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 world’s top HIV/AIDS experts are gathering in Durban, South Africa for the 21st International AIDS Conference - a meeting that fills me with hope that an opportunity is at hand to finally get the disease under control, but it’s an opportunity that is tempered with a little caution.
I am hopeful because the last time the conference was held in Durban in 2000, a moving experience for me personally, it was followed by real collective action around its theme “Breaking the Silence”, which was primarily about improving access to services and reversing widespread stigma and discrimination. I am also cautious in hoping for too much since we have known for some time what to do to bring the pandemic under control, yet that dream remains an elusive one.
At the time of Durban 2000, I was CDC’s Country Director in Botswana, which was a period of astronomical AIDS-related mortality and frustration throughout the region. Botswana had the highest HIV prevalence in the world. Funerals were a constant reality. The best and brightest segments of the population were dying at alarming rates – teachers, health workers, soldiers and police, businessmen, or anyone in which mobility affected their lives. President Bill Clinton had visited Botswana in 1998 and the word “AIDS” received no mention. A close colleague died from “that disease” and at the funeral in the home village relatives described how “demons had reached up from the underground”. Fellow African health professionals, whom I admired tremendously for their endurance, were quitting or refusing to care for AIDS patients because of the inevitable mortality they had experienced time and time again. It was hard enough to access an HIV test, let alone treatment. Highly active anti-retroviral therapy, or HAART, had been revealed at the AIDS conference in 1996 yet the cost of drugs at $5,000 per year put that hope out of reach for the masses. That was the frustration.
Durban 2000 was to change that. Nkosi Johnson, an 11-year-old South African child living with HIV/AIDS gave an impassioned and tearful speech, calling on the South African government to make treatment accessible, which it has, albeit with delays during President’s Mbeki’s tenure of deadly denialism about the causes of AIDS. Nkosi died soon after the conference. Speaking at the closing, President Nelson Mandela further inspired the audience and left us with a resolve to return to our countries and fight the war:
“…… We need, and there is increasing evidence of, African resolve to fight this war. Others will not save us if we do not primarily commit ourselves. Let us, however, not underestimate the resources required to conduct this battle. Partnership with the international community is vital. A constant theme in all our messages has been that in this inter-dependent and globalized world, we have indeed again become the keepers of our brother and sister. That cannot be more graphically the case than in the common fight against HIV/AIDS. ….” Nelson Mandela, 2000
Thanks to the leadership of President Festus Mogae, a former World Bank economist, Botswana became the first African country to roll out national programs. Other government officials heard the promise of anti-retroviral therapy (ART) and returned to lobby their countries to invest in testing, prevention of mother-to-child transmission, and comprehensive ART programs. Many have, like South Africa invest more than $2 billion per year in the epidemic. Many countries could do much better, such as those who rely excessively on external donors and invest little in their own epidemics from their own national budgets. There was a call in Durban 2000 for the formation of a “Global Fund” as a global financing mechanism, and indeed it was established through collective governmental and non-governmental action in 2002. And then President George W. Bush announced PEPFAR (The United States President’s Emergency Plan for AIDS Relief) in his 2003 State of the Union Address, which with tremendous bipartisan Congressional support has been the largest investment in a single disease in history.
New HIV infections and HIV/AIDS-related mortality have since plummeted to record lows. But we must not forget the past when the high mortality rate was so visible, so tragic, so preventable, and so harmful to households, communities, and society as a whole. We must not forget the importance of placing stigma and discrimination, a major obstacle to access, at the top of the agenda and which will require more local leadership than ever. And we must not forget that, in Durban 2016, we now have the tools at our disposal to bring the HIV epidemic under control, unlike in Durban 2000.
Dr. Kenyon arrived in Shanghai, China this morning to visit with leaders of various health care institutions and explore ways in which Project HOPE may be of assistance in the future. This being his first visit to Shanghai, Dr. Kenyon also took some time to visit Shanghai Children’s Medical Center (SCMC), which Project HOPE helped establish and where we conduct several programs.
Dr. Kenyon, Linda Heitzman and I met with Dr. Huang Hong, Secretary General of the Shanghai Health and Family Planning Commission. Dr. Huang, who was a HOPE fellow at Children’s Hospital of Wisconsin in 2003, praised Project HOPE’s work in Shanghai and in Dujiangyan City following the 2008 earthquake there. She also thanked Project HOPE for its support of SCMC, noting that the hospital in now well-known in China for providing excellent care to children with acute illnesses, especially congenital heart disease and cancer.
Dr. Huang shared with Dr. Kenyon some of Shanghai’s most pressing health challenges: acute infections that are mostly contracted from abroad, noncommunicable diseases due to improving economic development, and an aging population with higher incidences of diabetes, heart disease and cancer. It will be important for Shanghai to improve its community health service capacity. Shanghai has 2.2 million children aged 0-14 years; however, the city only has 3,200 pediatricians and around 3,200 beds for pediatric patients that must also accommodate some patients who travel to Shanghai for medical care who are from other areas.
In the afternoon, we met the Vice Mayor of Shanghai, Ms. Weng, Tie Hui at City Hall. It was an honor to meet the Vice Mayor given her busy daily schedule. Ms. Weng is very familiar with Project HOPE’s work in Shanghai, especially at SCMC. She thanked us for our support and mentioned that SCMC is a very famous pediatric hospital in China now. On behalf of the Shanghai government, the Vice Mayor thanked us for our vision and long-term, sustained support.
Ms. Weng outlined some of the local health issues. She said that the average life expectancy of Shanghai residents is about 82 years, and the health care system must provide good care for its residents and people from other provinces who seek advanced medical treatment in Shanghai. In addition to ensuring that Shanghai residents have sufficient health care services, the Vice Mayor also mentioned that the Shanghai government has spent 1 billion USD providing tremendous support toward health facility infrastructure development and health care worker training to eleven less developed regions of China. At SCMC, patients from less developed countries like Morocco also receive treatment. Shanghai’s support to Kashi City and four counties of the Xin Jiang Autonomous Region significantly improved maternal and child health and decreased the infant mortality rate by 20%.
Dr. Kenyon shared with the Vice Mayor that Project HOPE award Mr. Jian Zhongi, President of SCMC our 2016 Global Health Partner Award for his leadership and years of collaboration with Project HOPE in solving global challenges in pediatric health. Ms. Weng was delighted to know it. Dr. Kenyon also stated that SCMC’s success is based on its leadership’s vision and its staff’s diligent contributions. Dr. Kenyon is glad to know that SCMC has the capacity to help other regions of China and other countries to improve pediatric health care.
Dr. Kenyon also noted that the recent Chinese health reforms which emphasize primary care are important tasks for the government. While Project HOPE currently has a few projects in China – especially in pediatric asthma and adult diabetes care - he would also like to see Project HOPE help build a mechanism to enhance community health services and capacity.
Dr. Kenyon ended the visit with the Vice Mayor by saying that he is looking for further dialogue to find opportunities for future collaborations. The Vice Mayor said that the collaboration between Project HOPE and SCMC has lasted about 30 years, and Dr. Kenyon mentioned that he intends for Project HOPE to have further fruitful collaborations in Shanghai for the next 30 years.
Susan Opas is a pediatric nurse practitioner from Woodland Hills, CA who volunteered for Project HOPE on Pacific Angel 16-2, a humanitarian and civic assistance mission led by the Royal Cambodian Armed Forces working alongside their U.S., Thai, Vietnamese and Australian counterparts and volunteers from nongovernmental organizations like Project HOPE in Kampot Province, Cambodia. Susan treated pediatric patients at two makeshift clinics over the course of five days in mid-June 2016. Pacific Angel 16-2 was Susan’s sixth volunteer mission with Project HOPE.
The second site of this mission was truly within farmland. The fields in the area were wide open, growing sugar cane, rice, vegetables and coconuts. This area was more established than the first site, but the classroom (our clinic site) was filled with dirt and cobwebs and was dark as a dungeon. It took a lot of time to move desks and sweep with masks on to be ready. There were two small windows on each side of the room with little ventilation. The Air Force brought a generator and fans which worked until the fuel ran out. There was no electricity, so evaluating children in near dark was going to be difficult.
We were at this site for two days: June 17-18. Among the children’s diagnoses I provided were for another heart problem (hole between the ventricles), hernia, leg pain (growing pains), anemia, fever, headaches and dehydration, stomach aches, poor eaters, and minor skin issues. However, my teammates saw a teen post-motorbike accident who had two gaping wound and had been going to the local hospital every other day to be redressed. They also saw some major hernias, suspected TB, head trauma, a history of nose bleeds and all the other imaginable childhood issues we see at home.
At the end of the second day, a small group of us took sunglasses to the local hospital and got a tour. They have the basics. There is no central monitoring in the ICU. Patients share a large room. The newborn ICU consists of two isolettes. In the maternity ward, babies are in beds with the moms. In all cases, the families stay, provide basic hygiene care and bring food.
During the five days of this mission, we provided health assessments and minor interventions – antibiotics, inhalants, anti-inflammatories, wound cleansings, looking in ears and throats - to 3,486 patients. At the least they left with vitamins, a toothbrush and sunglasses.
Susan Opas is a pediatric nurse practitioner from Woodland Hills, CA who volunteered for Project HOPE on PacificAngel 16-2, a humanitarian and civic assistance mission led by the Royal Cambodian Armed Forces working alongside their U.S., Thai, Vietnamese and Australian counterparts and volunteers from nongovernmental organizations like Project HOPE in Kampot Province, Cambodia. Susan treated pediatric patients at two makeshift clinics over the course of five days in mid-June 2016. Pacific Angel 16-2 was Susan’s sixth volunteer mission with Project HOPE.
This mission began June 11 with a day to complete set-up that several U.S. Air Force and Australian Air Force volunteers started the day before. Our goal was to serve two community locations in the very south, central area of Cambodia. Both locations are in farming areas, but the first was quite more distressed than the second. In both settings we used local schools: the first was a middle school, and the second was an elementary school connected to a Buddhist wat (temple), which was incredibly gorgeous with walls and ceilings totally painted with Buddhist scenes.
Our first true day of mission work was June 13. Our clinics consisted of dental, optometry, general medicine, pediatrics, physical therapy and a pharmacy. The medicines provided were quite variable, so we had to stretch at times to utilize what we had. An example is loratadine (Claritin) for unavailable Benadryl. In addition to seeing patients, in pediatrics we each also dispensed our medication and, with interpreters, educated the patients’ parents about the medications.
My very first patient was an 8-year-old with subcutaneous tuberculosis. Yep, quarter-sized cysts full of TB. The next had his heart in the right side of his chest instead of the left along with a larger murmur, which seemed to be a hole in his ventricle. Cambodia has a much better referral system than other countries. So, our infectious disease person and the local hospital director coordinated the TB patient’s transfer and set up a plan for us to follow the patient’s routing throughout the mission.
The next day again I started with another heart murmur known as Stills Murmur, which is seen when significant anemia is present. Rice is the staple of life here, although I noticed on our van ride one hour from town that there are cows, chickens, turkeys and pigs. In some situations parents had the same complaints as in the U.S.: kids want the sugar and chips and somehow they have the money to get these. I saw lots of beer and soda available along the roadside.
On the third day, the last at this site, the number of patients seeking pediatric care dropped. I believe this was due to the kids being in school and unable to be seen while we were available. The most involved work of the day was cleaning skin wounds caused by kids scratching their bug bites without good hand washing. We closed our section early and began packing up for the move to the second site. We were awash with “gummy vitamins,” which patients, parents, the interpreters and the military were eating like candy.
Day four was a moving day. We started on a paved road out of town, but then we were on a red, dusty dirt road or muddy single lanes with lots of divots, which kept us awake until we arrived at the second site.
A Volunteer Nurse Assesses Maternal and Newborn Health Care
J. Beryl Brooks, the Developmental Clinic Coordinator for Improved Pregnancy Outcome at Memorial UniversityMedical Center in Savannah, is part of a team of medical volunteers who traveled to Sierra Leone in May to conduct a rapid assessment of maternal and newborn health care in health facilities there. This humanitarian mission is in response to a re-emerging crisis in country where maternal and newborn mortality is among the highest in the world. Here she shares a portion of her journal in which she recorded her personal observations of the trip.
Continuing our visit in Bo District, we talked to a number of staff members in Labor and Delivery and Postpartum about their pre- and in-service training.
There are no phones on the wards, so it is necessary to go from place to place to communicate and get things done. This is time consuming. Most phones in use are the staff’s personal cell phones. Electricity is intermittent, a problem for many reasons: oxygen concentrator not working, no lights to view the patients, etc. We found this to be a problem last night, too; when we returned to the hospital it was hazardous to get from place to place. There is no lighting in the hallways, many of which have drop-offs, steps and gaps. There was one functioning lightbulb in the pediatric ward requiring the use of flashlights for patient observation and care.
On Monday Dr. Asibey and I continued the assessment process and began some introductory trainings for Helping BabiesBreathe® and Essential Care for Every Baby. The nursing and midwife staff began each program with hesitance, but quickly recognized the value and became very enthusiastic learners. It was a great pleasure working with them. We found that the trainings were a great way to elicit information about what was available for patient care and what the staff’s training and capabilities were, much more effective than interview and observation.
The overall observation from our time in Sierra Leone is that the local health care professionals are overwhelmed by the responsibility of caring for very sick patients with limited supplies. Many are still very passionate about providing the best care possible despite the obstacles. Some are apathetic, but some are still willing to learn and grow. There is good teamwork and camaraderie for the most part.
On Tuesday, just before leaving for Lungi to fly home, I met Osman Kabia, Project HOPE’s Sierra Leone in-Country Consultant. He was delightful, as were all the staff members, and brought a feast prepared by his wife. What gracious and wonderful people are here in Sierra Leone. I am grateful for this opportunity.
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