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HOPE NEWS
[world globe logo image]

Vol. 27, No. 2, 1989
A publication of Project HOPE, The People-to-People Health Foundation, Inc.

HOPE Airlifts Armenian Children to U.S.

First Lady greets plane

[image: an elderly lady smiles and leans over a child laying on a cot].

First Lady Barbara Bush greets one of 37 Armenian children airlifted to the U.S. by Project HOPE.

Weeks of preparation involving Project HOPE headquarters' staff, The White House, U.S. and Soviet government agencies, 10 American hospitals and countless other concerned individuals and corporations, culminated February 9 at 2 p.m. when a U.S. Air Force C-141 aircraft landed at Andrews Air Force Base with a cargo of 37 injured and scared Armenian children.

The children, many of whom had never travelled outside their home country, were met by Project HOPE President William B. Walsh, MD, First Lady Barbara Bush, Ambassador of the Soviet Union and his wife, Mr. and Mrs. Yuri Dubinin, Senator John Warner and several other American and Armenian dignitaries.

The account of how these children came to the U.S. begins December 7, 1988 when an earthquake literally shattered the lives of thousands of Armenians. At least 50 towns and villages within 25 miles of the earthquake's epicenter were completely destroyed. Over 25,000 bodies were recovered, but Armenian authorities estimate the final death toll will actually be closer to 80,000 with diminishing hope for ever recovering most of the bodies. Over 13,000 people, many of them children, were injured in the earthquake and over 500,000 were left homeless. Though devastating as these numbers are, the Armenians have begun the slow road to recovery as they proceed to rebuild their homes and communities and care for the many sick and injured.

Immediately after the earthquake, Project HOPE founder, Dr. Walsh, approached Ambassador Dubinin and suggested that HOPE could assist children who had lost limbs or been otherwise injured by bringing them to the U.S. for treatment and in some cases fitting of pros- thetic devices. After negotiations with Soviet authorities and approval from Soviet leader Mikhail Gorbachev, Project HOPE's offer was accepted.

"What started as a humanitarian effort has turned into a dramatic breakthrough... we have established a new relationship between Moscow and Armenia (and the U.S.)," emphasized Dr. Walsh at a press conference immediately following the airlift.

Mrs. Bush became interested in the Armenian children and asked to greet the children, according to Dr. Walsh, after her son and grandson toured the disaster- struck area at Christmas. "It was a won-

Continued on page 2

HOPE News is published quarterly by Project HOPE, The People-to-People Health Foundation, Inc. Millwood, Virginia 22646
(703) 837-2100
William B. Walsh, MD, President and Chief Executive Officer
Rebecca Davis, Editor, HOPE News

In This Issue:
HOPE commits to five-year Armenian program
Guardian 'angel' watches over Armenian girls
HOPE in Africa: midwifery program in Swaziland







"It was a wonderful and moving experience to watch Mrs. Bush on the plane. These children had been rehearsing for hours how to say thank you and hello in English."
Dr. William B. Walsh

continued from page 1

derful and moving experience to watch her (Mrs. Bush) on the plane. These children had been rehearsing for hours how to say thank you and hello in English," Walsh continued.

In late January, a 10-member Project HOPE triage team was dispatched to Armenia to determine in consultation with Soviet and Armenian physicians which children could best benefit from treatment in the U.S. Members of the triage team included Project HOPE representatives William B. Walsh, Jr., vice president of operations and Tom Walsh, general counsel; John P. Remensnyder, MD, Harvard Medical School and chief of staff at Shriners Burns Institute, Boston and co-leader of the triage team; Warren E. Grupe, MD, professor and chairman of the department of pediatrics at SUNY, Syracuse and co-leader of the triage team; Norris C. Carroll, MD, Northwestern University Medical School and head of orthopedics division, Children's Memorial Hospital, Chicago; Munro L. Strong, MD, SUNY, Buffalo and orthopedic surgeon at Children's Hospital of Buffalo; S.K. Szyfelbein, MD, Edwin Wyman, MD, and Nishan Goudsouzian, MD, all of Harvard Medical School and Massachusetts General Hospital; and Denis Drummond, MD, orthopedic surgeon at the University of Pennsylvania and Children's Hospital of Philadelphia.

Triage team members examined approximately 300 children who had been injured in the earthquake. Originally, the team expected to bring back about 20 children to the U.S., according to Bill Walsh, Jr., who headed up the team in Armenia, but as the Armenian people began to accept and trust the Americans, parents of injured children approached the American doctors asking them to take their children back to the U.S. for treatment. Many of the patients the triage team saw in Armenia had not received proper medical attention because of the sheer volume of persons injured in the earthquake, which caused an overload on Armenian and Soviet hospitals.

It was reported by members of the triage team that many of the children had not smiled for three weeks after the earthquake. Some had lost close family members and had not been told of familial deaths. It was not uncommon for one child to awaken at night and begin to cry, causing the entire ward to cry.

The children, who range in age from 2 to 17, were evacuated from Armenia by the U.S. Air Force to Rhein-Main Airbase in West Germany where they were stabilized. From there, they were flown to Andrews Air Force Base in Maryland and subsequently transported to 10 hospitals across the country aboard 17 private aircraft.

A Project HOPE assessment team left in mid-April to lay the groundwork for the next phase of the project and to ensure that children returning to Armenia as well as others injured in the earthquake will have follow-up rehabilitation services. Project HOPE has committed to a five-year $5 million program in Armenia, including the development of a center for physical medicine which will provide physical therapy services and prosthetic and orthopedic services to pediatric patients. The program will also include a medical training and educational exchange component with Project HOPE health care professionals travelling to Armenia to work together with Armenian physicians and Armenian health personnel training at American medical institutions. As part of the exchange activities, Project HOPE will donate medical textbooks and teaching materials.

Theodore M. Cole, MD, chairman of the department of physical medicine at the University of Michigan is serving as HOPE's senior advisor for the rehabilitation project. He will be assisted by Ernest W. Johnson, MD, chairman of the department of physical medicine at Ohio State University.

[image: middle aged woman kisses the cheek of a young woman who is laying down]

Fifteen-year-old Anik Meloyan from Spitak, Armenia, receives a comforting kiss from her mother Svet at the Children's Hospital of Philadelphia. Photo by G. Loie Grossman, Philadelphia Daily News.

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American-Armenians Respond

Guardian 'angel' watches over Armenian girls

[image: A man is seated with four little girls. The youngest is sitting on his lap. They are all smiling]

Joe Kechichian with his four charges (left to right): Armanush, Silva, Anait and Lusine.

Being one of five American-Armenians in Charlottesville, Virginia has never been something Joe Kechichian thought about much. His ethnicity and bilingual abilities became a real asset, however, when he was called upon to interpret for four Armenian girls who were brought to the Kluge Children's Rehabilitation Center in Charlottesville. The children were part of a group of 37 who were airlifted to the U.S by Project HOPE for treatment of injuries sustained in the December 7 earthquake.

Two days before Lusine, Anait, Armanush and Silva arrived at Andrews Air Force Base with 33 other Armenian children, Kechichian, assistant dean of international studies at the University of Virginia, was approached by Mary Clark, MD, associate professor of orthopedics and pediatrics at UVA, who asked if he would meet the children and their parents at the airport.

Since then, Kechichian, also of Armenian descent, has acted as the girls' "unofficial guardian" serving not only as interpreter but also as social organizer. He has taken them to movies, the symphony, parks, museums, dinner, the dentist and tours of the community. Kechichian has translated for doctors, nurses, reporters and even psychiatrists. He knows, he added, because of the amount of time he has spent with them, that he has "gotten on their nerves" as well as the other way around.

Immediately after the arrival of the children, Kechichian attempted to mobilize the Armenian community in Richmond and the Washington, DC area to serve as volunteers and translators for the children. He appeared on television numerous times to plea for assistance, and the response, he said, was phenomenal. In the waning weeks of the children's stay, he came to rely on a small core of volunteers in the Richmond-Charlottesville area to translate for and entertain the children and their parents. Before the children arrived, Kechichian didn't even know the other Armenian-Americans in Charlottesville. The girls' stay in his community has been a real rallying point for the local Armenians, he added.

Two of the children, two-year old Silva and four-year-old Anait, have been fitted with upper limb prosthetic devices. Lusine, 7, and 14-year-old Armanush are currently undergoing physical therapy for crush injuries to their arms and hands.

According to Kechichian, the cold weather has hampered many of the girls' outside activities, but their days are kept full with school lessons, walks in the park, visits to historical Charlottesville sites, therapy and their favorite pastime, swimming. Despite loss of limbs, none of the girls, including the two year old, ever miss their swim lessons. The children had never swum before coming to Charlottesville.

Though the language barrier has been a challenge for non-Armenian speakers to overcome, the girls have become favorites of some of the nurses at Kluge Children's Rehabilitation Center, having been rather informally "adopted" by two nurses in particular who manage nonverbally to communicate with the children. Part of the therapy for Silva has been to interact with other children her age who are missing limbs. Through this therapy she has become fast friends with a two-year-old American girl who has also lost an arm. It is amazing, according to Kechichian, how unimportant language is to two year olds engaged in the serious business of play.

While the added duties of "guardian" for the children have sometimes been a lot of responsibility, Kechichian knows that because of his help and others like him, the experience for these children has been a physically healing one as well as a cross-culture adventure.

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With a little help from our friends ...

[image: A man standing on steps is tossing a box down to a man standing on a lower surface]

Project HOPE staff Jeff Klinefelter (left) and Mike Jaureguizar unload emergency medical supplies donated by 3M for the Armenian relief effort. Staff photo by Paul Burda.

Without the support and contributions of many individuals, hospitals and corporations, the Armenian airlift would have been difficult, if not impossible. Instrumental in arranging the Medevac transport from Frankfurt to Andrews Air Force Base and other logistical matters were Senator John Warner (VA), Representatives Frank Wolf (VA) and Tony Coehlo (CA) and the Department of State and Department of Defense. Also important to the success of this private/public sector initiative are the private donors that supported the initial phase of this project including 3M, members of the Ohio Insurance Industry, Medex and Cargill, Inc.

Warner-Lambert Co. graciously provided 12 corporate aircraft to fly the patients from Andrews Air Force Base to several U.S. cities; Johnson & Johnson supplied one aircraft, and three were provided by the University of Virginia. The American-Armenian community also deserves thanks for all the support they offered this project from the beginning. The following hospitals have donated all costs for the children's treatment and rehabilitation: Children's Memorial Hospital, Chicago; Children's Hospital of Buffalo; Millard Fillmore Hospital, Buffalo; Massachusetts General Hospital, Boston; Crouse Irving Memorial Hospital, Syracuse; Children's Hospital of Philadelphia; Shriners Hospitals for Crippled Children, Philadelphia and Tampa Units; Children's Hos- pital of Columbus, Ohio; University of Virginia Health Sciences Center Kluge Children's Rehabilitation Center, Charlottesville. The Ronald McDonald Houses provided housing and members of the American-Armenian community also extended their hospitality to the children and their guardians in the respective cities. Four American physicians volunteered to fly with the children to provide medical care on the plane from Frankfurt to the U.S. They are: Susan Briggs, MD, assistant chief of staff at Shriners Burns Institute, Boston; Christopher Chalian, MD, orthopedic resident at Children's Memorial Hospital in Chicago and Northwestern University Medical School; Gregory Dumanian, MD, gener- al surgery resident, Massachusetts General Hospital; and William Hannan, assistant professor of pediatrics at SUNY Health Science Center, Syracuse and attending pediatrician at Crouse Irving Memorial Hospital, Syracuse.

Wilensky wins award

Gail R. Wilensky, PhD, vice president of Project HOPE's Center for Health Affairs and Kala E. Ladenheim, former CHA policy analyst, were recently named winners of the 1989 Dean Conley Award for their article "The Uninsured: Response and Responsibility." The award is granted annually by the American College of Healthcare Executives to recognize contributions to health care management literature and to encourage health care executives to author articles.

Chinese hospital administration graduates receive degrees

Thirteen Chinese students received their master of science degrees in health services administration January 9 from the University of Alabama, making this the first group of students to finish this HOPE-sponsored program.

The degrees were presented by UAB President Charles A. McCallum, who was in the People's Republic of China to present the honors, as were Keith D. Blayney, dean of the UAB School of Health Related Professions and Howard W. Houser, PhD, director of the UAB School of Health Related Professions, international activities.

The students finished their coursework in August 1988 and completed practical experience at hospitals in China in December. The three-year program required the students to spend two years studying at Xian Medical University and one year at the School of Health Related Professions at UAB. These students will

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become the core of the hospital administration faculty at Xian Medical University. They also received master degrees from the Chinese university.

HOPE-sponsored student exchange programs, with the cooperation of UAB, have enabled health care professionals from other countries to study in the United States. Six UAB professors have taught in China as part of the exchange program.

[image: Five men stand together in commencement robes. all but one of them wears a graduation cap].
Attending the graduation of the first recipients of master degrees in hospital administration from the University of Alabama and Xian Medical University were (left to right): Shi Da-Pu, vice president, XMU; Keith D. Blayney, PhD, dean, School of Health Related Professions, UAB and hospital administration coordinator, XMU; Charles A. McCallum, DMD, MD, president, UAB; Chen Ming Zhang, minister of public health; Ren Hui-Min, president, XMU.


Teleconference Technology

Teleconference opening links seven Caribbean countries with HOPE Center

The telecommunications system uses telephone lines and satellites to transmit audio conferences and slow-scan television capable of transmitting images of people, graphics, x-rays or other diagrams.

Project HOPE history was made February 17 when The HOPE Center in Millwood, Virginia was linked with seven Caribbean countries via the foundation's new teleconference equipment. The occasion was the Project HOPE/Inter-Caribbean Teleconference opening between The HOPE Center and the University of the West Indies Distance Teaching Experiment (UWIDITE) Centers.

The teleconference was highlighted by several distinguished speakers including Project HOPE President William B. Walsh, MD, who spoke from Grenada to all participants on "Communications in Health;" the Honorable Daniel C. Williams, minister of health, Grenada; the Honorable Rex Nettleford, director of extramural studies, UWI, Jamaica; William B. Walsh, Jr., vice president for operations, Project HOPE; and Professor E.R. Walrond, dean, faculty of medical sciences, UWI, Barbados.

The telecommunications system uses telephone lines and satellites to transmit audio conferences and slow-scan television capable of transmitting images of people, graphics, x-rays or other diagrams. The HOPE Center is linked to Jamaica by telephone, which in turn is linked to Barbados, Grenada, Trinidad, Saint Lucia, Antigua and Dominica by satellite and microwave. The system can be used for educational programming initiated at The HOPE Center or any of the participating sites.

Bringing the latest in medical knowledge and techniques through continuing education and consultation opportunities, the teleconference system has already been used for at least eight presentations since it began operation in October 1987. These programs have included AIDS education programming for nurses, physicians and social workers to environmental health and burn management seminars. Nearly 1,000 health professionals have benefited from these programs.

The system is very cost effective, according to Carolyn Brye, RN, PhD, Project HOPE director of nursing, who was also been involved in planning the teleconference. A two-hour seminar capable of reaching 120 people on seven different islands costs between $500-$700 using the UWIDITE system. The travel costs alone would be exorbitant to bring all these people to one place for the same purpose, she said.

"Project HOPE anticipates that this new link will enable representatives from medical centers in the U.S. to participate in health care teleconferencing between The HOPE Center and the seven Caribbean nations. This sharing of information and expertise has great potential for improving health care," Brye said.

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HOPE in Africa

Midwifery program in rural Swaziland scheduled to begin in 1990

[image: the outside of a building with a sign that reads, 'Good Shepard Hospital.' Two women in nurses uniforms stand in front of it.]

Good Shepherd Hospital in Siteki, site of the new HOPE community health/midwifery program.

A community health/midwifery program in rural Swaziland, scheduled to begin accepting students in January 1990, is being developed to upgrade skills of nursing assistants, according to Carolyn Brye, RN, PhD, and director of Project HOPE's nursing program.

The one-year program will eventually be integrated into an existing two-year nursing assistant program in Siteki, Swaziland at the Good Shepherd Hospital. Initially, however, the community health/midwifery program will be offered to nursing assistant graduates who are already practicing in rural health clinics, Brye said. Until now, the nursing assistant curriculum did not include midwifery or community health studies. These new skills will better equip these nurses to provide primary care to mothers and infants in rural settings where oftentimes other health care personnel are not available. Siteki is located near the Mozambique border.

Project HOPE has been operating in Swaziland since 1985 when the foundation was invited by the Ministry of Health to begin a nursing education program at the Nazarene Nursing College in Manzini. This program, which will be phased over to the Swaziland MOH in February 1990, has been very successful, according to Agatha Lowe, RN, MS, and nursing coordinator in Swaziland. The coursework for this program includes a basic three-year nursing curriculum and one year of midwifery studies for the 100 students currently enrolled in the program.

A lot of young people are interested in this program, according to Lowe. Last time new students were accepted to the program there were 300 applicants for 30 open slots.

In the capital city of Mbabane, community health nurses are receiving advanced training at the Institute of Health Sciences to better prepare them for working in rural areas where nurses often serve as primary health care providers.

"These people are already trained nurses... they came from a community nursing background, and they will return to their communities," said Lowe.

The community health nurses, who were targeted for the program because of demonstrated leadership abilities, receive one year post-basic training, which includes one month of field experience in rural settings and frequently, many additional hours in the field, according to Lowe. Graduates of this program typically go on to supervisory positions in their communities.

The first group of community health nurses graduated in 1988 with a second group scheduled to complete their studies this year. The program will be phased over to the MOH in December 1989.

Swaziland shares many of the health problems of other developing African nations. Infant mortality due to diarrheal diseases is high, and upper respiratory ailments are common as is malaria and malnourishment.

Project HOPE has also contributed over 2,100 textbooks to the nursing programs in Swaziland and plans to provide additional books to the midwifery program.

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STAFF NEWS
Mark Papania, MD, MPH, has been named program director for Guatemala. Bettina Schwethelm, PhD, has been named coordinator, child survival pro- grams and Martha Desrosiers, BSN, CANP, has been named director of humanitarian assistance and special pro- jects at The HOPE Center.

The following short- and long-term fellows and staff have recently been enlisted by Project HOPE.

Armenia: Susan Briggs, MD; Norris Carroll, MD; Christopher Chalian, MD; Denis Drummond, MD; Gregory Dumanian, MD; Nishan Goudsouzian, MD; Warren Grupe,
MD; William Hannan, MD; John Remensnyder, MD; Munro Strong, MD; Stanislaw Szyfelbein, MD; and Edwin Wyman, MD.

China: Keith Blayney, PhD; Howard Houser, PhD; George Johnston, MS; and Marcia Petrini, PhD.

Costa Rica: Gina Ocasio and Benjamin Silverman, MD.

Grenada: Ralph Gersdorff, PhD; Edward McDonough, MD; Volney Steele, MD; Mary Tobin, MD; Daniel Weaver, MD; and LeRoy Werley, Jr., MHA.

Indonesia: Leslie Mancuso, BSN, MSN; Edward O'Rourke, MD; and Emily Rhine- hart, RN, CIC.

Poland: Michael Alexander, MD; Winslow Borkowski, MD; Mary W. Clark, MD; Mary Drew, RN; Henry Drott, PhD; Thomas Foley, MD; Warren Grupe, MD; William Harmon, MD; Susan Harris, RPT, PhD; Kathryn Jabbs, MD; Ruth S. Kamen, PhD; Marnie King, OTR; James Kitchin, MD; Karen McGowan; Barbara McHugh, RN, MPH; Gregory Peckham, MD; Nancy Spinozzi, RD; and Robert E. Wood, MD.

U.S. Southwest Border: Beatricz Dykes, MEd, RD.

HOPE Center: Freda Adamson; Deborah Barbour; Karen Bauserman; Bambi Crawford; Jill Furman; R. Bruce Lehman; Sandra MacMahan; Thomas Ritter; Radcliffe Roberson, MS; and Brian Shimp.

Join the HOPEGIVERS
Be a HOPEGIVER and join Project HOPE in making self-administered health programs available in nations around the world. Your contribution makes you a part of an important relationship between the HOPE volunteer educators in the field and their eager-to-learn counterparts in 16 foreign countries and the United States.
Your gift allows us to expand our reach in these countries with more medical supplies and assistance given to those in need. Your contribution to Swaziland will have increased impact through a special matching grant program. You can also designate your contribution to be used wherever the need is currently greatest. Please help us share our great wealth of medical, nursing and technical knowledge-be a HOPEGIVER today.

ARMENIA
Thirty-seven children who were victims of the December 1988 Armenian earthquake were brought to this country for rehabilitation services and in some cases, fitting of prosthetic devices. Your donation will help support a five-year commitment between Project HOPE and the Armenians to ensure these and other children have continued rehabilitative services in their home country.
unselected: $75.00
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SWAZILAND
With your help, Project HOPE can train nurses needed in rural villages to deliver health services to infants, children and women of child-bearing age. Your contribution will also help support the new midwifery program and other educational programs as well.

MATCHING FUNDS
unselected: $75.00
unselected: $40.00
unselected: $20.00
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Please allocate my contribution wherever the need is greatest $[blank]
Total contribution $[blank]

Mr. Ms. Mrs. Miss [blank]
Address [blank]
City/State/Zip [blank]
HNC 2702
Mail to: Project HOPE, Millwood, VA 22646

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AT THE CENTER
With every misfortune comes a new beginning. The tragic December 7 Armenian earthquake took thousands of lives and injured countless more. But along with the misery caused by this disaster, a new bond has been forged between the United States and the Armenian people. This bond will continue to expand as Project HOPE embarks upon phase two of the $5.3 million Armenian program- the development of a center for pediatric physical medicine in Yerevan.
This center will demonstrate what can be done with proper treatment and rehabilitation and will have a lasting impact on the future of child health care in Armenia. We have committed to a five-year program which will include the physical medicine center and an education exchange program with Project HOPE health care professionals travelling to Armenia to share their expertise in orthopedics, prosthetic services and physical therapy. We also hope that Armenian physicians and other health professionals will come to the United States as part of the counter- part experience.
I feel certain the private sector will respond to our requests to achieve our objective in Armenia, and I urge the American people to join us in making this important project a reality.
William B. Walsh, MD

[portrait photograph of William Walsh]

PROJECT HOPE
Millwood, Virginia 22646

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