REFUGEE RELIEF INTERNATIONAL NEWS
Issue #1 (reading time about 5 minutes)

IN THIS ISSUE

1. A note from Director of Operations
2. Mission Report: Land Mine Victims Thai border
3. SJ Mercury News Article About an Attack on Our Clinic


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A Note to newsletter recipients:

As many of you know, Refugee Relief International, Inc. is a very small organization with no paid employees. As Director of Operations, I field the email communications and try to respond as best as possible.

Many of you have written requesting a volunteer assignment overseas. Our annual budget ranges from $15,000-$30,000, which represents the amount of contributions we get from numerous sources. In the last year, contributions from Silicon Valley, where I live, have increased substantially in response to newspaper articles and word of mouth. This will allow us to increase our operational tempo if this increased donation stream is maintained.

The main expense for any mission is airfare for the personnel. Any ability you as a volunteer have to attract donations equal to your airfare, or use your own frequent-flier miles to get a ticket, will make it much easier for us to expand the number of missions available and thus improve your chances of being selected to staff one of the missions.

Up until this point, virtually all our missions have been in active combat areas where the risk to personnel is very high, and the need for combat skills in mission volunteers has been essential. We're developing a new program to place instructor/trainers for a one-month rotation at a clinic in a non-combat area along the Thai-Burma border. Opportunities for posting to this very unique treatment and teaching setting will probably become available in the second quarter of 2001.

Any need for volunteers that is not met by our existing pool of mission participants will generate a request for volunteers from this mailing list. The specifics on physical fitness needs, skill sets, and overseas experience or language requirements will accompany those requests for volunteers. Usually we can give at least three months' advance notice of the general time window for the mission, and missions rarely last longer than 2- 2 1/2 weeks.

The link below is to a recent San Jose Mercury News article describing an RRII relief mission on the Thai-Burma border. The text is printed as the last part of this email.
http://www.mercurycenter.com/archives/reprints/0500/Guido04292000.htm

David G. Mohler, M.D.
Director of Operations
Refugee Relief International, Inc.
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REFUGEE RELIEF INTERNATIONAL TRIP TO MAE SOT, THAILAND
AUGUST 2000

John E. Padgett, MMS, PA-C
President, Refugee Relief International, Inc.

At the request of the refugee hospital staff in Mae Sot, Thailand, (known as Doctor Cynthia's Hospital, after its director, Cynthia Maung), a two-man team from Refugee Relief International, Inc., traveled to the hospital to introduce a new low-tech prosthesis for amputees.

The Karen minority hill tribe, which in times of peace resided in the mountainous jungles of eastern Burma (now termed Myanmar by the military government), has become a victim of ethnic cleansing by the State Peace and Development Committee, as Burma's ruling regime now calls itself. The cleansing technique often involves the use of land mines, and many Karen have
become traumatic amputees while hunting, farming, or just walking in or near their villages. Many of these landmine victims have sought medical treatment in Doctor Cynthia's refugee hospital in Thailand.

Prosthetic technician Steven Hall volunteered his time, and American Orthopedic Supply donated four leg systems at their cost for demonstration purposes. The Odd Fellows Lodge of Upland, CA, committed to funding an ongoing project, making the prostheses available on a continuing basis.

The new prosthetic system introduced to the medical staff of the refugee hospital consists of three main parts: the polyethylene cup that fits onto the amputee's stump, the carbon fiber "leg" piece, and a pre-molded foot which attaches to the carbon fiber post. The system is lightweight, easily portable, and requires only simple tools, such as an Allen wrench and a saw, to fit to a patient.

The process of fitting a new leg to an amputee is as follows: The patient's leg is sized to the cup, right and left, extra small through extra large. Then the patient's leg length is measured, compared with the opposite side. The carbon fiber post is then cut to fit. Finally, the foot component is added. The polyethylene cup portion is flexible when heated, and can be fit snugly to the patient.

The team's purpose for this visit was to introduce the new prosthesis system to the Karen medical practitioners and, if they accepted it, get them comfortable with its application on their patients. In this venture, we were very successful. The Karen's chief prosthetic maker, Saw Mun Kay, was in attendance and within fifteen minutes of introduction to the system he was working with it and speculating on how it could be modified to meet local requirements. He was very happy that it is much lighter than the system of home made legs he makes individually, and that a prefabricated system would mean less of a wait for the amputees awaiting a prosthesis.

We personally observed the success and adaptability of this system. Less than an hour after one Karen man was fitted with the new leg, he was playing soccer with it!

While I was at the hospital, one of my former students asked me to assist him with a surgical case. A fourteen-year-old girl had a large mass at her left thigh and buttocks area, and he intended to remove it. It was a difficult surgery, under less than ideal - or even sterile - conditions, but we successfully removed the mass, which proved to be a benign cyst the size of a softball. We were concerned about infection, but with good nursing care and antibiotics, our patient recovered well and returned to her village.

It is my opinion that the trip was worthwhile, and of significant benefit to the Karen amputees. The low-tech prosthetic program has the appeal of being self-sustaining, as the Karen practitioners know to select the patients who will benefit from the new legs, measure them, and then request the specific leg systems from Mr. Hall. The Karen and Mr. Hall are in email contact with each other, and the Karen have a secure shipping address to which the leg systems may be sent. Ongoing funding for the project is being arranged.

Respectfully submitted,

John E. Padgett, MMS, PA-C
President
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Published Saturday, April 29, 2000, in the San Jose Mercury News

Relief team's risky journey
Combat conditions challenge Stanford doctor, companions
BY MICHELLE GUIDO
Mercury News Staff Writer

Just after dawn on April 13, Stanford surgeon David Mohler and three other men, members of a little-known organization of ex-soldiers who provide medical relief in combat zones, awoke in the jungle of eastern Burma and prepared to leave for a war-ravaged village 50 miles away.

After a breakfast of instant coffee and plain white rice, the relief workers set out on foot, their 70-pound backpacks filled with medical supplies. Twenty minutes later, the village they had just walked away from came under attack.

A group of Burmese soldiers entered the tiny village, called La Twee Tha, marched directly to the hut where the Americans had slept and riddled it with bullets. Mohler said villagers told him the soldiers had come to kill the American doctors. The soldiers then scavenged the hospital Mohler and his group had established, burned it down while the villagers fled in terror and planted land mines to prevent them from returning. It was over in an hour.

Mohler and his crew had been in dangerous situations before, but until earlier this month, they had never been the target of an attack. In the 18 years since Refugee Relief International (RRI) began, they have conducted medical missions in Afghanistan, southeast Asia and Central America. It's always dangerous work. But this time was different.

``We've always been under the impression that they would rather capture us than kill us,'' Mohler said from Stanford University Hospital on Friday. ``We don't necessarily expect good treatment, but this is the first time that they tipped their hand that they want to kill relief workers. So we took that personally.''

Since 1995, Refugee Relief International has conducted a dozen relief missions along the Thailand-Burma border, primarily to treat victims of land mines, often young children. Mohler said the area is crowded with refugees from the Karen (pronounced Kuh-REN) people in eastern Burma. The Burmese military junta has forced the ethnic Karens to relocate within the country, and Mohler said thousands have fled to squalid refugee camps across the border in Thailand.

The Burmese ``have an illegal government that was voted out of power and has been conducting internal `ethnic cleansing' of the Karen people outside the view of the media,'' said Mohler, who celebrated his 43rd birthday in the Burmese jungle. ``And you can't get a better cause than that, in terms of what we do.''

Lengthy travels
On a typical mission, a group of four to six RRI members will arrive in a country. In the case of Burma, they fly to Thailand and sneak across the border on foot. They then travel by land -- either walking or in pickup trucks -- across dense jungle to get to areas beyond the reach of civilian medical services. They usually are escorted by locals who know the area and provide security.

Though there are 40 members of RRI, a non-profit organization, Mohler said there's a core group of about 10 who make the most trips overseas. Most, like Mohler, are former special forces soldiers who can operate in war zones and other dangerous environments where other humanitarian agencies dare not go. The need is so great that RRI could operate year-round, Mohler said, but the group is limited because it doesn't get a lot of contributions.

``In my fantasy life, when my rich Silicon Valley friends become philanthropic, we'll start increasing teams,'' said Mohler, an Atherton resident whose wife, Heidi Roizen, is a plugged-in Silicon Valley venture capitalist and mentor to high-tech companies.

The organization (www.refugeerelief.org) does receive donations -- frequently from former patients of Mohler's or others who have heard of the cause. And RRI members often salvage old medical supplies that are still perfectly functional.

Andrew Hyslop of Santa Clara found out about RRI in 1986 when he was working for the Santa Clara Fire Department. He was looking for a building the department could burn down for a training exercise and stumbled across an old civil defense hospital filled with supplies that were ripe for donation. He heard about RRI and wrote to see if they'd be interested.

They were, and RRI took many of the supplies to El Salvador and Nicaragua in a mission to provide health care and medical equipment to the Contra rebels fighting Nicaragua's leftist Sandinista government.

RRI was established in part by the editors of the right-wing Soldier of Fortune magazine. And retired Army Maj. Gen. John K. Singlaub -- who led special forces units in Vietnam -- still sits on its board of directors. During the Iran-Contra scandal, Singlaub was active in supporting the Contras.

But current RRI members stress that the group has never been affiliated with or funded by the government and say their purpose is strictly to provide humanitarian medical relief.

When Hyslop, who was an Air Force medic in the '70s, started working with RRI in the mid-1980s, he mostly procured supplies and used his Air Force training to help the group pack efficiently for its trips. He went to Cambodia in 1996 to treat land mine victims and said it was one of the best experiences he's ever had.

Paying their way
RRI's annual budget is about $15,000, but that can go a long way if the volunteers involved pay their own air fare -- and many do.

``There are hundreds of organizations that are appealing to people for donations, and they all do about the same thing,'' he said. ``But we have a special niche in that we go into really hostile areas.''

Once they arrive in a place, the team works closely with the local medical practitioners. The surgical unit performs between three and 10 operations a day -- ranging from simple surgeries to amputations of limbs -- usually without running water or electricity.

Mohler said the doctors, nurses and physician assistants on the trips are not armed, but are generally protected by armed security forces. And though episodes like the April 13 attack can be terrifying, Mohler and his team insist they will go back.

``There's no greater adrenaline rush than combat. It's also terrifying,'' Mohler said. ``But with training and experience it becomes controlled terror and purposeful action, all designed to keep you alive and keep your team safe.''

Contact Michelle Guido at mguido@sjmercury.com or (650) 688-7590.

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