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PROJECT HOPE: 50 YEARS OF GLOBAL HEALTH SERVICE

Change and challenge is in the wind as 2008 comes to an end. The same is true when examining this month's ReachMD XM 160 special series Focus on Global Medicine. We take a look at both the changes and the challenges impacting global medicine.

You are listening to ReachMD, The Channel for Medical Professionals. Welcome to The Clinician's Roundtable. I am Dr. Maurice Pickard, your host, and with me today is Dr. John P. Howe. Dr. Howe is President and CEO of Project HOPE, and he has been the previous distinguished chair in health policy at the University of Texas Health Science Center at San Antonio, Texas. Today we are going to discuss what HOPE, an acronym for Health Opportunities for People Everywhere has come to me. In 1958 a naval medical officer, William Walsh, requested and received a ship from Dwight Eisenhower, which was converted to the first nonmilitary hospital ship, the SS HOPE.

DR. MAURICE PICKARD:

Dr. Howe, can you tell me what the mission of that ship was and what has it come to mean the Project HOPE now.

DR. JOHN P. HOWE:

And I might add, to the world, because as you look around the world today, it doesn’t take a great observer to come to any other conclusion that gosh, lots of people don’t understand Americans or like Americans and that quite clearly if we are going to leave this world to our children and grandchildren a better place, now is the time to step forward and find ways so we can reach out and build bridges along the peoples of the world with decreased trust, embrace with various cultures. Now, go back for a moment in 1958 it was a similar time. Lots of people didn’t understand Americans. In 1958, they didn’t like Americans. In fact, there was a book written of the Ugly American and it was <_____> mentioned that Dr. Walsh had a prescription and he went to fill it at the White House with President Eisenhower asking for that white ship. He made the case that the white ship would be a platform well for doctors and nurses volunteer, doctors and nurses, who would give up their practices at their clinics and their hospitals and serve on the ship while it was in one country, one trip, one year at a time. That three things would happen when the ship would leave. (1) Patients would have been better. (2) Skills would be transferred because local doctors and local countries would have been working on the ship in the OR on the wards with their fellow physicians and nurses from the United States and thirdly when the ship left, it would be a different view of America, and now we fast forward it today and is the large of South Asia as it was in the year of Dr. Walsh and President Eisenhower, is throughout the western world there are pockets of concern about our country, and what was a great prescription in 1958 is a great prescription today, that is, finding ways in which one very regular American physicians and nurses can volunteer to make a difference to find ways where they can reach out to colleagues around the world. Often used the examples Tashkent in Uzbekistan and Toledo, Ohio. Now we had two lawyers that we had gotten together, and one from Tashkent and one from Toledo, probably one had too less to talk about, why, because the laws are so different, language is different, but when you get two doctors together, one from Tashkent, one Toledo, there is lots to talk about. Whether they are a native of Uzbekistan or a native of the United States, you have a common retina, a carotid artery, a left ventricle. Not only that, whether it be Uzbekistan or the United States, the people of those two countries have a common concern, high priority for health; health of their women and children, men too, and so here at this world, this troubled world we are in, we have an opportunity as we did in 1958 to make a difference through our profession, medical profession in bringing people together. Now, taking back to two days after the tsunami. I was here with Project HOPE visiting with our senior leadership, talking about our people and programs in 36 countries when I received a call. The call was an unusual call, not one that I would normally attend from the Chief of Naval Operations, Four Star Admiral Vern Clark, who is calling to say, "doctor, I have a novel idea, two days after the tsunami. Again, doctor I have a novel idea. What's not novel is to send the Mercy, the big white hospital ship that's based in San Diego, navy hospital ship, 1000 beds, 85 intensive care unit beds, and 12 operating rooms. The Banda Aceh, the site of the tsunami; not novel to send it, not novel to have it be involved with humanitarian aid, but what is novel it has never been done in the history of the United States Navy is to have a navy hospital ship operated and maintained by the navy and have it to be staffed by volunteer American physicians led by Project HOPE. At that point, it was inspirational. In the space of two weeks, we had 4000 doctors and nurses from across the country apply for the 210 positions on the ship. We had an around-the-clock operation here at Project HOPE. The applications that were coming in one a minute, was just a tremendous appetite then and now for doctors and nurses to volunteer. What would happen was remarkable. The 210 physicians and nurses served onboard the hospital ship off the Banda Aceh for 2 months and then came back to Singapore and discharged their volunteers and the ship was on its way back and the middle of the night I got a call from the United States ambassador in Indonesia Lynn Pasco, doctor I am preparing a cable for morning review at the White House and I need your help before I send it, how so?, he said, during the cable the President asked him to turn the ship around and send it back. I said why, he said because there is a second earthquake near Taiwan, and but I can ask and turn the ship around if you would agree to re-staff it with another round of doctors and nurses, I said you have got our commitment. The ship was turned around at 6 a.m. that morning and by the time it got back to Singapore, we had 50 trauma surgeons and nurses; volunteers for Project HOPE had landed to aboard the ship and go to nearest island and at the end of the 4-month period, while the ship was in South Asia, volunteers had taken care of 49,500 Indonesians. It's a remarkable, remarkable number and they impacted the lives of Indonesians and their health needs as importantly as our tremendous shift in the view of Indonesians towards the people of the United States. Two months before the tsunami, there was a poll done by, as I recall on BBC asking the question what do you think of Americans, only 20% said favorably. After the ship had gone, the poll was repeated, what do you think of Americans, over 65% said favorably. So in the space of 4 months, what Dr. Walsh was talking about with President Eisenhower back in 1958 happened again, namely doctors and nurses reaching out to care for patients, this time Indonesians, had two or three different results when the ship left (1) patients were better, (2) there appears were more versed in how to care for patients, and certainly there was a different view of America. It's just a striking experience, but the grand experiment didn’t end there because the navy decided that gosh, it shouldn’t wait for another disaster, why not we send The Mercy back next summer, so sure enough in December of 2006, The Mercy went back to South Asia to the Philippines and Bangladesh and Indonesia. Why not we just take a quick commercial break and tell you that in between those journeys, one in 2005 and one in 2006 in South Asia, in our own country, there was an event that prompted the call for Project HOPE.

DR. MAURICE PICKARD:

New Orleans.

DR. JOHN P. HOWE:

New Orleans, absolutely, and the call came to me that we know you are an International Organization, but we need to have you make an exception with <_____> foundation, Project HOPE has experience of volunteering on navy hospital ships, so it has to go necessarily the Comfort Ship that was based in Baltimore was there for two or three weeks and 75 HOPE volunteer doctors and nurses in that, patients from Hancock, Harrison, and Jackson county in the Pascagoula area received care as a result of the HOPE volunteers and their navy counterparts and then coming back then to the next summer, there were about 61,000 patients cared for by the doctors and nurse of HOPE, navy, and from other countries on-board the Mercy and that has in recent pinnacle just a few months ago when the navy said we must have three ships deployed in the space of a year. The Peleliu, which is 100-bed 4-operating rooms went back to South Asia this past summer and when it entered the Da Nang harbor in Vietnam, my understanding it was the first time the navy ship of this sort had entered that harbor since the war ended, and strikingly it had HOPE volunteers on it just as it occurred at the Da Nang harbor in 1962 when the original SS HOPE went into Vietnam with HOPE doctors on it, the most memorable experience, but the second memorable experience occurred in the Salomon Islands. One of the patients that came to see the volunteers this summer in Peleliu was Mr. Kamani. Mr. Kamani was a young man in World War II. He was paddling between islands in Salomon Islands in World War II and he came upon a small island where there was clearly some people there that had been shipwrecked and, as he told the story, he recognized them as having been the victims of shipwreck, but they couldn’t speak his language, but what they were able to do was to carve on a coconut the name of the leader on that ship that went down and the name of the ship and they somehow communicated to him, take that coconut to a US Navy vessel and give it to them in hopes that they in turn would come to rescue. He paddled for 40 miles, 40 miles with a coconut in his canoe, presented it to the navy, a leadership on the ship, and as the story was told they looked at that coconut it said John F. Kennedy, PT109, just a remarkable story that our volunteers would be talking to Mr. Kamani and has then repeat that story from World War II. The other ship, the Comfort, which is the sister ship to the Mercy, 1000 beds, 85 intensive care unit beds, and 12 operating rooms; by the way, each of them is the 7th largest hospital in the United States of America, which just happened to float. The Comfort was sent to Latin America, 12 countries, and I won't forget standing on the dock in Corinto, Nicaragua, just north of Managua. Corinto is the industrial port. The big white hospital ship, the Comfort was there and I was standing on the dock with the Vice President of the country, Vice President Jaime Morales, you are about to go off to the ship, and he said this is an emotional moment for me. I said why sir, he said I stood in the same dock, 1966, 41 years ago and went out into another white ship to bank the volunteers, that was the SS HOPE, just a remarkable story, and then afterwards he and I went to the clinic in Corinto, there was a little girl being cared for by a nurse practitioner, volunteer from the Massachusetts General Hospital in Boston, high fever, looking very poorly. She had made a diagnosis. She was starting with some antibiotics. I turned to the mother and I said what does this mean to you? She said what it means to me is I will never forget the nurse from Boston. At that point, we came back to the dock and Vice President said I need to go thank this other gentleman here who is the captain of an other ship, the other ship was a <_____> transport ship that was unloading. It just appeared 3 days after they arrived was unloading 150 brand new tractors, a gift of the Nicaraguan people by Hugo Chavez. I don’t know how that ship just happened to be here after we did and the things we were doing, but I was told it wasn’t exactly serendipitous that there was a clear sense that what we were doing was being recognized in Latin America. In fact, the President of Cuba was in the papers talking about our mission and the fact that he was doing that long before the US had ever arrived, so again reaching out, breaking down cultural barriers, creating trust, having being done by just ordinary doctors and nurses, the people listening to the station as you and I are speaking, but I would add a postscript and that is that in March and April, another ship the Swift with HOPE volunteers will be in Liberia, Angola, Ghana, and Nigeria in West Africa, again reaching out to the people in need.

DR. MAURICE PICKARD:

I want to thank Dr. John Howe for being our guest today and we've been discussing Project HOPE and its unique relationship with the United States Navy.

I am Dr. Maurice Pickard and you've been listening to The Clinician's Roundtable on ReachMD, The Channel for Medical Professionals. For questions and comments, please send your e-mails to xm@reachmd.com or visit us at www.reachmd.com.

Thank you for listening to our special series Focus on Global Medicine as we celebrate this annual holiday season. Everyone at ReachMD wishes you and your family a happy holiday and a successful new year.

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