Author: Redazione Cuamm

YOUTH AND RESEARCH: FOR AN HIV-FREE FUTURE

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Provide local health authorities with updated information on adolescents and young adults HIV+ in order to strengthen the health system, particularly HIV services. This is the overall objective of the research that the University of Florence is carrying on in partnership with CUAMM in Shinyanga Region, Tanzania, as part of the project “Improving health and well-being of adolescents and young adults HIV+”, financed by the Italian Agency for development cooperation. There are 3 main Care and Treatment Centers (CTCs) involved, namely Bugisi HC, Shinyanga Regional Referral Hospital and Ngokolo HC.

The study will analyse barriers to access to HIV services for adolescents and young adults living with HIV, disaggregated by gender and age group, and explore their psychophysical status. Particular attention will be paid to investigate the impact of COVID-19 on both the access to HIV services and mental health of HIV+ adolescents and young adults.

«Research is essential to guide action and make informed decisions. Adolescents and young adults are at a vulnerable stage of life. As we strive to ensure UNAIDS 95-95-95 goals are met, we are conducting a mixed methods study to investigate barriers to access and utilize HIV services among HIV+ adolescents and young adults in Shinyanga region and to assess their mental health status. In the midst of COVID-19 pandemic, our study also aims to investigate the impact of COVID-19 on their wellbeing and the scars it has left in the public health sector», affirms Constantine Ntanguligwa, CUAMM doctor and principal investigator of the research.

Mixed methods, qualitative and quantitative, will be deployed for data collection. Particularly, a close-ended questionnaire, focus group discussions and in-depth interviews will be conducted. Moreover, data on adherence and access to HIV services from registry of the involved health facilities, will be analyzed to compare the situation before and during the COVID-19 pandemic.

«Working with teenagers, particularly those between 10 and 14 years’ old, requires a lot of care and delicacy. Many of them are not fully aware of what HIV is even if they are in daily treatment. Some of them face stigma at school and within their community for the HIV status. Moreover, mental health challenges are not to be underestimated and should be increasingly considered as key issues to be addressed – claims Chiara Didonè, CUAMM project manager in Shinyanga-. This has to be taken into account when designing interviews and formulating questions. This is why we have selected young doctors to support us in this phase, to put teenagers at ease».

If we want to imagine a future without HIV, we have to definitely start with adolescents and young adults, listening to them and making them feel an active part of this path.

A SPACE TO TAKE CARE OF PEOPLE

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From February 2023, all health units in Mozambique will be able to register patient data on chronic non-communicable diseases, particularly diabetes and hypertension, in the SISMA statistical system, developed by the Ministry of Health (MISAU), thanks to the support of Doctors with Africa CUAMM. An important and innovative step for the country, developed as part of the “Prevention and control of non-communicable diseases” project in Maputo and the provinces of Sofala and Zambezia, financed by the Italian Agency for Development Cooperation (AICS) and implemented in partnership with the Community of Sant’Egidio and AIFO. The intervention, recently concluded, has contributed to strengthening the Ministry of Health’s capacity to respond to the increasing incidence of noncommunicable diseases in the country, developing action aimed at improving early diagnosis and treatment.

According to the World Health Organisation (WHO), chronic non-communicable diseases cause 28% of deaths in Mozambique, of which 12% are due to cardiovascular diseases, 3% to cancer and respiratory diseases, 2% to diabetes and 7% to other chronic diseases. 33.1% of the Mozambican population is hypertensive: only 18.4% are aware of their condition and, even among those who are aware, about half do not monitor themselves and do not follow treatment regularly.

«The current digital system already permitted the collection and recording of epidemiological data, e.g. cases of malaria, while for chronic non-communicable diseases the available data were recorded monthly in the paper registers of each health unit and then transmitted first to the district, then to the province, and finally to the Ministry – says Paolo Massaro, who was in charge of the project for CUAMM-. Now in SISMA all screening for diagnosis and follow-up visits of patients are recorded, divided by gender, reporting any associated diseases and complications».

Together with the Ministry, CUAMM organised specific training for IT and statistical experts and focal points for chronic non-communicable diseases in the various provinces. Achieving this result has been a long process, above all constant coordination work with the local authorities and the Ministry’s Planning and Cooperation Department, which made it possible to create the first MISAU technical working group on chronic diseases.

In addition to the digitisation of data, the “cantinhos de rastreio”, spaces within the health units dedicated to screening for chronic non-communicable diseases, were also created. Activists and volunteers, including nurses awaiting employment or already retired, have been trained in chronic disease services. Today they take care of measuring blood pressure with a digital sphygmomanometer and checking the weight and height of all people who come to the health units before they are seen by doctors. «The cantinhos initiative was one of the best strategies adopted by the project – says Artimisia Mainato, nurse in charge of the project in the province of Sofala – because it allowed for a significant increase in screening, easing the workload of the clinical doctors and, as a result, also reducing waiting times for patients». In January 2023, the Ministry of Health approved the introduction and expansion of Cantinhos de Medição de Tensão Arterial on a national scale, as a standard and compulsory countrywide strategy.

The cantinhos are an additional and free service of the health units, which has led to a significant increase in the number of people screened for chronic diseases, which has grown from about 5 to 40-50%. A space to take care of people.

A NEW CLINIC FOR CHRONIC NON-COMMUNICABLE DISEASES

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«Help for life and health for all! With this message of hope and commitment, chosen by the health personnel, the PEN-Plus clinic for chronic non-communicable diseases at the government hospital in Pujehun was officially opened in a facility rehabilitated by CUAMM. This is a big step forward, achieved thanks to the PEN-Plus project, in collaboration with the Sierra Leone Ministry of Health and Sanitation, with funds from the Brigham and Women’s Hospital and the NCDI Poverty Network.

Operational since last December, it moved to the new building in February 2023 where, so far, about 170 patients are treated and followed-up, most of them with common chronic diseases, such as hypertension and type 2 diabetes, but also type 1 diabetes mellitus, sickle cell anaemia, asthma, chronic liver disease and epilepsy. The clinic provides medicines and available laboratory tests free of charge for all patients. With the activation of the service in a welcoming environment and the announcement to the entire community, we expect a significant increase in the number of admissions, aimed at bridging the large gap in the current right to care in Pujehun district.

Some results have already been achieved, such as the complex care of insulin-dependent patients with type 1 diabetes in an area where, until a few months ago, there was no insulin and few knew how to use it. Now we have young patients who measure their blood glucose at home with a glucometer, keep a blood glucose diary and are able to self-administer insulin. The aim is to create a place of health for all that will become a reference point for taking care of NCDs (noncommunicable diseases) and related emergencies-urgencies, to develop information campaigns on health determinants (from water to food, to the sewage system) for the population, and to decentralise established services to territorial health units. A long and complex process which, together with my colleagues, I helped to initiate and which I see growing every day amidst unexpected events, difficulties and pleasant surprises!

Witnessing the progress of nurses and clinical health officers in daily medical practice occasionally moves and spurs me on to continue the long process of training to achieve acceptable levels of care. The relationship with patients and their relatives also fills my days, when I am able to dedicate myself to them: they thank you for what you do, always and in any case, and every now and then they give me a pineapple, even if they have nothing. The parallels with the Italian context, where health personnel are more often the object of complaints than gratitude, immediately spring to mind. But the satisfaction, by far the greatest, is the fact that I started the process of setting up a clinic from scratch with all the organisational and bureaucratic problems attached. I have discovered and studied the aspects behind building a place of health and this will be very useful to me professionally.

I had no idea that behind the birth of a project from the very beginning, there were so many elements to be considered, issues to be dealt with: from the choice of the laboratory machine and reagents to the supply of electricity, between solar panels and a generator, from the order of medicines for a quarter to the daily recording of products consumed to ensure stocks. In Italy, working as a doctor in a public hospital, one takes many things for granted, but in truth a thousand processes and professionals are involved in ensuring the functioning of a health facility. Another daily challenge is to intervene on health determinants in a context that lacks resources. Imagine explaining to a diabetic patient in Pujehun that he has to reduce his consumption of the only food available every day, namely rice. He smiles and asks: “Doctor, will you give me some food then? Because, otherwise, I’m starving!”. Therein lies one of our greatest battles».

SEEDS OF FUTURE

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«When you go to St. Luke’s hospital in Wolisso, you hear many voices. Visiting the paediatric ward, then, you perceive a “symphony” of crying and laughter. Sitting on the rubber mat, which is never big enough, there are mothers and fathers with their children, playing and chatting. The 2-3-4 year olds are crawling, hiding between their parents’ coats and curiously observing the group around them».

This is how Fede Bagolin, a Universal Civil Servant in Ethiopia, describes entering the Catholic hospital in Wolisso, where there is a space dedicated to early childhood development, next to the paediatrics unit: here babies can play, while adults receive training and support on how to bring their children up in the best possible way.

The children are almost always hospitalised due to acute or severe malnutrition, on referral from local health centres; they receive care from hospital staff and CUAMM, in collaboration with CEFA, thanks to the “Seeds of future” project, supported by the Italian Agency for Development Cooperation (AICS).

Twice a week, Sisay, a nurse, together with Besha, a psychologist, meet mothers and their children for a few hours of play. Yes, because play is also fundamental to growing up! Sisay and Besha observe families, analyse their behaviour, identify relationship gaps and factors that inhibit children from playing freely when mothers are present.

After that, Besha starts interacting with the children, challenging them with new toys and input. Most of the games are made from recycled materials, during sessions held periodically with families, using old bottles, small stones, seeds, caps to increase the time parents spend with their children and to stimulate creativity».

In this way, Sisay and Besha try to generate curiosity, participation, verbal and non-verbal communication, strengthening the bond between adults and children. «This kind of interaction – Sisay emphasises – is very important to invite mothers to improve their approach and to show the great impact of closeness for the cognitive and physical development of children. A pathway to support parents in their care».

The second part of the activity focuses on nutrition, is also led by Sisay and is structured as an educational moment to develop mothers’ knowledge, from breastfeeding to weaning, to the correct diet according to age. «Most of the time, malnutrition is not caused by a shortage of economic resources or food availability, but by a lack of proper care in preparing meals and attention to children’s needs», points out Worku, CUAMM project officer for “Seeds of future” project.

During the training, they are taught how to prepare vegetables, the most common seeds available in the local market, for a balanced diet against malnutrition. After the training by Sisay, the mothers are encouraged to cook at the practice station. Some parents play with their children, others are busy at the cooker and still others receive individual advice from Besha and Sisay.

«Individual consultancy reduces the fear of judgement that some mothers feel when issues are addressed in a group situation, increases understanding and helps provide guidance on how to learn to listen and understand the child’s needs», testimonies Eleni, a paediatrician at CUAMM.

Individual counselling, group sessions on care, play, feeding and sharing knowledge on early child development are activities that not only strengthen the bond between parents and children, but also accelerate the recovery process of malnourished children, encouraging and supporting their physical and cognitive growth.

A DAY IN KANGAROO MOTHER CARE UNIT

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«Hands washed, mask and coat: this is what you need to follow Leta, nurse in the Neonatal Intensive Care Unit (NICU) and Silvano, an Italian Junior Project Officer specialized in Paediatrics, for visiting the babies. When entering in the kangaroo mother care unit (KMCU), the space dedicated to skin-to-skin contact between mother and baby, the light is soft and the operators is moving slowly, whispering.

I notice some women, but mostly babies. At the Catholic St. Luke’s Hospital in Wolisso, twin births are also common. The “kangaroo-therapy” unit takes in low-birth-weight and preterm newborns, who do not need to be admitted in the Neonatal Intensive Care Unit, because their general condition is not severe, but can be assisted and supported during the first 1,000 days of life.

Often, mothers suffer from a lack of family support, which has an impact on their health and the condition of their children; in KMCU, young women are supported by the health staff to understand the importance of strengthening care for newborns through education activities and medical follow-ups.

Leta and Silvano conduct the routine visits, monitoring the health conditions of the newborns, usually affected by jaundice, malnutrition, respiratory viruses and infections like bronchiolitis, meningitis and encephalitis.

Despite the language barrier, the health personnel try to establish a channel to communicate functionally and continuously with the mothers, in order to monitor and follow-up frequently with them. Due to the scarcity of some medical equipment, active dialogue is essential to understand the children’s status, reactions during the night and symptoms, to better utilize the resources and request laboratory examination only when needed.

Training sessions are delivered in the KMCU twice a week. Jiksa, a nurse in the Neonatal Intensive Care Unit, explains that kangaroo mother care is a powerful and easy method to adopt, from the earliest stages of life, for a prolonged period of time, through carrying and breastfeeding. This good practice helps to reduce mortality and morbidity in the infant’s first 1000 days, improves breastfeeding technique for healthy infant growth and adult well-being, and strengthens the bond between parent and child.

Thanks to KMC, babies can be discharged prematurely, because care is initiated and internalised in the hospital in an environment where parents learn together in a cooperative way how to improve the health of the babies and how to acquire confidence.

Jiksa, with the support of some graphical materials, explains the KMC method, in particular how to position the baby between and during feedings, how to properly feed a low-weight or preterm infant, how to supplement breastfeeding with additional nutrients, how to control appetite, breathing and body temperature.

The mothers are listening with attention, some previously attended other educational activities, but some are newly admitted. When Jiksa involves them in the discussion, the first honest question is: “Why are we doing this?”. Using many examples, Jiksa answers how both mother and child benefit from this habit. Heart and respiratory rates, oxygenation and blood glucose, as well as sleep patterns, behaviours observed and cognitive development improve significantly. Furthermore, the parent develops a sense of empowerment that is vital when there is no support system to grow the baby, to handle the feeding and the foster the bonding relationship between parent and child.

Postnatal care is essential to reduce mortality and morbidity, and KMC is instrumental to improve the health of mothers and children in environments where the resources are limited.

GROWING WITH AFRICA

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«It was March 2018 when I joined Doctors with Africa CUAMM. A five-year path of growing, commitment and achievements that I am proud of. To become, just today, a country administrator assistant in Freetown, the capital of Sierra Leone. My adventure in the organisation started as an accountant. Then, in Bo city, I took on the role of accounting supervisor for the “Saving lives phase II” project, a consortium programme of eight international NGOs, funded by the Foreign, Commonwealth and Development Office (FCDO). Here I coordinated the financial operations and activities of two accountants in Bonthe and Pujehun districts, under the mentorship and support of my colleague Giampaolo De Notari.

In May 2020, a step forward! I was delighted to accept the position of administrator of the same project that I had previously followed as an accountant, also “Saving lives phase II”, being the first Sierra Leone national staff CUAMM entrusted a role held by an International staff. Thanks to Cristiano Bassanini, the project coordinator, for his recommendation. It was an advanced role with more responsibilities ranging from budget management, financial reporting, forecasting, treasury management, risk management and office administration as well as communicating with donor and partners.

After five years, I continue to appreciate every aspect of my work in the administration and finance roles. The recognition that CUAMM has shown me over time not only gratifies me, but also makes me realise that I am heard and that my contribution also counts. The challenges that arise are daily; facing them takes time, perseverance and a positive attitude. With the right mindset and practices I am able to overcome them and grow in the process. Being part of Doctors with Africa CUAMM has has enhanced my skills, knowledge and experience a lot. I would like to thank CUAMM for the trust and confidence it’s always bestowed on me!».

THE AMBULANCES THAT NEVER STOP

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Three operative ambulances covering 15 healthcare units, all those in the city of Beira in the province of Sofala, Mozambique. They take care of transferring emergencies and urgencies from peripheral health units to the city’s central hospital, a fundamental service that began immediately after cyclone Idai and continues to this day thanks to the project “UR-BEIRA: strengthening emergency medical services in the city of Beira”. The intervention, financed by the Italian Agency for Development Cooperation, is implemented by Doctors with Africa CUAMM, with the collaboration of various stakeholders: the Veneto Region in partnership with the District Health Service of the city of Beira, the Emergency Medical Service of the Ministry of Health of Mozambique, the Central Hospital of Beira, Ca’ Foscari University of Venice and the P.O. Croce Verde of Padua.

Doctors, nurses, nursing assistants and ambulance drivers are on the front line, together, every day, with the aim of saving lives. As of February 2022, there are 750 referrals per month on average, about 60 per cent of which are obstetric, neonatal and paediatric emergencies, but also medical-surgical emergencies in general. «We work in all kinds of situations, without sparing ourselves, to guarantee the safety of our patients, – says Cristina Zinguessa José Zaqueu Macucha, a maternal and child health nurse assigned to the ambulance of the Chingussura Health Centre -. The work in the ambulance is really challenging. We are all trained and qualified professionals, but each emergency is a story in itself. One moment we are rescuing patients in a serious condition, another God blesses us with a delivery that we assist in the ambulance. What we do is rewarding, we help many premature babies arrive alive at the hospital’s neonatal ward, we encourage mothers to have skin-to-skin contact with their newborn, in some cases we administer oxygen and always check vital parameters. Our activities do not always go as we would like, we also have sad days. When we cannot get our patients to the hospital alive, it is painful, – Cristina continues – every “emergency professional” has many stories to tell, some sad and some happy, which give strength to continue the work. Several times we have received and referred patients in a critical condition, but thanks to the quick intervention of some colleagues from the hospital in Beira, these patients have recovered».

Emergencies have no timetable and when they come, they often do so all at the same time. A Tuesday a few weeks ago was one of those days when the ambulances in Beira never stopped. «When office activities permit, I like to accompany my colleagues during the ambulance service. That’s where you really find the sense of what we do, – says Marcello Mazzotta, CUAMM’s project manager in Beira. Tuesday was one of those days, and among the many referrals we made, there was that of a premature baby who weighed about 1 kg and therefore needed an incubator and support to breathe. So, we took him and his mother respectively to the Neonatology and Maternity wards at the hospital of Beira to receive the necessary assistance. On the way, the nurse of the ambulance put the baby in contact with his mother’s chest, practising kangaroo mother care, the skin-to-skin contact that avours the baby’s adaptation to the outside world, its development and also breastfeeding. Thanks to that simple gesture, the baby arrived at the hospital with a body temperature close to normal».

Each ambulance, each healthcare unit and four wards of the Beira hospital are provided with a mobile phone with monthly credit. Each health centre has a referral ambulance based on its geographical location. When the ambulance receives the call, if it is free, it immediately leaves to pick up the patient, otherwise it tries to contact the other ambulances to see which one can take care of the emergency first. «Even one more ambulance could make the service even more efficient, – says Marcello -. In the coming months, the project will involve setting up an operations centre managed by trained operators who will receive calls, perform triage and dispatch them to the relevant ambulances.

Although the service works and is essential for the population, challenges remain. «The condition of the roads, which are bumpy and often unpaved, makes it difficult to reach the health units. Journey times get longer and even speed must be moderate so as not to cause further damage to patients during transport», says Marcello. «Another difficulty is encountered in the health centres and at the central hospital in Beira, when dealing with colleagues, – adds Cristina -. Some of them have difficulty distinguishing an emergency from an urgency or even a routine case. Often, when we arrive in the emergency room, there are not enough nurses to receive patients. This system ends up being exhausting and most of the time we leave the health centres in a hurry without an answer».

Investment is therefore being made in training and raising the awareness of health unit staff regarding the importance of triage to improve their ability to rapidly assess the clinical condition of patients and, consequently, the need to transfer them or not. In addition, work is being done to improve the population’s perception of the importance of the service provided by ambulances, which often fail to pass between vehicles on the roads even with their flashing lights and sirens on.

«One day, around one in the morning, I picked up a patient who had suffered a physical aggression, sustaining serious injuries all over his body. After two veins had been canalised and saline solution administered, he was loaded into the ambulance with all vital signs below normal. His brother, who was accompanying him, was inconsolable, – Cristina tells -. I always tried to keep the patient awake until we arrived at the hospital where he was immediately admitted to Traumatology and treated by the emergency room doctors. The brother thanked the ambulance team for the commitment and dedication».

That is the meaning of what we do: it lies there, in knowing that without the ambulance service many people would have no chance of being saved.

FOR QUALITY HEALTH EVEN DURING AN EMERGENCY

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What is happening in Tigray? In this region of Ethiopia, the population is severely affected and living in precarious conditions due to the recent war, which has also undermined the health system. Because of the lack of fuel and availability of cash, vulnerable groups, in particular mothers and children, have been suffering from insufficient provision of health services. In addition, for the past two years, health care workers have not been receiving salary, and the health facilities have not been supplied with medical equipment and drugs.

Since the Federal Government of Ethiopia and the Tigray People’s Liberation Front signed the peace agreement, committing to create stability and retrieve the services in the region, Doctors with Africa CUAMM, starting from June 2022, has been implementing the project “Emergency support to equitable and safe access to quality health in Tigray Region”, supported by EU Humanitarian Aid (ECHO) funding, directly targeting three health facilities in the region: St. Louise Eye Clinic in Mekelle, St. Mary Health Centre in Edaga Hamus, and Kidane Mihret Hospital in Adwa.

The activities offered to strengthen the health team

CUAMM has organised several trainings in Adwa, in Edaga Hamus in Adigrat and in Mekelle. Among these, the training on basic emergency maternal obstetrics and neonatal care aimed to build capacity for health care workers, particularly midwives, on antenatal care, delivery and postnatal care services. Moreover, the training on community management of acute malnutrition was carried out to develop health care workers’ capacity to treat and support malnourished patients, considering that 50.3% of pregnant and lactating women and 22.7% children are suffering from global acute malnutrition (OCHA). These training sessions involved 50 participants. Furthermore, training on infection prevention and control and on health management inform system were organised, also in Mekelle, involving 70 participants.

These training helped the collaboration and coordination among different health facilities in the area, to improve the access to the health services. «Considering the last two years of conflict in the country, – affirms Yonas Tadesse, CUAMM Humanitarian coordinator – the provision of training to the health staff of the targeted health facilities and of the nearby health centres in Tigray is fundamental, leading to a better access to quality health service. By providing capacity-building to the staff, they can feel more motivated, willing to grow their skills and capacities to support mothers, children and vulnerable groups, as well as earn an income to sustain their families».

CUAMM also organised the “Referral pathway coordination workshop” targeting representatives of the health facilities of the area, aiming at coordinating the response to the challenges of the context.

«The referral – says one of the participants – is necessary and life-saving: due to the lack of cash and fuel, in the last two years people were unable not only to provide food, but also to find transportation to reach the health facilities. In addition, health facilities were not supplied with drugs, and the unpaid staff was often unable to reach the workplace and provide services».

According to OCHA, 83% of health facilities do not provide maternal services including prenatal care and deliveries, causing a dramatic surge of maternal deaths, 276 in 2021. At the end of 2021, after the first 13 months of conflict, the Tigray Health bureau reported the decline of the ANC services provision from 94% to 16% as well as of PNC from 73% to 19%. Deliveries assisted by trained health staff went from 81% to 21%, while pregnant and lactating women in acute malnutrition increased from 32% to 78%.

The first results thanks to the CUAMM project

By the end of January, thanks to the Referral Pathway system, CUAMM was able to support 86 patients, by providing fuel for ambulance and autonomous transportation, as well as access to medicines. Of these 86 patients, 9 were referred from the IDPs sites to St. Louise Eye Clinic in Mekelle, 40 from St. Mary Health Centre in Edaga Hamus to Adigrat Hospital and another nearby facility, and 37 from Kidane Mihret Hospital in Adwa to Adigrat Hospital.

«In St. Mary Health Centre in Edaga Hamus, – says Yonas – no MCH service was provided since the start of the conflict. Thanks to CUAMM, a pharmacist and a midwife were hired, allowing the restart of the services in September. So far 70 mothers gave birth safely at St Mary HC. Furthermore, in Kidane Mihret Hospital in Adwa, 3 women in severe conditions were referred, and thanks to the work of the senior gynaecologist and of the paediatrician 3 complicated surgeries were performed to save the women and their babies after caesarian sections».

Continuous presence, support for the fragile health system and investment in capacity building: these are the instruments CUAMM has been putting in place to enhance safe access to quality health services and reduce maternal and child deaths in Tigray.

http://ec.europa.eu/echo/

This document covers humanitarian aid activities implemented with the financial assistance of the European Union. The views expressed herein should not be taken, in any way, to reflect the official opinion of the European Union, and the European Commission is not responsible for any use that may be made of the information it contains.

THE VISIT OF WORLD DIABETES FOUNDATION IN FREETOWN

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The visit of a delegation from the World Diabetes Foundation to the Republic of Sierra Leone ends today. A one week duty travel alongside CUAMM workers to see firsthand what has been achieved so far and what can still be done in diabetes care to respond to what WHO has labeled as pressing public health problem. Together with the delegation, other important stakeholders took part in the visit as the representatives from the Ministry of Health and Sanitation (MoHS), the Directorate of Non-Communicable Diseases (NCD), the health authorities from PCMH and Pujehun district and the COMAHS (College of Medicine and Allied Health Sciences).

On field meetings between the urban area of Freetown and the rural districts around were scheduled to see firsthand the results of a collaboration that WDF and CUAMM started in 2017 with a first pilot project on gestational diabetes mellitus (GDM). Main results were the integration of a dedicated area for Diabetes Screeing (IDS) within the PCMH in Freetown – the referral hospital and the creation of specific spaces in the PHUs (Peripheral Health Units) in the western area of the country. 14.231 women took part in screening at the IDS clinic in the PCMH, 4.296 at the PHUs thanks to the project. Among the results, the creation of a referral system to the IDS clinic at the PCMH for patients diagnosed in the PHU; the design of the first Protocol for Integrated Diabetes Screening for all patients and the development of the first operational research on diabetes during pregnancy “A simplified diagnostic procedure for the detection of gestational diabetes mellitus in resource-poor settings: results and challenges.”

“Considering that the management of Gestational Diabetes Mellitus/ Diabetes in Pregnancy is limited in services provided in the routine activities done to pregnant women attending ANC. In Sierra Leone, WDF project which support the screening, follow up and management of pregnant women positive with diabetes, had not only helped the good outcome of the mother pregnant but it had also contributed to strengthening Sierra Leone profile on Maternal and infant morbidity and mortality.” Said José Moniz Da Silva- CUAMM Project Manager during the meeting with WDF delegation.

A two-year new project followed the pilot one allowing to extend the GDM screening service to rural areas as Pujehun district, in the southern province of the country where around 234.000 people live. Over two years, GDM screening services were introduced not only in Pujehun hospital but also in 5 BeMONC (Basic Emergency Obstetric and Newborn Care). Among the results: training sessions on GDM and data collection addressed to MoHS health workers, activities on nutrition education; follow-up of cases at risk for hyperglycemia during pregnancy (HIP) and training on the job to improve the quality of health services with the support of a expert. 17.682 women received the GDM screening compared to the 10.933 estimated. Over the length of the project advocacy activities on prevention, screening and GDM addressed to MoHS were also introduced in government policies and strategies for noncommunicable diseases.

As stressed by the management team at the PCMH, the integration of such services within the facilities represents a strength since integrated care can increase the system-level efficiency of treatment.

Currently 24 million adults are living with diabetes in Africa and only 46% of them know their health status. Lack of testing facilities and equipment, inadequate number of trained health personnel, poor access to health facilities and services are some of the barriers to diabetes testing. According to WHO the figure is projected to rise by 129% to 55 million by 2045. Over 70 years of presence in Africa, Doctors with Africa has witnessed the rise of numerous non-communicable diseases such as diabetes, little-known and neglected conditions. The partnership with World Diabetes Foundation permitted to implement interventions to bring about a change in health systems, engaging communities, local activists, health authorities and Ministry of Health.

 

Quelimane the cycling town

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“Once upon a time there was a little red bike that felt as fast as a racing car”. This is the story of a red bike with broken wheels unable to perform as it wish. Actually, it is more than this. This is the story of a child who suffers from undiagnosed health conditions and rides his red bike. Actually, it is way more than that. It is the story of a collaboration between the “A. Frattini” Arts High School in Varese and a little town in Mozambique, named Quelimane, where Doctors with Africa Cuamm works to tackle “Noncommunicable diseases”, with the support of the World Diabetes Foundation.

This story is about diabetes, especially type 1, that affects particularly children and the young. Maura Lucchini is an internist from Varese, she is 48 years old and mother of two. Previously, she spent two years in Uganda with CUAMM, three years in South Sudan, one year in Mozambique. Maura chose to invest her time and energies on this project because she thinks it is worth it.

“I started by training – says Maura, because this is a neglected disease. From August on, I have worked with doctors, nurses, nutritionists and psychologists both from Quelimane, in the province of Zambesia and Beira, Sofala province. I am now meeting the activists who works within the communities. We take care of the patients who get to the hospital when their health conditions aggravated. This is not enough. We have to go seek the patients in suburbs, villages and schools because type 1 diabetes is a hidden yet life-threatening disease, hence it is crucial to shed a light on it through the work of the activists”.

Africa is experiencing an increasing prevalence of noncommunicable diseases even though data are few and incomplete. In the sub-Saharan Africa region, less than one in 10 countries has published data on the incidence or prevalence rates of young people with type 1 diabetes. In Ethiopia, for example, the annual incidence was estimated at 2.1/100,000 (1995-2008) and in Tanzania and 1.8-1.9/100,000 (2010-2015).

Continuous and consistent follow-up of patients is limited, and many children and youth die before being diagnosed or accessing treatment, also contributing to the low incidence and prevalence rates estimated. This is where the commitment of Doctors with Africa CUAMM in providing health care and training comes from. Caring patients who seek treatment and training health workers and activists is a time-consuming effort that does not bring valuable results in a short time yet, it represents the commitment to the promotion of development for the future of the next generations.

What makes a difference, once again, is community outreach activities. And because good begets good, Maura dragged her friend Andrea and his students into this adventure.

“Andrea is a friend, says Maura, he is a teacher and member of both a theatre company and a band where also Alessandro plays, he was diagnosed with type 1 diabetes at the age of 16”.

By telling them about my job, we came up with the idea of engaging his students from the class I H, in writing a play script. Performances are an effective mean to train and educate in Mozambique, that is why once I received the script about the red bike and the “Wheelness”, I had it translated into portuguese and scheduled the exhibition to perform both in Quelimane on January 27th and in Biera on 31st in occasion of two health fairs dedicated to diabetes. Hoping that one day at least Andrea and Alessandro, if not the students themselves, will visit us here to witness what we have done, together”.

On these two days, in addition to the play, a multidisciplinary team (pediatrician, general practitioners, nutritionists, psychologists, nurses) informed the children and personal kits with a backpack, glucometer, notebook, and colored pencils were handed out.

Beside, a radio commercial also designed by the Frattini High School students and translated into local dialects was broadcast by local radios.

Students from Varese claimed:

“We enjoyed participating in this project and it is nice that it is coming to fruition. We hope that we can be useful to someone in the world, in our own way. This experience tought us to better use words, as we knew we were addressing them to sensitive people far away from us. It’s good to try to turn sensitivity into strength, to care and to heal, to keep going and never give up.” Finally, Prof. Minidio concludes, “A school that is open to dialogue and debate with the world can enable us to achieve the educational goals set by the UN Agenda 2030.”