Working with HIV/AIDs sufferers in Vietnam by Antonino Faibene

Raising awareness Photo by Lahcene Abib

British volunteer Antonino Faibene has worked with non-governmental organisations (NGOs) for over 5 years in various roles ranging from head of mission, advisor and Programme coordinator. In 2011 he worked as General Coordinator based in Hanoi, Vietnam on Doctors of the World’s ‘HIV Prevention and Treatment programme from May to December 2011. On his mission Antonino developed HIV/AIDS programme strategies and oversaw the handover of 4 open patient clinics to local authorities in Hanoi and Hoi Chi Minh city.  He explains about what the job entailed:

“My role included dealing with HR issues, writing applications or fundraising initiatives, attending meetings with local partners, and writing reports. I was also involved in planning as Doctors of the World (DOW) handed the project over to local partners.

The teams I worked with were really motivated and it was a great pleasure to work with them. They had been working at Doctors Ofof World for over ten years and felt a really strong bond with the organisation and the beneficiaries.  It was an excellent working environment with the team bonding with one another insofar as we’d eat and socialise with one another.”

Working with those who are on the margins of society who need access healthcare

Vietnam has a relatively good standard of living but specialised health services are still needed, such as HIV/AIDS prevention and basic healthcare for minorities. Strong traditional beliefs linking HIV/AIDS with what the Government labelled as ‘social evils’ have led certain groups to be discriminated against and ostracised by wider society. At times we would come across a certain amount of stigma and discrimination towards our work with at risk populations (such as male sex with malesmen having sex with men, female sex workers and drug users). However, local partners and beneficiaries welcomed the work we were doing. Our beneficiaries often came from poor or dysfunctional families, particularly in the case of sex workers and drug users that inject. I found that Doctors of the World is considered a model organisation in the field of HIV/AIDS.

‘The best part of the job was learning to be more open minded’

I made some good friends and learned a lot about my own attitude towards people living with HIV. I have always considered myself an open-minded person, but I realised I had some prejudices. I was initially unsure about the impact of beneficiaries as peer educators could have on the project because of their difficult backgrounds. Peer education involves training and supporting people living with HIV/AIDS or who are most at risk to effect change through awareness raising, encouraging clients to access our services as well as promoting the clinics. In the end I found that working side-by-side the peer educators were the key to Doctors of the World’s success in Vietnam. At least 30% of all patients who came to the Open Patient Clinics had had direct contact with a peer educator and had been persuaded to come by them.

“I have decided to stay in Vietnam.  Before starting this role I had already been to Vietnam on holiday. I love the country and was interested in the links between the social and medical aspects of HIV/AIDS. Going back to south eastEast Asia after a year in Europe and spending a year in the Middle East really felt like going back home. The green rice fields and familiar faces I saw from the airport on the day I arrived were a warm welcome.”

‘Despite our differences people share the same dreams and fears the world over’

“Throughout my work with NGO’s I have learned that despite different ways of communicating and language barriers, people share the same dreams and fears wherever you are. Volunteering abroad can suit many people. I think having ideals are important but the ‘saving the world’ attitude can be counterproductive if not balanced with a healthy desire to have a happy personal life before trying to improve other people’s lives.”

Beth Connelly, volunteer nurse at Project:London

Beth Connelly

Beth Connelly is one of our volunteer nurses and has been at Project:London since 2010. She retrained last year and in addition to her voluntary work she is a fulltime caseload community midwife. As a nurse Beth sees clients in the clinic and does basic health checks, gives advice, makes  referrals when necessary and advocates for the service users.

“I was interested in getting involved with Doctors of the World UK and I found out about Project:London and soon realised that health inequalities are not only present in developing countries! It saddened me to think that we neglect so many people when we have the NHS, and I wanted to use my skills to be able to help.

I am inspired by many of the people that come into clinic; many have fled war zones, left violent relationships or were forced to leave their homeland due to political corruption. Many people really do believe healthcare is a luxury rather than a human right, and are very grateful for the service. They do not want pity or money, they just want to be treated with respect and keep as healthy as they can.  I try to ensure that service users find a GP or health services so they can receive ongoing primary healthcare. I have learned a lot about immigration rights in the UK and realise how misleading and manipulative the media can be.”

"Working as a nurse in the NHS for four years has given me to the opportunity to work with many different ethnicity groups. I have furthered my understanding of other people’s cultures and beliefs.. However, I have been appalled by the way in which some people have been treated because of their immigration status. The NMC code of conduct states that as nurses, we should:

‘make the care of people your first concern, treating them as individuals and respecting their dignity.’(1)

However, there are ongoing barriers that restrict our abilities to deliver good quality care to every human being. With an increased awareness of health equalities in the NHS the Department of Health insists that:

‘Putting human rights at the heart of the way healthcare services are designed and delivered can make for better services for everyone, with patient and staff experiences reflecting the core values of fairness, respect, equality, dignity and autonomy’(2).

So if nurses were to act as advocates for those in our care and help them to access relevant health and social care, information and support, why does Project:London need to exist? There is a huge injustice when it comes to  care in the NHS and this problem needs to be addressed.

For example, a very anxious Iranian woman brought her 3 year old child to the Project:London clinic. Escaping from a violent relationship and catastrophic social consequences of her decision to leave her husband, she came to England for safety and protection. Her daughter had previously been diagnosed with epilepsy and had been on anti-convulsants since she was a baby. After running out of this medication, she tried to register her daughter with her local GP in north London. The response she received shocked and saddened me.  She was told ‘to take her to hospital if she has a fit, or come back when you have the correct documents’. This is just one of hundreds of stories I have heard about the barriers people are facing in accessing primary healthcare in the UK. I believe the attitude of staff towards these vulnerable people is due to ignorance and misguided management, not a lack of empathy or compassion for their client’s healthcare needs. Lately there has been a big emphasis on choice and patient-centred care in the NHS.  In contrast to this I now have greater understanding as to why so many undocumented people end up in A&E; ironically, it seems they really do have no other choice.

Why Beth is supporting the Doctors of the World UK E-petition ‘Health Is Not A Luxury’:

I urge all nurses to sign Doctors of the World’s  'Health Is Not A Luxury’ E-petition  calling for the right of vulnerable migrants to access healthcare regardless of their ability to pay.  I’m outraged by the lack of care being provided for these people!  As nurses, we cannot do our jobs properly whilst these barriers remain so do something today to make a difference and help these people."

References:

(1)Nursing and Midwifery Council (2008) The code: standards of conduct, performance and ethics for nurses and midwives. Nursing and Midwifery Council: London.

(2)Department of Health (2008) Human rights in healthcare: a framework for local action. DH Publications: London.

Celebrating Hannah Headden for International Nurses Day

Hannah Headden photo by Spike Johnson

For international nurses day on the 12th May, the anniversary of the birth of Florence Nightingale we’re highlighting one our lovely volunteer Support workers, Hannah Heddon who works  at our healthcare clinic Project:London. The clinic is run by Doctors of the World UK (Médecins du Monde) as part of our work to help vulnerable people worldwide, Project:London’s ethos is that health is human right.

Hannah has volunteered with Doctors of the World for over two years, while working as a nurse in the A&E department in Paddington. She graduated in politics and it was when she started helping out in youth development schemes and  supporting people with HIV and Aids that she became inspired to train as a nurse. Hannah is really caring and dedicated to the work we do and feels passionate about working with our service users. She has also learned a lot about public health issues.

“As a support worker I am the first ‘face’ that our service users often see. Many come to the clinic frightened and anxious, I meet people in the waiting room and go through a set of questions to gather social information regarding why our service users have attended the clinic. Some may not need active treatment at that point but all need help in accessing NHS care. I  signpost service users to other organisations that offer help in their local areas such as soup kitchens or offer legal advice.

I realise that the most important thing that you can do is listen and give people time to express their sadness or frustration at how their life has turned out. I am constantly amazed and humbled by our service users and their ability to remain positive against the odds. Service users are scared, ashamed or embarrassed about certain issues and building a rapport with someone in a short period of time is essential. It is not about listening to words alone but picking up on body language and putting yourself in someone else’s shoes. Often it’s about saying ‘I am here and I will do everything I can’ and that’s something we all need to be doing as nurses. I regularly encounter service users who have been in the UK for years, sometimes over 10, and are only attempting to access health services because they have reached breaking point; chronic pain left untreated, asthmatics without inhalers, women in their third trimester who have had no antenatal care or episodes of deep depression leading to thoughts of suicide.

Before I got involved with the work of Project:London, I didn’t fully understand how difficult it was to register or access primary care services for some people. However if you are homeless or sleeping on a church floor, how do you ever provide a proof of address to register at GP? Recent public discourse has suggested that ‘health tourism’ is endemic across the UK with many ‘tourists’ utilising a health service that is stretched to breaking point. I have yet to meet one of these ‘health tourists’ within the clinic and I would also argue that the NHS will be even more stretched if we do not fully integrate those most marginalised and disadvantaged within our society. Those in need will end up attending A&E departments for conditions that could have been treated at GP’s instead.

I am passionate about the NHS and the services they provide in the UK but I am also unwilling for healthcare to become exclusive. As nurses we must advocate strongly for those who do not have a voice I stand by the pledge I have taken as a nurse: to work ‘with integrity and compassion, with quiet heroics and loud advocacy and to break this promise would be detrimental to many’ (NMC, 2011). We must fight to ensure that we remember those that society has forgotten.”

Alison & her mission in Myanmar to celebrate International Midwives' Day

Alison Crabtree

To mark International Midwives Day, Doctors of the World UK is highlighting the valuable work our international midwives do around the globe. We want to highlight the fabulous work of one them who is just back from Myanmar (otherwise known as Burma).  Alison Crabtree, originally from Yorkshire, is a midwife and also trained as a nurse.  She went to work in the Pyapon township of the Irrwaddy Delta region earlier this year.  It was an area that suffered major destruction when Cyclone Nargis hit the region in May 2008.

Alison has spent most of her working life in the Bradford area, as a multi cultural area it was an ideal background for working overseas.  However, she’s no stranger to midwifery abroad having taken a career break to work with 3 other non-governmental organisations in Afghanistan, Ghana and Angola before this mission with Doctors of the World.

Job title: Maternal and child health advisor
Duration of mission: 3 months from the 8th January until the 10th April 2012

Alison explains why the mission was so important:
“Access to good quality primary health care is very limited for the population in the rural areas of Pyapon Township -  84% of the total population of the area live there (approximately 127, 000 people). They really lack trained health professionals, health facilities and added to this there are geographic constraints.  All of this means overall there’s limited access to the public primary health care system. Local people tend to resort to unofficial healers and traditional birth attendants however, there are many risks.  Many of these so-called health gurus work unsupervised and often provide poor quality care.

Group lessons on maternity care

The health system in Myanmar is centralised and severely underfunded. In 2009, the total expenditures on health represented only 2% of GDP( ). In addition, the health resources are not fairly distributed with most of the funding going on secondary healthcare, leaving the primary health sector under-resourced. The high maternal and infant mortality rate, 2.55 and 59.7 respectively per 1000 live births which demonstrates the seriousness of the situation. (In the UK the figures are 0.12 and 4.5 respectively.)

My work was part of the current community health project being implemented by Doctors of the World to improve the health status of the rural population.  The project is supporting 137 rural villages in the central, south-east and south Pyapon Township over a 2 year period. In fact the project aims to serve a rural population of approximately 127, 000 people.  Doctors of the World’s mission supports a network of community health workers, auxiliary midwives and, village health committees. It aims to improve health knowledge among the rural population.

I was working with the field team of national staff.  The team consisted of 8 nurses 3 nurses / midwives and 9 community facilitators.  The nurses / midwives role provide supervision to the Ministry of Health volunteers, community health workers and auxiliary midwives.  The rural population are fairly dependant on all of them.

I found what they need most medically are qualified nurses, midwives and doctors!  I signed up to do this mission because I enjoy this type of work, it is always challenging. I feel that I have something to offer in the way of education that is useful to the population.

The thing I learnt most is that one should never take for granted all the advantages we have with regard to health and education, housing, water and electricity.  It is only by experiencing day-to-day life in a situation when you have none of these luxuries do you really appreciate what you have back home.

I think volunteering is a personal thing and this sort of work would not suit everyone. You have to be able to adapt personally and professionally.  Personally, on this mission I learnt an appreciation of people who have lived under a restrictive regime."

If you are interested in volunteering overseas with us then have a look for more information.

Doctors of the World’s Project:London clinic appeals for volunteer doctors

Dr Lucienne Aguirre

Project:London is a health advocacy and plays a unique role in that it serves as a safety net for those who are struggling to access mainstream health services within the NHS.  The clinic is run by Doctors of the World UK (Médecins du Monde) in support of its work to help vulnerable people worldwide, Project:London’s ethos is that health is human right.

Project:London is currently appealing for volunteer doctors to come forward. The clinic was opened in 2006 and provides medical care. In 2011 we saw almost 1750 service users who had a range of complaints The need for doctors to volunteer at the clinic is vital, as some of our service users haven’t seen a doctor in years, some of them have undetected conditions, while others have illnesses that have gone untreated for a very long time and have become serious as a result. 

Project:London runs three times during the week as well as once a month on a Saturday.   At each clinic a volunteer doctor is needed on hand to meet people’s immediate needs until Project:London’s Support Workers are able to help people register with mainstream services through advocacy and negotiating with GP practices. 

Dr Lucienne Aguirre works as a Psychiatrist, she has volunteered at the clinic since late 2011 and likes to combine both psychiatry and human rights into her role at Project:London.

“I started volunteering for Doctors of the World in Sweden and carried on volunteering for the organisation when I came to live in London.  As a volunteer doctor, I provide healthcare to those that are not able to register with a GP and see to their mental heath problems if required. Since I work in the NHS, I can see the stark difference between NHS patients who have an array of services available to them compared to the vulnerable patients I see at Project:London who have many needs but no access to services. The NHS as a body needs to understand that we are not their enemy and we need their support so we can work as a team.

The qualities needed to fulfill this role include being a good listener and have lots of energy.  You can’t help everyone one that comes to the clinic and fix all their problems but we try our best to help in whatever way we can.  You do your best and learn from each case. I have loved listening to the personal stories of the patients and its been an opportunity to learn about new cultures and languages.  One of the best things has been working in a nice team and knowing what you can and will make a real difference to someone’s life.

Thanks to my voluntary work I have just got a new full-time job.  I am so passionate helping the vulnerable people that visit the clinic I will continue to volunteer around my paid work.  It has always been one of my dreams to work with Doctors of the World UK and I aim to continue this as long as I can.”

Clare Parsons, support worker at Doctors of the World UK's Project:London

Clare Parsons at Project:London

Clare Parsons started out volunteering as a support worker for Project:London in Bethnal Green. She was there from the very start in 2006, and cleared out and painted the rooms prior to the clinic officially opening.  Clare now works closely with vulnerable service users as part of the close follow-up scheme that Project:London runs.  She writes up the client’s experiences to be used as case studies for Doctors of the World’s advocacy work and bears witness to the difficulties people are experiencing in accessing heaqlthcare in the UK.  Clare also uses her Mandarin language skills to accompany clients to appointments at hospitals and to register with GPs. She fits her voluntary work around her full-time job as a Speech and Language Therapist within the NHS.

Thanks to her hard work and dedication with us and other charities, Clare has been nominated to carry the Olympic torch through London. Well done Clare!

Speaking about her work with Project:London Clare says;

“We live in a city where there are thousands of people who cannot access the healthcare they need to survive both emotionally and physically. The people who attend the clinic are the most marginalised and vulnerable in our society but they have frequently had the toughest treatment from local services. At Project:London we offer them a non-judgmental and friendly environment and empower people to take the next step in improving the quality of life for themselves.”

To recognise the support and dedication of other volunteers Doctors of the World UK have joined up with Blue Dot World. Blue Dot World offers a reward scheme for those who support our cause. If you are a volunteer and interested in finding out more about the scheme and its benefits, click the link the below. Blue Dot World

Doctors of the World help survivors of last year's tsunami cope with their grief and rebuild their lives in Japan

Class activites

It is the 1st anniversary since Japan was hit with one of the most powerful earthquakes in history, together with a tsunami, the disaster set off a nuclear explosion.  The destruction caused over 15,000 deaths and thousands became missing or injured. 125,000 households were damaged or destroyed.   

In the aftermath of the tsunami the Doctors of the World Japan team mobilised and chose Otsuchi as a project since it was one of the three most affected places that were accessible (other locations badly affected were part of an exclusion zone due to the risk of radiation ). Otsuchi was one of worst-hit towns due to its location in a narrow valley.  90% of its buildings had been destroyed by water and fire, and 1,400 people out of a population of 16,000 were dead or missing. Up to 5,500 homeless people were taking refuge in 44 collective shelters, including one that was housing over 1,000 people.

Doctors of the World Japan project in Otsuchi that was designed to address the mental health needs of the victims and relieve the psychological suffering caused by the disaster such as suicidal tendencies, anxiety and loneliness. It also aimed to ensure continuity of care for people who were temporarily unable to receive their treatment due to the destruction of the hospital, roads and transport. The programme offered medical and psychiatric consultations, as well as relief in the form of massages,  therapy through talking and relaxation techniques.

Dr Morikawa is a volunteer in Otsuchi.  BBC World Service Outlook programme spoke to him to find out more about the project.  In his interview he explained the issues victims were coming to terms with:

Therapeutic massages

“Classes have been put on to combat insomnia by talking through problems. The Japanese have a strong hesitancy to talk about emotional problems, this is why we gave non medical names to the classes, it was the only way people would attend. Most Japanese people try to solve problems on their own and especially more so in this region. The problem is when the problems become too overwhelming and lead to suicidal feelings. I think I managed to save three people who told me personally that they would not be alive had they not had this place to come to.

People come to the 'problem sleeping' classes, because they can’t get help elsewhere. One person only told me after ten months of attendance what was on their mind, that they held a lot of guilt, because they let go of their wife’s hand, but no-one could help him with his grief. These feelings have been left with a lot of people of all ages.  One young girl explained how she had to let go of her grandmother’s hand. People who have gone through this feel like they’re the only survivors and have a lot of grief and guilt. I offer advice and methods to deal with such emotions.

A consultation with one of Doctors of the World's health professionals.

The approaches we offer are 3-4 months of talking therapy, where we mainly listen, give support to those who survived and help relieve them of their guilt and help them understand that they had no other choice.

I am motivated to help rebuild the community and make Japan a better place. I feel like I can make a difference by helping people to talk through their emotions and help them feel more hopeful about the future."

To listen to the BBC interview in full click here.

© Photos by Eric Rechsteiner

National Student Volunteering Week; featuring Project:London volunteer Claire Ferrero

It’s National Student Volunteer Week from 20 – 26th February 2012. To highlight the wonderful work of our student volunteers we are sharing the experiences of one of our medical students, Claire Ferraro, who worked as a Support Worker at our Project:London clinic while she studied at the London School of Hygiene & Tropical Medicine. She also appeared in the student BMA news.

She says it was an ideal opportunity to practice her communication skills and have contact with patients: “The service users are often so desperately in need of help as a Support Worker you are easily able to see the positive impact of your work. It’s a real "get-away" from academic studies and quite often a harsh reminder of the difficulties some people face on a day-to-day basis. Whilst working/studying in the NHS, it's sometimes easy to forget that there are still people who miss out on our excellent healthcare.”

Volunteering gave Claire practical skills: “I became really confident at communicating effectively with service users via translators, either in person or on the phone, which should be invaluable in my foundation job in east London. In addition, I quickly learnt to be assertive on the phone with GP secretaries and practice managers whilst advocating for GP registration for service users. The clinic relies on working effectively in a team with other support workers, the nurse and/or doctor and communicating back to the office. I had first hand experience of giving explanations, recording accurate information, coping with distressed relatives, being empathic and this was always in the context of language and cultural barriers.”

“Project:London is a really friendly and rewarding place to volunteer. There is nothing better than being able to tell someone you've successfully found them a permanent GP. The overwhelming gratitude and relief at being able to access healthcare when they need it emphasises how much they were in need of help in the first place.” 

If you would like to become involved with Project:London or any other volunteer opportunities for Doctors of the World, read more.