Care providers' needs and perspectives on suffering and care in Bosnia and Herzegovina and Cambodia.

This exploratory study aimed to obtain insight into field-level care providers' views on suffering and healing as well as existing obstacles and needs related to providing care to their clients. This research provides a "snapshot" for a better understanding of existing care systems in two post-conflict settings. By identifying existing approaches to care and the needs of the care provider community, this research might be useful in guiding psychosocial assistance programming in post-conflict settings. Utilizing a semi-structured questionnaire, 45 care providers were interviewed, including local health care practitioners, traditional/ spiritual healers, and humanitarian relief workers, in Bosnia and Herzegovina and Cambodia. This study found that the majority of care providers in both settings perceived poverty and violence as significant causes and consequences of human suffering and, at the same time, felt ill-equipped in addressing these issues and related problems. Other issues that hindered these healers in providing care included: limited government/institutional support; lack of training; material resources and funding. Study findings point to a new framework for developing effective interventions and the need for further emphasis on supporting care providers in their work, and most specifically, in identifying and responding to poverty and violence.

The longitudinal impact of psychological functioning, medical severity, and family functioning in pediatric heart transplantation.

BACKGROUND: Few data are available on the longitudinal psychological functioning of patients after pediatric heart transplantation. The objective of this study was to determine whether pre-transplant psychological functioning, post-transplant medical severity, and family functioning relate to the psychological functioning of pediatric patients after heart transplantation. METHODS: The study included 23 patients who underwent heart transplantation between ages 3 and 20 years, survived at least 1 year after transplantation, and had been assessed previously after transplantation between 1993 and 1995. This study reports a second post-transplant assessment between 1999 and 2000. We assessed psychological functioning using the Children's Global Assessment Scale before and after heart transplantation. We assessed medical severity using the number of outpatient visits, hospitalizations, and biopsies and using the Side Effect Severity Scale. We used the Global Assessment of Family Relational Functioning Scale to rate family functioning. RESULTS: The majority of patients (15/23) were alive at the second follow-up. They had survived a median of 9.6 (6.1-12.9) years after transplantation. Similar to their first follow-up assessments, 73% demonstrated good psychological functioning after heart transplantation. Although we found no correlation between medical severity and post-transplant psychological functioning, we did find a significant correlation between family functioning during the first 2 years of transplantation and post-transplant emotional adjustment. CONCLUSIONS: The majority of children and adolescents have the capacity for healthy psychological functioning after heart transplantation. Nevertheless, ongoing psychological assessment and intervention is necessary for patients and their families who face pediatric heart transplantation because >25% probably will have emotional adjustment difficulties.