Author: Redazione Cuamm

INDIRECT EFFECTS OF COVID-19: LESS ACCESS TO CARE FOR THE POOR

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Data from a Global Fund report published a few days ago are very concerning: HIV, tuberculosis, malaria, long-time major endemics, are recording an alarming decline in diagnosis and treatment in poor countries.

Among the most significant numbers reported: there are 41% fewer HIV tests; referrals of tuberculosis patients — i.e., those with suspected TB referred for more in-depth diagnostics — have decreased by 59%; malaria diagnoses have decreased by 31%and pre-natal visits of pregnant women have dropped by 43%. These are some of the indirect effects that the Covid-19 pandemic has had in limited-resource settings (The impact of Covid-19 on HIV, TB and Malaria services and systems for health: a snapshot from 502 health facilities across Africa and Asia). The study compared the period from April to September 2019 with the same period in 2020; it considered 502 health facilities in 32 countries, 24 of which were in Africa (including also Ethiopia, Central African Republic, Mozambique, Sierra Leone and Uganda) and 7 in Asia. The situation it shows is very dire.

It is as if the last 10 years of progress was erased in the fight against HIV, TB, and Malaria. Based on the data coming out of this Global Fund study, the situation is truly grim and, once again, involves diseases linked to poverty,” explains Rossana Urso, Project Coordinator at Doctors with Africa CUAMM. This is a major drain on resources and work done. One example? In Angola, in 2020, half of the funds for the health sector (50%) were diverted to fighting the spread of Covid-19, which had the effect of diverting significant resources from the fight against other diseases such as tuberculosis and HIV.” She continues: “If you do not do tests on the population, you cannot identify people who are ill and give them treatment. The long-term consequences will be very serious, especially for the fight against HIV for which so much has been done.

The report’s introduction immediately paints a gloomy picture: “In 2020, the COVID-19 pandemic impacted the world beyond imagination. To date, it has infected more than 135 million people, killed over 2.9 million people, and is projected to plunge up to 115 million people into extreme poverty. As countries have gone into lockdown, gender-based violence has increased, unemployment has soared, and access to health care for the poorest and most vulnerable has been cut. Covid-19 has made people less likely to seek health care because they are afraid of getting infected with the virus.”

This situation has been confirmed by those working in the field for Doctors with Africa CUAMM who have recorded reduced access to care by about 30% in the hospitals where we operate. For example, at PCMH in Freetown, Sierra Leone, 2,000 fewer babies were delivered in 2020 than in 2019. Women gave birth at home, putting themselves and their babies at greater risk. Covid-19 has underscored the total fragility of the health systems of poor countries and aggravated the situation. For instance, as the Global Fund report shows, only 45% of the health units analyzed had adequate protection materials to defend against contagion and only 11% of centers in Africa were equipped to carry out rapid tests to detect Covid-19.

Rossana Urso says:

Facing this situation as CUAMM, we can commit even further to distributing protective material and equipment, to training health personnel so they can quickly identify suspected cases of Covid-19 and TB, which have similar symptoms, and we can support health authorities to find new approaches to restore people’s confidence, so they are not afraid to go to the hospital for treatment or to give birth. For example, in Angola, we will start a monitoring system for patients being treated for TB in Luanda so they can take the necessary medications, in order to reach everyone and lose as few patients as possible. And then most important of all: facilitating the vaccination of health workers and fragile people, because if a person is sick with HIV or TB and also contracts Covid-19, their hopes of survival are really very slim.

 

 

AN ONGOING COMMITTMENT

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A few weeks ago an important moment took place in Freetown to make a comprehensive evaluation of the 4-year intervention carried out by Doctors with Africa CUAMM and UNFPA with the support of the UK Department for International Development as part of the second phase of the Saving Lives project.

A moment to highlight the results achieved, the progress made but also challenging aspects and future prospects. The intervention in support of maternal health in three different hospitals in the country – the Princess Christian Maternity Hospital (PCMH) in Freetown, and the hospitals of Bo and Makeni – involved several strategic areas, from the training of human resources, to the improvement of the quality of services and health facilities. In particular, the High Dependency Units (HDUs), the intensive care units of the three hospitals, continued to be fully operational, ensuring a fundamental service for the survival of many women in a country where maternal mortality, although slightly improving, remains very high, 1,120 deaths per 100,000 births. The project has also provided management support and technical assistance to hospitals, the supply of drugs and personal protective equipment to combat Covid-19, and the engagement of communities through meetings and radio campaigns.

Doctors with Africa Cuamm’s objective is to continue its commitment to supporting Sierra Leone’s health system, particularly maternal and child health services. Ensuring the health of mothers and children means ensuring the well-being of the whole community.

Laboratory analysis: a delicate part of care

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Mauro Fattorini, lab technician, returned from Sierra Leone more than one month ago, after having carried out 4 missions in the country of about a month each. Here is the story of his experience.

“The lab technician profile is getting more and more important in Cuamm’s projects in Africa. Diagnostics is performed at various levels, even in systems with limited resources, but it becomes increasingly complex leaving urban areas and approaching peripheral and remote areas. The clinical-medical aspect is always linked to the diagnostic aspect, which consists in particular in the laboratory.

The laboratory is an environment that requires a delicate management and several machines to operate; in addition, to these machines must be guaranteed an adequate maintenance. And again, reagents are needed and in a context of limited resources becomes complex to have them without running into problems of speculation. The characteristics of the context and the skills of the staff must always be carefully evaluated: it is essential to understand if there are the conditions and the resources to really ensure the functionality of the laboratory. From success to failure, the step is really short.

My latest experience in Sierra Leone has been focused on the management of blood banks, blood transfusion and blood storage centres, and the management of their personnel. The project includes 14 centres in all districts and works in collaboration with local authorities in line with the national programme. The goal is double: actively communicate with the local counterpart and “act as a glue” between the periphery and the centre.

Previously my role was more within the hospital, and now, as the surgery has been extended, we have been working “at the country level”, with a broader and more comprehensive management. The project is very dynamic and therefore even more challenging. Initially, we have organized an assessment of the context and based on the survey’s results we organized the training activities of the local staff. One of the trainings was held in Freetown where the technicians from the peripheral areas came to attend to a theoretical-practical course and it was an opportunity to connect all colleagues. A second part of the training, more challenging, was on site, working closely with the technicians: five consecutive days in each blood bank.

The main objective of the mission was to understand if the blood banks were able to store adequately the blood bags that must be kept at a constant temperature of 4-6 degrees. But how to do it in a context where electricity comes and goes? We brought in all the districts the solar blood bank refrigerators districts and taught the local staff how to use them. Training must be accompanied by a process of informing and raising public awareness of the importance of donating blood. A path that will certainly take time because it involves a change of mentality and behaviour.”

 

Medicine and the senses

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“Tanzania amazed me so much: it is very welcoming; people are willing to help you with anything. Before leaving I was afraid to live in a context that I imagined unsafe. But this was not the case at all: being a country with a stable political situation for years, there has always been the chance to go out safely both in the village and in town” – says Stefania, JPO of gynaecology and obstetrics at the University of Milan Bicocca, who returned to Italy in early March after 6 months of service in Tosamaganga, in Tanzania.

During her university years, Stefania had already spent two months in Cameroon, gaining experience particularly in the delivery room. Then to India, where she worked as a nurse at a leper colony.

“This year, being at the 5th year of the specialty, I have had a more critical eye, a greater awareness and attention to the professional aspects- continues Stefania-. It was an incredible experience: a continuous stimulus, 14 hours a day. You face extreme situations, you have few resources and rediscover a more “human” medicine, more based on contact than the one we practice in Italy”.

Often here we lose ourselves behind bureaucracy and we immediately resort to instrumental examinations while in Africa the relationship with the patient, the medicine of the senses returns central. “Semeiotics is a great added value, especially for gynaecology and obstetrics – adds Stefania -. I have learned a lot in recent months: to know how to listen, how to interpret facial expressions of women, and to understand just from the clinical condition at what point the labor is, etc. I believe we should rediscover here too this dimension of the senses, which for obstetrics is fundamental“.

Among the many lessons learned in these months spent on the field, Stefania recalls the strength, dignity and courage with which people, in particular the mothers she took care of in hospital, face life. A life in which great joys and immense sorrows are intertwined every day and that is why it must be taken with “lightness”. And then the solidarity that you breathe, between mothers, but also among the staff. “There is great collaboration, we work side by side with the sole aim of working in the best way”.

That’s the same solidarity and cooperation that allowed to save the life of a young mother who had been referred rom the dispensary to the hospital of Tosamaganga for an eclamptic attack, a serious complication of pregnancy that could be lethal. “When she arrived at the hospital, the woman showed no signs of eclampsia – Stefania says – but after a few days she had a crisis and we had to do an emergency C-section. The clinical situation didn’t stabilize after the surgery and many other crises followed. It was decided to intubate her, despite the fact that there was only one oxygen fan for the operating room throughout the hospital, and then we took turns checking her condition over the next few weeks. We felt an incredible satisfaction and emotion when she was extubated and recovered completely” – concluded Stefania. A tough but really brave decision that allowed to save the life of the mother and her child who are fine now.

Today Stefania is back to major in gynaecology and obstetrics here in Italy, although with the desire to stay in Tosamaganga longer: a wish that, maybe someday, will bring her back on the field.

A REINFORCED COMMITMENT IN KARAMOJA

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“Yesterday at CUAMM office in Kampala, we had an important meeting with the presidents of the health professional associations of Uganda to share the mentorship activity plan of the“Reproductive, Maternal, and Child Health Services Improvement Project” (URMCHIP), financed by the World Bank and implemented by the Ministry of Health – tells Dr. Peter Lochoro, CUAMM Country Manager in Uganda -. We had the chance to discuss together the memorandum of understanding”.

The meeting held in Kampala aimed to introduce the URMCHIP mentorship activity that will be carried out in Karamoja in addition to the eight project CUAMM is already implementing in the region. The meeting took place in the presence of the executive director of the Association of Obstetricians and Gynecologists, the president of the Association of Surgeons, the secretary general of the Association of Anesthesiologists, the president of the Anesthetic Officers Association, and the president of Uganda Paediatric Association.

“Everyone welcomed the engagement and pledged to work together – adds Peter Lochoro -. Next week we are starting with the training needs assessment and hopefully an entry meeting with the district departments of health”.

A new and great opportunity to reinforce the commitment of Doctors with Africa CUAMM in Karamoja.

Vaccinate to cure

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Just in these days has begun the vaccination campaign against Covid at the hospital of Saint Luke of Wolisso, Ethiopia. After the start of vaccinations in Addis Ababa, the first doses arrived at the hospital in Wolisso, 120 kilometres from the capital: the goal is to vaccinate healthcare personnel in the forefront of addressing the different health emergencies for a reference population of over one million people. This is crucial given that, in the last month, there has unfortunately been a significant increase in positive cases, including some very serious, throughout the country.

“About 500 doses have arrived and they will be necessary to vaccinate all hospital staff, from doctors to cleaning staff – says Alberto Puccini, JPO in Internal Medicine in Wolisso –. The increase in cases over the last month has given a very strong boost to vaccinations of health workers here in Ethiopia. In fact, doctors and operators, witnessing the increase in cases even among colleagues, have better understood the importance of vaccination. The head nurse and the other nurses decided to get their shot at our first suggestion and they were very happy to have the chance to do it. I explained to them the possible side effects, so they didn’t get scared if they get a fever. To date 240 people have been vaccinated and we continue to visit the wards in order to remember the staff the opportunity of getting their vaccination”.

There is still much to do in Ethiopia, as well as throughout Africa: we need a concrete vaccination plan and we need more doses. The intervention of Doctors with Africa CUAMM aims to support local health services that were already fragile before the pandemic, and that are now even more at risk because of the virus. Health care workers are the heart of our intervention: they must be protected and trained, so that they continue to ensure all the communities safe deliveries, visits and all the essential health services.

Ethiopia Supporting the call of HINGOs

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As Doctors with Africa CUAMM, we strongly support the call by HINGOs for the protection of aid workers and civilians in Ethiopia, to ensure assistance to the people in need in the country. Publishing the statement by HINGOs, we condemn any action against humanitarian aid workers.

In light of two recent attacks on humanitarians in Ethiopia, the Humanitarian INGOs (HINGOs) call for the protection of all humanitarian aid workers and civilians to enable assistance to reach all people in need.

On 24 March in West Wellega, a GOAL vehicle was attacked, and the driver killed by unknown armed actors. On 23 March in Tigray, a driver with the independent medical agency Doctors Without Borders was beaten and their team witnessed extrajudicial killings of civilians by armed forces.

In both cases, the vehicles were clearly marked as belonging to humanitarian, non-governmental agencies. Both agencies provide life-saving nutrition and health care to crisis-affected men, women, and children across Ethiopia.

In the last year, seven humanitarian aid workers in Ethiopia have been killed by armed actors.

The HINGOs are principled humanitarian actors and work with the consent of the Ethiopian government and abide by the laws of the country. Our 54 members serve people in need regardless of ethnicity, politics, or religion.

In 2019, the HINGOs reached over 28 million people in need with life-saving assistance and essential services across the country. The HINGOs employ over 13,000 Ethiopian staff and fewer than 1% of HINGO staff are internationals.

The HINGOs strongly condemn the attacks and killings of humanitarian staff and civilians. We call on all armed actors to uphold Ethiopian and international humanitarian law. These attacks and killings must be fully investigated and those responsible should be held accountable in accordance with Ethiopian law.

Time to respond to COVID19 epidemic in Bangui

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According to WHO, the COVID-19 outbreak continues to evolve in Africa, since it was first detected in Algeria on 25 February 2020 and it is accelerating. As of August 29th 2020, there were 1,033,631 cases and 21,402 deaths within the WHO African Region.

In light of this situation, and of its ongoing mission, CUAMM is working every day close to the most vulnerable to respond to the pandemic in Africa, its collateral effects, and to continue to provide ongoing medical care.

On the 27th of august, in Bangui, in Central African Republic, CUAMM celebrated the delivery of medicines and medical supplies donated by the American global health and emergency response organization, Americares. This donation is part of the important efforts of CUAMM to support the pediatric complex of Bangui where it has operated since 2018, to improve clinical care for children and the hospital management quality.

The donation included almost 400 KGs of antibiotics, emergency medications, vitamins, chronic disease medicine, psychotherapeutics, painkillers, malaria test kits, and first aid supplies. Additional donations of aid from Americares are in progress, as part of a new partnership between CUAMM and Americares in Central African Republic.

Andrea Atzori, Head of International Relations for CUAMM says:

“This the result of a great work to promote partnership and engage organizations all over the world to support the work of CUAMM for women and children. Americares has again demonstrated the generosity of people with precious donations of drugs and supplies that are able to integrate CUAMM programs and provide lifesaving treatment for children.”

Haroun Habib, Director of Africa and Middle East Programs for Americares says:

“We are glad to work with CUAMM as a critical partner while focusing on health as a priority in times of crisis throughout Africa. Previously, our emergency programs team provided gift-in-kind donations to CUAMM in Mozambique after tropical cyclone Idai and we plan to ship at least one container and another air shipment of medicines and medical supplies to CUAMM in CAR in 2020-2021. Our ongoing and continuing work with CUAMM will help ensure that essential medical products are provided to patients and frontline health care workers to prevent and save lives through effective treatment of infectious diseases such as COVID-19.”

TB: A CHALLENGE TO FACE TOGETHER

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Maria Menya Nakeny is 34 years old mother of 6 children. She had to fight against tuberculosis, in three different stages: drug-susceptible tuberculosis, multi-resistant tuberculosis (MDR) and finally extensively drug-resistant tuberculosis (XDR). In 2016 Maria began to feel sick and she immediately turned to a traditional healer hoping to find a solution for her symptoms, but unfortunately the herbal treatment prescribed did not improve her health. Therefore, she chose to go to the health center in Lopeei where she was tested positive for tuberculosis.

In September 2016 Maria started a six-month treatment, but she stopped taking medication once she began to notice an improvement in her health, just three months after starting the treatment. The treatment for tuberculosis requires a long time, great consistency and continuity, and, although the improvements in health can be noticed quickly, it is essential to complete the whole treatment to avoid relapses. A few months after giving birth to her 5th child Maria started getting worse again.

“I went to the St. Kizito hospital in Matany and I was diagnosed with tuberculosis again. I was hospitalised for 3 weeks and then transferred to the nearest facility to continue the therapy – says Maria -. After a few days I was called again and admitted once more to Matany hospital for 3 months since I tested positive for MDR tuberculosis”.

Maria had to walk for more than 4 km every day to get her medicines at the Lopeei health center regardless the scorching sun or the heavy rains. This is precisely why she stopped the treatment again for over a week. The CUAMM team in charge of Maria’s case immediately went to her house to convince her to start again the treatment. Shortly after, Maria became pregnant again: “I was worried about how I would continue the treatment and the potential effects on my baby – Maria explains -. However, the health workers reassured and encouraged me to continue my treatment path”.

After further tests, Maria tested positive for extensively drug-resistant tuberculosis (XDR) and her treatment needed to be changed to respond to the variation in her disease.

“I realized that life is very important and I regret the moment when I had stubbornly decided to drop out the treatment. The CUAMM team and the health professionals have been committed to saving my life in every way, much more than I did for myself. I am grateful to them. I also managed to buy some goats and sheep that I take care of and now I live happily with my family”, concluded Maria.

After 4 years, in November 2020, Maria finally completed her treatment and won her battle against TB. Now she goes to the hospital once a month for check-ups. She survived thanks to the help of passionate and dedicated health workers and thanks to the support of Doctors with Africa CUAMM. She therefore suggests to all those who do not feel well in her community to go to the health center even just for a check-up and to receive the assistance they need. She also encourages people who have tested positive for TB to be steady with the treatment to avoid facing what she’s been through.

This is one of the many happy ending stories made possible thanks to the intervention in Karamoja to improve the quality of  services for diagnosis and treatment of Tb and multi-drug resistant Tb, particularly within the projects: “It’s Good Tb free! Project to contribute to a TB Free Uganda by 2020“, financed by the Italian Agency for Development Cooperation, as part of the expenditure for technical assistance to the Global Fund for the fight against aids, tuberculosis and malaria and implemented by Doctors with Africa CUAMM in partnership with the University of Milan and the University of Makerere, and the project ” Support to St. Kizito Hospital of Matany and to the Napak Distrcit in Karamoja”, financed by Fondation Assistance Internationale (FAI).

WORLD TUBERCULOSIS DAY COVID-19 IS SLOWING THE FIGHT, BUT UGANDA SHOWS SIGNS OF HOPE

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With 10 million sick people worldwide and 1.4 million deaths in 2019 alone, Tuberculosis remains one of the deadliest diseases. Twenty-five percent of new cases recorded each year are in Africa, and Covid-19’s arrival in the last year has put a strain on health systems here too. This risks being a major setback for the fight against tuberculosis. For World Tuberculosis Day, on March 24, Doctors with Africa CUAMM is joining the World Health Organization (WHO) in its urgent call that the “Clock is Ticking,” if we want to put an end to Tuberculosis.

In Uganda, in Karamoja, Doctors with Africa CUAMM is working on two projects to fight tuberculosis funded by Fondation Assistance Internationale (FAI) and by the Italian Agency for Development Cooperation (AICS). Even in the year of Covid-19, there are some signs of hope, which show how the fight against the “disease of poverty” can still be won with enough determination.

Simone Cadorin, project manager of Doctors with Africa CUAMM in Moroto, says:

“With Covid-19, we were afraid that years of work would be ruined. A year ago, the government stopped public transport, imposed a curfew, and banned travel. There was the fear was that people would no longer come to the hospital for monthly visits and to get their medicine. This we why we worked with local authorities to develop, in the midst of the emergency, home-based care for patients, visiting them at home and distributing medicines in rural areas with semi-nomadic populations. We have not only kept patients in treatment, but we have also greatly improved outcomes, going from 36% successfully completed treatments in 2019 to 85% in 2020 and bringing the dropout rate down from 42% to 11%. Lockdown measures have been recently relaxed in Uganda, and patients now come themselves to health centers. We still continue to maintain contact with each of them through the “village health teams,” who see the patients at home, make sure that they regularly take their medicine, and provide psychological help and social support to families and patients.”

It is often from the community that problems arise related to fighting viruses and infectious diseases, as we hear from Paul Okala, a patient that Doctors with Africa CUAMM has followed and who has suffered the consequences of the stigma and prejudices about Covid-19.

“Because of Covid-19,” he says, “in Karamoja, unfortunately, people think badly about those who wear a mask. I found out I had drug-resistant tuberculosis before the virus came. I was treated in Matany and then I was supposed to continue taking the medicine at home for a year, using a mask when I was with other people. Everything was fine until Covid-19 came. People started to treat me badly because I was wearing a mask; they thought I had the virus and that I would infect them. Nobody wanted to come near me and my landlord was about to kick me out. It was horrible. I didn’t know how to deal with it and even thought about giving it all up. Fortunately, the Doctors with Africa CUAMM team came and helped me to show everyone that I was not sick with Covid-19 and explain the differences between the two diseases and the different ways to handle them in the village too. Luckily, no one is upset with me anymore, and I was able to complete my treatment!”

Combating fake news about Covid-19 with training for health personnel and awareness raising in the villages was one of the major focuses of Doctors with Africa CUAMM in Uganda, as well as in the other seven countries where it is active. Many people stopped going to the hospital for fear of being infected, with the result that many women were risking their lives giving birth at home, and many babies were not being vaccinated against the most common diseases. The home-based approach developed in Karamoja shows that by going the extra mile, talking to the communities, and listening to their needs and fears, we can ensure continuity to our projects and provide health care to those who need it most.

March 24th, during the event for World Tuberculosis Day, the Ugandan Ministry of Health awarded Doctors with Africa CUAMM for their tireless and extraordinary support towards  TB services delivery in South Karamoja. The award was received by Peter Lochoro, CUAMM country representative in Uganda.