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One of the main pilars of our work is to train healthcare professionals to enable them to be change agents in their own communities. To this end, we support collegial exchange around best and evidence-based practices for the development of sustainable care models. During the most recent Team Perú outreach campaign, we provided a a training focused on helping first responders in a peri-urban community better respond to emergencies.
Over a 2-day span last week, HBI provided a comprehensive, didactic, hands-on workshop for 65 newly minted first responders in the Alto Cayma neighborhoods of Arequipa, Perú. A group of Team Perú volunteer nurses provided comprehensive training on topics ranging from basic evaluation of the scene and accident and personal protection, to advanced practices in patient transport, CPR, and critical care management skills (wounds, shock, broken bones, splints, and burns).
For HBI, building bridges means we work to support systems level transformation and personnel level formation. Last weeks Team Perú training helped to fill a critical gap in knowledge and skills for providers who are the first to respond to the complex needs of people in a large urban squatter community of over 40,000 people. Future trainings include working with volunteer firefighters and emergency medicine physicians and nurses to create better connections in the pre-hospital response to accidents and trauma. If you’re a emergency medicine provider (nurse doctor, paramedic, EMT) and speak Spanish – consider joining HBI to help train our colleagues in Perú. For more information, please contact us at: Info@HBInt.org
What: Donor and Volunteer Appreciation Picnic
When: Saturday August 8th, 12 – 4 pm
Where: Wallace Park Picnic Sitse 1600 NW 25th Ave, Portland
Who: You and your family and friends are invited to join us anytime throughout the day. Please allow us this small gesture to say thank you for your time, efforts, and donations, which continue to build bridges of hope and change.
Delicious tacos, summer salads, and beverages will be provided. Bring your family, a dessert to pass (if you’d like), and an outdoor activity to share: soccer, basketball, football, water balloons, frisbee, bocce ball, badminton, etc.
Come celebrate a shared sense of advocacy, collaboration, service, and a beautiful Portland summer day. Rain or shine we will be there; the picnic site is covered.
Ruth – February 2015
How do you care for medically fragile children in resource poor environments where educational attainment and economic viability are very low? This is a question that Health Bridges International (HBI) has been wrestling with for years.
In response to this compelling question, HBI developed The Ines Project for Medically Fragile Children. Working in collaboration with the Anglican Church of Perú, HBI initiated a care coordination program in four urban slums of Lima in the spring of 2013.
The project, drawing from the Medical Home model, is a team-based approach that focuses on helping families learn to advocate for their needs. It creates individual health and advocacy plans for medically fragile children who live in low resource areas. The team provides care coordination, health education, healthcare advocacy, and daily planning to each family. These relationships contribute to the rapid improvement in the quality of life for each medically fragile child and their families, as well as increased economic efficiency for the family, community, and health care system as a whole.
The purpose of The lnes Project is not to provide care, but to advocate for services. Working with local community leaders, our team pulls together resources, identifies opportunities, and supports families seeking the knowledge and skills they need to be self-advocates. HBI rigorously evaluates the impact of care coordination on health outcomes, cost containment, and quality of life indicators of the children and their families. Our goal is to expand The lnes Project to a number of communities where fractured services and constrained resources are unable to meet the complex needs of medically fragile children.
This past week I was back in Perú. The focus of the trip was reviewing the current operations of The Ines Project while planning toward expansion under a grant we received in late 2014. We met to strategize and diligently develop a plan for the next phase of our project.
The week, however, was about so much more than just planning meetings and writing to do lists. Early in the week our team went on home visits with Fanny, our nurse care coordinator. We met with family after family living in grinding, desperate poverty – families whose lives are changing due to their enrollment in the Ines Project. I want to tell you about one of these families.
Señora Rojas Quispe (not her real name) has faced many challenges in her life. She lives with her two children in a one-room home built by Habitat-for-Humanity high in the sand hills of a large slum just east of the Pan-American Highway in Lima. Her daughter, Ruth (not her real name), born with profound neurological deficits has a myriad of complex medical needs requiring around-the-clock care.
Prior to enrollment in The Ines Project, she had multiple, daily seizures and was completely incapacitated. Today, she is a smiling, happy 10-year old. However, the road to Ruth’s smile has been anything but direct.
A few years ago Ruth, her mother and her brother were thrown out of their home. Ruth’s father blamed Señora Rojas for Ruth’s condition and he threw them onto the streets with little more than the clothes on their backs. Without family support or a community to lean on they were homeless. Living on the streets, Ruth’s mother struggled to meet the complex medical needs of her daughter. Ruth deteriorated and suffered from a number of complications.
Our Health Ambassador found Ruth and her family at this time. The Ambassador helped to connect them with a temporary place to live and eventually a new home through Habitat. Eventually, about a year ago, Ruth was enrolled into The Ines Project. With great patience, continuous advocacy and the support of a caring team, the family stabilized Ruth. In fact, although Ruth will always have special needs, she is thriving in her new life.
Ruth and her family live in an area of Lima known as the Chanchería – “pigsty” in English. Just below their home is a large area where hundreds of pigs are raised. It is filthy and the smell is overwhelming. Yet, in this toxic environment, there is hope.
Last week, during the home visit, I truly understood the impact of our project. I am not certain words can completely describe the power of helping a child to regain their life. Our program is doing just that. We help children with complex medical and social needs reconnect with their futures. We help their families find dignity and hope.
We are not ending poverty with The Ines Project, and we are not changing the world – yet. We are, however – laying the foundation for economic, social and medical stability for families who have only ever known instability, hardship and pain. We are – improving the health and well being of medically fragile children. We are – helping families learn to advocate for their own needs. We are – building a model that has great potential to be reproduced in different locations and environments.
As we plan for future projects – we won’t forget the people we serve. People like Ruth and her family. Through The Ines Project for medically fragile children we’ve helped over 50 families learn to advocate for their own needs. We’ve developed a model program that has the potential to impact the lives of thousands of children. And that will most certainly change the world.
04 November 2014: The past few days have been a total whirlwind.
On Thursday we had an outreach project in a very impoverished community high on the road to Lake Llanganuco in Yungay. The school, a true model for other public schools in Peru, included primary and secondary grades (K-12). The total student population was no more than 40 – including a kindergarten class. The director of the school has done an amazing job pulling together programs at the government and non-government level to better serve the needs of her students. The school has a small garden where they are growing vegetables that feed the students. They have a field where the money from the sale of the alfalfa goes to offset desperately needed school supplies and equipment. Every student is fed breakfast and lunch – every day. Simply amazing.
We provided a series of health talks to all of the students. It was a great experience.
Later that afternoon we went to the Kawaq Yaku Café in Yungay. The café, run by an expat and his wife, is designed to be an incubator of microenterprise opportunities in the area. Boys from the Casa Girasoles (Union Biblica’s home from formerly abandon boys) work in the kitchen. In fact, the head chef is a formerly homeless boy. The food is great, but the mission of the café is even more important.
Later in the afternoon we went back to the Union Biblica Kusi camp and provided medical and dental care to the boys. Our clinic went on until later in the evening when we finally had to run back to our room to change clothes and stuff things into our bags before departing for the bus station.
Next up was an overnight bus ride (10+ hours) from Yungay to Lima. Thankfully, we were booked into “super cama” – which provided fully reclining chairs. Not exactly a restful nights sleep – but we all got a little shut-eye.
We arrived in Lima early on Friday morning and immediately went to a meting with the Ines Project health team. The meeting, a passing of the baton – as Dr. Townsend Cooper is handing over the reins of the project to Dr. Roberto Tarazona – was a great chance to reconnect on a number of the children enrolled in the project. Dr. Tarazona will be a very important part of the new direction of the project. Dr. Roberto, a Peruvian physician whose day job is with Caritas Peru, is a super networking and connected to everyone. He will certainly open a number of new doors for HBI and the Ines Project.
After the Ines Project meeting, we hurried back to the HBI office in Magdalena where we changed clothes, unpacked our dirty clothes and then rushed off to our next meeting with the Peruvian College of Obstetrics. At our late afternoon meeting with the College of Obstetrics, HBI penned a historic agreement to provide neonatal resuscitation training to all 27 departments in Peru. This is a critical project that will allow us to train thousands of midwives in the skills needed to saves newborns at birth. We are extremely excited for this opportunity.
Friday night ended with a walk to one of our favorite restaurants where we celebrated our new agreement and an extremely successful campaign.
Early Saturday morning we met with a Peruvian accountant who advised us on the steps needed to become a registered organization in Peru. This is a super important step for HBI. For over 20-years we’ve worked in Peru, but until now we have not taken the steps to become a registered organization. We’ve investigated the steps on a number of occasions, but felt the timing was not right. That is until now. The meeting went great and we will be reporting back to the Board with the plans for next steps.
Saturday afternoon included a number of last minute errands and tasks around the office. In the evening we went to dinner with a partner from a deaf advocacy organization. It was fantastic to reconnect with Ernesto. He is an old friend who has for over 40-years been a tireless advocate and servant to underserved children in Peru. He is a real role model and spending time with him always charges me.
Saturday night included a red-eye flight back to the U.S. Never fun – but a necessary part of our work.
Sunday and Monday gave me time to spend with my two lovely ladies and catch-up on emails – and a little bit of sleep.
Today, Tuesday I am back on the road. I’m off to Milwaukee, for a project I’m working on creating advocacy opportunities for children with mental health conditions. I just left Atlanta (I know – why did I fly to Atlanta to get to Milwaukee?) and as my flight left the runaway I watched the ground zoom under the plane and thought to myself – this is truly amazing. It is awe inspiring to travel by air. The simple act of lifting a large metal tube filled with thousands of pounds off the ground is amazing. It’s amazing what humankind can accomplish when we put our minds to it.
Experiencing the power of flight got me thinking about the work of HBI. On paper – the work we do should be impossible. We are a small non-governmental organization with a rather meager budget and only 5 staff. Yet, we serve thousands of people every year with our trainings; direct care programs and advocacy projects. Yes, it should be impossible to do all that we do – but so should taking a plane off the ground.
31 October 2014: On Friday, October 31, Health Bridges International signed a historic 5-year agreement with the Peruvian National College of Obstetrics. It is the first agreement between a U.S. based non-governmental organization and Peruvian professional association.
The convenio (Memorandum of Agreement) with the National College of Obstetrics is to provide training and consultation on the implementation of neonatal resuscitation standards in all the departments of Peru.
Dr. Robert Gehringer, HBI’s Medical Director, will be the lead trainer and oversee the five year implementation and training project.
HBI is proud to partner with the National College of Obstetrics to train professional midwives in saving babies at birth. We will be posting frequent updates to the HBI website throughout the project period.
29 October 2014: Standing in Daisy’s home was overwhelming. The stench was powerful. Dirty clothes hung from a makeshift line in the middle of the one room hut. There was no running water, no bathroom, and no electricity. Rather – a dirt floor, a single bed and a small table covered with discarded papers was all that made-up their home.
It has taken almost ten months to reconnect with Daisy. Trip after trip to the high mountain town where she fled with her family after her father lost his job and their home – continually led us to dead ends. Finally, our outreach worker (Charito) was able to connect with Daisy’s grandparents. Finding Daisy abandon on the streets, they had taken her in and she was living in their dirt floor home. She has not been on any medications for over 9-months and her seizure disorder is completely uncontrolled. Daisy is seizing up to five times per day.
Her grandparents took her to the local health post, but the nurse in charge was unable to help and referred them to a larger city two hours bus drive away. They never followed-up on his referrals. Fearful that the cost of having Daisy seen would be more than they could afford on their meager income as farmers – they turned to traditional healers. Now, Daisy was getting worse and her family did not know what to do.
Our plan is simple . . . and completely complicated. We need to link Daisy into care through the Peruvian government programs. In order to do this, she needs a formal transfer of care from the clinic in her hometown to the Hospital for Children in Lima. Actually, she needs two transfers of care. One transfer from her hometown clinic to the city of Caraz (2-hours bus ride away); and another transfer from the hospital in Caraz to the Hospital for Children in Lima – 10-hours bus ride down the moutains to the coast.
This will not be an easy task. Her father and grandparents are scared. They’re scared of the unknown. They’re scared of going to the big city of Lima where their style of dress, form of Spanish, and general way of being make it completely obvious they are from the mountains – and thereby, a lower socioeconomic class. For the biggest social challenge in Peru is not racial or even ethnic – it is economic. Lower socioeconomic groups face complicated challenges and overt bias. Daisy’s family knows this prejudice all to well . . . and their scared.
Our next steps are firmly based on advocacy. Charito (our outreach worker) will travel back to Daisy’s home in one week. She will take the family to the health post to complete the necessary paperwork and then load everyone onto a bus for the 2-hour trip to the city of Caraz. In Caraz, Charito will help to advocate through the process of transferring Daisy’s care and solidify a referral to the Hospital for Children in Lima. All of this advocacy and planning needs to happen in the next two weeks – or the original transfer of care will expire and the process will need to be started all over again. In addition to the logistically challenges – everyday that Daisy continues to seize she is loosing more and more brain function and more and more vulnerable to death.
There are thousands of children in situations similar to Daisy. The advocacy and support we are providing for Daisy is just a drop in the bucket of the overall need. However, HBI is committed to creating sustainable solutions to the complex challenges facing children and their families living in extreme poverty. With this commitment in mind, we have started pulling together partners and collaborations to expand the services and supports available to Daisy and her family. In fact, we have started to consider how to support an expansion of our Ines Project in the Caraz/Yungay area.
This won’t be easy. The cost of expanding our Ines Project is about $30,000. In addition, we are in the process of defining the next steps needed to sustain the project through Peruvian government funding and regional ministry collaborations. We know building sustainable models of care delivery is a long, slow, tedious process; and our advocacy is based on a commitment to help source a future for children like Daisy. A future filled with hope. A future filled with opportunity. A future filled with health.
Our work is not over. It’s just beginning.
27 October 2014: Without a doubt, the universal lesson of working in any transitioning and developing country is . . . be flexible.
Our plan this week was to provide health outreach projects in public schools in rural and impoverished communities around the town of Yungay. We received a phone call last night (Sunday) informing us that all of the area public schools will be closed on Monday and Tuesday of this week. Evidently, the entire region is celebrating the Festival of Yungay and the schools decided, at the last minute, to close. This news left us scrambling for a plan B for our Team Peru outreach.
In the spirit of bridge building, we quickly connected with our partners in the area and found private schools where we can conduct our health fairs. Today we will be at the Union Biblica Camp Kusi working with the Girasoles (formerly abandoned boys). We’ll be teaching hand hygiene, nutrition, self-care, conducting basic first aid trainings and running a dental clinic.
The last minute change in plans provided an opportunity to shift our schedule and focus a full day of services on the Girasoles at Camp Kusi. When one door closed another opened.
Dr. Robert Gehringer oversees the neonatal resuscitation training and practice of healthcare providers at the Medical College of Trujillo. Mannequins, reanimation masks, training manuals, and other didactic tools are provider by our stakeholders. A suitcase full of supplies is left with each collaborating college to continue training and practicing techniques in order to save the lives of still born babies. If you want to bridge the need to decrease infant mortality with continuing education, didactic tools, and lifesaving techniques contact us at firstname.lastname@example.org or make a donation to HBI NRP training here.
CPR Mannequin – Infant: $150 (3 per kit)
Ventilation Bags for infants $25 (6 per kit)
Training Manuals and other print materials $75 (1 per kit)
Other: towels, stethoscopes, bulb syringes $150 (2 per kit)
Make a donation for one complete NRP training Kit: $975
26 October 2014: We’re traveling along the barren landscape of the coastal region of northern Lima. Our 10-plus hour bus ride will take us high into the Andes. Like a time capsule, the bus ride will transport us to a different place and time.
The villages of the high Andes are otherworldly. They are often cut off from the rest of Peru. They exist as small islands of culture and tradition. Working in the villages feels like taking a step back in time. This week we will work in some of the most remote communities around the town of Yungay. We will partner with Union Biblica del Peru to expand the reach and influence of their schools outreach program.
Union Biblica, a multinational non-governmental organization with operations in over 60-countries, has been working in schools around the country of Peru for over 40-years. They teach “family values” (non-violent communication, healthy living, respectful relationships) to children in an attempt to model new behavior and practices. We’ve been working with Union Biblica for almost 20-years. We bring projects into the schools to provide a holistic health experience for children in desperately underserved areas. We partner with school administrators and classroom teachers to identify children of greatest risk and work to link them to services. This work is a long slow road. Our efforts are often measured in months and years.
Last year during our Team Peru outreach trip to Yungay we identified a young girl named Daisy. She has a critical type of seizure disorder that makes her vulnerable to having multiple, debilitating seizures everyday. She is extremely vulnerable to long-term complications – and even death. I recently learned that our efforts to support Daisy have not been fully successful. After countless trips to the remote village where Daisy and her family were living, the Union Biblica schools worker we hired to help advocate for the family met a brick wall she could not overcome.
Apparently Daisy and her family moved. Her father got into a physical altercation with the foreman at his job at the mines and was fired. They moved to the small town where Daisy’s father grew up. The town, a remote mountain hamlet, offered very little resources. Daisy’s mother quickly left her abusive alcoholic husband because of escalating violence. She moved in with a new man. He did not want Daisy. Daisy ended up on the streets. After an undetermined period of time living on her own on the streets, Daisy’s grandmother found her. When the Union Biblica schools worker found Daisy – she had been without her medication for an extended period. We worked to get Daisy linked back into care and made an appointment for her to be seen at the National Hospital for Children in Lima. We also made arrangements for transportation and accommodations for Daisy and her grandparents. They never showed up.
The Union Biblica schools worker went back up to their remote town, but was unable to find the family. They had, once again, moved. We don’t know where Daisy is now. This saddens me deeply.
Our work with Union Biblica is focused on building greater awareness and support for medically fragile children. We are making great strides – but we still have a long way to go. Our hope is that someday children like Daisy don’t fall through the cracks. Our hope is that every child can have a future filled with goals, dreams and new beginnings.