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                                                             Healthy people. Better world.
A CHILD SLEEPS AT MUANG SING HOSPITAL IN LAOS • BRYAN WATT




                                                                           WWW.DIRECTRELIEF.ORG
2   INDEPENDENT ADVERTISING INSERT      FINANCIALS        NOVEMBER 20, 2003                                                                                                  WWW.DIRECTRELIEF.ORG   WWW.DIRECTRELIEF.ORG                                                                                                                    NOVEMBER 20, 2003      NEWS      INDEPENDENT ADVERTISING INSERT        3

                                                                                                   Top Ranked in Efficiency,


         THINGS YOU SHOULD KNOW ABOUT
                                      10                                                           Accountability, and Leadership by:
                                                                                                                                                                                                    Direct Relief Invited to Advise
                                                                                                                                                                                                    UN Officials in Geneva
      DIRECT RELIEF INTERNATIONAL’S FINANCES
                                                                                                                                                                                                    Susan Fowler, Director of Programs, recently attended the Executive
                                                                                                                                                                                                    Committee meeting of the United Nations High Commissioner on
            STRICT BOARD OVERSIGHT AND GOVERNANCE: Direct Relief's operations                                                                                                                       Refugees (UNHCR) in Geneva, Switzerland. Several non-governmental
            are conducted in conformance with an annual operating budget that is vetted and



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                                                                                                                                                                                                    organizations from around the globe were asked to participate in the
            approved by its 30-member Board of Directors, which includes several former or                                                                                                          consultation sessions which were designed to provide a dialog between
            current CEOs/COOs and top executives of leading U.S. and international                                                                                                                  the U.N. and the agencies that operate and implement services for
            companies, five MBAs from schools including Harvard and Stanford, executives                                                                                                            refugees. Topics discussed included issues of security, health, and long-
            with over 130 collective years in the investment business, and three accomplished                                                                                                       term “durable solutions” for refugees, such as repatriation, integration,
            attorneys. All Board members are unpaid and sign conflict-of-interest agreements.                                                                                                       and resettlement.




                                                                                                                                                                                                                                                                                                                                                                                                                        PHOTO COURTESY UNHCR / L. TAYLOR
                                                                                                                                                                                                    For over ten years, Direct Relief has worked with numerous U.N.
            ADHERENCE TO NATIONWIDE STANDARDS: Direct Relief is registered



2
                                                                                                                                                                                                    agencies, including UNICEF, UNWRA, and UNHCR. The most recent
            with the appropriate authority in each U.S. state that requires a registration for                                                                                                      partnership with UNHCR involved assisting Congolese refugees, who
            soliciting support or conducting operations (currently 35). We believe this is                                                                                                          were displaced due to civil strife, at Kawambwa District Hospital in
            important as people increasingly research organizations on the web and make                                                                                                             northern Zambia. The talks in Geneva provided an opportunity for
            online charitable donations.                                                                                                                                                            Direct Relief to explore additional avenues to partner with UNHCR
                                                                                                                                                                                                    around the world. Two areas of need discussed included the plight of

            ACCOUNTABILITY: Direct Relief International meets the Better Business                  Highlights through October 31, 2003                                                              Colombian refugees in Ecuador and Venezuela, as well as refugees living
                                                                                                                                                                                                    in camps throughout sub-Saharan Africa.



3
            Bureau (BBB) Wise Giving Alliance’s Standards for Charity Accountability. The
            Alliance reports on national charities and determines if they meet voluntary           Cash received                                                                     $1,832,947
            standards on matters such as charity finances, appeals, and governance. For
                                                                                                                                                                                                                                                                                                MOTHER AND CHILD AT A REFUGEE CAMP IN TANZANIA
            more information, visit www.give.org.                                                  Wholesale value of medical product received                                      $72,370,396
                                                                                                   Leverage ratio YTD (wholesale value of aid for each dollar received)                       $39
            INDEPENDENT AUDIT: The Executive and Finance Committees of the
            Board meet monthly to review financial activities, investments, and overall            Average monthly cost to operate Direct Relief                                        $200,000



4
            agency practices. The Executive and Finance Committees retain and meet
            with an independent public accounting firm that conducts the annual audit              Number of employees                                                                         29
            and consults with the auditor, independent of any staff including the CEO and
            Controller, to discuss findings. Direct Relief’s Controller is a Certified Public
                                                                                                   Decrease in staff (from October 1999 to October 2003)                                      3%
            Accountant with over 15 years of professional experience, including significant        Increase in productivity (percent increase in value of aid provided Jan 1999 – Oct 2003)   51%
            nonprofit accounting and financial-management experience.
                                                                                                                                                                                                         Thank you for taking a moment to learn about Direct Relief International.


            STAFF COMPENSATION: The compensation of all Direct Relief staff mem-                   Year-End Donations Matter...                                                                          This newsletter describes how we work, our recent activities, and the effects of our efforts. Most importantly, this




5
                                                                                                                                                                                                         newsletter describes what we do with the money and material that is entrusted to us.
            bers is benchmarked each year against a survey of nonprofit compensation lev-
            els throughout Southern California and information from the Bureau of Labor                                                                                                                  Direct Relief’s work is simple conceptually, though often complicated logistically. We provide medicines, equipment,
            Statistics. All staff salaries, including that of the CEO, are consistent with                                                                                                               and supplies so indigenous doctors, nurses, and midwives in poor areas of the world can care for patients who otherwise
            those of the regional nonprofit sector for similar positions.                                                                  REQUIRED                                                      would go without. We aim to provide the right material, to the right people, at the right time – with timing being
                                                                                                                                                                                                         particularly important in emergency situations such as those that have occurred in Iraq and Liberia this year.
                                                                                                                     BY DECEMBER 31 TO MEET
                                                                                                                         BUDGETED EXPENSES                                                               The extensive support we receive from U.S. healthcare companies, which donate tens of millions of dollars worth
            LEADER IN EFFICIENCY AMONG ALL U.S. NONPROFITS: The                                                                                                                                          of their world-leading products to Direct Relief, enables us to leverage our modest cash budget to an extraordinary
            November/December issue of Consumers Digest ranks "Program Spending                                                        $2,537,291                                                        degree. We rely on private contributions – not government support – and for each dollar we spend, we typically




6
            Efficiency" of Leading U.S. Charities. Direct Relief is one of only five chari-                                                                                                              provide between $25-30 worth of medical material assistance (wholesale value) that have been specifically request-
            table organizations nationwide that receives a 99 percent or better rating.                                                                                                                  ed by a partner organization.
            Forbes magazine cited Direct Relief as one of only four U.S. charities with 100
            percent efficiency ratings in its December 2002 review. Worth magazine
                                                                                                                                                 RAISED                                                  But product donations do not address fully all the needs of our partner organizations and their patients, so we buy
            named Direct Relief one of “America’s Best 100 Charities” for efficiency and                                            BY SEPTEMBER 30                                                      as many of the life-saving basic medicines and supplies that are necessary and within our budget. Our partner
                                                                                                                                                                                                         organizations, in addition to providing much needed clinical care, are also leaders in the essential areas of public
            quality of work in its December 2001/January 2002 edition.
                                                                                                                                       $1,719,333                                                        health education, disease prevention, and maternal and child health. Direct Relief’s material support allows them
                                                                                                                                                                                                         to redirect whatever scarce funds they have to these high-impact programs that address the causes of poor health,




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                                                                                                                                                                                                         not just treat the symptoms.
            LAUDED BY WATCHDOG GROUPS: Charity Navigator gives Direct Relief its
            highest rating (four stars), and the American Institute of Philanthropy gives Direct                                                                                                         One in five people worldwide tries to live on less than a dollar a day, and millions of people die needlessly each year
            Relief an A- grade. (See www.charitynavigator.org and www.charitywatch.org)                                                                                                                  from preventable or easily treatable conditions. Because the challenge is so great, and our resources so limited,            Direct Relief Featured
                                                                                                                                                                                                         we are compelled to look for increasing efficiency in every aspect of our work.
                                                                                                                                                                                                                                                                                                                                      in National Ad Campaign
                                                                                                                                                                                                         I’m pleased to report that Consumers Digest, Forbes, Charity Navigator, and the American Institute of Philanthropy rate



8
            PLANNING FOR THE FUTURE: The Strategic Planning Committee of the
                                                                                                                                                                                                         Direct Relief among the most efficient of any charitable organizations in the United States. Also, the Better Business
            Board oversees three-year forward-looking plans, which contain measurable                                                                                                                    Bureau has evaluated Direct Relief International and determined that we meet the BBB Wise Giving Alliance’s Standards        Direct Relief is featured in a national advertising campaign that has
            goals and objectives and serve as the basis for the annual operating budgets,                                                                                                                for Charity Accountability. The Alliance reports on national charities and determines if they meet voluntary standards on    appeared in TIME Magazine, The Economist, and Scientific American. The
            staffing levels, and capital investments.                                                                                                                                                    matters such as charity finances, appeals, and governance. These independent evaluations are important to assure those       full-page advertisement, paid for by BD (Becton, Dickinson and
                                                                                                                                                                                                         who donate their hard-earned money to us that we are good stewards of their money. As important, it shows that our           Company) of New Jersey, highlights the company’s partnership with Direct




9           TRUSTED BY LEADING CORPORATIONS: Product donations have
            increased 67 percent during the period January 1 to September 30 from last
            year - $69.8 million in 2003 vs. $41.7 million in 2002.
                                                                                                     REMAINING AMOUNT NEEDED:
                                                                                                              $817,958                                                        $                          work is focused intensely on helping people who were born or thrust by events into vulnerable situations that prevent
                                                                                                                                                                                                         them from enjoying the wonders of a healthy life. We consider it a privilege to do so.

                                                                                                                                                                                                         Your support makes a genuine difference in the lives of people who face enormous challenges and hardships.
                                                                                                                                                                                                         Please help if you can.
                                                                                                                                                                                                                                                                                                                                      Relief to bring medical aid to people in countries afflicted by poverty or
                                                                                                                                                                                                                                                                                                                                      natural disaster.

                                                                                                                                                                                                                                                                                                                                      Edward Ludwig, the President and CEO of BD, in a letter to our organization
                                                                                                                                                                                                                                                                                                                                      wrote, “In these uncertain times, it is as important as ever to honor the needs
                                                                                                                                                                                                                                                                                                                                      of all people around the world, and remember that each of us can play a part



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                      THE IMPORTANCE OF YEAR-END DONATIONS!: Direct Relief’s                                                                                                                                                                                                                                                          in improving the quality of life … Thanks to the work of Direct Relief, a
                      ability to operate depends heavily on year-end donations. In each of                                                                                                                                                                                                                                            significant difference is being made in the wake of disasters throughout the
                      the past two years, Direct Relief has received more than one-third of                                                                                                                                                                                                                                           world where otherwise there would be little hope.”
                                                                                                                                                                                                         Thomas Tighe
                      its total cash contributions during the final eight weeks of the year.             SHAREHOLDERS MEETING AND SYMPOSIUM:                                                             President & CEO
                                                                                                                     PLEASE LOOK FOR MORE INFORMATION ON THIS                                                                                                                                                                         Direct Relief is honored by BD’s decision to highlight its longstanding part-
                                                                                                                       ANNUAL EVENT TO BE HELD ON MARCH 3RD.                                                                                                                                                                          nership in its national “Trust Partners” ad campaign. To read more on BD’s
                                                                                                                                                                                                                                                                                                                                      “Trusted Partners” campaign, visit the company’s website: www.bd.com.
4   INDEPENDENT ADVERTISING INSERT       PROGRAM HIGHLIGHTS             NOVEMBER 20, 2003                                                                                            WWW.DIRECTRELIEF.ORG                                                                                WWW.DIRECTRELIEF.ORG                                                                                            NOVEMBER 20, 2003         PROGRAM HIGHLIGHTS         INDEPENDENT ADVERTISING INSERT      5




                           10
    THINGS YOU SHOULD KNOW ABOUT
      DIRECT RELIEF INTERNATIONAL’S
               PROGRAMS

                                                                                                                                                                                                                                                                                         Prevention
1
            OUR APPROACH: Direct Relief’s programs equip indige-
            nous health professionals so they can care for people in
            need without regard to politics, religion, gender, race, or
            ability to pay.

            OUR PARTNERS: Direct Relief International’s network of                                                                                                                                                                                                                       and Education:
2
            partners includes more than 500 organizations, persons, and
            facilities in over 65 countries and is made-up of in-country
            partner organizations, healthcare institutions, international
            service clubs, including Rotary International and Lions Clubs                                                                                                                                                                                                                The Foundation of Good Health




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       PHOTO COURTESY PHOTOSHARE - WWW.PHOTOSHARE.ORG
            International, and other nongovernmental organizations.




                                                                                                                                                                                                                  PHOTO COURTESY AYACUCHO MEDICAL MISSION
            HOW WE DECIDE: Partner organizations are selected
                                                                                                                                                                                                                                                                                         D    irect Relief’s assistance program places a high priority on strengthening indigenous mater-



3
            using ten selection criteria and either strong referrals from
                                                                                                                                                                                                                                                                                              nal and child health care. We do this in partnership with facilities and organizations that
            trusted sources or our previous experience. Criteria include
                                                                                                                                                                                                                                                                                         provide quality clinical services and, as importantly, are leaders in the public health roles of
            the extent of need, the skill of providers and the quality of
                                                                                                                                                                                                                                                                                         education, awareness, and disease prevention.
            services, the inclusion of preventive and educational ele-
            ments, and emphasis on maternal and child health.
                                                                                                                                                                                                                                                                                         At the request of several of our in-country partner organizations, Direct Relief developed a series
                                                                                                                                                                                                                                                                                         of posters (below) to reinforce basic health messages critically important to healthy children:



4
            HOW WE HELP: Direct Relief provides medicines, equip-
                                                                                                                                                                                                                                                                                         pre-natal care, breastfeeding, weight monitoring of infants, and immunization. Direct Relief also
            ment, supplies, and nutritional supplements to approved
                                                                                                                                                                                                                                                                                         has prepared a Spanish language educational poster with funding provided by Johnson &
            partner organizations based on their specific requests and
                                                                                                                                                                                                                                                                                         Johnson to provide basic information about diabetes, a matter of growing concern in Latin
            local circumstances.
                                                                                                                                                                                                                                                                                         America, including diet and lifestyle choices. These simple educational tools are placed in clin-
                                                                                                                                                                                                                                                                                         ics to educate visitors and foster a discussion between staff and patients.
            WHY IT MATTERS: Financing health services in poor coun-
            tries is extremely difficult. Where patients lack funds, govern-
                                                                                                                                                                                                                                                                                         Two series of posters were created for Latin American and African countries. The African



5
            ments are broke, and no private health insurance exists, not
                                                                                                                                                                                                                                                                                         posters are in English and French, and the Latin American posters are in English and Spanish.
            enough money is available to procure basic supplies and main-         A MOTHER WAITS FOR CARE FOR CHILD WITH CLEFT LIP AT AYACUCHO REGIONAL HOSPITAL
                                                                                                                                                                                                                                                                                         The Asia series is coming soon!
            tain a staffed health facility or prevention program. Direct
                                                                                                                                                                                                                                                                                                                                                                                               TWO COMMUNITY HEALTH WORKERS PERFORMING A WELL-BABY EXAM AT A CLINIC IN UGANDA
            Relief’s material support enables the professionals to work, the



                                                                                  Peru: Notes from the Field
            patients to receive care, and scarce funds to be invested in staff
            and education and prevention efforts.

            WHY ELSE IT MATTERS: Health has intrinsic value for
            every person, but it is also essential for people to learn,



6
            work, and make a living. Trained health professionals in              DAN SMITH, Senior Program Officer
            poor countries represent the most important part of the
            healthcare infrastructure – and Direct Relief’s support
                                                                                  A    yacucho is one of the poorest areas in Peru, according to the World Health Organization, with only one




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       ARTWORK COURTESY JOHNSON & JOHNSON
            enables them to stay productively engaged and their                        physician for every 12,000 persons. Located in the mountains of Southern Peru, Ayacucho was one of the
            patients to receive needed care.                                      principal battlegrounds between the Peruvian government and the Shining Path guerrilla movement.
                                                                                  Although some guerrilla activity still remains and continues to be a problem, Ayacucho is attempting to



7
                                                                                                                                                                                                                                                            ARTWORK BY MICHELLE ONSTOT
            SHARED INVESTMENT: To ensure a shared stake in the                    rebuild its shattered economy and improve its healthcare system.
            assistance, in-country partner organizations are asked to
            assume responsibility for some costs, if possible, such as in-        Constructed in 1964, the Ayacucho Regional Hospital has 239 beds and over 550 employees. As the largest
            country transportation and logistics.                                 hospital in the state, it serves the city of Ayacucho and receives referrals from throughout the region. The
                                                                                  Ayacucho Medical Mission, an independent, U.S.-based support organization founded eight years ago by
            DISASTER RELIEF AND EMERGENCY ASSISTANCE:                             current president Dr. Ralph Kuon, recruits dozens of physicians, surgeons, nurses, translators, and other




8
            The same programmatic principles apply whether providing              medical professionals who pay their own way to volunteer at the regional hospital.
            ongoing assistance or disaster relief: we must know specifi-
            cally what is required, who is responsible, how the material          The patient population served by the hospital is the lowest socio-economic stratum in the country, with the majority
            will be used, and whether there is a secure logistics channel.        of the patients being subsistence farmers or workers from Peru’s informal work sector. Many others are homeless or live
            The main difference in emergencies is that time is of the             in isolated regions and may have never previously seen a physician.
            essence, and the process is accelerated.

            LEADING COMPANIES TRUST US: Direct Relief
                                                                                  I recently stayed with the Ayacucho Mission group for one week as a translator; when I arrived with the other vol-
                                                                                  unteers, we were welcomed by the Mayor of Ayacucho, the Hospital Director, the Regional Medical Director, and                                                                                          Here at Home: Preparedness and Emergency Response
9           receives significant product donations from dozens of
            healthcare companies, including Johnson & Johnson,
            Merck, Pfizer, Abbot Laboratories, BD, Bristol-Myers
            Squibb, GlaxoSmithKline, and Alcon.

                      OUR QUALIFICATIONS: Direct Relief is a
                                                                                  several staff physicians and nurses. It was clear that both hospital administration and staff supported the services
                                                                                  offered by the Ayacucho Medical Mission.

                                                                                  During my time at the hospital, I observed that the patients were diagnosed and treated carefully and that surgeries
                                                                                  were carried out in a professional manner. Surgical patients received pre-op check-ups and post-op care with blood
                                                                                  tests provided through the Mission laboratory. In addition to surgeries and outpatient consultations, other services
                                                                                                                                                                                                                                                                                         D     irect Relief International announced in September that it
                                                                                                                                                                                                                                                                                               will coordinate a county-wide education and outreach
                                                                                                                                                                                                                                                                                         effort to prepare vulnerable county residents to cope with
                                                                                                                                                                                                                                                                                         emergencies and disasters.
                                                                                                                                                                                                                                                                                                                                                             The Vulnerable Populations Program was originally launched in
                                                                                                                                                                                                                                                                                                                                                             2000 by the Santa Barbara County Public Health Department as
                                                                                                                                                                                                                                                                                                                                                             a pilot project to address the needs of those who will be unable
                                                                                                                                                                                                                                                                                                                                                             to act independently during an emergency or disaster. Due to
                                                                                                                                                                                                                                                                                                                                                             California’s state budget crisis, the county was not able to con-
                                                                                                                                                                                                                                                                                                                                                                                                                                    tations to targeted sites. The program will help facilities and
                                                                                                                                                                                                                                                                                                                                                                                                                                    individuals to create customized disaster preparedness plans and
                                                                                                                                                                                                                                                                                                                                                                                                                                    will encourage mutual aid agreements with local facilities and
                                                                                                                                                                                                                                                                                                                                                                                                                                    agencies to assist one another in case of emergency or disaster.
                      licensed wholesale pharmacy, and our staff has vast         included diabetes education, dental screenings, Pap smears, and nightly community health talks. I also observed                                                                                        An estimated 40,000 residents of Santa Barbara County -             tinue the program. With coordination efforts spearheaded by            For decades, Direct Relief has been involved in local emergency
                      experience in international health projects. The            thousands of doses of Direct Relief-supplied medicines were provided to patients who would not have been able to



10
                                                                                                                                                                                                                                                                                         nearly one in ten - are considered vulnerable in the event          Direct Relief and an initial grant by the Santa Barbara                preparedness and response in Santa Barbara County and
                      Program Committee of the Board of Directors,                afford them were it not for the Mission.                                                                                                                                                               of a disaster. Among those in our home community who                Foundation, the program is now able to continue providing pre-         throughout California, as well as other regional healthcare ini-
                      which provides general programmatic direction                                                                                                                                                                                                                      will be in need of special attention if a disaster strikes are      paredness instruction to facilities that already work with the vul-    tiatives. Direct Relief has constructed disaster preparedness
                      and oversight, is chaired by a physician who ran a          The Ayacucho Mission, which Dr. Ralph Kuon initiated and has continued to direct, is impressive. It is a continu-                                                                                      residents of nursing homes, home-based care recipients,             nerable populations and will begin outreach to other facilities as     structures at more than two dozen local schools, participated in
                      charitable health clinic in Latin America. (Visit           ing and successful program which provides professional medical services to people who are desperately in need.                                                                                         frail seniors, people with short term acute or chronic phys-        well as target programs serving children and the developmental-        county-wide disaster drills, provided dental care for 3,200 low
                      www.directrelief.org to see the full list of our            Partnerships such as these allow Direct Relief to provide ongoing medical support to indigenous healthcare systems,                                                                                    ical illnesses, and those with disabling acute or chronic           ly disabled. Along with preparedness efforts, Vulnerable               income and homeless children, donated 22,500 personal
                      credentials and qualifications.)                            which is one of our most important programmatic goals.                                                                                                                                                 mental illnesses. Direct Relief has begun to coordinate a           Populations Program Coordinator Christienne Durbin oversees            hygiene kits for the county’s indigent population, and provided
                                                                                                                                                                                                                                                                                         countywide education and outreach effort to prepare these           the training of AmeriCorps volunteers from the local American          surgical instruments and pharmaceuticals to low-income pri-
                                                                                  Dan Smith, M.A., is Direct Relief’s Senior Program Officer for Latin America. He has worked for the agency for fifteen years.                                                                          individuals for emergencies and disasters.                          Red Cross and Direct Relief's own volunteers to assist in presen-      mary care clinics throughout California.
6   INDEPENDENT ADVERTISING INSERT      PROGRAM HIGHLIGHTS            NOVEMBER 20, 2003                                                                                                         WWW.DIRECTRELIEF.ORG                                                              WWW.DIRECTRELIEF.ORG                                                                                                               NOVEMBER 20, 2003         PROGRAM HIGHLIGHTS         INDEPENDENT ADVERTISING INSERT       7




                                                                                    Iraq                             Helping Restart Health Services                                                                                                                                              Cambodia:
                                                                                                                                                                                                                                                                                                  Notes from the Field
                                                                                                                                                                                                                                                                                                  KELLY DARNELL, Program Officer


                                                                                                                                                                                                                                                                                                  D     uring the tragic reign of the Khmer Rouge, many Cambodian




                                                                                                                                                                                                                                                  PHOTO COURTESY HOUSE ARMED SERVICES COMMITTEE
                                                                                                                                                                                                                                                                                                        health facilities were destroyed and countless medical profes-
                                                                                                                                                                                                                                                                                                  sionals were either killed or escaped, never to return. After decades
                                                                                                                                                                                                                                                                                                  of conflict, only a handful of medical professionals remained in the
                                                                                                                                                                                                                                                                                                  country and the medical education system lacked qualified teach-
                                                                                                                                                                                                                                                                                                  ers and a strong curriculum. Approximately 52 percent of the 12
                                                                                                                                                                                                                                                                                                  million Cambodians are under the age of 18. For parents, finding a
                                                                                                                                                                                                                                                                                                  trained healthcare provider for their children is often impossible.

                                                                                                                                                                                                                                                                                                  During my assessment trip to Cambodia, I visited one of Direct
                                                                                                                                                                                                                                                                                                  Relief’s newest partner facilities, the Angkor Hospital for
                                                                                                                                                                                                                                                                                                  Children (AHC) in Siem Reap. AHC was founded in 1999 to
                                                                                                                                                                                                                                                                                                  provide services to the children of northern Cambodia, who




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    PHOTO COURTESY AHC
KELLY DARNELL




                                                                                                                                                                                                                                                                                                  historically have had very little access to health care, and to
                                                                                                                                                                                                                                                                                                  serve as a center for the further education and clinical training
                                                                                                                                                                                                                                                                                                  of Cambodian medical professionals.

                                                                                                                                                                                                                                                                                                  Staffed by a team of healthcare professionals from around the
                DR. KONDE HAND-PICKING SURGICAL EYE INSTRUMENTS DURING              CONGRESSIONAL DELEGATION PRESENTING DIRECT RELIEF MEDICAL SUPPLIES TO ST. RAPHAEL HOSPITAL IN BAGHDAD.                                                                                                        world, the hospital provides outpatient and inpatient services,
                HIS VISIT TO DIRECT RELIEF                                          FROM LEFT: REP. VIC SNYDER (AK), REP. MIKE ROGERS (AL), REP. BARON HILL (IN), REP. ROB SIMMONS (CT), SISTER MARYANNE,
                                                                                    REP. MADELEINE BORDALLO (GUAM), REP. STEVE KING (IA), REP. MAC THORNBERRY (TX), REP. GRESHAM BARRETT (SC), REP. TOM COLE (OK)                                                                                 basic surgery, and 24-hour emergency care to approximately
                                                                                                                                                                                                                                                                                                  5,000 children each month. In addition to caring for children,                        A STAFF MEMBER FROM ANGKOR HOSPITAL FOR CHILDREN (AHC) CONDUCTS A COMMUNITY HEALTH VISIT.


                Congo D.R.                                                          Direct Relief has been responding to the situation in Iraq with med-
                                                                                    ical support to health facilities in Baghdad, Nazirieh, and Basra.
                                                                                    Since the end of the war, Direct Relief has provided 11 shipments of
                                                                                    pharmaceuticals, medical and surgical supplies, and equipment, val-
                                                                                                                                                                    months, the hospital has experienced a significant increase in its
                                                                                                                                                                    workload due to the war, immediate postwar looting of other facil-
                                                                                                                                                                    ities, and increased health needs of the city’s residents. The hos-
                                                                                                                                                                    pital is recognized as providing state-of-the-art healthcare for Iraq
                                                                                                                                                                                                                                                                                                  the hospital also offers hands-on pediatric training to
                                                                                                                                                                                                                                                                                                  Cambodian healthcare workers. When the hospital first
                                                                                                                                                                                                                                                                                                  opened, Cambodian doctors and nurses worked one-on-one
                                                                                                                                                                                                                                                                                                  with volunteer doctors and nurses from countries such as the
                                                                                                                                                                                                                                                                                                                                                                                        zation that sends volunteer healthcare professionals from the
                                                                                                                                                                                                                                                                                                                                                                                        United States to health facilities around the world. Dr. Alia
                                                                                                                                                                                                                                                                                                                                                                                        Antoon, a pediatrician from Boston’s Mass General with a spe-
                                                                                                                                                                                                                                                                                                                                                                                                                                                                any treatment modifications. What struck me most as we arrived
                                                                                                                                                                                                                                                                                                                                                                                                                                                                at each home was how visibly surprised and grateful each family
                                                                                                                                                                                                                                                                                                                                                                                                                                                                was to be receiving such personal follow-up care for their child.

                Direct Relief                                                       ued at more than $10.5 million wholesale, all from private sources.
                                                                                    Direct Relief’s efforts, though private, are conducted in coordination
                                                                                                                                                                    but still falls short of what is considered a standard health facility
                                                                                                                                                                    in the United States as essential drugs and supplies continue to be
                                                                                                                                                                                                                                                                                                  U.S., Canada, and Great Britain. Today, these same Cambodian
                                                                                                                                                                                                                                                                                                  doctors and nurses are training their junior colleagues.
                                                                                                                                                                                                                                                                                                                                                                                        cialty in pediatric burns, was the HVO doctor stationed at the
                                                                                                                                                                                                                                                                                                                                                                                        facility during my visit. I spent a day with Dr. Antoon and sever-      In June 2003, Direct Relief sent its first shipment to AHC which
                                                                                                                                                                                                                                                                                                                                                                                        al nurses visiting rural communities to follow-up on recently dis-      included an incubator, exam lights, pediatric stethoscopes,
                Supports Leading                                                    with and approved by the U.S.-led Coalition Provisional Authority.              in short supply. Direct Relief's assistance to St. Raphael Hospital
                                                                                                                                                                    has included children's and adult multivitamins, antibiotics, drugs                                                           AHC came to the attention of Direct Relief through one of our
                                                                                                                                                                                                                                                                                                  U.S.-based partner organizations, Health Volunteers Overseas
                                                                                                                                                                                                                                                                                                                                                                                        charged patients who had been treated for burns and malnutrition.
                                                                                                                                                                                                                                                                                                                                                                                        As their children were weighed and examined, the parents talked
                                                                                                                                                                                                                                                                                                                                                                                                                                                                neonatal blood pressure cuffs, antibiotics, burn dressings, and
                                                                                                                                                                                                                                                                                                                                                                                                                                                                one of their most-needed items, a one-year supply of soy-based

                Eye Doctor                                                          S    r. Maryanne, director of St. Raphael Hospital in Baghdad,
                                                                                         writes, "By this letter I would like to express to you our deep-
                                                                                    est feelings of gratitude and thanks for your help…." The situation
                                                                                                                                                                    for hypertension, oral rehydration salts, casting material, syringes
                                                                                                                                                                    and needles, sutures, sterile gauze, and pain-relief medication. The
                                                                                                                                                                    most recent aid to St. Raphael’s was delivered by a U.S. congres-
                                                                                                                                                                                                                                                                                                  (HVO). HVO is a leading health education and training organi-                         to AHC staff about how their child was progressing and discussed        protein powder supplement for malnourished children.


                in Country                                                          in Baghdad remains critical and very dangerous as the city recov-               sional delegation (CODEL), led by Rep. Mac Thornberry of




                                                                                                                                                                                                                                                                                                                                                                          SHARIR CHAN
                                                                                                                                                                                                                                                                                                  Guyana:
                                                                                    ers from a severe summer that had temperatures hovering around                  Texas. The assistance consisted of 1,222 lbs. of material, with a                                                                                                                                                                                                                           LEFT: PROGRAM OFFICER KELLY DARNELL MEETING WITH PRIME MINISTER
                                                                                                                                                                                                                                                                                                                                                                                                                                                                SAM HINDS. BELOW: A GUYANESE BOY AT NEW AMSTERDAM HOSPITAL.
                                                                                    120 degrees, little security, no pure water, and limited electricity. In        wholesale value of $250,000.

                I n the Bas-Congo region of the Democratic Republic of
                  Congo (formerly Zaire), only three eye doctors serve a
                population of over four million people. It is estimated that
                                                                                    the aftermath of the war, Baghdad was caught in a deadly cycle:
                                                                                    with no electricity to pump water, locals were breaking into under-
                                                                                    ground pipes allowing raw sewage to seep into the system. In some
                                                                                                                                                                    With only 19 psychiatrists in Iraq and the prevalence of post-
                                                                                                                                                                    traumatic stress syndrome in the general population, identifying
                between 40,000 to 80,000 blind people live in the
                province, with fifty percent of those cases due to cataracts.
                                                                                    areas, 80 percent of patients were experiencing some form of water-
                                                                                    born gastrointestinal infection, and many children suffered from
                                                                                                                                                                    and treating patients with mental disease has become a large pub-
                                                                                                                                                                    lic health concern. Direct Relief has been partnering with the
                                                                                                                                                                    Freedom and Peace Trust, directed by Wasseem Kabbara, to pro-
                                                                                                                                                                                                                                                                                                  Notes from the Field
                The Boma Eye Hospital was founded in 1999 by Dr. Joseph             vomiting and diarrhea, leaving them badly dehydrated. In order to
                Konde, a Congolese national and U.S. board-certified doc-           address these increasing health needs, Direct Relief International              vide mental health professionals in Iraq with the pharmaceuticals
                                                                                                                                                                                                                                                                                                  KELLY DARNELL, Program Officer
                tor who completed his medical training at the University            has been working closely with a number of facilities in Iraq, includ-           they need to treat and maintain the health of thousands of trau-
                of North Carolina at Chapel Hill and received his                   ing Sister Maryanne’s St. Raphael Hospital.                                     matized people. Psychotherapeutic agents provided by Direct
                Doctorate of Ophthalmology from the University of
                Zimbabwe. While his colleagues stayed in the United                 St. Raphael is a private, charitable hospital that has been operat-
                                                                                                                                                                    Relief are being distributed to Iraqi physicians for use in mental
                                                                                                                                                                    health wards including Al-Rashad hospital in Baghdad, the only
                                                                                                                                                                                                                                                                                                  S   ituated on the northeastern coast of South America, Guyana
                                                                                                                                                                                                                                                                                                      is a sparsely populated country with just over 750,000 people.
                                                                                                                                                                                                                                                                                                  The population is primarily a mix of Africans, East Indians, and
                States and have established thriving practices, Dr. Konde           ed by a Dominican Order of nuns for over 100 years. In recent                   dedicated mental health institution in the country.
                                                                                                                                                                                                                                                                                                  Amerindians. Although the country’s healthcare system has                             The Amerindian communities in the interior have very little
                chose to return to the Democratic Republic of Congo with
                                                                                                                                                                                                                                                                                                  improved in recent years, many Guyanese, especially those living                      access to medical services since the majority of Guyana’s health
                his wife and three daughters to provide medical care to the                 DIRECT RELIEF WOULD LIKE TO THANK PFIZER INC FOR ITS GENEROUS GRANT OF $25,000 TO SUPPORT OUR ONGOING
                                                                                                                                                                                                                                                                                                  in the northern rainforest, still have very limited access to health                  facilities are located along the more densely populated coast of the
                people of his native country.                                           EFFORTS IN IRAQ. FOR UP-TO-DATE INFORMATION ON OUR WORK IN IRAQ, PLEASE VISIT OUR WEBSITE: WWW.DIRECTRELIEF.ORG.
                                                                                                                                                                                                                                                                                                  care and suffer from high rates of communicable diseases and                          country. The Moraikobai Hospital is the principal healthcare facil-
                                                                                                                                                                                                                                                                                                  nutritional deficiencies. The health system has also been partic-                     ity for the Amerindian villages within 100 miles. The small four-
                With a staff of 15, the Boma Eye Hospital sees over 4,000
                                                                                                                                                                                                                                                                                                  ularly hard hit by the “brain drain” that has been occurring for
                patients each year and treats an additional 2,000 at its eight
                                                                                                                                        Students and Parents                                                                                                                                                                                                                            room hospital is staffed by three nurses, one Peace Corps volunteer,


                                                                                    Bolivia
                                                                                                                                                                                                                                                                                                  decades as Guyanese doctors and nurses leave for better pay and                       and a “Medex” named Thomas George, who has a level of training
                outreach facilities. Financing the facility is exceedingly diffi-
                                                                                                                                                                                                                                                                                                  working conditions in other countries.                                                between a nurse and a doctor. Assigned to the village a little over
                cult because only 25 percent of the patients have the
                resources to pay for services. In 2002, the hospital and its
                facilities performed over 600 eye surgeries, including 304
                                                                                                                                        “Ride for a Reason”                                                                                                                                       For 19 years, Direct Relief has been providing medical supplies to
                                                                                                                                                                                                                                                                                                                                                                                        a year ago, Thomas has already created a community health com-
                                                                                                                                                                                                                                                                                                                                                                                        mittee, helped establish a clean source of drinking water, and
                                                                                                                                                                                                                                                                                                  strengthen local health efforts in Guyana. During my week-long                        worked to improve the level of services at the hospital through
                cataract extractions. The hospital also runs a high-dose vita-
                min A program that annually serves 15,000 children under
                the age of five. Ninety percent of its patients receive care free
                                                                                    I  n the summer of 2003, 25 participants joined in the “Ride for
                                                                                       a Reason” - a fundraising expedition by mountain bike from
                                                                                    the high Andes above La Paz, Bolivia, through descending
                                                                                                                                                                                                                                                                                                  assessment trip, I visited seven Direct Relief-supported hospitals,
                                                                                                                                                                                                                                                                                                  including our newest partner facility, the Moraikobai Hospital.
                                                                                                                                                                                                                                                                                                                                                                                        partnerships with organizations like Direct Relief and the Peace
                                                                                                                                                                                                                                                                                                                                                                                        Corps. In December 2003, Direct Relief will supply Moraikobai
                                                                                                                                                                                                                                                                                                                                                                                        with material assistance that includes a new exam/delivery table,
                of charge even though the hospital receives virtually no sup-       interior jungle and rainforest to Rurrenabaque, the center of                                                                                                                                                 After traveling three hours inland through the rainforest on                          inpatient beds, minor surgical instruments, quinine to treat malar-
                port from the government.                                           the Rio Beni Health Project. The expedition, a total of 300                                                                                                                                                   Guyana’s Mahaicony River, I reached the village of                                    ia, and antibiotics to treat upper-respiratory infections.
                                                                                    miles with a 13,000 foot drop in elevation, was led by Program                                                                                                                                                Moraikobai. The majority of native Amerindians make their
                In 2003, Direct Relief provided the Boma Eye Hospital with          Manager Christopher Brady to raise critical funds for Direct                                                                                                                                                  home in this remote community. Most of them live in small                             During the final days of my visit, I had a series of meetings with
                material assistance such as exam tables, wheelchairs, IV stands,    Relief’s Rio Beni Health Project. The expedition also provided                                                                                                                                                villages of palm-thatched huts and survive on subsistence agri-                       government officials, including Prime Minister Sam Hinds, First
                exam lights, bandages, surgical gowns, ophthalmic antibiotics,      the participants with a first-hand educational experience in                                                                                                                                                  culture, hunting, and fishing. The Amerindians have the high-                         Lady Uma Jagdeo, Minister of Health Dr. Leslie Ramsammy, and
                                                                                                                                                                                                                                             MATT KETTMANN




                ophthalmic sutures, and ophthalmic surgical kits. In addition,      humanitarian aid, the Amazon rainforest and altiplano ecology                                                                                                                                                 est rates of low-birth-weight babies, malaria, and malnourished                       Guyana Peace Corps Director Earle Brown to discuss how Direct
                Direct Relief has provided the hospital with 25 new manual          and Bolivian culture, history and nature. We thank all 25 par-                                                                                                                                                children in the country. In addition, they suffer from acute res-                     Relief can best help strengthen local Guyanese health services
                beds, donated by Hill-Rom Company, to help expand inpatient         ticipants, who not only completed this arduous physical feat




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    KELLY DARNELL
                                                                                                                                                                                                                                                                                                  piratory illnesses and diarrheal-related diseases due to poor san-                    and prevention activities and reach out to more isolated health
                care. Direct Relief-furnished equipment and supplies enable Dr.     but together raised over $80,000 for the project.                                                                                                                                                             itation and lack of access to clean drinking water.                                   facilities like the Moraikobai Hospital.
                Konde to provide care and reallocate scarce cash to invest in
                staff and conduct an outreach and education program, which          For more information on the Rio Beni Health Project, the “Ride for a            THE BOLIVIAN BIKE TEAM AT THE TOP OF THEIR MOST                                                                               Kelly Darnell has been a Program Officer at Direct Relief International for four years. She previously served as a Health Care Educator
                otherwise would not be possible.                                    Reason” and its participants, please visit our website: www.directrelief.org.   CHALLENGING ASCENT                                                                                                            with the Peace Corps in Cote d’Ivoire.
2003 Winter Newsletter
2003 Winter Newsletter
2003 Winter Newsletter

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2003 Winter Newsletter

  • 1. Paid Advertising Insert Healthy people. Better world. A CHILD SLEEPS AT MUANG SING HOSPITAL IN LAOS • BRYAN WATT WWW.DIRECTRELIEF.ORG
  • 2. 2 INDEPENDENT ADVERTISING INSERT FINANCIALS NOVEMBER 20, 2003 WWW.DIRECTRELIEF.ORG WWW.DIRECTRELIEF.ORG NOVEMBER 20, 2003 NEWS INDEPENDENT ADVERTISING INSERT 3 Top Ranked in Efficiency, THINGS YOU SHOULD KNOW ABOUT 10 Accountability, and Leadership by: Direct Relief Invited to Advise UN Officials in Geneva DIRECT RELIEF INTERNATIONAL’S FINANCES Susan Fowler, Director of Programs, recently attended the Executive Committee meeting of the United Nations High Commissioner on STRICT BOARD OVERSIGHT AND GOVERNANCE: Direct Relief's operations Refugees (UNHCR) in Geneva, Switzerland. Several non-governmental are conducted in conformance with an annual operating budget that is vetted and 1 organizations from around the globe were asked to participate in the approved by its 30-member Board of Directors, which includes several former or consultation sessions which were designed to provide a dialog between current CEOs/COOs and top executives of leading U.S. and international the U.N. and the agencies that operate and implement services for companies, five MBAs from schools including Harvard and Stanford, executives refugees. Topics discussed included issues of security, health, and long- with over 130 collective years in the investment business, and three accomplished term “durable solutions” for refugees, such as repatriation, integration, attorneys. All Board members are unpaid and sign conflict-of-interest agreements. and resettlement. PHOTO COURTESY UNHCR / L. TAYLOR For over ten years, Direct Relief has worked with numerous U.N. ADHERENCE TO NATIONWIDE STANDARDS: Direct Relief is registered 2 agencies, including UNICEF, UNWRA, and UNHCR. The most recent with the appropriate authority in each U.S. state that requires a registration for partnership with UNHCR involved assisting Congolese refugees, who soliciting support or conducting operations (currently 35). We believe this is were displaced due to civil strife, at Kawambwa District Hospital in important as people increasingly research organizations on the web and make northern Zambia. The talks in Geneva provided an opportunity for online charitable donations. Direct Relief to explore additional avenues to partner with UNHCR around the world. Two areas of need discussed included the plight of ACCOUNTABILITY: Direct Relief International meets the Better Business Highlights through October 31, 2003 Colombian refugees in Ecuador and Venezuela, as well as refugees living in camps throughout sub-Saharan Africa. 3 Bureau (BBB) Wise Giving Alliance’s Standards for Charity Accountability. The Alliance reports on national charities and determines if they meet voluntary Cash received $1,832,947 standards on matters such as charity finances, appeals, and governance. For MOTHER AND CHILD AT A REFUGEE CAMP IN TANZANIA more information, visit www.give.org. Wholesale value of medical product received $72,370,396 Leverage ratio YTD (wholesale value of aid for each dollar received) $39 INDEPENDENT AUDIT: The Executive and Finance Committees of the Board meet monthly to review financial activities, investments, and overall Average monthly cost to operate Direct Relief $200,000 4 agency practices. The Executive and Finance Committees retain and meet with an independent public accounting firm that conducts the annual audit Number of employees 29 and consults with the auditor, independent of any staff including the CEO and Controller, to discuss findings. Direct Relief’s Controller is a Certified Public Decrease in staff (from October 1999 to October 2003) 3% Accountant with over 15 years of professional experience, including significant Increase in productivity (percent increase in value of aid provided Jan 1999 – Oct 2003) 51% nonprofit accounting and financial-management experience. Thank you for taking a moment to learn about Direct Relief International. STAFF COMPENSATION: The compensation of all Direct Relief staff mem- Year-End Donations Matter... This newsletter describes how we work, our recent activities, and the effects of our efforts. Most importantly, this 5 newsletter describes what we do with the money and material that is entrusted to us. bers is benchmarked each year against a survey of nonprofit compensation lev- els throughout Southern California and information from the Bureau of Labor Direct Relief’s work is simple conceptually, though often complicated logistically. We provide medicines, equipment, Statistics. All staff salaries, including that of the CEO, are consistent with and supplies so indigenous doctors, nurses, and midwives in poor areas of the world can care for patients who otherwise those of the regional nonprofit sector for similar positions. REQUIRED would go without. We aim to provide the right material, to the right people, at the right time – with timing being particularly important in emergency situations such as those that have occurred in Iraq and Liberia this year. BY DECEMBER 31 TO MEET BUDGETED EXPENSES The extensive support we receive from U.S. healthcare companies, which donate tens of millions of dollars worth LEADER IN EFFICIENCY AMONG ALL U.S. NONPROFITS: The of their world-leading products to Direct Relief, enables us to leverage our modest cash budget to an extraordinary November/December issue of Consumers Digest ranks "Program Spending $2,537,291 degree. We rely on private contributions – not government support – and for each dollar we spend, we typically 6 Efficiency" of Leading U.S. Charities. Direct Relief is one of only five chari- provide between $25-30 worth of medical material assistance (wholesale value) that have been specifically request- table organizations nationwide that receives a 99 percent or better rating. ed by a partner organization. Forbes magazine cited Direct Relief as one of only four U.S. charities with 100 percent efficiency ratings in its December 2002 review. Worth magazine RAISED But product donations do not address fully all the needs of our partner organizations and their patients, so we buy named Direct Relief one of “America’s Best 100 Charities” for efficiency and BY SEPTEMBER 30 as many of the life-saving basic medicines and supplies that are necessary and within our budget. Our partner organizations, in addition to providing much needed clinical care, are also leaders in the essential areas of public quality of work in its December 2001/January 2002 edition. $1,719,333 health education, disease prevention, and maternal and child health. Direct Relief’s material support allows them to redirect whatever scarce funds they have to these high-impact programs that address the causes of poor health, 7 not just treat the symptoms. LAUDED BY WATCHDOG GROUPS: Charity Navigator gives Direct Relief its highest rating (four stars), and the American Institute of Philanthropy gives Direct One in five people worldwide tries to live on less than a dollar a day, and millions of people die needlessly each year Relief an A- grade. (See www.charitynavigator.org and www.charitywatch.org) from preventable or easily treatable conditions. Because the challenge is so great, and our resources so limited, Direct Relief Featured we are compelled to look for increasing efficiency in every aspect of our work. in National Ad Campaign I’m pleased to report that Consumers Digest, Forbes, Charity Navigator, and the American Institute of Philanthropy rate 8 PLANNING FOR THE FUTURE: The Strategic Planning Committee of the Direct Relief among the most efficient of any charitable organizations in the United States. Also, the Better Business Board oversees three-year forward-looking plans, which contain measurable Bureau has evaluated Direct Relief International and determined that we meet the BBB Wise Giving Alliance’s Standards Direct Relief is featured in a national advertising campaign that has goals and objectives and serve as the basis for the annual operating budgets, for Charity Accountability. The Alliance reports on national charities and determines if they meet voluntary standards on appeared in TIME Magazine, The Economist, and Scientific American. The staffing levels, and capital investments. matters such as charity finances, appeals, and governance. These independent evaluations are important to assure those full-page advertisement, paid for by BD (Becton, Dickinson and who donate their hard-earned money to us that we are good stewards of their money. As important, it shows that our Company) of New Jersey, highlights the company’s partnership with Direct 9 TRUSTED BY LEADING CORPORATIONS: Product donations have increased 67 percent during the period January 1 to September 30 from last year - $69.8 million in 2003 vs. $41.7 million in 2002. REMAINING AMOUNT NEEDED: $817,958 $ work is focused intensely on helping people who were born or thrust by events into vulnerable situations that prevent them from enjoying the wonders of a healthy life. We consider it a privilege to do so. Your support makes a genuine difference in the lives of people who face enormous challenges and hardships. Please help if you can. Relief to bring medical aid to people in countries afflicted by poverty or natural disaster. Edward Ludwig, the President and CEO of BD, in a letter to our organization wrote, “In these uncertain times, it is as important as ever to honor the needs of all people around the world, and remember that each of us can play a part 10 THE IMPORTANCE OF YEAR-END DONATIONS!: Direct Relief’s in improving the quality of life … Thanks to the work of Direct Relief, a ability to operate depends heavily on year-end donations. In each of significant difference is being made in the wake of disasters throughout the the past two years, Direct Relief has received more than one-third of world where otherwise there would be little hope.” Thomas Tighe its total cash contributions during the final eight weeks of the year. SHAREHOLDERS MEETING AND SYMPOSIUM: President & CEO PLEASE LOOK FOR MORE INFORMATION ON THIS Direct Relief is honored by BD’s decision to highlight its longstanding part- ANNUAL EVENT TO BE HELD ON MARCH 3RD. nership in its national “Trust Partners” ad campaign. To read more on BD’s “Trusted Partners” campaign, visit the company’s website: www.bd.com.
  • 3. 4 INDEPENDENT ADVERTISING INSERT PROGRAM HIGHLIGHTS NOVEMBER 20, 2003 WWW.DIRECTRELIEF.ORG WWW.DIRECTRELIEF.ORG NOVEMBER 20, 2003 PROGRAM HIGHLIGHTS INDEPENDENT ADVERTISING INSERT 5 10 THINGS YOU SHOULD KNOW ABOUT DIRECT RELIEF INTERNATIONAL’S PROGRAMS Prevention 1 OUR APPROACH: Direct Relief’s programs equip indige- nous health professionals so they can care for people in need without regard to politics, religion, gender, race, or ability to pay. OUR PARTNERS: Direct Relief International’s network of and Education: 2 partners includes more than 500 organizations, persons, and facilities in over 65 countries and is made-up of in-country partner organizations, healthcare institutions, international service clubs, including Rotary International and Lions Clubs The Foundation of Good Health PHOTO COURTESY PHOTOSHARE - WWW.PHOTOSHARE.ORG International, and other nongovernmental organizations. PHOTO COURTESY AYACUCHO MEDICAL MISSION HOW WE DECIDE: Partner organizations are selected D irect Relief’s assistance program places a high priority on strengthening indigenous mater- 3 using ten selection criteria and either strong referrals from nal and child health care. We do this in partnership with facilities and organizations that trusted sources or our previous experience. Criteria include provide quality clinical services and, as importantly, are leaders in the public health roles of the extent of need, the skill of providers and the quality of education, awareness, and disease prevention. services, the inclusion of preventive and educational ele- ments, and emphasis on maternal and child health. At the request of several of our in-country partner organizations, Direct Relief developed a series of posters (below) to reinforce basic health messages critically important to healthy children: 4 HOW WE HELP: Direct Relief provides medicines, equip- pre-natal care, breastfeeding, weight monitoring of infants, and immunization. Direct Relief also ment, supplies, and nutritional supplements to approved has prepared a Spanish language educational poster with funding provided by Johnson & partner organizations based on their specific requests and Johnson to provide basic information about diabetes, a matter of growing concern in Latin local circumstances. America, including diet and lifestyle choices. These simple educational tools are placed in clin- ics to educate visitors and foster a discussion between staff and patients. WHY IT MATTERS: Financing health services in poor coun- tries is extremely difficult. Where patients lack funds, govern- Two series of posters were created for Latin American and African countries. The African 5 ments are broke, and no private health insurance exists, not posters are in English and French, and the Latin American posters are in English and Spanish. enough money is available to procure basic supplies and main- A MOTHER WAITS FOR CARE FOR CHILD WITH CLEFT LIP AT AYACUCHO REGIONAL HOSPITAL The Asia series is coming soon! tain a staffed health facility or prevention program. Direct TWO COMMUNITY HEALTH WORKERS PERFORMING A WELL-BABY EXAM AT A CLINIC IN UGANDA Relief’s material support enables the professionals to work, the Peru: Notes from the Field patients to receive care, and scarce funds to be invested in staff and education and prevention efforts. WHY ELSE IT MATTERS: Health has intrinsic value for every person, but it is also essential for people to learn, 6 work, and make a living. Trained health professionals in DAN SMITH, Senior Program Officer poor countries represent the most important part of the healthcare infrastructure – and Direct Relief’s support A yacucho is one of the poorest areas in Peru, according to the World Health Organization, with only one ARTWORK COURTESY JOHNSON & JOHNSON enables them to stay productively engaged and their physician for every 12,000 persons. Located in the mountains of Southern Peru, Ayacucho was one of the patients to receive needed care. principal battlegrounds between the Peruvian government and the Shining Path guerrilla movement. Although some guerrilla activity still remains and continues to be a problem, Ayacucho is attempting to 7 ARTWORK BY MICHELLE ONSTOT SHARED INVESTMENT: To ensure a shared stake in the rebuild its shattered economy and improve its healthcare system. assistance, in-country partner organizations are asked to assume responsibility for some costs, if possible, such as in- Constructed in 1964, the Ayacucho Regional Hospital has 239 beds and over 550 employees. As the largest country transportation and logistics. hospital in the state, it serves the city of Ayacucho and receives referrals from throughout the region. The Ayacucho Medical Mission, an independent, U.S.-based support organization founded eight years ago by DISASTER RELIEF AND EMERGENCY ASSISTANCE: current president Dr. Ralph Kuon, recruits dozens of physicians, surgeons, nurses, translators, and other 8 The same programmatic principles apply whether providing medical professionals who pay their own way to volunteer at the regional hospital. ongoing assistance or disaster relief: we must know specifi- cally what is required, who is responsible, how the material The patient population served by the hospital is the lowest socio-economic stratum in the country, with the majority will be used, and whether there is a secure logistics channel. of the patients being subsistence farmers or workers from Peru’s informal work sector. Many others are homeless or live The main difference in emergencies is that time is of the in isolated regions and may have never previously seen a physician. essence, and the process is accelerated. LEADING COMPANIES TRUST US: Direct Relief I recently stayed with the Ayacucho Mission group for one week as a translator; when I arrived with the other vol- unteers, we were welcomed by the Mayor of Ayacucho, the Hospital Director, the Regional Medical Director, and Here at Home: Preparedness and Emergency Response 9 receives significant product donations from dozens of healthcare companies, including Johnson & Johnson, Merck, Pfizer, Abbot Laboratories, BD, Bristol-Myers Squibb, GlaxoSmithKline, and Alcon. OUR QUALIFICATIONS: Direct Relief is a several staff physicians and nurses. It was clear that both hospital administration and staff supported the services offered by the Ayacucho Medical Mission. During my time at the hospital, I observed that the patients were diagnosed and treated carefully and that surgeries were carried out in a professional manner. Surgical patients received pre-op check-ups and post-op care with blood tests provided through the Mission laboratory. In addition to surgeries and outpatient consultations, other services D irect Relief International announced in September that it will coordinate a county-wide education and outreach effort to prepare vulnerable county residents to cope with emergencies and disasters. The Vulnerable Populations Program was originally launched in 2000 by the Santa Barbara County Public Health Department as a pilot project to address the needs of those who will be unable to act independently during an emergency or disaster. Due to California’s state budget crisis, the county was not able to con- tations to targeted sites. The program will help facilities and individuals to create customized disaster preparedness plans and will encourage mutual aid agreements with local facilities and agencies to assist one another in case of emergency or disaster. licensed wholesale pharmacy, and our staff has vast included diabetes education, dental screenings, Pap smears, and nightly community health talks. I also observed An estimated 40,000 residents of Santa Barbara County - tinue the program. With coordination efforts spearheaded by For decades, Direct Relief has been involved in local emergency experience in international health projects. The thousands of doses of Direct Relief-supplied medicines were provided to patients who would not have been able to 10 nearly one in ten - are considered vulnerable in the event Direct Relief and an initial grant by the Santa Barbara preparedness and response in Santa Barbara County and Program Committee of the Board of Directors, afford them were it not for the Mission. of a disaster. Among those in our home community who Foundation, the program is now able to continue providing pre- throughout California, as well as other regional healthcare ini- which provides general programmatic direction will be in need of special attention if a disaster strikes are paredness instruction to facilities that already work with the vul- tiatives. Direct Relief has constructed disaster preparedness and oversight, is chaired by a physician who ran a The Ayacucho Mission, which Dr. Ralph Kuon initiated and has continued to direct, is impressive. It is a continu- residents of nursing homes, home-based care recipients, nerable populations and will begin outreach to other facilities as structures at more than two dozen local schools, participated in charitable health clinic in Latin America. (Visit ing and successful program which provides professional medical services to people who are desperately in need. frail seniors, people with short term acute or chronic phys- well as target programs serving children and the developmental- county-wide disaster drills, provided dental care for 3,200 low www.directrelief.org to see the full list of our Partnerships such as these allow Direct Relief to provide ongoing medical support to indigenous healthcare systems, ical illnesses, and those with disabling acute or chronic ly disabled. Along with preparedness efforts, Vulnerable income and homeless children, donated 22,500 personal credentials and qualifications.) which is one of our most important programmatic goals. mental illnesses. Direct Relief has begun to coordinate a Populations Program Coordinator Christienne Durbin oversees hygiene kits for the county’s indigent population, and provided countywide education and outreach effort to prepare these the training of AmeriCorps volunteers from the local American surgical instruments and pharmaceuticals to low-income pri- Dan Smith, M.A., is Direct Relief’s Senior Program Officer for Latin America. He has worked for the agency for fifteen years. individuals for emergencies and disasters. Red Cross and Direct Relief's own volunteers to assist in presen- mary care clinics throughout California.
  • 4. 6 INDEPENDENT ADVERTISING INSERT PROGRAM HIGHLIGHTS NOVEMBER 20, 2003 WWW.DIRECTRELIEF.ORG WWW.DIRECTRELIEF.ORG NOVEMBER 20, 2003 PROGRAM HIGHLIGHTS INDEPENDENT ADVERTISING INSERT 7 Iraq Helping Restart Health Services Cambodia: Notes from the Field KELLY DARNELL, Program Officer D uring the tragic reign of the Khmer Rouge, many Cambodian PHOTO COURTESY HOUSE ARMED SERVICES COMMITTEE health facilities were destroyed and countless medical profes- sionals were either killed or escaped, never to return. After decades of conflict, only a handful of medical professionals remained in the country and the medical education system lacked qualified teach- ers and a strong curriculum. Approximately 52 percent of the 12 million Cambodians are under the age of 18. For parents, finding a trained healthcare provider for their children is often impossible. During my assessment trip to Cambodia, I visited one of Direct Relief’s newest partner facilities, the Angkor Hospital for Children (AHC) in Siem Reap. AHC was founded in 1999 to provide services to the children of northern Cambodia, who PHOTO COURTESY AHC KELLY DARNELL historically have had very little access to health care, and to serve as a center for the further education and clinical training of Cambodian medical professionals. Staffed by a team of healthcare professionals from around the DR. KONDE HAND-PICKING SURGICAL EYE INSTRUMENTS DURING CONGRESSIONAL DELEGATION PRESENTING DIRECT RELIEF MEDICAL SUPPLIES TO ST. RAPHAEL HOSPITAL IN BAGHDAD. world, the hospital provides outpatient and inpatient services, HIS VISIT TO DIRECT RELIEF FROM LEFT: REP. VIC SNYDER (AK), REP. MIKE ROGERS (AL), REP. BARON HILL (IN), REP. ROB SIMMONS (CT), SISTER MARYANNE, REP. MADELEINE BORDALLO (GUAM), REP. STEVE KING (IA), REP. MAC THORNBERRY (TX), REP. GRESHAM BARRETT (SC), REP. TOM COLE (OK) basic surgery, and 24-hour emergency care to approximately 5,000 children each month. In addition to caring for children, A STAFF MEMBER FROM ANGKOR HOSPITAL FOR CHILDREN (AHC) CONDUCTS A COMMUNITY HEALTH VISIT. Congo D.R. Direct Relief has been responding to the situation in Iraq with med- ical support to health facilities in Baghdad, Nazirieh, and Basra. Since the end of the war, Direct Relief has provided 11 shipments of pharmaceuticals, medical and surgical supplies, and equipment, val- months, the hospital has experienced a significant increase in its workload due to the war, immediate postwar looting of other facil- ities, and increased health needs of the city’s residents. The hos- pital is recognized as providing state-of-the-art healthcare for Iraq the hospital also offers hands-on pediatric training to Cambodian healthcare workers. When the hospital first opened, Cambodian doctors and nurses worked one-on-one with volunteer doctors and nurses from countries such as the zation that sends volunteer healthcare professionals from the United States to health facilities around the world. Dr. Alia Antoon, a pediatrician from Boston’s Mass General with a spe- any treatment modifications. What struck me most as we arrived at each home was how visibly surprised and grateful each family was to be receiving such personal follow-up care for their child. Direct Relief ued at more than $10.5 million wholesale, all from private sources. Direct Relief’s efforts, though private, are conducted in coordination but still falls short of what is considered a standard health facility in the United States as essential drugs and supplies continue to be U.S., Canada, and Great Britain. Today, these same Cambodian doctors and nurses are training their junior colleagues. cialty in pediatric burns, was the HVO doctor stationed at the facility during my visit. I spent a day with Dr. Antoon and sever- In June 2003, Direct Relief sent its first shipment to AHC which al nurses visiting rural communities to follow-up on recently dis- included an incubator, exam lights, pediatric stethoscopes, Supports Leading with and approved by the U.S.-led Coalition Provisional Authority. in short supply. Direct Relief's assistance to St. Raphael Hospital has included children's and adult multivitamins, antibiotics, drugs AHC came to the attention of Direct Relief through one of our U.S.-based partner organizations, Health Volunteers Overseas charged patients who had been treated for burns and malnutrition. As their children were weighed and examined, the parents talked neonatal blood pressure cuffs, antibiotics, burn dressings, and one of their most-needed items, a one-year supply of soy-based Eye Doctor S r. Maryanne, director of St. Raphael Hospital in Baghdad, writes, "By this letter I would like to express to you our deep- est feelings of gratitude and thanks for your help…." The situation for hypertension, oral rehydration salts, casting material, syringes and needles, sutures, sterile gauze, and pain-relief medication. The most recent aid to St. Raphael’s was delivered by a U.S. congres- (HVO). HVO is a leading health education and training organi- to AHC staff about how their child was progressing and discussed protein powder supplement for malnourished children. in Country in Baghdad remains critical and very dangerous as the city recov- sional delegation (CODEL), led by Rep. Mac Thornberry of SHARIR CHAN Guyana: ers from a severe summer that had temperatures hovering around Texas. The assistance consisted of 1,222 lbs. of material, with a LEFT: PROGRAM OFFICER KELLY DARNELL MEETING WITH PRIME MINISTER SAM HINDS. BELOW: A GUYANESE BOY AT NEW AMSTERDAM HOSPITAL. 120 degrees, little security, no pure water, and limited electricity. In wholesale value of $250,000. I n the Bas-Congo region of the Democratic Republic of Congo (formerly Zaire), only three eye doctors serve a population of over four million people. It is estimated that the aftermath of the war, Baghdad was caught in a deadly cycle: with no electricity to pump water, locals were breaking into under- ground pipes allowing raw sewage to seep into the system. In some With only 19 psychiatrists in Iraq and the prevalence of post- traumatic stress syndrome in the general population, identifying between 40,000 to 80,000 blind people live in the province, with fifty percent of those cases due to cataracts. areas, 80 percent of patients were experiencing some form of water- born gastrointestinal infection, and many children suffered from and treating patients with mental disease has become a large pub- lic health concern. Direct Relief has been partnering with the Freedom and Peace Trust, directed by Wasseem Kabbara, to pro- Notes from the Field The Boma Eye Hospital was founded in 1999 by Dr. Joseph vomiting and diarrhea, leaving them badly dehydrated. In order to Konde, a Congolese national and U.S. board-certified doc- address these increasing health needs, Direct Relief International vide mental health professionals in Iraq with the pharmaceuticals KELLY DARNELL, Program Officer tor who completed his medical training at the University has been working closely with a number of facilities in Iraq, includ- they need to treat and maintain the health of thousands of trau- of North Carolina at Chapel Hill and received his ing Sister Maryanne’s St. Raphael Hospital. matized people. Psychotherapeutic agents provided by Direct Doctorate of Ophthalmology from the University of Zimbabwe. While his colleagues stayed in the United St. Raphael is a private, charitable hospital that has been operat- Relief are being distributed to Iraqi physicians for use in mental health wards including Al-Rashad hospital in Baghdad, the only S ituated on the northeastern coast of South America, Guyana is a sparsely populated country with just over 750,000 people. The population is primarily a mix of Africans, East Indians, and States and have established thriving practices, Dr. Konde ed by a Dominican Order of nuns for over 100 years. In recent dedicated mental health institution in the country. Amerindians. Although the country’s healthcare system has The Amerindian communities in the interior have very little chose to return to the Democratic Republic of Congo with improved in recent years, many Guyanese, especially those living access to medical services since the majority of Guyana’s health his wife and three daughters to provide medical care to the DIRECT RELIEF WOULD LIKE TO THANK PFIZER INC FOR ITS GENEROUS GRANT OF $25,000 TO SUPPORT OUR ONGOING in the northern rainforest, still have very limited access to health facilities are located along the more densely populated coast of the people of his native country. EFFORTS IN IRAQ. FOR UP-TO-DATE INFORMATION ON OUR WORK IN IRAQ, PLEASE VISIT OUR WEBSITE: WWW.DIRECTRELIEF.ORG. care and suffer from high rates of communicable diseases and country. The Moraikobai Hospital is the principal healthcare facil- nutritional deficiencies. The health system has also been partic- ity for the Amerindian villages within 100 miles. The small four- With a staff of 15, the Boma Eye Hospital sees over 4,000 ularly hard hit by the “brain drain” that has been occurring for patients each year and treats an additional 2,000 at its eight Students and Parents room hospital is staffed by three nurses, one Peace Corps volunteer, Bolivia decades as Guyanese doctors and nurses leave for better pay and and a “Medex” named Thomas George, who has a level of training outreach facilities. Financing the facility is exceedingly diffi- working conditions in other countries. between a nurse and a doctor. Assigned to the village a little over cult because only 25 percent of the patients have the resources to pay for services. In 2002, the hospital and its facilities performed over 600 eye surgeries, including 304 “Ride for a Reason” For 19 years, Direct Relief has been providing medical supplies to a year ago, Thomas has already created a community health com- mittee, helped establish a clean source of drinking water, and strengthen local health efforts in Guyana. During my week-long worked to improve the level of services at the hospital through cataract extractions. The hospital also runs a high-dose vita- min A program that annually serves 15,000 children under the age of five. Ninety percent of its patients receive care free I n the summer of 2003, 25 participants joined in the “Ride for a Reason” - a fundraising expedition by mountain bike from the high Andes above La Paz, Bolivia, through descending assessment trip, I visited seven Direct Relief-supported hospitals, including our newest partner facility, the Moraikobai Hospital. partnerships with organizations like Direct Relief and the Peace Corps. In December 2003, Direct Relief will supply Moraikobai with material assistance that includes a new exam/delivery table, of charge even though the hospital receives virtually no sup- interior jungle and rainforest to Rurrenabaque, the center of After traveling three hours inland through the rainforest on inpatient beds, minor surgical instruments, quinine to treat malar- port from the government. the Rio Beni Health Project. The expedition, a total of 300 Guyana’s Mahaicony River, I reached the village of ia, and antibiotics to treat upper-respiratory infections. miles with a 13,000 foot drop in elevation, was led by Program Moraikobai. The majority of native Amerindians make their In 2003, Direct Relief provided the Boma Eye Hospital with Manager Christopher Brady to raise critical funds for Direct home in this remote community. Most of them live in small During the final days of my visit, I had a series of meetings with material assistance such as exam tables, wheelchairs, IV stands, Relief’s Rio Beni Health Project. The expedition also provided villages of palm-thatched huts and survive on subsistence agri- government officials, including Prime Minister Sam Hinds, First exam lights, bandages, surgical gowns, ophthalmic antibiotics, the participants with a first-hand educational experience in culture, hunting, and fishing. The Amerindians have the high- Lady Uma Jagdeo, Minister of Health Dr. Leslie Ramsammy, and MATT KETTMANN ophthalmic sutures, and ophthalmic surgical kits. In addition, humanitarian aid, the Amazon rainforest and altiplano ecology est rates of low-birth-weight babies, malaria, and malnourished Guyana Peace Corps Director Earle Brown to discuss how Direct Direct Relief has provided the hospital with 25 new manual and Bolivian culture, history and nature. We thank all 25 par- children in the country. In addition, they suffer from acute res- Relief can best help strengthen local Guyanese health services beds, donated by Hill-Rom Company, to help expand inpatient ticipants, who not only completed this arduous physical feat KELLY DARNELL piratory illnesses and diarrheal-related diseases due to poor san- and prevention activities and reach out to more isolated health care. Direct Relief-furnished equipment and supplies enable Dr. but together raised over $80,000 for the project. itation and lack of access to clean drinking water. facilities like the Moraikobai Hospital. Konde to provide care and reallocate scarce cash to invest in staff and conduct an outreach and education program, which For more information on the Rio Beni Health Project, the “Ride for a THE BOLIVIAN BIKE TEAM AT THE TOP OF THEIR MOST Kelly Darnell has been a Program Officer at Direct Relief International for four years. She previously served as a Health Care Educator otherwise would not be possible. Reason” and its participants, please visit our website: www.directrelief.org. CHALLENGING ASCENT with the Peace Corps in Cote d’Ivoire.