all babies deserve simple neonatal care, regardless of resources. It focuses on improving outcomes in the neonatal period and reducing birth asphyxia. Each year, an estimated 10 million babies require breathing assistance. However, only one to two percent of babies require advanced care. In hospital-based settings in the rural departments of Honduras, including Intibuc
á, the neonatal death rate is 46.9 deaths per 1000 live births. In the United States, there are four deaths per 1000 live births.
    The course is taught at a fifth grade reading level, and focuses more on facilitation than traditional education – utilizing interaction and practice in pairs. Training partners learn to have a plan and materials in place at the time of delivery, to recognize whether a baby is breathing, and operating under time and pressure constraints in order to have a baby breathing in under a minute.

    Kathryn has attended and filmed 78 births at the Santa Lucia clinic. She meets with the labor and delivery team following each birth and leads a debriefing. They review the video and find ways to improve.  Kathryn will be spending her final month implementing the program at the main regional hospital in La Esperanza prior to beginning medical school in the fall. Srirama Josyula (Ohio State B.S. ’13; Ohio State M.D. ’18) will continue with the program in Santa Lucia and La Esperanza.

Staff Profile
Milton Concepción Villanueva Cruz

    Milton Concepción Villanueva Cruz, 38, is tasked with ensuring the public health for the communities of Santa Lucia, San Antonio, and Magdalena. Under his management, in addition to the other lead health promoters Suyapa Gómez del Cid (Concepción) and Manuel Laínez Ramos (San Marcos de la Sierra), our communities have seen dramatic improvements in the quality of public health and basic health education for our 36,212 community members.
    Born down the road in San Bartolo de San Antonio, Milton has a special place in his heart for our communities. His passion lies in supporting people through educating them about health, and so becoming a health promoter was an ideal fit.
    After graduating from college in 1999, Villanueva worked for Catholic Relief Services in nearby Colomoncagua for eight years. He joined Shoulder to Shoulder in 2008, establishing the health promoter program. At that time, there were no documents or processes in place. He quickly established the job responsibilities for the health promotion team.
    Today, Villanueva oversees 8 promoters in the Santa Lucia, San Antonio, and Magdalena municipalities. He supports them in the field and ensures they are fulfilling their numerous responsibilities, and coordinates with the outer health centers to realize they are doing everything they can to monitor the health of the communities.
    Health promoters have 48 individual responsibilities, from providing regular health and nutrition talks, to regular vaccination campaigns, to monitoring water quality. Milton prefers to work in the field, speaking with people out in the campo and educating them. His goal is “to bring them a message that actually changes things and has an impact for them.” He enjoys working with pregnant women, and has had many dramatic experiences assisting in home births and other neonatal emergencies.
    Many rural residents must travel several hours to receive care, but transportation costs are prohibitively expensive. Villanueva would love to see Shoulder to Shoulder eventually set up a microloan program with each of the municipalities we serve to provide emergency funds to families who require emergency care. In his previous position with Catholic Relief Services, Milton helped set up community-based committees that were provided seed funding of $100-$200 U.S. In turn, the committees provided emergency loans to residents. The committees established a structure to ensure the loan recipient was responsible for repayment.
    As Shoulder to Shoulder’s role continues to change and expand in Intibuca, Villanueva remains on the ground, providing the link between members of the community and our public health system. 
National Vaccination Campaign
During the last two weeks of April, we vaccinated thousands of children, elderly, and high-risk patients throughout our network. Learn More.


Johns Hopkins Brigade
We were joined by six passionate professionals for two weeks this past month. They took call, assisted in vaccinations, and made house calls. Learn More.


Helping Babies Breathe
Over the last year, Kathryn Taylor has taught a simple, but effective method to improving neonatal outcomes.        Learn More.


Staff Profile: Milton Villanueva
The head health promoter for the municipalities of Santa Lucia, San Antonio, and Magdalena, Villanueva is responsible for ensuring the public health of 16,000 individuals. Learn More

March and April By the Numbers

Patient Encounters: 6,797
Prenatal Check-ups: 659
Families seen through EAP visits: 161
Individual Home Visits: 401
Total Births: 47
Obstetric Emergencies: 23
Other Emergencies: 15

Dr. Lila Worden helps a patient locate her heart during a field clinic.
A San Juan woman holds her six-week-old granddaughter, delivered in the Santa Lucia clinic.

Dr. Zuroweste chats with an 89-year-old man about this year's crops.

Dr. Brett Wanamaker examines a child for parasites. 

A girl brings her two sisters to San Juan de Magdalena for their vaccinations.
Women waiting for their vaccinations. 

Dr. Olvin providing vaccinations.

Dr. Brett Wanamaker and Mike Piorunski listen to a man during a home health visit. 

Local schoolchildren volunteer to help with a clothing drive for newborns.

Dr. Mish Mizrahi entertains a young patient.

Kathryn Taylor and Srirama Josyula joking around at Cl
ínica Santa Lucia.

IMG_7488 2

Read about the inaugural graduating class for the Intibucá Bilingual School of the Frontier in our next issue. We're excited for our Kindergartners to advance to first grade and to create a fun, bilingual learning environment in the frontera. 

Why Your Donation Matters

    As the Honduran rainy season begins, every dollar makes a difference. Our clinics - even the accessible ones - are located at the end of the service lines, four hours from the nearest gas station and eight hours from the nearest medical supplier. The tenuous electricity and telecommunications grids experience near daily outages during the rainy season, requiring us to run diesel generators to provide power to our dental clinics, our labor and delivery rooms, and for patient consultations. We use and abuse our trucks and motorcycles sending our health promoters and EAP home visit teams into the campo to provide rural healthcare and bring patients to our clinics. All of our regular expenses are compounded by our remote locations.

    Your donation allows Dr. Ruben Martinez to take a woman in high-risk labor to the La Esperanza hospital four hours away. It puts gas in Milton Villanueva's motorcycle so he can check in on an 89-year-old homebound patient who lives two hours off the only major road. Your donation keeps our lights on when it is raining, there is no power, and a boy has badly cut himself with a machete while harvesting corn.
Ways to donate:
·   Donate through our website and review all of the ways to contribute. 
·   Send a tax-deductible contribution to our accounting firm at:
     Shoulder to Shoulder
     Pohlman & Talmage CPAs
     3445 S. Dixie Dr. #200
     Dayton, OH 45439
·   Provide a scholarship for a local student.
·   Donate Spanish-language medical textbooks or journals for our physicians.
·   Donate equipment, supplies, or medication. Check our website for a list of needed medications and supplies.

·   Travel on a brigade or volunteer with us.
·   Shop Amazon via our website and Shoulder to Shoulder receives up to 6% of your purchase at no cost to you.

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