Monday, February 8, 2010

Things change

Things change!! That was the theme of one of the church sermons we heard a year ago and that’s certainly proved true for us. Up until two weeks ago I hadn’t had enough hours in the day to get everything done for two months and now I’m sitting and waiting ……….for many things.

First, Gary has been medically evacuated to the US. He’s been diagnosed with moderate stage prostate cancer. It appears he may not be allowed to return. The PC policy for medical care is that when it takes more than 45 days to resolve they separate you from the PC. They will take care of him but he will no longer be able to serve. As one of the medical officers said to me last night, “you never know; miracles do happen”, but the expectation is that he’s finished. Our first clue was in preparation for departure the PC completed all closure paper work in the event he didn’t return.

After many tests in Kingston over six weeks, he left two days ago for Boston armed with all his results from PSA scores, digital exams, and a sixteen site biopsy report with accompanying tissue slides [Considering that a prostate is about the size of a walnut I can’t imagine much is left of his now]. He will need a few more tests in the US to see if it’s spread. Then he’ll consult with doctors before deciding which procedure and by whom the procedure will be done. The Jamaican urologist recommended he get this taken care of within the month, so that’s the target.

He sees his first doc Monday morning and after that we ought to have a pretty good idea as to which procedure and when it can be done. He’s scheduled to see another doc Friday morning and then will decide from there if more need to be consulted. With that information I’ll have an idea of when to schedule my emergency leave to be with him.

What comes next is up in the air. As we understand it oncology test results are simply estimates of a patient’s status and not until the doctor is able to see and test surrounding tissues do you have a reasonable idea of what is next. If it turns out to be a routine prostatectomy and he has laparoscopic and/or robotic surgery he’ll be up and at ‘em in about 3 weeks. If he needs standard surgery it could take six to eight weeks. If they find it’s spread beyond the prostate other interventions will be required.

So, here I am waiting and hoping all will be well for him. It’s tough and lonely without him. At this point [I may change my mind] the plan is for me to stay on here in Jamaica and just take the brief leave [I’ll get to the rationale for that shortly] if the first or second situations occur. If the latter occurs I will separate and stay home to be with him.

Another thing I’m waiting on are the results of a mega-grant proposal I submitted in January. [It’s unbelievable how things unfold and then appear to collapse before your very eyes]. In late October I was asked by a Jamaican leader to submit a proposal to the National Health Fund [a Jamaican Foundation] to take the concept of the Healthy Lifestyles Seminars I mentioned in the July 30 blog to a national level. That’s why I’ve been so busy. There have been meetings and consultations with Ministries of Health and Education officials, parish leaders and educators, and local people I have already worked with on this project. That plus the research and writing process took up 90% of my time and focus for the last two months. The grant was submitted January 26 with the understanding that it must be funded no later than March 15 [all along NHF officials have said “no problem mon”….we’ll see about that]. If it goes through it might become a major contributor in the island’s fight against the chronic disease epidemic. Over three years it will cost more than JM$300,000,000 [US$264,000] to fund the project and if it goes to the six years I recommend it will be in the JM billions. Below is the proposal’s executive summary so you get an idea of what is proposed.

If healthy lifestyles are the bedrock of wellness the Jamaican health care system has been ‘rocked’ in the last ten years with a precipitous 10% increase in chronic diseases associated with unhealthy lifestyles. The financial and human costs are rising annually. Jamaican research suggests inactivity is the leading cause for obesity and overweight in 90% of women; 28% of males smoke; 98.5% of all Jamaicans eat less than one fruit and/or vegetable per day; and 30% fry all protein foods [Wilks, 2008; Ferguson, et al 2008]. Further, up to 38% may suffer from depressive disorder (Brown, 2005). Diet, activity levels, overweight/obesity, stress, and smoking, each modifiable lifestyle behaviors, positively correlate with the incidence of chronic diseases that Jamaicans now face at an ever increasing rate: Type 2 diabetes, heart disease, hypertension, stroke, breast and prostate cancers, dyslipidemia, and osteoporosis.
Chapelton Hospital and the US Peace Corps are partnering to address this issue in Upper Clarendon. Presently three all age schools, St. Augustine Boys Home, and the Seventh Day Adventist Church of Chapelton, all in the Chapelton Health District, have had teachers, parents, youth and/or church members trained in healthy lifestyle practices (hygiene, exercise, nutrition, and stress management) during six-day (nine hours total) seminars at their respective sites. The aim of this model was for each participant who qualified for certification (according to written and practical examinations) to teach others: adults and children. Three all age schools, Chapelton, Rock River, and Wood Hall used HLS:TT certified teachers to instruct parents at PTA meetings and professional colleagues at staff meetings. As well, parents reached out to church members during services. The intent was to provide training for their colleagues to teach students and for parents to sustain the instruction at home. The objective was to provide a consistent message and skills that support the goal of reducing rates of chronic disease.
Acting within the structure of the Ministry of Education’s Health and Family Life Education Project (HFLE), the current proposal intends to test the Chapelton model, expand the concept of the HFLE project, and broaden the outreach of the Healthy Lifestyle Seminar to two parishes with distinctly different demographics, rural Clarendon and urban Kingston. In year one a random selection of 20% of public all-age and primary schools in both areas will test the template (with smoking cessation added) used in the Chapelton Health District. Certified Healthy Lifestyle teachers will conduct these seminars in their respective schools. Pre- and post-testing will identify knowledge gained as well as assess participants’ likelihood of changing their lifestyle behaviors in any or all of the five topic areas. On a monthly basis, certified teacher trainers will provide support, follow-up and further evaluation of progress at each participating school. During site visits trainers will also work with parent leaders regarding their skills development and participation in the effort.
The HLS:TT two-stage pilot and all-island project will: 1) be a partnership between MOE, Clarendon Health Department of the Southern Regional Health Authority, and the US Peace Corps; 2) run 39 months from March 2010 to June 2013; 3) reach 25 pubic schools in stage 1, 122 in stage 2 and 605 in the all-island effort ; and 4) cost $15, 194,761 in stage 1, with $ 13,106,761 requested from NHF, and an estimated $72,000,000 in stage 2. Yet to be set, costs for the all-island stage are estimated to be 3 ½ times those for stage 2. Pilot stages will identify successful strategies that best apply in rural and/or urban settings, allow for refinement of procedures, and ascertain more precisely the required materials/equipment. Using information and procedures developed in the two stage pilot, a revised effort will be developed for an Island-wide program designed to reach each parish with a similar concept. As we attempt to dramatically reduce the incidences and rates of chronic disease in Jamaica, this project will be a two-front attack from home and school on the current lifestyle practices known to be the sources of the current chronic disease epidemic.

So, I wait…..to see what happens with Gary…… and the proposal. Regardless of the outcome of the grant I won’t stay to implement it if Gary needs me, but it would be fulfilling to be able to see it through.

On the upside we’re still waiting on the Computer Center opening but it is eminent. There is a management committee in place, a J$983,777 grant was awarded to the Citizens’ Association for this, equipment is ordered and expected to be delivered next week, the room is secured, all tables and chairs are set up and waiting, phone and internet lines are in the cue for installation and the same is true for the burglar alarm. We’re planning a Grand Opening for the end of February [I’ll be away in the US but am sure they’ll carry it off in fine Jamaican style].

Another positive is that Gary’s situation may have accelerated the rate of project ownership by many of those in the community. Several of those we’ve worked along side appear to have realized they have to take over from us or all their efforts and money will have been wasted. With our scheduled departure only seven months away many have recognized the need.

What has been interesting to watch is how over time the belief and trust in what we’ve facilitated has been accepted and owned by the residents. It’s a demonstration of why two years is necessary. Initially, Gary and I had to do most of the work and we rarely had any leads on who to go to. Just last month someone stepped up and offered to find a truck to pick up five metal drums from a Kingston distillery who was donating them to the Citizens’ Association for water storage and garbage collection. When it was time to clean and set-up the Computer Center room people I’d never seen before showed up. A carpenter offered to donate his time to install a secure door for the Computer Center and a furniture maker is building a storage cabinet for the computer room tomorrow morning. Now that we’re about to leave we’re seeing residents appear from seemingly nowhere to contribute. All of this is reassuring that there may be a measurable residual once we leave.

I’ll keep you posted on Gary’s status; in the meantime keep everything you have connected to your body crossed for him. More lata, Margaret

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