Everyday Heroes:Working for Everyone's Health, Every Day

A caregiver at Trinidad’s Cyril Ross Nursery plays lovingly with two of the more than three dozen children who call the nursery home. © Chris Hamilton

The nursery is one of 17 institutions run by the Society of St. Vincent de Paul in Trinidad and Tobago, and the only one dedicated exclusively to children. Most of the young residents are HIV-positive; two have full-blown AIDS.

Daddy Nosa, a native of Nigeria, leads a team of mostly female caregivers, whom the kids call "mommies."With help from the nursery's manager, Hyacinth Cross, and volunteer doctor David John, they provide medical, social, emotional, and spiritual support to the residents, who spend their days playing, learning, and growing up like other children—except in a family of more than 40.

The doctors also case-manage 42 other HIV-positive children from throughout Trinidad and Tobago. The nursery hosts bimonthly clinics where outpatients are examined and receive medication, along with the doctors' advice on the importance of taking medication exactly as instructed.

Cross recalls that, in its earlier years, the nursery was a different place.

"This was the early 1990s," she says. "In those days, children were brought here to die. They were pale, withdrawn, and, because of the stigma attached to persons with HIV/AIDS, pretty much discarded. They were not on any kind of medication, because there wasn't a focus on treating anyone—especially a child—who was HIV-positive. The love and care they received here was enough to sustain some of them, but we had 17 deaths during our first few years of operation."

In 2002, the government began providing free antiretroviral treatment. Thanks to the medication and the staff's dedication, not one child has died since then.

Today, in addition to caring for its 38 wards and 42 outpatients, the Cyril Ross Nursery carries out research on HIV/AIDS care and treatment, making an important contribution to the international battle against HIV/AIDS.

The teenage mother-to-be lived in a remote Peruvian village in the department of Cusco. With help from some neighbors, her husband managed to carry her to the local health post. There, health worker Julio Llamaqponcca Huallparimachi examined Santa and placed a radio call to obstetrician Orlando Salas Alvino, at a larger health post in a village some distance away.

Hearing a description of the case, Salas made a diagnosis of eclampsia with neurological complications. He then placed his own radio call to the provincial health network to get help in transporting the patient to the nearest hospital.

First, however, the patient had to be taken to a place accessible by road. This meant carrying her to a town more than 10 hours away, where an ambulance would be able to reach her. Santa's husband, with the help of neighbors and Llamaqponcca, carried her on an improvised stretcher. Along the way, Salas joined up with the group and checked the patient's status.

Twenty hours into her ordeal, in a village called Pacupata, Santa gave birth to a stillborn baby. After several more hours of walking, the team reached San Fernando, where a waiting ambulance received Santa and set off for the hospital at Andahuaylas. Eight hours later, Santa finally arrived at the hospital, conscious but suffering from generalized edema. The hospital staff stabilized her, and the 16-year-old's life was saved.

Peru's Ministry of Health describes all those involved in saving Santa's life as "just one example of the thousands of everyday heroes who anonymously risk their lives and safety to save the lives of others."

Barbara Chinn manages the Whitman-WalkerClinic in Washington, D.C., "to make a difference." © Armando Waak/PAHO

Chinn has worked as an administrator and manager at the Whitman-Walker Clinic, an organization that provides health care and social services for people with HIV and for the gay, lesbian, bisexual and transgender communities throughout the Washington, D.C., metropolitan area. The organization is well known for its comprehensive model of care that addresses the special needs of its clients, many of whom live at or near the poverty level. The clinic provides services including medical and dental care, mental health and addiction treatment, legal assistance, case management, nutritional counseling, education and prevention efforts, and HIV testing and counseling.

"I have stayed at Whitman-Walker because I feel like the job is not done," says Chinn. "We have not made the inroads we had hoped to when we first started. I also have a commitment to my community to make a difference, and being here makes me feel like I'm actually making a contribution. It helps me have an answer to that question, Why was I put here?"

"I was scared and afraid it could be very dangerous," she recalls. "I couldn't afford expensive treatment in a private hospital, so I looked for help in my community." The help she found at La Clínica del Pueblo probably saved her life. The nonprofit community health center, which serves mostly Hispanic immigrants, diagnosed her tumor as malignant, signed her up for health insurance, then shepherded her through a maize of appointments, paperwork, and treatment, including two operations.

Vásquez beat the cancer and, in gratitude, signed up as a volunteer helper at the clinic. Recently she was appointed a member of the clinic's Board of Directors.

"Health is the greatest gift one can receive, and I received that gift from La Clínica," says Vásquez. "Every week I sit in the waiting room and listen to what other patients like me have to say… We talk about our concerns and suggestions, and I share them with the rest of the board. Now I am the voice of the patients, and I am proud to represent them."

The association's Maternal Infant Health Outreach Worker program trains local women with leadership abilities to serve as home visitors, who seek out families at risk for health, developmental, or social problems associated with poverty and geographic and social isolation. During visits, the home visitor listens attentively to mothers' concerns; provides guidance on nutrition, health, and child development; models effective parenting skills; and refers the family to local medical and social services. Home visits begin early in a mother's pregnancy, take place monthly, and continue for three years after a child's birth.

The focus is on building mothers' confidence in their ability to meet their own needs and those of their children. Because home visitors are from the same community—rather than being "outside" professionals—they can build trust more easily and become role models and mentors to the women they serve.

The program has been nearly as rewarding for the visitors as for the visited. Kathy Bracken recalls running into a mom she had visited more than a decade ago: "Her son is now a junior in high school, and her daughter is in middle school. She remembered my sons' names, and we exchanged updates on all the kids. We talked and talked, never missing a beat, just as though we were still visiting together once a month. It began to seem as though I was actually on a home visit as she asked my advice on some school situations going on in their family. Thirty minutes later, we're saying goodbye, and she looked at me and thanked me for everything I had done for her family all those years ago. These times included the birth of her daughter and the passing of her mother. She said it had meant more than I would ever know."