TME is pleased to announce that we have placed another microscope in Guatemala, the country where our organization began. This microscope has been donated to Wuqu’kawoq (wuqu’kawoq.org), also known as the Mayan Health Alliance. This organization provides advanced care to patients with complex medical conditions free of cost, delivered in the first language of those it serves (primarily Mayan dialects, such as Kaq’chikel.
The Microscope Exchange is honored to have been able to donate a microscope to Veterinary Street Outreach Services (VetSOS) in San Francisco. VetSOS is a community organization which provides free veterinary care to the companion animals of homeless San Franciscans. They hold monthly clinics in a specially equipped mobile outreach van at soup kitchens, on city streets, under freeway overpasses, and in parks.
By going directly to homeless people, Vet SOS team builds relationships of trust, and this often serves as a first step to link each pet’s guardians with health care services as well. VetSOS is operated by the SF Community Clinic Consortium, which provides free medical care to the homeless in San Francisco.
Although the VetSOS receives donated lab services, until now they have not been able to submit slides for dermatology concerns. As such, their vets have often had to do a best educated guess to treat animals seen at their street clinics. With the new donated microscope, VetSOS will be able to examine skin scrapings for suspected mites, parasites, bacteria, and yeast. The microscope will be based at VetSOS’s new Tenderloin clinic site at The St. Anthony Foundation, where the organization will also run an addition 3-4 clinics a year.
Although this is both The Microscope Exchange’s first domestic donation, and its first veterinary donation, we could not imagine a better organization or cause to support. Please read more about VetSOS and consider supporting their work!
MLK Day marked an important day for us here at The Microscope Exchange, as we were able to make our largest donation to date. Teaming up with IMEC America (IMECAmerica.org) TME will be able to get 30 of our bench-top microscopes to lab sites in Jeremie, Haiti as well as developing sites in West Africa. Once in place, our microscopes will allow for earlier detection and diagnosis of diseases in these areas, saving an anticipated 500 lives per year, per microscope. We are all very excited to be able to get our microscopes from their storage cabinets and out into clinics where they can really make a difference.
This donation was truly a team effort, as we had to coordinate the delivery with IMEC and wrap our 30 scopes to prepare them for their voyages around the world. Thanks to the amazing folks at the UPS Store in Burlington we had the bubble wrap and packaging needed to make sure these microscopes arrive in one piece. And thanks to all the microscopes that have been donated thus far, we will be able to improve the lives of thousands of people throughout the world.
The microscopes will be helping with IMEC’s part in rebuilding the Francois de Sales Teaching Hospital
in Port-au-Prince, Haiti, which was destroyed during the 2010 Haitian earthquake and in supplying the a hospital being constructed in Arsii, Ethiopia, which will serve 1.2 million Ethiopians
that have never had access to any form of health facility.
This past week I traveled to Concepción, Honduras. I lived there for a year after college and it’s the most rural, hard to get to spot I’ve ever lived. It’s at least three hours to the closest grocery store and that’s when it hasn’t rained and the dirt road is passable. When I came back this week not much had changed. A road paving project has been underway for three years now but still hasn’t made much progess except knock down a bridge and cut down a bunch of trees.
I worked for an organization called Shoulder to Shoulder which has a contract with the Honduran government to provide health care to most of the Department of Intibuca. The clinic in Concepcion is one of several run by this NGO. When I arrived at the clinic the place was practically abandoned. The town hadn’t had running water for over a week so the dentist, most of the doctors, and other staff were gone because they couldn’t clean instruments and provide many of the services they typically do. None the less, dedicated patients waited to see the one doctor on call. While this clinic is basic and a couple of hours away from the nearest hospital it is the site of urgent care for thousands of people living in the surrounding villages. This clinic sees up to ten births each month, care for dog bites and machete wounds, and regular treatment for more common ailments.
With me on this journey was a Nikon microscope. Surviving several flights and the bumpy road to Concepcion I was able to deliver it successfully to this clinic’s lab. A full-time lab technician, Freddy, runs the lab and can do basic blood and urine exams as well as X-rays. Tests such as cervical cancer screening are sent away to a lab in a larger town. This microscope will be used for a nutrition project called MANI 4. It will follow three previous nutrition projects named Improving the Nutrition of Children in Intibuca that provide nutritional supplements to the poorest children in the area and measures their growth and incidence of anemia. To learn more about this project check out their website.
University of Vermont COM, MS-1
Greetings from Zimbabwe! Adam and I have been in the city of Harare already for over a month. We thank you for your patience awaiting this first blog post!
We are stationed in Parirenyatwa Hospital, a sprawling complex with over 2000 beds that serves as a community hospital for Harare and a referral center for the entire country. There is hope that it would be a fantastic location for UVM students and residents to rotate in the future. As such, we have been doing our best to serve as forerunners and representatives.
Prior to our arrival, we had almost idea of what to expect. Not too long ago, Zimbabwe was one the more prosperous nations in Africa. However, the country’s many woes have been highly publicized in western media over the past decade. In 2008, Zimbabwe was the source of the world’s worst inflation, with prices doubling daily with currency eventually ballooning by a stunning 22 orders of magnitude. In the midst of the economic collapse and the HIV epidemic, Zimbabwe became the site of the world’s lowest life expectancy in a country not in wartime—37 years old in men and 34 in women. At one time, over a quarter of the country’s population was HIV positive (it is now estimated to be around 15%).
Without a reliable source to tell us how much things had improved, we expected the worse. The Zimbabwean immigration website informed us that visitors were required to bring in sufficient funds to survive the length of their stay—which we guessed meant no functioning ATMs. Visa requirements were Byzantine and Adam spent dozens of hours on the phone with the embassy, trying to get a straight answer. Tourist blogs warned that waving with an open palm—the sign of political opposition—was an imprisonable offence.
What we have found, however, is one of the friendliest and most pleasant countries we could imagine—and one that has made great strides forward from the chaos of the 2000’s. We have been welcomed with a smile everywhere we have gone, and never felt unsafe for a moment. In addition, although the country still has overwhelming medical needs, we’ve been surprised at the comprehensiveness of hospital services and robustness of the medical education system.
Adam is in the surgery department and I am in the pediatric department. For me, the experience has been a thought-provoking juxtaposition between familiar medicine alongside huge differences in pathology, culture, and resources.
For example, every morning our team—made of medical students, residents, and an attending pediatrician—go on patient rounds. The bedside physical exams and teaching are usually superb. I feel right at home with about half of the pathology—bronchiolitis, neonatal sepsis workups, neonatal jaundice, asthma exacerbations, and diabetic ketoacidosis. We get labs and imaging when needed, and usually provide standard-of-care treatments.
Yet it is impossible to ignore the fact that somewhere around half the hospital’s patients are HIV infected. Malaria is on the differential for any febrile illness, and TB for basically any chronic illness. Less than ten years ago, this hospital was the epicenter of one of the largest cholera epidemics in recent history, one of the only nosocomial cholera epidemics ever recorded. Medication shortages, staff shortages, and bed shortages are the norm. And perhaps the only reason things function at all is that it is an up-front, pay-for-service hospital—those who are truly destitute are referred to far more crowded and under-resourced centers.
From my point of view, this mix of familiarity and along with high volume, acuity, and new pathology has served as an ideal transitional learning experience.
It is also an ideal place for additional resources to make an enormous difference. There is a fantastic infrastructure in place here, and the hospital is staffed with dedicated, talented, and experienced medical professionals. Any new medical resource here is immediately utilized to its absolute maximum capacity. For example, when Adam showed up on the surgery wards carrying a copy of a new edition of a surgical question bank he had brought, it attracted the attention of every member of his team. Adam soon decided he had little choice but to donate the text to the department, and within a week dozens of spiral-bound copies of the text had been distributed. One week later, some residents and physicians had already completed the entire book (and pearls from the book quickly were finding their way into clinical practice).
As such, we believe that the University of Zimbabwe and Parirenyatwa Hospital are perfect partner sites for The Microscope Exchange to support and collaborate with. And we are excited report that we have already been able to present a magnificent 5-headed teaching microscope to the University of Zimbabwe College of Health Sciences (UZCHS). We are confident it will get a remarkable new lease on life here that may last for many decades.
UZCHS is the only medical school in Zimbabwe and the source of nearly all of the country’s physicians and nurses—going on to serve a population of almost 15 million. Nearly 200 students matriculate each year at the medical school. The challenges these students undergo on the path to becoming health professionals can be shocking. Students will save every penny they have to purchase new textbook editions—paying sometimes twice the books cost in shipping—just stay abreast of standards of care. From the years of crisis, students tell stories of eating on the 0-0-1 plan (one meal per day), and having no water to wash their hands after dissecting in the anatomy lab. Their educational model is in the strictest British tradition—meaning that what we consider student abuse in the US counts as a complement here. Although we heard Zimbabwe was suffering from enormous brain-drain, we have found that the hospitals are full of residents and new attendings excited to improve their country and grow as physicians.
Most pertinently for our perspective, medical students at UZCHS learn histology and pathology on only a few dozen outdated microscopes. The professors in the UZCHS department are skilled pathologists and microbiologists, but lack the resources to provide the necessary training in diagnostics and pathology for students (even though doctors across the rural areas of the country are expected to perform most microscopy themselves).
We presented the microscope to the Dean of the Medical School, and between all of the hospital’s clinical departments, he chose medical education as the greatest area of need. The microscope will be utilized by multiple departments around the clock. Most excitingly, its top-of-the-line scope mounted camera will allow projected microscopy for entire lecture halls, effectively creating the capabilities of nearly 200 microscopes.
We will be back with some final departing thoughts. We have been having an incredible experience, and want to thank those who have made this trip, and our microscope donation possible, including
the UVM office of medical education, and Dr. Sadigh for transporting the 80lbs scope from the US and through customs.
After some missed connections, I have received the news that the lab at UCI has received the 100x oil immersion objective for the 5- headed teaching scope we brought last summer and everything is working well. Now onto the camera…
The following post was written by Taylor Weston, a high school senior from Bridgewater, CT who brought a microscope with her to Chitwan, Nepal while participating in global health experience with Projects Abroad:
I left for Nepal on December 7th out of JFK airport with the microscope in five pieces securely packed in my suitcase. I had a four-hour layover in Dubai then continued from there to land in Kathmandu on December 8th around 6pm. A member from the organization I was working with, Projects Abroad, met me at the airport and drove me back to the hotel in Kathmandu. We spent the night there and in the morning boarded two buses to start the 5 and a half hour drive to Bharatpur, a district of Chitwan, where were would be staying for the next week. Once there I realized how different Bharatpur was from the more touristy area of Kathmandu. The roads weren’t paved; mostly all dirt and the shops and houses were more shacks than buildings. All the signs were now in Nepali with hardly any in English. We stayed at the Hotel Global, which was placed in good distances from the hospitals we’d be working and shadowing at. All 19 of the volunteers were split into groups of 3 or 4 and then given a schedule showing when we’d be at which hospital. During my time there I was able to visit the Chitwan Community Hospital, the Chitwan Eye Hospital, the family planning clinic, and an outpost hospital located in a very rural part of Chitwan 45 minutes away from the hotel. On our first day we went to the Community Hospital. We shadowed the internal medicine doctor, who talked to us about his training in becoming a doctor and how they all need to be proficient in English because all of the medical books are in English. He then brought us around with him as he visited with patients, translating what they were saying and what he was doing. We then went into the labs to look around. This is where some culture shock hit me. There are no sanitation measures taken in these labs. Blood samples are strewn all over the counters, no gloves are used, and there is a pink hairdryer being used as a heat source. There was only one microscope in this lab, which looked like a lower grade than the one I had brought. When we went back to the hotel that night, I went and talked to Binod, a Nepali local who works hand in hand with Projects Abroad, if it would be beneficial if I donated my microscope to the community hospital. Binod later decided that I should instead donate it to the largest hospital in Chitwan, The Chitwan Medical College, instead. This was a problem though because I was leaving before the director of the hospital would return from a conference in Kathmandu. Binod told me that he’d be willing to take it over himself and let them know where and who donated it. As of now the microscope is being used in the labs at the Chitwan Medical College and I am still waiting of the pictures of it actually in the lab. This was a life changing experience and words cannot describe how grateful I was to be able to make sure a significant donation that will be able to improve the lives of many Nepalese people.
I’m writing on the afternoon of our final day here at the Uganda Cancer Institute. As is often the case, the end really came up quickly. It’s been a bit of a scramble over the past couple days to try to finish all the projects we had started, tie up various loose ends, and leave everything in order for the next batch of students in the fall. But it’s beginning to look like we’re going to get everything squared away and we need to start facing up to the fact that we are actually going to be leaving tomorrow!
Some microscope updates: When Dr. Sadigh came last week, he was able to bring along two more microscopes that were donated by some of his colleagues in Connecticut. Since we had already been working with the lab here at UCI, we decided to see if we could find any other places that would benefit from an added microscope to their lab. I was connected to Mr. Ponsiano Ayiko, the superindendent of labs at Mulago Hospital, the main hospital for Kampala and most of Uganda. After a couple of meetings we were able to locate a home for one of the scopes within Mulago’s main Hematology Lab. They had been working with only one microscope to serve the hematology needs of entire six-story, 1,500 bed hospital. In an area of the world with endemic malaria, a disease diagnosed by looking at a sample of blood under a microscope, that certainly qualifies as under-resourced. The microscope is going to good use and the staff of the Hematology Lab were excited about the prospect of hosting UVM students in the future.
We also talked with Dr. Abraham here at UCI who is in charge of outreach programs to the UCI satellite offices in Arua and Mbarara. Currently, all cancer cases in the country are referred to the UCI campus in Kampala. In the next few years, however, UCI will be trying to build their satellite offices to provide more comprehensive cancer services throughout the country. The hope being that with more convenient locations, people will be more likely to seek and adhere to treatment. At the moment, the office in Arua has a trained pathologist on staff but no lab equipment. The microscope will be a huge step in the right direction. Soon they will hopefully be able to diagnose and monitor cancers at their remote locations. And again, Abraham had a lot enthusiasm for taking future UVM students on the 5 hour drive to across the country to Arua so they could learn how UCI is trying to provide services to those who would have no chance otherwise.
Other than that, it has been a lot of saying good bye. We will definitely miss this place. Absolutely everyone has been friendly and helpful and we have learned an incredible amount. I hope we have been able to contribute a little in return and laid some groundwork for a long future collaboration between UCI, UVM and the Microscope Exchange. I’m running out of time right now, but I will try to post a final wrap-up and reflection on our experience when I return to the US in couple days.
We lost David this week as he returned to his practice in Connecticut. It’s been great to work with him and his excellent guidance left us confident as Karl and I presented our research at the UCI Research in Progress meeting Wednesday morning. Luckily in David’s place we gained Dr. Sadigh and his daughter Mitra. Dr. Sadigh has been an equally valuable resource on the wards and it’s been exciting to talk with him about the potential future of the collaboration between UVM and UCI.
We hit some snags setting up the camera on the 5-headed teaching scope. Sometime in the next couple days, I’ll need to venture into downtown Kampala in search of the cables necessary to connect the camera to the computer they have in the lab. In the meantime, Karl discovered that we were able to connect the camera to a projector, which at least gave us a sense of the quality of images the camera can produce. I proudly present below the first images transmitted from the teaching microscope camera at UCI! It may be hard to tell from the photos but the images are quite crisp and I think it bodes well for being able to capture images of high enough quality to share between departments.
Also today we had the opportunity to tour the new Uganda Cancer Institute building set to open in the next one or two years. It is a six story, 70-bed facility perched on a hill with views across old Kampala. It has it’s own operating rooms, pathology labs, and various wards. I tired to take some pictures of the pathology lab and future home of the donated microscopes, but they are located in the basement and presently very dark. It is exciting to get a glimpse into UCI’s future and to think about how TME is playing a critical role in that development.
A slow week for TME here at the Uganda Cancer Institute. We are waiting on a couple parts that will hopefully enable the telepathology capabilities of the 5-headed teaching scope we provided to the UCI lab. Our big project in the upcoming week will be to push to get that operational before we head back to Vermont.
On Monday, we were able to visit St. Stephen’s Hospital, a community health center just down the road from where we are staying in Mpererwe. The hospital has 40 beds and serves about 80,000 people. The building is divided into male, female, pediatric, and antenatal wards, 4 private patient rooms, an operating theater, a lab, and out patient facilities. During our time we got to spend time in each as well as ride along with the ambulatory team as they made outreach visits to homes in the community. It was a great way to gain some appreciation for the different levels of health care in Uganda.
I took advantage of the opportunity to talk to the lab techs at St. Stephen’s as they gave us a tutorial on microscopically diagnosing malaria. Though they have a bench top microscope that suits their small space, we discussed other possible needs they may have as they try to build a more comprehensive diagnostic center. Again this will be great site for students to get some experience at in the future and hopefully, we will be able to send future students with something to give back as well.
Other than that Karl and I have been rounding on patients, moving along with the data entry on our research project, and enjoying tea and meals with the Luboga’s. Hard to believe our time is over halfway gone already!