Surgery Mission Trip

Team Manual

Guatemala City, Guatemala

November 6-13, 2011

Austin Smiles

INTRODUCTION

The Shalom Foundation

“Shalom” is a Hebrew word meaning “peace, health, safety, completeness, wellness, hope” and more. The Shalom Foundation is a 501(c)(3) non-profit organization dedicated to providing assistance to children and their families living in extreme poverty. Shalom provides services in four key areas: medical care, nutrition, education and housing and community development.

Through Shalom’ s Education Program thousands of children receive the opportunity for a good education and are prepared to graduate from elementary, middle and high school. Ongoing Educational opportunities are also provided to medical and education leaders through cooperative seminars, hands-on workshops, health clinics and surgical missions. Education is an important cornerstone of The Shalom Foundation’s programing in Guatemala.

Through the Nutrition Program a filling meal and clean water is provided to hundreds each day. Our Nutrition Program continues to grow with the addition of a clean water initiative with support from Rotary and church partners. This program will continue to grow in order to serve thousands of people in Guatemala each year.

The Community Development and Housing Program bring safe, clean homes to families living in the most deplorable conditions. These modest homes include electricity, running water, plumbing, fully functioning windows and doors with secure locks. Community development has included improvements to local schools, water systems, clothing and shoes, community events and clinics.

With support from private individuals and organizations, The Shalom Foundation has served children and families for more than 14 years.

In 2005, The Shalom Foundation and Monroe Carell Jr. Children’s Hospital at Vanderbilt began working together to improve the lives of children in Guatemala launching the “Medical Initiative”. The Medical Initiative has transformed the lives of children through surgical care. It has also changed the lives of participating doctors, nurses and medical team members, transforming their lives here. In 2007, The Shalom Foundation began seeking a facility in Guatemala City to remodel and equip as a modern medical facility to better serve the children and to provide a surgery center for medical teams year round. With the purchase and renovation of the facility, The Moore Pediatric Surgery Center opens in 2011 to serve children and families from across Guatemala. Joint efforts also involve Belmont University, Vanderbilt University, VU Institute for Global Health, Rotary, Living Waters for the World, Children’s Hospital in Denver, Mayo Clinic, various loyal church partners as well as numerous other organizations in both countries.

The Moore Pediatric Surgery Center

The Moore Pediatric Surgery Center serves as a base of operations for medical services and surgical procedures for children living in acute poverty from across Guatemala. Without intervention, these children would otherwise go untreated sometimes as social outcasts, facing life-long suffering or death.

All funds contributed toward the purchase of the properties, equipping and operation of the surgery center will be tax deductible. With support and guidance from architects, engineering firms, doctors, nurses, administrators from hospitals and surgery centers, The Moore Center will function as a modern, short-stay facility with all necessary and expected features. Great attention has been given to the facility’s design based upon its intended purpose and future use.

The 12,000 square foot facility features 3 operating rooms, 3 pre-op beds, 5 first-stage recovery beds, 21 recovery/overnight stay beds, crib room, nurses’ station, laundry facilities, sterilization suite, family waiting areas, elevator, conference room, kitchen, office space. Detailed floor plans document the use of all space. The facility is located at 6 calle, 0-55, zone 1, Guatemala City -- convenient to many areas of the city. You can visit our website and take a tour, www.TheShalomFoundation.org

The Moore Pediatric Surgery Center serves as an international “home base” for the Children’s Hospital at Vanderbilt and for Children’s Hospitals, Medical Centers, and medical teams from across the country supporting Slalom’s Medical Initiative. The facility will be utilized by teams year-round. These teams will work with local Guatemalan medical specialists to provide much-needed surgical procedures to the poor within a modern facility. By partnering with in-country doctors and nurses for any follow up treatment, the most and best care can be provided to the most children.

This unique model can provide on-going services where there are otherwise none available. The Moore Center provides hope and the opportunity to heal hundreds of children each year. Charitable care services provided through the surgery center will transform hundreds of families each year, touching thousands of lives.

The total cost including purchase, renovation, and equipment is approximately $1.6 million. This figure reflects the purchase of the property, all related fees and taxes, and numerous significant contributions of professional services including: design work, construction, remodeling and specialized installations. Projected costs also reflect in-kind donations of medical equipment, parts and supplies both large and small impacting all areas of the surgery center and every function.

Financial support and in-kind contributions are necessary to sustain on-going operations of the surgery center. Donations from private individuals, grants, partner institutions, music industry events, annual benefits and funding campaigns will support The Moore Center. Recognition is available to organizations and individuals making significant and generous contributions. Donors will be acknowledged at the facility through the Patrons Wall and at specific locations throughout the building.

Specialists from the United States and Guatemala continue to work together to properly equip, operate and sustain the facility. Your participation is greatly appreciated.

Introduction

GUATEMALA

Location:Guatemala is located in Central America. Its borders are shared by Mexico to the north and west, the Pacific Ocean to the south, and to the east Belize, Honduras and El Salvador. Guatemala covers an area slightly smaller than Missouri at 67,661 square miles. It is located in the Central Time Zone.

Weather:Guatemala maintains a tropical climate and is called the “Land of Eternal Spring.” Average year-round temperatures run 75 degrees during the day and 50-60 at night. June through October is the rainy season, while November through May sees the drier, most pleasant conditions.

People:Guatemala’s population is 14.2 million, with approx. 5 million living in Guatemala City. Fifty percent of the country’s population is under the age of 18. The primary language spoken is Spanish, with up to 40 indigenous languages spoken in the remote and rural areas of the country.

Culture:Guatemala’s culture is a unique product of ancient tribal influence and a strong Spanish colonial heritage. About half of Guatemala’s population is mestizo (known in Guatemala as ladino), people of mixed Spanish European and indigenous ancestry. Ladino culture is dominant in urban areas, and is heavily influenced by European and North American trends. But unlike many Latin American countries, Guatemala still has a large indigenous population, the Maya that has retained a distinct identity. Deeply rooted in the rural highlands of Guatemala, many indigenous people speak a Mayan language, follow traditional religious and village customs, and continue a rich tradition in textiles and other crafts. The two cultures have made Guatemala a complex society that is deeply divided between rich and poor. This division has produced much of the tension that has marked Guatemala’s history.

Government:Guatemala operates under a democratic constitutional government. President Alvaro Colom began his presidency January 15, 2008 and will be president for 4 years. The vice president, Rafael Espada, is a well known heart surgeon who practiced medicine in the United States for many years. This is an election year in Guatemala and a challenging time.

Currency: Guatemala’s currency is the quetzal. The exchange is approximately 7.7 to 8 Q =1 US dollar. Most businesses (or vendors in Antigua) we frequent accept US dollars of a VISA, MasterCard of AmEx card. Each member can easily make a modest exchange of US dollars at the front desk of your hotel (which should be all that you will need for personal purchases).

Background:The Maya civilization flourished in Guatemala and surrounding regions during the first millennium A.D. After almost three centuries as a Spanish colony, Guatemala won its independence in 1821. Since, it has experienced a variety of military and civilian governments as well as a 36-year guerrilla war which left the country in human and economic despair. In 1996, the government signed a peace agreement formally ending the conflict, which left more than 100,000 people dead (some estimate 200,000) and created some 1 million refugees.

Guatemala City is one of the largest urban agglomerations in Central America and the capital of Guatemala. It sprawls across a range of ravine-scored mountains, covering an entire mountain plain and tumbling into the surrounding valleys. The city’s elevation is just less than 5,000 feet above sea level.

Antigua is among the world’s best preserved colonial cities. It sits in a highland valley overlooked by the spectacular Agua Volcano (3,765 meters high). A little further away are two other volcanoes Acatenango and Fuego. Tourists visit Antigua every year from around the world to enjoy its incredible natural beauty, historic architecture, and unparalleled local shopping.

Electricity:110v the same plug configuration as in the United States. All travel appliances will work in your hotel rooms.

Population: 14,280,596

Population below poverty line: 75%

Population living in extreme poverty: 16%

Under-5 mortality rate (per 1,000 children): 57 / 50 (m/f)

Percent of population age 60 and older: 5.3%

A significant share, 59%, of Guatemalan residents lack access to any healthcare services.

Even when health facilities are present, they are often understaffed and lack medicines and equipment.

In terms of diseases, major causes of death in Guatemala still include treatable and communicable diseases such as diarrhea, pneumonia, malnutrition and tuberculosis.

Guatemala has among the worst performances in the world in terms of child growth attainment, with an overall stunting rate of 44% of all children under 5. Guatemala ranks fourth in the world for stunting rates.

Life expectancy at birth in Guatemala is the lowest in all of Central America and infant mortality is the highest.

Over four-fifths of the women in the poorest quintile give birth at home, where they lack sanitary conditions for safe delivery.

*Statistics taken from the World Health Organization and the CIA World Fact book, CLAS Vanderbilt.

Population, Health Statistics and Outcomes

Guatemala, Central America

Team Information

Surgical Team Members:

Bob Clement, MD Team LeaderStella Denny, RN Mission CoordinatorKendyl Richards, Ex Director Mission AdministratorWayne Porter, MD Anes Team Leader

OR 1:Bob Clement, MD Plastic SurgeonDan Ernst CRNAPaige Pearson CST (Scrub)Janice Ryan RN Circulator     

OR 2:Jim Cullington, MD Plastic SurgeonDavid Wainwright, MD Plastic SurgeonCarlos Murillo, MD Plastic Surgeon – ResidentCindy McWhirter CRNABarbara Powell CST (Scrub)Andrea Guidry RN Circulator

OR 3:George Seremetis, MD Pediatric UrologistStephanie Shields CRNALeilani Briseno CST (Scrub)Patti Tabin RN CirculatorGenevieve Mounce, MD AnesthesiologistMargaret Willis Anes. Tech

PACU (Recovery Room)Cindy Thomas RN (area leader)Mary Kay Lauden RNDaira Wilson RNGayle Cullington RN

Surgical SupportTom Kirk Inner Core/Sterilizing Instruments

Post Operative Care/Floor DutyElizabeth Stephens RN (area leader)Gene Cummings RNElsa Colunga RN

Pre-Operative/TriagePat Connally, MD ENTCarolyn Cummings RNMelissa Leech Speech Pathologist

Team Information (cont)

Computer / PhotographerTara Kessler (JR League) ComputerJill Baumhover (JR League) Photographer

Dental / ObtuatorsTom Sentz DentistLiz Fox RNBrandyn Raymond (JR League) Volunteer

Non-Medical VolunteersDeborah Kirk Spanish Translator / Board Member

The Shalom Foundation Team Members:

Dr. Ken Moore, MD Medical Director-USAllison Bender Executive Director, The Shalom Foundation Maria Jose de Gallardo Director-Guatemala, The Shalom FoundationTommy Sanders Director of Operations, The Shalom Foundation Claudia Hurtarte Missions Coordinator-Guatemala, The Shalom FoundationElisa Arenales Intern-Guatemala, The Shalom Foundation

The Moore Pediatric Surgery Center Team Members:

Dr. Sidney Hagen Acting Medical DirectorMiriam Garcia Head NurseRafael Paredes Social workerJose Fernando Rios Business AdministratorJoseline Pinzon Receptionist, CoordinatorMara Morales Book keeper, FacilitatorNurses, Residents, Social Worker, Translators, Volunteers, Housekeepers, Maintenance

Travel Information

**A security tax of $3 (or Q20) per person previously required to leave the country at the airport has now been included in the ticket price.

Carry-On Baggage Restrictions:

On instruction from the Transportation Security Administration, airlines advise customers that the following items are permitted inside the sterile area through the screening checkpoint:

Liquids, gels and aerosols in small containers (3 oz. /90ml or less) in a clear re-sealable 1 quart/1 liter plastic bag. The bag with its contents must be subjected to inspection separate from carry-on bags.

Medications (including non-prescription medicine) without the requirement that the customer’s name appear on prescription medicine.

Baby formula/milk (to include breast milk), baby food, medications, and liquids/gels that are needed for diabetic or other medical conditions if not contained in a closed/sealed transparent re-sealable 1 quart/1 liter plastic bag and/or if in containers larger than 3 oz. (90ml) each must be declared to the TSA at the security checkpoint for screening.

In U.S. domestic airports, liquids (to include beverages), gels and aerosols purchased in the sterile area of the airport may be taken on board the aircraft. Customers may be subjected to a secondary screening if entering the screening checkpoint with liquids, gels and/or aerosols.

Baggage Allowance:

1 carry-on plus 2 checked bags per person; checked baggage size & weight restrictions: maximum 50 lbs and 62 linear inches (total length + width + height) per piece. Each team member is asked to utilize their second checked bag for team or Moore Center supplies. We will discuss needed supplies and “wish lists” so that everyone will know what to pack and how to utilize their second bags.

For international flights, all bags must be checked a minimum of 60 minutes before departure time.

Accommodations:Clarion Suites Hotel14 Street 3-08 Zona 10, Guatemala City P: 011-502-2421-3333http://www.clarionhotel.com/hotel-guatemala_city-guatemala-GT001In Antigua, GuatemalaPorta Hotel Antigua 8 Calle Poniente No. 1, La Antigua, Guatemala, Sacatepéquez P: 011-502-7931-0600http://www.portahotels.com/content/porta-hotel-antigua

Cellular Phones, Internet Service:

Your cell phone may not function in Guatemala City without additional services and arrangements with your provider. Individual cellular phones require international service to function in Guatemala. There are fees for international calls, email and texting services. These vary by company and can be quite expensive even with pre-planning.

Two basic cell phones will be provided for Team Leaders by The Shalom Foundation in Guatemala and provide excellent clarity and communication for simple calls home. Additional minutes are easily purchased.

Internet connectivity is available at hotel and at The Moore Pediatric Surgery Center.

Emergency contact info for your family:Maria José de Gallardo, Shalom Foundation Cell: 011-502-5318-6372MJGallardo@TheShalomFoundation.org

The Moore Pediatric Surgery Center, 6 calle, 0-55, zone 1, Guatemala City, Guatemala615-656-3499, US number (local call from Middle Tennessee or domestic long distance)011-502-2220-2020, International long distance

To call home during the trip:If you wish to call home in the evenings, you may do so from your hotel room. You may use a calling card or credit card. To do so, dial “0” for the hotel operator, then request to be transferred to an AT&T operator. Have your credit card ready and they will connect your call using your credit card. Prior to departure, make sure your particular credit card will accommodate international call.

Three Guatemalan cell phones will be provided to the Team Leader.

Temperature Forecast: From Weather.com - estimated average temps: hi of 72 degrees and low of 61 degrees. November is during the dry season.

Recommended Vaccines:

Vaccine Vaccine Information SheetHepatitis A http://www.cdc.gov/nip/publications/VIS/vis-hep-a.pdfTyphoid http://www.cdc.gov/nip/publications/VIS/vis-typhoid.pdfHepatitis B http://www.cdc.gov/nip/publications/VIS/vis-hep-b.pdfTetanus http://www.cdc.gov/nip/publications/VIS/vis-td.pdf

Team Roles & Responsibilities

Trip/Team Leader

Responsible for overseeing conduct and adherence to safety guidelines and is accountable to the international leadership committee.

Identifies procedures for the surgical mission. Makes final decision on the number/type of team members and approves medical staff. Works with clinical coordinator to ensure correct supplies and/or necessary equipment available,

packed, and included in the shipping manifest. Participate in pre-trip planning and post-trip follow up meetings as required. Works with other surgeons/anesthesiologists to schedule/prioritize cases Sets daily schedule if changes are considered while in Guatemala

Surgeons (including any residents and fellows)

Help determine surgical procedures and required team members Work with team and Shalom Foundation to ensure correct supplies, medications, and/or

necessary equipment available, packed, and included in the shipping manifest. Participate in pre-trip planning and post-trip follow up meetings as required. Screen patients at clinic in Guatemala Participate in prioritizing and scheduling patients for surgery

Anesthesiologists (including any residents and fellows)

Help determine surgical procedures and required team members Work with clinical coordinator to ensure correct supplies, medications, and/or necessary

equipment available, packed, and included in the shipping manifest. Participate in pre-trip planning and post-trip follow up meetings as required. Screen patients at clinic in Guatemala Participate in prioritizing and scheduling patients for surgery Set up operating rooms

CRNA

Works with clinical coordinator to ensure correct supplies, medications, and/or necessary equipment available, packed, and included in the shipping manifest.

Participate in pre-trip planning and post-trip follow up meetings as required. Set up operating rooms

Clinical Coordinator / OR Nurse

Participate in pre-trip planning and post-trip follow up meetings as required. Recruit nursing staff by reviewing applications and determining qualifications Work with team to ensure correct supplies, medications, and/or necessary equipment available,

packed, and included in the shipping manifest. Supervise packing Determine team work flow

OR Nurse

Participate in pre-trip planning and post-trip follow up meetings as required. Work with team to ensure correct supplies, medications, and/or necessary equipment available,

packed, and included in the shipping manifest. Participate in packing supplies Participate in clinic as needed and/or assist in setting up ORs

PACU Nurse

Participate in pre-trip planning and post-trip follow up meetings as required. Work with team to ensure that the PACU has the correct supplies, medications, and/or

necessary equipment available, packed, and included in the shipping manifest. Participate in packing supplies Participate in clinic as needed and set up PACU

Health & Safety Guidelines

Before you leave, give copies of your passport and any credit cards you plan to use to a family member or trusted friend. Contact your credit card company to alert them that you will be using this card in Guatemala so that your card is not suspended due to potential fraud concerns. This is important for your ease of travel.

Several days prior to departure, begin drinking plenty of water. Guatemala City’s elevation is just less than 5,000 feet.

In Guatemala, drink only purified water; use only ice made from purified water.

First aid kit will be available (Cipro, Imodium, Tylenol, etc.); see Lori Graves.

Do not eat ANY foods from street vendors. You can get sick.

Eat only fruits that can be peeled.

Take and use hand sanitizer often.

NEVER go anywhere alone; remain with the group AT ALL TIMES.

Clean out your wallet. Take only necessary identification, credit card(s) or cash. It is advisable to purchase a special pouch or belt for the purpose of discretely carrying your valuable items. If you don’t need it, don’t take it.

We suggest you leave all non-necessary valuables at home, including all jewelry.

When possible, always ask permission before you take a picture of someone: “¿Un photo, por favor?”

While traveling in vehicles in-country, always wear your seatbelt.

Tips for Communicating through a Translator

Speak to the audience/individual, not the translator.

Speak slowly and clearly.

Speak loud enough for the translator to hear and understand you.

Use short simple sentences. Allow time for the translator to speak.

Be conscious of the time factor. Remember, everything has to be repeated.

Avoid slang. Slang confuses the audience because it does not translate well.

Packing Lists

Essentials: Passport and vaccine card if one was provided for you Second ID such as driver’s license Cash (new /$ 20.00) and credit card (only what is necessary – for dinners,

incidentals and shopping. Please contact your credit card provider to inform them of your travel to Guatemala or your card could be suspended due to potential fraud worries.)

Travel wallet Team manual, notebook/journal, pen Camera, batteries, battery charger and/or disposable camera Personal prescriptions, medications (pack in carry-on), vitamins and eye drops Glasses, contact lenses, contact lens cleaner Hand sanitizer and handi-wipes Sunscreen Umbrella and/or rain jacket Reading material

Clothing List: Scrubs will be provided by The Moore Pediatric Surgery Center each day. You are

welcome to bring your own scrubs in addition to those provided at the center if you have a preference for a particular design or fabric choice.

Work shoes (for clinic and surgery days) Casual pants such as jeans, cotton pants, khakis and/or casual summer skirt(s) Casual shirts of your preference: T-shirts, button-downs, long-sleeved, polos Casual shoes for the evenings; comfortable walking shoes for Antigua Light jacket, sweatshirt, fleece or sweater for cool evenings Slacks, skirt, jacket for dedication activity Saturday evening Sleepwear, slippers, flip flops Work out clothes, running shoes, running socks, iPod Belt(s), socks, underwear

Sundries and Miscellaneous: Shampoo, conditioner, hair gel, hair spray, blow dryer, curling iron, comb/brush Any special soap in plastic container or shower gel (soap provided by Clarion Suites

along with bottled water each day for brushing teeth) Deodorant Toothbrush, toothpaste, dental floss, mouthwash Tweezers, nail clippers and file (pack in checked bag) Cosmetics, cosmetic bag, compact mirror, makeup remover, cleanser, moisturizer Razor and shaving cream (pack in check bag) Quart size zip lock bags for any liquids carried onto plane; one per traveler

Useful Spanish Phrases and Words

Pleasantries   Introduction / Introducionplease Por favor What's your name? ¿Cómo se llama?thank you Gracias My name is . . . Me llamo . . .thank you very much Muchas gracias Pleased to meet you. Mucho gusto.

you’re welcome De nadaI'd like you to meet . . .

Querria presentarie a…

no problem No hay de que This is . . . La presento a . . .I'm sorry Lo siento Where are you from? ¿De dónde es usted?

I'm from . . . Soy de . . .Hello and Goodbye / Hola y Adios How are you doing? ¿Cómo está usted?Good morning Buenos dias I'm (very) well. Estoy (mui) bien.Good afternoon Buenas tardes I'm (very) bad. Estoy (mui) mal.Good evening Buenas noches I'm so-so. Estoy asi-asi.Hello Hola Miss SeñoritaGoodbye Adiós Mr./Sir SeñorSee you tomorrow Hasta mañana Mrs./Ma'am SeñoraHave a nice day Que pase buen dia

Health / Salud      

How are you feeling? ¿Cómo se siente? doctor el medicoI don't feel well. No me siento bien. nurse el enfermeroI feel well. Me siento bien. height la alturaI feel better. Me siento mejor. weight el pesoI feel worse. Me siento peor. pulse el pulsoIt hurts. Me duele. blood pressure la tension arterialPain El dolor medicine (drug) la medicinaWeak Débil bandage el vendajeThe surgery is finished.

La cirugía se termina a pill una píldora

Your child will be well. Su niño será bien. wound la heridaSurgery was successful.

La cirugía tuvo éxito scar la cicatriz

The Body / El Cuerpo      

Brain la cerebro heart el corazónNeck el cuello stomach el estómagoShoulder la espalda belly la barrigaArm el brazo hip la caderaHand la mano skin la pielWaist la cintura bone el huesoChest el pecho blood la sangreThigh el muslo skull el craneoKnee la rodilla lung el pulmon

WHAT TO EXPECT AT THE MOORE PEDIATRIC SURGERY CENTER

THE MOORE PEDIATRIC SURGERY CENTER STAFF

The Moore Association employs a full time Medical Director, Business Administrator, Chief Nurse, Bookkeeper, Maintenance Supervisor and Social Worker. Part-time staff members for each surgical mission trip will include surgeons, nurses, residents, pharmacists, laundry and cleaning staff, translators and a patient transportation/housing coordinator. A group of fine local surgeons have been assembled to provide the proper pre-screening and appropriate follow up care for each mission team’s patients. Proper and excellent post –care is one of the most important keys to a successful outcome for each child.

The Shalom Foundation’s Director for Guatemala also works with our teams providing overall program leadership and coordination between US teams and our Guatemalan partners.

FACILITIES, EQUIPMENT & SUPPLIES

The Moore Center is equipped and furnished with support from medical partners from across the US. Visiting team members will feel at home. The more modern equipment will improve efficiency and effectiveness in the work we are doing.

Surgery Center amenities include: 3 Operating Rooms

o Each OR is equipped with:

OR Table Anesthesia Machine Central Suction Central Oxygen, Nitrous Oxide & Medical Air (two locations each OR) OR lights Air Conditioning Back-up Generator Electro-cautery units

(Tour is available on www.TheShalomFoundation.org)

PACU with 5 beds with air conditioning Instrument Washing Area Instrument Sterilization Room with 2 steam sterilizers and one small autoclave. 20 over-night patient recovery beds including cribs with guest chairs, side tables, wall lamps

and over-the-bed tables Semi-private patient bathrooms with each recovery room Nurses’ station Pharmacy Elevator for patients transportation from 1st floor into ORs in 2nd floor Consultation area Team members’ dressing rooms, showers with hot water Doctor´s lounge area with AC Conference Room with Telemedicine Option WIFI Internet Connection within the Moore Center Clean water systems for the OR floor and Kitchen Patient and family waiting room

Patio waiting and play area Family Cafeteria Prayer and ministry room Secured parking for Guatemalan and US team members Back-up generator Telephone and internal communication system Electronic security system, 20 cameras, continuous online visibility Sewage treatment plant Soap and hand gel dispensers throughout facility Resident sleeping quarters with bathroom

MPSC will provide:1. Med Gases (oxygen, nitrous oxide, medical air), central suction 2. Purified water to surgery suites, scrub areas, sterilization room as well as hot water.3. Electricity including emergency generator with automatic switch after 3 seconds of power

loss4. Laundry service for all towels, linens and drapes5. Basic surgical instrumentation and supplies to aid in cases as required6. Resource for meds, prescription drugs and anesthetic gases to be purchased in country

thru MPSC. A list of basic supplies and drugs available through MPSC will be provided for each team during the planning period.

7. MPSC will be responsible for all building maintenance and up keep. A Maintenance person will be available for needs regarding the building, furniture, equipment or utilities.

8. Onsite bio-med technician during surgical mission to assure function of medical equipment.9. An adequate inventory of basic supplies and medicines according to a published list.

STAFFING FOR MISSIONS TEAM

MPSC WILL PROVIDE:1. Physician who will work with the team, surgeons and specialists in advance of the mission,

during the mission to insure surgeons’ orders are followed, medication is given as indicated, charting is completed, family members are informed and patients discharged. MPSC Medical Director will be on call during the night (along with the Guatemalan residents who are on site) to attend any emergency that may occur and will contact the team leader for questions or assistance as needed.

2. Nursing staff to cover post-op and over-night stay patient care through well trained nurses who have been carefully selected

3. In-house Resident(s) on-site, rotating every 24 hours during the week of the surgery mission

4. Medical Director´s guidance, assistance and support at all times prior, during and after any surgical mission

5. Secure and pre-screen patients according to specialty and dates of team with charting and labs in order. Minimum age and weight requirements will be established. Feeding protocols can be recommended for malnourished patients prior to surgery.

6. Contact, screen and secure a specialist surgeon according to the team’s discipline who will be responsible before the Guatemalan Health Ministry for follow-up care for all patients. This surgeon will sign off on the license for US Surgeons and Physicians to practice medicine in Guatemala.

7. Volunteer and paid English/Spanish translators to assist the team at the MPSC stationed throughout the building and during their activities.

US TEAM LICENSING, PREPARATION & SUPPORTMPSC WILL:

1. File for the medical license of each and all physicians that come to the MPSC. Nurses and aid staff do not require licenses.

2. Coordinate and secure all permits from the Guatemalan Health Ministry to import medications that the team is bringing into the country. This can only be achieved if the team’s inventory of meds along with other necessary information is receive by TSF / MPSC staff at least 6 weeks in advance of team´s arrival

3. MPSC will utilize a paid, professional customs agent who will facilitate the drug import process along with Health Ministry Letter of Authorization while the team passes through Customs at the Guatemala City Airport. TSF & MPSC will coordinate the team’s payment of the taxes on the importation of meds.

4. Provide Lunch for team members at the surgery center (screening day and days of surgeries).

5. Ground transportation. TSF will provide ground transportation thru an in-house service or outsourced with insurance. Ground transportation will be provided for the team during the mission and one day of sightseeing activities in Guatemala City or Antigua, Guatemala.

a. 14- passenger van (s) from 1 day prior to patient screening “clinic” day and up to 3 days after surgeries are completed. Appropriate vehicles will be provided for team members in excess of one 14-passenger van up to 2 total vehicles.

b. Truck (basic pick-up truck) for luggage transportation (arrival and departure).

6. TSF will provide,Two cell phones for team administrator and Lead Surgeon with 50 local minutes included to be used for communication between MPSC staff and team. Additional minutes can be purchased in any retail location safe and convenient to team member access (convenience stores, grocery or drug stores). Cell phones provide excellent communication and can be used to make international calls. (Additional minutes for cell phones are at team’s own expense.)

7. Plan a Celebration Dinner hosted by TSF & MPSC.

TSF AND MPSC WILL:1. Make available to patients, access to clinical lab at a very low cost and at a close distance,

but will not be responsible to cover such cost. Each patient is responsible to cover their own pre op, trans-op or post op testing (including but not limited to blood work, clinical laboratory, x-rays, MRI, CAT scan, ultrasound, or any other requested or ordered by physicians of the MPSC).

a. The MPSC has subcontracted a clinical lab “on demand” and “on call” to manage samples for testing including processing and reports needed.

2. Manage a patient’s transfer to ICU if necessary. The Medical Director, Surgical Team Leader and Guatemalan surgeon will assess the best option for patient care according to MPSC Procedures. The Moore Association of Guatemala Medical Chairman may also be consulted if necessary. He should be made aware immediately of any potential transfers to ICU.

The MPSC Medical Director and/or Medical Chairman will have the power and authority to decide what is best for the patient and will secure parent consent for transfer in the event visiting physicians are not in agreement with the decision on how to handle patient,

3. Provide and coordinate two weeks of post op care and updates on follow-up care of all patients.

4. Provide patient data available for follow-up and updates. An electronic patient data system is being investigated and will be employed as soon as possible .

PATIENTS WILL BE PROVIDED WITH:

1. Information regarding upcoming surgery trips through advertising, an online calendar and pro-active communications with health care providers, the medical community and humanitarian aid organizations.

2. An initial evaluation by a physician along with necessary testing for proper evaluation and care including appropriate pre-op care to bolster overall health.

3. Chart and Patient History.4. Admission to MPSC on day patient’s surgery is scheduled.5. A satisfying waiting area.6. Basic hospital supplies while patient is in surgery center (including meals, fluids for patient

only, waiting chair for relative, cafeteria area, waiting area).7. Post Op Care according to physician’s orders.8. Guidance and coordination with social worker in advance of surgical visit for housing,

transportation and other needs.9. Guidance and coordination with MPSC personnel for labs, x-rays, tests and other needs.10. Post Op and follow up appointments with local physicians.

OPERATIONAL COSTS:

TSF & MPSC has furnished, equipped and staffed The Moore Surgery Center, providing for all operating costs year-round through fundraising efforts, in kind donations and the generosity of partners.Patients will be required to pay a minimal dignity fee according to their socio-economic status as evaluated by a social worker. No patient will be denied treatment for lack of funds. No payment agreements will be established with patient families, as the fees will be manageable for this poor socio-economic group.

Each Surgical Partner Team is asked to assist with the continuance of this project by raising and donating to The Shalom Foundation/ MPSC for each visiting mission trip $ 10,000 US.

Another simple cost reduction is the efforts of team members getting donations of supplies and equipment from their vendors and bringing them in their checked luggage. This reduces operational costs of maintaining inventories. The Shalom Foundation can provide tax identification forms for deductibility should suppliers request it.

CONTINUED COLLABORATION IN GUATEMALA & THE US

The Shalom Foundation strives to improve overall health, nutrition and medical care for children, women and families in Guatemala and the US. Through education, training, deployment of resources and expertise, research, heightened awareness and a strong commitment to service, TSF hopes to achieve these goals via The Moore Pediatric Surgery Center.

Medical partners and non-profit organizations with an interest in Guatemala have successfully referred patients to TSF. Our intent is to build sustainable relationships across the United States and Guatemala to serve children from across all of Guatemala, to increase medical education and research opportunities. Partnerships and collaborations with fine medical institutions, universities, medical schools, service organizations and research entities are essential to the program. We seek these opportunities with and through our Surgical Partners.

We will rely upon our own efforts, those of our Surgical Partners and endowment Patrons to learn more, to establish and grow an excellent medical program touching thousands of individuals each year.

THANK YOU FOR YOUR INVESTMENT OF TIME TO PLAN AND GO!! YOUR EFFORTS WILL CHANGE LIVES! AND WATCH OUT, YOURS MAY BE ONE OF THOSE CHANGED!