The ASE Foundation’s humanitarian mission and training events program is designed to bring humanitarian adult and pediatric cardiac care to developing countries, teaching local clinicians and providing direct services to those in need. These efforts not only impact the lives and well-being of countless patients in underserved populations, but they also serve to spotlight the versatility and adaptability of cardiovascular ultrasound while advancing practice standards to uniform treatment and improve patient care worldwide.

chile_arg_map-734x1024Northwest Argentina
August 2015

ABOUT OUR PROGRAM

ASEF and FAC volunteers have returned from northwest Argentina where they conducted a humanitarian event with Argentina’s indigenous communities.  We’re proud to announce our volunteers for this event, and we thank them for their support.  In addition to lending their professional skills, each volunteer funded his/her own travel to Argentina.

Team Leaders:
Roberto M. Lang, MD, FASE – University of Chicago Medical Center, Chicago, IL, USA
Federico M. Asch, MD, FASE – Washington Hospital Center, Washington, DC, USA
Ricardo E. Ronderos, MD, PhD, FASE – Insitiuto de Cardiologia La Plata, La Plata, Argentina

Industry Partners:
Special thanks to our industry partners – Philips and Agimed – for providing the ultrasound equipment and technical support required to make this event a success.

Philips1_web agimed

Federico M. Asch, MD, FASE* – Washington, DC, USA
Gustavo Avegliano, MD, PhD – La Plata, Argentina
Marcia M. Barbosa, MD, PhD, FASE* – Belo Horizonte, Brazil
Rigo Boccanera, MD – San Francisco, Provincia de Cordoba, Argentina
Hector Busto, RDCS, FASE* – Ogden, Utah, USA
Mario Cerruti, MD – Tartagal, Argentina
Julieta Alvarez Daneri , Agimed clinical support – Buenos Aires, Argentina
Alejandro Diaz, MD, PhD – Tandil, Provincia de Buenos Aires, Argentina
???????????????????????????????Julia Diaz Carrizo (Tecnica) – Salta, Argentina
German Dubs, Ultrasound Manager, Agimed – Buenos Aires, Argentina
Analia Fuentes, MD – Salta Argentina
Pablo Ernesto Garófalo, MD* – Rosario, Santa Fe, Argentina
Narcisa Gutierrez, MD – Salta, Argentina
Martín Ibarrola, MD, FASE* – Buenos Aires, Argentina
Cecilia Juarez, BS, AAS, RDCS* –Tewksbury, Massachusetts, USA
Leda Kantor – Tartagal, Argentina
Georgeanne Lammertin, RDCS, RCS, FASE* –North Salt Lake, Utah, USA
Lili Lang – Chicago, Illinois, USA
Roberto M. Lang, MD, FASE* – Chicago, Illinois, USA
José Antonio LeFavi, MD – Salta, Argentina
Juan Alberto Martina, MD – Rafaela, Provincia de Santa Fe, Argentina
Miguel Angel Chavez Medina, MD – Salta, Argentina
Jimena Miragaya, Ultrasound BL Manager, Philips Argentina – Buenos Aires, Argentina
Leonardo Mora, MD – Tartagal, Argentina
Carlos Olivello, MD – Resistencia, Provincia de Chaco, Argentina
Bharatbhushan Patel, RDCS, RDMS, RVS, FASE* –Nutley, New Jersey, USA
Aldo Prado, MD, FASE* – Tucumán, Argentina
Rhonda Price* – Raleigh, North Carolina, USA
Rodrigo del Rio, Philips truck driver – Buenos Aires, Argentina
Jose Daniel Rivera, RCS* – Durham, North Carolina, USA
Veronika Rodriguez, BS, RDCS, FASE* –Long Beach, California, USA
Alejandra Rolón, Agimed clinical support – Buenos Aires, Argentina
Ricardo E. Ronderos, MD, PhD, FASE* – La Plata, Argentina
Carina Scicoli, MD – Salta, Argentina
Jorge Secchi, MD – Salta, Argentina
Walter Stoermann, MD* – San Juan, Argentina
Jorge Tazar, MD* – Tucumán, Argentina
Miguel Ángel Tibaldi, MD – Cordoba, Argentina
Mario Yellamo, MD – Orán, Argentina

*ASE Members/Staff

*Local leaders include (photo – left to right):  Drs. Mario Yellamo, Ricardo Ronderos, and José Le Favi

Description:
In partnership with the Argentine Federation of Cardiology and other invited echocardiography societies in Argentina and Brazil, ASEF volunteers worked to identify and treat cardiovascular disease in native populations in northern Argentina, near the Bolivian border and within the shadows of the majestic Andes Mountains. Ultrasound equipment and technical support was generously provided by our industry partners – Philips and their South American distributor, Agimed.

The Wichi, Guarani, Chorote, Tapiete and Toba indigenous communities are located in a large geographic area call Chaco.  Chaco is located in North Argentina, south and East Bolivia, Paraguay and south Brazil.  It is bordered by the Pilcomayo River and the Bermejo River in the area of Argentina, in the territories of three Argentinian Provinces – Salta, Chaco and Formosa. These native communities receive visits from health agents, who are part of these communities and trained for basic health services.  The indigenous communities are referred to different local hospitals located near their settlements in Tartagal, Embarcacion, etc. The access for high tech medical resources is limited, and the access to cardiologists dedicated to their care is also very limited. As a result, their possibilities to reach a diagnosis and treatment for cardiovascular disease with the use of current technology are very poor.

The primary purpose of this proposed humanitarian action was to collaborate across multiple societies in diagnosis and recognition of cardiovascular disease in such populations and organize a proper action to solve detected cardiovascular disease.

Preliminary Preparations:
Representatives from ASEF and the Argentina Federation of Cardiology (FAC) visited the area in September 2014 to meet the leaders of these native communities, to determine their acceptance of a medical event for their communities.  This activity would be impossible without their acceptance and support.  Approximately 27 representatives from the indigenous communities were present, including the leader of the Wichi Community.  The discussion took place over a three-hour time period.  During the initial visit, the logistic possibilities for medical work were studied, as well as safety, transportation facilities and lodging possibilities for the volunteers involved in medical tasks.  The local leaders gave enthusiastic support for the event, and promised to get the appropriate community members to the activity.

DAILY REPORTS

Left Behind – By Rhonda Price, ASE Staff
9 August 2015

I’ve been in Salta, Argentina for three days.  My job has been to “herd” the US-based volunteers that are arriving here for a humanitarian/medical event the ASE Foundation is doing with the indigenous communities that live on the Argentina/Bolivia border.  Herding volunteers isn’t as easy as you would think in this day of flight cancellations/delays and the resulting missed connections.

Five out of six of our sonographer volunteers arrived yesterday – tired and groggy but ready to get to work.  Georgeanne, the other volunteer, arrived late this afternoon after days of travel.  (It’s not easy getting from Salt Lake City, Utah to Salta, Argentina.  The menu today at the café on the plaza also pointed out that too much salt is unhealthy!) The sonographers and physicians for this humanitarian event met up earlier this afternoon at Plaza 9 de Julio in the city center for the 4-hour bus ride to our event.  I reluctantly sent them on their way without me. Georgeanne and I will catch a ride with a local physician tomorrow AM and join the rest of the group mid-day.

Overall, Salta is good place to be left behind.  Here are some photos of our group and Salta la linda:

5volunteers (2)

The group of volunteers, minus Georgeanne.  We ate large plates of meat after this picture was taken.

Guemes

General Martín Miguel de Güemes, defender of northwestern Argentina from the Spanish during the Argentine War of Independence (with the help of local gauchos), helped me search for the US-based volunteers from his perch overlooking the city.

TakingOff (2)The combined group of physicians and sonographers before boarding the bus for the 4-hour ride to northwest Argentina.  Dr. Lang is behind the tall people, and the sonographers are barely visible on the top left.  Front left is Dr. Le Favi, a Salta cardiologist who organized the local logistics.  Thank you, Dr. Le Favi! LeavingBusThe bus leaving … wait for me!  Bus transportation was courtesy of the University of Salta.
art1

Street art in Salta.

PrettyinPink

The cathedral on the plaza is a pretty pink color.

Salta_SunsetSunset over the Andes.

A Great Beginning – Compiled reports by the volunteer group
10 August 2015

Our volunteer group is complete at last!  The last of our volunteers arrived today after a marathon travel event from Salt Lake City to Houston to Buenos Aires (two different airports) to Salta and then five hours by car to the most northwestern part of Argentina.

We saw around 125 patients today, twice as many as we thought we’d see in one day.  The patients were from Argentina’s original/indigenous communities, and some came from as far as 50 miles away.  Buses were provided by the local government. Through the assistance of sponsor Philips/Agimed, our medical team had the benefit of high-end ultrasound equipment that enabled complex diagnoses.  Dr. Roberto Lang estimates that 5-6 lives were saved today thanks to those diagnoses.  They diagnosed a baby with an unsuspected cardiac tamponade, a young child (15 y/o with coarctation of the aorta) and also diagnosed a young patient with severe aortic stenosis due to a unicuspid aortic valve. In addition, they also diagnosed a patient with a large ASD and one with endocardial fibroblastosis secondary to a parasite infection. The driver Philips hired to deliver the equipment to this remote corner of Argentina could have hidden away until it was time to return the equipment.  Instead, he chose to use the days helping to feed the patients and their families, transporting several patients to local hospitals for follow-up care, and returning 50 people to their homes.  His kindness is contagious.

The Argentina physicians participating in this event are geographically diverse, representing 10 different provinces in Argentina.  They are here as representatives of the Argentina Federation of Cardiology (FAC).  Also participating is Dr. Marcia Barbosa, immediate Past President of the Interamerican Society of Cardiology (SIAC).  The South American physician team is joined by Dr. Roberto Lang, ASE Past President and Co-Chair of the International Relations Advisory Committee, and Dr. Federico Asch, ASE Board of Directors and Chair of the Guidelines Committee.  The experience on this team is very deep and this opportunity to work side-by-side and have relaxed conversations over shared meals is a unique opportunity for all.

We continue tomorrow …


A Few Words – An audio report from Dr. Roberto Lang
11 August 2015

Today’s “Daily Report” comes to you in English and Spanish from Dr. Roberto Lang, a native Argentinian (but many years at the University of Chicago) and one of the leaders of our event.

An introduction to our event (English)

An introduction … (Spanish)

What we found (English)

What we found (Spanish)

The logistics of the event (English)

The logistics of the event (Spanish)

We took a break in the middle of the day to enjoy a meal prepared by the indigenous women who have been taking care of us.  Here are some favorite photos of the day:

Danny_StewSonographer Danny Rivera digging into his first bowl of stew.  BharatSonographer Bharat Patel entertaining a local child.
 StewStew cooking on the stove.  The meat was goat.  Women from the local indigenous communities prepared our lunch today.  WomanThis woman is one of the community leaders and has been taking care of us this week.  She can whip up a stew or slice a papaya at a moment’s notice.
YelamoDr. Yellamo of Oran, Argentina created an impromptu dessert for the group from the papaya tree (see the fruit behind his head).  He can be very entertaining.  art

Art at the radio station

 LiliLLili Lang entering data.  She worked hard! PhilipsPhilips reps with Drs. Lang and Ronderos.  That’s Jimena Miragaya, Ultrasound BL Manager South LatAm for Philips on the left and Germán Dubs, Ultrasound Sales Manager at Agimed on the right.

A Few Words Continued … An Audio Report from Dr. Ricardo Ronderos (English and Spanish)
12 August 2015

Dr. Ronderos gives an overview to the event, talks about the challenges of working with the indigenous communities, and the findings on day 3.
Introduction (English)
Introduction (Spanish)
Relationships (English)
Relationships (Spanish)

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3

A Special Resolution – written from the perspective of Rhonda Price
13 August 2015

We finished our final day of examinations after seeing a total of 653 individuals in four days … more than twice the number we expected!  But the day wasn’t all work … I forgot to mention that yesterday for lunch we were treated to beautiful and plentiful platters of empanadas.  They were delicious! Today we were fed juicy, simply prepared pieces of chicken.  We did not go hungry this week!  At lunch, the sonographers were presented certificates from FAC and the Salta Society, along with “special” gifts.  Part of the pleasure for the week has been sharing meals with the medical team and community members and getting to know each other.

We finished our work and at the end of the day carpooled across town to the Council of Governments building for the City of Tartagal.  They had called a special session in our honor – a gesture I was told was very unusual – and very touching.  A special resolution was passed recognizing our volunteer work with the Pueblos Originarios del Chaco Salteño and handcrafted plaques were presented.  Between all the local politicians, the medical team, leaders from the different indigenous groups, and representatives from the radio station, we filled the building and enjoyed our new celebrity.

Afterwards, our group was treated to an asado, which involves eating lots of smoky meat – chorizo, blood sausages, different cuts of beef – and drinking Argentinian beverages.  After some unfortunate karaoke, dancing, and the telling of stories and jokes I couldn’t understand (probably for the best), we walked back to the hotel in the cool night.  It can be very warm in Tartagal this time of year, but for our week it was cool and often drizzly.

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Photos above:  Bharat and Cecilia enjoy homemade empanadas.  Dr. Ronderos receives his special plaque at the Council of Governments presentation.  Gathering for a group photo following the presentation with members of the community.


A Picture Says a Thousand Words
14 August 2015

Watch this photo/video created by Dr. Aldo Prado:
ASE FAC 2015 Tartagal

Dr. Federico Asch prepared this photo/video in Spanish and English:
Tartagal 2015 (English)
Tartagal 2015 (Spanish)

And sometimes a thousand words paint a picture:
Learn more about Team Tartagal in Echo Magazine (Vol 4 Issue 1)
Read coverage in the local news here.  *Please note the doctor identified as Dr Lang is actually Dr. Juan Alberto Martina from Rafaela, Provincia de Santa Fe. 
Read the FAC: Federación Argentina de Cardiología newsletter covering the mission trip here.

 

Photos provided by our Volunteers:

This is Hector working hard

This is Hector working hard

Dr. Rondero with Danny Rivera

Dr. Ronderos with Danny Rivera

Dr. Asch entertaining some young patients

Dr. Asch entertaining some young patients

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A Fond Farewell  – written from the perspective of Rhonda Price
15 August 2015

On Friday morning, we packed our belongings and made our final 8-block (10?) walk back to the radio station for our good-byes.  There were no patients to see, but the community leaders were there in full force, ready to send us off in style.  One by one, they opened their hearts and expressed their love, often through tears.  There were very firm bear hugs all around.  And … fried doughnuts drizzled with sugar cane syrup.

When we returned to the hotel, the bus was waiting to take us back to Salta.  Before we pulled away, Dr. Le Favi did the roll call:

LeFavi Roll Call

The group made our way back to Salta, where we said our goodbyes all over again, departing as friends with good memories and exchanged emails.

The sonographers and I stayed the night at Hotel Salta, and had our final celebratory dinner of beef and Malbec before they were to start making their way back to Buenos Aires and the flight home the following day.

One of the frustrations in participating in an event such as the Tartagal humanitarian event is the inability to communicate the significance to those who were not there.  It was a week most of us will never forget.  Dr. Roberto Lang, who has had an esteemed career, called the experience the highlight of his career.   There were moments during the week when I thought to myself, “I’m going to wish I had this moment back.”  I do.

The different organizations – ASEF, FAC, the radio station, the community leaders – all worked in harmony for the good of the patients.  Our “plan” for the week had been to take the best possible volunteers, premium equipment, and some spare cash in case of emergencies.  Our plan worked.  Despite our best intentions, we ended up receiving more than we gave.

On behalf of all the volunteers, many thanks to the ASE Foundation for making this opportunity possible, and to the donors for funding it.  Keep up the good work.  You’re making a world of difference!

Nancy

 

Photo:  On behalf of the sonographers, Danny Rivera gave a cash donation to Nancy Lopez, to be used for those in need of assistance.  The physicians also collected funds, and additional gifts were given to help furnish the kitchen.



Some Final Thoughts

We believe the success of this mission was not just in bringing highly qualified cardiologists and high tech echo machines, it was mostly for the way it was conducted: starting by educating ourselves about the cultures and traditions of the indigenous communities, and involving their leaders from the initial planning stages so we could care for them respectful of their concerns, their culture and their place.
Federico M. Asch, MD. FASE – Washington, DC

We lived an amazing experience, crossing the line between different cultures but finding on the other side just human beings like us. We achieved one of the best things that we could have achieved – the confidence of people who usually are rejected and discriminated against in the western culture. But the biggest emotional impact was the deep understanding and teamwork of many different people coming together from different states, provinces, and continents who became friends in just a few days.  We will never forget this experience!!
Ricardo Ronderos, MD, PhD, FASE – La Plata, Argentina

This was one of my best moments in my career, I am so happy to be part of this.
Roberto M. Lang, MD, FASE – Chicago, IL