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 start of the rainy season in the Caribbean brings a reminder that the work of improving public health in vulnerable countries is a daily grind that goes on long after the media spotlight has shifted elsewhere after a natural disaster like a hurricane or earthquake. Nowhere is that truer than in Haiti, where local health workers and their international partners face a constant struggle to prevent and contain cholera outbreaks.
There are always risks of cholera outbreaks in the country, mainly due to the difficulty of accessing drinking water. Awareness is an important factor in the fight against this epidemic but the largest burden rests with accessing drinking water.
The daily fight against cholera was made even more complicated on October 4, 2016, when Hurricane Matthew barreled into Haiti, causing the largest humanitarian emergency since the 2010 earthquake and initiating a chronic cholera outbreak.
Winds of 225 kilometers per hour completely destroyed 36 of the country’s 212 cholera treatment centers and caused widespread flooding and destruction. The storm also heavily affected the health system, which was already under-resourced, and tore the roofs off of 10 of the 28 health centers in Nippes Department.
Since then, local authorities and outside agencies have worked to rebuild the battered health care infrastructure, and to cope with the inherent challenges of Haiti’s endemic health care situation.
Haiti is a country of 27,200 square kilometers where a little over half the population lives in rural areas. Fifty percent of citizens consume water of questionable quality and nearly 75% have limited access to health services. Cholera is an acute diarrheal disease that can kill within hours if left untreated, according to the World Health Organization. Most of the infected can be successfully treated with oral rehydration solution; however, severe cases will need to be treated quickly with intravenous fluids and antibiotics.
People in the Nippes region are particularly vulnerable. Although it did not suffer a widespread cholera outbreak after Hurricane Matthew, each rainy season brings an imminent threat of cholera and other gastro-intestinal diseases because it weakens the health system and makes the population more vulnerable, especially for those residing in the rural areas.
Thanks to the efforts of the Haitian government, private institutions, and NGOs like Project HOPE, cholera and sanitation awareness are on the rise. The problem with clean water in Haiti is a major challenge, especially among rural and hard-to-reach communities. And there is always a need for more resources. In communities that are aware of the risk, people have been taught about washing their hands and boiling or purifying water with chlorine tablets and they’ve been educated about using latrines. Yet given the lack of safe drinking water in the majority of communities, awareness alone will not stop spontaneous outbreaks from occurring.
Project HOPE’s Response
In the aftermath of a natural disaster like Hurricane Matthew, a swift, coordinated emergency response and long-term planning to prevent and fight cholera are critical.
In the wake of Hurricane Matthew, Project HOPE had a team on the ground within 24 hours of the storm, and on invitation from the Government of Haiti, met with Interim President Jocelerme Privert to discuss and guide priorities for disaster response operations.
Project HOPE responded by sending medical volunteers, gift-in-kind medical supplies, and constructing a Cholera Treatment Center at the Sainte-Thérèse Hospital in Miragoâne, the capital of Nippes. Prior to its creation, cholera patients in the Nippes Department would have to travel three to seven hours away with difficult road conditions in order to get treatment – a journey that can be life-threating for a cholera patient. Since 2010, Project HOPE has sent medical volunteers to train and assist local health care professionals in areas affected by cholera, and continues to monitor the risk of cholera in the event a hurricane like Matthew once again threatens Haiti. The new Cholera Treatment Center in Nippes serves as a long-term resource, not only after Hurricane Matthew, but in the face of future potential outbreaks as well, strengthening the health system in Nippes for years to come.
In Uzbekistan, receiving the proper training to care for patients with tuberculosis (TB) is difficult. Health care providers have to travel to the capital city, which can be hundreds of miles away, for clinical consultations and training. These long trips make it difficult for medical professionals to provide the best care they can, as they are unable to exchange advice and expertise with others in the field.
That’s why Project HOPE, under the United States Agency for International Development (USAID) Tuberculous Control Program and in partnership with the Uzbekistan Ministry of Health and the Republican Scientific and Practical Medical Center of Tuberculosis and Pulmonology, recently launched the Center for Innovative Distance Training and Monitoring in Tashkent, with a regional satellite office in Bukhara. The Center will address the long-distance challenges that come with treating TB in Uzbekistan by providing professional development, clinical consultations, and mentoring to health care workers and medical students, both onsite and remotely.
Now, medical professionals working at the Center in Tashkent can share their knowledge easier and provide online consultations with their colleagues at the Bukhara Regional TB Hospital, which will make TB diagnoses and treatment quicker and more accurate. The Center will also allow health care workers at regional TB institutions the ability to train in TB procedures from a distance.
“The Center for Innovative Distance Training and Monitoring will become a leading institution for the professional development of healthcare providers and students by providing access to the newest approaches on TB prevention, detection, and treatment. This contributes to the common goal of reducing the burden of this disease in Uzbekistan,” noted Gary Robbins, Uzbekistan Country Office Director, USAID/Central Asia.
Video-conferencing, information technology, and office equipment were all provided by the USAID TB Control Program to support the Center. The program will continue to grow with additional satellite branches coming to other regions of Uzbekistan, linking TB professionals across the entire country. This network will improve the quality and access to TB services to patients across Uzbekistan.
The main objective of the five-year, $7.6 million USAID TB Control Program is to reduce the burden of tuberculosis in Uzbekistan and prevent multidrug-resistant forms of the disease. The program includes a wide range of activities, including training health care workers to strengthen the health system, improving interagency coordination and cooperation, and increasing access to TB diagnosis and treatment.
My experiences as a Project HOPE volunteer have been unforgettable and irreplaceable.
I was originally a Peace Corps volunteer serving in Chad and Liberia, where I learned to adapt to challenging living conditions and work activities and was able to use the placements as a springboard to travel Africa on a shoestring budget. That experience then allowed me to move on to Project HOPE, and I’ve never looked back.
I started with HOPE’s land-based programs in Brazil, where I was a nurse educator in Natal and Maceio, working at universities and hospitals. HOPE has given me the opportunity to help people around the world, most recently in Wuhan, China, where I was a faculty member in a large nursing program for two semesters.
In Brazil, I helped to establish a well-baby clinic that provided community health support. The team held a “graduation” party for one-year-olds and celebrated with the mothers, who dressed their healthy babies in the cutest outfits, posed for photos, ate cake, and made a huge, beautiful mess! Celebrating with these families and looking around at these healthy infants, thanks to the resources we provided, I felt very proud to be a part of the project.
In 2016, I took another step in my lifelong volunteerism and was elected President of the HOPE Alumni Association. This meant volunteering in a different capacity—serving as a spokesperson, promoting giving opportunities for alumni, and working on ongoing programs through alumni grants. The great thing about Project HOPE is that our volunteers make a community. Everyone who has ever worked for HOPE is automatically a member of the Alumni Association and can participate in HOPE efforts in various ways. The legacy of being a HOPE volunteer is a long-term connection with former co-workers and counterparts and allows us to integrate life-changing cross-cultural and career experiences as we move through our lives and gain new perspectives. I would have to say that being a HOPE volunteer just “runs in your blood!”
Our Alumni Association goes back to the very beginning. The founders first served on the SS HOPE. Over the years, our membership has evolved and includes everyone from individuals making long-term commitments to those who have accepted short-term and repeated assignments, including disaster relief programs. Alumni have accepted multiple program assignments in various capacities and it’s an amazing community to be a part of.
To any student or health professional interested in international volunteer experiences, I encourage you to take part in what HOPE has to offer. HOPE opens pathways for future opportunities and creates lifelong friendships with individuals who become cherished friends. Not to mention, you add valuable experiences and skillsets to your resume. The cross-cultural and travel opportunities become something you want to continue to satisfy, and these moments are available when you least expect them. Project HOPE has an excellent record of service, functions in a very cost-effective manner and is highly regarded by similar agencies for its sustainability and philosophy of working hand-in-hand with people it serves. National Volunteer Week is a great opportunity to reflect on the positive impact that volunteers bring to underserved communities and recommit ourselves to HOPE’s important mission.
Over the weekend, Project HOPE hosted an intricate exercise at our headquarters that simulated a large Level Three international emergency. We worked with a consortium of experts in the field, Humanitarian U of Canada, the Johns Hopkins Center for Humanitarian Health, and Massachusetts General Hospital’s Global Health Division. This Humanitarian and Disaster Response Simulation Training workshop brought participants from around the world who are first responders or potential first responders in their respective areas.
With emergencies, you’re never fully prepared. The onset is rapid, and each scenario is unique. Preparedness is really what will make the difference in the effectiveness of your response, how many lives you can save, and how you can support affected communities and help them recover. So the question is, are humanitarian workers prepared? Well, yes and no. Emergency response is a young person’s game. There are always new generations coming up that need to be trained. So the more you prepare and go through these routines, the more effective you will be when you hit the ground. While there’s really no time where you can say someone is fully equipped and ready to respond to a crisis, we have to aspire to continue learning by working together.
And learning to respond in disasters is more vital than ever because disasters are happening more and more. We’re seeing more frequent natural disasters, but we also have a higher number of civil conflicts today than we had in the past. There are more people displaced from their homes today than there have been since World War II. More refugees are internally displaced. The growing population means that each disaster affects more people. There is a higher level of humanitarian need today than we’ve seen in recent history, which means we need more actors on board and more capacity to respond.
We’ve learned a lot of lessons over the years. As an industry, we are very self-reflective and self-critical, always looking to improve and build upon past experiences and mistakes. There’s been a tremendous amount of effort over the last 15 years to reform the way we do international humanitarian response. A lot of that is strengthening coordination mechanisms between all the various actors, ensuring the leadership on the ground have strong decision making skills, as well as supporting the funding mechanisms to make sure the funds are available for when they are needed.
We’re proud of the work we’ve done to prepare emergency responders for the next crisis. We want to be able to extend this training to regions where there is a high prevalence of natural disasters. The first responders in an emergency are not the international staff that get deployed, they are the local communities. Local responders are the ones that are going to do more to alleviate suffering and save lives than anyone else.
My goal with this training is to prepare volunteers and show them that coordination is the key to a successful response. There are so many actors involved in any response and if you’re not coordinated, you’re going to get in each other’s way. It doesn’t matter how many resources you bring to the table, if it’s not properly coordinated, it’s not going to get the people who need it when they need it. Working with our diverse partners to plan this training shows how we can and should work together to solve problems and we’re looking forward to continuing to prepare future responders for the next crisis.
Damir Bakhytzhanovich Doshchanov knew something was badly wrong when he fell ill last September. “I felt faint, coughed for several weeks. I was sweating, and lost my breath very easily ,” said the 27-year-old migrant living in Kazakhstan, where he had moved in search of work after growing up in a small village that is part of a republic in Uzbekistan.
Damir sought help in a local hospital and was treated by Banu Kalmagambetova, a social worker from an organization that is partnering with Project HOPE to combat cross border TB among labor migrants.
“I was educated about tuberculosis and the project and the importance of timely examination. I was diagnosed with tuberculosis and received support to adapt to hospital conditions and to prepare myself for a long treatment,” Damir said.
The Almaty region, where Project HOPE and its partner, the PF Taldykoran Regional Employment Assistance Fund is working, is the most populous administrative region of Kazakhstan. It attracts many migrants from neighboring countries, as well as from regions within the country, in search of more lucrative work from the booming energy and mining industries. However, these migrants are not always aware of their health problems which means that the very threat of tuberculosis (TB) can be very stressful for someone attempting to start a new life in a new place.
Kazakhstan has among the highest incidence of multi-drug resistant TB in the world and the large influx of labor migrants has posed serious challenges. Migrants have not had access to TB services due to a lack of information and legal, financial and language barriers. Even though Project HOPE and its partners launched a three-year program to improve TB services in the migrant community in 2014, Kazakhstan still faces a challenge in addressing TB control issues among its labor migrants. The stigma associated with TB can make patients feel isolated from the rest of the community and Project HOPE’s community-based approach has helped migrants find social support services to help combat the stigma associated with TB.
The “Addressing Cross Border TB, M/XDR-TB and TB/HIV Among Labor Migrants Program” aimed to remove these legal barriers in accessing care for internal and external migrants, to ensure TB prevention and care for migrants while strengthening community systems and increasing the role of civil society.
Project HOPE’s Impact
Project HOPE established pilot sites in areas with the highest concentration of labor migrants. This network of migrant-friendly medical facilities provided diagnostic and treatment services for migrants including those with an “undocumented” status. These services included information and education activities, outreach to migrants, referral to medical facilities and social and motivational support for treatment adherence. National and international technical experts from cross-sector working groups collaborated on a national manual about TB control and providing services to migrants.
Reaching out to the migrant community presents its own challenges. They are usually closed communities making it difficult for local health systems to reach migrants with TB symptoms and refer them to migrant-friendly health facilities. The solution: Project HOPE worked with local non-profit organizations to create a bridge between migrants, the health sector and government authorities. During the program’s implementation, they developed and issued cross-sectoral plans to implement TB control activities in pilot sites with representatives of local governments, health and labor departments and other organizations approving these plans and actively participating.
The success of the program shows that NGOs have proven to be team players in the battle to eradicate TB, especially when conducting activities among high-risk TB and difficult-to-reach key populations, making it easier for them to advocate for government funding for local partners and secure additional funding for outreach activities.
Today, Damir is doing much better.
“Thanks to Project HOPE, I received the necessary medical diagnostic testing and the treatment was prescribed,” he says.
“After being discharged to the outpatient stage of treatment and continued monitoring, I had difficulty paying for train tickets and the program helped me again to ensure I adhered to treatment. I am very grateful to everyone for their attention, support and assistance. Now I am sure that I will be healthy and will return to my family.”
Statistics on Migrants
Outreach workers and volunteers have reached approximately 145,000 migrants directly -- and nearly 44,000 migrants passed active TB screenings.
TB notification among external migrants has increased four to five times in the three years since the start of the program.
The program pilots launched in 2017 detected TB in three out of four external migrants and, out of migrants with drug-sensitive TB detected in 2015 to 2016, more than 80% were treated successfully and 8.2% were referred to their home country to continue treatment.
The “Addressing Cross Border TB, M/XDR-TB and TB/HIV Among Labor Migrants Program” is funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and implemented by Project HOPE in partnership with WHO, the International Organization for Migration (IOM) and the International Federation of Red Cross and Red Crescent Societies (IFRC).
EDIT: This post has been updated.
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