39 th National Conference on Pediatric Health Care So you want to go on a medical mission trip but don t know where to start. March 19-22, 2018 CHICAGO Disclosures I have no relevant financial disclosures. Kristin S McHarg, CPNP, IBCLC Learning Objective USNS COMFORT Hospital Ship with PROJECT HOPE LITTLE BY LITTLE HAITI Name three components to consider in choosing a medical mission trip. My personal experiences 2007 2009 2011 2017 HOMBRE VCU Medical School trip to Honduras USNS COMFORT USNS Comfort Project Hope Hopies and all service military personnel 1
Helicopter flights to and from the ship in Guyana and Suriname Tents/ school buildings/ other sites for clinics/ screening for possible surgery Church clinic spaces in Honduras USNS COMFORT Hospital Ship with PROJECT HOPE LITTLE BY LITTLE HAITI My personal experiences 2007 2009 2011 2017 HOMBRE VCU Medical School trip to Honduras Applying Dental Sealants in Honduras Water filtration system taking water buckets to villagers in their homes 2
Residents learned to filter their drinking water Honduran village home and family Port au Prince, Haiti in 2011 after the 2010 Earthquake USNS COMFORT Hospital Ship with PROJECT HOPE LITTLE BY LITTLE HAITI My personal experiences 2007 2009 2011 2017 HOMBRE VCU Medical School trip to Honduras Tent cities in Port au Prince, 2011 Gramothe village, across the mountain from our guest house 3
Hiking to work down the mountain, across the river bed and back up another mountain Optional ride to clinic on an ATV or in the back of a pick up truck Open air clinic spaces no electricity until 2017! Clinic spaces curtain dividers and 8 stations some with dental chairs Line up to be seen on the first day of clinic A home in the village of Gramothe 4
Villagers washing their laundry in the river bed stream Carrying loads of onions to market Is it a surprise that many visits to the clinic are for neck and back pain? What to Consider in Choosing an Organization TIME COMMITMENT COST RELIGIOUS OR SECULAR FOCUS EXPECTED ROLE LANGUAGE/ TRANSLATORS LOCATION PERSONAL SAFETY HOUSING/ ACCOMODATIONS ETHICAL ISSUES/ QUALITY OF CARE TIME COMMITMENT Paid expenses or stipend with long term commitments Short term individuals pay their own travel, housing, food, etc SHORT TERM generally one week minimum LONG TERM Doctors without Borders, others may require a 6 month or longer commitment COST Some groups offer scholarships Will your employer give you time off or will you be using vacation time or taking off time without pay? Ask if you are expected to fundraise or collect supplies Average cost for a 1 week trip is $1000 $2000.00 (about half is travel) 5
Within your scope of practice First Do No Harm Hospital/ acute care focus versus primary care RELIGIOUS OR SECULAR FOCUS EXPECTED ROLE Pediatric focused or will you also see adult patients Is there a teaching component Will providing immunizations be part of your mission LANGUAGE/ TRANSLATORS Are you fluent in another language Are translators provided and trained LOCATION Passport or VISA requirement Personal Safety Vaccines or medications recommended More expensive to travel further HOUSING/ ACCOMODATIONS Homestay with local families Guest house for volunteers Dorm or hotel Dormitory style sleeping at a church building in Honduras 6
Mountain Top Ministries Guest house Bunk beds in guest house QUALITY OF CARE Who is planning and leading the mission Will you have necessary medications and supplies BELIEVE THERE is GOOD in the world Resources for Finding Volunteer Opportunities International Medical Volunteers Association http://www.imva.org Finding volunteer opportunities; hundreds of organizations Health Volunteers Overseas http://hvousa.org Teaching, more hospital based and acute care www.projecthope.org www.globalvolunteers.org Many volunteer opportunities in health care and other fields www.healthcarevolunteers.com medical volunteer opportunities, national and international International Medical Corps www.imcworldwide.org Global first responders, rapid deployment within 72 hours, for 2 8 weeks www.shorttermmissions.com www.internationalmedicalrelief.org www.medicalmissions.org Medical Missionaries www.medmissionaries.org nonprofit, volunteer opportunities in US and abroad. Focus on Haiti/ Dominican Republic border. Heart to Heart International www.hearttoheart.org Current presence in Haiti, Guatemala References: Chapman, C.S. (2007). So You Want to Go on a Medical Mission. The Journal for Nurse Practitioners, Nov/ Dec 2007, pp. 707 712. Dewitt, A. (2010). Give Your Best. Create Space independent Publishing. Hassler, D. A. (2017). Serving Others Through Mission Trips. Journal of Trauma Nursing, 24 (1), pp. 57 60. Kidder, T. (2003). Mountains Beyond Mountains. New York: Random House. Norton, D.P. (2004). International Volunteer Work for the Practicing Pediatrician. Pediatric Annals, 33:10, pp. 699 707. Stone, D. (2008). The Samaritan s Dilemma. New York, N.Y., Nation Books. Walsh, S.M. (2010). Walking in Broken Shoes: A Nurse s Story of Haiti and the Earthquake. Grace Acres Press. 7
39 th National Conference on Pediatric Health Care March 19-22, 2018 CHICAGO Assessing Health Needs in Rural Haiti Through Community-Based Research Penny Neal, PhD, MSN, CPNP, PMHS Learning Objectives At the completion of this educational session: The learner will be able to describe the utilization of Participatory Rural Appraisal (PRA) as a guide to empower local community leaders in a global health setting. The learner will be able to identify at least two PRA tools and how they are used to assess community health needs. The learner will be able to summarize common health needs in rural Haiti. Drs. Penny Neal and Amy Knowles have no conflict of interest, sponsorship or commercial support associated with this research endeavor. Both researchers are employed by King University and have affiliation with non-profit organization, Medic Samaritan. Background and Significance Population of 10 million people Poorest country in the Western Hemisphere Ranks 168 out of 187 on the Human Development Index (WHO.int, MidwivesforHaiti.org) Approximately 80% of residents walk over 2 miles daily for fresh water from river, stream or cistern Over 50% of residents live in inadequate or unsafe shelter Less than 10% of homes have accessible bathroom or sanitation facilities Less than 5% of homes have any type of energy source Setting, cont. Health in Haiti One in every 14 children die before age 5 One out of every 83 women die during childbirth In rural Haiti, 75% of women deliver at home without any trained provider For the poorest of families, 90% have no prenatal or skilled care at birth (WHO.int, MidwivesforHaiti.org) Review of the Literature Previous Participatory Health Assessment conducted in rural Haiti Key findings: loss of productive land, minimal irrigation & sanitation resources, priorities of maternal health, malnutrition, diarrhea, and general distrust of organizations Limited research has been conducted in Haiti 1
Methodological Approach Qualitative Participatory Rural Appraisal (PRA) study Generates knowledge of a social system with the aim of bringing about change Cyclic process of action, reflection, and interpretation Conceptual Model for Partnership and Sustainability in Global Health (Leffers & Mitchell, 2010) A rural village in southern portion of Haiti Setting Beloc, Haiti- Population est. 4,000 PRA Tools PRA in Action Mapping Scoring Transect Walk Focus Group Discussions Institutional Relations Exercise Root Cause Analysis/ Preference Ranking Findings Identified needs Local clinic/pharmacy Food security Water catchment Latrines Business opportunities Paving asphalt road Developed action plan & disseminated written report Reflection & Implications Mutual goal setting & establishing priorities to foster ownership of health strategies Empowerment Trust & relationship building Deeper understanding of health needs in rural Haiti Creation of long term sustainable partnerships/ interventions to improve health outcomes of the communities 2
Limitations Limited generalizability Timeframe of 1 2 weeks for assessment period Limited number of tools that local participants can be trained to implement Dr. Penny Neal 1 (865) 804 1464 www.medicsamaritan.org pneal@medicsamaritan.org plneal@king.edu Questions? References Leffers, J. & Mitchell, E. (2010). Conceptual model for partnership and sustainability in global health. Public Health Nursing, 28(1), 91 102. Medic Samaritan (2010). Healthcare education and engagement program. Retrieved February 17, 2016 from http://medicsamaritan.org Midwives for Haiti (2006). Why Haiti? Retrieved February 17, 2016 from http://midwivesforhaiti.org Sethi, S. & Belliard, J. (2009). Participatory health assessment in Haiti: Practical tools for community empowerment. Progress in Community Health Partnerships: Research, Education, and Action, 3(3), 257 264. Sonoma State University (2015). Center for Community Engagement. Retrieved February 17, 2016 from http://sonoma.edu/cce World Health Organization (2016). Haiti. Retrieved from February 24, 2016 from http://who.int/countries/hti 3
39 th National Conference on Pediatric Health Care March 19-22, 2018 CHICAGO Disclosures I have no disclosures at this time for this presentation. Haiti: The Student and Faculty Experience Ashley Marass DNP, CPNP Learning Objectives Understand the benefits of study abroad for nursing students. Excellent experience Clinical time Cultural competency Global view Study Abroad in Nursing Student s View Self efficacy Self confidence Social responsibility Influence inequalities around the world Rewarding Life changing Where? Haiti, north eastern border with DR Danita s Children Orphanage School 1
Danita s Children Who? Three Faculty 4 PNP students BSN Accelerated new graduate PNP DNP new graduate Internal medicine MD University of South Alabama What? Treated almost 400 children in 3 days Two days of clinic in the new medical center One day of clinic in the community at an orphanage /school Excursion day Local hospital Citadel Swimming Education with local nurses Community Orphanage Community Orphanage Brought essential medications Transported through the village Treated all classes in the school 2
Malnutrition Clinic Malnutrition Clinic Held babies Stabilized babies Overnight stay Admitted 4 babies Education Citadel Students taught nurses Nurses taught students Issues Conclusion Weather DNP projects Travel warnings Wonderful experience for the faculty and students 3
References Edmonds, M. (2008, January). The lived experience of nursing students who study abroad: a phenomenological inquiry. Lived Experience of Nursing Students Who Study Abroad, 208 p. Kelleher, S., FitzGerald, S., & Hegarty, J. (2016). Factors that influence nursing and midwifery students' intentions to study abroad: A qualitative study using the theory of planned behaviour. Nurse Education Today, 44157 164. doi:10.1016/j.nedt.2016.05.019 Kent Wilkinson, A., Dietrich Leurer, M., Luimes, J., Ferguson, L., & Murray, L. (2015). Studying abroad: Exploring factors influencing nursing students decisions to apply for clinical placements in international settings. Nurse Education Today, 35(8), 941 947. doi:10.1016/j.nedt.2015.03.012 4