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.
A Volunteer Nurse’s Assessment
J. Beryl Brooks, the Developmental Clinic Coordinator for Improved Pregnancy Outcome at Memorial University Medical 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.
After we arrived at the Lungi airport in Sierra Leone, we took an exhilarating (bumpy) ferry ride to Freetown. I met Dr. Asibey, a pediatrician from Ghana who will be working on the team, on the plane and we were able to talk together briefly during the stop in Monrovia. She is very nice and very enthusiastic about the assignment.
The Project HOPE staff had paved the path for us, so getting from airport to hotel went smoothly. We then met the rest of the team: Mariam, HOPE’s in-country coordinator; Sheka, the driver; and Dr. Little, a neonatologist from Dartmouth, NH. The next day we met with the Chief Medical Officer for the Ministry of Health for Sierra Leone, who was also very helpful.
After Freetown, we traveled to Bo, about a three-hour ride, passing through many villages and forested areas along the way. At the Bo District Health Compound, local staff members attended a workshop on Helping Babies Breathe® presented by Dr. Little with some assistance from Dr. Asibey and me. The staff was very interested and had a lot of questions.
We also met with local officials including the District Health Officer and did a walk-through assessment of the hospital and facilities. Other assessments here included a rural clinic and the labor and delivery area of the hospital – where we assisted with the delivery of a beautiful baby boy.
We noted that the clinic we visited seemed farther from town than it actually was because of the rough condition of the road – a difficult journey for a sick or laboring patient traveling from the health clinic to the Bo District Hospital, especially since most transportation is on the back of a motorbike.
Upon entering any facility, staff directs you to wash your hands, and your temperature is taken and shown to you – an attempt to prevent the resurgence of Ebola.
At the end of the week, we went to the postpartum unit of the hospital where they were prepping a case for surgery. After observing the surgical prep, we headed to the antenatal and postnatal clinic, which involved climbing over rebar and other construction materials and debris. We envisioned what it must be like for pregnant women and mothers with newborns to negotiate this same obstacle course.
There, Dr. Asibey was able to help stabilize a malaria case that came in with active seizures. She also helped another patient with severe anemia and possible renal failure.
This was a very long day due to a severe lack of supplies and equipment. Some medications were unavailable at the hospital pharmacy, so Mariam went to the local pharmacy to purchase them. The staff is very nice, trying to do the best they can, but definitely could use help.
Hundreds of thousands of patients with multidrug resistant tuberculosis (MDR-TB), a form of TB infection caused by bacteria that are resistant to powerful drugs used to cure the disease, suddenly have reason to hope. The World Health Organization (WHO) has just cleared a new shortened treatment regimen for multidrug-resistant tuberculosis (MDR-TB) which carries grave risks for nearly half a million people who developed a condition that killed 190,000 people in 2014.
The disease is so pernicious that it cannot be treated with the standard six-month course of medication which is effective in most TB patients. Patients with rifampicin-resistant or MDR-TB are treated with a different combination of drugs, usually for 18 to 24 months. But the regimen is arduous and can have terrible side effects.
The WHO recommendation shortened the treatment plan by nine months. The treatment duration in the new regimen is 9-12 months instead of 18-24 months. This means treatment will be less grueling for patients and less burdensome on already stretched health systems in many parts of the world. And the cost of the drugs required for treatment will drop to less than $1,000 per treatment course. This is a leap forward for MDR-TB patients, but there is still a long way to go because the WHO’s new recommendations on the use of a shorter MDR-TB regimen come with specific conditions and there are serious risks for worsening resistance if the new regime is used inappropriately (e.g. in XDR-TB patients). Project HOPE is supporting national programs in the Central Asia region through strengthening monitoring and evaluation of the programs and to implement WHO guidelines.
In a USAID funded program in Central Asia, Project HOPE has already discussed with national programs how to use the shortened regimen in pilot programs under stringent monitoring. It is really a big step forward - and a very important one for patients who now face shortened treatment periods and can return to their normal lives more quickly.
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
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.
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.
They worked with the National TB Program (NTP) to outfit two vehicles with GPS devices to better monitor the fuel consumption, ensure the driver is taking the most efficient route and doesn’t deviate from assigned destination, and ultimately deliver higher quality sputum samples for laboratory testing.
They also outfitted two social workers with pocket GPS devices. These pocket devices can track the routing and the duration at various stops such as with patients. Since the expected duration of a Directly Observed Therapy-Short Course (DOTS) session is 30 minutes, tracking the actual amount of time spent at each stop on a planned route can provide an affirmation of potential quality of service (and identify when insufficient time is spent).
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.
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