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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.
Posted By: Tom Kenyon, M.D., M.P.H. on June 8, 2016
It seems unbelievable to those of us who remember the 1980s and 90s, but HIV/AIDS often seems regarded as yesterday's crisis. It no longer grabs headlines. That doesn't mean the fight against the disease is over -- in fact, far from it which is why the United Nations General Assembly is holding a high level meeting on HIV/AIDS over the next two days to rededicate the world to controlling the epidemic by 2030.
That we can even think of making HIV/AIDS history is the direct result of one of the most comprehensive and successful international public health operations in human history – one that can be a blueprint for the fight against future epidemics and pandemics. As President Barack Obama said in a statement ahead of the UN meeting: "The past 35 years tell a story that bends from uncertainty, fear, and loss toward resilience, innovation, and hope."
And as we consider how to confront other public health crises, including our recent challenge from Ebola and the current epidemic very much in the public eye, Zika and other threats to come, it's useful to reflect on why the HIV/AIDS fight has largely worked thus far.
Yes, it has taken resources, evidence-based approaches, and hard work. But for me, the most important watchword is: Perseverance. There were times when the battle against HIV/AIDS looked dark indeed. But the many health professionals, governments, and NGOs, including Project HOPE, that were involved in the effort to combat the disease have never given up. And this is what they have achieved. According to new UN figures released ahead of the conference, the number of HIV-positive people taking antiretroviral medicines more than doubled to an estimated 17 million people from 2010 to 2015, including two million people who were started on the lifesaving treatment last year alone.
Global coverage of antiretroviral medicines hit 46 per cent at the end of 2015 and progress was most notable in eastern and southern Africa, where coverage increased from 24 per cent in 2010 to 54 per cent in 2015, reaching a total of 10.3 million people. AIDS-related deaths fell from 1.5 million in 2010 to 1.1 million in 2015. But as deaths decline, we mustn’t forget the staggering mortality during the era when treatment was not available. We must persevere.
One of the most important cogs in the anti-AIDS machine is a U.S. effort: The President's Emergency Plan or AIDS Relief (PEPFAR) -- which debuted under President George W. Bush and has continued under President Obama. To date, the program has had staggering results. It has provided lifesaving antiretroviral drugs to 9.5 million people. It has delivered HIV testing and counseling to more than 14 million pregnant women. And thanks to PEPFAR, more than one million babies have been born HIV free. It is highly significant that the program has not been an old fashioned top-down aid and emergency effort. It's been driven by health professionals and partnerships with governments in the most affected nations -- and in fact has done vital work in establishing sustainable public health systems that will be the backbone of improving health care -- especially in Africa for generations.
Just as importantly, governments and politicians from all persuasions, perhaps slowly at first but later with the full force that only coordinated international action can bring, recognized the danger from HIV/AIDS and the need to tackle it aggressively. That aspect of HIV/AIDS coordination provides a model for how bipartisan political efforts and diplomatic coordination actually work well to advance global health issues.
It's important that when we look back at the 35 years of fighting HIV/AIDS that we consider our successes -- that's how we can summon up the emotion and the political will to carry on the struggle -- and that's why the UN meeting is so crucial. But much remains to be overcome – including, stigma and discrimination, poor access to services, and lack of sustainable financing.
The conference will look at ways to increase the commitment of individual nations to cope with various aspects of their own epidemic. This includes how best to finance new treatment regimes, how to find the right mix of motivated and knowledgeable leaders, and the use of new data techniques to identify marginalized populations.
It’s also a reality that people in countries affected by HIV/AIDS have finite resources to spend on their own health and there is more competition for those resources than ever before. Now that the threat from noncommunicable diseases is so evident, some governments must confront a new reality: "Do I buy diabetes, hypertension, and cancer medicines, or do I buy HIV medicines?"
And there are still parts of the world, including Nigeria and parts of Eastern Europe for instance, where the fight against HIV/AIDS is still not being won -- for all the success elsewhere. That is why meetings to set new goals and to examine current and future policy like the one at the UN this week are so vital. Global leaders need to set the stage for those who do the actual work.
And it comes back to that word: Perseverance. No person, government or country can fight HIV/AIDS or other health crises alone. We all share risk and we all need to share in the response. And it’s not just true of this epidemic but other public health threats as well, both known and unknown.
Students at Wuhan HOPE School of Nursing Offer Excellent Care
Posted By Sharon R. Redding, RN, EdD, CNE, Project HOPE Volunteer, currently serving as a nurse educator at the Wuhan HOPE School of Nursing on June 1, 2016
Community service is one of the major activities of nursing students at Wuhan HOPE School of Nursing, in Wuhan, China, where I have been volunteering for the Spring 2016 semester. For several years, students have volunteered each Sunday at a local nursing home after having been introduced to this facility during their Community Health nursing course. This facility also serves as a clinical practice site for student nurses in the Nursing Assessment course. Students have the opportunity to listen to heart and lung sounds of residents at the nursing home, as well as perform other health assessments. This benefits both residents and students, as there are no professional nurses employed at the home. Blood pressure, hearing and vision screening, blood glucose monitoring, and other assessments of the mouth, teeth, skin, hair and nails, as well as mobility are completed. The students then present their findings to a nurse from a Chinese community health center who visits the home each month.
During their clinical experience, the students recognized that many residents lacked family support and opportunities for recreation and education, so they took it upon themselves to expand their presence through weekly Sunday visits. Students plan recreation activities such as listening to music, group singing, physical exercise and playing various games. These are accompanied by discussions of health issues such as correct use of a cane, walker or wheelchair, oral hygiene, handwashing and other topics. My role as a Project HOPE nurse educator is to supervise students in their clinical experiences at this home and also support the students in their community outreach efforts.
I recently organized a program with the help of a grant from the Gamma Pi-at-Large Chapter of Sigma Theta Tau International Nursing Society – an organization to which I belong. This provided for the purchase of bibs, small towels, toothbrushes and toothpaste to be donated to the nursing home. The Wuhan student nurses’ volunteer group also asked nursing faculty and staff to participate by donating additional toothbrushes and toothpaste to supplement the grant. Students observed that residents have major dental problems, and lack fine muscle control and self-care abilities. Their clothes are often soiled after eating and need protection, which is why students chose to use the grant funds to buy bibs and small towels.
Students planned a special program to present the supplies to the director of the home. This was well-attended by students and faculty, and the director chose to have the event documented by a videographer so that the activities could be shared with nursing home administrators. Residents gathered and music was provided. Residents also organized and presented their own musical selections. One resident – a former opera star with the Beijing Opera – sang for the group.
The entertainment portion of the program was followed by an education presentation for assistive personnel working at the nursing home about dental hygiene and feeding techniques for residents needing assistance. Residents had their blood pressure checked and students also provided blood glucose monitoring for residents needing this assessment.
As a Project HOPE nurse educator in Wuhan, my job is varied. Outreach to the community, fostering educational experiences in settings with limited resources, and promoting volunteerism are examples of how the mission of Project HOPE can become a reality.
Dr. Sharon Redding is from Omaha, NE. She has a doctorate in Education and a Master’s Degree in Nursing. She was a former HOPE Nursing Educator in Brazil for seven years in the 1970s and 1980s. She is now a volunteer teaching in both the undergraduate and graduate programs at Wuhan HOPE School of Nursing. This school was established in 2002 with the cooperation of Project HOPE and offers the only baccalaureate nursing program in English in China. Dr. Redding works with faculty in implementing creative teaching strategies, evaluating the curriculum and the use of appropriate testing. She assists graduate students in developing their research proposals and writing their theses. Helping faculty to design research to develop evidence-based practice is another of her activities. She is also called upon to do presentations and workshops at colleges and medical centers in Wuhan and nearby provinces.
Posted By John Bronson, Sr. Director, Technical Strategy and Innovation, Global Health on May 3, 2016
Late last spring, Project HOPE’s global staff submitted 20 pioneering ideas to be considered for the first Internal Global Health Innovations Challenge. This challenge encouraged staff working at program sites around the world to submit original solutions to improve health for underserved populations. The entire HOPE organization had the opportunity to vote on one of the 20 promising ideas and four others were chosen by technical staff to each receive a $20,000 innovative grant, supported by HOPE’s long-time partner, Eli Lilly and Company, Inc.
One of the winners was an idea proposed by the Tajikistan team to incorporate global positioning system (GPS) tracking devices to improve TB sputum transportation and patient monitoring thereby increasing the success of TB treatment.
Proper medicine adherence is critical to effective treatment of Tuberculosis. Great sums are invested in resources for Directly Observed Treatment (DOT) for TB, which confirms patients regularly take their drugs and complete treatment under supervision by community social workers (CSW), thus achieving cure and preventing the development of drug resistance.
The results of our test activity showed increased confidence that patients received treatment. Patients, as well as CSWs and coordinators embraced with enthusiasm the system as an additional mechanism, which increased the chances of better control and ultimately for a cure. The information was positively received by NTP, with an interest and readiness to support the system as one of the additional methods to improve the DOT upon broader confirmation of results.
The initial stage of the project began with the project team in Tajikistan conducting a three month demo trial to verify the concept and determine if it was viable.
The next phase of development is to establish research comparisons to document the efficiencies, quality of services and improved outcomes. The team has begun the process of selecting the company for delivery and installation of the GPS devices, and GPS tracking is planned to begin in early June.
Posted By Krenare Jashari, Project HOPE Volunteer on April 26, 2016
In 1999, the war in Kosovo forced 7-year-old Krenare Jashari‘s family to leave their home and become refugees in Macedonia. Nearly 17 years later, Krenare returned to Macedonia, this time to help others now caught up in the largest refugee crisis in Europe since World War II. Krenare, now volunteered at a refugee camp in Tabanovce, Kumanovo, where Project HOPE continues to help with the donation of supplies, medicines and volunteer medical help. Recalling her own personal history as a refugee, Krenare reflects on the emotional considerations that refugees experience.
I would like to use this opportunity to thank Project HOPE for making it possible for me to be part of their volunteering community which allowed me to spend some time at the refugee camp in Kumanovo.
This experience took me back to the days in 1999, during the war in Kosovo, when I was a refugee in Macedonia. I now am able to use my past experiences to better understand those who are going through a similar situation.
My first memory as a young refugee in Macedonia begins with the sound of a crib rocking, as my mother tried to put her youngest to sleep while attempting to keep her two other small daughters warm. She was also just two months away from giving birth to another baby.
I remember being scared. I could hear people moaning and crying. My sister’s little voice was saying she wanted to go home now, where she could she see our nana. Two nights later, I lay down looking at the dark sky, pretending that I was asleep. All I could hear is what sounded like a happy voice: “They are here.” It was my father’s voice. As I lifted my head up, I saw a few men who were handing over blankets. As my father laid a blanket over me, I told him I did not want to sleep, so he took me into his arms.
We spent two months in Stenkovec, the refugee camp in Macedonia. Queuing for a piece of bread took forever. We would practically peel our skin off scrubbing it, a desperate attempt to get the ink stamp off our little hands so we could get back in line for more food.
I remember people coming to visit us; any sign of affection made me feel like I belonged somewhere. Often I wondered: Where did they come from? Why do they seem different -- a lot paler? Everything I had known was taken from me. One minute I had a big family – aunts and uncles that I would visit every weekend – and the next moment I was surrounded by strangers.
And now, as a 24-year-old adult walking around the camp in Tabanovce, Kumanovo (a municipality of Macedonia), I had so many questions: Who are those children playing with? Is it a brother or a sister or a complete stranger?
Going back in time overwhelmed me with memories I had as I went from living in a small tent at the refugee camp in Macedonia with my mom and dad and my two little sisters to then living in a big castle in Millstreet, Co. Cork, Ireland – a place for asylum seekers.
I began to ask myself more questions: Where will these people go? Who will be their salvation? As an adult now I see things differently. How does a parent feel when their child wants their favorite toy or wants to go home? What's the impact on a teenager who's already going through physical and emotional changes? How does the former teacher or engineer feel – now a refugee sleeping in a tent?
From my personal experience, I can truly say that being forced to flee your home and leave behind everything that’s familiar and dear to you is one of the toughest challenges anyone can face. However, seeing how various NGOs such as Project HOPE are working together to offer basic needs such as food, water, shelter and access to health services, really makes me proud of my colleagues who work hard day and night to help the refugees through the darkest moments of their lives.
Let’s all take a moment to reflect on the things that really matter and help a little every day to make the world a safer place.
Project HOPE has been supporting the Syrian Refugee Crisis through our program in Macedonia since September of 2015. Krenare hopes to be able to return to Macedonia to provide more assistance with volunteers.
World TB Day
Posted By Alex Trusov, Project HOPE Sr.Director, TB Portfolio on March 23, 2016
A century-and-a-half ago tuberculosis (TB) was such a fact of daily life that the tragic romance of a young woman dying from the disease was immortalized in Giuseppe Verdi’s famous opera La Traviata.
No one is writing operas, or their modern equivalent, movies or television shows about TB these days, and most people probably never give it a second thought — even though it is a disease that has afflicted the likes of celebrities like Nelson Mandela, Ringo Star, Sir Tom Jones and Tina Turner.
But would it surprise you to know that the deadly lung disease remains a potent killer of more than a million people a year worldwide in the second decade of the 21st century?
The World Health Organization (WHO) reports that in 2014 there were 9.6 million new cases of TB and about 1.5 million people died from tuberculosis -- more than the population of the U.S. state of Montana or the population of Swaziland.
When I was a young fellow at the Moscow Medical Academy, my senior colleagues told a story about the time when they started to look for another job after Dr. Selman Waksman, microbiologist at Rutgers University, introduced Streptomycin and later new anti-tuberculosis drugs developed in the early 1960s. Thanks to these medicines thousands of patients even with severe cases were cured in six months.
TB sanatoriums where patients spent years were not needed any more. In the U.S. these places, once dubbed “waiting rooms for death” were finally closed. Many doctors and medical students thought there were no longer any meaningful careers to be pursued in curing TB. The disease faded from the curriculum of many medicals schools in the U.S. and Europe — a trend that soon went worldwide. But TB was not gone and it found the conditions it needed to strike back.
First, poor populations worldwide did not get meaningful access and consistent effective treatment with the new drugs – so the disease continued to spread inexorably.
Then, multiple drug resistant forms of tuberculosis (MDR TB) appeared even in wealthy countries where some populations were not correctly treated until fully cured. And third, HIV/AIDS acted as catalyst for tuberculosis to explode among immune-compromised populations from the mid-1980s. Within a decade, the number of TB cases in the U.S. jumped sharply.
The revived threat of TB inspired a new fight against the disease. A strategy of monitoring patients carefully when they took each dose of anti-TB drugs and recording their progress was pioneered by Karel Styblo (IUATLD) and successfully piloted in Tanzania, Malawi, Mozambique and Nicaragua. It showed early promise for wider use.
Richard Bumgarner, leading the World Bank’s health programs in China, invited Styblo and the WHO to build on this approach to design a TB control project for World Bank financing in China where TB was the number one killer, claiming 400,000 lives a year. By the end of 1991 pilot Chinese counties were achieving double the previous rates of cure in tuberculosis. A large World Bank grant was made to China for TB control. Bumgarner moved to the WHO to help expand its tiny TB program and build the WHO Global TB Programme. WHO declared its first Global Health Emergency in 1993 and named the new TB approach DOTS (Directly Observed Treatment Shortcourse). Nearly 80 percent of people were cured, at a cost of less than $10 per life and $3 per new infection avoided (“TB Join the DOTS.” The Economist. May 20, 1995, P.89).
Project HOPE also started its first TB activities in the early-1990s when Richard Bumgarner wrote to and convinced Dr. Bill Walsh, Project HOPE’s founder, to build TB programs, first in the Central Asian Republics, and later in parts of Europe and Africa. After he retired from the WHO, Bumgarner joined Project HOPE to strengthen the efforts of our team.
Today Project HOPE successfully guides TB programs in Europe/Eurasia and Africa with funding by USAID, GFAMT and private donors for more than US$40 million, and provides additional humanitarian assistance for hundreds of millions dollars to save lives of people all around the world.
Project HOPE invests significant efforts to build political commitment in countries where TB programs are implemented and support principles of humanity that started when Waxman brought, almost illegally, a few grams of the new Streptomycin to the USSR to save the life of Ira Zukerman who was dying from tuberculosis meningitis.
In over 20 years of TB program implementation, Project HOPE pioneered universal education for medical doctors, nurses, patients, their relatives and communities. The programs have sought to combat the stigmatization of patients in their communities, improve tolerance and empower patient and health professionals to address the needs of TB patients.
Much improved methods of diagnosis such as GeneXpert, developed by Rutgers University where Streptomycin was created, are being successfully introduced by Project HOPE in TB control programs in Africa, Europe and Central Asia
Following the WHO’s END TB strategy and US Government TB control strategy, Project HOPE provides assistance to patients and their family members from the most vulnerable groups of population – women, children, migrants, HIV positive people, injection drug users and former prisoners. This fight has made enormous success, helping to save an estimated 46 million lives worldwide since 2000. It must be continued forcefully so that TB does not again come back in even more deadly forms.