SCCM Members Bring HOPE to Patients in Need

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Society members Marie Baldisseri, MD, FCCM, and Mary Jane Reed, MD, both volunteered recently as part of Project HOPE aboard the hospital ship USNS Comfort. Project HOPE, a 50-year-old effort to offer Health Opportunities for People Everywhere, partnered with U. S. Navy medical personnel to embark on humanitarian assistance missions throughout the world. During this four-month tour, the ship traveled to 12 countries to provide various forms of examinations, screenings, immunizations, surgeries and other medical care. In addition, Project HOPE volunteers and Navy medical personnel provided training and education to local healthcare professionals.

Baldisseri and Reed joined the tour for three-week periods at different times. Baldisseri traveled to Ecuador, Colombia and Haiti, while Reed helped patients in Trinidad, Tobago, Guyana and Suriname. Those aboard included physicians, nurses and other healthcare professionals, such as veterinarians, optometrists and dentists, who delivered care at temporary land-based clinics and on the ship, which was converted from an oil tanker into a mobile hospital in 1987. Volunteers had access to advanced, state-of-the-art equipment on the ship, comparable to most land-based U.S. hospitals. The USNS Comfort has 12 operating rooms, the ability to surge to 60 to 80 intensive care unit (ICU) beds and can accommodate up to 1,000 medical personnel. The sheer size and capacity of this ship is incredible, said Reed, but second to the mission at hand.

At each port, elementary schools, warehouses and basketball gymnasiums were transformed into makeshift clinics where volunteers would find thousands of patients lined up waiting for treatment; some had been camping outside for weeks. Rudimentary triage areas would be established, and paper signs would lead patients to various treatment rooms. Baldisseri spent most of her time at these land-based clinics, treating patients with advanced forms of basic conditions, such as diabetes, hypertension and vascular disease. “The common theme is poverty,” Baldisseri explained. “Many of the patients turned to the volunteers because they could not afford healthcare or insurance. Most of these people barely had enough money to feed themselves, much less to purchase medications or pay for procedures. People take their medications very erratically or not at all.” Reed mostly performed routine surgeries aboard the USNS Comfort, but in countries with more resources and follow-up capabilities, patients could seek more complex care, such advanced ear, nose and throat procedures as well as orthopedic, plastic and pediatric surgeries.

The experience with Project HOPE broadened the perspectives of both doctors. “You realize how lucky the United States is. For all our problems with healthcare, we do have a great amount of resources; they are just distributed unevenly. You learn that the rest of the world has incredible poverty and needs, and then you come home and realize we have the same thing, we just need to be attuned to it,” Reed reflected. She also noted that even simple procedures equated to huge leaps in quality of life; some routine surgeries could ensure one’s livelihood and survival. “The simple things are the things that the patients needed the most. For example, there were many patients in Suriname who needed hemorrhoid surgery because their conditions were so bad, they couldn’t even ride their bikes to work anymore.”

Common problems were rampant in certain areas and, without the technology and vast resources to which most doctors were accustomed, the key for healthcare professionals was to rely on their own clinical acumen. In Haiti, tuberculosis was so ubiquitous, all the volunteers wore masks. In most countries, if someone complained of a stomachache, the patient automatically was flagged for intestinal worms. “Stepping out of your comfort zone is the biggest challenge initially,” Baldisseri said. While treatment on the ground was rather basic, patients with complex diagnoses could be transferred back to the USNS Comfort for full laboratory and radiologic evaluations, including full-service computerized tomography (CT) scans and pathology workups.

Just as Project HOPE functions as part of a larger mission to win hearts and minds through health diplomacy, these doctors also were striving to achieve a greater personal mission. “As a physician, you want to make a bigger difference in the world,” Reed said. “It’s a combination of wanting to test yourself in a challenging environment and wanting to touch another society to see if you can do good.”

In September 2008, the two friends also travelled to Swaziland, Africa, with a private non-governmental organization, Project Africa Global, to provide healthcare to people in that country, which has been devastated by AIDS and tuberculosis. The volunteers learned quickly that they had to manage unstable patients with only fluids and without invasive or even consistent hemodynamic monitoring. They learned to do without basic laboratory tests to diagnosis and reassess very ill patients. Diagnoses were augmented only by basic radiology. CT scans and magnetic resonance imaging were not available anywhere in the country; mechanical ventilation outside the operating rooms wasn’t possible.

During that mission, both said they found SCCM resources very valuable in helping train the in-country medical personnel to improve care. “It was good for me as an intensivist to learn how to take care of really sick patients without falling back on high-tech equipment,” Baldisseri commented. “It’s one of the philosophies of the Fundamental Critical Care Support courses – you learn how to manage seriously and critically ill patients without all the resources and personnel to which you might be accustomed.”

Baldisseri presented lectures about implementing the Surviving Sepsis Campaign and the multiprofessional ICU model. She introduced staff to online resources such as iCritical Care Podcasts, www.LearnICU.org, and American College of Critical Care Medicine guidelines. In developing the hospital’s ICU, medical staff have been clamoring for protocols and guidelines, such as those produced by SCCM. While Baldisseri was able to teach the medical staff in Swaziland important lessons, she also hopes to apply her new knowledge to a local AIDS clinic, bringing the education cycle full circle.

Members such as Baldisseri and Reed serve as important examples to healthcare professionals and those considering volunteerism. They are carrying out the mission and vision of SCCM – to secure the highest quality care for patients – in ways that are special and unique, as they go beyond the call of their everyday practice. Every SCCM member has an opportunity to follow the spirit of their example, and one need not travel to foreign countries on humanitarian missions to do so.

“Whatever you do, you need to do well,” Baldisseri said. “Whether it is in your own hospital or clinic setting, in a rural or an urban setting, or as part of a humanitarian mission in South America – it gets back to the basic critical care philosophy that we are here to take care of patients. Peter Safar said that the ICU is without walls; we should be cognizant that seriously ill patients are everywhere.”

Taking extra care at the bedside, spending a few more minutes with a patient’s family, and becoming more involved in SCCM to be part of a greater movement are all ways to fulfill personal commitments to provide improved quality care. “No matter what your profession, if you make even a small difference in someone else’s life, that brings people together,” Reed said.