Hand-Washing is Exciting ... and Cost-Effective!

A donation to a non-profit should make an impact. And with the AAVia Foundation your support does.

We fund a Bolivian-based program run by a rural nursing school that reaches schools and communities throughout its province to promote hand-washing and dental care.
That should excite you!
Why?

Because to public health specialists such a program is fantastic, even "exciting!" And you should believe them.

Children practicing hand-washing, via School of Nursing at Pucarani.

The handy chart below from the Global Handwashing Partnership shows how hand-washing is considered one of the MOST COST-EFFECTIVE interventions for lessening deaths and disability:

Chart via Global Handwashing Partnership blog.

By decreasing diarrhea and acute respiratory infection frequency, hand-washing lessens death rate of children, missed school days for children, malnutrition, and delayed growth of children. Remarkably, research shows hand-washing promotion remains effective even years after a program finishes as folks continue the new habits, and it seems to be self-promoting as others in a community pick up the habit.

Hand-washing promotion isn't only cost-effective, it likely makes money many-fold for societies by avoiding costs of illness and maintaining children's health.

--Timothy Malia, MD
Medical Director & Co-Founder, AAVia Foundation for the Health of Bolivian Children

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Bolivia Needs a Bigger Boat

Give a man a fish, feed him for a day.

Teach a man to fish, feed him for a lifetime.

--Chinese proverb

I've become amazed how often people refer to that famous proverb after we explain the goals and efforts of the AAVia Foundation for the Health of Bolivian Children.

Typically, we acknowledge the point and move on. But, honestly, it's never felt exactly right.

It was this year's Shark Week that helped me understand what was missing from the idea. Shark Week is an annual summer "event" when Discovery, an American cable TV station, has a week of shark-based programming.

Included in that week of programming is the classic film Jaws. The famous scene when the three protagonists are on the boat looking for the great white shark which had menaced the summer beaches completed in my mind what the AAVia Foundation is doing.

You're gonna need a bigger boat.

--Police chief Brody in "Jaws"

On that boat were three men with a lot of motivation, knowledge and experience -- a very powerful skill set for a team to possess. Nevertheless, police chief Brody, marine biologist Hooper, and grizzled old fisherman Quint were lacking one thing: a boat sufficient for the challenge of beating that shark.

And so it is for our efforts in Bolivia!

We know people with motivation, knowledge and experience working hard for children's health in Bolivia. In so many important ways, they do not need us to teach them anything -- they already know "how to fish." They also understand how great their challenges are to improve the health of Bolivian children.

What they need is a bigger boat in the form of funding and equipment that is lacking in their resource-poor environment.

And that is why we are doing what we do.

--Timothy Malia, MD
Co-founder & Vice President, AAVia Foundation for the Health of Bolivian Children
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Say Ireland ... Think Bolivia

Happy St. Patrick's Day!

May green beer and corned beef brighten your day.

May our Irish heritage and jilty tunes filled with bodhran and flutes warm your heart.

May happy tales and words of affection for all you love fill the air on this day we celebrate that snake-banishing, Welsh-born saint we call Patrick!

On this special Irish day, however, I have one request:

When you say, "Ireland," just think, "Bolivia."

This, of course, is a play on a scene in Butch Cassidy & the Sundance Kid where Butch, the man with ideas, explains why he and the Kid should go to Bolivia. He describes the rich mines and all the wealth they could collect with their bank robbing skills. Comparing Bolivia to the old Gold Rush in California, Butch ultimately says:

So when I say, "Bolivia," you just think, "California."

I trade California and Ireland for one simple reason. Bolivia and Ireland share histories with similar struggles, influences, and high points.

• Both are physically isolated geographically. Bolivia by mountains and its landlocked modern borders. Ireland by the sea.

• Both influenced the world during Europe's Dark Ages. Bolivia with the Tiwanaku culture. Ireland with its monasteries, monks and scribes who kept copies of the great books of antiquity and later re-spread Christianity through Europe.

• Both have often been invaded by foreign powers. Bolivia with the Huari, the Inca, and later the Spanish. Ireland with the Romans, the Vikings, and later the English.

• Both suffered through centuries of poverty while a small number of people, often foreigners, gained wealth from control of the land and resources.

• Both were affected by periods of massive death bordering on genocide. Bolivian natives dying of smallpox, cholera and other Old World diseases, and later working in the silver mines, after the Spanish arrived. The Irish through the Great Famine of the mid-nineteenth century.

• Both have seen a significant emigration of its young and talented looking for opportunities abroad over the years.

• Both cling to their traditional languages while trying to forge ahead in the modern world. Bolivia with Aymara and Quechua. Ireland with Gaelic. 

Yet their histories do differ in many ways today. Ireland has done well this past century -- its economy is secure, children are educated, health care excellent. Bolivia on the other hand still struggles --  its economy is weak, it struggles with narco-traffickers, its children often work rather than attend school, and the medical system is impoverished (only $235 per person per year on health care).

So today, while celebrating St. Patrick's Day, you may raise a glass in cheer for Ireland, or shed a tear when hearing Danny Boy, or share special moments with family and friends, but please also pause and remember Bolivia, the kindred spirit of Ireland!

We are working to make a better future for Bolivian children. Support our efforts with a donation to the AAVia Foundation for the Health of Bolivian Children. Then pass the word so others can understand the history and the need.

We are getting started and your help so far has given us the footing we need. Word is coming soon for projects on the ground in Bolivia -- and you'll be to thank for them.

Slainte!
--Tim

Timothy Malia, MD
Co-Founder & Vice President
AAVia Foundation for the Health of Bolivian Children
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Mountains & Forests, Sand & Salt: Bolivia's Natural Beauty

At the AAVia Foundation for the Health of Bolivian Children, we often point out challenges faced by impoverished Bolivian children needing medical care. And we support our colleague starting a center for infants and children with colo-rectal problems who need high-level care or face life-long risk of problems and complications. But there is a lot more to Bolivia than poverty and barriers to medical care.

On a map, Bolivia looks small because it borders Brazil, one of the world's largest countries, but Bolivia is actually as big as the states of Texas and California combined! And Bolivia has remarkable diversity: Amazonian rain forests; savannas; mountain valleys; high peaks; Titicaca, the world's highest navigable lake; and even the world's largest salt flat which lies remotely at 12,000 ft (3600 m) elevation!

This tourism clip from Bolivia is worth a watch if you want to get a taste of the land's and its people's majesty. Enjoy.

And, remember, "Bolivia ¡te espera!"

--Timothy Malia, MD
Co-founder, AAVia Foundation for the Health of Bolivian Children
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Can Technology Help Bolivian Patient-Doctor Relationship?

Where does trust, communication, accountability--and technology--fit in the AAVia journey?

Medical care depends on trust, communication and accountability as those attributes support the relationship between patient and provider. This remains as true today as in ancient Greece when Hippocrates (460BC-370BC) established the early foundation of modern medicine.

Technology, however, adds another factor to the equation today. When used well, it leverages information so patient and provider can make good decisions and monitor care to improve health. But the risk remains that technology can be a barrier between the two parties, or replace one of the three primary attributes--in either case, a grave error.

A new medical technology should only be part of care if it improves the patient-doctor relationship and is both easy to use and effective.

I just learned of  a non-invasive test (that is, no poke or needle stick to get blood) that rapidly checks for anemia and may pass muster for the above criteria. It is designed to be reasonable for use in poor, rural, under-developed areas of the world.

I read an interview with the lead researcher, Myshkin Ingawale, on the TED blog and then watched the related TED video.

The new portable technology (ToucHb) would allow community health workers to assess patients for anemia, help them get proper care, and then monitor if the treatment is working. Since the test is non-invasive, patients do not have to fear pain or bleeding.

It would support the trust patients have for a community health worker, facilitate communication about anemia and the treatments, and allow for accountability as treatment effectiveness can be documented.

I don't know if the ToucHb itself will ever play a part in the efforts of the AAVia Foundation for the Health of Bolivian Children; but I can say our inaugural project depends on properly balancing modern technology with proper medical care based on a strong patient-doctor relationship.

Our Bolivian partner, Dr. Edwin Dolz, is a pediatric surgeon who is establishing the Centro Nacional de Patología Colorectal Pediátrica in the Hospital Arco Iris, a charity hospital in La Paz, Bolivia.

The goal for the center is to provide excellent medical assessment and treatment, including skilled surgical care using appropriate medical technology when needed, for children having severe intestinal problems. When an infant or young child has Hirschsprung's Disease or congenital colon malformations, they and their families suffer greatly without proper medical care. But the cost of care is a barrier for impoverished Bolivian families; thus leading to long-term health complications for the child, and greater stress for the family.

With our support, children will have access to both medical technology and better health otherwise unavailable to them--and the trust, communication, and accountability between our Bolivian partners and their patients will be ever stronger!

--Timothy Malia, MD
Co-founder, AAVia Foundation for the Health of Bolivian Children
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Our Blog: Warm in December, Cold in June

Welcome to the first blog post for the AAVia Foundation. We look forward to posting about our activities, stories of our experiences, news reports, updates from our Bolivian partners, and whatever else we can imagine. Our hope is this will help readers better understand our motivation to support efforts in Bolivia for children's health.

Today, however, I wish to point to great poetry, specifically Robert Frost (1874-1963) and a poem he wrote about one hundred years ago, The Mountain (1915). 

Frost was a Pulitzer Prize winner and the first poet asked to read at a presidential inauguration when John Kennedy invited him in 1960. He used his life in New England to color his poetry with natural world imagery and colloquial speech which related to common-man life both literally and metaphorically. His work is a major part of how rural American life of the early twentieth century will forever be remembered.

While most may recall Frost's poem The Road Not Taken ("Two roads diverged in a yellow wood ... I took the one less traveled by, And that has made all the difference."), we were drawn to The Mountain and from it found the name of our blog: Warm in December, Cold in June, as it reflects where we are and where we hope to go.

In the poem, a man is visiting a town which sits in the shadow of a mountain. As he hikes toward the mountain he meets a local farmer who is walking with an ox and cart. The conversation which follows relates how the mountain's size limits the growth of the town and that there are stories of a spring at the top which is "almost like a fountain," and which feeds a brook that flows down the mountain. The brook is storied as being "always cold in summer, warm in winter." The old man, though he has lived there a long time, has never climbed the mountain or seen the spring but he encourages the visitor to consider ways to climb the summit.

Later, the visitor tries to learn more about the brook and the water's temperature when he asks:

"Warm in December, cold in June, you say?"

And the old man replies (with what I imagine is a slow, heavy rural New England accent and dry humor):

"I don't suppose the water's changed at all.

You and I know enough to know it's warm

Compared with cold, and cold compared with warm.

But all the fun's in how you say a thing"

.
The poem winds down with no finality as the farmer turns to continue walking with his ox and cart. We never know if the visitor hikes the mountain finding the brook and its spring, or simply returns to the town where he started.

So goes life. We travel, sometimes to places that are "held in the shadow" of something grand like a mountain. We meet locals who encourage us to hike and explore new places. We ask questions and learn from the locals, understanding more of their past and possibilities for the future. But those possibilities are never certain and the reality that will unfold is only determined by what we choose to do next.

That defines the AAVia Foundation for the Health of Bolivian Children at this juncture. 

Bolivia lies in the southern hemisphere where, yes, the weather is warmer in December and colder in June. The peaks of the Andes Mountains dominate the geography. And we are learning from the locals so we may understand possibilities and choose our actions to better shape the future as we all climb the summit which lies before us.

--Timothy Malia, MD

Co-founder, AAVia Foundation for the Health of Bolivian Children

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