For the Children

Rounding the corner to the clinic’s at the General Hospital in Grenada, I was struck by how much had changed and yet how much had stayed the same during the thirteen years that the Children’s Health Organization Relief and Educational Services, CHORES, has been providing assistance to the children of Grenada. Two familiar faces were discussing a child who may need to be brought to the United States for corrective cardiac surgery. Dr. George Armstrong a pediatric cardiologist and Chief Medical Officer of Wolfson Children’s Hospital in Jacksonville, Florida and Dr. Beverly Nelson, the pediatrician in Grenada, were evaluating the echocardiogram of a twelve year-old boy who had been previously diagnosed with rheumatic fever and subsequent rheumatic heart disease at four years of age and had been followed by Dr.’s Nelson and Armstrong since his initial presentation. That day it was decided that he would not need surgery at this point, but would continue with his program of monthly penicillin prophylaxis and be seen at the next cardiology clinic in six months. Both the patient and his mother looked relieved as they thanked Dr. Armstrong and left the clinic on their long walk home.

This patient and thousands of others have benefited from the services of CHORES, a not for profit, non sectarian children’s health care organization based in Jacksonville, Florida. It was in September of 1989 when Dr. John Assi, Dr. George Armstrong, Ms. Laura Windle and I along with eight other pediatric professionals first boarded the BWIA jet in Miami for our initial project to Grenada. Few of us had done any missionary work outside the United States and we were excited but nervous in not knowing what to expect or how we would be received. How did we all come to be going to Grenada? That is a story of circumstance. Earlier that year Ms. Windle was contacted by a friend that was helping coordinate medical donations for Grenada. Laura, then working for Dr. Assi, told him what she was doing and he asked how he could help. In speaking to Dr. Assi, I also became interested which led to my contacting Dr. Nelson and performing a fact finding trip to Grenada in the spring of that year.

Grenadian by birth, raised and educated there and in the United States, Dr. Nelson began reaching out on behalf of Grenadian children from the moment she returned to practice medicine in her beloved island nation in 1989. "I love medicine and I love my country," says Nelson. "I knew there were complex problems in tertiary care for our children due to lack of specialty services and outdated medical facilities. My decision to return carried with it a responsibility to bring about change.” When asked about her help from Jacksonville, Dr. Nelson stated, "I've always known there was a larger hand working in this, but I could never have dreamed this miracle that is CHORES."

In 1989, during the first CHORES project, Dr. Armstrong was astounded to discover the incidence of Rheumatic Heart Disease among the children of Grenada occurred at a rate approximately one hundred times that in the United States. Rheumatic fever and secondary rheumatic heart disease is, for the most part, preventable and has nearly been eradicated in North America. With the assistance of CHORES, the Grenadian Heart Foundation and the Ministry of Health, several Grenadian children have received cardiac surgery in the United States to replace heart valves destroyed by repeated episodes of rheumatic disease. CHORES has assisted with programs of health education through which the Grenadian population has been made aware of this serious disease, including measures of early detection and prevention. Over the past ten years Dr.’s Nelson and Armstrong have noticed a dramatic change in the pattern of this disease, with the incidence of new onset and recurrent rheumatic heart disease in Grenada having been significantly reduced. This is due to the ongoing educational programs and monthly prophylactic injections of penicillin provided by the Ministry of Health to individuals identified as having rheumatic disease.

CHORES’ programs in Grenada focus in a number of different areas for which services are provided on each project, giving continuity in a number of different areas. In addition to pediatric cardiology, CHORES provides programs in pediatric specialty surgery and anesthesia, physical, occupational and speech therapy, prosthetics, medical education and engineering and construction. We work closely with the Ministry of Health in providing programs of public health education including the “Back to Sleep” program for prevention of SIDS. Recently Ms. Jeannie Blaylock of First Coast News has brought her “Buddy Check Program” for the early detection of breast cancer to Grenada calling attention to women’s health issues. With the assistance of Dr. Armstrong, Wolfson Children’s Hospital and the Ronald McDonald Home, CHORES has brought a number of Grenadian children to Jacksonville for medical evaluation and treatment including surgery. In Grenada alone, CHORES has performed more than seven thousand patient evaluations and donated more than five million dollars in services and an additional two million dollars in material donations.

CHORES also has an ongoing commitment to the Philippines. The first CHORES project to the Philippines occurred in 1990 when Dr.’s James McCrory, Craig Down, Jose Martinez and I flew to Manila to teach the first AHA Pediatric Advanced Life Support (PALS) in Asia. Since that initial project, CHORES has provided eight programs to this country. PALS has been taught on each project and on the last two projects, pediatric speciality surgery has been included in the program. The patients and their parents are especially appreciative of our services. In the Philippines, an especially difficult patient was brought to Dr. Warner Webb who accompanied a CHORES project to Zamboanga. This child had advanced disease and there was nothing that could be done to help him. Taking time and explaining all this to the family was healing for them and they were appreciative of him coming all that way to help the people of that region. In addition to the projects, with the help of FOREX, a shipping company in Orange Park, CHORES provides medical materials to the Philippines on an ongoing basis.

What has made CHORES efforts to Grenada and the Philippines so successful over time? "The key to our success has been twofold," says Armstrong, who has been on twenty-three of the twenty-five CHORES projects to Grenada. "One, we listen to the needs of the people and respond . . . we don't tell them what we think they need. Two, we keep coming back. They know they can depend on us." CHORES schedules programs to Grenada every April and September to provide continuity of care. In discussions with the Minister of Health, Claris Modeste M.D., Armstrong learned that CHORES had been providing service to Grenada far longer than any other non governmental organization. The success of each effort, both in Grenada and the Philippines are only accomplished with the participation and commitment of people at both ends of the project. This commitment has been recognized in the Grenadian Parliament, where recently, governmental assistance been allocated for these programs.

Other reasons for CHORES successes stem from the commitment and consistency of individuals both here in the United States and those in the countries served. Without the support of the local practitioners and business owners in these countries the successes that CHORES has made would be vastly diminished. Imagine trying to get a sixty-foot container of medical supplies through Customs, coordinate and arrange hundreds of patients to be seen in a variety of clinics or disseminate information and educational materials months ahead of time for a PALS course without the assistance of the local practitioners. Impossible - without a doubt!

CHORES’ twice yearly projects to Grenada requires planning at least one year in advance. Areas of pediatric specialty surgery need to be identified, schedules need to be cleared and medical donations need to be procured and shipped in coordination with each of our efforts. Corporate supports from Publix, American Airlines and TecMarine, ICS Logistics and the Jacksonville Port Authority, have helped transport needed supplies from Jacksonville to Grenada. In Grenada, local businesses help sponsor airline tickets, the Grenada Hotel Association provides housing during the projects and local car rental agencies provide automobiles. It is truly a collaborative effort, not just physicians that make these projects work. With everyone doing just a small part, tremendous things can be accomplished.

Health care in the United States is very atypical of what occurs globally, especially in developing countries. Individuals that participate on these projects get a better understanding of the way medicine is practiced for the majority of our world’s population.

CHORES volunteers gain an insight and appreciation of the talents of health care practitioners who provide care in developing countries, without the technology easily accessed here in the United States. It is an opportunity to share our knowledge and resources with those who can truly benefit from them. It gives us a chance to feel vital to make a difference in a child's life, a difference that would not occur if we had not been there. It gives individuals a sense of personal and professional fulfillment not always appreciated here in the Unites States. It gives Dr. George Armstrong, the busy medical director of Wolfson Children's Hospital, a chance to step back and do "what I was trained to do.”

We are blessed in Jacksonville with a number of pediatric specialists and children’s advocates who are committed to improving the health care of children in developing countries. This includes physicians, nurses, physician assistants, physical, occupational and speech therapists. Also, involved are pediatric educators, prosthetists, biomedical engineers, contractors and artists. This diverse and talented group of individuals have come together in concert with those dedicated and committed individuals in Grenada and the Philippines, forming a community of people dedicated to the betterment of children’s health, promotion of health education and children’s health issues in these developing countries. What can CHORES and Jacksonville show the rest of this country? We at CHORES firmly believe that what we have done is create a model that other children’s hospital communities around the United States can emulate. There are more than eighty such pediatric communities in this country alone that could develop projects such as CHORES. The committee on International Pediatric’s of the American Academy of Pediatric’s has called for “the development of chapter to chapter liaisons between pediatric communities in the United States and those in developing countries.” We at CHORES have done this and more.