Thursday, September 25, 2008

Project HOPE Volunteers Don't Slow Down Their Pace

This is the last blog entry in the series "Snap Shots from the Field" written by Project HOPE volunteer Lynne S.

Lynne, a freelance writer from Oregon, was HOPE's volunteer Public Affairs Officer (PAO) on the USS Kearsarge while it was in Nicaragua. Thanks for your hard work Lynne!

Happy reading!

Snap Shots from the Field... "Everyone will be this day."

Project HOPE volunteer nurse Michelle Pena listens through a stethoscope, then tells another woman that her heart sounds good. Pena’s eyes lift when the woman hands her a foil packet of medications she was told to take. Pena and a military doctor carefully scrutinize the packet, trying to determine what kind of medication it is.
A cooling breeze flows through the open windows of the classrooms. Shadows disappear and the lines outside slowly dwindle to a few dozen people.
As the day winds down, medical providers are acutely aware of people still in line, many of whom have waited all night to see someone.
Most of the doctors and nurse practitioners see an average of 50 patients each day. They are exhausted, yet no one slows down their pace.

There are just too many people who need help. Fortunately, everyone will be seen this day.

Monday, September 22, 2008

Project HOPE Volunteers Dispense Education Not Just Medication

In this excerpt from Lynne's notes she writes about the different ailments, sometimes uncommon in the US, Project HOPE volunteers see on these missions. She also writes how volunteers also try to dispense education to their patients while treating them.

Thanks for reading!

Snap Shots from the Field... "Every contact with a patient is an opportunity to educate."

The mother is clearly proud of her son. He’s a handsome boy with bright eyes and hair neatly brushed back from his forehead. Her hand drifts over his shoulder and her fingers gently alight on his back as Project HOPE volunteer MD Dale Rai quietly asks him questions. The boy, maybe about 12 years old, appears to be in good health.

The mission offers doctors like Rai the chance to tackle cases not normally seen in a standard practice, like malaria and dengue fever. But for the moment, another patient arrives and the man in front of him is complaining of a sore back. To the bemusement of his patient, Rai drops down to his hands and knees and slightly arches his back to demonstrate an exercise that will relieve back pain.

For many people, this is their only chance to see a doctor. The Project HOPE volunteer doctors and nurses who have descended on the school are some of the best in their field. But even so, health care this day comes in a bare bones classroom with rough cement floors, no private rooms and only the instruments carried on shore by doctors and nurses. People plagued by problems for months, even years, are hoping doctors can do something, anything to help them.

Inside another classroom, Christopher Truss listens as a translator tells him the woman in front of him is complaining of worms that have crawled up her GI tract. He’s seen it many times before. “They block your intestines and you pass worms in your stool,” the gastroenterologist says matter-of-factly. Worms are endemic within the local population and de-worming for parasites is one of the most common problems encountered by medical providers.

“Many people are the walking-well,” says Truss, “people with chronic problems but no access to care. He admits that not every problem can be dealt with, “but even some suggestions can make a huge difference,” he says. Every contact with a patient is an opportunity to educate; telling patients to frequently wash their hands or to clean food with boiled water is just as significant as dispensing medications.

All day a Navy combat photographer weaves in and out of the various clinics set-up in classrooms. One moment he’s assisting an injured man through a door, the next, snapping compelling photos of the people who have come here this day. “This is the best work I’ve ever done while in the military,” he says proudly.

And so it goes throughout the day. Teams of translators, medical providers and support staff work their way through a maze of problems hour after hour. They sit without complaint, listening, questioning, and utilizing the best of their expertise.

“Easy, easy, does it hurt?” Rai asks while scraping a benign tumor from one man’s scalp.

Wednesday, September 17, 2008

Project HOPE Volunteers Offer Care to Women and Children

Lynne S. accompanied Project HOPE volunteers day in and day out as they headed back and forth from the USS Kearsarge to shore to provide care for the people of Puerto Cabezas. Below she recounts what she sees and hears in Puerto Cabezas, Nicaragua.

Snap Shots from the field...Life in Puerto Cabezas

In Puerto Cabezas’s grinding poverty is awash in contradictions. One Nicaraguan woman familiar with Puerto Cabezas tells me how air conditioned taxis wait down by the docks for returning lobster fishermen whose pockets are loaded with cash. Lobster divers squander their hard-won cash on drugs, prostitutes, and air-conditioned taxis that drive them around all day. Little money reaches their families, she says.

Nonetheless, poverty is extreme and it’s the women and children who bear the brunt of it. Lack of working infrastructure means garbage is heaped everywhere you cast your eye: on sidewalks, streets, around the tiny wooden shacks that serve as unofficial stores. At the local hospital, buzzards feed on medical waste left on the ground. Piles of moldering garbage are scattered throughout the hospital’s boundaries, crowding the walkways that one worker swabs with a wet mop and some kind of disinfectant. Her efforts seem utterly useless.
What’s even more striking is that, despite the poverty, locals show up at the clinic in clean shirts and dresses, obviously their very best clothing. Little girls arrive in flouncy princess-style dresses that bring out the cameras. It could be a sign of respect for the volunteers at the clinic, or it’s simply customary to dress in your best when seeing a doctor.

Indeed, there is no mistaking the importance of the moment. People listen intently to the visiting U.S. medical personnel, leaning forward, absorbing every word spoken, whether it’s in Spanish, fluently spoken by many of the doctors and nurses, or through Miskito translators.

Monday, September 15, 2008

A Project HOPE T-Shirt is a Symbol of HOPE

In the excerpt below Project HOPE volunteer public affairs officer Lynne S. recounts how the hundreds of patients waiting to be seen by the American doctors and Project HOPE volunteers mistake her for a health care provider as she walks around the clinic in Puerto Cabezas, Nicaragua and what a enlightening experience it is to realize that her Project HOPE t-shirt is much more than just a uniform to the people waiting in line.


Snap Shots from the Field...“Excuse me, miss, can you help me?”

Leaning over the wire fence and dressed in a white ball cap, open-neck shirt and jeans, Roy Fredrick, 27, has spotted me in my “Project HOPE” t-shirt. As I turn, a broad smile spreads out over his smooth-skinned face. “My grandmother needs help,” he says, gesturing to a nearby elderly woman sitting on a fold-up chair. Her eyes are blurry and in pain, he says, hoping that I will somehow fast-track her inside.

The screeners have heard every story possible from people who are desperate to get to the head of the line. Lines begin to form around 3 a.m. as locals wait for the Continuing Promise teams to arrive each morning. Many say they have walked 7 or 8 miles to get to the clinic.

I speak to one of the military screeners, asking if it’s possible to get her in early. He shoots me a weary look. It’s a request he’s probably heard not once but dozens of times this morning. Everyone is sick; everyone wants to get in first.

While we wait, Roy, born in the south near Bluefield, tells me that health care is almost impossible to get. People have come today because they know the U.S. has the “best people and the best pills. It’s a big opportunity to get help.”

While talking, we are rapidly surrounded by people pressing against the fence who mistake me for a doctor or nurse. Five or six people clamor to speak to me at once. One man pulls his eye lids down, gesturing at me to take a look. Another shoulders Roy aside and speaks to me in Miskito, the indigenous language, while he pleads for help.

It’s a sobering moment. Earlier that morning, I casually slid on my Project HOPE t-shirt while dressing, giving it little thought. Suddenly it’s no longer a garment worn for work, but a potent symbol of hope.

Friday, September 12, 2008

Project HOPE Volunteers Completed Important Work on the USNS Mercy

David Eddy, Project HOPE's Operations Officer onboard the USNS Mercy Profiles Volunteer Lynne Bouffard

It was another rainy morning that turned hot and humid at the Waigani village, the primary care medical site in Port Moresby, Papua New Guinea. The local population had lined up as early as 0230 in the morning with hopes of receiving free medical care provided by the USNS MERCY health care provider teams. These teams were comprised of Navy staff, partner nation medical staff, Project HOPE volunteers and other international groups.

Project HOPE has once again supported the U.S. Navy in the Humanitarian Civic Assistance (HCA) mission, Pacific Partnership 08 to Vietnam, Timor Leste, Papua New Guinea, and the Federated States of Micronesia aboard the USNS MERCY Hospital ship. As the Operations Officer for this HCA mission I was blessed to have such a devoted and dynamic team of health care providers with me. Physicians, Pharmacist, Pediatric and Family Nurse Practitioners, Midwifes, Medical-Surgical Nurses, PACU Nurses and Nursing Educators from all over the U.S. brought a plethora of skills and talent. In all, Project HOPE brought 34 volunteers to these missions.

One of Winchester’s own, Dr. Lynne Bouffard, a Family Nurse Practitioner gave up 40 days of employment to volunteer her services to Project HOPE for this worthy cause. Because of Lynne’s expertise, she was used extensively in both the Papua New Guinea (PNG) and Micronesia medical missions that covered over 18 different sites for one to three day intervals.

Lynne’s typical day was getting up at 0430, eating a very small and limited breakfast, and reporting to the rallying point called Casualty Receiving area to muster (Navy word for accountability formation), and picking up her MRE for her lunch meal. MREs or Meals Ready to Eat are a high calorie meal in a plastic bag used on a regular basis by our military. After muster the boarding of the band-aid boats (a small Navy boat used to transport up to 20 people) would commence to transport all to shore. Transferring from one moving ship to another in the open sea can be a tricky, and it’s always a wet experience. Once ashore, all providers are moved across land by local buses to their designated work site. Everyday regardless of the site location the scene was the same. A line of people waiting in the morning rain sometimes extended more than a mile long on the muddy paths leading to the work site. Very few of the people wore shoes, but those that did displayed sandals that for the most part had been worn out some time ago. Tired and wet by the time they reached the front of the line to be treated, they always provided the greeting of the day with a big smile. More times than I can count the people would say to me and the rest of the providers, “Thank you for what you are doing for our people. God bless America”.

Respiratory illnesses in all age groups ranging from mild upper respiratory infection to tuberculosis, asthma, and pneumonia are quite common. Malaria in PNG is an enormous issue. HIV rates are high, and leprosy a disease uncommon in the U.S. is also an issue.

The team by the end of each day had seen over a thousand people. At 4:30pm, all equipment would be packed up for the return to the port to be transported back to the USNS MERCY ship. Dinner, the Commodore’s daily update, and Project HOPE's daily review meant that Lynne and the rest of our volunteers were free to shower and go to bed after 8:30PM. A long day for anyone, and certainly a long day for a volunteer that has traveled so far from home to provide medical care to a people that seldom ever see a health care provider.

As long as the days were, Lynne never complained once. Every evening when I would ask her how her day was, she would always smile and indicate “I had a great day”. While her experience was great, she and the rest of us paid an emotional price for the suffering from illnesses and injuries that we witnessed on a continual basis. You can’t help but lose a piece of your heart to these very sick children and adults. While Lynne’s stories could be many, she was humbled just to be in their presence and to assist them in their time of need.

The people of Winchester can be very proud of what Lynne and many like her do out of the kindness of their own heart. We at Project HOPE are blessed to have such professionals represent us every single day in these endeavors. They give up their jobs, vacation, and retirement to support such a noble calling. Project HOPE's credibility and legacy are a direct reflection of their absolute professionalism and the spirit of American volunteerism.

Lynne is no stranger to volunteerism. she was the first nurse practitioner hired by the Northern Shenandoah Free Medical Clinic to provide care to the working poor. She continued to volunteer at the clinic for over 7 years while working at Selma Cardiovascular Associates in Winchester . In 2006 she was awarded the Free Medical Clinic Volunteer of the Year. she presently lives in Fredericksburg with her husband David and children Jennifer and Jonathan

David A. Eddy
Pacific Partnership Operations Officer
Project HOPE

Wednesday, September 10, 2008

Project HOPE Volunteers Offer Comfort in Nicaragua

Snapshots from the field are notes and stories collected by Project HOPE volunteer and freelance writer Lynne. Lynne joined our medical volunteers as they worked along side the team from the USS Kearsarge for Continuing Promise '08--a humanitarian mission to Latin America involving non-governmental organizations, the U.S. Navy and government organizations. In the excerpt below volunteer Lynne recounts the story of a lobster fisherman from Puerto Cabezas, Nicaragua. Lynne spoke to the fisherman as he waited be seen for his paralysis.


Snapshots from the field...Fishing for Lobster

They are visible everywhere. Men with weathered faces awkwardly hobble around with canes and walkers; others manipulate curious home-made wooden wheelchairs that look like carts with levers spun around to propel the cart forward.

Robert Gilberto Mendiola looks older than his 37 years. Laboring for every breath he takes, he shuffles along with the aid of a walker. He barely covers a foot before he stops, utterly exhausted.The lobster fisherman is paralyzed on his right side. Clad in a blue t-shirt and embroidered jeans, he swabs his face with a face cloth. There is no expression on his face, or hope in his eyes. He's come here this day expecting Project HOPE to cure his debilitating injury.

A lobster diver for 20 years, Mendiola is a casualty of an industry where untold numbers of men are paralyzed, maimed, or killed as they drop to ever greater depths in search of lobster. The more lobster grounds are over-fished, the deeper they dive. Safety standards appear to be non-existent and decompression sickness is rampant.

Through a translator, Mendiola claims he can hold his breath for 30 minutes; he says he plunged to 130 feet. The dangerous work left him with a decompression injury, paralysis and a wife and six kids to feed. Five hundred men have died where he works, Mendiola says.

He jiggles one knee in agitation as he speaks. "It's the only income they have; there is no other way to survive," the translator explains while Mendiola falls silent. "No jobs in the city (Puerto Cabezas)." Lobster divers are a major source of income for the town. The temptation to take such risks is great. I learn that a lobster diver can earn $500 US and more for 12 days of work.

Many now are making less as lobster grounds are depleted and divers plunge deeper and deeper in search of them. How will Mendiola feed his family?"Only God knows," he says. He needs help to stand. He looks down towards the pharmacy set up by Continuing Promise 2008. Anyone else can reach it in a swift few steps; it will take Mendiola a good five minutes even with the aid of an enlisted man. He can't afford painkillers, but today, they are free at the clinic. He knows nothing can be done for his paralysis, but he came anyway, desperately seeking answers.

Monday, September 8, 2008

Project HOPE Volunteer Lends an Ear in Nicaragua

Below is another excerpt of notes and stories from the Nicaragua portion of the Continuing Promise mission. These notes and stories are of our volunteers and their encounters with local patients in the coastal town of Puerto Cabezas and were written and compiled by Project HOPE volunteer Lynne S. Enjoy!


Snapshots from the field..."It was important that someone listen to him."

Nearby in Medicina General # 2, Eddie drops his motorcycle helmet on a desk and slides into the cramped school desk in front of Project HOPE volunteer Maria Rivera, who is a family Nurse Practitioner (NP) and a certified nurse mid-wife.

Perspiring, hesitant, his face is lined with weariness. Five years ago, he slowly tells Rivera, he was robbed at gunpoint. Filled with anxiety, he can’t sleep at night. Rivera nods, listening carefully. She knows he can’t afford professional therapy, and it’s not part of the services offered by Continuing Promise this day. She gathers her thoughts, quickly debating what she can offer from the limited medications available at each site.

As she begins to speak, he leans forward, hanging on her every word. “I’ll give you Benedryl to help you sleep, but you need to seek out a family member, trusted friend, or a member of the clergy,” she urges. “Find someone you can talk to.”

Eddy looks down and away. Dozens of people wait outside for their turn, but Rivera is willing to give him the time he needs. “You were assaulted, yes, but you are here, alive and well, and that's a good thing.” He stands slowly, thanks her and leaves.

“For Eddy it was important that someone listen to him,” she later explains.

She speculates that it’s probably the first time Eddie has ever had a chance to talk about his ordeal without being criticized or questioned. The work of Project HOPE volunteers goes far beyond dispensing medicine; often, they may be the only safe place for someone to talk, especially in a culture where machismo is ingrained and feelings are kept hidden.

Not long afterwards, Rivera leads a young pregnant mother behind two white sheets draped over wire. “Can you hear that?” the maternal child health care specialist queries as she manipulates her field Doppler over the woman’s swollen abdomen. The entire room is filled with the echoes of a tiny thump thump, thump thump. The young woman smiles in disbelief. It’s the first time she’s ever heard the heartbeat of her 12-week-old baby.

Friday, September 5, 2008

Project HOPE Volunteer Provides Snap Shots from the Field in Nicaragua

While our first set of medical volunteers were on the USS Kearsarge in Latin America as part of Continuing Promise '08, Project HOPE also had a volunteer public affairs officer on board to capture moments, pictures, and stories from the field. Lynne, was aboard the Kearsarge for two weeks. She really did a wonderful job of capturing the day in life of a Project HOPE volunteer. Below is the first snap shot of a series that will be posted to our blog. Thanks for your support!

Snap Shots from the field... "Someone mentions it’s 122 F outside."

Or maybe it just feels like it outside Juan Amos Comenius High School in Puerto Cabezas, Nicaragua. It’s barely 9 a.m. and already shirts are soaked through. Sweat streams down faces. Puffs of red dust swirl about as dozens of feet pound back and forth.

Inside the broad courtyard ringed by classrooms, Project HOPE volunteers, military doctors, nurses---medical, dental and optical—along with support people, are scrambling to man stations set up inside various classrooms. Hammers pound and saws whine as Seabees build benches for the school library, repair ceilings and re-wire dilapidated classrooms. A CH-53 E Super Stallion helicopter clatters overhead.

Hundreds of locals, including many indigenous people, the Miskito, are lined up outside a decrepit chain link fence, waiting to be pre-screened for the clinics. Curious, patient, they watch the controlled chaos.

Babies squall. Scrawny, emaciated dogs dart underfoot searching for scraps of food. Life is hard here in this remote, difficult-to-reach town on Nicaragua’s Caribbean coast, 232 miles from Managua over barely passable roads. People...dogs...every living thing appears to face an uphill battle to survive in this environment. Women fan themselves and mop faces with face cloths brought from home. Others walk about with small towels draped over their heads to ward off the burning sun.