First-time visit to St. Albert’s Mission Hospital

Dr. Lowell Schnipper and I visited St. Albert’s in late July and early August 2016, mainly to learn more about the needs of the hospital’s cervical-cancer prevention program. Dr. Schnipper is an oncologist with Beth Israel Deaconess Medical Center and Harvard Medical School. Joining us was Ms. Megan Jukich, who manages a clinical laboratory at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, where I also work. Megan provided the following account of her visit to the hospital.
…Darrell 

We arrived at St. Albert’s at 1 a.m. on a Friday morning after nearly two days of travel (and a few hiccups) from Columbus, Ohio. I walked into the guest cottage and happily collapsed into bed, relieved that I could fully recline and sleep. Despite my exhaustion, I awoke early and, after enjoying a lovely breakfast with my companions, Darrell Ward and Dr. Lowell Schnipper, we headed up the path that led to the hospital.

We crossed through the gate onto the hospital grounds where we met Dr. Julia Musariri  for a tour of the hospital. Back in Ohio, I work at a state-of-the-art cancer hospital. We treat patients every day with life-saving drugs, and, when those fail, we treat them with experimental drugs in an effort to both prolong their life and learn how to treat future patients. I oversee a laboratory that has protocols and processes that we follow to ensure that we comply with or exceed standards. We follow safety precautions when handling patient specimens, just as anyone caring for these patients would in any other part of the hospital. But this was my first visit to a hospital in a developing country, and during my time at St. Albert’s, I saw things that I struggled to comprehend.

Long before we arrived, the region had been suffering through a severe drought. The hospital water system provides water to the entire mission of 3,000 people. It includes the 140-bed hospital, the parish, the primary and secondary schools, school staff and the relatives that live with them. The secondary school has 900 students. The primary school has a total 1,200 students. The rest are mission staff with their domestic workers and other dependent relatives. By the time we arrived, the hospital was rationing water to the entire community.

Hand washing during water rationing due to drought. St Albert's Mission Hospital 2016

Prolonged drought led to water rationing at St Albert’s in 2016. It meant that one nurse had to pour water from a pitcher over the hands of another nurse for hand washing.

 It’s hard to imagine how a hospital can function without running water, yet St. Albert’s was forced to. There was no alternative. This meant that we had to flush toilets in the hospital using buckets of water and that a surgeon scrubbing for surgery used water poured over his hands by a nurse from a bucket of water. There was rarely soap and certainly no hot water. Without these basic things, the chance for disease and infection to spread is so much higher and it’s nearly impossible to thoroughly clean things like surgical instruments, work surfaces, and floors of operating theaters. Having to carry in water requires extra labor for an already overworked staff. And what would happen if the buckets of water ran low at a critical moment?

 Walking through the male and female wards, I noticed that patient beds were different sizes and and models, a result of what was available or donated. Some beds had mosquito netting above them, but some did not. Signs posted around the hospital encouraged the opening of doors and windows to help stop the spread of tuberculosis. The reason for many hospitalizations, according to Dr. Julia, was diarrhea, respiratory infections and pneumonia. Since most households have limited access to clean water and the inability to practice hand hygiene because they cannot afford soap, it’s easy to understand how sickness can spread quickly. In addition, most dwellings house a large number of people in a small space, so it’s no wonder that infections spread easily from person to person.

 In the maternity ward, I saw three expectant mothers sitting on a bench, eating sadza (a cornmeal mush that is a dietary staple in southern Africa) and beans – hardly a

nutritionally-balanced meal, yet it’s what the hospital can provide. There is also a post-natal wing, and across from that is a small room for premature babies. They are looked after by the nurses at St. Albert’s with no help from life-sustaining machines such as ventilators or incubators. I learned of a baby born with  twisted arms and legs that survived only a few hours. The only help that could be offered was to cast his limbs in plaster in the hopes of straightening them.

In the male ward was a man whose foot had been run over by an ox cart, a fairly common injury in rural Zimbabwe. Another patient, an epileptic, had a seizure and fell into a fire. His foot was burned so badly that his toes had to be amputated.  These are the real risks of everyday life in rural Zimbabwe. If someone is lucky enough to have a mode of transport aside from walking or a bus, it’s often an ox cart. Being bounced around or leaning too far over the side can easily lead to falling out and being run over. Burns are common because a large fire for cooking is found inside (or outside) nearly every home, often the only way to boil water or prepare sadza.

Our visit to the hospital pharmacy revealed mostly empty shelves. Zimbabwe’s National Pharmacy has no medications to supply to the nation’s hospitals. In the rehabilitation department, the staff helps patients as best as they can using hand-me-down crutches, walkers and exercise equipment; a pile of recycled casts and mismatched braces for arms and legs is piled in a corner.

In the hospital  kitchen, food is prepared for patients and staff using biofuel from an underground biogas generator buried nearby. The laundry includes a sewing room where we meet the woman who makes surgical pads used during operations by hand because buying them pre-made is too costly. The counseling offices are located near the administration block. HIV testing is offered there, along with suicide, domestic violence and grief counseling. It was here, with the social workers and counselors, I would spend most of my time in the coming week.

I had the privilege of observing several counseling sessions throughout the week, always with the permission of the person seeking help. The sessions were in Shona, but the counselors translated for me so I could understand the problem. Each session left me feeling numb and drained.

I knew that Zimbabwe was not immune from issues such as suicide and domestic violence, but as I began my visit, I suppose I anticipated other, perhaps more stereotypical problems, such as AIDS and HIV infection. As I observed the counseling sessions, I was struck by the dire circumstances facing each individual.

In one case, a 21-year old woman spoke of her husband abusing her. It was the ninth time it had happened in their three year marriage. She sat slumped in the chair, hat pulled down to cover her eyes. Everything about her signaled defeat and despair. She came for HIV testing because although she was faithful, she wasn’t sure that her husband was. Her test results came back negative, and although she said she wanted to use protection with her husband in the future, the reality was that he likely would not agree to it, leaving her continually at risk if he is unfaithful. In another case, I sat silently as a man talked of ingesting pesticide, an increasingly common way to attempt suicide. Although I couldn’t understand what he was saying, his voice shook as he spoke and he often seemed on the verge of tears. I’ve been in that same vulnerable state, and it was all I could do to keep from reaching out and taking his hand, a tiny gesture from one human to another who has been where he was.

I was also fortunate enough to venture out for a day with the Community Home-Based Care team. It was a continuation of a launch of a sanitation and hygiene initiative sponsored by CAFOD, a Catholic international development charity based in England and Wales. We visited a local primary school, rural health clinic, secondary school and village – all were participants in the pilot project because of their vulnerability to disease outbreaks. Centenary itself had experienced an outbreak of typhoid just two weeks earlier. I was shocked to see that there was only one toilet for boys and one for girls at the primary school, which served over 500 students. Upon arriving at the secondary school, a group of students told us that the toilets had no water, leaving no way to flush the waste or for students to wash their hands. In all of the toilets, waste was overflowing and we were told it was cleared away only twice per week. The smell inside the boys’ toilet was overpowering.

I couldn’t comprehend how these students, many of whom overcome many challenges to even attend school in the first place, dealt with the obstacle of not having access to a working toilet every day, all day. I was facing my own challenge that day – the start of my menstrual cycle. After going all day without access to a toilet, I was grateful when we stopped at a shop. I was close to tears when I discovered the bathroom consisted of a toilet bowl with no seat, toilet tissue or running water and more than a few flies. Later that night, I realized that what I had to deal with that day was ugly and uncomfortable, but this is what the community around St. Albert’s faces every day. An overwhelming majority of women and girls cannot afford a luxury such as tampons or sanitary pads. The reality is that school attendance by girls drops around the time that they begin menstruating. Not only is it a challenge, but it has a significant negative impact on their education. 

In the weeks leading up to my arrival at St. Albert’s, I thought about what I might experience while there, but I had no expectations. Every day, I marveled that this hospital continued to function – not only function, but thrive – under the most challenging of circumstances. Moreover, the staff continue to keep their heads up, continue to smile, continue to persevere. It would be so easy for compassion fatigue to set in, seeing these things day in and day out, and perhaps it does, but I never witnessed it. In the short time I was there, the times I had to catch my breath or fight back tears became too numerous to count. In the evenings, I found peace in taking walks through the nearby hills, watching a glorious sunset, or sitting under the stars marveling at their brightness and the clarity of the Milky Way, neither of which pictures can do justice.

Yet, I woke up every morning  grateful for a chance to do it all over again. I laced up my sneakers and walked the dirt path up to the hospital. Day in and day out, my heart felt fuller as the layers of dirt continued to coat my shoes. I never expected to love this community as much as I do, especially within such a short time . I never expected to be so sad when I left, worried about how they would continue to get what they need to do their work. I certainly never expected to return home filled with the notion that I could make a difference, but that is what I intend to do.

To this day, I put on those sneakers, now a deep brown instead of their usual grey, and think about the path that I walked and where it’s leading me. I can’t bring myself to wash away the dirt  – it’s a daily reminder of those I left behind, and I’m looking forward to the day l I can return to them.

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“Understanding Cancer” Workshops a Success

In an earlier post, I described preparations for two “Understanding Cancer” workshops at St. Albert’s Mission Hospital in Zimbabwe Nov. 10 and 11. I worked with Dr. Julia Musariri, the director of St. Albert’s, and with Dr. Stanely Tapesana, one of the hospital’s doctors, to present the workshops to nurses, midwives and other hospital staff. Dr. Tapesana presented the first workshop on Tuesday, 10 Nov.; I presented the second on Wednesday 11 Nov. Both went well, and we learned much from the experience.

The workshops were sponsored by the The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James).

The “Understanding Cancer” workshops were based on Introduction to the Science of Cancer (ISOC), a free, noncredit, online course offered by the OSUCCC – James and Ohio State’s Office of Distance Education and eLearning. The online course includes more than 35 videos. Each video lecture explains a particular cancer-related topic.

The “Understanding Cancer” workshops presented 14 of the videos used in Ohio State’s online course.

The goal of the online course is to promote cancer prevention globally through education; the goal of the “Understanding Cancer” workshops is to provide cancer education to audiences that have limited Internet access using key ISOC videos.

Dr. Stanely Tapesana and Mr. Joseph Makaza preparing for the "Understanding Cancer" workshop.

Dr. Stanely Tapesana and Mr. Joseph Makaza preparing for the “Understanding Cancer” workshop.

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Cancer Education at a Mission Hospital in Zimbabwe

Hello, Everyone –

I am writing to you from St. Albert’s Mission Hospital in Zimbabwe. The hospital is located in a rural area 120 miles north of the capital city Harare. I am in second and final week here, and I am working with the doctors at St. Albert’s to hold two one-day cancer-education workshops. The workshops will use selected video lectures from the free, noncredit, online video course Introduction to the Science of Cancer. To learn more about the online course, visit http://go.osu.edu/scienceofcancer.

Cancer is a serious problem in sub-Saharan Africa, where cervical cancer and breast cancer are leading causes of cancer death among women and prostate cancer is a leading cause of death among men. Liver, stomach and colorectal cancers are also serious problems. People in Zimbabwe and throughout the region have a limited understanding and awareness of cancer, and fear and stigma can prevent early detection. Treatments for advanced cancer are unavailable, unaffordable or both for most people, making cancer prevention and early detection all the more important. But both require comprehensive cancer education presented in an appropriate and culturally sensitive way.

Map-sAfrica_croppedRural hospitals in low-income countries such as Zimbabwe have few opportunities for comprehensive cancer education. For these workshops, The Ohio State University cancer program and Ohio State’s Office of Distance Education and eLearning, along with staff at St. Albert’s, are attempting to use selected video lectures from the online course, followed by a question and answer period, to bring cancer education to this rural hospital. A key question is whether a laptop computer, digital projector and audio equipment provided by the host hospital is a practical way of holding such workshops.

Hospital director, Dr. Julia Musariri, and staff physician Dr. Stanely Tapesana were willing to give it a try. Together we planned to hold two workshops, one for hospital staff and one for secondary- and primary-school teachers in the area. We also thought we would share this exciting opportunity and experience with the larger OSUCCC – James community. Continue reading

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Visit to St. Albert’s by critical-care pediatrician

Hello, Everyone,

I want to director your attention to a new page on the site that describes a visit to St. Albert’s in March 2015 by Dr Rasika Venkatraman, a young doctor then completing her fellowship in pediatric clinical care medicine at Nationwide Children’s Hospital in Columbus, OH. BHA helped coordinate her visit, and Dr. Venkatraman kindly helped BHA by delivering a new cryotherapy unit we’d purchased for the hospital’s cervical cancer prevention program.

See her photos and read the captions here. Note that some of the photos show frank traumatic injuries or consequences of disease.

Darrell

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Progress report: St. Albert’s Mission Hospital Cervical Cancer Prevention Program

Hi, Everyone,
BHA has received the 2014 second-quarter report for the St. Albert’s Mission Hospital Cervical Cancer Prevention Program. The project began in August 2013 to reduce the suffering and death from cervical cancer, the leading cause of cancer death of women in Zimbabwe and the region.

St. Albert’s director Dr Julia Musariri, and program director Dr. Neela Naha, obstetrician/gynecologist at St. Albert’s, say that the screening and treatment program has been well received by women in the district, and that it has drawn women from outside the district.

From the program’s beginning in August 2013 through 31 June, 2014, St. Albert’s has screened 1,864 women for changes on the cervix that could become cancerous. They detected 63 cases of precancer (3.4%) and 25 possible cancers(1.3%). Of the women screened, 23% were HIV-positive.

The St. Albert’s program prevents cervical cancer by examining the surface of a woman’s cervix – the opening of the womb – for patches of cells that are in danger of becoming cancerous.

The precancerous cells are detected using a method called visual inspection with acetic acid and camera (VIAC). Dr. Naha removes the patches using a method called cryotherapy, or another method called loop electrosurgical excision procedure (LEEP). Removing the precancerous cells early stops cervical cancer from developing.
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VIAC Clinic Installed in New St. Albert’s Outpatient Department

St. Albert’s Mission Hospital opened a new and larger outpatient department (OPD) in February. The building and furnishings were purchased with support from Rock No War! and other Italian NGOs.

The new Outpatient Department building at St. Albert's Mission Hospital houses the hospital's cervical cancer prevention clinic. Photo: Darrell E. Ward, March 2013.

Room 8 of the OPD houses St. Albert’s Cervical Cancer Prevention Project, which has been established with help from Better Healthcare for Africa through a grant from the Sarita Kenedy East Foundation and contributions from BHA donors.

“Room 8 has become a popular room for the women,” says St. Albert’s director Dr. Julia Musariri. “There is always a long queue.”

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Women’s Vulnerability to HIV Infection: A Possible New Contributor

According to the World Health Organization and UNAIDS, women in sub-Saharan Africa account for nearly 60 percent of all people living with HIV in that region.  (Women account for 52 percent of all people living with HIV in low- and middle-income countries globally.)

Why this is so isn’t fully understood. Physical, social, cultural and economic factors can increase women’s vulnerability to HIV infection, but they don’t explain the whole picture. Recently, a team of Norwegian infectious-disease specialists working in South Africa’s KwaZulu/Natal Province proposed a new, plausible, but-still-unproven explanation: genital bilharzia infection.

Bilharzia, also called schistosomiasis, is a parasitic infection acquired in rivers, lakes and streams infested with the parasite. The mature parasite is a blood fluke (a trematode flatworm) that lives in tissues of an infected human. Continue reading

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World Cancer Day is 4 Februrary

Hi, Everyone,

The Union for International Cancer Control (UICC), with support from the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), recognizes 4 February each year as World Cancer Day.

Some quick facts about cancer from WHO:

  • 7.6 million people worldwide died from cancer in 2008.
  • About 70% of cancer deaths occur in low- and middle-income countries.
  • It’s estimated that 30% of cancers can be prevented.

Read more facts about cancer here.

The theme for World Cancer Day 2014 is “Debunk the Myths!”
Myth 1: We don’t need to talk about cancer.
Myth 2: There are no signs or symptoms of cancer.
Myth 3: There is nothing I can do about cancer.
Myth 4: I don’t have the right to cancer care.

Visit the World Cancer Day web page for more about planned events and to download fact sheets, evidence sheets, posters and postcards.

Be well…Darrell

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Three Nurse Practitioners-In-Training Visit St. Albert’s

Hi, Everyone,

In late May 2013, three young women – Maki Matsumura, Kelsey Lynd and Tracy Powell – who were graduates of the Yale nursing program and had completed their first year of training as nurse practitioners at Yale visited St. Albert’s for about six weeks. Here is Tracy’s account of their visit.

Kelsey, Maki, and I finally made our way to St. Albert’s. What everyone who visits says is true: this place is miraculous. This rural community hospital is an inspiration to us. They provide care for so many people regardless of ability to pay and receive very little money from the Zimbabwean government.

Seated from left: Kelsey, Tracy, Dr Julia Musariri, Maki. Standing: a young guest, Dr. Rosalba Sangiorgi, a public health specialist who has spent many years at St. Albert's, Melania Nyamakuba

Our experience in Zimbabwe exposed us to many situations and diseases that were cared for and treated using little to none of today’s sophisticated technology.  We assisted staff with catching babies, dressing and packing wounds, vaccinating infants and children, monitoring pregnant women and fetal development, and dressing burns. Tuberculosis, malaria, and HIV are abundant and a part of life, as is death, which we witnessed daily. We helped where we could but came away with much more, including lifelong friends. There are many stories, both hope-filled and heartbreaking. Here, we’ve included a few pictures with a brief narrative. Continue reading

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BHA Accomplishments for 2013

Hi, Everyone,

Here is an overview of Better Healthcare for Africa’s key activities and accomplishments for 2013, with links for more information. Please note that much of what we do is made possible by your donations.

  • I am particularly pleased to report that the St. Albert’s cervical-cancer prevention screening and treatment clinic began operation August 1. In its first three months, the clinic screened 646 women, detected 20 cases of precancer and five cases of possible cancer.

The cervical-cancer prevention project involves close collaboration with Dr. Lowell Schnipper, Chief of Hematology/Oncology and Clinical Director of the Beth Israel Deaconess Medical Center Cancer Center, and Theodore and Evelyn Berenson Professor of Medicine at Harvard Medical School; Dr. Julia Musariri, Director of St. Albert’s Mission Hospital; Dr. Neela Naha, Ob/Gyn at St. Albert’s, and several St. Albert’s staff, particularly Mr. Joseph Makaza, District Health Information Officer, and Mrs. Itai Nyamuranga, PCN, Counselor. Continue reading

Posted in Activities, Better Healthcare for Africa | 2 Comments