Jim Cohick at CCW training event in Haiti

I cannot believe we are already nearly two months into 2012, yet in other ways I feel farther down the 2012 timeline. I have had a busy schedule since the first of the year with trips to Honduras and the Dominican Republic, and meetings in Washington, DC. As I write this, I have just completed a week-long trip in Haiti (my first trip there). For the remainder of the month, my plans have me in Boston, then off to Uganda for about eight days.

In Honduras, the primary reason for my trip was to connect with the CURE Clubfoot Worldwide (CCW) Honduras coordinator, Grace, and medical director, Dr. Vasquez. He is extraordinarily busy, so most of my time was spent with Grace. Dr. Jay Bridgeman, an expat orthopedic surgeon whom I met on my prior visit, is involved with a number of initiatives that combine efforts of CCW and the CURE hospital in San Pedro Sula. Grace is great to work with, and we settled some CCW-related administrative matters. She is also able to understand how to arrange needed meetings with key players outside of our CURE programs to help our efforts for collaboration. She was instrumental for setting a meeting with the employer of a Honduran neurosurgeon we are scheduling to train in the CURE Hydrocephalus surgeon training program at CURE’s facility in Uganda. The result of this meeting ultimately helped finalize the outstanding items for this training to occur. She is working with both Drs. Vasquez and Bridgeman to leverage the CCW clinics — over 15 locations — for raising awareness of other CURE hospital services.

In the Dominican Republic there are continued challenges for our hospital in Santo Domingo and the CCW program. Brusy is the CCW DR coordinator, and Dr. Vidal, an orthopedic surgeon at a Santo Domingo rehabilitation hospital,  has recently taken the reigns as medical director for the CCW DR program. There are six clinics around the country — two in Santo Domingo, and one each in Santiago, San Francisco, San Juan, and Nabor. There is always a need to at least periodically review the effectiveness of the clinis in quality and volume. Turnover in key clinical personnel, change in focus by the clinic partner, and other factors can create dynamics for consideration of changes to or even closure of a clinic. Creating more synergy with the CURE hospital and in-country abilities to raise donations are goals we agreed upon as priorities.

Security and personal safety issues remain a high concern, a priority, and a reason for prayer for all those associated with our hospital and the larger community throughout San Pedro Sula and Honduras, and to a lesser extent with Santo Domingo. Please keep these matters in your thoughts and prayers for our staff and their families, for the families and patients we serve, and for those who visit and support our hospitals and programs in these two countries.

I mentioned having meetings in Washington, DC; Tim Erickson, a CURE colleague involved with the emerging organizational operations for CURE Hydrocephalus, and I met with our government consultant with staffers from two congressional representative offices (Rep. Platts and Rep. Chris Smith), the head of an influential attorney lobbyist who has a strong personal connection to hydrocephalus with his family, and members of USAID. We chiefly spoke with them about Dr. Ben Warf’s recent published article about the effectiveness of the endoscopic treatment for which we train surgeons through our CURE Hydrocephalus surgeon training program. The article was published in November and used well-accepted public health metrics and calculations which USAID, the World Health Organization (WHO), UNICEF, and others measure cost-effectiveness. The conclusions of the paper show our program to be very cost-effective and compelling to consider for scaling up. Compared to published studies for vaccinations and HIV/AIDS treatment programs, our program returns more value. We hope this will create momentum as we look for USAID to create and fund a program for treating hydrocephalus in the developing world.

In Haiti, there was a training program for CCW held in the central plateau region, about four hours by road over the mountains from Port au Prince. Views on the drive were gorgeous. During the two-day training, we had 25 nurses and doctors from three different clinics in the central plateau region. Dr. Bob Cady, a retired US pediatric orthopedic professor from Syracuse, facilitated the training in coordination with Dr. Francel. They used the standardized curriculum created from surgeon trainers within CCW and part of the Global Clubfoot Initiative (GCI), a consortium of individuals and organizations involved with and committed to eliminating the disability caused by clubfoot across the developing world. This series of PowerPoint lectures was vetted last October by the team of orthopedic surgeons that are part of the CCW India program, also known as CURE International India Trust (CIIT). The CCW Haiti coordinator is Kendy, and the CCW program medical director for Haiti is Dr. Francel, who was an orthopedic surgical fellow with CURE, having spent time in our Santo Domingo facility and a number of places within the US and Canada. Here are some photos from this training event:

At the end of the trip, Dr. Cady, Kendy, and I visited a hospital where teams from the US, led by the University of Miami’s Children’s Hospital, treat children with hydrocephalus. On my flight home to Chicago, I met with members of the Miami’s Children’s team and shared ideas and perspectives on our initiatives. Dr. Ragheb, a prominent and lead pediatric neurosurgeon for the team, is a contemporary of Dr. Ben Warf and has arrived at the same conclusions as Dr. Warf for the use of endoscopic surgical techniques for treating hydrocephalus. We don’t know how his team and our program might converge for Haiti or elsewhere, but we are open to the possibilities and keeping in touch.

The threads that are part of each initiative, one for clubfoot and the offer for hydrocephalus, often appear and intertwine in almost everything I do — travel to existing programs, strategic planning for next steps, and pursuit of goals. That intertwining has been remarkable to me, though it probably should not be a surprise. I hope to understand how to bring more fullness to both initiatives through their combined and separate activities. I am reading Eric Metaxas’ biography on Dietrich Bonhoeffer. I am trying to understand his approach to defining his philosophy of theology, and the resulting extraordinary actions in extraordinary times. I wonder how I can apply these things to what I do — my role and application as it involves facing and combating two debilitating but curable medical conditions. I am convinced successes realized, as well as those to be realized, are the result of grace and blessings showered by the God we choose to serve.