"As nurses practicing in a well-developed country, all hands were on board with thoughts of aggressive care to provide this child with her best chance," reflected HOPE volunteer, certified registered nurse anesthetist Jenna Dobling.
Her middle name is “Hope”. When she was born, at 29 weeks of gestation, she had a different name– and not much hope. Daran Joy Celino had had a twin who died in utero, sending her mother into premature labor at Tapaz District Hospital, on Panay Island in the Philippines.
“The baby looked malnourished, dehydrated and scared,” said Project HOPE volunteer Melissa Fantasia. At a skeletal two pounds, every rib was visible as she gasped for breath a week after her birth.
Because the $1,000 cost of a month in a facility with an equipped NICU was far beyond the means of the family of eight, the Celinos made the difficult decision to keep her at Tapaz, even though the hospital does not have the equipment to deal with the medical needs of an extremely premature baby.
When the team from Project HOPE arrived, they immediately went to work to set up an IV for Daran Joy, based on the suggestion of hospital nurses.
“As nurses practicing in a well-developed country, all hands were on board with thoughts of aggressive care to provide this child with her best chance,” reflected HOPE volunteer, certified registered nurse anesthetist Jenna Dobling.
But after twenty minutes of working with the too-large needles and the small, hard to find veins, the IV had still not been placed. Daran was crying and the costs, calculated per item used, were mounting.
“I could see in her eyes that she was anxious,” said HOPE volunteer, Massachusetts General Hospital RN Arme Gallanero, who is originally from Panay Island, about Daran’s mother, Maria Rose Celino. Gallanero sat down and talked with her. “Because of all of the people working on the baby, it made her think that something was seriously wrong. So I explained the potential dangers ahead and asked her what she wanted.”
“Once realizing how upset the child’s mother was, we became aware of the ethical dilemma we as nurses trained in Western medicine were facing. Even though our hearts were in the right place, it was important to take into account how to manage this child with the limited resources available,” admitted Dobling.
The HOPE team recallibrated their approach based on the wishes of the mother: to help her feed Daran.
Because breastfeeding wasn’t effective and it was difficult to keep a tube down the baby’s throat, HOPE volunteer Melissa Fantasia, also an RN at Massachusetts General, tried a technique she devised while working in the hospital’s postpartum and respiratory acute care units. Taping a feeding tube to gloved index finger, she inserted it into Daran’s mouth and allowed her to suck. “The method keeps tongue down and doesn’t force the baby to work so hard, wasting her energy,” said Fantasia.
It worked. Fantasia was asked to teach the hospital’s nursing staff her method, and soon a feeding schedule was established. That day, the Celino family decided to change their baby’s name from Daran Joy to Angel Hope.
“I had an epiphany the other day,” said Dobling. “It is basically that global health is about learning lessons, being flexible and adjusting to cultural differences. I’m not here to change anything. I’m here to support these patients.”
Angel’s survival is still a question, but says Fantasia, “I think it’s important for mom to know that people are doing everything that they can to save the baby. Based on the fact that she changed her name to “Hope”, I think that what we are doing also gives her hope.”
editors note: Angel Hope passed away as the Project HOPE team was finishing up their deployment. Jenna Dobling reports that HOPE volunteers were able to accompany the family home and that it was an emotional time for all involved.