ラオスで訪問看護を続けたい。山を越え悪路を進み、子どもたちのもとへ

The origin of the far-flung Outreach Team for both hospitals of Friends Without A Border was born out of necessity, for both patients and for the proper functioning of the hospitals.

 

One person was there from the beginning of Outreach and continues to lead the program today, Kazumi Akao, director of Outreach and representative of FWAB Japan. Kazu, as she is known to everyone, has guided the program to bring care and support to patients in their home villages, often after the crisis of acute care in the hospital.

 

Kazu was at the Angkor Hospital for Children in Cambodia from the first year in 1999, starting as a volunteer nurse and the following year as a Registered Nurse on staff. Within the first year she saw the dilemma of a 9-year-old girl who suffered from viral encephalitis and when hospital treatment got her out of crisis, she continued to have needs.

 

The girl was very stiff, could barely move or even roll over, had trouble swallowing but her options for care were limited. “We needed to make a plan for the patient, otherwise the patient could be in the hospital forever,” Kazu recalled. In consultation with her doctors, Kazu decided to go back home together with the family.

 

The hope was to enlist the local medical clinic staff in her care. But Kazu and the family were told that if a patient can’t move by herself it’s the same as if she’s died. And there was nothing the clinic would do for home care.

 

Kazu said, “I was shocked and the family was even more shocked.” The Outreach program was created to fill the gap. Teaching family members and neighbors how to move the young girl and feed her became the treatment program, far from the hospital.

 

At first the program had no dedicated vehicle, only the part time use of a very old car on very bumpy roads. Kazu spent some of her weekends and holidays convincing drivers to take her to remote villages. “We couldn’t make a plan but we could go out,” she said. The program soon got attention to the full hospital and funding was allocated for two staff members, Kazu and a Cambodian nurse.

 

One major need in Cambodia was follow up care for HIV treatment, especially medication monitoring. The prevalence of HIV in Cambodia was extensive in children, and qualified Angkor Hospital for Children to get a significant grant from USAID to do home care. The multi year grants through local NGO partners paid for a vehicle and to increase the Outreach Team staffing.

 

In addition to medicine allocation, the team concentrated on education needs, including peer programs for children and parents to learn about treatment and lessen stigma, life help for patients and families. In some cases, the program was able to pay for parents to help at the hospital and in communities. “Life is hard for many people, they are low income, they were so happy to have a job,” Kazu said.

 

She also remembers the children who went from being young, at risk patients to thriving adults living normal lives. “One boy, he became a nurse, he’s working now, he still calls me.”

 

Another patient, “came in as a very small sick baby, now he’s a parent himself.”

 

As the program expanded and solidified its value became clear. “We recognized the people who received home care were more likely to make appointments and take medication properly,” Kazu said. Outreach was integrated into the children’s hospital goal of sustainable, stable care of patients.

 

In 2013, after more than a dozen years, Kazu left Angkor Hospital for Children to join the very beginning of Lao Friends Hospital for Children(LFHC). “I was wearing a helmet and coming to the construction site every day,” she recalled. “Some people thought I was a contractor or a construction manager.”

 

Instead of overseeing the building, Kazu was setting up programs and Outreach was part of the hospital program from the beginning. While HIV was not as prevalent in Laos as in Cambodia, its treatment was not well understood and stigma remained.

 

Dosages for HIV medicines are based on a patient’s weight. Body weights must be accurate and updated, especially for growing children. LFHC gets HIV medicine from the Provincial Hospital and must account for the allocations to individual patients.

Once again, at first there was no vehicle for Outreach, requiring Kazu and one nurse to double up on a motorcycle, while carrying equipment, and they could only go out nearby in Luang Prabang. LFHC opened in February 2015 and later in the year Outreach got its own vehicle. They began going out farther from the new hospital and determining the needs for patients at home.

 

Home care was broadly defined, beyond HIV medicine, looking at malnutrition including lack of food and deficiencies in nutrients or vitamins, along with kitchen or cooking needs, or even someone to cook. Water supply and sanitation were assessed, to prevent chronic vomiting and diarrhea. “If we go to their house we could see if there are pigs near their water or other problems,” Kazu said.

 

Other concerns include TB, mental problems, mobility, abuse, social issues including finances and family problems, development problems and delays and chronic diseases.

 

“We want to have the best education for them to give them help.”

 

Health care extends to home care because otherwise, “many times we treat the disease and then they go home. It’s not like it’s only the disease of the moment, we want them to keep their health. Many times it’s not over when they go home. The physical part maybe changed but other problems are still there.”

 

To make assessments and to set a schedule, Outreach confers with all the other departments in the hospital to determine who is ready to go home and who will need follow up care. The ongoing patient needs already at home are considered for locations and scheduling.

 

“We make a plan every week; we go out every day,” Kazu said is the standard operating procedure now. Planning is critical, with remote villages connected by very rough roads and travel very slow. The terrain is steeper in Laos than Cambodia and the raining season makes some roads impassable.

 

“I really like building up relationships with the families and the patients,” she said about the satisfactions. With familiarity, understanding also increases and community support can fill some families’ needs. “We don’t want the patient’s family to be isolated.”

 

She told the story of a mother who had lost six children and her last child suffered from severe malnutrition. After the child left the hospital following nutrient infusions and returning to her home village, Kazu went out to talk with the village chief. Neighbors then contributed eight chickens and the child’s father built a cage. First they ate eggs, then they ate and traded chickens and eggs. Soon they were growing vegetables and the child was putting on weight.

 

There are now 150 patients on the Outreach roster. More come on the list all the time, as patients are discharged. Some go off the list as health improves and care stabilizes.

 

Kazu remembered another child who suffered from malnutrition at age 2 and on a recent visit by the team to his village, “he saw us and came running up so happy to see us and we were so happy to see him.” The boy is now 5-years-old and no longer a regular out-patient. He is healthy and happy. He recognized the familiar green heart, or seed sprout symbol on the hospital truck. “I saw you,” the boy yelled out as he ran up.

 

Like any parent or child facing difficult health situations, there is often fear and worry. “At the beginning they shut off their feelings, they have no expression,” Kazu said.

 

The Outreach staff members put the patients at ease by smiling, laughing, talking, listening. The challenge can be difficult. “I always tell them, don’t give up. We are professionals. We do this job. It’s our job to help them. Don’t give up.”

 

Kazu is soon to turn 60-years-old [in May]. She has a master’s degree in nursing, with education and training in Japan and the United States. She oversees a staff of seven at LFHC, with international volunteers joining the team on a regular basis.

 

After 24 years helping care for sick kids at Angkor Hospital for Children and Lao Friends Hospital for Children, she’s learned the same thing over and over. “Many times we have to be patient, we have to explain again and again, try different ways, think about what they can do, what they want to do, what we can do. It is all very important.”

 

John MccCathy

Newspaper Reporter, Environmentalist,  Author, Boise, Idaho, USA