Resources for Medical Education And

What it reported doing in 2012

BRINGING SPINE HEALTH CARE AND ON-SITE MEDICAL EDUCATIONTO THE DEVELOPING WORLDBELIZE SPINE PROGRAMRMEC established the goal to partner with communities and hospitals indeveloping countries to improve access to quality spine care by:1) Promoting excellent clinic management from diagnosis to follow up;2) Training orthopedic surgeons in diagnosing and treating spine pathology;3) Developing educational programs to sustain community access to qualityspine care;4) Establishing strong bilateral partnerships.Over the course of two years, a relationship with Karl Heusner Memorial Hospital in Belize City was developed; KHMH is the first location that RMEC is supporting the development of a sustainable spine clinic pursuant to our mission stated above.Why KHMH and Belize? Karl Heusner Memorial Hospital is the main referring center in Belize. It is estimated that KHMH has a draw of about one million people, which includes the Belize populous of 350,000 and pull from surrounding countries. On average, KHMH sees about 135 patients a day and most of these are trauma cases. With this large populous, the Belize community is in need of a clinic well-trained in treating spinal pathologies and spine trauma.Orthopedic surgeons at KHMH perform a limited number of spine surgeries, primarily focusing on basic cases and trauma cases. The orthopedic surgeons are very cautious about complex and instrumented cases, as they have limited access to the required instrument trays and devices, as well as lack the needed continuing education in diagnosing spinal pathology and surgical trainings in advanced techniques. To compound the delivery of care, approximately 50% of surgeons in Belize are foreign-born; the surgeons at KHMH operate under diverse educational and training backgrounds. This disparity in surgeon training poses challenges in establishing standards of care at KHMH and results in disparate treatments and perspectives in providing spine care.To summarize, KHMH is in need of continuing and specialized education programs in diagnosing and treating spinal pathologies, as well as in need of updated instrument trays, devices, and technology. Lastly, and importantly, KHMH is open to a partnership that will improve access to quality spine care for their patient population.The Belize Spine Program is a tailored, bilateral, clinical, and educational outreach program addressing the needs of patients seeking treatment for a spinal pathology.The program began small; in February, 2011, Dr. Williams and Ms. George traveled to Belize and treated two adult patients, as well as holding clinic. In May 2011, Dr. Williams, Dr. Youssef, and Dr. George returned for the 3-month follow up and clinic, as well as further relationship building. February 2012 marked the one-year anniversary of the BSP; Dr. Williams and Ms. George returned to perform four more life changing surgeries, alongside the Belizean team, held clinic, and supported educational talks. In August 2012, a team of six (Dr. Williams, Dr. Moulton, Ms. George (RN), an OR specialist, a Certified Neurophysiologic Intraoperative Monitor (CNIM), and an assistant) traveled to Belize prepared to treat the 13 year old seen previously in clinic in February, as well as two adult patients. During the one-week trip in August 2012, fourteen patients were evaluated in clinic, three patients received life changing surgical treatment, critical educational opportunities for a number of physicians were supported, and steps toward greater collaboration were made. Numerous pathologies were seen in clinic including degenerative lumbar spondylolisthesis, lumbar spinal stenosis, lumbar arthodesis, adolescent idiopathic scoliosis, Scheuermann's Kyphosis, spina bifida/ mylomeningocele, dysphagia due to cervical spine procedures, and cases where additional tests were needed before a diagnosis could be made. Three patients seen in clinic were operated on throughout the week ahead. The cases included the following: (1) a 54 year old w

Financial Efficiency

• Mission deployment rate: Limited
• Program expense ratio: Limited
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 100%; rating input score 100; 60th percentile among comparable filings
• Pay-setting controls: Limited
• Foreign activity oversight: Limited
• Grant itemization coverage: 99.8%; rating input score 100; 56th percentile among comparable filings
• Major donor itemization: Yes; rating input score 100
• Related-party transparency: Limited

Accountability

• Independent voting board: 100%; rating input score 100; 63rd percentile among comparable filings
• Governance controls: 6 of 8 controls in place; rating input score 75
  • Conflict-of-interest policy: Pass
  • Whistleblower policy: Pass
  • Document-retention policy: Pass
  • CEO compensation review process: NotApplicable
  • Other executive compensation review process: Pass
  • Form 990 shared with the board: Pass
  • Board meeting minutes documented: Pass
  • Audit committee oversight: Missing
  • Independent financial-statement audit: Fail

Sustainability

• Operating margin: -90.3%; rating input score 2; 2nd percentile among comparable filings
• Total-asset coverage ratio: 0; rating input score 0; 0th percentile among comparable filings
• Liabilities to assets ratio: Limited
• Officer compensation ratio: 7.8%; rating input score 40; 40th percentile among comparable filings

Growth

• Program expense growth: Limited
• Revenue growth: -0.3% per year; rating input score 0; 41st percentile among comparable filings
• Asset growth: -82.2% per year; rating input score 0; 2nd percentile among comparable filings