Angelite Nurses

Seeing no end to the outmigration of Filipino nurses and doctors, a former health secretary has taken steps to “tame the exodus” and achieve a win-win situation for both the Philippines and foreign countries employing our medical professionals.

For a number of years now, Dr. Jaime Galvez-Tan, former Department of Health (DoH) Secretary, has been working for partnerships among countries recruiting Filipino nurses and doctors.

Tan, who initiated an extensive study on the exodus of medical professionals and its effects in the Philippine healthcare system, has formulated ways to improve the situation by seeking bilateral agreements with receiving countries such as Canada, Finland and Australia, among others.

“I have accepted globalization and I have accepted that Filipino nurses are bound to go. Let us tame the exodus; you cannot stop them; that is their human right. Let us tame it,” said Tan, an educator at the University of the Philippines (UP) College of Medicine and founder of Health Futures Foundation, Inc., which trains community health workers nationwide.

Though lacking official government backing, Tan was able to secure on-going negotiations from recruiting countries such as Finland, Canada, Australia and Bahrain to establish a trust fund for health human resources development.

“We can turn migration into a positive force rather than a negative force.”

The proposed RP-Partner trust foundation seeks the adoption of a Philippine region such as Iloilo, Surigao, Agusan del Norte and Agusan del Sur with the recruiter pouring direct investments in its health system.

Tan is also negotiating for employed nurses to return to the Philippines after two years of service abroad to share their knowledge among Filipino nurses for a period of six months. “I call this brain circulation,” he said.

For nurses who may opt to stay and teach in the Philippines, Tan has asked recruiting countries to provide a Masters Degree scholarship to be provided by the state or the hospital where the nurse is employed.

Other negotiations in the “win-win” bilateral agreement include the provision of three nursing scholarships in a Philippine nursing school partner for every Filipino nurse recruited by the state or the hospital and the improvement of a healthcare facility for every 10 nurses recruited.

For 20 nurses recruited, a nursing school should be improved and for 50 recruited Filipino nurses, Tan seeks for the improvement of a training hospital.

Tan’s research shows the Philippines remains the top exporter of nurses to the world and the number two exporter of doctors, following India.

MANILA, FEBRUARY 9, 2010 (STAR) By Sheila Crisostomo  - For the last three years, the number of registered Filipino nurses taking the US National Council Licensure Examination (NCLEX) has been declining, indicating that fewer Filipino nurses are seeking work in the United States, a labor organization said. Trade Union Congress of the Philippines (TUCP) secretary-general Ernesto Herrera said only 15,382 took the US licensure exam for nurses in 2009, compared to 20,764 in 2008. In 2007, 21,299 Filipino nurses took the NCLEX.
The former senator said there is a need to “build up the competitiveness of Filipino nurses in foreign labor markets.” One way is to shut down the 152 nursing schools previously classified by the Commission on Higher Education as “substandard.”
Herrera also proposed that nursing schools publish their passing rates in the annual licensure exam “so that buyers of nursing education may be guided accordingly.”
He said the Technical Education and Skills Development Authority (TESDA) should also provide free second-language training to nurses seeking employment in non-English-speaking countries.
Herrera also said that many nursing students do not get proper clinical training in hospitals because there are too many of them.
“Hospitals can no longer accommodate all our nursing students in emergency rooms, operating rooms and delivery rooms. There are just too many of them waiting in line to observe procedures,” he said.
“The capabilities of all state-owned hospitals, whether run by the Department of Health or by local governments, to provide superior clinical training to junior and senior nursing students (must be strengthened),” he added.

Rape allegations were reported in a quarter of city's 119 nursing homes in those two and a half years, records show

Authorities have investigated at least 86 cases of sexual violence against elderly and disabled residents of Chicago nursing homes since July 2007, but only one of those cases resulted in an arrest, a Tribune investigation has found.

Allegations of criminal sexual assault, or rape, were reported in a quarter of Chicago's 119 nursing homes during those 2 1/2 years, government records show.

State law requires nursing homes to notify police immediately when they receive an allegation of sexual violence or abuse. However, no police reports were filed in connection with at least nine alleged sexual attacks reported by the state Department of Public Health, according to Chicago police records released to the Tribune. In a 10th case, the allegation was reported to police months after the incident.

Police and state investigative reports depict the terror endured by elderly and disabled women in some city nursing facilities where predatory males troll through common areas and unlocked bedrooms with little supervision.

Almost all of the 86 cases the Tribune examined involved residents attacking other residents. Only a handful of the alleged attackers were employees or visitors; the lone successful prosecution was of an orderly.

The frightening atmosphere is another consequence of Illinois' unusual reliance on nursing homes to house younger psychiatric patients with sometimes violent criminal records. Many understaffed facilities are ill-equipped to treat these residents or monitor their behavior.

Government records show that the 30 Chicago facilities where rapes were reported were roughly twice as likely to house convicted felons and mentally ill patients as the 89 city nursing homes without a sexual assault allegation.

At Rainbow Beach Care Center on the South Side, a 61-year-old woman said she was afraid to fight or scream and could only say, "No, no, no, please," as she was allegedly raped by a schizophrenic 47-year-old man with a "history of inappropriate sexual behavior toward females," according to a state health department report. When a police report was filed months later, it said the woman had called the sex "consensual."

A physician had previously ordered that the alleged attacker be given periodic shots of the drug Depo-Provera, a form of chemical castration used on male sex offenders. But state health inspectors found no medical record indicating those shots were given. State investigators also said the facility failed to conduct a "thorough investigation" to determine whether the same man had raped a second woman.

A few miles away at All Faith Pavilion, a female resident was hospitalized in a "catatonic state" with a swollen black eye, broken nose and human bite marks, state records show. She told authorities she was raped by a schizophrenic48-year-old male resident in the facility. The woman remained hospitalized for at least a month, a state report said.

No charges were brought in the Rainbow Beach and All Faith cases.

The owners and administrator of All Faith declined interview requests. Eric Rothner, a co-owner of Rainbow Beach, issued a written statement saying: "Every day, we confront a unique set of challenges and we deal with them realizing that if it were not for our facilities, our residents would be living on the streets. All of us caring for this population are keenly aware of these issues and work to overcome them 24 hours a day, seven days a week."

'Something hidden'

Most of the 30 city homes with alleged attacks had substandard staffing levels, which experts call a key indicator of patient safety. Of the 23 homes that federal authorities have rated on a ratio of nursing staff to residents, 21 were rated "below" or "well below" average on staffing levels, while two others were deemed average, the Tribune found.

In addition to 48 reports of criminal sexual assault, which is a felony, Chicago police records show 28 allegations of criminal sexual abuse at city nursing facilities since July 2007. Those sexual abuse cases, which include charges of molestation and groping, can be misdemeanors under some circumstances.

One of the nine alleged attacks that did not turn up in police records released to the Tribune came to light in May 2008 during a state inspection of Rothner's Sheridan Shores Care & Rehabilitation Center on the North Side. Three "alert and oriented" women described "the fear they were experiencing at night time" when they awoke to find strange men in their rooms, sometimes standing over their beds, according to the state inspection report.

One woman said: "It scared me to death!" Another recounted staving off "2 attempted rapes during the night when male residents entered her room using the stairwell," the state report said. A facility investigation confirmed one woman's allegation about a male intruder standing over her bed, but Sheridan Shores' administrator denied to state investigators knowledge of any attempted rape.

Although both police and state health inspectors investigate allegations of sexual violence in nursing homes, the Tribune found that the two agencies rarely communicate with each other about the incidents and do not typically share reports on violent incidents or pool their expertise and resources.

The extent of the violence in Chicago nursing homes was unknown to the state ombudsman's office, which fields abuse complaints from nursing home residents and their families. That agency investigated only two sexual abuse allegations in Chicago homes during a recent 12-month period, according to its records, while police listed 27 reports of sexual assault at city nursing homes during that time.

"We believe the reports are less frequent than they should be — we think there is something hidden here," said Karen Roberto, a Virginia Tech professor who studies sexual assaults against the elderly in nursing facilities.

The small number of arrests related to recent rape allegations in Chicago nursing homes — 48 rape reports, one arrest — sharply contrasts with figures on sexual assault allegations citywide, official figures show.

Last year, Chicago police investigated 1,446 criminal sexual assault reports and made 450 arrests. Though some rapes can involve multiple defendants and some arrests can be linked to reports from the previous year, that amounts to roughly one arrest for every three reports.

Similarly, the FBI estimates that nationally there were 89,000 rape reports to law enforcement agencies in 2008 and 22,584 arrests.

Prosecution pitfalls

Experts say a variety of factors can interfere with investigating or prosecuting sexual assault reports in nursing homes. Often the victims suffer from dementia or appear delusional and can't describe the attacks in enough detail to assist investigators.

In December 2008, for example, a health care worker found evidence of sexual trauma on an elderly female resident of Warren Park Health & Living Center on the Northwest Side. The woman, who was hospitalized after the alleged attack, said a man came into her room and sexually assaulted her, but she "was unable to provide any further (information)," according to a Chicago police report.

Some facility residents are afraid to speak out because they live alongside their alleged attackers, others are anxious about alienating their caregivers or being moved from the only homes they have, and many simply feel too weak to face the ordeal of police questioning and forensic examinations.

"When they're at the end of their life, a lot of times people give up. It takes a lot of strength to go to police," said Karla Vierthaler, outreach coordinator at the Pennsylvania Coalition Against Rape.

Some cases become compromised because residents delay reporting the alleged attacks until they are visited by a relative or trusted caretaker. By then, any DNA or forensic evidence can be lost.

A Tribune review of police and state health reports found that although many facility operators responded immediately to rape allegations, some unwittingly cleaned up crime scenes rather than properly preserving evidence.

Others downplayed the incidents as consensual sex. They "act in their own self-interest rather than the interests of the residents," said Holly Ramsey-Klawsnik, a Massachusetts-based sociologist and mental health clinician.

For their part, police sometimes drop their investigations too quickly when faced with the host of obstacles from both victims and facility employees, said Ronald Costen, a former criminal prosecutor who directs Temple University's Protective Services Institute.

"You have to treat these cases of sexual assault in a long-term care setting like coming across a dead body on the side of the road — you have to look for hard, forensic evidence," Costen said.

In addition, experts said, police sometimes decide that mentally ill perpetrators lack the intent needed for successful prosecution and may have a better shot at treatment in nursing facilities rather than prison.

Only one of the 48 Chicago cases involving the most serious allegation, criminal sexual assault, was referred to the Cook County state's attorney's office for felony review, according to a records search done for the Tribune by prosecutors.

Chicago police say they vigorously pursue every sexual assault allegation. "We're not real quick to drop investigations ... that's not the case," said Thomas Byrne, chief of detectives for the department. "Sexual assaults are something we take very seriously."

In April 2008, police were summoned after midnight to Somerset Place on the North Side after a mentally ill 28-year-old resident told staff that he had beaten, then raped a schizophrenic 53-year-old woman after forcing his way into her fourth-floor bedroom, records and interviews show.

The man told police "he wanted to make a confession," and a police report said he sexually assaulted his female housemate "without the victim's consent." Sent to the emergency room with a blood-filled and swollen black eye, the woman told police and Somerset employees she had been sexually assaulted.

The victim's mother, Dorothy Foster, of Bolingbrook, saw her daughter at the facility the next day. "I just broke down," Foster said. "It was so bad."

But in the end, no arrest was made in the case. According to a police detective's report, the victim refused to cooperate with officers. She and the male resident now live in different facilities.

Somerset, another Rothner nursing home, sent a description of the incident to the state Department of Public Health as required by law, and the facility has not been accused of wrongdoing in the case.

Somerset has had seven reports of alleged sexual violence since July 2007, more than any other Chicago nursing home, records show. Federal and state authorities this month moved to revoke its state nursing home license and cut off its federal funding because of citations for abuse, safety breaches and other problems. The facility is contesting those actions.

Tribune reporter Anne Sweeney contributed to this report.

dyjackson@tribune.com

gmarx@tribune.com

But state officials declined to fine the hospital.
Ronca, a 33-year-old mother of three from Pennsylvania, was put under anesthesia and prepped for brain surgery on April 10 to correct her Chiari malformation - a condition that causes terrible headaches and other debilitating symptoms.
Unbeknown to her, Dr. Paolo Bolognese was en route to a family vacation in Disney World the morning of the procedure, and Dr. Thomas Milhorat, his partner and the chief of neurosurgery, refused to cover. Milhorat told OR staffers he was busy and directed them to wake Ronca up and reschedule.
North Shore suspended the two prominent neurosurgeons for several weeks. Milhorat, 73, was forced to step down after the Daily News exposed the incident.
The Health Department slapped the hospital in September with 14 violations of the public health code, including its no-show surgeons, an anesthesiologist who put the patient under with no one to operate and lying to the patient.
In North Shore's plan of correction, which was accepted and released by the Health Department yesterday, the hospital disagreed with seven of the state's 14charges.
The hospital dismissed the surgery mishap as "a result of an unfortunate confluence of a few errors, not a 'systemic' failure resulting from the absence of bylaws or policies."
The department's decision not to fine the Manhasset institution was another slap in the face to Ronca, who is suing the doctors and North Shore's Chiari Institute.
"I cried again," Ronca told The News when she learned the hospital got off without a fine. "The Health Department never called me to hear the facts from me. It's just another betrayal."
Ronca said since the ordeal, she has suffered recurrent nightmares and pain that plunged her into a deep depression, for which she was hospitalized in October.
"I've had a lot of issues trying to come to terms with what they did to me. The Health Department just assumed there was no injury," she said.
hevans@nydailynews.com

 

Henrietta Lacks' cells were essential in developing the polio vaccine and were used in scientific landmarks such as cloning, gene mapping and in vitro fertilization.Medical researchers use laboratory-grown human cells to learn the intricacies of how cells work and test theories about the causes and treatment of diseases. The cell lines they need are “immortal”—they can grow indefinitely, be frozen for decades, divided into different batches and shared among scientists. In 1951, a scientist at Johns Hopkins Hospital in Baltimore, Maryland, created the first immortal human cell line with a tissue sample taken from a young black woman with cervical cancer. Those cells, called HeLa cells, quickly became invaluable to medical research—though their donor remained a mystery for decades. In her new book, The Immortal Life of Henrietta Lacks, journalist Rebecca Skloot tracks down the story of the source of the amazing HeLa cells, Henrietta Lacks, and documents the cell line's impact on both modern medicine and the Lacks family.
Who was Henrietta Lacks?
She was a black tobacco farmer from southern Virginia who got cervical cancer when she was 30. A doctor at Johns Hopkins took a piece of her tumor without telling her and sent it down the hall to scientists there who had been trying to grow tissues in culture for decades without success. No one knows why, but her cells never died.
Why are her cells so important?
Henrietta’s cells were the first immortal human cells ever grown in culture. They were essential to developing the polio vaccine. They went up in the first space missions to see what would happen to cells in zero gravity. Many scientific landmarks since then have used her cells, including cloning, gene mapping and in vitro fertilization.
There has been a lot of confusion over the years about the source of HeLa cells. Why?
When the cells were taken, they were given the code name HeLa, for the first two letters in Henrietta and Lacks. Today, anonymizing samples is a very important part of doing research on cells. But that wasn’t something doctors worried about much in the 1950s, so they weren’t terribly careful about her identity. When some members of the press got close to finding Henrietta’s family, the researcher who’d grown the cells made up a pseudonym—Helen Lane—to throw the media off track. Other pseudonyms, like Helen Larsen, eventually showed up, too. Her real name didn’t really leak out into the world until the 1970s.
How did you first get interested in this story?
I first learned about Henrietta in 1988. I was 16 and a student in a community college biology class. Everybody learns about these cells in basic biology, but what was unique about my situation was that my teacher actually knew Henrietta’s real name and that she was black. But that’s all he knew. The moment I heard about her, I became obsessed: Did she have any kids? What do they think about part of their mother being alive all these years after she died? Years later, when I started being interested in writing, one of the first stories I imagined myself writing was hers. But it wasn’t until I went to grad school that I thought about trying to track down her family.
How did you win the trust of Henrietta’s family?
Part of it was that I just wouldn’t go away and was determined to tell the story. It took almost a year even to convince Henrietta’s daughter, Deborah, to talk to me. I knew she was desperate to learn about her mother. So when I started doing my own research, I’d tell her everything I found. I went down to Clover, Virginia, where Henrietta was raised, and tracked down her cousins, then called Deborah and left these stories about Henrietta on her voice mail. Because part of what I was trying to convey to her was I wasn’t hiding anything, that we could learn about her mother together. After a year, finally she said, fine, let’s do this thing.
When did her family find out about Henrietta’s cells?
Twenty-five years after Henrietta died, a scientist discovered that many cell cultures thought to be from other tissue types, including breast and prostate cells, were in fact HeLa cells. It turned out that HeLa cells could float on dust particles in the air and travel on unwashed hands and contaminate other cultures. It became an enormous controversy. In the midst of that, one group of scientists tracked down Henrietta’s relatives to take some samples with hopes that they could use the family’s DNA to make a map of Henrietta’s genes so they could tell which cell cultures were HeLa and which weren’t, to begin straightening out the contamination problem.
So a postdoc called Henrietta’s husband one day. But he had a third-grade education and didn’t even know what a cell was. The way he understood the phone call was: “We’ve got your wife. She’s alive in a laboratory. We’ve been doing research on her for the last 25 years. And now we have to test your kids to see if they have cancer.” Which wasn’t what the researcher said at all. The scientists didn’t know that the family didn’t understand. From that point on, though, the family got sucked into this world of research they didn’t understand, and the cells, in a sense, took over their lives.
How did they do that?
This was most true for Henrietta’s daughter. Deborah never knew her mother; she was an infant when Henrietta died. She had always wanted to know who her mother was but no one ever talked about Henrietta. So when Deborah found out that this part of her mother was still alive she became desperate to understand what that meant: Did it hurt her mother when scientists injected her cells with viruses and toxins? Had scientists cloned her mother? And could those cells help scientists tell her about her mother, like what her favorite color was and if she liked to dance.
Deborah’s brothers, though, didn’t think much about the cells until they found out there was money involved. HeLa cells were the first human biological materials ever bought and sold, which helped launch a multi-billion-dollar industry. When Deborah’s brothers found out that people were selling vials of their mother’s cells, and that the family didn’t get any of the resulting money, they got very angry. Henrietta’s family has lived in poverty most of their lives, and many of them can’t afford health insurance. One of her sons was homeless and living on the streets of Baltimore. So the family launched a campaign to get some of what they felt they were owed financially. It consumed their lives in that way.
What are the lessons from this book?
For scientists, one of the lessons is that there are human beings behind every biological sample used in the laboratory. So much of science today revolves around using human biological tissue of some kind. For scientists, cells are often just like tubes or fruit flies—they’re just inanimate tools that are always there in the lab. The people behind those samples often have their own thoughts and feelings about what should happen to their tissues, but they’re usually left out of the equation.
And for the rest of us?
The story of HeLa cells and what happened with Henrietta has often been held up as an example of a racist white scientist doing something malicious to a black woman. But that’s not accurate. The real story is much more subtle and complicated. What is very true about science is that there are human beings behind it and sometimes even with the best of intentions things go wrong.
One of the things I don’t want people to take from the story is the idea that tissue culture is bad. So much of medicine today depends on tissue culture. HIV tests, many basic drugs, all of our vaccines—we would have none of that if it wasn’t for scientists collecting cells from people and growing them. And the need for these cells is going to get greater, not less. Instead of saying we don’t want that to happen, we just need to look at how it can happen in a way that everyone is OK with.