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.
Susan Opas is a pediatric nurse practitioner from Woodland Hills, CA who volunteered for Project HOPE on Pacific Angel 16-2, a humanitarian and civic assistance mission led by the Royal Cambodian Armed Forces working alongside their U.S., Thai, Vietnamese and Australian counterparts and volunteers from nongovernmental organizations like Project HOPE in Kampot Province, Cambodia. Susan treated pediatric patients at two makeshift clinics over the course of five days in mid-June 2016. Pacific Angel 16-2 was Susan’s sixth volunteer mission with Project HOPE.
The second site of this mission was truly within farmland. The fields in the area were wide open, growing sugar cane, rice, vegetables and coconuts. This area was more established than the first site, but the classroom (our clinic site) was filled with dirt and cobwebs and was dark as a dungeon. It took a lot of time to move desks and sweep with masks on to be ready. There were two small windows on each side of the room with little ventilation. The Air Force brought a generator and fans which worked until the fuel ran out. There was no electricity, so evaluating children in near dark was going to be difficult.
We were at this site for two days: June 17-18. Among the children’s diagnoses I provided were for another heart problem (hole between the ventricles), hernia, leg pain (growing pains), anemia, fever, headaches and dehydration, stomach aches, poor eaters, and minor skin issues. However, my teammates saw a teen post-motorbike accident who had two gaping wound and had been going to the local hospital every other day to be redressed. They also saw some major hernias, suspected TB, head trauma, a history of nose bleeds and all the other imaginable childhood issues we see at home.
At the end of the second day, a small group of us took sunglasses to the local hospital and got a tour. They have the basics. There is no central monitoring in the ICU. Patients share a large room. The newborn ICU consists of two isolettes. In the maternity ward, babies are in beds with the moms. In all cases, the families stay, provide basic hygiene care and bring food.
During the five days of this mission, we provided health assessments and minor interventions – antibiotics, inhalants, anti-inflammatories, wound cleansings, looking in ears and throats - to 3,486 patients. At the least they left with vitamins, a toothbrush and sunglasses.
Susan Opas is a pediatric nurse practitioner from Woodland Hills, CA who volunteered for Project HOPE on PacificAngel 16-2, a humanitarian and civic assistance mission led by the Royal Cambodian Armed Forces working alongside their U.S., Thai, Vietnamese and Australian counterparts and volunteers from nongovernmental organizations like Project HOPE in Kampot Province, Cambodia. Susan treated pediatric patients at two makeshift clinics over the course of five days in mid-June 2016. Pacific Angel 16-2 was Susan’s sixth volunteer mission with Project HOPE.
This mission began June 11 with a day to complete set-up that several U.S. Air Force and Australian Air Force volunteers started the day before. Our goal was to serve two community locations in the very south, central area of Cambodia. Both locations are in farming areas, but the first was quite more distressed than the second. In both settings we used local schools: the first was a middle school, and the second was an elementary school connected to a Buddhist wat (temple), which was incredibly gorgeous with walls and ceilings totally painted with Buddhist scenes.
Our first true day of mission work was June 13. Our clinics consisted of dental, optometry, general medicine, pediatrics, physical therapy and a pharmacy. The medicines provided were quite variable, so we had to stretch at times to utilize what we had. An example is loratadine (Claritin) for unavailable Benadryl. In addition to seeing patients, in pediatrics we each also dispensed our medication and, with interpreters, educated the patients’ parents about the medications.
My very first patient was an 8-year-old with subcutaneous tuberculosis. Yep, quarter-sized cysts full of TB. The next had his heart in the right side of his chest instead of the left along with a larger murmur, which seemed to be a hole in his ventricle. Cambodia has a much better referral system than other countries. So, our infectious disease person and the local hospital director coordinated the TB patient’s transfer and set up a plan for us to follow the patient’s routing throughout the mission.
The next day again I started with another heart murmur known as Stills Murmur, which is seen when significant anemia is present. Rice is the staple of life here, although I noticed on our van ride one hour from town that there are cows, chickens, turkeys and pigs. In some situations parents had the same complaints as in the U.S.: kids want the sugar and chips and somehow they have the money to get these. I saw lots of beer and soda available along the roadside.
On the third day, the last at this site, the number of patients seeking pediatric care dropped. I believe this was due to the kids being in school and unable to be seen while we were available. The most involved work of the day was cleaning skin wounds caused by kids scratching their bug bites without good hand washing. We closed our section early and began packing up for the move to the second site. We were awash with “gummy vitamins,” which patients, parents, the interpreters and the military were eating like candy.
Day four was a moving day. We started on a paved road out of town, but then we were on a red, dusty dirt road or muddy single lanes with lots of divots, which kept us awake until we arrived at the second site.
A Volunteer Nurse Assesses Maternal and Newborn Health Care
J. Beryl Brooks, the Developmental Clinic Coordinator for Improved Pregnancy Outcome at Memorial UniversityMedical Center in Savannah, is part of a team of medical volunteers who traveled to Sierra Leone in May to conduct a rapid assessment of maternal and newborn health care in health facilities there. This humanitarian mission is in response to a re-emerging crisis in country where maternal and newborn mortality is among the highest in the world. Here she shares a portion of her journal in which she recorded her personal observations of the trip.
Continuing our visit in Bo District, we talked to a number of staff members in Labor and Delivery and Postpartum about their pre- and in-service training.
There are no phones on the wards, so it is necessary to go from place to place to communicate and get things done. This is time consuming. Most phones in use are the staff’s personal cell phones. Electricity is intermittent, a problem for many reasons: oxygen concentrator not working, no lights to view the patients, etc. We found this to be a problem last night, too; when we returned to the hospital it was hazardous to get from place to place. There is no lighting in the hallways, many of which have drop-offs, steps and gaps. There was one functioning lightbulb in the pediatric ward requiring the use of flashlights for patient observation and care.
On Monday Dr. Asibey and I continued the assessment process and began some introductory trainings for Helping BabiesBreathe® and Essential Care for Every Baby. The nursing and midwife staff began each program with hesitance, but quickly recognized the value and became very enthusiastic learners. It was a great pleasure working with them. We found that the trainings were a great way to elicit information about what was available for patient care and what the staff’s training and capabilities were, much more effective than interview and observation.
The overall observation from our time in Sierra Leone is that the local health care professionals are overwhelmed by the responsibility of caring for very sick patients with limited supplies. Many are still very passionate about providing the best care possible despite the obstacles. Some are apathetic, but some are still willing to learn and grow. There is good teamwork and camaraderie for the most part.
On Tuesday, just before leaving for Lungi to fly home, I met Osman Kabia, Project HOPE’s Sierra Leone in-Country Consultant. He was delightful, as were all the staff members, and brought a feast prepared by his wife. What gracious and wonderful people are here in Sierra Leone. I am grateful for this opportunity.
A Volunteer Nurse’s Assessment
J. Beryl Brooks, the Developmental Clinic Coordinator for Improved Pregnancy Outcome at Memorial University Medical Center in Savannah, is part of a team of medical volunteers who traveled to Sierra Leone in May to conduct a rapid assessment of maternal and newborn health care in health facilities there. This humanitarian mission is in response to a re-emerging crisis in country where maternal and newborn mortality is among the highest in the world. Here she shares a portion of her journal in which she recorded her personal observations of the trip.
After we arrived at the Lungi airport in Sierra Leone, we took an exhilarating (bumpy) ferry ride to Freetown. I met Dr. Asibey, a pediatrician from Ghana who will be working on the team, on the plane and we were able to talk together briefly during the stop in Monrovia. She is very nice and very enthusiastic about the assignment.
The Project HOPE staff had paved the path for us, so getting from airport to hotel went smoothly. We then met the rest of the team: Mariam, HOPE’s in-country coordinator; Sheka, the driver; and Dr. Little, a neonatologist from Dartmouth, NH. The next day we met with the Chief Medical Officer for the Ministry of Health for Sierra Leone, who was also very helpful.
After Freetown, we traveled to Bo, about a three-hour ride, passing through many villages and forested areas along the way. At the Bo District Health Compound, local staff members attended a workshop on Helping Babies Breathe® presented by Dr. Little with some assistance from Dr. Asibey and me. The staff was very interested and had a lot of questions.
We also met with local officials including the District Health Officer and did a walk-through assessment of the hospital and facilities. Other assessments here included a rural clinic and the labor and delivery area of the hospital – where we assisted with the delivery of a beautiful baby boy.
We noted that the clinic we visited seemed farther from town than it actually was because of the rough condition of the road – a difficult journey for a sick or laboring patient traveling from the health clinic to the Bo District Hospital, especially since most transportation is on the back of a motorbike.
Upon entering any facility, staff directs you to wash your hands, and your temperature is taken and shown to you – an attempt to prevent the resurgence of Ebola.
At the end of the week, we went to the postpartum unit of the hospital where they were prepping a case for surgery. After observing the surgical prep, we headed to the antenatal and postnatal clinic, which involved climbing over rebar and other construction materials and debris. We envisioned what it must be like for pregnant women and mothers with newborns to negotiate this same obstacle course.
There, Dr. Asibey was able to help stabilize a malaria case that came in with active seizures. She also helped another patient with severe anemia and possible renal failure.
This was a very long day due to a severe lack of supplies and equipment. Some medications were unavailable at the hospital pharmacy, so Mariam went to the local pharmacy to purchase them. The staff is very nice, trying to do the best they can, but definitely could use help.
Hundreds of thousands of patients with multidrug resistant tuberculosis (MDR-TB), a form of TB infection caused by bacteria that are resistant to powerful drugs used to cure the disease, suddenly have reason to hope. The World Health Organization (WHO) has just cleared a new shortened treatment regimen for multidrug-resistant tuberculosis (MDR-TB) which carries grave risks for nearly half a million people who developed a condition that killed 190,000 people in 2014.
The disease is so pernicious that it cannot be treated with the standard six-month course of medication which is effective in most TB patients. Patients with rifampicin-resistant or MDR-TB are treated with a different combination of drugs, usually for 18 to 24 months. But the regimen is arduous and can have terrible side effects.
The WHO recommendation shortened the treatment plan by nine months. The treatment duration in the new regimen is 9-12 months instead of 18-24 months. This means treatment will be less grueling for patients and less burdensome on already stretched health systems in many parts of the world. And the cost of the drugs required for treatment will drop to less than $1,000 per treatment course. This is a leap forward for MDR-TB patients, but there is still a long way to go because the WHO’s new recommendations on the use of a shorter MDR-TB regimen come with specific conditions and there are serious risks for worsening resistance if the new regime is used inappropriately (e.g. in XDR-TB patients). Project HOPE is supporting national programs in the Central Asia region through strengthening monitoring and evaluation of the programs and to implement WHO guidelines.
In a USAID funded program in Central Asia, Project HOPE has already discussed with national programs how to use the shortened regimen in pilot programs under stringent monitoring. It is really a big step forward - and a very important one for patients who now face shortened treatment periods and can return to their normal lives more quickly.
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