First off, an update on the two abandoned babies: they were not there when I went to work after my three days off. I was told that the girl (who was very cute and term) had been adopted, while the boy (who was a premi, but seemed very healthy—though of course small—to me) had died.

Working at HIC has certainly taught me a great many things, none more so than how to multi-task. I’ve gotten used to—though certainly haven’t mastered—watching the perineum’s of two women who are pushing wondering who will give birth first and if I’ll have adequate time to change gloves to catch the second ones baby, to do the admission paperwork while making sure that a resuscitated baby is still breathing appropriately, and to triage patients while checking frequently for the presence of the baby’s head of a woman squatting and pushing on the floor. I’m forever impressed at what the nursing staff (as they are the main staff that run the maternity) do every day. As I say I’ve gotten used to this type of work environment, but it still stresses me out and makes me anxious. They however, are so used to it and so good at balancing multiple patients at once, that I don’t think they even notice it at this point. I think it’ll be a bit of a transition to go back to the U.S. and for each patient to have her own room (instead of an open room with three tables) and to have to certainly still have to multitask, but in a very different way.

This week I had the pleasure of visiting the Maison de Naissance (MN), a birthing type center about 30 minutes from Cayes. MN is located in a tiny town pretty far off the main road and provides much needed services to the women in the area (many of whom would never come all the way to Cayes to give birth and so would just give birth alone, or with a traditional birth attendant). MN had 7 post-partum beds, a two-bed birthing room, provides prenatal consultation serves, and birth control services (among other services). It was really nice to be able to visit MN and see a different type of birthing environment. Because MN is smaller than HIC, it was much calmer than the maternity ward I’m now used to—though I was told I visited on a very calm day. It was wonderful to see what good care the midwives were able to offer the laboring women and those who came for prenatal consultations.  High quality clinics like MN are invaluable—in my opinion—to Haiti as they provide skilled birth attendants and health care services to women in rural areas who wouldn’t typically make the journey to the nearest hospital, but nonetheless need/deserve such healthcare. 

 

NATO soldier

Hope Through Healing Hand's mission is to promote health worldwide as a currency for peace. This Memorial Day, we'd like to say a huge thank you to all of our armed service men and women who have given sacrificially to protect our freedom and to promote peace around the globe. You are heroes in our eyes, and we thank you for your service.

Image from Nato.org

Every Newborn Campaign

Articles and Videos You Don't Want to Miss

May 21 2014

This week has been the launch of the Bill & Melinda Gates Foundation's #EveryNewborn campaign, and we've seen great coverage on social media and around the web on this important issue. Here are some of our top links for you to see, in case you missed them:

Melinda Gates's speech to the World Health Organization on May 20, 2014.

Who Has Been Caring for the Baby? by Dr. Gary Darmstadt, senior fellow for Global Development at the Bill & Melinda Gates Foundation

Saving 3 million Babies Is Easier Than You Think, from TIME's Jeffrey Kluger

 

May Newsletter

May 15 2014

Happy Mother's Day!

Her.meneutics article: "Family Planning Through A Global Lens," by Jenny Eaton Dyer, Ph.D.

Christianity Today's Her.meneutics features articles that are at the interface of women's issues and cultural issues. We were proud to have the opportunity to publish an article this week discussing the importance of access to contraception and information about a variety of family planning methods, including fertility awareness, in the developing world. These are life-saving, life-changing tools for women and families. 

In a season when contraception is debated and discussed in our own nation, it is important to consider how contraception is a pro-life cause worldwide.

U.S. Moms Support Healthy Mothers and Children Worldwide this Mother's Day

This week, Hope Through Healing Hands launched a press release citing notable faith leaders, influentials, and parents who have taken a stand to promote awareness and advocacy for maternal, newborn, and child health. 

Amy Grant, Grammy-winning Artist, notes: “Those of us who have experienced healthy pregnancies here in the U.S. need to remember how uniquely fortunate we are. For the most part, we get to choose when and how we give birth, and we have all the health care we need before, during, and after delivery. In other parts of the world, the reality is tragically different. It is estimated that 1 in 39 pregnant women in Africa died in childbirth in 2013.”

We are excited to share all the leaders who have generously offered their endorsements to the coalition. We invite you to take a moment to read about why they are speaking up for women in the developing world.

Speaking Engagements: Why Family Planning is Critical in the Developing World

Over the course of the past month, Executive Director Jenny Dyer, Ph.D. had the opportunity to speak at the Center for Strategic and International Studies on "Ethiopia's Investments in Family Planning: Lessons for U.S. Policy" along with other experts. Dyer spoke on the interface of faith and health pertaining to healthy timing and spacing of pregnancies in the developing world and its role in awareness and education both in Ethiopia as well as the United States.

We invite you to learn more about her trip to Ethiopia as well as the event. Please see the "Family Planning and Linkages with U.S. Health and Development Goals" policy paper as well as the video showcasing the amazing work done there in family planning.

Dyer also spoke at ETSU's College of Public Health on "Saving Mother and Child: Why Planning Families is Critical in Developing Nations." She offered a lecture to students and faculty that can be viewed here.

We wish everyone a Happy Mother's Day,

Bill Frist Signature

Bill Frist, MD

Originally published in The Tennessean, May 3, 2014

When we married in December 2007, we knew we wanted to enjoy the adventure of marriage together for a while before having children. So, we concocted a whimsical battle cry: “Baby Free Until 2013!”

In summer 2013, after thoughtful conversations, we decided to go off birth control. And lo and behold, we quickly became pregnant. The battle cry worked.

As we watch Jena’s belly grow, we realize how fortunate we were, especially as some of our closest friends and family have not had nearly as much ease. We also recognize that for many, contraceptive access and the ability to time pregnancy are not universal.

You see, we work for two organizations that provide health care to HIV-infected and affected people in Africa, and we have been given a unique window into the lives of many girls, women and men in countries like Kenya, Uganda, Zambia, Ethiopia, Rwanda and Central African Republic. For our friends in that part of the world, the nuanced discussion of family planning is very different than the one we hear in the U.S.

In Lwala, Kenya, 16-20 percent of the adult population is HIV-positive. The Lwala Community Hospital is providing more than 1,000 HIV patients with life-saving medical care. Many of these patients come to us for contraceptive options.

Try to imagine that you are our friend Maurice. You are facing some frightful questions because you are HIV-positive, but your wife, Betty, is not. A nurse explains to you that the hospital is out of condoms, so you must abstain from sex or risk infecting Betty. The nurse says the condom shortage is nationwide and there is nothing she can do.

Imagine that you are our friend Sarah. You are just 13 and a new mother to a premature baby boy named Moses. You have had to drop out of school to care for your new child. You did not plan on getting pregnant, but an older relative forced himself on you while he was drunk. Your parents know about the rape but have decided not to confront the relative and instead blame you. Your circumstance makes you one of the 300 pregnant teens who delivered their babies at Lwala Community Hospital last year.

When you bring Moses in for immunizations, you ask the nurse for birth control pills, but she tells you they are not available to you without parental permission. “How do I avoid getting pregnant again?” you ask.

For us as Americans, these seem like unimaginable predicaments related to contraception — catch-22s with life-altering consequences. But, sadly, these stories are not unique in Africa.

We are Christians, propelled by our faith in a loving and merciful God to do the work we do. Most of the year, we make our home in Tennessee. We are not abortion-rights activists or “lefty liberals.” We understand why some people of faith are hesitant to support increased access to contraceptive choices. But our view has been broadened through our experiences and the many conversations we’ve had with families in Africa.

The nuanced circumstances of couples like Maurice and Betty, or young teenagers like Sarah, cannot be addressed with one-dimensional responses. We must take seriously the complexity and urgency of the dilemma for many around the world. International policies, politics and financing must do more to account for the real predicaments people face.

We believe that families have the right to time their child-rearing; protect themselves against HIV; and pursue healthy, productive and prosperous lives. We believe that teenage girls should be able to avoid unintended pregnancies and the difficult decisions and desperate measures that sometimes follow. And we believe that access to contraception is critical to reducing poverty and promoting health.

As we welcome our newborn baby, we invite you to join us in respectfully broadening the conversation around contraception to include the perspective and urgency of our friends in Africa.

James and Jena Lee Nardella live in Nashville. James is executive director of Lwala Community Alliance, and Jena is co-founder of the nonprofit Blood:Water Mission.

CSIS Ethiopia blog

In January, we traveled as part of a CSIS delegation to Ethiopia to see the work happening there in their Health Extension Workers program. Because of their leadership focus on advancing maternal health and the healthy timing and specing of pregnancy, contraception use has risen from 15% in 2005 to 29% in 2011. This is a tremendous gain, although there is still a long way to go before every women who wants access to contraception has it.

Watch this video to learn more about the program.

By Jenny Eaton Dyer, PhD

Having just concluded teaching my annual course at Vanderbilt, Global Health Policy and Politics, I am inspired to write a blog series based on a session I teach regarding the “psychology of global health.” In that session, I have students read a chapter from Peter Singer’s The Life You Can Save. In this chapter, he outlines six reasons  for “Why We Don’t Give More” in terms of philanthropy.

In this blog series, I will write on both why you may OR may not care about global health, along these lines of Singer’s arguments, and I will offer reasons for both. I think this helps explicate our thinking and behavior when it comes to helping people in our global village. It may explain why you are drawn to a specific nonprofit to donate or why you could care less about advocacy, for example.

The first reason it is difficult for us, as humans, to care about global health issues is that it is overwhelming! We are MUCH more apt to give or participate if we focus on ONE single person. Studies show that if we can focus on ONE name, ONE face, and ONE story – we will donate or act far more than if we had the opportunity do the same amount of good for 1000 people. Or even just two. This is called focusing on the “identifiable victim.” We have the capacity to hone in on the one, but not the many. Not even more than one. 

Because a group of people can easily succumb to anonymity in our minds, we lose the emotional stamina and persistence it takes to altruistically donate or take action to save lives. “The many” overwhelms our emotional response system.

We need an image of just ONE person to sustain our interest long enough to feel a human connection, perhaps a transference, with their personal story. This is why child sponsorships are so successful, for instance.

Perhaps put more clearly, we have two systems of thinking. Our first system is emotional, intuitive, and reactive. This system allows us to give generously during an earthquake as we mourn the victims or come to aid quickly during a flood. This system responds immediately with an outpouring of altruism.

Our second system is analytical, logical, and deliberative. As we consider more deeply our actions, we tend to act less quickly and allow for strategy and pragmatism to prevail. 

Most non-profit organizations will attempt to elicit your emotional—system one--response  to a crisis. They want you to move quickly without much analysis.

When it comes to advocating for maternal and child health and the healthy timing and spacing of pregnancies, we instead are asking you to deliberate. To think along the lines of action at a global scale. We would like to ask you to engage system two for a thoughtful, long term stragey of prevention.

220 million women around the world don’t have access to family planning but want to avoid pregnancy, and 287,000 women lost their lives in childbirth last year. Moreover, 6.9 million children will die from preventable, treatable disease this year.

We challenge you to think strategically about these problems for a moment and to partner with us as we draw on years of research, on-the-ground experience, and cultural expertise.

Over the next several weeks we’ll discuss why you may or may not care about global health. We will review Singer’s work highlighting how futility, parochialism, the diffusion of responsibility, fairness, and money affect the good we could do for global health.

We will look at the flip side of that as well. We will discuss why global health is of utmost importance in terms of national security, foreign policy, economics/investments, public health, and humanitarian reasons.

In this age of increasing globalization—we are the generation that can feasibly achieve global health goals for millions. Far beyond our expectations.

We hope you will join us.

 

Technology and Poverty

Contraception in Ethopia

Apr 09 2014

Roman Tesfaye quote

Today, I am speaking at the Information and Communications Technology for Development and Faith (ICT4DF) Network Conference preceding the Infopoverty World Conference hosted at the United Nations this week. This conference focuses on the interface of technology and the alleviation of poverty in the developing world. In particular, my session hosts a number global health experts speaking to this issue from a faith-based perspective. Questions include: (1) How do ICT4DF tools maximize results in empowering global missions outreach and sustainable development; and (2) how can we transform traditional organizational paradigms from charity-based missions to maximum impact for developing communities. 

I speak at the Church Center for the United Nations on the new technologies of family planning or Health Spacing and Timing of Pregnancies (HTSP). I will discuss the issues and facts around maternal, newborn, and child health as well as HTSP.  In doing so, I will highlight Ethiopia as a strong example of increased contraception prevalence. Moreover, I will share the newer implant, Jadelle, as a contraceptive option available for Ethiopian women who wish to avoid pregnancies for up to five years. These kinds of technological advances in reversible contraception will save lives, keep girls in school, and increase economic stability—for families and for the nation.

Roman Tesfaye quote

 

While working in the Accident & Emergency Department in Georgetown, Guyana, I noticed one thing that was very different from what I’m used to back in Nashville: few to no ambulance arrivals. That is because there is essentially no EMS system in Guyana.

There are a few ambulances that are a part of the hospital system. These are used mainly for transport between outlying hospitals and GPHC, where I was working. They are also used to transport patients in our hospital to the CT scanner, located in another building, or to transport laboring mothers from the L&D ward to the main hospital, where the operating rooms are located. When used for transport from an outlying facility, they are staffed with a driver, sometimes a nurse, and an “attendant”, who might be able to assist the nurse. In addition, multiple family members will usually ride with the patient.

I happened to glance in the back of one of these ambulances to see what sort of equipment they carry. Not much, I found out. There is room for a stretcher along one wall, and along the other wall is a long bench for other passengers. There was an oxygen tank under the stretcher, although I could not tell how much, if any, oxygen was present. Having worked in EMS, I am used to seeing a bag full of airway equipment, some suction equipment, and some basic medications and IV start supplies; none of this was present on this ambulance.

While working in the A&E I received a few patients who had been transferred via this ambulance service. Occasionally, they came with a nurse who could give a patient report, as well as some papers with labwork and a history, but often we had little to no information about these patients. Notably, I never treated a patient brought in by an EMS crew from any sort of scene (i.e. an automobile accident or a medical emergency from home). Guyana does have a 911 equivalent for calling for an ambulance, but this number is not staffed at all times. Even when you can get through to someone, there is no telling how long it will be before an ambulance is available to pick you up, or what sort of personnel and equipment will come with it.  Most people who are the victims of some sort of trauma will either take a taxi or have a family member drive them to the hospital.

The problems with this are many. First, for trauma patients, there is no spinal immobilization. There are occasional attempts to stop bleeding by family members or bystanders, but often these were unsuccessful. At home, our fully trained paramedics will often pick up a patient with heart failure and severe respiratory distress and by providing treatment in the field and in the ambulance will have them almost asymptomatic by the time they arrive in the Emergency Department.

As an Emergency Physician and former EMT, I have read about the start of EMS in my country, when there was little to no actual medical care provided and was more just transportation. I was continually reminded of that while in Guyana.

The week I left, the Rotary Club had returned for the second part of a series of paramedic classes for the nurses in the hospital. While I think it is wonderful to provide this additional training, there is still much do be done in terms of infrastructure to create a functional, though needed, EMS system. More ambulances will need to be obtained, and a minimal level of equipment will need to be stocked and maintained on the ambulances. There must be a more cohesive system for dispatching the ambulances, as well as some sort of base at which the ambulance and crew is quartered. There will also need to be qualified personnel to work on the ambulances.

There is tremendous potential in creating a transport system that can respond to emergencies, provide some minimal, life saving care, transport patients to the hospital rapidly, and communicate with the receiving hospital to give basic patient information and acuity, particularly for the trauma population.

It took a while for me to realize how spoiled I am back at my home hospital, as compared to GPHC. Of course I immediately realized that that had different medications, fewer medications, and access to fewer labs and imaging tests, but I had expected and was prepared for most of that. But then one day it hit me: individually wrapped alcohol prep pads. There are at least a hundred of them in every patient room back home. In my haste to grab one, I probably drop about 3 on the floor and never pick them up.  They don’t exist at GPHC. Here, there is a large container of cotton (like a giant cotton ball), over which someone pours alcohol and then you pull off a piece of cotton.

Ashley Brown baby

After that, I began to notice more and more how spoiled I had been. One patient had accidentally ingested a bit of formalin. What would have been a 5 minute call to the poison center became over an hour of research and calculations to figure out if she had ingested a lethal amount. A 6-year-old child with an unrepaired congenital heart lesion arrived cyanotic (blue), with dangerously low oxygen levels. Though I had just given the residents a lecture on the topic a week prior, this was the first patient I had actually seen with the condition, as most patients in the US with this lesion have had it repaired very early in life. We gave the appropriate treatment within the bounds of available medications, but what I really wanted was a conversation with a pediatric cardiologist.

I will come home appreciating all of these experiences when I had to figure it out on my own, and I think I am a better physician because of it. Now, though, I have a new appreciation for the vast resources that are just a phone call away.

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