PROGRESS REPORT: GROWTH AND CHALLENGE

The Kilimanjaro Children's Hospital, which began as a single bed basic dispensary, is now a 120-bed hospital in Tanzania, East Africa, offering outpatient, inpatient, surgical, obstetric, dental and pediatric treatment. Throughout its progress, the Hospital's mission has remained consistent. Dr. Mark Jacobson, physician-in-charge of the Hospital and Town Clinic, confirmed in his Annual Report for the Year 2000 that the Hospital's goal "continues to be to provide competent, loving care to the sick, while working together with communities to promote health."

Dr. Jacobson's Annual Report chronicles a remarkable 18% overall growth in patient care, compared to the previous year. During 2000, a total of 44, 612 patients received care at the Hospital's main campus, which is located near the village of Ngaramtoni, within the Arusha Region of Tanzania. The Hospital's outpatient department, which provides 24-hour care, seven days a week, increased its services by 12% over the previous year, seeing 12,954 patients. The Mother-Child Health Unit ("MCH Unit"), which provides immunizations, prenatal care and well-baby check-ups without charge, saw an additional 21,007 patients. Immunizations for children and pregnant women, a major component of hospital services, increased 19% over 1999 levels.

The Surgical Department performed 1,735 surgical cases concentrating on orthopedic work, corrective plastic surgery and gynecology. Much of the orthopedic surgery arises from skeletal fluorosis, a crippling condition that causes bone deformities because of excessively high fluoride levels in local drinking water sources. Gynecological surgery at the Hospital has expanded to provide fistula repair, free of charge, to women who suffer from this condition as a result of extremely difficult natural childbirth under harsh conditions in the Tanzanian countryside.

Community participation in health care is deeply embedded in the Maasai culture, and is essential to the Hospital's effective partnerships. The Community Based Health Care Team, consisting of village and school-based health workers, nutrition advisors, traditional birth attendants and AIDS counselors circulate through five nearby villages working on tetanus and tuberculosis vaccinations, nutrition education, disease prevention and new water systems to lower fluoride levels.

A hospice care program, the first to be introduced in Tanzania, began at the Hospital in 1999, and continued to expand into a home-based program providing palliative care and spiritual support for terminally ill patients and their families. Most hospice patients suffer from end-stage cancer or AIDS, and many hospice volunteers from congregations and communities receive training at the Hospital.

Despite the Hospital's many successes, the burden of disease inevitably falls heavily on the most vulnerable population - infants and young children. Over 50% of children admitted to the Hospital are malnourished to some degree, according to Dr. Jacobson's Annual Report. Although malnutrition is the primary diagnosis for only 1% of Hospital admissions, young patients who enter the Hospital with other diagnoses plus malnutrition have significantly higher mortality. For this reason, among others, children suffered death in greater proportion than adult Hospital patients. One-third of all Hospital deaths occur among children under five years old. Among the total Hospital population, malaria, pneumonia and trauma are the leading causes of death.
In order to keep pace with growth in patient care, staff increased in both quantity and educational levels. Twelve new Hospital positions were added, bringing the total number of employees to 172. Professional education programs were offered to medical and nursing staff, and the Hospital expanded its educational lectures and demonstrations to invite medical professionals from other regions of Tanzania. Nine Hospital employees received the opportunity to participate in long-term study to upgrade their skills through staff scholarship and loan programs.
"2000 has been a great year for the Hospital," wrote Dr. Jacobson. "The spiritual growth, development of new surgical services, community outreach, development of the town clinic and the continued increase in patient flow all contributed to a very good year." And yet, these successes bring increasing financial challenges. Remaining faithful to its goal of turning away nobody in need of medical treatment, the Hospital provides abundant charity care.
Continuing financial support from C6 contributors is the Hospital's lifeblood. Please give as generously as you can, so that the Kilimanjaro Children's Hospital can continue to open its doors and offer its healing to sick children and their families.

FINANCIAL SNAPSHOT
Mark Jacobson, physician-in-charge of the Kilimanjaro Children's Hospital, speaks eloquently of the struggle to maintain high-quality medical care at affordable costs in the midst of Tanzania's staggering poverty and wrenching inflation. "We struggle with two conflicting goals," he acknowledged in his Annual Report. The Hospital's purpose is "to witness and to serve the poorest of the poor," and yet "we must simultaneously seek to become more self-sufficient in terms of operating costs."

Drought, famine, refugees, devaluation and a 10% national inflation rate all contribute to the grim economic landscape in Tanzania. While patient visits to the Hospital increased by 18% between 1999 and 2000, staff salaries increased by 35% to comply with government recommendations. Due to pressing domestic obligations arising from a series of natural disasters and refugee emergencies, the Evangelical Lutheran Church of Tanzania discontinued its subsidy to the Hospital during 2000, heightening the financial challenge.

In the face of these challenges, the Hospital continues to operate through a combination of patient fees and charitable contributions. Last year the Hospital generated 63% of its income from patient payments and other local sources, while the remaining 37% came from international donations. In a nutshell, this explains the reason for C6's continuing commitment to keep the Hospital doors open, thanks to the generosity of our supporters and the development of an Endowment Fund (see related story).

In far-sighted efforts to provide a financial bulwark for the Hospital, Dr. Jacobson steered successful efforts to open a Town Clinic within the city of Arusha. The Clinic attracts employed urban outpatients, in contrast to the predominantly rural patient population at the Hospital's main campus. As in America, fees from paying patients help subsidize care for those who are not able to pay. An employer-based health insurance program sponsored by the Hospital was initiated in 1996, and quickly doubled in size by 1998, growing to some 2000 members from 20 local companies. Another insurance program now has some 5,000 participating members, and together these two insurance plans account for slightly over 20% of the Hospital's patient income. These programs represent "a significant effort toward self-reliance," as envisioned by Dr. Jacobson.

Self-reliance is fundamental to Maasai culture, and even the poorest patients expect to make a payment for the treatment they receive. In 2000, the average KCH inpatient paid $4.58 per day (U.S.), equivalent to 3,666 Tanzanian shillings. This amount covers all Hospital services including surgery, medications, x-rays and laboratory work. The average hospital stay at KCH is 10 days, so the average hospital bill at KCH is about $46. This amount may seem very smalal by American standards, but for a Maasai family it can easily dwarf an entire month's earnings.

Hospital costs during 2000 to provide comprehensive care to its 45,000 patients was minimal by U.S. standards -- $485,000 --- and yet this is an overwhelming financial burden within Tanzania. Looking on the bright side, Dr. Jacobson observed that "each day the Hospital serves 100 inpatients, 150 outpatients, does five operations, and performs 50 laboratory tests for a total cost of less than $1400 for that day." In light of this inspiring commitment among Hospital leadership and patients, can there be any doubt of the need for C6's continuing support? Please give, so that children can live.

Cooking Up Support for Kilimanjaro Children's Hospital
Thanks to the creative culinary efforts of Board of Trustees President Dr. Diane Lucas,
C6 Administrator Susan Fox, and Trustees Caroline Luttrell and Heather Fleck, the Kilimanjaro Children's Hospital Cookbook is now available to everyone who has a "taste" for supporting C6. The Cookbook's first release, which was publicized in the Denver Post, was so successful that it is already going into a second printing.

Designed so that recipes are accompanied by traditional African proverbs and facts that stimulate interest in the Hospital or describe the Maasai culture, the cookbook cover features a dramatic and colorful full-page photograph of a Maasai woman and her infant taken by C6 supporter Jim Lessig during a recent trek to Africa. Inside are some 240 of our very best, tried and true, favorite family recipes with personal, sometimes humorous, and often heartwarming introductions by contributing cooks. Each contributor's relationship to C6 is included, so that the book also serves as a 'family tree' for C6.

The recipes included in the KCH Cookbook originated in many countries: East Africa, India, Malaysia, South Africa, Singapore, China, Norway, England, Germany, Mexico, Greece, Turkey, Jamaica and Italy are all represented, along with many "out-of-the-way" specialties from the U.S.A. In addition, the book is filled with Maasai life and lore, describing in the Maasai's own words their beliefs, their traditional prayers and songs, and their fragile existence in this modern world.

High quality heavy weight paper is used throughout this sturdy, spiral-bound publication which deserves a place on the bookshelf of every philanthropic chef and family kitchen. The Kilimanjaro Children's Hospital Cookbook will make a beautiful gift for holidays, family celebrations and personal milestones. Each time you purchase the Cookbook (priced at $20, plus $5 shipping and handling), you are strengthening and extending the C-6 family, and contributing to the health of Maasai children whose hope for the future depends, in large measure, on a generous spoonful of you support.

To order copies of the Cookbook, please make your checks or money orders payable to Kilimanjaro Children's Hospital and send them with the order blank below to: Kilimanjaro Children's Hospital, Attn: Cookbook Orders, 1740 High Street, Denver, Colorado 80218. A complimentary cookbook will be sent to all donors of $500 or more to the KCH Endowment Fund.

Rotary Club Climbs Kilimanjaro

In October, 2000, C6 Trustee and Rotarian Mark Williams led the Rotary Club of Evergreen, Colorado to East Africa in the "Climb for Children 2000." Twelve hardy adventurers spent two weeks enjoying the sights and sounds of Tanzania and raised over $230,000 in direct contributions, which will be partially matched by Rotary International. The trip is chronicled at the website: http://www.climbforchildren.org.

Mark Williams, president-elect of the Rotary Club of Evergreen, recruited the Climb for Children participants by speaking to dozens of Rotary Clubs throughout Colorado. Williams' Rotary delegation included 7 Rotarians, 3 children of Rotarians, and 2 friends of Rotary. The 12 members of the expedition were: Carol Carter, Arthur Duffy, Carl Forsberg, John Gaudreau, Christine Graff, Sarah Graff, Curt Harris, Diane Kessel, Chris Klispie, Ken Klispie, Mark McCullick, and Mark Williams.

When the participants arrived in Tanzania, they were greeted with a celebration at the Hospital where they spent two-and-a-half days touring the facility, the surrounding villages, and the Town Clinic in the nearby city of Arusha. They attended Hospital staff meetings and went on rounds with the doctors. An afternoon with native healers and midwives was a wonderful and unforgettable experience for the participants, who also spent another memorable afternoon at the local village of Losinoni, speaking with local Maasai residents and village leaders. The objective was to completely immerse the group in the object of their charity --- and it worked!
The adventurers then went on a photo-safari at Lobo, in the Serengetti, and at Tarangire National Park. Unfortunately, the animal migration had not yet begun, but that didn't dampen the enthusiasm of the group. The safari was "absolutely wonderful," in their own words.

A local church service and a visit to the Town Clinic prepared the climbers for their departure from the Arusha region, and then it was off to Mt. Kilimanjaro for the next leg of their memorable expedition. Eleven members of the group took the "Marangu" route up the mountain, and experienced the full spectrum of hour-by-hour weather changes in the course of their climb. (One member of the group chose not to climb the mountain and stayed instead in a village close to the Hospital.) By the middle of the second day on the mountain, it was snowing at 11,000 feet. Two of the climbers stayed at the Horombo Hut, while the remaining nine trekked on to Lobo Hut, the highest shelter en route to the summit. The third day was cold, but that night the skies were clear as the group set off for the highest point on the mountain. Remarkably, seven of the nine who tried made it up to Gilman's Point, and four went on to Uhuru Peak.

A well-earned celebration dinner at an Indian restaurant, when the group descended, helped sooth tired muscles. On the last morning in Tanzania, the group toured the Monduli Maasai Girls' School, where there are continuous, impressive improvements in educating young Maasai women. Rev. Dave Simonson and his wife, Eunice, veteran Lutheran missionaries from the U.S.A. and who were instrumental in founding the Kilimanjaro Children's Hospital, are local champions of the Monduli Girls' School and the inspiring young women there. The African experience of Climb for Children 2000 ended with a luncheon meeting for participants with leadership from the Arusha Rotary Club. Everyone had fun, and the stories were very interesting.

As Mark Williams summarizes the trip, "Projects like this succeed because of relationships over time. The purpose of these trips is to foster and nurture those relationships across decades. We are so very grateful for the hospitality shown us by Mark and Linda Jacobson, by the staff at Selian, and by the Simonson family."

Endowment Fund Builds Toward Sustainability

Every step toward self-sufficiency for Kilimanjaro Children's Hospital adds to the hope that our doors can remain open to all patients. As the volume and expenses of patient care increase, Dr. Jacobson and his staff feel mounting pressure to ensure the Hospital's financial survival despite fluctuating local conditions. Kilimanjaro Children's Hospital needs a consistent source of income to bridge the gap between operating expenses and income from patient fees. Patient care needs exceeded patient income by approximately 3% in year 2000, and there is a consistent margin of need each year to cover the costs generated by the Hospital's charity care.

To address the Hospital's ongoing need, C-6 established the KCH Endowment Fund under the leadership of Trustees Paul Dahlgren and Chuck Fox. The Fund needs to accumulate a principal of approximately $400,000, in order to generate sufficient income for the Hospital's necessary annual infusions. So far, we have collected $35,000 toward this goal. Please help us build toward the Hospital's sustainable self-sufficiency by designating your donation in the enclosed envelope for the KCH Endowment Fund. Asante sana!

School Walks Take Giant Strides of Generosity

Once again this year, energetic 7th grade students from Cherry Creek's Horizon and West Middle Schools put the needs and welfare of Maasai children in Tanzania ahead of their own, as they participated in the annual KCH "Walks for Children."

Horizon Middle School students jogged and walked multiple times around their school track raising money and spirits with each lap completed. Led by their teachers Ann Hill, Craig Smith, Judy Elder and Katie Stahl, Team 7-1 had a fun and energetic workout, followed by a pizza party to celebrate. The next day, teachers Ron Gardia y Ortiz, Mary Stratton, Pam Sippel and Colleen Car of Team 7-2 cheered their students on to victory, and then celebrated with a pizza party of their own. The combined efforts of these two teams raised over $4,000 for the Kilimanaro Children's Hospital. Congratulations, Horizon!

Seventh grade students from West Middle School walked the Highline Canal in three separate groups to raise money for the Hospital, returning to school grounds for cookies, fruit and some well-deserved pats on the back. Encouraging them along the way were teachers Vicki Timm, Alex Droege, Liz Parker, Paul Wiggins, Sharon Weil, Chris Walderhaug and Barbara Waggoner as well as many parent volunteers and some younger siblings. The combined walks at West raised a total of $10,863! A special thanks goes to student Cassie Crown and her family for raising over $500. Congratulations, West!

Hundreds of Maasai children have benefited over the years from funds raised through Colorado middle school "Walks for Children." Student participants also benefit from the joy of giving, and the knowledge that their compassionate and generous efforts help relieve the suffering of sick and injured children half-way around the earth. The Maasai culture and the lifestyle of Colorado middle school students may be worlds apart, but children everywhere share the same needs to learn and grow, the same love of life and family, and the same needs for health and safety. By introducing Colorado students to the lives and needs of Maasai children, KCH hopes to promote understanding, generosity and appreciation for different cultures. We salute these wonderful young people, their parents, and especially their teachers for sharing the gifts of health and life.

KCH needs more teachers and parents to get involved in sponsoring Walks for Children in local schools. C6 administrator Susan Fox and supporting trustees can provide slide shows, videos and personal visits to help launch new locations, and we welcome your participation. Lesson plans in geography, language arts, history and other subjects may lend themselves to including a segment on Africa, and summer vacation is an ideal time for teachers and school personnel to gear up for next year's activities and student fundraising plans. Student honor societies and church youth groups are additional potential sources of support. Join us for a fun and healthy project by calling Susan Fox at 303-393-8650.

American Doctors Help Maasai Patients

In early December, 2000, Dr. Bill Brown of Denver, Colorado led a health care team to the Hospital campus in Tanzania that screened 60 patients and operated on nearly 40 cases including cleft lip and palate; burn contractures; various malignancies; osteomyelitis; breast infections; depressed skull fractures requiring craneotomies; surgery for spina bifida; several pediatric craniofacial cases including a nasal frontal encephelocele (an opening in the front of the skull, permitting the brain to protrude between the eyes) and a child with occipital encephelocele (brain protrusion at the back of the skull and neck.) Technology and support for some of these cases does not currently exist in the local area, so visiting physicians bring valuable skills and experience.

Members of Dr. Brown's team included Dr. Alan Klein, a pediatric anaesthesiologist; Dr. Roderick Lamond, a neurosurgeon; Deborah Malone, a critical care nurse and Dr. Brown's daughter, Amanda Brown. Dr. Brown and Amanda spent a day in surgery with Dr. Janis Perialis, who has a significant amount of plastic surgery training and provides treatment to many patients in Moshi, Tanzania. Dr. Perialis joined the American team during their stay in Selian, scrubbing in on many of the cases and providing significant assistance.
The Olympus Corporation generously provided Dr. Brown with the "permanent loan" of a new colonscope, gastroscope and light source, which are critically needed instruments at the Hospital. Generous donations of medications and supplies by Exempla/St.Joseph Hospital and HealthOne/Presbyterian-St.Luke's Hospital provided additional valuable products.

Dr. Brown is currently working on travel arrangements for bringing Tanzanian patients with more complex conditions to Presbyterian/St.Luke's Hospital in Denver. He has a commitment from PS/L and from some airlines for travel arrangements. Interested parties who are willint to support this effort are urged to contact Dr. Brown at 303-830-7200.

A LETTER FROM THE PRESIDENT
2000 was a banner year for Kilimanjaro Children's Hospital, a year which saw a 19% increase in the number of patients, to 44,612! The year 2000 also saw the opening of the Town Clinic to improve access to medical services, and numerous improvements toward an even higher standard of medical and surgical care, including, but not limited to, hospice care and AIDS education. The hospital staff increased by 12 positions to 172!

All this occurred despite economic inflation, currency devaluation and the strain of severe drought and famine; Still, our patients managed to pay the major portion of the cost of their care, our donors closed the financial gap, and no one was turned away.

These are, as you are no doubt aware, very difficult times for Africa. I would like to challenge each and every person reading this to find a way to do just a little bit more for the children of East Africa. As a recent medical graduate, I know first hand the frustration that stems from lacking the time and resources to climb Mt. Kilimanjaro for KCH. But I also know that there are many ways here at home that we can all help support this lifesaving project through walks, climbs, school projects, dinners, cookbooks, raffle tickets, and more! We need everyone's help! And please log onto our new web site -- www.kilimanjarochildrenshospital.com -- for ways to strengthen our endowment, so that Kilimanjaro Children's Hospital will always be there!

Finally, I would like to thank Dr. Jack Cochran, our immediate past president, for his six (yes, SIX!) years of inspired leadership. His will be big shoes to fill, and I promise to do my best. With your continued help, we will succeed.

Asante sana,

Diane Lucas, M.D., Ph.D.
President, Board of Trustees,
Consortium for Community-Centered Comprehensive Child Care