Category Archives: Health Initiatives

“Do you have any questions for me?”

By Lindsay O’Brien, Associate Director, U.S. Programs 

We all know that it’s a good idea to have a list of critical questions ready for our short visits with the doctor in order to maximize those precious few minutes with an expert. (With doctors’ appointments averaging about 18 minutes1,  it makes sense to come prepared). And yet how many of us have given a quick “no” at the end of an appointment when asked, “Do you have any questions for me?” Whether it’s because we’re unprepared or embarrassed, the appointment is ended on an incomplete note, and we may have missed an opportunity to give our care providers an important piece of the puzzle.

The Greater Killeen Free Clinic in Killeen, TX is working to solve this problem.

healthblog3On a visit to the clinic in the spring, I was struck by the impressive health outcomes of the Killeen’s Chronic Care Clinics. These “clinics” are actually year-long education series and wellness visits for individuals suffering from a chronic disease – diabetes, hypertension, heart diseases, asthma or COPD and/or thyroid disorders. (The national statistics on these preventable health problems are staggering: about ½ of all adults in this country have a chronic health condition, and these chronic conditions are the leading cause of death and disability in the U.S.2 These conditions are also notoriously difficult to treat.3) Patients enrolled in the Chronic Care Clinics at Killeen are provided with education on subjects including proper nutrition, exercise regimens and disease and prescription management. They learn effective ways to manage their disease.

Before acceptance into a Chronic Care Clinic at Killeen, patients sign a contract promising to attend mandatory appointments and education sessions. The contract explicitly states the dates and times of quarterly appointments as well as the ramifications of missed appointments. An addendum to Killeen’s Patient Contract is the Pledge of Care. Both patients and Killeen staff pledge to adhere to 14 different standards of care, including mutual “respect, honesty and compassion” and always telling the truth.

healthblog2One pledge really caught my attention: Killeen promises their patients that they will “listen to and answer your questions.” On the flip side, the patient pledges to ask questions when he/she does not understand “until I do understand.” There is an expectation at Killeen that patients will learn everything that they can about their conditions, and they will come to appointments prepared and leave informed. Just as importantly, Killeen staff are committed to ensuring that their patients are empowered with the information to make informed decisions about their care.

Explained by Executive Director Marlene DeLillo, “Patients in the program are wholly committed to improving their health. The Patient Contract clearly explains the program expectations and our commitment to serving as their medical home. And the Pledge ensures that patients know how much we care about them while also demanding participation and honesty. The contract and pledge have definitely enabled the success of the Care Clinics.”

The results of this comprehensive, patient-centered care at Killeen are impressive. Of the 188 diabetic patients participating in Killeen’s clinics, 153 showed an average of 3% point decline in A1C levels over the course of 24 weeks. “One patient’s A1C level dropped from 11.4 to 6.2 in 12 months. We were thrilled,” said Sheila Brooks, clinical supervisor.

When Brooks asks her chronic care patients, “Do you have any questions for me?,” you can bet she doesn’t take no for an answer.

As the nation’s largest provider of donated medical aid to the U.S. health care safety net, AmeriCares works with over 800 free clinics and health centers in all 50 states. Supported by the GE Foundation, the U.S. Programs help partner clinics to increase capacity, provide comprehensive care, improve health outcomes and reduce costs for patients. Our vision is for every person in this country to have access to affordable and high quality health care regardless of their ability to pay. The Greater Killeen Free Clinic in Killeen, TX is one of our safety net partners.

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1 http://www.washington.edu/news/2008/07/14/rx-for-time-crunched-physicians-communication-skills-that-increase-physician-efficiency-and-patient-satisfaction/
2 http://www.cdc.gov/chronicdisease/overview/
3 http://ecp.acponline.org/augsep98/cdm.htm#Note1

#HealthCareHeroes

By Max Antonucci, AmeriCares Social Media Intern
By Max Antonucci, AmeriCares Social Media Intern

[inlinetweet prefix=”” tweeter=”@AmeriCares” suffix=””]When I first heard #HealthCareHeroes, it took a while for me to understand it.[/inlinetweet] The hashtag’s purpose seemed simple: to help spread the word about the heroes we see providing quality health care to others – people like doctors and other medical professionals. Except it then hit me: how many of these kinds of heroes do we really know that well?  It might not be enough for the idea of a health care hero to ever really catch on. But recently I figured out the true meaning behind #HealthCareHeroes, and how it can apply to a lot of people we know.

I finally understood it when I discovered what AmeriCares was supporting in Japan with our local partner, Hope Worldwide Japan (HWWJ). [inlinetweet prefix=”” tweeter=”AmeriCares” suffix=””]This video shows how an unusual approach to healing led to my revelation about #HealthCareHeroes.[/inlinetweet]

#HealthCareHeroes from AmeriCares on Vimeo.

Startling Facts about Maternal Mortality in the U.S.

By Amanda DiMeo, AmeriCares Monitoring & Evaluation intern
By Amanda DiMeo, AmeriCares Monitoring & Evaluation intern

When one thinks of mothers dying during childbirth, the United States is probably not a country that comes to mind.  It’s common knowledge in the international community that a large majority of maternal deaths occur in developing countries.  The World Health Organization reports steady progress in the reduction of maternal deaths since 1990, with a 45% global decrease. However, when looking at the figures specific to the U.S., the statistics tell a different story.

The U.S. is the only developed country in a group of eight where maternal deaths have increased between 2003 and 2013, according to the Institute for Health Metrics and Evaluation. In 1990, the maternal mortality ratio was 12.4 deaths per 100,000 live births. In 2013, this number is much higher at 18.5 per 100,000 live births, which the Lancet suggests is underreported. The report ranks the U.S. 60th for maternal death on a list of 180 countries, meaning 59 countries are doing a better job at keeping their mothers alive than we are.

US1211_AO_DSC_0732Most alarmingly, some of America’s cities suffer higher rates. The city of Detroit has a maternal death rate triple the national average. Between 2008 and 2011, Detroit’s maternal mortality ratio averaged a disturbing 58.7 per 100,000 live births. This number is even more startling when compared to the rates of similar developed countries. From 2009-2013, the maternal mortality ratios of the United Kingdom and Sweden averaged 8 per 100,000 live births and 4 per 100,000 live births, respectively.

The hardest thing for me to grasp when seeing these numbers is the fact that many of the causes of maternal death are preventable. Women die as a result of major complications of childbirth, including severe bleeding, infections, and high blood pressure (leading to eclampsia).  In the developing world, these causes could be attributed to lack of resources, among other factors. However, in the U.S., we have well-equipped facilities and skilled health care providers. We are the country that spends more on health care than any other developed country (17.9% of GDP, according to World Bank), and we have the resources to prevent maternal mortality.

So then, my question is: why are they still dying? [inlinetweet prefix=”” tweeter=”AmeriCares” suffix=””]This upward trend in maternal mortality likely reflects some inequalities in the health care system[/inlinetweet]:  a complex combination of lack of access, poverty and ethnic/racial disparities. To put this into perspective, the CDC (2003) reports that African American women in the U.S., regardless of education level, had maternal mortality ratios that were three to four times those for white women.

US1205_AO_DSC_0003

One of the many rewards I’m finding as part of my internship at AmeriCares this summer is seeing the work that the organization is doing to help lower rates of maternal mortality both in the U.S. and abroad.  As an example, within the U.S. partner network for FY14, AmeriCares provided enough prenatal vitamins and folic acid to fill about 200,000 prescriptions. Abroad, AmeriCares works with partners in countries such as Afghanistan, where we provide safe birthing kits at Afshar hospital, just outside Kabul.

[inlinetweet prefix=”” tweeter=”AmeriCares” suffix=””]To improve the maternal mortality ratio, maternal health must be a priority. [/inlinetweet]

Health Inequity – Cholera as the Lens

By Elisabeth Stark, AmeriCares intern for Asia/ Eurasia Partnerships
By Elisabeth Stark, AmeriCares intern for Asia/ Eurasia Partnerships

After my first semester in college, I came home to find the biography of Dr. Paul Farmer, Mountains Beyond Mountains, sitting on my desk with a yellow sticky note affixed to the front that read, “E – read this. Love, Mom.” I stacked the book on my bedside table without looking at it, exhausted by a grueling set of exams. A few days later, however, I picked up the book and couldn’t put it down. I have always been interested in medicine, but as I read Dr. Paul Farmer’s account of his efforts to bring health care to “those who need it most,” I was inspired in a whole new way.

This family, each member suffering from cholera, is being treated at an AmeriCares partner clinic in Haiti by local healthcare workers.
This family, each member suffering from cholera, is being treated at an AmeriCares partner clinic in Haiti by local healthcare workers.

Since then, my understanding of health inequity has grown enormously, and with it, my resolve to address it. One of the starkest representations of health inequity is the worldwide death toll from cholera. Cholera is not only preventable with adequate sewage and sanitation systems and general access to clean water, but is also treatable. And it’s inexpensive to treat, at that. All you really need is water. Water that I take for granted every day when I wash my hands, take a shower or fill a drinking glass. Still, [inlinetweet prefix=”” tweeter=”AmeriCares” suffix=””]more than 100,000 people die from cholera each year – almost all in developing countries.[/inlinetweet]

At AmeriCares, I’m surrounded by a group of inspiring individuals who have dedicated themselves to addressing some of the world’s most pressing health issues, including cholera mortality. AmeriCares greatest commitment to fighting cholera so far has been in Haiti, a country vulnerable to cholera outbreaks due to limited access to clean water and sanitation. Furthermore, Haiti is prone to disasters such as hurricanes, earthquakes, and rainy season flooding—all of which can exacerbate these vulnerabilities. AmeriCares provides IV fluids, oral rehydration solutions, antibiotics, disinfectants and buckets, among other supplies, to help health workers in Haiti care for patients in critical need during outbreaks. These supplies can, and do every day, make the difference between life and death for cholera patients.

Joenne (paitent's name has been changed), age 7, survived an episode of cholera two years ago because she had access to IV rehydration fluids donated by AmeriCares.
Joenne, age 7, survived an episode of cholera two years ago because she had access to IV rehydration fluids donated by AmeriCares.

One of the Haitian patients AmeriCares has reached is Joenne*, who was only five years old when cholera struck. She suffered from vomiting and diarrhea, and arrived, unresponsive, at our partner clinic. Joenne received donated IV fluids to reduce her dehydration, and in minutes, she was able to move and regained consciousness. Thanks to AmeriCares participation in the fight against cholera in Haiti, our partner clinic was able to quickly restore Joenne’s health and save her life.

It took only one hero, one champion of underserved populations, for me to realize my passion for working towards global health equity. But it is the everyday hero, the health worker in Haiti who saves a child like Joenne or a logistical partner who ensures the timely delivery of AmeriCares donated products, whom I wish to honor in this post. [inlinetweet prefix=”” tweeter=”@AmeriCares” suffix=””]These #HealthcareHeroes are making tangible differences in people’s lives every day.[/inlinetweet]

*Patient’s name has been changed.

How a Clean Birth Kit can save Mothers and Infants

by Becky Reindel, AmeriCares Extended Network intern
by Becky Reindel, AmeriCares Gift-In-Kind intern

My first volunteer experience was in the maternity ward of a Connecticut hospital. My job consisted of restocking the shelves with medical supplies, diapers, diaper bags and sometimes even car seats. All of these items were available to the new mothers if they could not afford the products on their own. My interactions with the mothers included wheeling each mother and child out to their car at the end of their stay. In these brief interactions, I was able to see the joy that accompanies childbirth. Though language barriers sometimes kept our conversations short, the mothers gladly told me the names of their newborns and how excited they were to bring them home.

Milad and her son at her first postnatal check-up. Photo courtesy of American Medical Overseas Relief
Milad and her son at her first postnatal check-up. Photo courtesy of American Medical Overseas Relief

Until starting my internship at AmeriCares, I took this image of childbirth for granted. As I began doing research on maternal health through the group intern project at AmeriCares, I quickly learned that the supplies, the hospital and even the joy of new motherhood were not ‘givens’ worldwide. [inlinetweet prefix=”” tweeter=”AmeriCares” suffix=””]All too often, childbirth involves the preventable death of a mother or infant.[/inlinetweet]

I was particularly shocked to learn about the lack of access to health care facilities in Afghanistan. Only 34 percent of deliveries in Afghanistan had a skilled birth attendant present, according to the Afghanistan mortality survey (2010). The World Health Organization (WHO) identified the lack of skilled birth attendants worldwide as a major barrier to reducing maternal mortality rates. This is certainly an issue in Afghanistan, which is the only country outside of Africa to have maternal death rates above 300 deaths per 100,000 live births. Afghanistan also has high rates of infant and child mortality with one in five children dying before age 5.

There is a way to begin saving mothers and infants who lack access to skilled birth attendants, and AmeriCares has partnered with an organization in Kabul, Afghanistan, to find a local solution. The solution they found costs just two dollars.

Community outreach and education are a key factors in reducing maternal mortality. Photo courtesy of American Medical Overseas Relief
Community outreach and education are a key factors in reducing maternal mortality. Photo courtesy of American Medical Overseas Relief

The WHO identified the need for clean birth kits to lower the mortality rates during unattended home births. The kit comes in a biodegradable pouch and includes hand sanitizer, surgical gloves, an under pad, scalpel, cord clamp and nasal aspirator. Among other aid to the region, AmeriCares in partnership with American Medical Overseas Relief (AMOR) plans to donate 1,200 clean birth kits to Afshar Hospital’s Community Outreach and Patient Education program (COPE). In the initial phase of the program, 200 birth kits have been sent to the region. The distribution of these kits is targeted at areas with the most need: impoverished and isolated communities around Kabul.

[inlinetweet prefix=”” tweeter=”AmeriCares” suffix=”-“]It is exciting to discover the innovative ways that joy can be restored to childbirth[/inlinetweet] in communities around the globe. Maternal mortality rates are decreasing worldwide, but until every woman has access to skilled attendants, there must be alternative solutions—like the clean birth kits—to give women safer birthing environments and keep infants free from infection.