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.
When most people think of refugees, they think of tent cities on the African savannahs, the communities of Cambodians and Burmese that sprung up on the Thai border, or the cramped shacks of Gaza.
But at a time when war, fraying national borders, and even the early impacts of climate change are triggering human exoduses into neighboring countries, there is a new challenge that the world must understand and confront.
It’s the plight of urban refugees. In fact, about 66 percent of the world’s refugees don’t live in camps, they live among us, often in places where the host community is almost as poor as the refugees themselves. Unfortunately, national governments and international aid agencies are not yet really able to work effectively in these mixed urban settings.
The deepening refugee crises around the world will be on many of our minds on World Refugee Day on June 20. The issue is becoming so acute, that governments, relief agencies and NGOs are now having to place it at the center of all their policy making on humanitarian and aid issues.
The situation is especially acute in the Middle East. The extraordinary humanitarian crisis sparked by the civil war in Syria, and Iraq before that, has seen hundreds of thousands of people flee the fighting, seeking refuge in neighboring nations and Europe.
The news media offers extensive coverage of the camps that have sprung up in Jordan — a country that already carried a huge burden after taking in refugees from the Middle East conflicts of previous generations, but not many people know that only 10 percent of the Syrian refugees who fled to Jordan live in those vast camps. The rest of them are spread across towns and cities.
This is a reality that creates complex challenges for NGOs, the UN, and host governments when they think about how to help refugees. It is also a situation that threatens to create resentment towards refugees from the communities in which they settle.
Think about it for a moment. Refugee organizations often concentrate more on the well-being of refugees than their host communities. For example, the UN High Commissioner for Refugees is mandated to fund refugee relief, but not host community development. This could mean providing vaccines to refugees and not the impoverished local community, fostering resentment, reinforcing segregation, and in some cases sparking violence.
We are just beginning to recognize the emergence of such humanitarian dilemmas that come with changing patterns of refugee migration and settlement. However, we have not yet adapted to what will be a difficult challenge in the years to come.
When I started working with refugees, after shelving my previous career as a civil engineer following some time observing the acute humanitarian suffering unleashed in Sierra Leone by a terrible civil war, I would have assumed most refugees spend only a short time in a camp — six months perhaps or maybe a year.
I was shocked when I found out that all refugees stay in exile for many years, with some of them remaining in exile for more than 20 years (Somali refugees in Kenya, Burmese refugees in Thailand), and those that stay in urban areas tend to stay in exile for even longer and that means of course that not only are host nations struggling to deal with new refugees, they must cope with new generations of refugees who are born in host nations.
Today there are about 65 million refugees or displaced people around the world — 10 million of whom are what we call “statelessly displaced” — jargon for those unfortunates who have no rights, are badly in need of help, and now lack citizenship. Making matters worse, many urban refugees fall into this category.
The biggest refugee crisis right now is in Syria and its surrounding nations. The war has raged for almost six years and is nowhere near resolution. It has killed around 400,000 people so far and created 4.8 million refugees and 6.8 million internally displaced people.
Of the 4.8 million refugees more than a million have made it to Lebanon, 680,000 to Jordan and another 2.6 million are now in Turkey. There are numerous challenges to helping the refugees who live in camps, but we have worked in refugee camps before with success. However, the more diffuse distribution of Syrian refugees spread around towns and cities in neighboring countries creates a problem we are not yet well equipped to deal with efficiently. That’s because if funding is earmarked to deal with refugees, that money cannot be spent on host communities. And if foreign aid is intended to be spent on host communities, it cannot therefore be used to provide care to refugees.
In practice, in places like Jordan and Lebanon, this breeds tensions between refugees and people who live in communities that have taken them in. Before long, this is going to become a very sensitive political issue in the countries involved. That’s why we are going to have to start thinking out of the box. In these communities we should examine the challenge of expanding health care capacity for the local population and care for refugees as a singular challenge.
We owe it to these countries to do something to help. Leaders, policy makers, implementers, funders and academics need to rethink how we balance the healthcare needs of the refugee and host communities. This problem is only going to get more serious and will cause further misery for refugees who already have grim prospects, if the world doesn’t act soon.
For more on Rabih Torbay's insights on how to address the plight of urban refugees, listen to his interview on the Global Health Checkup Podcast:
HOPE volunteer experiences cultural differences and similarities at Vietnam hospital
HOPE volunteer Christine Booth changed careers after 25 years to become a registered nurse. She currently works on a medical surgical floor in a hospital outside of Rochester, NY. She recently served on a Pacific Partnership land-based mission trip in Vietnam. She and 10 other HOPE volunteers implemented side-by-side training to local health care professionals and provided patient care.
Nursing is a second career for me. Previously I was employed in the property management industry for 25 years becoming a Vice President/Asset Manager overseeing a portfolio of 10,000 apartment units in several states. But I had become disillusioned with the corporate world and saw numerous openings in the local newspaper for nurses. I started working as a patient care technician to see if nursing would be a good fit. Within six months my father was hospitalized with a stroke that left him paralyzed on the right side. My mother and I cared for him for three years until he finally succumbed. While sitting at his bedside one day, I made the decision to return to school and begin the process of becoming a nurse.
I graduated four years ago and decided to go on this mission in an effort to help those less fortunate than myself. Although I have been on three medical missions in the past, this is my first medical mission with Project HOPE.
While in Vietnam, I worked alongside the Navy nurses on the burn/wound ward of DaNang General Hospital. The hospital ward was divided into groupings of six patients to a room with a small bathroom to share. The windows opened up into a hallway where the patients’ clothes were hung to dry. The two patients I cared for lay on metal beds covered with a straw mat. Next to them were the provisions for their stay: water, snacks and meals provided by their family. The Vietnamese families are extremely involved with patient care and play an active role in their recovery.
I was surprised to find that two of my patients were suffering from injuries as a result of the Vietnam War.
My first patient was a young man who was employed as a soldier. One month earlier he had stepped on a landmine and was severely injured by the explosion that severed his left arm, which was now amputated below the elbow. He was also blinded by the blast and had several wounds on his right arm and hand. His brother stood by his side and cared for him.
The second patient was an older man who had been returning to the hospital for the past 40-plus years for ongoing treatment for a non-healing wound on his left shin from the Vietnam War. He had a prosthetic on his left leg and a glass eye on the right. His son was there to help with his care. While changing the dressing on his wound, his family handed me a tube of Aspercreme (a topical pain reliever) to apply on his leg. The cost of this over-the-counter ointment was 700,000 Dong – the equivalent of $30 U.S. dollars. According to www.wageindicator.org, the average monthly salary of a Vietnamese worker last year was $145. I didn’t have the heart to tell them the medicine would not heal the wound but only reduce pain and discomfort to the area. I applied MEDIHONEY (a medical-grade honey-based product for the management of wounds and burns) and covered the wound hoping this one application would stimulate wound healing.
I would definitely go on another mission trip with Project HOPE in the future. As I do on all my trips abroad, I saw firsthand that people are people. Regardless of our cultures – mothers, fathers and children all experience the same challenges, joys and sorrows.
Neonatal Nurse Provides Expertise and Learns Much Along the Way
Kylee Nelson is a Project HOPE volunteer who served at the University Clinical Center for Pediatrics in Skopje, Macedonia, where she provided training to nurses through continuing education and side-by-side modeling. Originally from Omaha, Nebraska, Kylee graduated with a degree in Biology from Clemson University and then completed an accelerated nursing program at Emory University in Atlanta. She is now a Neonatal Intensive Care Unit (NICU) nurse.
I always knew that I wanted to go abroad somewhere and help out, however I had no idea what that entailed. Last summer (2016), I started feeling the need to get out of my own bubble and my own comfort zone and see the world in a different way, by helping those who truly need it. I also knew that by helping others, they would be helping me. I wanted to learn from others and see how people around the world operate different than I'm used to operating. That is when I started researching places online and found this amazing opportunity with Project HOPE. Although this is my first Project HOPE mission, I hope it is not my last!
I am the first volunteer from the U.S. to come help in the NICU here in Skopje. It was evident from the start that there is a big need for more education for the nurses. I have been able to do some research and put together a few PowerPoints to share with the nurses. It is always so rewarding when what I teach them actually clicks, and I see them making changes in their day-to-day care of the babies.
I have given the nurses the educational tools and resources to find answers to questions that they might have. I have also tried to express that while things can go wrong in the NICU, it is still a team effort and if they are starting to become overwhelmed, they should just ask for help – there is nothing wrong with admitting that you need a little help now and again.
When it comes to what they have taught me though, I have definitely received so much more than I ever could have imagined! What they have given me has been so valuable. They have showed me what teamwork, hard work and dedication is truly like. Unfortunately, they don't have the greatest working environment in terms of space and equipment (that will be changing with the opening of the new NICU), but they make the most of it and put their hearts and souls into their work every single day. They have taught me patience and the value of not taking little things for granted. I will be forever grateful for the time that they have given me and everything that I have learned from them along the way.
While in China to promote health care worker training, Project HOPE CEO Dr. Thomas Kenyon had the opportunity to visit Lujiazui Community Health Center – a pilot community health center (CHC) for HOPE’s pediatric asthma program in Shanghai.
Shanghai’s prevalence of asthma is the highest in China at 7.57 percent. Previously, young patients had to travel to crowded tertiary hospitals like the Shanghai Children’s Medical Center (SCMC) for treatment because most CHCs did not have pediatric clinics. This made it difficult for patients to complete follow-up appointments and resulted in low controlled rates of asthma.
In 2015, Project HOPE initiated the China Pediatric Asthma Prevention and Management Program with funding from AstraZeneca and support from the Shanghai Children’s Medical Center and 14 community health centers in the Pudong District of Shanghai. The program helps CHCs strengthen their own pediatric asthma clinics to benefit local children in many ways including decreasing wait time, reducing medical costs and helping to control asthma symptoms in these young patients.
To support the program, Project HOPE worked with SCMC to train 35 doctors and nurses from 14 CHCs in the Pudong District of Shanghai, qualifying them to open their own pediatric asthma clinics. HOPE also donated a portable lung function machine and three nebulizers to each CHC for their pulmonary function test rooms and nebulization rooms. Pediatric asthma medication was provided to the CHCs with support from the Pudong Committee of Health and Family Planning.
The results have been inspiring. All the CHCs have now opened their own pediatric asthma clinics and data shows that patients are achieving the same asthma control level with less money spent in CHCs compared with those who had their follow-ups at SCMC.
During Dr. Kenyon’s visit to the pilot center, he discussed the program with Dr. Liu Lingjun, the asthma clinic’s doctor. Dr. Liu indicated that most of her patients were very satisfied with the convenience of their local asthma clinic and shared a poignant example. “One of my patients could not complete the 12-month follow-up protocol because it was too difficult for her to travel to SCMC to see a doctor,” Dr. Liu said. “The patient spent an entire day traveling to SCMC, waiting for the appointment, attending the appointment itself and then returning home. This patient is now able to go to the nearby Lujiazui CHC to get prescriptions and receive lung function tests and nebulization, making the treatments far less time consuming and practical.”
In addition to convenience, medical costs have been reduced because national medical insurance has better coverage in CHCs. Doctor-patient relationships are also reportedly much better in the CHCs because doctors are able to spend more time communicating with patients than doctors at SCMC.
Dr. Kenyon thanked the dedicated hospital staff for investing their time in professional training and making great strides in helping pediatric asthma patients receive better care.
Hurricane Matthew served another blow to the disaster-worn people of Haiti last fall. More shelters were ripped apart, roads washed out, buildings destroyed and lifesaving medical care became even more challenging to access. People were weary and fears of another cholera outbreak were a major concern for those trying to survive in the hurricane-torn southwest region of Haiti.
Project HOPE was on the ground in the aftermath of Hurricane Matthew, providing medical volunteers and essential medicines and supplies to help with immediate needs. But with your support, HOPE has stayed on to support damaged health systems and also help support infrastructure that will benefit the health of Haitians for years to come.
One of those projects is a new cholera treatment center, being completed next month at the St. Therese Regional Hospital in Miragoâne, the capital city of the Department of Nippes in southwest Haiti.
Cholera is an acute diarrheal disease that can sometimes kill within hours if left untreated, and locating a cholera treatment center at the St. Therese Hospital in Miragoâne is a lifesaving measure.
Before this center was built, people who lived in the Nippes Department had to travel long distances, up to three and four hours to get care for complicated cholera cases. Because of the aggressive nature of the illness, three or four hours can mean a matter of life or death. The new cholera treatment center at St.Therese Hospital now makes care accessible immediately for those near Miragoâne, and even those living in the most remote areas can get care within an hour or two.
In addition to its central location, the region also has medical professionals who are already trained in advanced cholera treatment. Project HOPE volunteers actually worked at the St. Therese Hospital following the Hurricane in October and knew that the staff at the St. Therese Hospital had the skills they needed to care for cholera patients and would be able to use the new facility immediately.
The new 20-bed cholera treatment center will be completed and open to care for patients soon.
The center was built with the help of Project HOPE partners, Mazzetti and the Sextant Foundation, who have experience working in Haiti and provided volunteer engineers to oversee the design and construction for the center, which was built by a local Haitian construction company. The cholera treatment center has brought together the best practices from similar facilities in Haiti and other cholera treatment centers around the world. It uses renewable energy and a renewable energy distribution system. The center will strengthen the health system by allowing doctors to treat a normal case load of cholera and other diarrheal diseases throughout the year, and support a large response in the event of a cholera outbreak in the region.
People in the community are relieved that there is now a cholera treatment center that is more centrally located, knowing if they are ever infected with this deadly disease, help is near and chances of survival increased. Thank you to all of you who supported Project HOPE’s Hurricane Matthew relief projects, including the Edna McConnell Clark Foundation, 3M, Pfizer, Merck, CSRA, UnitedHealth Foundation and their employees, and the many individuals who donated. This support helped to ensure construction of this much needed cholera treatment center!
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