Copyright 2012.Writers: Laura Chanchien Parajón, Jessica Chapman-Martínez, Christy LaffertyEditors: Laura Chanchien Parajon, Marlene Francis, David ParajónPhotos: Cassie Butler,  Dave Stalsbroten, Jordan TimpyGraphics: Jessica Chapman-Martínez Design: Laura Chanchien Parajón, Jessica Chapman-Martínez

The AMOS ValuesLoving Our Neighbor

Empowering People for Service

Service to Those in Need

Good Stewardship of Resources

Peace & Justice

Respecting the Rights and Dignity of All People

“The Spirit of the Lord is on me, because he has anointed me to proclaim good news to the poor. He has sent me to proclaim freedom for the prisoners and recovery of sight for the blind, to set the oppressed free, to proclaim the year of the Lord’s favor.” Luke 4:18-19 The year 2011 is the year that my dad and AMOS co-founder, Gustavo Parajón died.  We mourn his passing but also celebrate his vibrant and tremendous life. All of the memories that we keep are a treasure we will always cherish, as are the lessons that he taught all of us. One of the greatest lessons that Dr. Gustavo left behind was his model of rural health care, which AMOS has embraced from the beginning.  Rooted in empowerment, Dr. Parajón’s model is based on the participation of community members to improve health in their own communities.  

The model is amazing because it really works.  When community members receive health training and get organized, they can take action in meaningful ways to improve health, such as ensuring vaccinations for children, monitoring growth to detect malnutrition, deworming to eliminate parasites, educating community members, using water filters and latrines to improve sanitation, and even managing a small clinic to see patients and dispense medications!  Because they use a census-based system, they also ensure that even the farthest homes are cared for and no one is left out.  We try hard to encourage the health leaders to be as equitable as possible and to prioritize those families most in need, as Jesus taught all of us to do. Thanks to all of the support received from churches, foundations, International Ministries and generous individuals, AMOS was able to serve 27 rural communities (over 13,000 people) this year.  Together we have kept the maternal mortality and infant mortality rates low and have been able to care for other health needs in these communities through direct patient care and preventive measures. Without your support, none of this would have been possible!  Thank you for being a vital part of this dream to make a difference in the lives of those in need. We look forward to continuing to partner with you this coming year!

Blessings!Dr. David ParajónDr. Laura Chanchien Parajón

Letter from the Directors

Dr. Nour Sirker and his wife Carolyn (left), founders of the Samaritano Foundation, have been missionaries in Nicaragua since 1992. In a life dedicated to serving others, they helped to found the Principe de Paz church in Nejapa, they ministered to low income families through the Samaritano clinic, and they developed and ran two urban Christian schools which serve over 480 children. In recent years, as they contemplated the expanding future needs of their ministry, they have explored uniting with another Christian organization whose vision for medical ministry matched their own.

Meanwhile, for the past four years, AMOS has been experiencing rapid growth as our rural community health work expanded to 27 villages. To continue serving a population of over 13,000 people in rural Nicaragua, as well as house volunteers who come to support the work, AMOS needed a permanent facility for offices, training, and guest housing that would accommodate the organization’s growth.

The Blessing of a New HomeIn December 2011, in what a member of First Baptist Church of Fort Lauderdale (home church of the Sirkers) called a “God-incidence”, the boards of Samaritano and AMOS unanimously agreed to transfer ownership of the 15 acre Samaritano property to AMOS. The property includes an outpatient clinic, an ambulatory surgery, an office building and various guest facilities, and is an answer to prayer.

It gives AMOS the opportunity to both broaden and diversify its ministry to the people of Nicaragua. The AMOS staff have already settled into the new facilities. Our rural community health programs continue to thrive and the Samaritano urban clinic has operated without pause. We are grateful to God for this wonderful blessing and for the opportunity to expand our ministries to the people of Nicaragua

The Samaritan Donation to AMOS:

An Answer to Prayer

Dec. 12, 2011 --Dr. Sirker and Caroline hands off keys to to Drs. David and Laura with their respective boards.

Map of New AMOS grounds:15 acre property

Storage Area

Prayer Garden

Guest House

Office

OperatingRoom

Clinic

Volunteer House

Photos of the New AMOS Grounds

AMOS Health and Hope is a Christian non-profit organization dedicated to improving the health and well-being of people who suffer from the unjust conditions of poverty. We are a seeking to develop a comprehensive health care program in poor rural areas of Nicaragua that will effectively empower local leaders to provide essential healthcare to their communities, especially the poorest and most vulnerable members.

AMOS is an acronym that stands for A Ministry Of Sharing, and is also named for the biblical prophet, Amos, because of his passion for social justice & sensitivity to the poor.

Our Mission is to improve the health of impoverished communities by working alongside them in health, education, and development.

Our Vision is:

• Health for all people• A world where no child dies of a preventable

disease• Effective and empowering health care

systems

Our Guiding Values are:

• Loving our neighbor• Empowering people for service• Good stewardship of resources• Service to those in need• Respecting the rights and dignity of all

people• Peace and justice

About AMOS Health & HopeIN

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"Never again will there be in it an infant who lives but a few days..." --Isaiah 65:20

Making a Difference in Rural NicaraguaHealth by the people and for the peopleIn remote rural communities, people often have to walk up to three hours to get health care -- which can mean the difference between life and death for a sick child.

To bring health closer to the people, AMOS trains and supports a network of local health promoters and their health committees to provide essential health care services that save lives and ultimately help to improve the well-being of impoverished communities.

AMOS now works in the Nicaraguan departments of Matagalpa, Chinandega, Boaco, and the RAAS, serving over 13,000 people.

Preventable Illnesses

Service to the Most Vulnerable

Access to Health Care

Essential Medications Deworming

Did you know about these needs?

Every day, 20,000 of the world’s poorest children die each day of treatable and preventable illnesses, such as diarrhea and pneumonia.

Children who are poor in Nicaragua are three times more likely to die than children who are not poor.

The poorest people in Nicaragua have the least access to health care and have to travel an average of more than one hour by foot to a local clinic.

Over 50% of people in rural areas lack access to essential medications.

Over 50% of all children in Nicaragua suffer from parasite or “worm” infections which can result in anemia, growth stunting and poor school performance.

And how AMOS helped in 2011?

Trained AMOS health promoters were able to treat hundreds of children for pneumonia and diarrhea, as well as give talks to over 14,000 people on prevention of illnesses.

AMOS health promoters prevented the deaths of the poorest children, doing over 4000 home visits to the most vulnerable people in their communities to assure health care coverage.

AMOS health promoter and health committees increased health care coverage by running and managing 27 basic health clinics in their own communities -- some of the most difficult to reach areas in Nicaragua-- and saw over 12,000 patients this year.

AMOS provided the necessary medications for the 27 rural health clinics along with trainings and regular supervision to improve quality of care.

AMOS promoters dewormed over 10,000 people and improved water and sanitation to fight against worms.

CHINANDEGA22. La Consulta - Isabel Peralta 35 Families, Pop. 31323. El Obraje - Ramiro Morales 122 Families, Pop. 55824. La Pimienta - Silvina Lainez 94 Families, Pop. 387

MATAGALPA17. Sabalete - Pedro Pablo Guillén 105 Families, Pop. 60018. San Jose de la Mula - Juan de Dios 135 Families, Pop 62419. Fila Grande - Petronilo Gaitán 146 Families, Pop. 56220. Tapasle - Salvador López 112 Families, Pop. 55821. El Socorro - Isaac Fley 136 Families, Pop. 365

RAAS

25. Nawawasito - Ramón Barrera 57 Families, Pop. 32526. Banko de Sikia - Ismael Sequeira 79 Families, Pop. 38627. El Cedro - Augustin Malueños 91 Families, Pop. 577

1. Nacascolo - Victor Urbina 65 Families, Pop. 3502. Tierra Blanca - Yadira Sevilla 65 Families, Pop. 2913. Bajos de Tomatoya - Elia Eloisa Urbina 63 families, Pop. 2774. La Aurora - Ivania Cisneros 44 Families, Pop. 3265. El Coyol - Nelson Polanco 202 Families, Pop. 6866. El Bejuco - Zabdi Coronado 85 Families, Pop. 3767. La Majada - Ana Delfina Urbina 54 Families, Pop. 2638. El Cerro/La Cañada - Jackeling Cinco 51 Families, Pop. 442

9. El Roblar - Arellys Espinoza 71 Families, Pop. 41010. Cumaica Norte - Catalino Jarquin 70 Families, Pop. 48311. Cumaica Sur - Paola Ortega 170 Families, Pop 80712. La Laguna, Casas Nuevas, Poza, San Bartolo - Gioconda Jarquin 123 Families, Pop. 44613. Malacatoya 1 - Fatima Ireyda Gonzalez 77 Families, Pop 22614. Malacatoya 2 - Marlene Velázquez 80 Families, Pop. 23815. Las Macias - Leonel Jarquin 71 Families, Pop. 32916. Laguna de San Onofre - Timotea Romero 107 Families, Pop. 515

BOACO

Where AMOS Works

MANAGUAAMOS HeadquartersSamaritano Clinic, Nejapa

Health promoters are people who are selected by their communities to be trained in the basic provision of health care services, but also in prevention of disease and the promotion of health in their communities. They minister to people in their communities to improve physical, spiritual, and emotional health.

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“A Health Promoter is an agent

of change in their community” --Juan de Dios Blandón, Health Promoter

of San Jose de la Mula, Matagalpa

Meet the health promoters... INTRODUCTIO

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Community-Based Primary Health Care Program

It all begins with a census and the belief that “Everyone is counted and everyone counts”

Often when aid is given, it goes to the strongest and most able-bodied – those who have the resources to ask for help or travel to a distribution point. This can magnify the disparities in a community, with certain families receiving an inordinate amount of goods and services while others are left in the dark.

By taking a census, the health committee can help to ensure equity and fairness. They can ask, “Who is missing here and what can we do for them?”

The census is also a tool for community organizing. In every community, the health promoter and the health committee post the results of their work on the wall. The census information collected by the communities has led to school buildings, sanitation projects, water projects, and better collaboration.

The Problem:Health inequities are avoidable. The fact that poor children in Nicaragua are more likely to die or get sick from completely preventable or treatable illnesses such as diarrhea and pneumonia is a health inequity.

The Need: Decrease existing health inequities by 1) Reducing preventable and treatable child and maternal death and illness in rural Nicaragua and 2) Improving access to health care.

The Program:AMOS Health and Hope partners with rural communities to improve health by using the strategy of community-based primary health care (CBPHC). “Community-based” simply means health care for the community, and by the community. We help communities to develop their capacity to assess, understand and respond to priority community needs as well as helping them to identify local leaders who will take up the cause of good health. (See the program activities on the following page)

The Hope: We have developed a network of trained health promoters and health committees in 27 rural communities who manage and run their own community clinics, prevent and treat the most common illnesses, and work together with governments, churches, and local non-profits organizations to organize and improve the health of their communities.

AMOS seeks to continue working in the departments of Boaco, Chinandega, Matagalpa, Region Autónoma Atlántico Sur (RAAS), developing a rural health system to bring health services to people in rural communities.

Ana Delfina, health promoter of La Majada giving a prescription to woman from her community

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Community census: Every person counts

When special care is given to the most vulnerable people, it makes it possible to decrease health inequities for all.

Community based primary health care is defined as “essential health care based on practical, scientifically sound, socially acceptable methods and technology that is universally accessible to all in a community through their full participation, and geared towards self-reliance and self-determination”1.

AMOS health promoters are trained to use activities that have been proven to be effective in improving the health of children and women2. Below are some of the primary health care activities carried out by health promoters this year.

1 WHO. Declaration of Alma Ata, 1978.

2 Freeman, P. and Perry, H. How Effective is community based primary health care in Improving the Health of Children? Community Based Primary Health Care Working Group. July 2009.

Community Based Primary Health Care Activities

Health education - Promotion of hygiene (especially hand-washing), breastfeeding, nutritional counseling.

Proper food supplies and nutrition Promotion of exclusive breastfeeding until 6 months, education on complementary feeding after 6 months to prevent malnutrition.

Maternal and child care - Family planning, promotion of clean delivery, home based neonatal care.

Safe water and sanitation - Assuring potable water, education on clean water habits, latrines for sanitation.

Immunization - Assuring children are immunized against the major infectious diseases such as hepatitis, tetanus, diphtheria, measles.

Appropriate treatment of common diseases - Community based treatment of childhood pneumonia, reinforce integrated management of childhood illnesses.

Mental, emotional and spiritual health - Promoting suicide prevention and counseling skills.

Community systems - Strong outreach systems with trained and supported health workers with a census based system for registering tracking families in a community.

Provision of essential medication - Inventory, proper dosing of medications; preventive use of Vitamin A.

Prevention and control of common diseases - Tracking illnesses in the community for prevention and control.

Community based primary health care is defined as “essential health care based on practical, scientifically sound, socially acceptable methods and technology that is universally accessible to all in a community through their full participation, and geared towards self-reliance and self-determination”1.

AMOS health promoters are trained to use activities that have been proven to be effective in improving the health of children and women2. Below are some of the primary health care activities carried out by health promoters this year.

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Community-Based:

“Community-based” simply means health care for the community, by the community – in a word, empowerment. AMOS works by invitation only, meaning that we only serve communities that request our services. Once a community has asked for assistance, AMOS comes alongside and helps the community to identify local leaders who will take up the cause of good health. These local leaders then form a health committee, which works in conjunction with a health promoter. The health promoter is an individual who receives basic medical training in order to provide treatment, medicine, and preventive care. Together, the committee and the promoter help to care for every individual in their community, with special attention given to the most vulnerable people.

Census-Based:

Census-based health care is a crucial component of AMOS’ core methodology that helps to ensure equitable aid distribution while also facilitating community organization.  It begins with the attitude: “Everyone counted and every one counts.”  Each year, the health committee goes to every single house in their community, counting the number of people in each family and taking special note of individuals with increased risk factors including pregnant/nursing mothers, newborn infants, and patients with chronic disease.  This data allows the community to gain a better picture of the overall health situation, which in turn creates opportunities for action and quantifiable interventions which ultimately result in improved health.

Evidence-Based:

Knowledge for the people and by the people is one of our mottos at AMOS. We strive to help people in the communities to be their own investigators, to determine their priorities, conduct their own research in partnership with AMOS and others, and create plans for action to improve the health of their communities. At AMOS, we see ourselves as long term co-learners and partners to collectively work towards healthier communities.

Partnership-Based:

AMOS seeks systemic change at the legislative and policy level via a three-way partnership with:1) the government (MINSA – Nicaraguan National Ministry of Health), 2) local leaders and 3) non-government organizations (AMOS).  For more information on the nature of this partnership, we recommend reading Just and Lasting Change by Daniel and Carl Taylor (Johns Hopkins University Press, 2002). Coordination with MINSA (National Ministry of Health): Vaccination campaign, census sharing.

Faith-Based:

AMOS is a faith-based organization.  All of our work flows out of the conviction that God cares for the poor and that His heart is for compassion, healing and justice.

PROCESS

AMOS’ methodology is built around a philosophy of accompaniment and community empowerment. We work alongside local leaders, providing supervision, training, evaluation and monitoring. We also help communities to gather and analyze their own data so that they can make decisions to help their communities based upon the data they have collected.

Methods We Use

Participatory Training Evaluation and MonitoringHealth promoters receive special training three times a year on topics including vital signs, wound care, medicine prescription, respiratory illnesses, growth monitoring, and obstetrics. The participatory training methods that AMOS

uses are based on popular education concepts developed by Paulo Freire, using the promoters’ lived experiences as a starting point for developing new knowledge. The trainings are skills-based, ensuring competency in basic skills and use of protocols in order to prevent maternal and child deaths.

Each community makes a yearly plan with quantifiable goals.  AMOS monitors progress toward these goals and assists communities in developing effective strategies

to reach their health objectives.  For example, a community might seek reduced diarrhea rates, improved nutrition for children under 5, or project-based goals such as installing water filters.  Using the data gathered through the census & patient charting, AMOS can monitor important indicators such as disease prevalence and infant growth rate to evaluate the efficacy of each intervention.

Supportive Supervision Community ResearchAMOS maintains a regular supervision circuit, visiting and accompanying local health promoters 4-6 times per year.  In each community, AMOS physicians and nurses accompany promoters on home

visits, replenish the pharmacy at the clinic and review patient charts with the promoter.  They also obtain progress updates on community health goals, provide ongoing training modules and answer any questions the promoters might have.

AMOS investigates problems at a community level through a methodology called “community-based participatory research.” Evidence has shown that when communities participate in researching and

understanding a problem, they also develop greater ownership of the solutions. We start with the concerns of the people, and then use the following community-based participatory research methods: Photovoice and prevalence studies for anemia, and deworming.

The Problem: An estimated 80% of the rural population of Nicaragua lives on less than $2 per day, which makes access to essential medications and healthcare extremely difficult. Many people forego essential operations or risk crippling debt.

The Goal: Increase access to higher level health care services for patients from rural areas.

The Program: AMOS helps rural patients navigate the complex Nicaraguan health care system. By providing transportation from their communities, and room and board at AMOS, people from rural areas can have access to services in Managua that are not offered close to where they live. We also provide glasses, lab tests and medications for more complex medical problems.

The Impact: In 2011 we were able to help 77 different patients with varying health needs such as cancer treatment, visual problems, anemia, diabetes, and arthritis, among others.

With the help of White Cross, we were able to provide the local hospital Roberto Calderón with bed sheets and also essential medications to the “Hogar Senil” or Baptist Senior Home to help with their residents.

Rafael’s Story:Four-year-old Rafael Mejia-Gomez is the youngest of nine children. He and four of his siblings live in the same home as their mother Juana Gomez in La Consulta, Chinandega, a poor community in Nicaragua where 47 families struggle to survive in an arid, remote village. In May, Juana noticed little Rafael had difficulty eating. Isabel Peralta, the

health promoter for La Consulta, found a large growth on the left side of Rafael's tongue.  While Isabel can treat common illnesses in children such as diarrhea or pneumonia, he refers patients he is unable to treat. However, when Isabel referred Rafael to the government health clinic two hours away in Villa Nueva, the doctors there could do nothing for Rafael. Not satisfied with this response, Isabel called AMOS headquarters, and we were able to arrange a referral to the national children's hospital in Nicaragua’s capital of Managua, where all the reference hospitals for the country are located. Rafael would not have been able to undergo the necessary healthcare had it not been for AMOS’ Patient Care Program, which helps people living in extreme poverty with medicines, emergency transport and housing, clinic visits or lab tests that they otherwise could not afford. Thanks to this program, we were able to arrange for Juana and Rafael to come to the AMOS headquarters in Managua, a seven-hour drive from La Consulta. Like many Nicaraguans, Juana is illiterate and had never traveled to Managua by herself so the trip was frightening for her, but Isabel made sure the mother and son got to our headquarters safely and that Rafael received the necessary surgery to remove his tumor at the National Children's Hospital. Now, Rafael’s tongue has completely healed. His mother feels blessed and thanks both God and AMOS for help in his recovery. 

Patient Care Program

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The Problem: Central America is constantly exposed to natural disasters including earthquakes, hurricanes, and volcanic eruptions. Extreme poverty, and difficult access to remote rural areas during times of disasters can result in more deaths and disability than occurs in more developed areas of the country.Program: While AMOS works primarily in long term development, we also work to respond rapidly to disasters that occur in the remote communities we serve. Recent disaster relief efforts this year:In Chinandega, AMOS works in three rural communities -- El Obraje (140 families), La Consulta (50 families) and La Pimienta and Calderon (125 families). These are amongst the poorest communities we serve because the land in this region is so dry. In August and September of 2011, these communities suffered approximately four weeks of constant downpour resulting in flooding, and in the case of La Pimienta, total isolation by the rising water levels. AMOS was able to make several trips to Chinandega to provide each family with food rations, and the health promoters with essential medicine in coordination with the government Ministry of Health (MINSA). In addition, we were able to fund 30 families who lost their crops in the flooding.By making these trips AMOS not only gave tangible support but also communicated to these communities that they were not forgotten.

The Hope: These communities have suffered the same disaster two years in a row. In 2012, we will be working on a disaster mitigation program with these communities to prepare BEFORE disaster strikes.

Health Promoters Share their Experiences of the Flooding in 2011

Trapped by the Constant RainsSilvina Lainez, health promoter of La Pimienta, says “We are surrounded by rivers, and our situation is difficult. There are no more paths because they have turned into mud…because it keeps on raining…and the women and children can’t come out.  It is hard for us because we are so isolated right now. We can’t even go out to buy food or to work."

Losing Crops Ramiro, health promoter of El Obraje says, “We have had just as much rain as when Hurricane Mitch came. It just keeps raining, and we have lost all our crops. AMOS was able to help us with some seeds and materials for growing family gardens after the flooding had passed, which was a great help..”

Remembering those in needIsabel Peralta, health promoter, La Consulta, ”The food we got today, for a small family of four, will last one week. We have been completely abandoned until now – AMOS remembers us, and we know that what they give is given with love -- which makes all the difference.” 

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Disaster Relief Efforts in 2011

Youth Empowerment to improve health

The Problem: Youth Risk Factors Every year,16 million teenage girls become mothers worldwide, 5.4 million people die from smoking and 2.5 million deaths are attributable to alcohol (WHO, 2009). In Nicaragua it is estimated that 50% of teens ages 15-19 living in extreme poverty become pregnant for the first time (INIDE 2005); smoking prevalence is 35.5% in youth ages 11-22 and only 55% of rural youth ages 10-19 attend school.

The Need: To build healthier lives for youthIn 2010, youth in the communities we serve asked us to support a dream: “We face problems like excessive drinking, violence, and teenagers getting pregnant. But we can do something as youth if we participate and work together. We can learn to raise healthy families with no violence, to fill ourselves with values, and to have a better future -- not just for our own communities, but for all of Nicaragua,” says Jeymi Jarquin, youth leader in Las Macias, Boaco.

In a world that easily becomes fixated on “tackling problems” like early pregnancy and drug use, AMOS is focusing on youth assets, working in collaboration with a program called Teen Smart, which seeks to help young people cultivate their strengths, promote self-awareness, and develop a vision for their lives. The Program: Our goal is to offer holistic care for youth. In 2011, AMOS and TeenSmart formed a partnership to develop a pilot program in 4 rural communities to do the following:1. Train and empower youth facilitators in rural

communities to form youth support groups to promote healthy behavior.

2. Evaluate the potential impact of a youth empowerment program in a rural community

3. To understand the logistical, financial, supervision, and technical needs for implementing a youth empowerment program in rural communities

Results of the Pilot Project• Eight rural youth leaders were trained from the rural

communities of La Consulta, Chinadega; Las Macias, Bocao; San Onofre, Boaco; and Banco de Sikia, RAAS.

• A total of 102 adolescents participated in the Teensmart curriculum.

• Youth facilitators reported increased ability to resist smoking, drugs and alcohol as well as increased ability to organize for improved health in their communities.

• The facilitators also created a new name for their group called JOSECHAS (Youth planting seeds and harvesting hope)

“We started with only 30 youth and now we have over 50 attending weekly meetings. Before we could see that these youth lived in a much darker world, without purpose and no signs of goals. Many were into drugs, alcohol, and smoking. Now, after a year, we see a change. Our youth see a bright world with the beauty of life and principles that go along with it. I want to help the youth to continue forward. The youth are excited and motivated to learn more. My dream is that together, we can create and live in a better environment where we can all see the beautiful light of day.” - Juri Somoza, JOSECHAS Youth Leader

Our Hope In 2012, AMOS received a grant from the Seattle International Foundation (SIF) to isupport the expansion of the JOSECHAS Youth Empowerment Program. This program will train youth facilitators in an intensive health and wellness program, using an intervention model adapted from TeenSmart, to engage young people in social action projects and public policy goals related to healthcare in their communities.

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Teen Pregnancy Drugs Communication Service to Improve Anemia

This girl is talking with someone who is willing to listen to her. All of us go through phases where we need someone to listen to us. There are people out there willing to listen because maybe they have gone through the same problems at some point too. We should always be willing to help others who need us.

There are many children in our community that have anemia. With these leaves we can help to improve anemia of those children. With other vitamins from AMOS we can also help.

There is marijuana, cigarettes and alcohol available in our community. This is damaging to one’s health and it lowers the user’s self esteem. We want to fight to get rid of it. We ourselves can be good examples and motivate others to join us.

Even though we have family planning methods in our clinic, many people don’t know about them. With the help of our health promoters, we can teach the youth about family planing methods like pills and condoms.

Photovoice is a community-based participatory research method by which people can identify, represent and enhance their community through documentary photography projects1. Community members use cameras to share images of their community problems as well as community strengths. Pictures are selected by the participants themselves to share their stories as well as facilitate change through local organizing.AMOS uses the photovoice methodology with local youth leaders to help them recognize their strengths, identify needs and help them develop educational materials to use in their own communities2. They then use these stories and photos as educational tools for their youth empowerment program.Other uses of PhotoVoice through the youth program have included:

1. Development of health training tools specific to their communities’ contexts2. Creating educational posters3. PhotoVoice session with youth in their home community

The following photos and stories are key themes the youth identified during the 2011 photovoice activities and are now using for their program.

TeenSmart & PhotoVoice

Youth StrengthsYouth Concerns

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1 Wang, C, and Burris, M.A. 1997. “Photovoice: Concept, Methodology, and use for Participatory Assessment.” Health Education and Behavior 3. no. 24: 269-872 Wilson N, Minkler M, Dasho S, et al. Getting to social action: The Youth Empowerment Strategies (YES!) Project. Health Promot Pract 2008;9: 395–403

Home visits are an important part of a Health Promoter’s job because it allows them to better understand the patient’s everyday environment and how it affects their health. They make a map of all of the houses where vulnerable people live in their community so that they can be sure to visit them more frequently.

Esteven Jarquin had been frail for a while. He had a severe case of malnutrition that was worsened by pneumonia and severe anemia. His health was deteriorating so we referred him to the government health center in Teustepe.

The doctors at the health clinic, however, said that they could do very little for Esteven.

One day after they released him from the health center, he and his mother paid me a visit at my clinic. I gave her the normal health recommendations for how to improve his nutrition by eating more often, and also by eating iron rich foods. I also visited Esteven at home to make sure he was eating enough.

It was a long and hard fight against malnutrition and respiratory illness, but in the end we were victorious. Thanks to God and the hard work we did. Today Esteven is enjoying life and good health. He is no longer malnourished, his pneumonia is gone and the anemia has diminished, leaving him with his natural skin color. His mother is thankful because she found that what the hospital couldn’t do for her family, she could do in her own community without spending any money. Her child doesn’t get sick anymore and her worries are over.

- Leonel JarquinHealth PromoterLas Macias, Boaco(pictured right)

Saving Lives Through Home Visits

The Problem: Anemia is a major global public health issue affecting nearly two billion people worldwide. Common causes of anemia include a low intake of iron and poor absorption of iron, especially during periods of high growth in childhood and pregnancy, menstruation, and heavy parasitic infections.

The Need: Anemia can result in both maternal and child mortality in severe cases. In growing children, iron deficiency anemia can also result in stunted growth and poor school performance. Addressing anemia can greatly improve the health of mothers and their children.

The Program: In 2011, thanks to the help of churches and the Hemocue company, which makes quick field tests for detection of anemia, AMOS was able to test 923 children between the ages of 6 to 60 months for anemia in 27 rural communities for anemia.

The Results: Compared to national data, children in rural communities experience much higher levels of anemia. (See graph below). This may be due to both lack of food, as well as food choices low in iron.

The Hope: In 2012, AMOS will continue working with the rural communities to seek shared solutions for addressing anemia in their communities. (see next page)

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0% 100%Anemia Anemia

Percentages of Children with Anemia by Age

Anemia Program:Improving child developmentand nutrition

Percentages of Children with Anemia by Region

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4557 61 62

38

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Boaco Matagalpa Chinandega RAAS Nicaragua

Children 6-23 moChildren 24-60 mo

1. Training of health promoters and health committees to do health stations. Data is collected by community members themselves along with AMOS staff and volunteers through tests for anemia and for malnutrition.

5. Meeting with health promoters to analyze differences in their communities, possible causes, and how they can take action to decrease anemia rates.

2. Results shared with each parent; children who had anemia are treated.

6. Further training of health promoters using learned lessons regarding anemia treatment.

3. Advice is also given to the moms regarding foods rich in iron.

7. Community trainings with the hojas verdes (green leaves) that are rich in iron and other vitamins.

4. A community meeting is then held to share the results of the anemia testing.

8. Community meetings to develop social action plans to decrease anemia.

Anemia Project Process

Mom from Cumaica Norte: “Before the work of AMOS, we didn’t even know our children had anemia or malnutrition. But with the knowledge that our children had anemia, and with the education about how we can treat and prevent anemia, I was able to give my children the right kinds of foods, and avoid coffee and sugar, and now my children do not have anemia.”

PROG

RAM

When families drink from unclean water sources (rivers, springs, open wells) and people defecate in the open, water becomes contaminated and diarrheal diseases become endemic. Less than 20% of the population we serve in rural Nicaragua has access to safe drinking water. However, piped drinking water is not a possibility for the majority of the communities we serve because people’s houses are so far apart. With proper sanitation, hygiene education, simple waste management tools, and water purification technology, disease can be prevented. Point of use (POU) filters are the main option for delivering clean drinking water to homes in the communities that we work with. One of the most promising POU filters is known as the biosand filter.

To date, AMOS has installed over 500 biosand water filters in 10 communities in conjunction with Aqua Clara International,

Clean Water For All!Successes with the Biosand Filter

GlobeMed of Rhodes College and many short term mission teams. The biosand water filter is made of local materials and can provide a family with 40 liters of water per day for up to 10 years. Built and maintained by local community leaders, these filters have proven to be effective in removing over 90% of the pathogens related to waterborne illness. Using a portable laboratory, we analyze samples of the water sources, the individual filters and storage recipients to ensure that community members receive the cleanest water possible.

Drinking clean water, however, is more than just having access to clean water. It also means knowing the steps to keep the water free from further contamination. We work with the local leaders to continually educate their communities

about the use of the filter, its maintenance, hygiene and

sanitation so that the water they drink is truly clean.

A Municipal Replication Model:Primary health care in San Jose de los Remates

IMPA

CT

Since 2007 AMOS has been working in the municipality of San Jose de los Remates (SJR) to develop an effective and sustainable municipal model for primary health care that could be replicated at other sites. According to primary health care pioneer Dr. Carl Taylor in the book Just and Lasting Change, sustainable development occurs when communities are true partners in development (BOTTOM-UP), the government has enabling policies and regulations that foster cooperation (TOP-DOWN), and non-governmental agencies provide the ideas and capacity building for change to occur in communities

(OUTSIDE-IN). (See figure to the right, adapted from Just and Lasting Change by Carl Taylor and Daneil Taylor-Ide.

THE MODEL: AMOS developed a municipal model which draws upon the work of other primary health care pioneers including Drs. Gustavo Parajon, Carl Taylor and Dr. Henry Perry. AMOS coordinates with the Nicaraguan government Ministry of Health (MINSA) in SJR to increase health care coverage and to improve health outcomes by sharing data and participating in influencing local policy change.

Below is a graphic demonstrating the relationship and roles of the three partners working together for improved health in the rural communities in San Jose de los Remates

Partner RoleGovernment

“Top-Down”

Policies, Regulations

• Provide structures for free basic health services at the municipal level

• Provide food subsidies and lunch program for children

• Shared goals and training with MINSA

AMOS

“Outside-In”

IdeasMentorship

• Provide training and support for health promoters, health committees, MINSA health workers; provision of essential medications infrastructure for rural clinics

Communities

“Bottom-Up”

Partnership

• Trained health promoters carrying out census, provide education and essential health care

• Community members use services provided and participate in community activities

The Model: Working towards sustainable development through primary health care

Impact of Primary Health Care:Success story in San Jose de los Remates

IMPACT

IMPACT: The graph below shows a significant decrease in both child under five mortality from 2009 through 2011 in the municipality of San Jose de los Remates (SJR). Compared to Nicaraguan and U.S. mortality data, SJR had a higher mortality rate when the promoters started their work, but within a two year period of time, the program was able to significantly bring down mortality rates, showing the strength of a community driven intervention using community based primary health care. Below is also a timeline that outlines the different interventions that were implemented in SJR from the initiation of the project in 2007 until 2011.

Graph: Decrease in child under five mortality rate in the municipality of SJR, Nicaragua 2009-11 Compared to US and Nicaragua Child Under 5 Mortality Rates and Timeline of Program Events

•AMOS begins coordinating with the government Ministry of Health (MINSA)•Health committees (HC)selected in each community•Training in coordination with MINSA

•14 Health promoters (HP)selected by their communities•Training of 14 promoters and health committees •First community Census by HPs and HCs in SJR

•14 Health promoters begin work in community based primary health care•Continuing education 72 hours per year•Supervision visits every 6 weeks

•Mortality data shows that the majority of deaths in 2009 were from neonatal deaths•Therefore continuing education (72 hours/ year) focused on pregnancy and newborn surveillance through home visiting by health promoters

•Continued supervision visits focusing on post partum newborn home visitation•Focused training (72 hours/year) on clinical skills, counseling, and referral for more complicated medical problems.

Full implementation of Community Based Primary Health Care ModelInitiation of Community Based Primary Health Care Model

U.S. under 5 child mortality

rate in 2010 was 8 in every 1000

live births.

Access to Health Care:A Mother in NeedArrelys Espinoza lives in the mountain community of El Roblar, a two hours walk from the municipal center of San Jose de los Remates (SJR) in Boaco, Nicaragua. She is known throughout her community as the promotora -- a health promoter who serves her community. Like many other health promoters throughout SJR, Arrelys is trained to serve her community by promoting health, preventing disease and providing basic health care services.On April 5th, Arrelys was at her home when word was sent to her that one of her patients, Rosa, needed her help. Since the majority of people do not have cell phone signal, nor can they afford cell phone minutes, the only way messages are sent in this disperse mountain communities is by foot, with children often being the messengers. As soon as she got the message, Arrelys quickly went to find Rosa on the narrow, winding dirt paths down the mountain and through a forest of trees and coffee plants. She found Rosa on the path doubled over in pain, and with heavy vaginal bleeding. Arrelys quickly took vital signs and knew Rosa needed an ambulance. Since AMOS provides cell phones and minutes to the health promoters, and AMOS promoters are recognized by the government clinic as first responders, a call from Arrelys to the clinic meant an ambulance was quickly dispatched. Arrelys and others in her community, helped Rosa through 1 km of rugged hills to get to the dirt road where the ambulance was waiting for them. Arrelys then accompanied Rosa to the health center, and helped support her, while Rosa was stabilized by the physicians, who diagnosed a miscarriage, and transferred her to the regional hospital for further care.Says Rosa, “I am so grateful for having an AMOS health promoter in my community. If it were not for Arrelys, I could have died on the side of the road.”

And in response, like so many of the promoters who inspire us every day with their commitment to serve those most in need, Arrelys said, “What touched me the most about Rosa, is that she told me she could never repay me for what I had done, but I would never ever expect payment. Before I came to AMOS, I felt I couldn’t help anyone. But now I know what to do, and with the help of God, I am motivated to continue to help my neighbors.”

Delegations and Volunteer ProgramSU

PPO

RT

Program: The AMOS Delegations & Volunteers program is an opportunity for individuals, groups and churches to directly serve alongside communities in rural Nicaragua. Thanks to the long term accompaniment, love and support from many teams and individuals through the years, this program has greatly aided the efforts of AMOS as we help provide rural communities with integral primary health care.

Delegations: Groups between 10 and 20 people on a delegation (short term mission team) visit a rural community to help support priority community projects such as building clean water systems, health clinics or school buildings, and also conducting health screenings. In addition to the projects, groups are encouraged to develop relationships with the people of Nicaragua to understand the realities of living in extreme poverty and what we can do together to improve the health of poor and marginalized populations.

Volunteers: Individuals who come to volunteer from 1 week up to two years work alongside our AMOS staff and community members on projects in the areas of public health, communications, construction, training, delegation coordination, and translating.

In addition to infrastructural changes such as clinics, school buildings or water filters, the majority of the communities became more organized as a result of accompaniment by the delegations program.

All the activities I participated in on this trip emphasized the importance of community empowerment and participation, a message I think I can carry on to

whatever I end up doing in the future- Sarah Endres

I learned a lot about myself and my personal goals and interests in medicine.I loved working with everyone at AMOS!

- Carolyn Lamere“ ”

The following is a list of all of the delegation teams and volunteers who served with us in 2011. Some were from American Baptist Churches but there were many from other organizations such as universities, hospitals or other denominations.

DELEGATIONSChrist the King Church, WA Jan 14-24 100 Filter Construction: Sabalete, MatagalpaMid-America, IA February 18-2750 Filter Construction: La Pimienta, ChinandegaAlderson Broaddus, WV March 4-13 43 Filter Construction: El Roblar, BoacoChemeketa Community College, OR March 19-26 Health screening stations: SJR, BoacoProvidence Hospital, WA April 8-16 Health screening stations: MatagalpaFBC of Greater Cleveland June 24-July 6 43 Filter Construction: Cumaica Norte, BoacoPark Avenue, KS August 5-14 39 Filter Construction: Cumaica Norte, Boaco

G2G, WA September 2-11 62 Filter Construction: San Jose de la Mula, Matagalpa

Providence Hospital, WA Oct 1 - 10Health Promoter Training: SJR, Boaco

West Virginia Baptist Convention Nov 17-27Health screening stations,

VOLUNTEERSDave StalsbrotenDelegations CoordinatorJan - November Andres SierraFilter labsFebruary - July

Delegations and Volunteers of 2011

Rich, Kim & Sean BernardDelegations Volunteers March 4 - 13Cheryl DuMondDelegations volunteer/Translator March 17-27 Amanda & Matt Cummins,Joe BaldauffHealth Stations, filer labsApril 8-17 Sarah Paragamian Anemia and malnutrition studyMay 29-July 20 Carolyn Witman Anemia and malnutrition study June 2 - July 22 Cassie ButtlerVideographer & communicationsJuneMonica ChanWater Filter Supervision & labsJune 12-August 1Erika Spring Delegations Volunteer, Data EntryJuly 3-16GlobeMed (Sarah Endres, Carolyn Lamere)Water Filter Supervision & labsJuly 17 - August 14Operation Agri (Jill & Russell Ashley Smith)PhotographyAugust 9 - 18John Caroll Delegations volunteer & TranslatorSeptember 2-11Jordan Timpy Videographer & communicationsSeptember 12 - December 5Miguel Tello Circles TrainingNovember 30-December 3

SUPPORT

SUPP

ORT AMOS Financial Summary

Our goal is to make the most out of every gift,so together we can help as many people as possible.

AMOS relies on the generosity of individuals, foundation grants, and churches to help us assure quality health care services to the most vulnerable populations living in rural areas.

In 2011, we spent a total of $173,399 on community health care. The average per person cost comes out to $14 a year to serve nearly 12,000 people in 27 rural Nicaraguan communities.

In addition, contributions from our volunteer delegations contributed an additional $91,898 for clinic building, school building, and water & sanitation projects for rural communities.

We can only pursue this vision of serving the most vulnerable people through the continued support of our donors. Your trust encourages us to continue seeking the resources that will allow our comprehensive health programs to flourish.

We are also grateful to our committed staff and partner communities who help work to ensure AMOS resources are used effectively and responsibly.

Thank you!

2011 Donations & Grants: Breakdown of AMOS Funding Sources

30% Delegations

20% Grants

43 years of partnership: Rev. Martin Rolfs-Massaglia presenting plaque to the late Rev. and Dr. Gustavo Parajon for his Christian commitment, service and dedication in ministry in Nicaragua.

“When people support a cause or a ministry they want to know that their support is making a difference in the world.  Supporting AMOS Health and Hope is, perhaps, the best investment of the dollar imaginable.  Our congregation loves knowing that our support of AMOS empowers villages in rural Nicaragua to save and transform lives.  We feel honored to accompany Nicaraguans in establishing the means of providing health care in their villages where it did not exist before.  We have seen with our own eyes the empowerment of the people in those villages as they are supported in forming health committees and choosing and then being served by a health promoter.  AMOS is changing the world one village at a time and we feel so blessed and privileged to be partners in that change.”

 Martin Rolfs Massaglia

Pastor, First Baptist Church of Greater Cleveland

33% Faith

communities

17% Individuals

Breakdown of program expenses

2011 AMOS Expenditures

Primary health care program$198,695

Delegation Projects$99,570

Administration$18,494

63%31%6%

31% Community clinics

12% Clinic building and repairs

9% Essential Medications

20% Water and Sanitation

10% Health promoter trainings

4% Deworming

4% Patient care

5% Community empowerment

3% Disaster relief

SUPPORT

SUPP

ORT THANK YOU TO ALL

OUR SUPPORTERS!PARTNERSGlobeMedTeenSmartAqua ClaraWipe Out WormsThe Worm Project Fraconia MennonitesWake Forest UniversityPaso PacificoMINSA (Ministry of Health of NIcaragua)MINED (Ministry of Education of Nicaragua)

FOUNDATIONS & ORGANIZATIONSWhite CrossOperation AgriThe Strachan FoundationLake Family FoundationNorth American Taiwanese Medical Association Foundation The Masek FoundationWake Forest UniversityWake Forest University School Of Divinity

Good Stewardship

BOARD MEMBERSKevin Lake, MDBob McElroy, MDRev. Dr. Tim Spring, D.MinLaura Chanchien Parajón MD, MPHDavid Parajón MD, MPH, MBAOctavio CortésSixto UlloaArthur FrancisMarlene FrancisRomán Santamaría, DDS

of Resources

WV Baptist ConventionBridges of Hope -- Alliance of BaptistsGlaxo Smith Kline FoundationMedical Foundation of North CarolinaDuniway Middle School Student CouncilKiser Construction LLCMorris Farms, Inc.North Carolina Baptist Hospital

DONORS OF 2011Aaron & Mallory HeggeAdrian RogierAlbert FrederickAlderson Broaddus CollegeAlex & Carol NeubertAlliance of BaptistsAllison DemmertAlma & Matthew ReedAmanda ArfstenAmanda CollyerAmber LuikartAndrea GaiAndrew StrombergAndrew ZieglerAngela ChenArnold & Mary ShihArthur & Gayle SchmidtArthur & Naomi HuntBaptist Temple, PksbgBarbara BrinkleyBeatriz & Warren TaylorBette & Jim BagnallBeverly A. KenyonBill & Kathy Ogle

Bill CummingBreanne AkersBrian Behnken Brian Mark Doyle & Elizabeth Anne StuartBruce & Becky Van Der BeekBurton Baptist ChurchCaitlin McEathronCalvary Baptist ChurchCarol W. ThomasCaroline & Francis OdaCarolyn Anne LamereCarolyn WhitmanCasey & Lauren CarlsonCassandra FoustCathy ChangchienCeline ImpertChadwick & Kezia NewtonChadwick NewtonCharles & Heather BulfinchCharles GroveChemeketa Community CollegeCheryl DumondCheryl RehlingChien-Tai ChenChris & Michelle KillingstadChristian Aid MinistriesChristian St. JacquesChristopher BeckleyChristopher ChenChuntung & Li-Shei ChangchienChurch of the MessiahClarence ArnesonColin IgawaConnie M. SchmitzCourtney Nikki EtienneCristina & Scotty ParajónDale Herrigstad

Dan SwihartDaniel & Evelyn PittsDanielle YoungDarlin A RuizDave StalsbrotenDavid & Claudia GrixoniDavid & Rebecca ChapmanDavid EdwardsDavid ShriverDeAnn WhippleDeborah Norton & Jonathan SledgeDeidre DrukDennis & JoAnne JenkinsDennis & Patricia ElonkaDick & Paige CantwellDon & Nelly FishcerDouglas & Erin CarlsonDouglas & Kimberly DonleyDouglass & Rebecca CraigDr. Robert & Joan HolmbergDuane & Eileen TaylorDustin LaneEdwin RiveraElaine CartwrightEllie HappelEmily KensethEric & Lori Tissue Erwien & Juanita SaputraErwien & Junita SupatraEugenia KirchnerEvery Nation ChurchFBC AmesFBC AnacortesFBC Ann ArborFBC BentonFBC MattoonFBC OsageFBC SpencerFBC TopekaFBC Greater ClevelandFBC Managua

SUPPORT

Good Stewardship

FBC WaterlooFBC New Horizons SS ClassFloye Nui SumidaVic & Fran LeanzaFrederick & Patricia BentleyGary & Margarett KunzGeorge & Christina BurkholderGeorge & Susan MaiocchiGerald & Carrie LinGlenn D. BratcherGrace Trinity Community ChurchGregory & Amy McLarenHarvey & Lauri CarlsonHector & Argentina GonzalezHenry Bode & Susan Cartland-BodeHillary RitenburgHoward & Cheryl CopeHoward HammondIrl & Clarice GroveJacquetta MayerJames & Phyllis KnaufJames & Barbara RossJames & Kathleen JolinJames & Rebecca RileaJames & Susan GroveJames HsuJames S.C. Hsu & Orchid YanJames WhitehouseJane KinneJanet & Paul OwensJanet A. SpaldingJanet C. BrownJared & Michelle TartarJared & Sarah CepedaJean & Warren Burton

Jean BurtonJean SacatshJeannette ThroneJefferson Street Baptist Community at LibertyJennifer AngeloJennifer BurchettJennifer ScottJennifer SpringJeremy BullJerri Morgan-ReinerJessica & Luis MartinezJewell MorrisJill & David BernsteinJill & Jennifer KnottJill CrawfordJim HoekwaterJoan & Hiro HuangJoan ParajónJoe BaldauffJohn & Joan LaneyJohn & Lisa McDarmentJonathan SledgeJonathon & Amy LipkoJoshua GebhardtJoyce M. CollinsJulie SextonK.L Ngai & Linsen NgaiKaren DonahueKaren LambKasey & Lauren CarlsonKatharine HoughKayode AriwodolaKeith & Sarah PulvermacherKeith & Winifred Dewey

Keka IchinoseKenneth PeeryKenton & Karen TamKevin & Paula HuberKevin & Suzanne LakeLa Vonne BoyerLaura KlebsLaVonne BoyerLinda & David StroutLisa & Helios Ovando-ArreolaLucky RayLydia ImoffMarcella AndersonMargaret CarollMarjorie TamMartin Rolfs MassagliaMary & Walter HightowerMary MooreMary Vo.Matthew MulletMcGrawville Baptist ChurchMelissa & Cindy KerleeMelvin L. DoxieMervin & Alice HanscamMichelle StanberyMiles McEathronMitchell HuberMonica ChanMyrna ParrisNan LieboldNancy H. WheatonNaomi BoydNicholei InnNicole HylandNoah Fletcher

SUPP

ORT

of Resources

Noel & Michelle JamesNorth Hills Community Baptist ChurchOle & Sara LindboOliver & Valerie StalsbrotenPark Ave Baptist ChurchPatricia LongPaul NelsonPeter & Marilyn GustafsonPullen Memorial BaptistRebecca & William TallmanRene MoralesRhodes CollegeRichard & Elizabeth MyersRichard & Kim BernardRichard & Marla SnyderRichard CantwellRiley MullettRita PaulRobert & Katharine McElroyRobert & Martha CarpenterRobert & Rebecca EndresRobert CarpenterRobert McElroyRobert SchneiderRoman VelasquezRose & Robert StilesRoyce & Angeline JonesRoyce JonesRuss & Cynthia BernsteinRussell Weaver & Jennifer ScottRuth & Richard StuartSandra Robinson-Nance & Jamael NanceSean & Brenda CornettShaun McMichaelShawn Silva

Shelley YonemuraSt Mark Presbyterian ChurchSusanna MyersSuzanne & Fouad DarweeshThelma J. OdonnelTherese WinkelThomas & Marion MetzTim & Pauline SpringTim SchmidtTimothy & Kirsten Johnsen MartinTimothy SchmidtTobili Sam-YelloweTom & Gail LitwilerTsunie & Ching Chih ChanchienTyler TanakaTyler TanakaUniversity Baptist Church MinneapolisVickie ArnoldWake Forest Baptist Medical CenterWakefield Baptist ChurchWayne & Kathy BeckwithWest End United Methodist ChurchWestover Baptist ChurchWini DeweyXplore CrossfitYadira OrtizYvette OngZwu-Shwin & Seh Seh Lin

SUPPORT

Co-Founders & DirectorsDavid Parajón, MD, MPH, MBA Laura Parajón, MD, MPH

Security & MaintenanceOtilio GutierrezDomingo SolanoNelson Varela

Logistics, Transportation & MaintenanceJuan Carlos LatinoAlberto BenavidesGuillermo Mora

Communications & DelegationsJessica Chapman-MartinezFelicia ZamoraElizabeth Calero

Medical ProgramRoberto Martinez, MDRosa Malespin, MPHMiguel GarciaRoberto Garay

AdministrationMartin Diaz, MBA Danelia VilchezEveling OrtizGloria Herrera

Thanks from the AMOS StaffSpecial thanks to all who have supported us with prayers, in-kind donations, physical presence and encouraging words so that we

may serve with hope.

Contact InformationUS MAILING ADDRESSAMOS Health & Hopec/o Rev. Tim Spring, Board Secretary3088 Haberlein Rd.Gibsonia, PA 15044-8232

PHYSICAL ADDRESS IN NICARAGUAKm 9.5 carretera viaja a León, del cementerio Nejapa 1600 metros al noroesteManagua, Nicaragua

PHONE NUMBERSNicaraguan Office 011.505.2271.2933

WEBSITEamoshealth.org

FACEBOOKfacebook.com/amoshealth

FLICKRflickr.com/photos/amoshealth