5) Description of health product/service offering: We are developing a health community to provide access to health and surgical services to low-income patients in under-served rural Guatemala. Currently these individuals are marginalized and must travel great distances to major urban centers in order to see a doctor. They often suffer from ailments, such as hernias, that would be considered minor to the healthcare system of their country, but which have a major impact on their ability to provide for themselves and their families. Conditions such as hernias, recto-vaginal fistulae, phimosis, hydrocoel, biliary tract and other disorders can be treated effectively based on an outpatient/short stay medical model common in the US but almost unheard of for the poor in this part of the world. A healthcare facility staffed by volunteer professional will fill the major gap in the current healthcare system in rural Guatemala while providing a model for expansion and replication in other developing countries.

6) Description of innovation: This outpatient surgical facility will be staffed by specialists engaged in short-term service "vacations" in a secure residential environment. Specialists will be encouraged to travel include their family and incorporate day trips to the surrounding country side and sessions in the native language to enhance their experience. We see this as an opportunity for two-way education; building bridges through empathy and the education of both volunteers and patients - volunteers are educated through the experience as a whole and patients gain necessary knowledge through short presentations in the waiting room. Medical procedures are performed to minimize hospitalization while addressing needs which currently interfere with the patient's full engagement in daily life activities.

7) Operational model: This is an expandable community based on outpatient sugical facility allowing for short term (24 to 48 hour) inpatient care with seperate, but adjoining professional residence complex to accomodate volunteers and their families. Nominal financial contribution from the patients (to include barter of services or products) will insure value of the services rendered while still providing expert care. The envisioned facility will include examination rooms, operating rooms, pharmacy, laboratory, radiology, labor and delivery as well as nursery and recovery rooms. Future expansion to include training facility for nurses and other local healthcare resource personel, orphanage and institute for specialty care and education of children with major birth defects. Resident religious community (i.e. convent) will provide man power to maintain continuity of daily operations.

8) Human resources: 1) Henry John Zielinski, MD, FACS, KM - 35 years medical experience; general/trauma surgeon; co-founder of the Pray It Forward Foundation; provider of medical/surgical services to Ecuador, Guatemala, Haiti & Honduras. 2) Herbert Chavez - Guatemalan entrepreneur; employed by the Guatemalan Ministry of Education; active member of local social welfare network. 3) Rosanna Chavez - employed by the Ministry of Public Health and Social Welfare; active member of local social welfare network. 4) Elizabeth Summerland, RN - 25 years medical experience; nursing coordinator for the Pray It Forward Foundation. 5) Shawn Pinto, PA - 15 years medical/surgical experience; Pray It Forward medical team member and project coordinator. 6) Alessandra Zielinski - Pray It Forward team member, translator and consultant.

9) Key operational partnerships: Eventos Catolicos (Orlando and Annabella Coronado) - Guatemalan social welfare organization that runs an intercity hospital in Guatamala City that provides health services for under-served low-income population regardless of religious affiliation. Organizers of the Feria Catolica, largest social outreach event in the Americas. Provided our intial entry for medical work into the country, helping to familiarize us with the specific needs of the community and connecting us with the appropriate networks and contacts. Americares (The Order of Malta) - Suppliers of donated medication for our work. Med-Share International - Corporate provider of donated supplies and durable medical equipment. Lions Club International - provider of donated eye glasses for distribution during our recent work in Honduras; plans for ongoing involvement. Other Corporate Donors - we have recieved support from several other medical and pharmaceutical corporations resulting in tens of thousands of dollars worth of medicines and surgical supplies over the last 5 years. Future Partners: Local Religious Community - religion plays a major role in Guatemalan society and can provide a ready source of long- term dedicated volunteers and play a significant role in disemination of information about this project. US Universities - we will seek to establish a partnership with at least one major University to supply us with interns (pre-med, public health and social justice students). The Guatemalan Government

10) Financial Sustainability

          • Fees charged to clients?: Yes

          • How do you assure affordability?: We have found that services provided without a nominal fee are held in low esteem by recipients. This being said, fees will be assesed on a sliding scale with in-kind services/products accepted as payment. No client in need will be turned away because of inability to pay.

          • Earned incomes as a percentage of operating costs: 15

          • Other funding sources: Our ultimate vision is of a non-profit, self-sufficient and self-sustaining health venture. Our current sources of funding include a community of finacial donors within the US and multiple sources of significant in-kind donations. We have recieved a verbal commitment from an international service organization to fund initial research tools and assesment studies we are conducting in Guatemala. This secular organization and at least one faith-based group have expressed interest in our work thus far and our vision for serving the poor in Guatemala.

          • Strategy for long-term sustainability: The work of our team on the ground in Guatemala will be supplimented by visiting groups of medical volunteers. Word of mouth among medical professionals from our work thus far has already identified a cadre of interested physicians, nurses and paramedical staff willing to donated their time as well as transportation costs to the facility. Other volunteers (e.g. University interns) will also incur little cost to the organization. We also plan to set up a small cottage industry (similar to one we currently have running in Milot, Haiti) to generate income for our organization as well as interest in the project as a whole. We hope our work will demonstrate tangible benefit to the local government in the provision of healthcare to underserved areas of their country and receive nominal support.

11) Current and Future Impact

          • Total number of clients: 8,500

          • Clients in the past year: 2,000

          • Percentage of low-income clients: 99

          • Impact: The direct service provided through clinical visits and/or surgery allows the patient to return to a more productive life as many have been unable to work due to their health problems. We also use the encounter of providing health services as a perfect opporunity to educate the patient and their family about immediate health hazards and appropriate changes in behavior to improve personal and family health.

          • Overall "market": As in many Latin American countries, there is great demand for health sevices in Guatemala. According to USAID, Guatemala has the region's lowest public investment in social services. Within Guatemala healthcare is primarily located in urban areas and is squewed toward those with financial means. With a population of over 12 million, 65% of which is located in rural areas and 56% of the country living in poverty, the current system does not adequately meet the country's needs. The poor rural populations as the most marginalized. This is a pilot project to prove the sustainabiliy of this rural health delivery model and its tangible benefits which lend themselves to replication across Central and South America. In several years we hope to expand into the countries of Honduras and Ecuador.

12) Scaling up strategy

          • Stage of the initiative: Start Up stage.

          • Expansion plan: This specific branch of our ongoing work is in the start up phase. Establishment of a pilot community to allow for surgical services to be provided on the model of American outpatient surgical care. Involvement to date has been limited to short-term missions in the Caribean, Central and South America. We are looking toward institutional development with involvment of like-minded professionals and partnership with the next generation of aspiring public servants. The next three years will be dedicated to refining our pilot project and expanding our focus and capabilities to include matters of great concern to the Guatemalan government (i.e. prevention of and care for children born with neural tube defects/meningomyelocoel/spina bifida).

13) Policy change: Rotating medical teams and interns need not make long-term committments to this specific project. However, it is an opportunity to educate them while they their excercise their professional skills in an altruistic manner. Doctors, nurses and students can return to their home with a broader perspective on global health issues and the effects of poverty, potentially influencing their career path. We also hope to demonstrate to the government that definite treatment of medical problems can be done with minimal expenditure and risk while also providing an opportunity for public health education even among the illiterate segment of the population (e.g. folic acid as a preventative agent for neural tube defects among women of child-bearing age).

14) Origin of the initiative: My involvement over the last 5 years in the developing countries of Ecuador, Guatemala, Haiti and Honduras has comprised of short-term missions in which I have partnered with existing local social service groups as well as major US medical corporations and hospital organizations. Seeing so much benefit resulting from my involvement over such a short period of time, I began to think about long- term benefit from a more committed residentially based model.

Contact Information:
Henry  Zielinski
Surgeon
Pray It Forward Foundation
(NGO)
340 Kennestone Hospital Blvd, #130, Marietta, GA, 30060, USA
Guatemala
Tel: 678-355-9969
Fax: 678-355-5278
Email: samaritansurgical@yahoo.com