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.
Gevgelija, Macedonia is a small town just north of the border with Greece. Until recently this small rural community of 20,000 was of little note on the world political scene. The massive migration of refugees has changed the importance of this town. It will live forever in the annals of history and the memory of hundreds of thousands of refugees who pass through on their migration northward.
Migrants cross the sea from Turkey to Greece. They pass through Greece, first by ferry and then by any means possible to get to the border with Macedonia. Gevgelija is the first stop on the rail line that crosses from north to south in Macedonia. In Gevgelija, for 25€ they can board a train and quickly move to the Serbian border and toward their goal of a better life in Western Europe.
The change for Gevgelija started with a trickle of migrants in the spring. The vanguard of the migration crossed the border check point and walked less than a kilometer to the train station. At first the numbers were small and the migrants were processed quickly at the train station and moved on.
Within a month the train station was inundated with thousands of people traveling northward. The train station could no longer function and the regularly schedule trains overflowed with people. Some had proper documentation but others may not. In a few months the trickle became a flood stressing the resources of the town and the nerves of its people.
The Macedonia government and The United Nations High Commission on Refugees (UNHCR) recognized the need to respond. They recognized that Gevgelija was an important milepost where migrants could find food, water, proper documentation and, if needed, medical care. They could also be organized in manageable groups for the next stage of their journey.
In response to the crushing demands of a tidal wave of migrants, the UNHCR created a Migrant Transit Center in a farm field just a few hundred meters north of the Greek border. After leaving Greece, migrants walk a short dirt path to the camp. Before entering they are organized into groups of fifty. Each small group is then admitted to the Center and given Macedonian travel credentials that allow them to stay in Macedonian for a maximum of 72 hours. They also get a bag of food, water, blankets, and access to health care if they need it.
Non-Governmental Organizations (NGOs) play an important role in helping the migrants as they enter Macedonia. Both the Red Cross and Project HOPE cooperate in providing medical service that ranges from care of scrapes and bruises to the emergency needs of a baby in respiratory distress. Other NGOs give out water and provide valuable translation services.
It is impossible to stereotype the migrants. Almost ten thousand pass through the Transit Center each day. They don’t stay long….maybe four hours for most. They are men, women and children. They range in age from newly born to octogenarians. Many are college students. An impressive number are well-educated professionals seeking to bring their talents to a new home in Germany or Sweden or maybe Great Britain. Most have risked their lives to cross the sea, escaping the camps in Turkey where they have stagnated for a year or more. Some are called “economic” immigrants who are moving with the rest with the hope of a better life in Europe. Predominately they are from war-torn Syria, but an ever increasing number come from Afghanistan and Iraq.
Gevgelija will never be the same. The city’s economy has been taxed by the crushing needs for policing, trash removal, emergency medical care and an untold litany of other services that seem trivial until the need is multiplied by hundreds of thousands. There is no end in sight. Officials won’t even speculate on how long the migration will continue or how many more people will pass through the Migrant Transit Center.
Gevgelija will never be just a sleepy little border town again. For some locals this seems tragic. For half a million migrants it will be a significant milestone on their journey northward. They will remember the kindness and support that they were given by the Macedonian people and organizations like Project HOPE.
Patti Nicks, RNC, MSN is a registered nurse who specializes in maternal and child health from British Columbia, Canada. She spent five weeks recently volunteering at the University Hospital in Pristina, Kosovo, where she provided side-by-side trainings and lectures to the health care professionals working in the labor and delivery ward to improve the quality of care provided to the new mothers and their babies.
I came to the University Hospital in Pristina, Kosovo to bring my knowledge and expertise in neonatal, perinatal and maternal and child health to the health professionals here. In particular, I came to impart my knowledge of infection control and the importance of breastfeeding. Over the course of five weeks, I worked alongside hospital staff in the labor and delivery ward and provided lectures and side-by-side trainings to the doctors and nurses at the hospital on topics such as post-partum hemorrhaging and infection control.
An average of 30 babies are delivered at University Hospital every 24 hours. I was able to work alongside nurses and doctors managing the care of the mothers and their newborns under difficult circumstances. Limited prenatal care and a lack of prenatal education make it difficult for the mother to understand what is going on inside her body. Due to the number of births, delivery is often rushed in order to empty a bed needed for the next delivery.
The nurses and doctors do amazing work under extreme conditions. Just five nurses manage the care of more than 40 patients and their newborns during the day, and the staff ratio decreases to just three nurses at night and on weekends. The amazing nurses do this unbelievable feat every shift with limited equipment and resources.
I am so incredibly thankful Project HOPE is here in Kosovo. There is a great deal Project HOPE can do to improve the quality of maternal and neonatal health care by training health care workers, providing for equipment needs and bringing health care practices up to the latest standards. It has been my privilege to be able to report back to Project HOPE on the needs I witnessed in Kosovo and begin to provide trainings to health care workers that will improve the quality of care for new moms and their babies in Kosovo in the future.
The first day of a new mission for Project HOPE volunteers is often an intimidating time. The challenges of a new site, new people, different languages and a host of other unknowns can be overwhelming. But for Dr. Corey Kahn and nurse Louisa Reade, their first day was very productive.
Each mission starts with planning and orientation. These meetings set the tone for weeks to come. Once the meetings end, it is time to travel to the site and get to work stocking and setting up.
The team is working on the southern border of Macedonia, just a few hundred meters from Greece. Migrating immigrants travel through Greece heading to Europe. Their first stop in Macedonia is the Immigrant Transit Center. There they get official transit papers and wait for a train that takes them north to the Serbian border. While at the transit center, these traveler receive food, water, blankets and the opportunity to get medical care delivered by the Project HOPE team.
On the first day the number of patients was limited. A strike by the ferry boat workers has stalled the transportation of immigrants from Greece. Even with the small numbers passing through the transit center, there were patients to be seen. Most patients have the routine bumps and bruises associated with weeks of traveling. One more serious patient fainted and hit his head. This type of injury involves the skilled care of a well prepared team. The Project HOPE team of Corey and Louisa were well prepared to care for the patient.
About 2,000 migrants passed through the camp on the team’s first day. Compared to the last few weeks this is considered a "slow" day. This short lull won't last. The ferry boats are back to work, and there are reports of over 10,000 immigrants on buses heading for the Macedonian border. Tomorrow promises to be busy!
We all are well acquainted with the burden of Type 2 diabetes which accounts for a great share of non-communicable diseases (NCDs) overall. But what about the lesser known type 1 diabetes?
To draw greater attention and action to addressing both conditions, the Lilly NCD Partnership Summit 2015 took place recently in Porto Alegre, Brazil. It was an awe-inspiring event which answered my concerns and my worries suddenly felt feather like!
Let me first share my concerns: the number of children developing type 1 diabetes every year is increasing rapidly. A person with type 1 diabetes needs to follow a structured self-management plan, including insulin use and blood glucose monitoring, physical activity, and a healthy diet. In low-income set ups, access to self-care tools, including self-management education, as well as to insulin, is too often limited. This can lead to severe disability and early death in children with diabetes.
During a field visit while in Brazil, I witnessed some great work done under the Lilly NCD Partnership. The Institute for Children with Diabetes (ICD) has pioneered comprehensive care model which includes innovative yet simple training and education tools for rooting the concept of type 1 diabetes management amongst children and adolescents along with their families. The goal is to help these children become more involved in their treatment and significantly reduce acute hospitalizations and chronic complications of diabetes. Unfortunately in India we lack such robust tailor-made care models catering to type 1 population. However I am highly optimistic that uptake of learnings and findings from the ICD model – and others best practices we saw during the summit can provide long lasting solutions to the problem of diabetes in India youngsters.
The Lilly NCD Partnership once again underpins the strength of collaborative efforts for influencing the global NCD policies.
Jovin Panthapattu is a final year Doctor of Pharmacy (Pharm.D.) candidate from the University at Buffalo, School of Pharmacy and Pharmaceutical Sciences. As a Project HOPE volunteer, he is completing his advanced pharmacy practice experience rotation at the Alluri Seetharama Raju Academy of Medical Sciences (ASRAM) Hospital in Vijayawada, India.
The Department of Community Medicine at ASRAM wants to teach its students to practice the three principles of community medicine: the prevention of disease, the promotion of health and the prolongation of life.
One such initiative is pop-up clinics (medical camps) in underserved areas with a volunteer workforce of health care professionals and students from ASRAM. Located primarily in schools, these clinics serve to prevent, detect and treat diseases through public health awareness and education. “We focus primarily on mothers and children, specifically school-going children and adolescent groups.” said Dr. P.G. Deotale, Professor and Head of the Department of Community Medicine at ASRAM. “These clinics are possible through the collaborative efforts of departments like pediatrics, orthopedics, general medicine, ophthalmology, ENT, and pharmacy, which he affectionately calls his ‘ASRAM Family.’”
A medical camp offers free services and allows patients access to health care which they might not have been able to afford. “Many of the patients we encounter live in extreme poverty, and community medical camps are often well received because they allow doctors to catch undiagnosed cases of common non-communicable diseases like diabetes and hypertension.” said Dr. U. Vijay Kumar, Professor of Community Medicine. Services offered include ECG readings, eye checkups, blood pressure and blood glucose screenings. Through funding from the medical college, the pharmacy is able to provide medications free of charge to the patients. Patients also may be referred to ASRAM’s Urban Health Center, which provides free consultations, laboratory investigations and free medicines from a limited formulary. The camp I participated in last weekend saw roughly 200-300 patients during a three-hour period.
As a volunteer at these medical camps, I had the opportunity to work with the pharmacy team. From sorting and organizing medicines to filling and dispensing prescriptions, I was involved in various aspects of the pharmacy workflow and operations. The biggest challenge during my time here has been the language barrier. I love counseling patients about their medications. However, since I don’t speak the language, it makes the conversation difficult, especially when there are additional regional dialects involved. Thankfully, a nurse was on our team and did an excellent job counseling patients about the medication.
I am thankful for the plethora of opportunities afforded to me by ASRAM during my stay thus far. It has been a great learning opportunity, whether I was working with staff in the intensive care units or providing assistance with health care outreach initiatives in the community!
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