To catch the vision

Adventist Health International helps struggling hospitals build a strong foundation

Your mission, should you choose to accept it: form a boot-strap organization with no regular source of funding or paid staff, go out into the poorest of the nations, and develop a plan to revitalize health-care programs in crisis.

Founders of Adventist Health International (AHI) accepted that very challenge several years ago, and are now assisting struggling institutions in six nations--and facing a backlog of requests for help from many more.

The roots of Adventist health care were firmly established in the early 1900s with years of hard, creative work and sacrifice. Today, the Church operates more than 160 hospitals, and Loma Linda's alumni have been instrumental in establishing most of these health-care institutions.

Nearly half, however, are in third-world countries and face harsh conditions: weakening economies, shrinking budgets, wars, deteriorating buildings, limited professional staff, changing national and Church politics, and even genocide.

The average income in the 50 poorest countries of the world is between $300 and $500 a year, of which only $3 to $5 is spent on health care per person per year.

Why begin a battle against such overwhelming difficulty? "If the medical need still exists," says Richard H. Hart, MD, DrPH, president of AHI and chancellor of LLU, "then our Biblical commission to teach, preach, and heal is still valid.

"Loss of our international commitment would undermine what this Church is all about and what Loma Linda University has come to embody," he adds. "If we lose those institutions, we fundamentally change the character of Loma Linda. We are not just helping them; they are helping us."

The first institutions to become Adventist Health International members were Gimbie Adventist Hospital in Wollega, Ethiopia; Davis Memorial Clinic & Hospital in Georgetown, Guyana; and Mugonero Adventist Hospital in Kibuye, Rwanda. All were in desperate straits and in danger of being closed. Institutions in Cameroon, Haiti, and Zambia are undergoing initial strategic evaluation and planning this year.

Strategy

Two little girls wait with varying degrees of enthusiasm to see a physician at Gimbie Adventist Hospital in Ethiopia.

AHI has identified four components for a successful turnaround: an organizational structure that provides for clear governance and management roles linked with health-care management experience, governance strengthening, management training, and resource mobilization.

With the approval of the Church structure, a separate board of directors for the institution or health-care system is created as a legal entity to do business in that country. "While a separate governance structure is a key factor, our whole approach involves working with the Church--not to close it out in any way," says Donn P. Gaede, MPH, secretary for AHI and assistant professor of health administration, School of Public Health.

Next, the new board is trained how to function as a board, including such areas as strategic planning, balanced budgeting, staff selection, etc. AHI officers and other lay Church members with expertise in specialized areas also serve on the board.

In Africa, the management training aspect has led Loma Linda University to launch a four-year master of public health program at the University of Eastern Africa Baraton in Kenya. The program, which has 65 students from 20 African nations, includes physicians, administrators, teachers, nurses, and Church health secretaries. (See separate story beginning on page 56.)

With the first three components in place, only then is resource mobilization initiated. Buildings are constructed or repaired, equipment is secured, and personnel are recruited. "It is tempting for many people to jump over the first three steps, and start with the easy visibility of step four," says Dr. Hart, "but we don't get there until the first components are in place. Otherwise, we are just putting on a Band-Aid; we are not fixing the system."

Implementation

"Our goal in each of these institutions is to make their operations self-supporting as much as possible," says Mr. Gaede.

Davis Memorial Hospital, once the premiere hospital in Guyana, had deteriorated until the occupancy rate was two to five patients a day--with a staff of 68 people running the hospital, no attached physicians, and very low morale among the staff. The Church voted to shut it down. That was before AHI was invited in to try to save the institution.

"AHI has made real progress in Guyana," says Mr. Gaede. "It is now one of our bright spots."

The AHI initiative achieved "a complete turnaround of a dead institution," says Elie S. Honoré, MD, MPH, director of the health & temperance department of the Inter-American Division of Seventh-day Adventists and a 1985 graduate of the School of Public Health. He notes that the foundational step of putting together a functional board has made "a world of difference."

The buildings are being upgraded, training programs have begun, and medical staff and management recruited. "The hospital has been meeting payroll for a year," says Mr. Gaede.

On February 18, 2001, official opening ceremonies were held at Davis Memorial Hospital for a Foundation Health-care Worker training program. This program provides a basic introduction to health care through instruction and exposure to each department of the hospital and its various responsibilities.

During the planning phase of the curriculum, the Ministry of Health of Guyana recognized the value of the program and designated it as a stepping stone to various health careers.

Mr. Gaede (left) meets with Dr. Joseph Bizimana Nzabamwita, Adventist Health Ministries director of the Rwanda Union Mission, during a summer work session.

Alexander A. Isaacs, MPH, a 2001 graduate of the School of Public Health who now works in the Ministry of Health in Guyana, was named course director.

Coupled with the opening ceremonies was the dedication of the Healthcare Learning and Resource Center at Davis Memorial Hospital. Center resources are not only available to students in the training program, but also to students in the community. Major supporters of the project were Dr. and Mrs. Gordon Thompson. Dr. Thompson is a 1948 graduate of the School of Medicine.

In Ethiopia, Gimbie Adventist Hospital--threatened with closure by the government if the facility and services were not brought up to standard--approximately $300,000 was raised to build a new hospital. Rafters for the three-story hospital are now being installed, and plans are to have the building completed by the end of the year. "More important," says Dr. Hart, "we have staffing and full services back on board."

Expatriots from Loma Linda serving at Gimbie include medical director and surgeon Kenneth D. Rose, MD, a 1988 graduate of the School of Medicine; Nick A. Walters, MD, a family practice physician who graduated from the School of Medicine in 1989; and Darla Lee, RN, MPH, a 1989 School of Public Health graduate who serves as matron.

Mr. Gaede (left) poses with Karora Rural Dispensary personnel in the Kibuye District, Rwanda.

Loma Linda students, faculty, staff, and alumni continue to serve in a variety of roles in the renaissance at Gimbie, from internships and administration to research and construction. (See sidebar on page 41 on parasitic infection research done in Ethiopia.)

A portion of a letter posted on the AHI website on July 16, 2001, by Dr. Walters illustrates Gimbie's ongoing needs: "I was called to the delivery room and the nurse was trying to get a patient to deliver, but her labor had slowed down. We started a medicine to speed it up. Just at that time there was an auto accident, and we ended up with nine casualties. The first [patient] died en route to the hospital and there was not much we could do. The second one had some deep cuts on the face and a head injury.

"Three medical students from Loma Linda are here right now, and I called them to come and help. They have finished their first year and have not had any clinical experience yet, but they got plenty that day. I started one of them sewing up the scalp of one of the patients, and then I got called to the delivery room again.

"There was another woman who had come to the hospital with very severe vaginal bleeding. She had delivered a baby at home two weeks before and had been bleeding quite a bit since then... When I checked her, I discovered the

placenta [was] half in and half out of the cervix. I had to remove [the placenta] right away to stop the bleeding... As I was doing this, the other lady in the bed right next to her decided that it was time to deliver, so I had two of the medical students do the delivery while I was... removing [the placenta].

Mr. Gillespie meets area children at Karora Rural Dispensary in Kibuye District, Rwanda.

"The newborn baby then did not want to breathe, so I prayed, took off my outer layer of gloves and helped to jump-start the little one, and then put on another outer layer of gloves and finished up the job I had started. I then ran back to the emergency room and helped to take care of the other seven patients that needed to be seen from the auto accident." (For the complete letter, read "Road to Gimbie" at .)

Mugonero Adventist Hospital in Kibuye, Rwanda, which had been shut down, is now operating. "It's slowly getting back on its feet," says Mr. Gaede. "All of Rwanda has been trying to recover from the genocide."

Mugonero Adventist Hospital, overlooking Lake Kivu on the western border of Rwanda, has about 100 beds. In addition, a polyclinic in the capital has about 20 beds. (A polyclinic is somewhat between an outpatient clinic and a hospital and can take overnight patients, but surgeries cannot be performed there.) AHI Rwanda also runs a dental clinic in Kigali.

An occasional water shortage at Kigali has led individuals to value each drop. "It's very interesting to wash up with about a cup of water," says Mr. Gaede. "The city would turn on the water only for a short time each day--usually at 2:00 a.m. That's when whoever hears the water come on jumps up and fills the buckets."

This summer, Mr. Gaede and James E. Gillespie, CPA, director of internal audit, LLUAHSC, and chief financial officer of AHI, are spending some time at Mugonero analyzing the hospital's management structure and operations system.

"The school of nursing on the Mugonero campus is amazing," says Mr. Gaede. "Close to 500 students are enrolled, but they have minimal books and no lab materials. The students have very little to study except for notes they take."

What lies ahead

At Mugonero Adventist Hospital, pastor Simon Gakwaya (left), administrator; Dr. Mark Habineza (center), medical director; and Kezie Ayinkamiye, chief of nurses, pose for the AHI photographer.

When asked if he is encouraged about the progress made so far by AHI, Mr. Gaede replies, "Definitely! Every time I go out there, I feel like I'm going on the front line. We are out where there are not enough resources, and the work is overwhelming. There's more work than we can ever do, so we try to stretch our resources the very farthest.

"I have learned, however, that God tends to work things out at the right time, and frequently we have to wait until that right time comes," he continues. "Sometimes we think, 'Well, maybe we're going under'--but no, the right thing, the right person, comes along.

"I'm finally learning not to get uptight," he reveals. "At one board meeting, the board faced the critical problem of having no doctors on the staff. We started praying about it, and then we started looking and came up with two doctors that day that nobody had known about," he recounts. "One doctor was right there in town, and he came right over. It's one of those things where you do what's right first, and somehow God takes care of it.

"Health care is an arm of the Church that can be a demonstration truly of the love of God to the communities," notes Mr. Gaede. "We provide services out of compassion for the people we serve. When we see a problem and we care about the people, we are driven to help solve that problem.

"Through our health-care work, not only can we be a channel of God's love to the community, but another function is to play a role in encouraging our Church to grow this attitude of love for the community," he adds.

Funded only by donations and grants, AHI's needs are many. Along with money, a tremendous need exists for qualified people. AHI officers are looking for physicians, nurses, allied health personnel, and administrators--using a variety of means to reach possible candidates.

In addition to launching a website and newsletter, avenues of communication are sought in other publications and through informal networks of churches and institutions, former missionaries, and alumni.

"While we have begun the MPH program to develop nationals for administrative roles, we still need expatriots who are willing to serve," says Mr. Gaede. "I keep hoping people will begin to catch a bit of the vision, because there is tremendous opportunity out there.

"One problem we are encountering, however, is that while young people may be willing, their student loans are so high they can't afford to go," reveals Mr. Gaede. "Right now, we have a young woman who recently graduated from Johns Hopkins University who is eager to serve, and the mission is willing to cover her living expenses, but her student loans are a big hurdle.

"Another young man who is adept at fixing things is willing to travel from hospital to hospital to service their medical equipment," Mr. Gaede continues. "We desperately need that, but we have to fund him.

It will cost money to transport him and his tools, and pay for the repairs."

Invitation

"While always acknowledging the enormity of the challenge, AHI is moving steadily and confidently into the future," concludes Dr. Hart. "If you would like to join us--as a volunteer, a donor--or would just like additional information, please e-mail me at <rhart@llu.edu>, write me at Loma Linda University, Loma Linda, California 92350; or check out our website at www.adventisthealthinternational.org>."

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