In the Field Blog
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.
HOPE works in more than 25 countries worldwide. Please enjoy our blog as we document the successes and challenges of our work.
Shavkat Tursunbayev spends his days scouring abandoned buildings, construction sites and the streets of Karshi in southeastern Uzbekistan, looking for people who may have been infected with tuberculosis (TB).
He’s not a doctor or a traditional health worker, but a former convict whose own remarkable turnaround story and recovery from TB, a highly infectious but curable disease, was only possible with the help of the USAID TB Control Program, in which Project HOPE is a key partner.
Now he’s determined to help others follow his own path back to health and a new life.
Like many people in Uzbekistan and around the world, Tursunbayev has battled TB. After an initial infection 10 years ago, he was re-infected while serving a prison sentence. Overcrowding and a lack of awareness about how TB infection is transmitted make inmates particularly vulnerable. And because many former inmates distrust doctors and officials, they fear getting tested and seeking treatment.
In 2016, as he was still undergoing treatment for TB, which is free in Uzbekistan, Tursunbayev received support from a multidisciplinary team of health providers and outreach counselors established by USAID at a regional TB clinic in Karshi. To improve access to TB care, these teams provide comprehensive assistance, particularly to those who are most vulnerable to the disease: women, children, migrants and former inmates. Outreach counselors taught Tursunbayev the importance of following and completing his TB treatment and gave him the emotional support he needed to get better. Project HOPE works with partners like USAID to help Uzbekistan reduce the country’s TB burden and prevent the emergence and spread of multi-drug resistant forms through prevention, diagnosis and treatment for all, including those who are most vulnerable to TB.
With his health restored, Tursunbayev decided to help those who were struggling as he once had. He joined the multidisciplinary team that had supported him during his illness, first as a volunteer and later, after receiving training from USAID, as a staff member responsible for outreach among one of the country’s most vulnerable populations that he knew well: former prison inmates.
When he finds potential patients on his daily rounds, Tursunbayev encourages them to get tested and seek treatment. Among them are people who began TB treatment but then discontinued. They now suffer from much more dangerous drug-resistant TB.
Understanding their challenges better than almost anyone else, Tursunbayev knows that many of his clients lack stable employment, a permanent home, or connections to their families. They have personal and social needs that go beyond medical treatment. His experience in prison and his compassionate, non-judgmental approach makes Tursunbayev the perfect person to show these clients that health is their greatest asset and something they must protect.
“People come to trust me very quickly and agree to go to the TB clinic for testing,” says Tursunbayev. “I know how to talk to my clients and make them feel safe.” As a peer, he is able to forge strong connections that others can’t. “I love my work! Outreach is for me. If I can do some good and help people, I know my life is not for naught,” he reflects.
In the year since joining the team, Tursunbayev has become a highly respected outreach counselor, valued equally by his teammates, his community, and the people he helps. His recent marriage and the upcoming birth of a child have been particularly encouraging for his clients. Through him, they see that TB can be cured and, like Tursunbayev, they can go on to lead lives full of purpose and fulfillment.
Since the start of the USAID TB Control Program in 2015, counselors like Tursunbayev have been working in four regions of Uzbekistan as part of multidisciplinary teams established by USAID and its national partners. The program has provided patient-centered outreach and support to nearly 28,000 individuals vulnerable to TB, with 148 patients enrolled in TB treatment and on the road to full recovery.
As a palliative care specialist and former Navy nurse with more than 25 years of experience, I have been lucky to bring my skills to countries around the world as a volunteer with Project HOPE.
I’ve done a fair amount of disaster response, deploying with Project HOPE to Texas after Hurricane Harvey as well as Haiti, Japan and the Philippines in the past. As a disaster response nurse, I’ve overseen disaster management training programs and supported long-term health programs that evolved from those disaster response activities.
I’ve also been able to use my palliative care specialty to train other nurses. In 2016, I volunteered in China, organizing End-of-Life Nursing Education Consortium training for more than 90 nurses at the Wuhan University HOPE School of Nursing. I was drawn to the idea of teaching again during the Pacific Partnership in 2017.
The Pacific Partnership is an opportunity to partner with the United States Navy to implement side-by-side trainings with local health care professionals. Being on a Navy ship getting to teach others was a feeling like no other, so I just knew that I had to return to Vietnam again this year for the 2018 Pacific Partnership deployment.
Being a palliative care nurse, I was assigned this year to the oncology floor where I worked with doctors and nurses to care for one patient at a time. I also spent time every day training other nurses on palliative care techniques. There is a huge need for palliative care learning, especially for nurses, so helping them learn how to provide well-rounded care to the patients was incredibly rewarding.
To me, one of the most important things I can do as a nurse is listen. In Vietnam, I would sit and talk to the patients and ask them what was important to them. Every female patient I talked to started crying during our conversations because no one had really talked to them before about their future, fears or options. I tried to be a role model for the medical staff, showing them that it’s important for the patients to have these conversations instead of avoiding them.
For instance, I met with a 53-year-old woman who had bilateral breast cancer. In Vietnam, breast cancer cases are often much more advanced than in the U.S. The woman was getting chemotherapy, but the prognosis was poor.
I met with her a couple times and we really bonded. She was alone with her 15-year-old daughter and trying to make ends meet despite being sick. With her in the hospital, her daughter was forced to try and hold things together and home. I just felt so much sadness for the family, and for the woman in particular. I knew that just being able to talk to someone would be therapeutic because no one else had asked her for her story yet. And sometimes getting to tell someone your story is just as therapeutic as medicine. Even though I couldn’t fix her, I couldn’t make the cancer go away, allowing her to talk and express her concerns was powerful.
The most impactful thing we can do as medical volunteers is send the message that someone cares. In Vietnam, I saw how the patients felt that and knew it to be true. So educating other health care providers on the power of palliative care and giving them skills that can make a long-lasting difference is one of the biggest things I love about working with Project HOPE.
On June 3, Guatemala’s Fuego Volcano erupted, covering entire towns in ash and driving nearly 13,000 people from their homes. In response, Project HOPE mobilized an emergency response team (ERT) that included medical practitioners to conduct a rapid needs assessment and provide immediate relief and assistance.
Our team visited cramped local shelters, hospitals and affected communities and provided health care services, medicines and logistics support to people in Escuintla and Sacatepéquez. Our volunteers met and cared for those who needed medical attention. A volunteer doctor on the ground, Elizabeth Lee, describes setting up the clinic in Escuintla:
“The road into Esquintla was closed due to landslides and debris and much of the town has evacuated. The Fuego Volcano continued to erupt sporadically, sending ash, sand, debris and toxic air into nearby towns. Yet some people have remained in this town, whether due to worries about looting or because they have no place to go. To enter the town, we had to pass through a couple military checkpoints. Businesses were closed and there were no cars on the road. A thick layer of black sand collected along the edges of the road and fine ash covered roofs and fences. While it seemed deserted, we knew there were people in the town that needed medical care and our challenge was figuring out how to let them know we had arrived.”
“We worked with a local church, built of stucco, painted yellow with a corrugated metal roof, to set up a clinic in the town. Inside were a dozen pews made from pine slats, two horizontally for the seat, two vertically for the back, which we decided were perfect for exam tables. We rearranged the sanctuary and set up shop, deciding where to check patients in and where our “pharmacy” will be. Working with the church, which already had deep connections to the community, we were able to make access to the clinic as easy as possible for residents.”
“Each day, we saw patients, mostly kids and the elderly, with asthma, coughs and sore throats resulting from the persistent ash and smoky air. We also saw patients who were dizzy with dehydration, in pain from burns, abrasions and sprains, plus patients with chronic problems like blood pressure and diabetes. We wrapped the burns, treated cuts, and provided medicines, inhalers and water. We were a lifeline to a community otherwise cut off from medical care.”
In Guatemala, Project HOPE provided health services to 407 people in communities and shelters. Our team worked in shelters, clinics and mobile medical units, and also provided home visits to people living in remote communities. HOPE volunteers also conducted health education sessions with 1,204 patients, families and community members on topics like understanding diagnoses and treatment plans, recognizing danger signs among family members or friends with injuries or illnesses and good hygiene practices to prevent illness. Medical volunteers also developed a color coding system to help patients who were unable to read be able to follow their prescriptions and take their medication properly.
By using the HOPE model of partnering and coordinating with key emergency response stakeholders, we were also able to establish a distribution system to ensure medicines were easily identified, accessible when needed and utilized prior to their expiration date.
Communities affected by the eruption of the Fuego Volcano are facing a long and difficult recovery process. As Dr. Lee says, “There’s no going back for the thousands who had to flee. The towns they lived in and the farms they worked on are gone and it will be decades before anything grows in those areas again.”
This will be a long-term challenge for Guatemala and Project HOPE is committed to helping the people of Guatemala and will continue to explore ways to provide support.
Thanks to Project HOPE and its partners, more than 85,000 high risk people benefited from HIV testing and counseling in Malawi, Namibia, Nigeria, and Ethiopia last year. For many, including Meria and her six-year-old daughter Chisomo in Malawi, the programs are a lifesaver.
Meria had experienced persistent diarrhea and headaches. Too weak to walk to the nearest health center 10 kilometers away, she was unsure of the cause, until community health workers at One Community Malawi stepped in.
One Community is an initiative that aims to mitigate the impact of HIV while preventing new infections in high risks areas. The initiative is funded by PEPFAR through USAID and implemented by Johns Hopkins University’s Center for Communication Programs in partnership with Project HOPE, Plan International and Global AIDS Interfaith Alliance.
A Community Resource Person (CRP) from One Community visited Meria’s village to offer health education and services at a nearby church compound where she was able to find help. At the end of a group session that day, Meria and some others agreed to take an HIV test. She found out she was HIV positive.
Two weeks later, she received an unexpected visit from another CRP with One Community, who had come back to follow up on Meria’s treatment and offered further counselling. This time, she went to the health center and received Anti-Retroviral Therapy (ART) and peanut-based nutritional supplements.
When the CRP made a second home visit to check on Meria and link her to a local support group, he noticed six-year-old Chisomo was sick. He advised Meria to take Chisomo to the health center and encouraged her to bring all her children for HIV testing when One Community was back in the village in a few days.
Six-year-old Chisomo tested positive and was started on ART. She was admitted to the Nutrition Rehabilitation Unit where she was discharged a month-and-a-half later after her condition improved.
“I was taught about how I can disclose to her; the first step I have taken is to inform her of the importance of taking her medication. I told her that it is the reason she is not sick as she was before. She understands and sometimes informs me that she needs to take her medication before I tell her to,” explained Meria.
Motivated by the need to demonstrate positive living to Chisomo who will one day become fully aware of her status, Meria has become a community champion for HIV testing.
“My HIV status is not a secret. I disclose to everyone because I have experienced how close to death not knowing my status brought me. I do not want the same for the people around me. So now, as much as I can, I tell people to get tested,” says Meria.
From her advocacy work she has referred more than six people for testing. Two tested positive and joined Meria’s support group and together, they continue to work and assist each other with our daily lives.
For more information on One Community please visit the website www.onecommunitymw.org.
Project HOPE is a recent recipient of the Pfizer Global Health Fellows Program (GHF), an international volunteer program that places Pfizer colleagues and teams on short-term assignments with leading international development organizations in key emerging markets. During assignments, Fellows use their professional, medical, and business expertise in ways that help increase access, quality, and efficiency of health services for people in greatest need.
As about 100 people settled into the Park Hotel in Delhi, India, recently, they walked into a meeting space unlike most others. Rather than a room setup where attendees would face a stage with endless PowerPoint slides, participants’ chairs formed a circle so that they could face each other, even during the opening plenary session. While there was some uncertainty and confusion about the unique setup, that feeling dissipated as the details of Project HOPE´s Non-Communicable Diseases (NCDs) consultation and the day’s agenda emerged. With this consultation, participants were in charge, not the facilitators. The thoughts, questions, and ideas of those who were in attendance drove the meeting. And it was the responsibility of the participants to capture ideas and questions, and also synthesize findings.
All of the participants were aware of the challenges India faces with NCDs like diabetes and cardiovascular disease and how debilitating the reality on the ground can be. They quickly reached an energetic consensus that the work to solve this problem is not only necessary with regards to public health and human life, but also to ensure India maintains and sustains the robust economic growth it has seen in recent years.
“We figured out how to beat HIV. We can figure out how to beat NCDs, too.”
Having worked at an organization focused on supporting individuals with HIV in the mid 1990’s, I can say that the disease seemed like an insurmountable problem, even in the United States. But seeing how the U.S. and a large part of the world overcame the biggest challenges with HIV, I know India is ready to tackle NCDs. And as the group correctly acknowledged, the diversity and complexity of Indian society requires flexible solutions rather than a ‘one size fits all’ approach.
In his keynote address, Dr. Jitender Singh, Minister of State in Prime Minister’s Office, acknowledged that India has gone from one end of the disease spectrum, malnourishment, to the other, obesity. As he said, disease used to be a “one week affair,” meaning that after a diagnosis was made, a resolution, whether good or bad, came quickly. But with NCDs, solutions must match disease development, so they must be long term and sustainable.
Dr. Singh also pointed out that economic growth will be driven by the health of the population. In India, 70% of the population is under the age of 40, so in order for those people to contribute to the economy, they must be healthy. In the afternoon’s Open Source Technology (OST) session, participants were asked to develop topics of discussion that they would then lead. Within minutes, a number of people had stepped forward to introduce topics important to them, and off the groups went. There were two separate 75-minute discussion sessions on topics like community engagement in healthcare, empowering healthcare workers, and developing sustainable systems to ensure follow up care was available. At the end of both sessions, participants were first asked to vote on the best ideas, then reflect on the experience and share their biggest takeaway from the entire session.
It was a truly inspiring event. And while there are follow up questions, like how stakeholders can continue to work together to take action and inspire action for long-term solutions, the problem is not insurmountable. We know that any action taken will have to be intelligent, sustainable, and flexible enough to adapt to a country of close to one billion people and this consultation enabled leaders in the field to find ways to move toward those solutions.