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.
I grew up in an Air Force community and was gratefully mentored towards my goal to be a nurse by an Air Force nurse. Talks of relocation and life in “foreign countries” were shared by childhood friends. I too wanted to travel, learn first-hand about lands, people, their cultures and their ways of living. Due to my role as a full time University-based nursing educator from 1974 to 2001, along with raising children, travel out of the Continental United States wasn’t possible. In 2001 I made a career move from the University to community-based specialty practice in developmental/behavioral pediatrics. While I love this specialty practice and the patients and families we serve, I am not involved in general pediatric healthcare. But, in this practice, I can arrange time off. Through a family member I became aware of Project HOPE’s varied volunteer and humanitarianism opportunities - many collaborating with U.S. Military and other NGO groups. The missions presented on the website were rich with opportunity to renew my basic skills, travel to unique (and real) – less visited places. To places I would be challenged to give care to children, perhaps more in need than those near home.
My best memory was my first mission, Pacific Angel 2011 staged several miles outside Pekanbaru, Sumatra, Indonesia. HOPE warned there might not be sufficient need for a Pediatric Nurse Practitioner – which made me smile then and now. The primary mission was to see how rapidly the Air Force could set up a “Humanitarian Assistance/Disaster Relief” unit - a pallet-bound tent clinic and city ready to travel and be functional, within a day. The clinic opened to over 800 patients the first day. Adults brought their children along as they were full time caregivers. As families learned their children could be seen, the volume increased by the hour, then over the days. Pediatrics became so busy the Family Practice MDs began seeing as many children as adults.
Each year since 2011, I have felt honored when accepted to a new mission. 2012 was Pacific Partnership aboard the USNS Mercy. I boarded in Manado, Indonesia to travel the Philippine Islands including Samar and Cebu. Living as do our Navy personnel opened my eyes to their discipline in service. When not at an Islands’ clinic examining, treating, and learning of that community’s ways of living, I volunteered aboard ship. I loved working the Mess line. There I had the chance to thank our Service persons for their dedication at home and abroad. It was exciting “manning the rails” as the Mercy steamed in to Subic Bay, Manila. 2013 was aboard the USS Pearl Harbor. I joined this multinational military and NGO mission in New Caledonia and traveled to Manado, a highly populated Marshall Island. In 2014 Typhoon Haiyan destroyed many Philippines lands. HOPE sent emergency responders to Tapaz Island. In September I examined children in the local hospital, met with community and military leaders of Tapaz to review the Island’s recovery and ongoing needs. Once again in 2015 I worked with Navy providers, this time aboard the USNS Comfort anchored outside Port-au-Prince, Haiti. I saw so many with so little resources since the 2010 earthquake. June 2016 was PacAngel in Kampot, Cambodia, a multinational, East-West sharing of health care information and hands-on care.
I am asked, “What is humanitarianism?” I am repeatedly humbled by families who wait in long lines in hot and humid weather for me to examine their children. Their thanks and signs of appreciation are my enduring gift. Seeing the resilience of children and compassion of their elders resets my moral and emotional compass and grounds me. How fortunate I am to be in this nursing profession I love. Earning the chance to share knowledge among national and international peers affirms my worth. Upon my return I want to kneel and kiss home ground with thanks for my opportunity to give of my skills and my time. Many parents, co-workers and friends want to hear of my adventures. I feel through telling my stories they gain empathy for others and may find a place or organization where they too can give in their special ways. Coming home, I am often physically exhausted, but days later I start thinking about my next opportunity.
J. Beryl Brooks, the Developmental Clinic Coordinator for Improved Pregnancy Outcome at Memorial University Medical Center in Savannah, Georgia, is a medical volunteer with Project HOPE.
The 9/11 terror attacks in the United States broke our nation’s heart and shocked us to the core, but for me, the shock gave way to a sense of determination to serve as a volunteer for a medical humanitarian organization. With Project HOPE, I felt inspired to make a difference. If I could in some way help save a life, educate a nurse or inspire health professionals to build healthier communities, I was determined to do it.
My first mission with HOPE was a three-week assignment at ASRAM, a regional teaching hospital in Eluru, India where I helped enhance the skills of staff nurses. My second mission was a two-week assignment on USNS Mercy, the U.S. Navy hospital ship where Project HOPE often provides medical volunteers, working as a staff nurse on the pediatric pre- and post-operative unit while it was anchored off shore near Roxas City, Philippines.
In May of this year, I was in Bo District, Sierra Leone doing assessments of the district hospital and rural primary health clinics. The HOPE team taught two American Academy of Pediatrics Programs called Helping Babies Breathe and Essential Care for Every Baby. I was honored to work alongside other team members including Dr. George Little, a Neonatologist from Dartmouth Medical Center in New Hampshire, Dr. Jacqueline Osibey, a pediatrician from Ghana, and Mariam Sow, our program coordinator.
Sierra Leone is in great need of humanitarians, especially in health care as it has one of the highest rates of maternal and newborn mortality in the world. The country is still recovering from the devastating Ebola epidemic, which had a terrible impact on the country. Progress had been made in reducing maternal and newborn mortality by providing free access to maternal health services until Ebola struck and crippled the health system. The epidemic caused a severe shortage of health workers and a lack of adequate supplies. This meant that thousands of women had only limited access to maternal health services. The use of child soldiers in the country’s decade-long civil war was another painful memory for the health professionals I met. These nurses and health experts are my heroes. They persevered during conflicts and global health emergencies, coping with a lack of resources or paychecks at times. They are true humanitarians.
Prior to volunteering with Project HOPE, I served for two years as a Peace Corps volunteer in Nepal as a health educator. I also did a two-week assignment with a group from Alabama providing health services in two rural health clinics in Honduras.
My best memories as a humanitarian so far have been seeing the excitement and confidence in the eyes of staff in Nepal and Sierra Leone when they reported their successes in resuscitating newborns using the skills they learned from the programs that I helped to present.
To me being a humanitarian means trying to understand others and their needs and caring enough to be motivated to do something positive to make their lives better. There is always a need for help and medical expertise in underserved communities, and I have skills to share. I have been very fortunate in my life and do not take that for granted. So I’m just passing it on.
Susan Tussey is a family nurse practitioner from Pennsylvania, who spent two weeks aboard USNS Mercy in the Philippines in late June and early July as a medical volunteer for Project HOPE as part of Pacific Partnership 2016.
I spent two weeks as a medical volunteer aboard USNS Mercy in the province of Albay in the Philippines, moored at Legaspi City. The mission met the goal of working with partner nations to exchange and share best practices in health care, disaster preparedness, dental care, optometry, nutrition and veterinary care.
I joined two family practice physicians in several in-patient units on the Mercy as well as provided medical care alongside local providers in community health exchanges (CHEs) in three different locations: Ligao City, Duraga City and Tabaco City. Aiding with patient care at each visit were translators from LDS Charities, student nurses from Bicol Regional Medical Center, Blood Donor Nurses and the Philippine Army Nurse Corps. Between patients we were able to share the differences and the similarities with each nation’s health care population and education curriculum.
The age range at the CHEs ranged from infant to elderly, and basic health care (prevention and treatment of minor conditions) were provided. Because of financial strain, health care was often the last expense for the folks attending the CHEs.
Some interesting conditions were present that are not usually seen in the United States. One that stands out was a 9-year-old girl who had been brought in with a heel condition that had been present for six months. It turned out that she had probably stepped on an object that penetrated the heel and had a massive infection that required surgical intervention. Yet, she was not complaining one bit. After several lengthy discussions with her mother and grandmother regarding the urgency of seeking care in a hospital, it wasn’t totally clear that they would eventually seek care. Just as they were leaving, they asked to have another area checked and raised the back of the girl’s dress to expose a bump on her lower back. Amazingly what it appeared to be was an unresolved 10 cm oval-shaped meningocele – a condition that is usually taken care of at birth. She did not seem to have any neurological impairments from this and advised them that this also needed evaluation by a neurosurgeon.
The children we saw were in general very stoic, polite and cooperative – somewhat different from typical child health visits in the U.S. Most everyone at the CHEs received a hygiene kit with items that included toothbrushes, toothpaste, washcloths and soap. The Dental department brought along the “tooth mascot,” which was a big hit with the children. Some glasses were available from optometry, and physical therapy was available for musculoskeletal complaints along with nutritional advice and information.
The Filipino people we treated and trained were very appreciative of the collaborative efforts. They share their typical foods such as pancit, pork adobo, banana fritters, rice and foods not readily available in the U.S. such as mangosteen, santhol, and pili nuts. Meanwhile the Mayon Volcano, the longest active volcano in the Philippines, lurked in the distance. It majestic, perfect cone and constant steam trails hover over the area.
Overall, the experience was very humbling, but rewarding. I was glad to have been able to make a small difference in the population.
Strengthening Support in Private and Public Sector Systems
This year a series on breastfeeding in the Lancet affirmed the multiple benefits of exclusive breastfeeding for children and for mothers.
- Immediate breastfeeding within an hour after birth would significantly reduce neonatal mortality.
- Optimal breastfeeding could prevent over 800,000 deaths each year in children under 5 years of age.
- Breastfeeding improves cognitive performance of children.
- Women who breastfeed have a reduced risk of breast cancer.
The analysis also reports that breastfeeding would benefit the economic development of households and nations. Reduced health care costs and improved cognitive ability could help accelerate progress toward the Sustainable Development Goals, the theme of this year’s World Breastfeeding Week August 1-7, 2016.
Tragically, less than half of the world’s newborns benefit from early breastfeeding and even fewer are exclusively breastfed for the first six months. Women need support for breastfeeding both at home and at work.
To support women at the workplace, Project HOPE’s HealthWorks project, launched in 2012 with funding from Merck for Mothers, worked with factory owners and managers in five factories in Subang District near Jakarta to improve support for breastfeeding. The five factories employ over 11,000 women.
Indonesia has laws in place that protect women’s right to breastfeed, including mandatory provision of lactation rooms and breaks for working women. However, compliance with these laws in factories is low, less than 20 percent according to a 2014 survey in Jakarta conducted by the International Labor Organization. The report cited lack of awareness of the policy by factory owners.
A year after the project started, Project HOPE conducted a survey in three factories. The percentage of women breastfeeding went up by 15 percent in two factories that established or improved lactation rooms equipped with a refrigerator and breast pumps, and that created a new factory policy to encourage women to take lactation breaks. But more support is needed for exclusive breastfeeding at home. While breastmilk provides all the nutrition a baby needs for the first six months of life, many women continue to provide their babies with bottles of infant formula or other supplemental nutrition, sometimes provided by family members who care for the baby while the mother is working. This not only increases the infant’s risk of infection, it reduces the infant’s desire to breastfeed, which reduces the production of breastmilk. Additional counseling and education is needed for women and families about overcoming common misconceptions and breastfeeding problems.
In addition to the private sector, Project HOPE is also working with the public health services in villages to support breastfeeding through the Saving Lives at Birth project, funded by Johnson and Johnson in Serang District since 2012. Project HOPE is building the capacity of Health Centers to support exclusive breastfeeding as part of skills improvements during Basic Emergency Obstetric and Neonatal Care training. The project to-date has reached 41,000 mothers and infants and exclusive breastfeeding from birth to six months of age has risen from 28 percent to 58 percent during the program. In our continuing efforts to support optimal breastfeeding, we are training the government’s community health workers to bring breastfeeding counseling to households, ensuring families have the right information at the right time.
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.
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