JUST IN TIME In Low Resource Settings
Nessun campo trovato.
Autore: Redazione Cuamm
SHEDDING LIGHT ON NEGLECTED TROPICAL DISEASES
30 January marks World Neglected Tropical Diseases Day, a group of infectious and parasitic diseases that mainly affect developing countries. More than a billion people in the world are affected, more than half live on the African continent. CUAMM and AMREF are turning the spotlight on this issue, focusing on Nodding syndrome, on which they work together in South Sudan.
The two organisations also make up the Nodding syndrome alliance (NSA), an alliance established with the aim of responding to the needs of people with epilepsy through integrated, multi-sectoral action to strengthen the resilience of patients and that of their communities.
«In a landscape where donors are increasingly reluctant to provide long-term funding – says Chiara Scanagatta, CUAMM’s head of projects in South Sudan – and cooperation between partners is more complex, the NSA is a really positive experience, because it allows us to unite our voices into a stronger one to do advocacy and promote more appropriate policies with local authorities and stakeholders».
Being chronic or long-term diseases, there is a need for continuity in treatment and care, which cannot only be clinical, but integrated with social and economic rehabilitation. From the need for constant resources to the involvement of families to whom dedicated support is guaranteed.
«From April 2020 to December 2022 – Chiara continues – 920 patients are regularly followed at the primary health care centre in Mundri and 300 at Lui. A challenging job, but one that we are determined to carry on, together and with dedication».
South Sudan, protagonist of one of the worst humanitarian crises of all time, is one of the countries most affected by neglected tropical diseases. Most of the population lives in extreme poverty with limited access to basic health services. The conditions of insecurity and political instability that accompanied the civil war have further compromised the country’s ability to cope with NTDs.
These include NS, a degenerative epileptic syndrome, endemic in South Sudan. It mainly affects children between 5 and 15 years of age and is characterised by episodes of sudden and repeated head jerks (hence the name “nodding syndrome”), with devastating effects on physical and neurological development.
Why they are called neglected diseases
They are called neglected diseases because they do not receive the necessary attention and funding for their prevention and treatment. These diseases can cause irreversible damage to people’s health and productivity and contribute to endemic poverty in affected countries. There are twenty NTDs currently recognised by the World Health Organisation, among them dengue, leishmaniasis, rabies and onchocerciasis, known as “river blindness”, associated with the development of Nodding syndrome.
THE PRIDE OF ENSURING A DIFFERENT ENDING
«I want to remember the story of a mother, with two different endings. Memunatu is a 26-year-old woman in her second pregnancy who lives in Bonthe, a remote village in Sierra Leone. With her husband, she was very scared because two years ago, in her first pregnancy, she had gone into labour at home and when she arrived at the hospital to give birth, the doctor was not there. Therefore, she had first been sent to the UBC hospital in Muttru, an hour and a half away both by boat and by car. Then, due to the lack of a dedicated resource person, she was referred to the hospital in Serabo, another hour by car. When they arrived there, it was too late and the twins she was expecting died during the caesarian section. When I met her, I saw the fear of that woman and her husband, almost their resignation that they would also lose their next baby.
Seeing that, again, something was wrong, the husband urgently called the Red Cross operator, saying that his wife was about to give birth and needed help. The Red Cross operator called me on the private line because the husband could not get to the hospital directly and, in the end, we managed to send a boat to pick her up. She arrived at the hospital after a three-hour journey, we had already prepared the operating theatre and thirty minutes later mother and baby were fine! That is precisely why the outcome of this story means so much to me. It is an expression of CUAMM’s commitment in the field and carries a message of hope. We cannot save everyone, but even one makes a difference».
People and skills
«Let me recap my experience. I spent the last 4 years in Sierra Leone. This was my first long professional mission outside of my country. A different and challenging context and therefore an intense experience but always with a strong willingness to “get in the game” and learn. I started working in Bonthe as medical doctor focused on maternal and child health; then I moved to Pujehun and Freetown where I held a more advanced role with more responsibilities. I’ve definitely learnt and grown a lot and I want to thank CUAMM for this because it has always believed in me and invested in my training. Whenever I was faced with a complex situation or had doubts about how to manage it, I could always count on the support of doctor Enzo Pisani who was based in Freetown.
I’ve become an EmONC Advisor, an Emergency Obstetric and Newborn Care advisor, and I’ve trained 37 clinical mentors across the Country who are now mentoring 292 healthcare workers in the 16 districts of Sierra Leone on the seven “signal functions” as per WHO standard, seven key obstetric services that has been identified as critical to basic emergency obstetric and newborn care. It has been a capacity building pathway and I am proud of it.
Sierra Leone consistently ranks as one of the deadliest places on Earth to have a baby, particularly in some districts such as Bonthe, a remote island in the south of the Country. It can be reached by boat and during the rainy season it is all flooded with water and mud. Therefore, access to health services in this area, particularly to assisted deliveries, is very complex due to its location and the characteristics of the context. So personal life is not easy there: we were the only expats and my wife was the only one with white skin, besides the fact that we didn’t speak local languages. In Pujehun the accessibility to services is “easier”, however the maternal mortality rate is still very high. Several factors determine this: firstly, the lack of qualified human resources and the few that do exist live in the biggest cities. Many health workers are volunteers, meaning that they do not receive a salary, or at least not regularly, and this severely undermines their motivation and their commitment to work. Moreover, mainly for cultural reasons, people in the villages tend to rely on traditional healers».
This is the meaning of CUAMM’s commitment to give mothers and children another chance.
© Photographs by Valeria Scrilatti
IN EASTERN EUROPE
IN EASTERN EUROPE
With our heart in Africa, at the outbreak of a war on our doorstep, Doctors with Africa CUAMM has offered support to healthcare facilities in Ukraine by sending medicines, equipment and consumption material. In addition, food, essential goods and equipment to cope with the low temperatures were also delivered while psychological support was offered to the most vulnerable. These are CUAMM’s main levels of commitment which was later extended to Moldova, where medical personnel was sent to serve in two refugees shelters and Poland, where training activities were delivered in UNICEF “Blue Points”. A solidarity that involves many people and goes beyond borders.
IN UKRAINE
The war that broke out in February 2022 shows no sign of ceasing. Destruction, violence and atrocities are under everyone’s eyes every day. There are approximately 5 million displaced persons and 8 million refugees. Launched in Chernivtsi city, on the Romanian border where CUAMM collaborates with the local association VRB, the intervention has now been extended to 42 hospitals in 9 different Oblasts. The intervention consists in providing a broad logistic and healthcare support by distributing medicines, medical equipment and kits, food and essential goods, as well as tents, clothing and equipment to cope with the cold winter. In addition, throughout the intervention psychological support was offered to the population harshly hit. The Ukrainian healthcare system was also reinforced with the provision of 4 ambulances for the referral of patients to hospitals and mobile clinics. VRB volunteers, involved in material distribution to the most at-risk areas played a key role along with institutions and companies such as AICS, OCHA, UNICEF, UHF, Caritas, Veneto Region, Gilead and many citizens who offered their time to help the Ukrainian population.
IN MOLDOVA
Moldova is one of Europe’s poorest nations and struggles to give adequate response to the crisis of refugees fleeing Ukraine. CUAMM’s work, in accordance with the Ministry of Health and the WHO, focuses on 2 reception centers in Chisinau, the capital of Moldova, were over 300 refugees are accomodated. Thanks to doctors and nurses who alternate from Italy, basic health screenings are performed also in mobile clinics and drugs are distributed, especially to chronically ill patients.
IN POLAND
Of the 8 million Ukrainian refugees seeking asylum in European countries, more than 1.5 million were accomodated in Poland. In the cities of Warsaw, Krakow and Przemysl CUAMM has offered UNICEF volunteers working at the “Blue Points” some training activities. A total number of more than 100 operators took part in the activity focusing on psychological, healthcare and legal assistance.
IN ITALY, BY THE SIDE OF REFUGEES
As the war started, CUAMM offered support to young boys and girls housed in the Minor Seminary in Rubano, in collaboration with the Diocese of Padua. A group of CUAMM volunteers has also been active at the Immigration Office at the Police Headquarters in Padua where a increase in Ukrainian requests and accesses was registered after the Russian invasion. Throughout the year, about about 6.800 hours of volunteering were spent to respond to over 22.000 asylum requests.
EQUALIZE: A CALL TO ACTION AGAINST AIDS
We must fight the inequalities that hold back progress in HIV prevention and treatment. This is the message, a strong call to action from the United Nations, on the occasion of World AIDS Day, which happens every first of December.
Doctors with Africa CUAMM is committed effectively to contributing to the fight against HIV infection, first of all by making testing accessible even in the last mile. Many activities have been organised during the two weeks, from 21 November to date, in some of CUAMM’s eight countries of intervention.
«In Tanzania – explains Chiara Didonè, project manager of programme on HIV financed by AICS, led by the University of Florence – in particular, in the district of Shinyanga, in synergy with local institutions, as is CUAMM’s practice, we have promoted three days of awareness-raising on HIV in the villages of Tinde, Ihalo and Didia. Each activity began by recalling that World AIDS Day is celebrated on 1 December, an opportunity to raise awareness about a problem that is still widespread. Since the target groups are heterogeneous – mothers, children, adolescents – we chose to focus on a few key messages for greater effectiveness: prevention, the importance of testing and treatment, and combating social stigma. In all three information campaigns the Tanzanian authorities participate, together with the representative of the “Konga group”, an association of HIV+ patients. On the day in Tinde 300 people took part, in Ihalo 150 and 170 were tested. Today in Didia we expect 300 more».
«I thank CUAMM – says a young villager from Ihalo – for coming so far to offer a very important service, such as HIV testing, to the entire population. The closest health facility is half an hour away by car and the road is not always easily accessible, especially during this period, the rainy season, so having the possibility to be tested at home is a salvation».
«Also in Mozambique, in the province of Tete – reports Laura Villosio, CUAMM doctor – we participate in the World AIDS Day with various initiatives, together with the authorities of the country, the provincial service and civil society. This is an opportunity to address sexual health among adolescents, the target group of our activities. In Mozambique, according to 2017 estimates, there are five new infections per year per 1,000 inhabitants. In addition, 38 per cent of infections between 15 and 59 years of age fall in the 15-24 year old population. Therefore, many young people are HIV-positive and many children are born HIV-positive. Today, CUAMM in Tete takes part in a health fair where our activists, together with the technical team, promote information sessions and plays. Of course, everyone has the opportunity to be tested for HIV; we also offer an invitation to take the Covid-19 vaccine. Today’s Day was preceded by fifteen days of activism in remote villages, also on the topic of HIV».
CUAMM AND UNICEF SUPPORT REFUGEES POPULATIONS IN MOLDOVA
Promotion of healthcare assistance for refugees and emergency preparedness among health workers are at the core of the intervention that aims to provide quality health sevices to vulnerable populations fleeing the Ukranian conflict in Moldova.
CUAMM Doctors with Africa in partnership with The United Nations Children’s Fund (UNICEF), launches a project in Chisinau, Moldova, to promote healthcare assistance for refugees and boost emergency preparedness among health workers in peripheral facilities hence strengthen the capacity at national level.
Refugee families, vulnerable groups and mothers and children fleeing the Ukranian conflict can now access safe and quality healthcare assistance in Chisinau where two health centres are being supported with provision of lifesaving drugs, essential supplies, consumables, PPEs and medical equipment. The centres also offer vulnerable groups access to multiple services such as informative sessions and distribution of informative materials on health and hygiene promotion plus specifically child-tailored materials, routine immunization, health checks on vaccination coverage and NCDs prevalence to vulnerable populations. The centres accommodate between 150 and 250 people (the number varies depending on the refugees’ movements), mostly of Roma ethnicity and/or from Azerbaijan or Armenia. These are women, men, children, and the elderly.
Lack of human resources and specialized professionals in peripheral facilities can undermine the response capacity putting people who seek healthcare services at risk. For this reason education is a key component of the intervention implemented by CUAMM in collaboration with UNICEF that encompasses a training programme in Emergency Preparedness with the ultimate goal of improving medical teams’ emergency response capabilities at all levels.
Following consultations with the Ministry of Health and in partnership with UNICEF, emergency preparedness trainings and assessment have been designed to foster health workers’ capabilities. A 20-hour training paths of mentors (key medical and non-medical staff) in Emergency Medical Services (EMS) in each of the three targeted hospitals will be offered to ensure adequate response in case of health-related disasters while in the same facilities trained mentors will deliver a 10-hour mentoring paths to 100 medical and non-medical staff under the supervision of CUAMM. Additionally, assessment of management and clinical gaps in emergency preparedness and disaster response in the 3 concerned hospitals, establishment of an emergency medicine consultative coordination body at the hospital level (in each of the 3 hospitals), and development of a training package for hospitals’ staff will be included.
This comprehensive training program seeks to achieve a multiplier effect both establishing and institutionalising mentoring as a model of continuing professional development and leading to a significant and sustained impact on emergency preparedness hence enabling the healthcare staff of the Institute of Mother and Child, the Emergency Hospital, and the Republican Hospital in Chisinau to effectively respond to the ongoing refugee crisis and address future emergencies.
Since the beginning of the war in Ukraine, Moldova have sheltered the largest number of refugees: 89.000 refugees have been registered in the country. Starting from April 2022, CUAMM has been operating in Chisinau – the capital of Moldova – where the team provided basic medical care to the Ukrainian population through Emergency Medical Teams. The assistance offered aims not only at ensuring continuity of treatment and follow-up to Ukrainian refugees, as well as preventing the deterioration of minor illnesses; but also preventing the already fragile Moldovan health structures from being overwhelmed by the influx of refugees.
FROM EMERGENCY TO RESILIENCE
«Intervention continues in Ethiopia for displaced people, refugees and host communities in the Somali region, with a project financed by the Italian Agency for Development Cooperation, implemented by the International Committee for the Development of Peoples (CISP), in collaboration with Doctors with Africa CUAMM and Action Aid. CUAMM works, in particular, in the woredas of Aw-Bare, bordering Somalia, and Boklomayo, on the border with Kenya, where more than 10,000 IDPs and more than 120,000 refugees from Somalia are concentrated, living in five refugee camps.
Overall, the project is implemented in an area that is in a state of humanitarian crisis due to conflicts between ethnic groups and opposing forces that have led to the displacement of whole communities, compounded by frequent droughts, repeated flooding and the relentless spread of epidemics. In addition, with a weak health system poorly equipped with drugs and tools, the combination of these factors makes the vulnerability of host communities, displaced persons and refugees high.
In this context, where resources are scarce or inaccessible for many of the families, the lives of girls are continually endangered, in a strongly patriarchal society in which women are involved in domestic work, child-rearing, agricultural work and water supply, but have no power.
With the combination of humanitarian, environmental, epidemic and economic crises, girls and women are among the most vulnerable and CUAMM, through its intervention, decided to take action, providing support and tools to improve their sanitary conditions and protect them. In mid-November, the distribution of hygiene and sanitation kits began to 6,000 women, including 4,300 (70%) from displaced and refugee communities, and 1,700 (30%) from host communities.
The distribution reached women with disabilities, single mothers, pregnant and breastfeeding women, and was integrated during the information and awareness-raising campaign as part of the health education programme. The aim is that the women and girls involved will not only benefit from training in health, hygiene, prevention and reduction of disease transmission, but will also be provided with tools to start putting into practice the good habits suggested by community health workers and volunteers. The hygiene kit contains two bars of soap suitable for washing clothes, a bar of body soap and a washable and reusable cloth pad. CUAMM field team collected positive feedback from the beneficiaries, who received and appreciated the kit that will enable them to save some money they would otherwise have had to spend at the market where prices are constantly rising.
CUAMM’s commitment therefore aims to provide solutions and tools that will have a lasting impact over time, especially with activities concerning the implementation of awareness-raising campaigns on good hygiene practices for the prevention and recognition of Covid-19, the training of health workers in health centres and community workers. Finally, the provision of protective equipment, materials and drugs. The urgency of the context translates into the need to work at the community level on infection prevention, the adoption of healthy behaviour and the recognition of signs of illness, improving the training of health workers and encouraging people to go to health centres».
TOGETHER TO IMPROVE THE QUALITY OF HEALTH SERVICES
«Since 2017, Doctors with Africa CUAMM has been working at the PCMH, the maternal and child hospital in Freetown, the capital of Sierra Leone. Thanks to a new programme of the United Nations Population Fund (UNFPA), financed by the Italian Agency for Development Cooperation, Cuamm supports a series of health staff training, the education activities of the students of the specialisation school in Obstetrics and Gynaecology, the pharmacy and its universal health care service, with a view to reinforcing the improvement of the care provided.
Recently, we received a donation of sanitary material to fight and reduce infections. As CAUMM, we have also offered cleaning and waste collection products, increased handwashing points within the wards, and equipment such as trolleys, to deposit sterilised material», says Claudia Mocci, CUAMM project leader in Freetown.
«We are two gynaecology residents – explain Alessia Sala and Marina Valeriani, Junior Project Officer, – who arrived at the Freetown Maternal and Child Hospital a few months ago. We started working here with the other trainees and residents. It is a very different reality from what we were used to, there are so many patients, so little material available, and every day is a challenge! The first few weeks we just observed to understand how we could fit in, then we started the activity like everyone else. We are growing on a daily basis and trying to teach practices that residents here have no way of learning, such as ultrasound. For the moment, it is a challenging and difficult experience, but at the same time stimulating and educational».
A commitment that continues despite the difficulties, to guarantee the necessary care for African mothers and children.
ANNUAL MEETING 2023 RELIVE THE BEST MOMENTS
A special thanks to the more than 1,800 people who came from all over Italy to live together at the Annual meeting of CUAMM and to give voice to Africa.
A special thanks to the many guests with us on stage and to the 1,800 people who came to Milan, from all over Italy, to give voice to Africa and put at the center the future of young Africans who wish to remain in the land where they were born. Today, all together, we have relaunched the commitment to take care of mothers and children. Everyone’s support is the greatest encouragement to face the new challenges with tenacity and determination, always and in any case, WITH Africa in the heart!
Relive the best moments of the Annual Meeting!
ANNUAL MEETING 2022 RELIVE THE BEST MOMENTS
A special thanks to more than 4,000 people welcomed the Holy Father and listened to his encouragement to continue this path, to “not be afraid to go to difficult places,” today Saturday, Nov. 19th, in Rome’s Paul VI Hall at the Annual Meeting of Doctors with Africa Cuamm.
Relive the best moments!