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.
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.
Michele Bobosky, Emergency Nurse
Michele Bobosky is a certified emergency nurse in Ventura, California who has vast experience in treating cholera patients in Haiti on previous missions to the country with Project HOPE. When Hurricane Matthew struck Haiti, Michele was keen to get back to the country to help build capacity so hospital staff would be prepared for a potential surge in cholera cases and to help improve the quality of basic health services.
I have circled the globe with Project HOPE, working as a volunteer nurse in Southeast Asia, the Pacific, the Caribbean and the United States after Hurricane Katrina. I first joined Project HOPE in 2005 in Indonesia after the tsunami and then three other times including in Haiti. I was first led to medical humanitarian work after 9/11 - the first time I worked as a nurse in disaster medicine. It was so special to me that I was able to help anybody on such a terrible day. I had experience as a trauma nurse but it was the aftermath of 9/11 that gave me the bug to learn more about emergency medicine. I started doing FEMA training and CERT (Community Emergency Response Team) work and when the big tsunami hit Indonesia in 2004, I felt that I was the right person to support a medical team there and that led to my first mission with Project HOPE which had partnered with the US Navy in the region.
Doing any kind of medical humanitarian work is a privilege, and going to low resource countries reminds us how lucky we are to have so many resources at home. This work makes me feel proud to be American. It’s easy to feel drawn to help Haiti. Haitians are a beautiful people. They have grace, kindness and humor. On this mission, I have worked alongside Haitian nurses and other health professionals at the St. Therese Hospital in the Nippes region and travelled with the HOPE disaster response team to assess health needs in other areas. I feel more compelled than ever to share my skills to help build Haiti’s health capacity. During this mission I have worked closely with the nurses at St. Therese Hospital, teaching them how to safely administer medicine to children who require a lower dose than an adult; we have improvised on how to navigate an IV bag when there are no clamps available to control the flow for administering IV fluid infusions; we have also focused on dressing wounds effectively to stop the flow of blood; and I have been sharing a few other ‘tricks of the trade’ to make their work more effective so patients can heal quickly. I saw cases which required basic care and some trauma cases from motorcycle accidents which occur with some frequency in Haiti. The first thing we can do at Project HOPE to make people’s lives better is to focus on their health. A knowledgeable health care worker can keep communities healthy.
Disasters happen and I am glad to have been able to come back to Haiti three times now, twice at the Albert Schweitzer Hospital in 2010 and 2011 to respond to cholera outbreaks and now to address the impact of Hurricane Matthew. There has been an increase in cholera cases in the hard-hit areas of Haiti and health authorities believe that will spread and the Ministry of Health wants to be prepared. The actual care of cholera patients is well prescribed by the World Health Organization protocols; they have signs up in the hospitals actually. But the challenge for Haiti at times is to know where to get IVs they need. Where do they get their oral rehydration source? Where is the patient’s toilet? Where do they put the waste, how do they wash their hands? Project HOPE typically answers all of these questions. It has delivered donated medical supplies and antibiotics to Haiti and there’s more to come. HOPE volunteers train local health professionals how to take care of the rest. The local health workers here don’t have experience with a big surge. We want to help prepare hospital staff with that possibility and the Ministry of Health is working hard to be prepared for a major surge.
I feel lucky to have been in a position in my own life to help Project HOPE in Haiti and further afield.
Jon Brack, Photojournalist
Jon Brack is a Washington, DC-based photojournalist who has been embedded with Project HOPE’s medical volunteers and disaster relief team following disasters in Southeast Asia and, most recently, in Haiti. Jon has also conducted a photography workshop for the Project HOPE team in the Dominican Republic.
It’s hard to see a place you love so much, hurt so bad.
Haiti is a very vibrant culture and country. It’s a remarkable place that I love visiting. It was hard going there in October knowing my purpose for going was to capture the trauma and devastation caused by Hurricane Matthew. It was hard knowing that this place that I really loved had gone through something really terrible. I arrived within the first two weeks of the disaster to join Project HOPE’s disaster relief team and take photographs to show the hurricane’s impact. We visited an area that was hard hit around Les Cayes and other areas in the south including the St. Therese Hospital in the Nippes region, where Project HOPE medical volunteers are now caring for patients, some of whom are showing signs of cholera while others need basic medical care.
All the stories I had heard before I arrived in Haiti last month proved to be true. The damage was far worse than anything I had seen in other places. Project HOPE’s team assessed the damage and health needs that would be required in the weeks and months ahead. I saw homes with missing roofs and trees that were snapped. A hillside which had been a forest was clear cut and whole vistas that would have been green were now brown. People were silent, traumatized by the destruction. But I also saw pride and resilience among some who were sifting through the wreckage of their homes or the local church and cleaning up debris.
This was not my first experience in a disaster zone. I went with Project HOPE to the Philippines after Typhoon Haiyan three years ago. I also took many photos after the earthquake in Nepal last year. The destruction caused by each kind of disaster is different, but I found the destruction more severe in Haiti than what I had seen in the Philippines or Nepal.
I hope that my pictures will inspire more medical volunteers to help communities in need, and inspire more gift-in-kind donations of medicines and supplies to a country that’s struggling. It’s rewarding to use photos to tell the stories of these people who maybe wouldn’t otherwise have a voice. Photography is my strength, my ability and my passion that I can use for good and I am willing to go to a place like Haiti to use my skills to make something better for Haitians in a time of trauma.
I try to take pictures that are in context of the situation instead of just a baby that’s crying, for example. I try to take a picture that shows why that’s happening. If I can get that context, I think it’s a richer picture that shows the real need that exists in a disaster zone. In Nepal, I was working with HOPE doctors and nurses directly caring for patients. I have great respect for HOPE volunteers, who go to disaster zones and get blood on their hands, quite literally, in some cases. I have taken a lot of pictures in my career and have worked on a lot of projects but being on a medical mission with HOPE, I am part of a larger endeavor with a clearly-defined purpose. It’s very rewarding to be part of a team in such a purpose-driven mission.
Jim Schermerhorn is a Physician Assistant and HOPE volunteer in Haiti. His work following Hurricane Matthew is Jim’s third medical mission with HOPE this year. He was part of the HOPE team on the hospital ship, the USNS Mercy, for two deployments in 2016. Jim is also a member of the U.S. government’s Disaster Medical Assistance Team (DMAT) that responded to the flooding in Louisiana earlier this year.
This is my third time in Haiti. I was here in 2011 for the first serious cholera outbreak in Haiti and I was also here in 2008. Haiti is a difficult place to work. There are lots of challenges for health care providers and that’s what we’re here to address.
I am part of a team that was deployed two weeks ago to help assess how Project HOPE could best address the possibility of a surge in cholera following Hurricane Matthew. I have been concentrating on working with the St. Therese Hospital in Miragoane in the Nippes region. I’m working with health authorities as part of the Project HOPE team and coordinating with other NGOs that are working in this area. We’re focused on developing an outline of a plan that would address cholera at St. Therese Hospital.
There are ongoing staff shortages and a lack of resources at the hospital and many challenges in the health system as a whole, before you add cholera into the mix. At St. Therese, there are patients that also need regular medical care.
The case definition of cholera is watery diarrhea which is identified in an area or region that has already tested positive for cholera. In this area in Nippes, they have documented cholera. This means that every case of watery diarrhea is considered suspected cholera and we have no way to determine whether it is cholera because the hospital doesn’t have the ability to test for the disease. But what the hospital is doing is separating all of those patients who have the case definition of cholera and they are staying in a separate area in a separate building within the hospital compound and they receive IV medication. But currently, the hospital does not have the medications and the antibiotics and the support services and staff to work both in the hospital and in the separate cholera area.
We have seen several people with watery diarrhea. In fact the two nurse practitioners I am working with referred one case over today for a patient to be moved to the separate area for people with suspected cholera. This is not a high cholera situation right now. What we are concerned about is that it very easily could be. So we have to come up with a plan to address the possible scenario where the hospital could go from the one or two cases of watery diarrhea to 15 or 20 or 50 or 75. If that happens, could the hospital handle it? That’s the challenge that we have and that’s what I’m trying to work on.
I have participated in international humanitarian assistance disaster response work for many years with many different organizations, including Project HOPE. I think the best way that those of us in the United States can help people in developing countries like Haiti is to work in close coordination with the health authorities and other NGOs to build the health infrastructure and capacity of health workers here.
Fresh from hurricane-stricken Haiti, where HOPE volunteers continue to bolster the health system and care for families impacted by the most recent disaster, Andrea Dunne-Sosa, Project HOPE’s Director of Global Volunteer Programs and the Americas Region, reflects on the experience of humanitarian aid workers on the ground immediately following disaster situations.
When the alarm went off at 5:30 this morning, I immediately jumped out of bed. Even though I left Haiti yesterday, I wanted to be in solidarity with our team still on the ground.
I am thrilled and reassured to be home with my beautiful son and family, but it is hard to adjust to the regular pace of routine life after days and weeks in such a high intensity environment. In Haiti, the devastation of the storm in the heavily affected areas is inescapable. Relief workers are constantly thinking about the people, the families, the children who have been impacted by the disaster. At the same time, we also have to constantly be figuring out how to balance the resources and security of the relief team on the ground with all the overwhelming needs of the people. Questions bombard your brain.
Have I read all of the latest reports? Is the security team in place for our volunteers to travel tomorrow? Where should our team be to have the greatest impact? Do we have a plan if one of the vehicles gets a flat tire? Will our satellite phone work in a remote area of the country without communications? How can we coordinate with the government and other teams to get ahead of cholera before the next outbreak? What if it starts raining again when our team is hours from home base and the river crossing is flooded?
Every email you send, every meeting you attend, every communication you make, takes on the highest level of importance. Lifesaving importance. Your brain is on fire 24/7, figuring out what are you going to do, at any given time. You are up at dawn and still working late into the night. The situation can change in an instant, so you have to be flexible, ready, available, professional and thoughtful, all while your heart aches in the face of the humanitarian crisis unfolding minute-by-minute in front of you. Life takes on a greater intensity, a greater sense of purpose.
Then you are home, with regular electricity, mobile service, a safe comfortable bed. An email comes in from the office, about a time card deadline. And you realize you are not in Haiti anymore.
For now, I am back at HOPE headquarters in Millwood, Va., supporting the relief effort from the comfort of my office and at home, surrounded by my family. But half of my heart remains in Haiti with the HOPE team on the ground. The team that doesn’t get to tuck their children into bed at night, doesn’t have regular communications and is still working 24/7 to make sure they do everything possible to help those in Haiti still needing care.
Two of those relief workers are Nurse Practitioners Maya Ginns and Lindsey Martin from Massachusetts General Hospital. Maya and Lindsey began work yesterday at the St. Therese hospital in Miragoane, Nippes. St. Therese is a facility 3 1/2 hours west of Port-au-Prince, where 10 of the 28 health facilities in the region no longer have rooftops due to Hurricane Matthew, stretching too thin an already limited health system. The St. Therese hospital has a severe shortage of health professionals, including no pediatrician on duty and support for the maternity ward only four days per week, despite the nearly 70 babies born there each month. The dedication of the current hospital staff is simply valiant, doing the absolute best they can with limited personnel, limited supplies, and an influx of patients.
When I was there, just a few days ago, I saw a family, smiling and holding their absolutely beautiful newborn baby, waiting for services for their infant that just were not available. It was heartbreaking.
But one of the highlights of my relief work in Haiti was when I was meeting with the Director of the St. Therese Hospital, knowing that I was going to be able to send HOPE volunteers to the facility to support the dedicated existing staff, that continues to work, despite the demanding and stressful environment.
The St. Therese Hospital also has a small cholera unit, but only has room for three or four patients, insufficient supplies, and is in desperate need of upgrading. Around the country, 34 cholera treatment centers were completely destroyed during the hurricane. The threat of a cholera outbreak looms heavy in the hurricane impacted areas. That’s why HOPE volunteer Jim Schermerhorn, a Physician’s Assistant and disaster response expert who was in Haiti during the devastating cholera outbreak after the 2010 earthquake, is working with HOPE and our partners to identify long-term solutions to support the health system in case of another outbreak. HOPE is securing plans and resources to help train health care professionals and rehabilitate cholera treatment centers to diagnose, treat and prevent cholera outbreaks in the coming weeks.
HOPE has been working in Haiti since the mid-1980s and is committed to supporting recovery from Hurricane Matthew and helping to strengthening the health care system in the long run. Whether through our dedicated volunteers, training programs, donated medical supplies and lifesaving medications, programs to support maternal and child health, or rehabilitating cholera treatment centers, HOPE is making a difference.
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