HOPE works in more than 35 countries worldwide. Please enjoy our blog as we document the successes and challenges of our work to provide Health Opportunities for People Everywhere.
The devastating earthquake in Nepal on April 2015 damaged many facets of human life and the land itself. As the result, people who were already marginalized and vulnerable have become more fragile and left with very few health and social services.
In partnership with Government of Nepal, Ministry of Health and Population, Center for Disaster Philanthropy, as well as Nepal Public Health Foundation, Project HOPE carried out a post-disaster needs assessment in 14 severely affected districts.
As a result of the assessment, the “Better Access and Services Provision to Improve Maternal, Neonatal Child Health Nutrition and Hygiene Service in Makawanpur” was launched in five of the remotest villages where the Chepang are one of the major inhabitants. This program is named SPARSH in Nepali.
Makawanpur district is in the central development region of Nepal. Along with other ethnic groups, Chepangs are one of the most prominent tribal groups residing in the district. Chepang initially had a semi-nomadic (slash-and-burn agriculture) lifestyle, but this is now slowly shifting to a more settled way of life, relying increasingly upon the produce of permanent fields of maize, millet and bananas. Mostly uneducated and without much exposure to other regions, the health and social indicators of the tribe were found to be marginally low. The earthquake only exasperated the health challenges faced by the tribe.
SPARSH has successfully marked its presence in the Chepang community through an orientation program, direct community dialogue, awareness campaigns and community mobilization including a healthy baby competition and other school based activities. At the same time, SPARSH has joined the government effort directly and indirectly by providing communication training to front line health workers, community workers, health posts and similar entities. Technical support has been provided to establish birthing centers where there is no health facility. Mothers are encouraged to participate in informative group meetings and other community engagement activities.
The program aims to have long-lasting impact on health workers, the health system and the entire community.
While I was working as a physical therapist, I decided to take up work as a volunteer teacher of math and physical science in the north of Namibia in 1999. It is here that I was first impacted by HIV/AIDS. At the time, before antiretroviral therapy (ART) was available in Africa, a diagnosis with HIV in Namibia was a veritable death sentence. I stood by and watched as friends and colleagues wasted away emaciated, often stricken with diarrhea and then passed away from infection that their weakened immune system could not fight off. HIV was then a mysterious and highly stigmatized condition in the community where I lived. Some of the parents of my grade 9 and 10 students were dying, members of the large household where I lived were dying. In the pancake flat environment where I lived I could spot about eight homes as I scanned in each direction from the home where I lived that everyone had at least one member who died from AIDS-related illnesses. All of this happened within the first year and a half of my arrival to Namibia 17 years ago. All we had at the time were messages about the importance of people who were struck by the disease to live with a positive attitude. This did little to ease the suffering of people diagnosed with HIV which often quickly progressed to AIDS.
While I was living amongst this tremendous suffering, I decided that I wanted to join the fight against HIV/AIDS. We have come a long way and things have changed significantly. Lifesaving ART is available. HIV testing is available. Now with Project HOPE as the Africa Regional Director, I feel fortunate to lead an inspiring team who are fighting HIV/AIDS in Namibia and across the African continent. We are now at a stage in this battle where we can seriously talk about strategies to end AIDS in Namibia in the next 15 years and on the continent of Africa as well. This sense of optimism and hope was expressed again at Namibia’s first National AIDS Conference during the week leading up to World AIDS Day. Many of us come to conferences like this to feel reenergized, recommitted and inspired by the work of those around us. The conference has worked well in that regard for me and I look forward to sharing ideas and striving for real public health solutions with the Project HOPE team to save lives in the future. And Project HOPE even won a first-ever Namibia HIV/AIDS Hero Award for Civil Society!
I am extremely proud to attend Namibia’s first HIV/AIDS conference in Windhoek with many of the people who are driving the HIV/AIDS response here, including members of the Ministry of Health and Social Services, UN agencies, support groups for People Living With HIV (PLHIV), U.S. government implementing agencies for PEPFAR including USAID, the business community and civil society groups like Project HOPE’s Namibia team.
The aim of the Namibia National AIDS Conference is to reach a consensus on how to end AIDS in Namibia by 2030. The 2015 HIV/AIDS report by UNAIDS revealed that more than 210,000 people are living with the virus in Namibia and more than 149,000 are on antiretroviral therapy (ART). According to UNAIDS, 18 million people are on ART worldwide.
The conference gives us an opportunity to share information on new interventions. Specifically, we are looking at UNAIDS recommendations, reviewing epidemiologic evidence, current strategic documents from the Namibian government and critically reviewing the current response in Namibia. At least 100 scientific and programmatic presentations have been showcased here and Project HOPE’s innovative work has been well represented for its contribution to the response. HOPE’s work on economic empowerment to improve PLHIV adherence to care and treatment was presented by Wilfred Luyanga and was included in the conference recommendations on the first day.
During the second day of the conference, HOPE’s work in electronic data capture, Community Based ART (CBART) Refills to improve adherence to lifesaving therapy was presented as well as our innovative ART Client tracing of people who stopped taking their medicines.
Project HOPE’s novel approach of targeting the homes and families of PLHIV for comprehensive health, economic and social services and how this approach has improved the lives of children infected with and affected by HIV was also showcased.
The consensus among delegates here is that if we are going to stop the epidemic in Namibia we will need to increase efforts and investments because aside from the challenges of starting in the fight against HIV/AIDS in Namibia, finishing the fight is most difficult part of this massive and complex effort. Namibia is a country where ending AIDS is possible and there is political will and financial commitment from the Namibian government to pursue this. It is clear that if we remain in the status quo, we will not end AIDS, but rather, the number of people living with HIV will continue to grow. To end AIDS here we will need a more targeted approach including HIV prevention by ensuring that young women are empowered, tested, receive and adhere to treatment. It is also crucial that older men who infect younger women are circumcised, tested, and adhere to ART to ensure that the virus is not in their bloodstream.
There is much work to be done to establish consensus and common action to end HIV in Namibia by 2030 and the Project HOPE Namibia team is deeply invested in collaborating with other stakeholders to develop innovative public health approaches to save lives.
Dr. Ketan Nadkarni was a recipient of the Dr. Charles A. Sanders and Project HOPE International Residency Scholarship 2016 while he was a resident in pediatrics at the University of North Carolina. He worked at Project HOPE’s program site in Shanghai. The scholarship is endowed by the North Carolina GlaxoSmithKline Foundation and is offered to medical residents and fellows studying at one of North Carolina's four medical schools.
When I saw an email in Mandarin with the English words "Welcome Ketan," my heart skipped a beat, excited to think I might be in line for what would be the experience of a lifetime. This past September I spent one month living in Shanghai and rotating through Shanghai Children's Medical Center (SCMC) as part of the Dr. Charles A. Sanders and Project HOPE International Residency Scholarship program. I spent time working on the general ward team, pulmonary department, hematology-oncology and Traditional Chinese Medicine clinic.
My favorite part of the medical experience was working in the Traditional Chinese Medicine clinic. I had the opportunity to learn acupuncture, tuina (therapeutic massage) and herbal therapy, in addition to the principles governing them. Kids with conditions such as asthma, allergies, tics, headaches and insomnia were treated in ways completely opposite from Western medicine tactics. Instead of pharmacotherapy, patients were treated holistically.
I saw significant improvement in patients before my own eyes, and even learned how to perform basic acupuncture. This intrigued me so much that I brought this experience and knowledge back to North Carolina with me, and taught my colleagues through a presentation. This experience opened my eyes to alternative medical management and has caused me to have a more open mind when approaching these common pediatric conditions.
In addition to working at SCMC for the month, I had the opportunity to learn about Chinese culture through travel. China is a beautiful and vast country, filled with ancient history, magnificent sights and delicious food. I spent a weekend in Beijing, and walked the Great Wall of China. This was one of my bucket list items and I cannot describe in words how it felt to be on top of the world. It seemingly stretched on for an eternity and was truly surreal to be at the same site that defended the Ming Dynasty centuries ago.
I also visited the Forbidden City and Tienamen Square while in Beijing. On a different weekend, I took a train into beautiful Hangzhou, an ancient city, home to the famous West Lake, towering pagodas, beautiful shrines and heaps of history.
Lastly, Shanghai itself had so much to offer that I never ran out of things to see. The Pudong skyline is like a rainbow that lights up the sky at night, while the Jing'an temple and Yuyuan gardens draw thousands of visitors a day. One of my favorite activities was getting lost in the city, and finding hidden gem family-run restaurants with the best xiaolongbao (steamed dumplings) you can imagine. Additionally, the people in Shanghai, particularly at the hospital, were incredibly hospitable. I was treated with nothing but respect and kindness.
However, this experience did not come without obstacles. The most significant obstacle was the language barrier. Whether it was on hospital rounds, at restaurants, or on public transportation, not being able to communicate in Mandarin or Shanghainese made daily life a lot more difficult.
There was also a great deal of culture shock and isolation that comes with any long travel experience. It was challenging being away from family, friends, colleagues and the friendly confines of UNC Children's Hospital. Trying new food on a daily basis was eye opening, especially with meat and vegetables I had never seen before.
Lastly, being in a city with over 25 million people was overwhelming at times, making my hometown of Chicago feel minuscule (about 3 million). I bought a phrasebook to learn basic Mandarin, immersed myself in Chinese culture until it became second nature, and used the immense population to make as many new colleagues as possible. All in all, I feel that I came back to the U.S. more flexible and adaptable to new situations, ready to handle whatever I encountered with an open mind.
Thank you, Project HOPE and Dr. Charles Sanders, for an absolutely wonderful experience that made me grow and mature not only as a physician, but as a person as well. I look forward to future endeavors with Project HOPE and with global health in general.
Applications for the Dr. Charles A. Sanders and Project HOPE International Residency Scholarship 2017 will be online in January 2017.
Quality of life education and practice
Carma Erickson-Hurt, Doctor of Nursing Practice (DNP), is a Project HOPE volunteer and expert in palliative care. Carma has volunteered her specialized skills to provide health care training in palliative care and end of life nursing education all over the world.
Early this November, I spoke with an interdisciplinary group at the Shanghai Children’s Medical Center. This group included nursing leaders, bedside nurses, physicians and social workers, and focused on the integration of pediatric palliative care – a relatively new concept in China. We had great discussions and there were many questions.
The World Health Organization (WHO) defines palliative care as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
Pediatric palliative care includes the entire family and focuses on quality of life as defined by the individual patient and family. Palliative care experts include a team of doctors, nurses, social workers, spiritual experts and others trained in palliative care. Care is provided through an interdisciplinary approach directed toward pain and symptom management, advance care planning and information sharing through informed discussions, psychological, social and spiritual support.
Although palliative care and the importance of the interdisciplinary plan of care are relatively new concepts in China, the staff at the SCMC is eager to develop the expertise and then serve as a model for the rest of China. They have already begun to incorporate this type of care with pediatric patients and their families.
Annually, there are more than 500 new patients with cancer admitted to the hospital. Some children with incurable cancer will have their last moment of life spent at the hospital. The need for palliative care throughout the cycle of care is well recognized among health care professionals.
Sometimes children and families need time alone, so the staff at the SCMC created the “Blue Planet Room” – a peaceful place that incorporates a soothing and comfortable environment far removed from the rest of the busy hospital. This beautiful space was decorated through the generous gift of local interior designer Mr. Zhu, Jie.
The staff knew they needed this room, but didn’t have a clear plan on how and when to use it. Together, we came up with a strategy for implementing its use – one that would emphasize the benefits of this room to patients and their families. I’m confident that the staff will now be more proactive about creating palliative care and policies and procedures.
The room holds a large bed where families can be physically together in a close and loving way, unlike the typical hospital bed or crib. The room has a large screen television for playing movies or listening to music. Peaceful décor includes pictures of Mother Goose with her baby gosling, and an angel lightly reflected on the wall reaching for a star. The ceiling is painted with stars. Toys and stuffed animals are available.
The palliative care training included topics such as pain management, differentiation of morphine dosage for patient comfort, approaches to disclose disease prognoses with parents, and the suggested time to start the bereavement consultation. Future training is planned to continue to develop the expertise of the palliative care interdisciplinary team members.
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