When Don Hohne visited the Arusha region of Tanzania in 2012, he saw a man with an enlarged abdomen, swollen with fluid to the point that it looked like he was nine months pregnant. Seeing the man’s pain and discomfort, Hohne’s group inquired with a local palliative care staff member if the fluid could be removed.
He recalled the staff member saying, “Yeah, it’s possible that we could do that. It could be problematic getting him to the hospital, and then he doesn’t have any money, so he has no way of covering any of the costs.”
Hohne’s four-person group from Gilchrist, a Maryland nonprofit providing hospice and palliative care in partnership with Nkoaranga Lutheran Hospital where that staff member worked, decided to fund a hospital trip for the man, whose name was Thomas. So he was loaded onto a motorcycle and bumped down rugged roads to the Lutheran hospital, which is housed in a series of one-story buildings connected by covered walkways.
Gilchrist provides care for the seriously ill in Baltimore, Carroll, Frederick, Harford and Howard counties and Baltimore City — serving about 5,300 patients annually and about 940 daily — mostly in people’s homes and residential care facilites, such as assisted living or nursing homes, as well as across its various facilities, said Lori Mulligan, the senior director of development and marketing. It orchestrates the partnership out of its Hunt Valley corporate office, which is its main administrative office, and has five buildings with 62 beds across the three in-patient centers in Towson, Columbia and Baltimore City.
Hohne, of Sykesville, one of Gilchrist’s chaplains and an ordained minister through the United Methodist Church, said Thomas’ care cost “a pittance” compared to what it would cost in the U.S.
“You either have what you need or the community provides it, or you go without,” the nonprofit’s clinical specialist for spiritual care said.
‘So much with so little’
Gilchrist Hospice Care began traveling to Nkoaranga, where the hospital is located, in 2010 and aims to bring a new four-person team composed of Gilchrist staff and volunteers, some of whom are medical professionals, every other year. Tanzania, a country of about 53 million people, is located on the east coast of Africa along the Indian Ocean. Nkoaranga Lutheran Hospital members have traveled to the U.S. to visit Gilchrist once and are planning to bring a three-person group in April 2019. The trips are used to share palliative care techniques and observe each other’s practices.
The groups’ connection began in 2009, when Gilchrist President Catherine Hamel went to a National Hospice and Palliative Care Organization conference and attended a section focused on U.S. hospices in partnership with African groups. She thought it would be valuable to be a part of one, said Robin Stocksdale, Gilchrist’s global partnership coordinator. The Gilchrist and Nkoaranga Lutheran Hospital bond is one of Global Partners in Care’s 50 partnerships connecting hospices in 20 states with 12 countries, said Lacey Ahern, the program director for the organization. Global Partners in Care links U.S. hospice and palliative care groups with “sister organizations in low-resource settings,” according to its website.
Hohne, 61, said that during the trip they would head out over the hot, dusty terrain in a Land Rover with the hospital’s palliative care team in Arusha to visit patients in their homes, coursing up and down difficult roads to ramshackle buildings where people slept and cooked in the same room.
“What we would arrive to find would be a person, a patient, an individual there in that community who was struggling through some sort of end-of-life terminal disease or condition; it could have been terminal cancer, it might have been something that wasn’t entirely diagnosed,” he said. “Or, oftentimes, we would be visiting with families who were struggling with the after-issues around some members of the family who had died of AIDS.”
Palliative care is dealt with in a “very different way” in Tanzania, said Dr. Paul Mmbando, a native Tanzanian who directs the Evangelical Lutheran Church’s palliative care program in the African country and who spoke from Tanzania to a reporter. Stocksdale, who works closely with Mmbando and the hospital’s leadership, said that with a lack of medical resources, there’s a greater focus on interpersonal services, such as prayer, singing and emotional support.
Sharmean Young, of Baltimore City, is a health information management specialist for Gilchrist’s pediatric team who went on the trip in 2015. She said the use of basic supplies to help with wounds really stood out to her, recalling that local staff used a mango from a family’s front-yard tree to help keep a woman’s wound clean, placing the chopped, unripe fruit on her head. She was surprised by how much the people were able to do with a small staff.
“I was shocked,” Young, 45, said. “It was life-changing. They were so overwhelmingly grateful for every little bit that we give them.”
Karen Hohne, a nurse and Don Hohne’s wife, agreed the experience was life-changing. She recalled climbing up a hill with local staff to visit a young boy with Type I diabetes in a home with dirt floors and no refrigeration for preserving insulin. He ended up in the hospital, which didn’t have strips for its glucometers for testing blood sugar, so she and her husband purchased some and brought them back, she said.
“Just simple things like that we take for granted here is such a hardship for them there,” she said. “I have a greater appreciation for our medical system here, and greater compassion for people who are living in developing countries who don’t have the quality of medical care that we have here.”
The sub-Saharan African palliative care team serves “well over” 1,000 patients with about five medically trained staff members and 30 volunteers, Stocksdale said. Mmbando said the doctor-patient ratio in Tanzania is one per 25,000 patients, and many of the patients struggle with cancer, HIV and AIDS.
“The partnership kind of breathed a new life to people in that category, who can’t afford to care for themselves anymore,” he said. “[Gilchrist visitors] managed to see how people do so much with so little and still make a difference in human life, and they fall in love with that.”
About 1.4 million adults and children — about 2.5 percent of the country’s population — are living with HIV in Tanzania, according to a UNAIDS 2016 country fact sheet, and about 33,000 adults and children died that year from AIDS. The Evangelical Lutheran Church of Tanzania has a network of 24 hospitals throughout the country, each with a palliative care program, and Global Partners in Care has 12 partnerships within that network, Ahern said.
Gilchrist does year-round fundraising for Nkoaranga Lutheran Hospital’s $68,000 operating budget through a variety of events, such as concerts, Breakfast with Santa and the sale of African crafts in local churches, as well as payroll-deduction donations from Greater Baltimore Medical Center and Gilchrist employees and community organization donations. Volunteers who return from the trip are also charged to help fund-raise for a year following their trip. Since the trips began, 12 people have gone, all of whom are from Gilchrist’s service area, Stocksdale said.
Other area organizations also have contributed to the operation of Nkoaranga Lutheran Hospital’s hospice services.
In 2014, with the help of the Rotary Club of Hunt Valley and a private foundation, Gilchrist was able to buy a Toyota Land Cruiser for the hospital to use as an ambulance. Funds have also gone to the hiring of a doctor, patient hospital stays, home visits for hospice care, medication, school scholarships for children, HIV support groups for children and adults, and volunteer training, among other efforts.
There are also discussions about potentially building a free-standing palliative care facility to serve northern Tanzania, but they’re still in the preliminary planning stage and a site has yet to be determined, Stocksdale said.
Upcoming fundraising efforts hosted by Gilchrist include a “Paint and Sip” event on Aug. 14 at Greater Baltimore Medical Center, during which mocktails and snacks will be served while people paint. Admission is $45, and those interested can register through Eventbrite. Gilchrist is also raffling two tickets to the Ravens-Steelers game; winners will be drawn Aug. 15. Donations can also be made at gilchristcares.org.
“It’s made a huge difference in this part of the world, and many people’s lives have been changed,” Mmbando said.
For more information on Gilchrist’s partnership with Nkoaranga Lutheran Hospital or fundraising opportunities, contact Robin Stocksdale at firstname.lastname@example.org.