2015: Off to a great start!

Knock has had a productive and exciting couple of months in Tanzania!

PIONEERING MINDS ANNUAL STUDENT MEETING

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We held our annual meeting of scholarship students in early January, where we welcomed two new students and discussed student performance and our expectations. Last year, through advice from our students, we agreed to offer gifts to those who finish top five in their class. This year, we had three such students – Sharifa (Class 6), Evance (Form 3) and Evarist (Form 3) – and were thrilled to present them with gifts [see above photos: our Country Manager, Max, presents gifts to the three students]. We also had two Form 5 students who after their first term, were in the top five of their classes, so we will award them in June if they maintain their status.

Student-elected club leadership - Brenda, Loveness, Elia, Lusi, Erick, Fratime and Najma

Student-elected student club leadership – Brenda, Loveness, Elia, Lusi, Erick, Fratime and Najma

CONSCIOUS LIVING CLUB
Our first primary school club was piloted in February with 60 eager and bright young minds. The club is comprised of 60 girls and boys from classes 3-7.  Meeting after school twice per week and taught by some incredibly awesome young peer educators from a Tanzanian NGO called Youth Control Society (YOCOSO), the club covers important life skills topics such as self-esteem and decision making, reproductive health, drugs and alcohol and HIV/AIDS.  Teaching methods vary from traditional to using song, dance and drama. The students elected their own student leadership who help manage the day-to-day of the club. The pilot month went exceptionally well and we have already added two more schools!

NEW TANZANIAN BOARD
We have recently built a new board of directors in Tanzania to help drive the strategy and growth of Knock’s programs there. Our first board meeting was held in January where voting took place for board positions. We are really looking forward to the increasingly local ownership of Knock’s work.

Knocking Out 2014

A look at what Knock achieved in 2014…

Pioneering Minds Scholarship Program
We added 7 more students to our scholarship program this year, bringing our total to 43 sponsored students in a variety of primary and secondary schools and technical training programs throughout northern Tanzania. Four students are entering great secondary schools and we are anxious to watch their success continue. Edwardi, Salome, Caroline and Joyce all joined advanced level programs (Form 5) in pursuit of their professional goals. Joyce, who is studying a Physics, Chemistry and Biology track in hopes of going to medical school, ranked first in her class after the first semester. We are so proud! It continues to be an honor to watch all of our students grow throughout the years and begin to realize opportunities not otherwise easily available to them.

Business Development and Livelihoods
This year we reinstituted our provision of access to capital for small business development. Focusing on agriculture and animal husbandry, Knock gave out an average of $1,000 each to several individuals earlier this year. We are anxious to see the results of these loans and how they help to propel lives forward.

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Healthcare
Knock continued our ongoing medical missions with another trip to Nicaragua in October, with one set of doctors working in pediatric urology in Managua and another at a regional hospital in Jinotega. As in past missions, we trained local doctors and donated life-saving medical equipment to both areas, and fulfilled promises we made from previous trips in 2013. Our medical mission is unique compared to those of other surgical missions with whom we are familiar. Our focus is on training and giving the equipment that hospitals do not/cannot get on their own; we work with their staff, ensuring that they can continue after we leave. This is consistent with Knock’s mission of developing self-­sustaining practices to assist the community. To date, Knock has shipped over $750,000 worth of medical equipment and supplies.

Lunch Program
Knock provided daily school lunch in Tanzania at Mrupanga Primary School for the sixth consecutive year and at Longuo Primary School for the third consecutive year, to a total of over 850 students. Student attendance and performance continues to be strong as a result.

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Nicaragua Medical Mission – October 2014

10628293_10202805708973494_8229004034091948296_nAlthough I joke about the travails of travel and the challenges faced working in a particular country, you should not think for a moment that I would change any of it. While most, if not all, the challenges revolve around navigating foreign bureaucracies, it is all part of the experience of doing what we do. Moreover, it helps us appreciate more the actual work being done; standing side by side with our foreign colleagues, providing a level of care/expertise and equipment that might not otherwise be available. At the end of the day, this is about the patients, not any of us, or the unyielding customs officer, or the hospital director napping at his desk.

With each succeeding mission I marvel at the care, compassion and dedication of those medical professionals who are patient focused each and every day – despite the distractions. This mission was no exception and, given the distractions, the success was that much sweeter. We were able to accomplish what we wanted and provide our local colleagues the equipment, training and support that they requested and that we promised.

IMG_0585We had two missions going at the same time; Chuck Durkee stayed in Managua and worked with Dr. Olivares, a pediatric urologist (as is Chuck). They handled many complex cases for which Chuck’s assistance and guidance were essential. Moreover, given that this was Chuck’s third time working with Dr. Olivares, he was able to provide follow-­up on previous training he provided. Indeed, Chuck remarked that since he was here last October, Dr. Olivares has performed more skin graft procedures that Chuck showed him, more times in the last year than he had done himself. The cases basically fall into three types (on an overlapping continuum), and all the cases here are congenital (hereditary). I think it is important to explain them in greater detail than normal so you get a sense for the complexity (as if operating on children wasn’t complex enough).

Less complex cases where our doctors are able to show local doctors different techniques or refinements to their existing techniques.

  • Two hypospadias (a congenital condition where the opening of the penis does not come out to the tip of the glans but opens somewhere along the shaft). Occurs in about 1 per 300 boys. 4 days post op the repairs on the two boys looked great.

Management of complications of patients previously operated upon.

  • In one case, a 3 year old girl had a single kidney. He repaired it, but the repair failed, and she was now draining through a tube in her side. Her blockage was both by the kidney and the bladder. We re-­explored the kidney, found the blockage, and hooked her back up. It was a very difficult surgery as there had been a severe infection after the first surgery and everything was scarred. She did well and was sent home after three days. When we return, we will fix the blockage by the bladder and she should be fine.
  • A baby with ureteroceles (a peculiar congenital blockage of the ureter where the ureter enters into a blocked “bubble” in the bladder rather than directly into the bladder as is normally the case). Dr. O had punctured the bubble to get better drainage, an accepted technique, but now there was massive backing up, or reflux, from the bladder to the kidney. We opened the bladder, took out the bubble, narrowed the ureter (it was about 5 times normal diameter) and hooked it back in. The goal is for it to remain unblocked, without reflux.

Management of rare complex anomalies for which Dr. O requested help.

  • A 14 day old infant had mild heart and lung problems. He had a normal appearing penis but on the top of the penis was a small opening leaking urine. He had only one kidney. Right above the penis on the lower abdomen was a round area of thin skin without muscle beneath it. We did a cystoscopy and found: two urethras, one through the penis, one through the small draining opening. They joined together at the level of the prostate. When we entered the prostate area, going deeper we found two openings, each which lead to a separate bladder. There was only one kidney (the left) but it drained into the right bladder. The area of thin skin ballooned up like a water balloon. This is the rarest variant of a rare problem, called covered bladder exstrophy, occurring one per several 100,000 live births. The duplicated bladders make it even rarer. These patients leak continuously until corrective surgery. But, since there is no blockage, and the single kidney is functioning well, it can be safely corrected at a later age.
  • 3 year old girl with a bladder exstrophy (the bladder is open to the skin and drains continuously). There is no skin, muscle or bone in the midline and the bladder is not a sphere, but just a simple round structure sitting on the surface. Dr. O had not done these repairs before. An orthopedic surgeon cut through the pelvic bones so we could bring the pelvic bones together in the middle– –a significant procedure in and of itself. We rolled the bladder back into a sphere and closed her abdominal wall, put her vagina in the correct location as it was too far anteriorly placed, reconstructed her genitalia, created a new urethra. As a result, we believe she will be continent. Finally, we created a belly button, since she did not have one. She was doing great on the first day post-­surgery.
  • The same day we examined a 3 year old boy, never operated upon, who urinated from his anus. We found a second opening right at his anus in the 12 o’clock position (bet you never thought of your anus as a clock). We put the scope up and entered into his bladder. He had a normal penis but the urethra was too narrow to pass a scope through. We passed a wire through it and found where it located into the urethra coming from the anus. We will slowly stretch up his penis urethra to normal size by placing progressively larger catheters each week and can then close the urethra to the anus.
  • 3 year old girl who had a balloon like structure coming out of her urethra into the vaginal opening. It was an ureterocele and Dr. Olivares incised it with scissors 6 months earlier. She still had partial blockage of the kidneys and reflux, or backing up. We explored and found she had 4 ureters, not two. One ureter (from the right) went into the ureterocele, and one ureter (from the left) went down her urethra to the vaginal opening. She also had big pockets or pouches (diverticuli) on each side of her bladder. We took out the ureterocele, removed the pockets, cut off the lower part of the left and right ureters described above, sewed them into the sides of the other two ureters and hooked the other two ureters back into her bladder. The end-result is the bladder will not reflux or be blocked. Surgery went extremely well but was quite a ride, since the x-­rays available are much less detailed than what we use in the U.S. Therefore, we are forced to make educated guesses about what is going on and to be prepared for a number of surprises.

IMG_3053While Chuck worked in Managua, Brian Keuer and a small team headed north to Jinotega to work at the regional hospital with Dr. Montenegro, a local urologist. Courtney Desmond Keuer acted as interpreter (and quickly proved herself to be the most valuable member of the team by far), Bob Wadman, our mister-­fix-­it/utility player who always proves more than his worth on these trips, and myself (I leave you to judge). We came to Jinotega in February of 2013 to do a site visit and it became readily apparent that our services and equipment would be of great benefit. The Hospital is the largest in the province and serves about 800,000. Dr. Montenegro is a very gifted and dedicated urologist but lacks the equipment that would be readily available in any western hospital. Alas, this is not a western hospital. On our initial visit we promised Dr. Montenegro that we would bring the equipment she would need to do the most likely cases in Jinotega – cystoscopes, resectoscopes, cautery machine, light sources, cutting loops, camera and video among other things. Without this equipment, the most routine or diagnostic procedures, might necessitate a patient’s trip to Managua, almost 3 hours away (and even farther if coming from north of Jinotega). Throughout the week Brian and Dr. Montenegro did a variety of cases, including the following.

  • 58 year old woman with a renal mass that had been present for several years causing severe stomach and flank pain. The doctors performed an open left radical nephrectomy (partial removal of the kidney) to remove the large tumor. The patient recovered well and was able to leave the hospital in 3 days.
  • A 44 year old woman with recurrent urinary tract infections and a hydronephrotic (swollen) nonfunctioning left kidney. We performed the first laparoscopic radical nephrectomy at the hospital using equipment that had been at the hospital for some time but that we were able to assemble.
  • A number of TURs(trans urethral resection of the prostate) which is the most common ailment seen and which would either necessitate the trip to Managua or result in an open, surgical procedure absent our equipment. TURs had not been performed in Jinotega by Dr. Montenegro, or anyone, prior to our arrival and Brian’s excellent training on our donated equipment.
  • The first TUR that Dr. Montenegro did solo was a gentleman in his 50’s that had an indwelling catheter for at least two years which helped him void and empty his bladder. She was able to trim away excess prostate tissue and leave him without the discomfort of his catheter.

IMG_4914By the end of the week, Dr. Montenegro expressed that she began to feel more confident in handling the flexible and rigid cystoscope and in performing TURs. A number of TURs were scheduled in the coming weeks, so there is but little doubt that Dr. Montenegro will soon be more than proficient.Unfortunately, not all those who waited for treatment were treated. It was heartbreaking to have to turn away a gentleman from his kidney surgery due to a bad case of bronchitis. He had recurrent infections and pain from his kidney and had traveled 3 days from the forests near the border with Honduras for possible surgery. The decision was in his best interest as a major kidney operation and the anesthesia that it required would likely do him more harm than good at that particular time. We hope to be able to treat him on a subsequent trip.

Our medical mission is unique compared to those of other surgical missions with whom we are familiar. Our focus is on training and giving the equipment that they do not/cannot get on their own; we work with their staff, ensuring that they can continue after we leave. This is consistent with Knock’s mission of developing self-­sustaining practices to assist the community. There is little doubt that training local doctors to doprocedures, and providing them with the necessary equipment, will have a positive and continuing impact long after we’ve left. While we certainly helped clear a backlog and handled cases that were particularly vexing, we were focused on treating a significant number of cases in tandem with the doctors so they would have the necessary training and skills to handle such cases after we left. As Dr. Montenegro remarked, the skills and willingness of Knock volunteers to undertake such a mission results in the betterment of the lives of millions of people who might need specialized urological procedures, and now have a urologist with advanced equipment and training to provide it.

IMG_4803I feel good about the mission because it fulfills a promise we made to Dr. Montenegro and the people of Jinotega on our first visit in February 2013.Tuesday I walked through the Children’s Hospital with Chuck and Dr. Olivares as they examined the patients they operated on the day before, including one discussed above. The little girl was doing well lying in bed with her parents sitting beside her. As Dr. Olivares talked to them the nervousness left their faces and they seemed somewhat relieved. In a country that doesn’t think too kindly of America, given our history with Nicaragua (a country of 6,000,000 – think about our fear of the Sandinistas and a communist takeover. Did this really pose a threat to us in the 1980s?), I wondered if this little girl would ever know that an American doctor helped perform her life saving/changing surgery. Her parents certainly would, and that made me further wonder if this would cause them to think differently about Americans or America? (not knowing how (or if) they felt about us to begin with). This, I believe, is what we should be doing. Missions like these, display the best of America and Americans, our compassion, our life saving skills and expertise, our world-­class technology and limitless innovation. I’ve seen it first-­hand with the doctors on this trip. Say what you will about the state of American healthcare (and I’ve got plenty but I’ll spare you), there is no question that US doctors are absolutely the best in the world. Although doctors from elsewhere are almost always welcome (with a few exceptions), the places we’ve visited have been clamoring for US doctors, as they too view them as the best of a very good lot. I’m proud and humbled to work with such dedicated individuals. It is largely because of them and the work they do, both here and abroad, that reminds me every day why we do what we do despite the (at the end of the day) really minor frustrations and inconveniences.

At a time when we hear a lot (from US politicians) about American Exceptionalism, you also hear it from non-­Americans as the beneficiaries of American medical services, American technology and American compassion. It makes me wonder why we are so quick to bomb no matter the cost, and yet fail to realize the long-­term harm we are doing both to ourselves and our “adversaries.” No better way to make today’s adversaries into tomorrow’s allies than through missions like these, student exchange programs and a host of others. Let others see us not through our ineffective (petty) government, but as compassionate, caring and talented individuals. How can we lead if we can’t get our own house in order? Can’t we, as Americans, do better than this? I certainly think we can, and this is why we will continue to organize Knock Foundation trips.

None of this would be possible without your kindness, generosity and support which goes to buy the much needed, life-­saving equipment used on these missions and then donated to the host physicians/hospitals. We hope you will continue to support us in our efforts and consider joining us on one of our volunteer trips in the future (there is usually a non-­medical component as well). To donate, I encourage you to go to the Knock website at http://www.knockfoundation.org and click on “Donate” (or you can simply send me a check made out to “Knock Foundation”). All of your donations are tax deductible.

Very truly yours,

Bruce

Knocking Out 2012 – A Look Back at the Year

22 December 2012

Knock Foundation has had yet another full year. As you reflect upon this year, we ask that you make a commitment to Knock Foundation so that we can continue helping under-served populations in Tanzania, Kenya and Ethiopia. Read on to see our accomplishments from 2012. 

Education continues to be a main focus of Knock’s work. This year we were able to add 13 students to our scholarship program in Tanzania, where we now have a total of 31 deserving students who have the opportunity of receiving an improved level of education. 

Knock was able to continue its fourth year of the school lunch program at Mrupanga Primary School and its first full year at Longuo Primary School.  Between the two, we provided a nutritious school lunch to almost 850 students. The school lunch program has shown to improve class attendance and national exam scores. 

Knock continued its support of the 35 students at Tulivu Kindergarten in Moshi, Tanzania, where we provided morning porridge and much-needed books and supplies.

In 2012, with help from United Therapies and The Earth Institute at Columbia University, Knock sponsored our fifth medical mission to Africa with our first trip to Ethiopia. Working in the northern city of Mekelle, our team of urologists treated dozens of patients while training local doctors in the latest in medical care.

Our efforts included the following:
• Treated two patients who had been impaled by ox (apparently this is a common problem).

• Treated a young boy struck by lightning, who had the lightning travel through his body and out his penis.

• Performed a 7-hour surgery (the longest in the hospital’s history) on a 3 ½ year old who was born with an open bladder protruding through his skin. Without the surgery the boy would not have survived.

• Performed a myriad of open prostatectomies, cystoscopies and resections.

• Knock donated and shipped a full container of medical supplies to Ayder Referral Hospital and Mekelle Hospital in Northern Ethiopia. One hospital staff member commented that Knock provided supplies that they hadn’t seen (but sorely needed) in over 3+ years.

• A team of volunteers traveled to Southern Ethiopia to work with the 100 AIDS orphans, living at the Awassa Children’s Center.

We are currently organizing our 2013 medical trips, including a February trip to Nicaragua and a return trip to Ethiopia in April, in addition to collecting another container of medical supplies. Please contact us if you would like more information or are interested in joining the trip. 

We at Knock Foundation dream of new possibilities for the future. As we welcome 2013, we are looking forward to maintaining our current projects as well as continuing to look for new opportunities. 

Please join us in providing sustainable change that will allow people to lift themselves out of poverty. Every donation makes a difference.  Make your year-end donation today. As always, thank you for your continued support. Knock Foundation could not offer the amazing opportunities it does without support from donors like you. 

Happy Holidays and best wishes for a great new year!
Michelle, Kim, Barry, David and Bruce

Important News Regarding Matumaini Child Care Center
Late last year a conflict arose between Matumaini Child Care Center and Knock. Knock has met with every possible government agency/official at the district, regional and national levels to try to reach a resolution that would allow the kids we have grown to love and care deeply about to continue being cared for with our funding. It has been a long and trying road and until today, a resolution has still not been reached. Knock funded the center until the expiration of the partnership agreement on July 31st and even continued so for the months of August and September.  But Knock had to make the difficult decision to cease our funding at the beginning of October. We are still funding school for many of the children and continuing to look for opportunities to care for as many of the children as possible. 

We want to assure you that your donations to Knock Foundation are still being used effectively and efficiently and we are doing everything we can with our partners on the ground to ensure this remains true. If you have any further questions, just let us know and we will be happy to talk more about it.

Swimraiser in the Caribbean

In October I participated in a 5-mile inner-island swim in the Caribbean. Thanks to numerous donors I was able to raise $10,000!! This race was a challenge to say the least – Not only was I not a swimmer before this race – I had never done a race before, not so much as a 5K run. Race morning – I was so nervous I could barely get dressed… let alone put sunscreen on which I needed a lot of. Once we got to the ferry we went through body marking and I got #29 written on both arms. Once to the island, we had 15 minutes on the beach to “warm up” or get mentally read … I stood trying to calm down. I had my goggles on and my music headset ready.

The horn blew and I let everyone sprint into the water and I walked in behind. I swam a few strokes with my head above water and then took a deep breath and put my face in. Instantly my ear buds to my music came out, I rolled to my back to try and fix them but with the waves I was unsuccessful. I gave up and rolled back to my belly to keep swimming and saw a scuba diver below me – checking on me. It was nice knowing there were safety kayakers and divers, literally surrounding me from top to bottom 🙂

The first 2 miles crossing the channel from Buck Island to St. Croix were the most physically challenging; the swell was bigger than I had anticipated. The next 3 miles were along the coast of St. Croix – it was breathtakingly beautiful. I saw several sea turtles, 2 stingrays and really pretty fish. I missed the drink station boat but luckily had a kayaker offer me a bottle of water. He kindly opened it and handed it to me at which point his kayak capsized with his young son in it. I dropped my water and tried to help. Once they were safe I pressed on. I was parched. The hardest stretch for me was 3.5 to 4.5 miles. My shoulder was hurting, my tongue was like sand paper, I was starting to get seasick and I wanted to quit. I thought of all the generous donors and kept kicking. The final turn buoy felt as if someone was slowly pulling it further and further as I swam towards it. It reminded me of teaching a child to swim and backing up as they come towards you.

I finally could put my feet down and heard a ton of cheering; I had an overwhelming feeling of relief and accomplishment. I finished 4 minutes over time but was so proud I completed it. There were some serious competitors – even Gold Medalist Misty Hyman was there! 5 miles was definitely further than I had imagined (think of it as 88 lengths of a football field). And 4 hours in the water was longer than I had ever thought possible. Thank you to everyone who made this swim-raiser so successful!

~Michelle