Author: Redazione Cuamm

The burden of non-communicable diseases (NCDs) in Sub-Saharan African countries is rapidly rising, specifically diabetes has a more increasing prevalence. In particular, the World Health Organization (WHO) estimates a diabetes prevalence of 5.6% in Angola which is experiencing a double burden of communicable and non-communicable diseases due to changes in lifestyle and diet. NCDs, in fact, are challenging the already overwhelmed Angolan health system which needs to improve the availability and accessibility to NCDs related services.

In order to achieve this purpose, Doctors with Africa CUAMM and the World Diabetes Foundation (WDF) are strongly committed together to fighting against NCDs in Angola as well as in Ethiopia, Mozambique and Sierra Leone. In Angola, CUAMM and the World Diabetes Foundation (WDF) have implemented the project “Improving Diabetes Mellitus Diagnosis and Management in Luanda Province” since 2018, in continuity with a previous joint intervention. The project aims to strengthen diabetes control through the improvement of prevention, early diagnosis and management of the disease. The intervention adopted a participative approach aiming at involving all the stakeholders and particularly the community in order to ensure a greater ownership and sustainability of the project’s outputs as well as a better impact in the fight against NCDs.

A final event of the project took place yesterday in Luanda; both political authorities and health workers showed their satisfaction for the intervention:

«I really appreciated the technical support given to national and local health institutions, in particular for the development of the national plan for diabetes management and the guidelines on the diagnosis and management of type 2 diabetes – claimed Helga Freitas, the Director of the National Directorate of Public Health -. Moreover, the awareness-raising activities with local communities have been fundamental to promote the importance of diabetes prevention and early diagnosis».

Therefore, a gradual change of approach by policy makers to non-communicable diseases is evident. NCDs are increasingly recognized as a public health issue that requires an effective answer at primary healthcare level, with family doctors having a key role in the fight against NCDs.

Key achievements

13,000 people tested for diabetes
3,100 people sensitized through awareness-rasing activities
93 health care workers trained
282 supervisions in the health facilities

Leaflet “Improving diabetes mellitus diagnosis and management in Luanda province, Angola”

World Food Day is a very important occasion in which we want to reaffirm our dedicated commitment for nutrition. A commitment that we have been carrying out for years in African countries, where we operate by supporting national policies and programs, promoting food education and managing cases of acute and chronic malnutrition, which are still widespread in this continent.

This day promoted by FAO, which won the Nobel Peace Prize on 9 October 2020, calls for global solidarity to help the most vulnerable communities, which have become even more fragile due to the Covid-19 pandemic, currently underway. This is why we join the motto “Grow, Nourish, Sustain. Together” which also summarizes our commitment alongside the African populations and in particular alongside mothers and children.

Mothers and children are the most vulnerable social part. Unfortunately, it is often not only food that is lacking, but also the knowledge to cook nutritious meals with the available products. This is also one of the target of our “Mothers and children first. 1,000 days” program. This project aims to raise awareness among mothers on the topic of food and to support them in the crucial period of their life, which goes from the beginning of pregnancy to the two years of the child’s life, ensuring all the visits, food and all the needed support in this delicate age of development.

Within the food projects that we promote, community activities are also of great importance such as the Village Health and Nutrition Day, awareness raising event promoted by Doctors with Africa CUAMM as part of the Unicef-Tubadilishe project, on the World Food Day occasion. The purpose of the event is to involve the community on nutrition issues through cooking demonstrations, food education and measurement services for children under five, to assess their nutritional status. During the event, there will also be demonstrations on the breeding of small animals to diversify protein-rich foods for domestic consumption and demonstration of the cultivation of nutritious products in order to guarantee consumption throughout the year for families.

“Practical learning in food preparation based on five food groups helps to broaden community awareness in changing the eating pattern. As the Village Chairperson I will encourage the community to participate to health days and village nutrition days on a quarterly basis to continue learning more about proper nutrition intake to help reduce malnutrition in the community. ” says Ikuna village chairman Hezekiah Michael Mwenda.

Only together, it is possible to make a remarkable difference and for this reason Doctors with Africa CUAMM continues its dedicated and daily commitment “with” Africa.

Memuna Kemal Siraj, 33, works at the Turmi Hospital in South Omo, Ethiopia, where Doctors with Africa CUAMM strives to improve maternal and child health as part of The First 1,000 Days: Ensuring Quality Health Care to Mothers and Children in the South Omo Zone, a project supported by the Italian Agency for Development Cooperation. Memuna is an integrated emergency surgical officer (ESO), a health worker authorized to operate on obstetric emergency and emergency general surgery patients. Prior to her service in South Omo, Memuna worked for the Ethiopian government and for various other NGOs in remote, difficult areas of the country, particularly the Gambela and Somali Regions.

«When you start working as a health professional, the government assigns you to one of the country’s regions» Memuna explains. «Initially I was sent to the Somali Region, a tough place with few resources and a culture and language very different from my own. It wasn’t easy, but it was there that I became familiar with and impassioned about emergency surgery».

However, she was not enthusiastic about and dedicated to her job from the get-go: «When I was in high school I wanted to study mathematics and become a teacher, but here in Ethiopia you can’t always freely choose what you want to do. So the decision was made that I would study to become a health worker» Memuna explains. «I remember that I cried a lot at first, but then I accepted my responsibilities and slowly but surely began to grow keen about the work I was doing. Years later I still remember an episode that affected me deeply, and which perhaps makes my work even more meaningful to me today. When I was ten our neighbor, a woman my family and I were very close to, got pregnant. One day my mother and I went to her place, where she was about to give birth. She suddenly began to lose a lot of blood and then, after fainting, was taken to the closest health center. But it was too late; sadly, she passed away. I remember asking my mother over and over again why it had happened, and her telling me: “Her placenta got to her brain”. I was just a child, but I knew that her answer made no sense. I kept asking the same question for a long time, and always got the same answer, until – thanks to my studies and my work – I understood that what had occurred was due to an obstetric complication that could have been prevented had the woman been helped earlier and had an assisted delivery in a health facility. When you’re managing emergencies you have very little time to think and make decisions, and it’s even more difficult in settings where communities who don’t understand the value of health care don’t go to health centers or hospitals when in need. Ever since then, every day I choose to take action to try to change things, to avoid getting somewhere when it’s already too late».

This became truer than ever after Memuna was obliged to tackle a number of emergency situations.

«I especially remember a 13-year-old girl who was pregnant and in terrible pain. She was still so small that it would have been impossible for her to have a natural delivery, but her father and husband refused to sign a form allowing her to be given a Cesarean. She came to the health center after two days of labor at home and started suffering from a heavy infection. After more than 24 hours, she absolutely needed to be operated but the closest hospital was 450 kilometers away on a bumpy road. Only then did her family members finally give their consent for her to undergo a Cesarean, but it was too late to save her baby. After she was admitted to the maternity ward for monitoring, the girl’s blood pressure began to fall and she started to bleed heavily. The only way to save her life was to give her a hysterectomy – an operation to remove her uterus – but once again her husband refused to give his consent, and left the hospital, leaving his young wife there. Luckily we managed to save her, but the experience made it even clearer to me how important it is to raise awareness among communities, particularly among women themselves, to make them aware of their rights and help them fight to defend them, thus gaining more independence. What gratifies me the most, and makes it possible for me to face the challenges that arise daily, is being able to serve those most in need: women. I have a special relationship with them: I try to give them constant support, to urge them to defend their rights, and to do so on their behalf when they cannot themselves».

«My work also entails some challenging and frustrating aspects» Memuna continues. «Even though we ESOs play an important role, we are not always treated like the equals of our colleagues – for example, the gynecologists. I’ve always experienced my job as a responsibility towards both myself and others, but sometimes you realize that some of your colleagues and superiors put far less passion and commitment into their work. I believe it all depends on how much you’re motivated and driven to do your job well. That’s what I’m trying to do with the hospital staff in Turmi: to strengthen their sense of trust and to convey passion and care for everything we do, as well as for people. When I first got here there was lots of muddle: medical records were not taken down properly, and the attention given to patients was often superficial. Now, as we work side by side in an effort to grow together and help each other improve, I see things beginning to change. We’re handling a larger number of Cesareans, and are able to offer better service in terms of managing obstetric emergencies, which formerly could be dealt with only in Jinka».

«The most important lesson I’ve learned? That access to health care is – and must be – a universal right. I try to put this idea into practice daily» Memuna concludes. «Ethiopia is a country filled with many different ethnic groups, and there is a lot of discrimination based on one’s origins. But I’m confident that if we stay committed and patient, change is possible».

Doctors with Africa CUAMM, with the support of the Italian Agency for Development Cooperation, has launched an emergency intervention in the Gambela Region in Ethiopia, aimed at reducing the risk of spreading Covid-19 in the refugee camps of Nguenyyiel, Tierkidi and Jewi, where thousands of South Sudanese refugees, who fled the country during the civil war, reside. The Gambela Region hosts over 300,000 refugees distributed in seven camps including that of Nguenyyiel, which represents the most densely populated camp and consequently the one with the highest epidemiological risk.

The project, lasting for four months, also develops in the neighboring area of the camp, in the Woreda of Itang. It provides extraordinary support to the isolation centers, equipped for the management of Covid-19 as well as ensuring the continuity of essential health services in the affected area, primarily those related to maternal and child health. The intervention focuses on staff training, on raising awareness and promoting good hygiene, health and nutritional practices, in particular for the prevention of the main communicable diseases. It also deals with providing individual protection materials for the healthcare personnel, who are involved in this project and are serving at the screening and isolation facilities in the three camps and in Woreda.

Since April 2017, CUAMM, in partnership with Women and Children First UK, has implemented the project “Improving maternal, perinatal and newborn health and reducing mortality in Goro Woreda” within the Southwest Shewa Zone of the Oromia region, Ethiopia. This project, financed by Comic Relief, strongly promotes a Participatory Learning and Action (PLA) approach that facilitates communities’ engagement in making their own decisions on issues that affect their lives. In particular, PLA supports awareness-raising activities and encourages rural communities, especially women and pregnant women, to come up with local solutions to improve maternal and newborn survival and health.

«Saving women’s lives in childbirth is not just the responsibility of the individual but is important for our whole community» – one of the Goro Kebele group members claims.

During the project, local trained female facilitators have set up and led group meetings to: identify problems affecting women and children during pregnancy, childbirth and the newborn period; identify local solutions to these problems; plan, implement and evaluate such solutions. More specifically, the problems prioritized were malaria, diarrhea and complications during labor and delivery. In order to tackle them, the communities suggested different strategies which have led to encouraging positive changes such as: using bed nets correctly, implementing proper hygiene and sanitation practices; increasing ante-natal care visits and skilled deliveries.

«So far, thanks to awareness-raising activities in the communities, correct use of bed nets has increased, and we are starting to see a reduction in cases of malaria» – Goro Woreda Health Office Director affirms -. «Before, in case of children’s illness, diarrhea for example, the community used traditional methods to treat it. Now children are taken to the health center and given medicines» –  adds a PLA Group Member in Gurura Kebele.

Despite the considerable progress that has been achieved by the PLA groups in Goro Woreda, a few challenges remain, requiring great effort and action also from local authorities and all communities’ members. Among others, there is the need to improve access to health care facilities centers and ensure maternity waiting homes (MWHs) establishment. Both solutions will help to reduce pregnancy-related risks.

A clear lesson emerges from this intervention: long lasting sustainable changes is possible starting from the communities and their active participation in developing their own rights.