Andean Health Vision Campaign Booklet

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					                                                                         "VISION CAMPAIGN"
                                    Andean
                                    Health &
                                  Development




AHD is raising $6 million to build                                $6 M
a hospital, a physician training
                                                                  $5 M
center, and a global health
research center in the severely                                   $4 M
underserved city of Santo                       Bridge funding

Domingo, Ecuador.                               from the Inter-
                                                American Dev.     $3 M
                                                Bank


                           Individual Donors      Raised
                                                  Already
                                                                  $2 M

     The Harry & Jeanette Weinberg Foundation                     $1 M

            Ronald McDonald House Charities
                                           MISSION
                                                             Andean Health &
                                                             Development (AHD) is
                                                             fundamentally changing
                                                             health care in Latin America
                                                             by providing sustainable,
                                                             quality medical care today
                                                             and by training the health
                                                             care leaders of tomorrow.

In 1984, David Gaus graduated from Notre Dame with a degree in accounting and had no idea what to do
with his life. Based on the advice of Rev. Theodore Hesburgh, Past President of Notre Dame and Chair of
the AHD Advisory Board, Gaus embarked on a mission to Ecuador and returned with an inspired vision:
provide quality health care to the rural poor. After completing medical and public health training at Tulane
University, Gaus convinced friends to raise funds for Hospital Pedro Vicente Maldonado.

                                                       HOSPITAL PEDRO VICENTE MALDONADO




In 2000, the facility opened its doors, quickly becoming a vital resource in the local community and gradu-
ally achieving financial self-sustainability (2007). In 2008, AHD began a residency program in partnership
with local universities to train Ecuador’s Family Physicians with the best practices of medicine and hospital
administration.

Success bred the desire to replicate this model and now, Gaus and AHD seek to establish a second self-
sustaining, quality medical facility and training center for another region in dire need of services, Santo
Domingo. Ultimately, the concept might be applied throughout Latin America, making a significant contri-
bution to high quality medical services delivery in the region.


                                                               HOSPITAL SANTO DOMINGO
Medical Services Delivered
at Hospital PVM since 2000:                                                                                 I
3,600 childbirths                                                                                           M
3,650 surgeries
11,00o hospitalizations                                                                                     P
107,000 outpatient visits
16,900 emergencies
                                                                                                            A
265,000 filled prescriptions
375,000 lab tests
                                                                                                            C
124,000 meals to patients                                                                                   T
                Graduates of and Residents Enrolled in AHD’s
                    Family Practice Residency Program
                                                Graduated in 2011:
               Dr. Sara Romero, Current Director of the Outpatient Department at Hospital PVM
                           Dr. Carlos Troya, Current Medical Director at Hospital PVM
                     Dr. Lida Ordonez, Family Physician at a public hospital in rural Ecuador
                    Dr. Isabel Pacheco, Family Physician at a public hospital in rural Ecuador

                                              Graduating in 2012:
                     Dr. Amanda Tene, Future Medical Director at Hospital Santo Domingo
                 Dr. Juan Carlos Perez, Future Attending Physician at Hospital Santo Domingo
                 Dr. Miguel Obregon, Future Attending Physician at Hospital Santo Domingo
                  Dr. Alicia Guevara, Future Attending Physician at Hospital Santo Domingo


                                           Graduating in 2013:           Graduating in 2014:
                                           Dr. Blanca Aigaje             Dr. Karina Cando    Dr. Angelica Perez
                                           Dr. Gabriela Suarez           Dr. Noemi Chavez    Dr. Carlos Mejia
                                           Dr. Veronica Barahona         Dr. Diana Cajamarca Dr. Mauricio Cuadrado
                                           Dr. Oswaldo Lopez
                                           Dr. Stefania Bautista



                                            Hospital Santo Domingo will train 15 Family
                                            Physicians each year. After graduation, these
                                            doctors work for AHD’s hospitals or in the public
                                            or private sector, thus perpetuating high quality
                                            care into other parts of the country.
$6 MILLION GOAL FOR THE AHD VISION CAMPAIGN
Purchase of Land and Exisiting Building                                                                                 $1,425,000
Construction/Renovations of the 50-Bed Hospital, Physician Training Center, & Research Center                           $1,550,000
Working Capital for Start-up Operations at Hospital Santo Domingo                                                        $300,000
Family Practice Residency Program (‘11 - ‘15)                                                                            $750,000
5 Years of AHD/Saludesa Operating Costs (‘11 - ‘15)                                                                     $1,975,000

                                                                                                                     $6,000,000
RETURN ON INVESTMENT
The above investment in physical resources, start up costs, and transition costs will provide the following returns
for a total self-sustaining annual budget of $3.55 million:
1. Hospital Pedro Vicente Maldonado’s annual budget self-sustaining at $1.2 million
2. Hospital Santo Domingo’s annual budget self-sustaining at $2 million
3. Family Practice Residency Program’s annual budget self-sustaining at $350,000


                    Excerpts from a feasibility study conducted by a team from
                          UC-Berkeley’s Haas School of Business in 2010
In Santo Domingo, there is currently only one public hospital with 141 beds for a population of 400,000.
Below are some observations of that hospital from the Haas study.

...The small facilities and lack of staff cumulatively create the most frequently cited weakness of the Gustavo Domínguez
[public Ministry of Health] hospital: the long waiting times. The hospital is only open for patient consultations between 8am-
4pm on Monday through Friday. Beyond those hours, the only option for patients is the Emergency Room. This means that
getting an appointment for a consultation is an incredibly difficult process. Patients or their family members have to camp
out overnight outside the hospital in hopes of being first in line to get an appointment for the following day...

...Even after getting into the [public Ministry of Health] hospital, its not easy for patients to get time with the physician. Con-
sultations last between 10 and 15 minutes, and sometimes patients have to wait for the doctor for long periods of time. A
man from the low-income cooperative told us about the day he gave up on the Ministry of Health hospital, “One time my sis-
ter broke her arm. We got an appointment and the doctor told us to go buy supplies for the cast. I bought the supplies and
came back and we waited for the doctor. He didn’t see her all day. We were there from 8am-5pm and no one saw her, so we
left and I took her to a private clinic.”...

...While the [public] hospital is crowded in every area, there are some areas where the problem is particularly acute. The
director of the hospital said that the most problematic areas for overcrowding are with maternity patients and internal medi-
cine, which respectively account for 32% and 24% of patient days....

...Another major weakness of Gustavo Domínguez [the public Ministry of Health hospital] is its ability to handle emergency,
trauma and critical care patients. The four doctors in the emergency room do not have residency training in emergency
medicine and have to manage an average load of 180 patients per day with only 12 beds. As a result, patients are often
crowded into the hallway. The hospital has 3 basic ambulances, but due to the high level of traffic accidents and the size of
the population, it should have at least 6. The ambulances are not equipped for patients in critical condition, resulting in high
mortality rates of patients being transferred to Quito or Guayaquil. Moreover, ambulance drivers do not have medical train-
ing, so there is little on-site medical attention for traffic accidents. Many patients, even after traffic accidents, arrive at the
hospital in taxis. The hospital has little ability to handle multi-injury traumas and patients in critical condition. For instance,
according to one employee, although the hospital has a ventilator, no one at the hospital knows how to use it properly...
          ABOUT SANTO DOMINGO, ECUADOR
Population: 400,000
Location: Northwest province of Santo Domingo de
los Colorados
Prevalent Health Conditions & Needs: dehydration,
diarrhea, cardiovascular problems, diabetes, snake-
bites, automobile accident injuries, and pregnancy/
childbirthing complications.
Number of Public Hospitals: 1 with 141 beds




  INSIDE HOSPITAL SANTO DOMINGO
  50 beds                 Ultrasound
  Operating Room          Blood Tests
  Pharmacy                Neonatal Care
  Prenatal Care           X-Ray
  Dental Department       Outpatient Services
  Emergency Room          Training of Family Phyisicians,
  Laboratory                  Nurses, & Hospital
                              Administrators
Financial Self-Sustainability
A  HD’s first facility, Hospital PVM, utilizes a unique combination of local financing mechanisms to be
   100% financially self-sustaining. This means that donations from the U.S. are used to expand the
AHD model and train the residents, as opposed to paying for day-to-day operations at the hospital.

Financial self-sustainability is possible because of a unique partnership with Ecuador’s Social Security
Institute (IESS). IESS provides a type of public insurance that pays the hospital for medical care on a
services-rendered basis. Those that do not have this insurance pay a small fee for service (e.g. $8 for an
outpatient visit or $160 for a child birth).

In Santo Domingo, we project 100% cost recovery before the second year of being open.
 This is possible because:
       • Santo Domingo’s undeniable high demand for medical care, reinforced by a UC-
             Berkeley Haas School of Business study on market demand in June 2010.
       • Government programs, which provide fees for services.
       • AHD’s established relationship with Ecuador’s Social Security Institute, which
              currently provides payments to Hospital PVM on a services-rendered basis.
       • The provision of cost-efficient hospital services equal to those at Hospital PVM.




Partnerships & Collaborations
International Partnerships
University of Wisconsin-Madison Department of Family Medicine
University of California-Berkeley Haas School of Business
University of Notre Dame Center for Social Concerns
Inter-American Development Bank
Schwab Foundation & The World Economic Forum

Local Partnerships
Catholic University of Ecuador, Medical School Affiliation
The Luis Vargas Torres University, Nursing School Affiliation
The National Social Security Institute,
     Public-Private Partnership
Awards & Publications
Awards to Dr. David Gaus
Milwaukee Academy of Medicine Humanitarian Award, 2012

Social Entrepreneur for Latin America, Schwab Foundation & the World Economic Forum, 2010

Social Entrepreneur Award from the Notre Dame Entrepreneurship Society, 2009

The Dr. Thomas A. Dooley Award from the Notre Dame Alumni Association, 1999

Spirit of Ignatius Award from Marquette University High School, 1999

Capovitz Medical Award for Outstanding Senior Student in the Discipline of General Internal Medicine,
       Tulane Medical School, 1992

AOA Honor Medical Society, Tulane Medical School, 1991


Publications

Gaus D. The Rural Hospital in Ecuador, Health Affairs 28, no. 4 (2009): 1003–1010; 10.1377/hlthaff.28.4.1003

Gaus D., Herrera D., Heisler M., Cline B.L., Richmond J. Making secondary care a primary concern: the rural hospital in
      Ecuador. Pan American Journal of Public Health. 2008; 23(3): 212–7.
Gaus DP, Herrera DF, Mantyh WG, Girdhari RP, Kuskowski MA. Quantifying the reduction in nonmedical costs after the
      introduction of a rural county hospital in Ecuador. Rev Panam Salud Publica. 2011;29(6): 423–7.



    Saludesa Medical Manual
  by David Gaus & Diego Herrera
                                                        Contact Info
                                                        Mailing Address:
                                                        Andean Health & Development
                                                        University of Wisc. Dept. of Family Medicine
                                                        1100 Delaplaine Ct.
                                                        Madison, WI 53715

                                                        Email: info@andeanhealth.org

                                                        Phone: (619) 788-6833




                                                                                                                          7
Ways of Giving

We respectfully ask that you make a contribution to Andean Health & Development
to bring more quality, sustainable medical care to the poorest of the poor in Ecuador.
Please find a pledge card enclosed. The following naming opportunities are available
at Hospital Santo Domingo.

Santo Domingo Campus...................................................................................$1,500,000
Hospital..............................................................................................................$1,000,000
Ronald McDonald House Charities Maternity & Children’s Ward..................$500,000
The Daniel & Eileen Meehan Outpatient Facility..............................................$150,000
Physician Training Center....................................................................................$150,000
Nurse Training Center..........................................................................................$100,000
Emergency Room....................................................................................................$75,000
Operating Room......................................................................................................$75,000
Dental Department.................................................................................................$50,000
Pharmacy..................................................................................................................$50,000
Laboratory................................................................................................................$50,000
7 Patient Rooms........................................................................................................$25,000
Sponsor a Family Physician Resident’s 3-Year Training........................................$10,000
Governance
BOARD OF DIRECTORS
Rev. Theodore Hesburgh, CSC, Chair, President Emeritus of the University of Notre Dame
Michael Heisler, M.D., MPH, Vice Chair, Professor of Medicine at the University of South Dakota
David Gaus, M.D., MPH & TM, AHD’s Executive Director, Associate Clinical Professor of Medicine at the
            University of Wisconsin-Madison

ADVISORY BOARD
Rev. Theodore Hesburgh, CSC, Chair, Notre Dame, Indiana
Michael Heisler, M.D., MPH, Vice Chair, Sioux Falls, SD

Barnett L. Cline, M.D., MPH, Ph. D., San Antonio, Texas
Alan Gianotti, M.D., San Francisco, California
Michael Hansen, Fort Lauderdale, Florida
Louis M. Nanni, Notre Dame, Indiana
Paul O’Hop, Washington, D.C.
John C. Rudolf, Seattle, Washington
Luis Rosero, New York, New York
Beth Toomey, Seattle, Washington
Peter Urbain, Chicago, Illinois
John F. Williams, M.D., Ed. D., MPH, Washington, D.C.
Timothy J. Willis, New York, New York

HONORARY BOARD MEMBER
Rosalyn Carter, Former First Lady of the United States

SCIENTIFIC ADVISORY COMMITTEE
Barnett L. Cline, M.D., MPH, Ph. D., Chair, President Emeritus of the Department of Tropical Medicine at
       Tulane University
Joseph A. Cook, M.D., Adjunct Professor of Epidemiology in the Gillings School of Public Health, University of
       North Carolina, Chapel Hill
Michael Heisler, M.D., MPH, Professor of Medicine at the University of South Dakota
Dominic Montagu, DrPH, MBA, MPH, Assistant Professor of Epidemiology & Biostatistics at UCSF, Lead of
       Health Systems Initiative at UCSF Global Health Group

SALUDESA ADVISORY BOARD
(AHD’S ECUADORIAN COUNTERPART FOUNDATION)

María Elena Andrade, J.D., Quito, Ecuador
David Nelson, Ph. D, Quito, Ecuador

MANAGEMENT
David Gaus, M.D., MPH & TM, Founder, Executive Director
Diego Herrera, M.D., Director of Ecuador Operations
Laura Dries, MBA, Director of U.S. Operations
   AHD is tax exempt under section 501c3; Federal ID Number: 39-1809174. AHD financials are audited by Lulloff & Taylor, LLC, CPA.
            Hospital PVM financials are audited by Pinto & Garces, Associados Cia. Ltda. Tax returns available upon request.

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