Categoria: News

The sufferings of women in northern Mozambique

Posted on by Redazione Cuamm

«I have long carried out that feeling of shame before speaking out and seeking support – said Yvon, 36 years-old from Cabo Delgado. – but I believe we have all gone through some sort of violence just because we are women. Aquiring awareness on this, helped me realize gbv is the elephant in the room and it is only by speaking out that we can dismantle the taboo and help other women raise their voce».

Yvon is a 36 years-old woman from Muidumbe, northern Cabo Delgado, Mozambique. In 2022, due to the insurgencies in the northern province of Cabo Delgado, she fled her home to Pemba together with her partner and 5 kids.

For 7 years, the province of Cabo Delgado has been a conflict zone, with about 834,304 internally displaced people. Most have experienced or witnessed extreme violence including killings, sexual violence, kidnappings, extortion, and villages being burnt. Some have lost their entire family.In this context of displacement and conflict, gender-based violence is among the major safety problems.

«We had no place to go when we left Muidumbe, as we arrived in Pemba we had to find a way for living. Everything was difficult and soon my husband started blaming me» said Yvon recalling how she entered in a series of psychological violence that later resulted in physical aggression.

The risk factors underlying GBV are multiple, interrelated, and mutually reinforcing. These include individual factors, such as young age or illiteracy; societal factors, such as poverty, unemployment, and displacement; behavioral factors, such as alcohol and substance use; and environmental factors, such as complex emergencies, armed conflicts, and impunity. These factors worsen during crises, resulting in an increase in GBV cases, disproportionately affecting vulnerable groups such as IDPs, women, and young girls.

Intimate partner violence can have severe short- and long-term physical and mental health effects, including injury, depression, anxiety, unwanted pregnancies, abortions, sexually transmitted infections, and worse. GBV can affect social well-being, leading to loneliness, social withdrawal, and a sense of victimhood in the affected person.

In the city of Pemba and the district of Montepuez, in Cabo Delgado province, Doctors with Africa CUAMM addresses gender-based violence with a multisectoral and community-based approach. Within safe spaces (casa de proteção) for women and girls, CUAMM teams conduct awareness-raising activities on GBV and the prevention of sexual exploitation and abuse (SEA) using various methodologies such as theater, community dialogues, workshops, and more.

«By engaging women and young girls who have experienced gbv in social activities we aim to overcome the social emargination in which they often end up living because of the stigma and that sense of ashame that can have long-term psychological damages» explained Lúcia Maria de Fatima Henriques, CUAMM psychologist.

Photo by Marco Trovato

CUAMM’s intervention in the province combines operational research and field actions to provide psychological support (MHPSS) and integrated clinical and legal assistance to victims of gender-based violence (GBV) in collaboration with government legal services and the Mozambican association MULEIDE.

«We work to assist women and young girls throughout the process, from the reporting to court, offering also health assistance and psychological support – explained Isefa Sufo, CUAMM Legal Assistant -. We have trained local authorities on gbv management case and the collaboration is good but we do know that the process can be extremely long and exhausting for the survivor and it is our duty to inform them» stated Isefa.

From 2021 to the present, CUAMM has been working to mitigate GBV risks and improve responses for survivors, actively involving communities, raising public awareness, and addressing the urgent need to provide integrated services. Today there are 12 supported safe spaces in Cabo Delgado that offer care, psychosocial support, and information for other services related to safety and health needs. There were 900 people supported in 2023 for GBV or MHPSS (Mental Health and Psychosocial Support). Over 60 women have been supported and legally assisted to date.

«We have seen improvements over the last years, when we started gbv was not a priority on the agenda, not even something the civil society was interested in but things are changing – said Elisa Fernando Tembe, CUAMM Project Manager -. In the long-run we’d like to enrich the service ensuring a safe place to live to the survivors who suffer perpetrated domestic violence».

Objectives of the Intervention:

  • Improvement of Access to GBV and SEA (Sexual Exploitation and Abuse) Services in line with international guidelines, the intervention aims to facilitate survivors’ access to services by covering costs such as transportation and medications, providing hygiene kits, and, in some cases, integrating the most vulnerable individuals into an economic support system.
  • Enhancement of Mental Health Services targeting at-risk individuals, especially women and young girls who have survived gender-based violence. In collaboration with local health authorities, after referring the most sensitive cases to government mental health services, the Cuamm team ensures regular follow-up and involvement in age-, gender-, and context-specific group activities conducted within safe spaces.
  • Prevention and Preparedness for Managing GBV and SEA Cases through safety audits in intervention areas, the activity aims to strengthen services offered in coordination with the Ministry of Health, the Provincial and District Directorate for Gender, Children, and Social Action, as well as the Technical Working Group on Psychosocial Support and Mental Health.

Gender based violence at glance

Gender-based violence is a human rights violation perpetrated by an aggressor against a person because of their gender or sex. The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.”  The most prevalent form of gender-based violence is committed by intimate partners (Intimate Partner Violence). Globally, it is estimated that, on average, 27% of women aged 15 to 49 have experienced violence by an intimate partner (IPV) or a non-partner during their lifetime and millions are those affected by other forms of gender-based violence, such as child, early, and forced marriage, sex trafficking, and harmful traditional practices. The highest prevalence of GBV globally is reported in the regions of Africa and Oceania.

According to a recent report by the Secretary-General of the United Nations “Sexual and Conflict-Related Sexual Violence” for the year 2022, the countries where this violation of human rights is most widespread are the Central African Republic, South Sudan, Democratic Republic of Congo, Mozambique, Ethiopia, just to mention sub-Saharan Africa.

Ensuring logistics support amidst conflict

Posted on by Redazione Cuamm

1,000 days have passed since the Russian invasion of Ukraine that has pushed CUAMM to take action in favor of over five million internally displaced people and 5.8 million refugees.

Last week our team in the field got to Chernihivska Oblast to deliver kits and consumables including  emergency bags, an orthopedic surgical kit, and ABC kits (Non-disposable, adult and paediatric) intended for the emergency services and surgical units for in-patient and trauma care to Borzna Central City Hospital. The facility is a second-level healthcare provider with 140 beds and it serves as referral points for the sorrounding area being the only facility in the radius of 80 km to be equipped with a surgery room and a trauma ward for the treatment of gunshot wound victims.

The security context of Chernihivska Oblast has been influenced by its proximity to the Russian border. At the beginning of the war, on the 24th of February 2022, Chernihivska Oblast was invaded by the Russian military. According to the International NGO Safety Organisation (INSO), in the period 16-31 October 2024, 141 total incidents were recorded, of which 94 in the previous two weeks only. In the first week of November, 28 incidents were recorded in the Oblast. This caused high pressure on the area’s central hospitals, including those in Borzna.

«In recent weeks, unfortunately, we have witnessed an intensification of the conflict, especially in areas close to the frontline, such as Dnipro and Sumy. The country’s healthcare system is increasingly strained, and the challenges are countless: in some areas, facilities are destroyed; in others, there is a lack of supplies, and even human resources are scarce. It is a dramatic situation that, despite the extraordinary resilience of the Ukrainian people, worsens day by day» said Antonio Zardini, CUAMM Head of Mission.

In the past three weeks alone, CUAMM has distributed about 500 kg of materials including medical equipment, consumables and emergency kit. This effort reaches the highest-risk areas, going as far as 10 km from the front line to ensure support to those struggling to guarantee healthcare to the population.

The activity is in line with Strategic Objective 113 of the HRP (Ukraine Humanitarian Response Plan) 2023 and Sectoral Objective 114 of the health cluster. It also aligns with the cluster’s standard activity: “Procure, pre-position, and distribute essential medicines, medical equipment, and medical commodities to health facilities”. The medical equipment kits to be distributed have been composed by CUAMM according to the needs of local hospitals and health authorities and following the guidelines set by the WHO Health Request Planning and Response Tool.

From our first activity concentrated in the city of Chernivtsi to the border with Romania, CUAMM’s intervention has grown reaching the war-affected areas of Kharkiv, Donetsk, Dnipro, Zaporizhzhia, and Kherson with logistics support and provision of supplies to the health facilities in need.

Our project is part of a 46.5 million euro initiative funded by the Italian Agency for Development  Cooperation, reaching 900,000+ people affected by the Ukraine crisis and it is being implemented in collaboration with Caritas Italiana, Caritas Drohobych Sambir and Volonterskiy ruh Bukovyny (VRB).

Doctors with Africa CUAMM has been working in Ukraine since March 2022, providing multisectoral responses to the urgent needs of the most vulnerable populations affected by the Ukrainian conflict. Since the onset of the humanitarian crisis in Ukraine, CUAMM has adopted a flexible, multisectoral approach to address the multidimensional needs of war victims. In close collaboration with local authorities and civil society organizations, CUAMM has developed an intervention strategy aimed at supporting and integrating the socio-healthcare system in conflict-affected countries, ensuring access to essential and life-saving services for the most vulnerable groups.

All in One zoonotic disease response

Posted on by Redazione Cuamm

In Karamoja region, northern Uganda, CUAMM is working to reduce the incidence of human and animal communicable diseases through All in One project funded by Agenzia Italiana per la Cooperazione allo Sviluppo and implemented with Africa Mission.

All in One is part of the fight against the Coronavirus pandemic, which has made even more evident the relationship that exists between human, animal, and environmental health.  The objective of the project is to intervene in a context such as Karamoja, at high endemic risk of communicable diseases both human and animal, to reduce the incidence of such diseases, adopting a health model based on the integration of different disciplines that is inspired by the concept of One Health.  The initiative at a global level is aligned with SDG 3, and in particular with target 3.3, and contributes to the implementation at the district level of the One Health National Strategic Plan of the Ugandan government.

The intervention is being implemented in particular in the districts of Napak and Moroto, in a context with a high endemic risk of both human and animal communicable diseases, with the aim of reducing the incidence of these diseases and building more resilient social and health systems, strengthening their preparedness and capacity to respond to diseases.

The sensitization activity is being supported by awareness raising activities and radio spot reaching a wide range of population. “Safeguarding Karamoja from Antimicrobial Resistance! Use antibiotic Wisely, Save Lives: St.Kizito Matany Hospital Leads on Antibiotic Stewardship to combat Antibiotic Resistance” is the slogan chose by CUAMM on occasion of the Global Antimicrobial Resistance Awareness Week

All in One acts on three levels namely community, health and livestock to create an integrated system of prevention, monitoring, and control of diseases with epidemic potential, through:

1) the prevention of infections through the improvement of hygiene conditions and practices at the community level. The intervention aims to rehabilitate 70 wells and building 210 pit latrines, promoting the conscious use of safe water sources and improved latrines, and combating the widespread practice of open defecation, which is the main cause of infectious diseases among the community.

2) the improvement of infection and control practices and epidemiological surveillance at the health care level intervening in 16 peripheral health centers and strengthening two hospitals’ laboratories also by supporting the animal infectious disease surveillance system and animal welfare through trainings to veterinary and para-veterinary staff in addition to livestock vaccination.

A Global “One Health” Approach

Antimicrobial resistance (AMR) is a challenge that transcends medicine, connecting human, environmental, and animal health within the One Health framework. Addressing this crisis requires integrated actions, including research, training, prevention, and policy development, to mitigate the impact of a growing threat to public health worldwide.

US Embassy to the Holy See visiting CUAMM

Posted on by Redazione Cuamm

On Tuesday, Novemebr 19 the U.S. Embassy to the Holy See delegation, represented by Laura Hochla – Chargé d’Affaires together with Alyce Ahn – Political-Economic Officer and Chiara Di Mizio – Public Engagement Specialist has been welcomed to CUAMM headquarter in Padua.

«It is a privilege to visit the headquarters of CUAMM, our long-time partners. We are honored to support the substantive and impactful work of your team. CUAMM’s efforts to improve the health of vulnerable communities in Africa and in many other countries facing challenges is an inspiration. Thank you for all you do” said Laura Hochla during the meeting.

The visit was an occasion for the delegation to meet CUAMM Country Representatives and better know our commitment in 9 countries in sub-Saharan Africa as well as our interventions in Italy and Eastern Europe.

«Since several years, CUAMM relationship with the US Embassy to the Holy See has played a key role for our activities both in Africa and in Italy. We are grateful for the funds received which allows us to keep working for the most vulnerable groups, not only in Africa but also here in Italy» said Don Dante Carraro – CUAMM Director General mentioning the collaboration between CUAMM and the Immigration Office at Padua Police Headquarters.

Laura Hochla – Chargé d’Affaires at US Embassy to the Holy See and Don Dante Carraro – CUAMM Director General

CUAMM has been working in collaboration with the Padua Police Headquarters since March 2022 to support the Office in managing and running hundreds of requests resulting from the Ukrainian crisis. Today, thanks to the fund received from the US Embassy to the Holy See, the collaboration continues. Speaking of CUAMM’s commitment in Italy, another health intervention mentioned during the meeting was the one in Apulia region where CUAMM works to provide health services to refugee and migrant communities in the province of Foggia. An intervention that has also benefited from the support of the US Bureau of Population, Refugees, and Migration (PRM) through the Julia Taft grant.

Being CUAMM’s main mission, the meeting gave ample room to various topics related to the work in Africa. The discussion ranged from CUAMM long-term commitment in favor of maternal and newborn health, to the latest efforts in supporting faith-based organizations across 25 Africa countries, to the main challenges in the poorest countries namely South Sudan and Central African Republic, to the lessons learned from the over 66-years-long presence in Uganda, the discourse also delved into localization as a new paradigm in humanitarian aid and international cooperation.

«As CUAMM we strengthen local capacities to deliver high-quality healthcare services. We work in partnership with MoHs, healthcare providers, and civil society partners and provide technical assistance and capacity building, as well as other resources they may need to institutionalize and sustain evidence-based approaches and best practices with proven life-saving impact. We regularly work with facilitators from MoHs when delivering trainings so as to ensure adherence to national guidelines and standards» stated Andrea Atzori – Head of International Relations at CUAMM concluding the meeting.

 

World’s diabetes day breaking barriers, bridging gaps

Posted on by Redazione Cuamm

About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. The Africa region, is expected to experience the highest increase in diabetes globally with the number of people suffering from the disease predicted to rise to 55 million by 2045.

Diagnosis, together with cost and access to treatment remain the main challenges for people living with diabetes in sub-Saharan Africa.

«People living with diabetes often ignore their status until serious complications arise. That’s because diabetes, as other non communicable diseases, can be silent therefore go unnoticed. – said Katunzi Muazema CUAMM specialized nurse in Tanzania. In recent years, however, an increasing number of people with chronic diseases have sought healthcare services because they know what NCDs are and can recognize their signs and symptoms. This is the result of our work that integrates activities at community level and provision of health services».

While noncommunicable diseases such as diabetes remain largely underfunded, in Tanzania, Sierra Leone and Mozambique CUAMM continues to be committed to ensuring that all people who are diagnosed with diabetes have access to equitable, comprehensive, affordable and quality treatment and care.

TANZANIA

In Tanzania NCDs including diabetes are responsible for 34% of all annual deaths, as reported by the World Health Organization (WHO). The increasing burden of NCDs in the Country is compounded by limited access to healthcare, inadequate health education, and insufficient prevention strategies, especially in rural and underserved communities. Understanding the knowledge, attitudes, and practices (KAP) of the population regarding NCDs is essential for developing targeted interventions and policies to combat this public health crisis. In this context, Doctors with Africa CUAMM is advancing its project “KNOW TO CURE: Fighting NCDs through Continuous Training of Personnel in Tanzania”. One of the main aims is to strengthen peripheral health facilities in the rural areas of the Iringa District Council.

The activities encompass: monthly clinical activities and on the job training in 9 health centres (HCs) in Iringa district; data collection and monitoring outcomes and follow-up at HCs level; annual training for health-care personnel of Iringa district; building training and supervision a network of peer supporters; drugs availability record to know the needs ofthe HCs and to correctly plan orders; kap survey to understand the needs and knowledge of rural population outside the HCs.

In Iringa District and at the Tosamaganga Hospital CUAMM’s work on NCDs proceeded in 2023, with the hospital acting as the district’s referral facility for the diagnosis and care of chronic patients and peripheral facilities supporting treatment and follow-up. In 2023 alone, we have performed 1.873 visits for diabetes and 79 hospitalization, plus 4.298 visits for hypertension.

SIERRA LEONE

The burden of non-communicable diseases (NCDs) in Sierra Leone has grown significantly in recent years. The MoHS recently adopted an “NCDs Strategic Plan 2020-2024”, which also reports NCDs contributing to 41% of mortality in the Country, corresponding to an estimated 29,700 related deaths every year. There are many reasons why the rate of NCDs is so high in the Country. Among others, a widespread lack of awareness among patients, regarding diseases and risk factors – particularly diabetes; a severe shortage of medicines, along with only 11% of public health facilities providing diabetes services and health inequities, with services available more in urban (34%) than in rural facilities (7%). Additionally, the country suffers from high rates of chronic childhood malnutrition (as well as pockets of severe malnutrition), which has been found to contribute to the development of NCDs in adulthood (Lancet Maternal and Child Nutrition Series, 2013).

In Pujehun district, we opened the PEN-Plus clinic for chronic non-communicable diseases a year ago. The opening, funded by the Brigham and Women’s Hospital and the NCDI Poverty Network, was the result of the collaboration with the Ministry of Health and Sanitation of Sierra Leone. The clinic provides diagnosis and treatment of patients mainly suffering from 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. Over the past year alone, we have performed 513 visits for diabetes and 1.143 for hypertension.

PEN-Plus is an integrated care delivery strategy focused on increasing accessibility and quality of services for type 1 diabetes (T1D), rheumatic heart disease (RHD), sickle cell disease (DCD) and other severe NCDs affecting poor rural and peri-urban communities in LMICs. PEN-Plus entails decentralizing lifesaving care services for severe NCDs (that are usually available only in referral hospitals) to first level rural hospitals, and equipping available mid-level providers – such as nurses, clinical officers and health officers – with the skills needed to provide integrated chronic care services including diagnosis, symptom management, and referral for surgical and other speciality care when needed. The PEN Plus strategy builds on the cost-effective WHO’s package of essential NCD interventions (PEN) for primary health care in low resource settings.

In addition, a intervention funded by World Diabetes Foundation (WDF) is being implemented by CUAMM in the districts of Pujehun and western area. Over the last 6 months, several activities have been conducted to strengthen early screening, referral and community education on diabetes and hypertension namely outreach screening with the active participation of the community members, including women’s leaders and education and sensitization through both dissemination of IEC materials and radio talks. As of the end of July 2024, such activity reached over 6.000 people during outreach screening, health facility visits and training of healthcare workers.

MOZAMBIQUE

In Mozambique, CUAMM continues to bolster its efforts to combat diabetes and non-communicable chronic diseases. In 2023, through the intervention funded by World Diabetes Foundation, we worked on diagnosing and treating type 1 diabetes in 5 hospitals located in the provinces of Sofala and Zambezia. As a result, an overall number of 344 visits for diabetes and 110 hospitalizations were performed.

This year CUAMM’s commitment to responding to NCDs including type 1 and type 2 diabetes, has expanded to the provinces of Maputo, Tete and Cabo Delgado therefore ensuring provision of care in 58 health facilities in 5 provinces thanks to the support of multiple partners, namely World Diabetes Foundation, AICS, PEN-Plus and Mass General Brigham and Women’s Hospital. According to the WHO Country Profile 2018, Mozambique reported 69,100 deaths due to non-communicable diseases (NCDs), an estimated 27% of all deaths in a population of 28,829,000 inhabitants. Mozambique has the highest proportion of undiagnosed diabetes (86.7%), followed by the United Republic of Tanzania (79.8%) and Tunisia (75.0%). Nationally, Mozambique’s prevalence is 2.4% among adults aged 20-79, and diabetes is responsible for the death of 9,485 individuals aged 20-59 and 635 children every year.

Every year more than 15 million people die prematurely from NCDs, with 85% of deaths occurring in low and middle- income countries (LMICs) (WHO, 2021). It has been estimated that chronic diseases will cause more deaths than communicable diseases by 2030, including in Africa. Additionally, chronic (especially co-morbid) patients are costlier to manage for health systems and suffer significant financial losses themselves due to inability to work for periods of time and costs they may incur to access and receive care. Accordingly, prevention and treatment of NCDs, including in LMICs, is comprised in the health-related targets of the Sustainable Development Goals (SDGs) Agenda.

 

CUAMM Enciende su compromiso with Manos Unidas

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CUAMM “Enciende la llama” in Angola, Mozambique and Sierra Leone and participates in the global campaign Enciende tu compromiso launched by Manos Unidas.

Lighting a candle as a symbol of the promise of a better world, is the call of the Spanish NGO “an act to which society can actively join in and thus demonstrate its support for the countries of the South and the action that Manos Unidas supports in them”. Today, Doctors with Africa CUAMM is glad to shed a light on its commitment in Angola, Mozambique and Sierra Leone thus advocate with Manos Unidas for the commitment to building a more equal world.

Through the partnership with Manos Unidas, Doctors with Africa CUAMM has and still is promoting health development interventions in multiple countries in sub-Saharan Africa, namely Angola, Mozambique and Sierra Leone with field of interventions ranging from maternal and neonatal health to HIV response among youth and adolescents.

In Angola CUAMM and Manos Unidas join efforts in favor of women and newborns by providing integrated health and nutritional services in Chiulo Catholic Hospital. An intervention that will directly benefit 1.976 recipients while reaching an overall number of about 300.000 people in the drought affected province of Cunene.

In Sierra Leone through “Improving quality care and diagnostic services for critical-ill mothers” CUAMM and Manos Unidas are working to reduce maternal mortality and morbidity in Bombali District where the Holy Spirit Hospital is located. By providing specialised training on HDU and supporting the hospital (HSH) with the provision of equipment for the establishment of an HDU as well as laboratory reagents to enhance diagnostic services, the intervention aims at reaching 6.010 recipients, mainly pregnant women.

In Mozambique, youth and adolescents were the direct recipients of an intervention planned to improve access to HIV services in 9 SAAJs (Serviço Amigo do Adolescente e Jovem) in Beira city and Nhamatanda district. The intervention aimed to educate young people/adolescents (ages 10-24) about safe sexual behaviors, encourage (voluntary) HIV testing, improve access to and quality of HIV healthcare services for adolescents/youth, and ensure adherence to ART, particularly for pregnant and breastfeeding HIV-positive women.

 

A new possibility for newborn babies in Karamoja

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Yesterday, Doctors with Africa CUAMM, together with the Embassy of Ireland and the Ugandan Ministry of Health, inaugurated the new Neonatal Intensive Care Unit (NICU) at the St. Kizito Hospital in Matany in Karamoja, north-eastern Uganda.

Another important step for this region, which continues to be the poorest in the country and has the lowest socio-health indicators, and where access to health services remains a major challenge. Access to neonatal care is too: «in Karamoja there is an average of 550 perinatal deaths per year, of which 160 are neonatal deaths, many of them preventable. One of the main causes is the absence or poor functionality of neonatal units, often lacking in infrastructure or adequate equipment and qualified health personnel» reports Lilly Achayo, Cuamm project leader.

«There are still many newborn babies who lose their lives in Karamoja due to different causes and NICU is instrumental in saving them. I would first like to thank the health workers who work with commitment and dedication in such a complex context. I thank Doctors with Africa CUAMM and the Embassy of Ireland because this intervention will allow neonatal and paediatric cases to be managed differently, generating a positive impact on the entire region» added Diana Atwine, Permanent Secretary of the Ugandan Ministry of Health.

The construction of the NICU in Matany is in addition to the support that CUAMM provides, thanks to Irish Aid, to ensure the functionality of Neonatal Intensive Care Units in three other hospitals in the region – Moroto, Kaabong and Abim. It does this through the development of adequate infrastructure, capacity building of staff and the provision of necessary equipment.

«The new NICU represents a milestone in the 20 years of service of the Embassy of Ireland in Karamoja. We are proud and grateful for the valuable partnerships with CUAMM and the Ugandan Ministry of Health» said Irish Ambassador Kevin Colgan.

The action is part of a broader intervention to strengthen the region’s health system at all levels, to help improve access to and quality of maternal, newborn, child and adolescent reproductive health services (RMNCAH).

Activities focus on strengthening the capacity of district health management teams, in particular data analysis, planning and monitoring of services. Investment is then made in improving the clinical competence and skills of health workers in the management of RMNCAH services, with a focus on sexual and gender-based violence. Among the main objectives is the improvement of interventions aimed at adolescents, including the adoption of contraceptives and the prevention of teenage pregnancy. Finally, one component of the intervention concerns improving capacities for the collection, storage, distribution and use of safe blood and blood components.

This is a very wide-ranging intervention, which reiterates CUAMM’s commitment to the different levels of the health system and with a special focus on the care of newborn babies. Because taking care of the health of the youngest, is taking care of the health of the country.

 

 

 

Improving quality and accessibility of NCDs services in Ethiopia

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The burden of non-communicable diseases (NCDs) in sub-Saharan African countries is rapidly increasing, with diabetes showing a spiking prevalence. In Ethiopia, there are more than 1.7 million people with diabetes, making it one of the four African countries with the largest number of patients living with diabetes mellitus (DM). DM and Cardiovascular disease accounts for 18% of the total deaths in Ethiopia.

“Improving diabetes and hypertension prevention and access to care” is the project launched in 2018 by CUAMM to improve the quality of Type I DM treatment and care services provided at primary, secondary and tertiary-level facilities in Ethiopia. The commitment has continued ever since thanks to the partnership with the Ethiopian Diabetes Association (EDA) and Federal Ministry of Health (FMoH) and the continuos support from World Diabetes Foundation.

In a workshop held in Addis Ababa, CUAMM gathered with partners and national stakeholder to give account of a three-years long commitment to respond to NCDs in Ethiopia.

«I encourage you all to keep up the commitment of these years and retain the lessons learnt. By doing so, your daily work, and especially the patients you care for, will benefit from this journey we have made together in responding to non-communicable diseases» said Mr Addisu Worku – Ministry of Health’s Head of NCDs and Mental Health, addressing the participants, health workers and practitioners from the 34 supported facilities.

Over the past three years, the intervention has showed remarkable results. Activities have been implemented in 34 hospitals in 11 regions and 2 City Administrations of Ethiopia. The hospitals were selected against the number of Type I DM patients receiving treatment and care in the hospitals and efforts were made to equitably determine the number of hospitals to be included in each of the regions. Training of healthcare workers and improvement of monitoring and evaluation activities of Type I DM treatment and care services in the project-supported health facilities were the core of the project.

As a result: 305 healthcare workers including 101 doctors and 204 nurses have been trained; 3 rounds of medical supplies have been distributed to 34 project-supported faicilities; 59 rounds of mentorship activity and 57 rounds of supportive supervision have been conducted; 5 review meetings have been funded.

To date, lack of testing and diagnosis equipment, inadequate number of qualified healthcare personnel, poor access to healthcare facilities and poor awareness about diabetes are obstacles to diagnosis in the Africa region. Only 46% of people living with diabetes in the African region know their status, raising the risk of severe illness and death, potentially worsening the situation in the region which already has the world’s highest mortality rates due to the disease. According to the WHO, 24 million adults in Africa are living with diabetes. This figure is expected to increase by 129% to 55 million by 2045 (WHO, 2022).

With the support of World Diabetes Foundation, Doctors with Africa CUAMM is committed to make NCDs services accessible to all in by promoting quality and accessibility of services up to the hardest-to-reach areas.

Every mum matters Chiulo

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«That day had been particularly intense, and to be honest, so were the previous ones. One postpartum hemorrhage after another, two emergency hysterectomies within 72 hours to save the lives of two young women aged 24 and 28, there hadn’t been a single moment to catch a breath».

Matilde Lusiani is still emotional when she recounts the birth she assisted at Chiulo hospital, Angola. She is an Italian midwife serving in this little hospital in Cunene Region, a facility of 234 beds  that serves a population of approximately 306,550 people. Working at Chiulo hospital is challenging: the hospital has essential equipment and basic goods like running water is not something people take for granted here.

«The biggest challenge – said Matilde, – is facing the fact that we have nothing to work with. You constantly wonder “What can I do with this?” and the answer is nothing. It is frustrating and you feel powerless. But some other days you manage to do “everything with the nothing you have”. It was around 5 pm; I had just arrived home and was taking care of some paperwork when a girl came in a hurry, completely out of breath. I was alone because my colleagues were dealing with a urgent vacuum-assisted birth. As the girl arrived, I soon realized that was a urgent matter: a woman was giving birth outside the hospital. There was no time to get her to the delivery room. So, I grab a pair of gloves, and run after the girl. I run toward the church, about 200 meters from the hospital, right in front of the police station. The woman, squatting under a tree, was giving birth. Chickens were grazing nearby and motorcycles passing by. Beneath her, only a dirty cloth. When I arrived, I noticed the baby’s head was already out. It only took a second push to have the baby in my hands. I used the glove elastic to clamp the umbilical cord and cut it with a pair of kids’-friendly small round-tipped scissors. I had them in my coat pocket, the previous resident left them home before moving out. I don’t think I’ll ever take them out of my pocket.” Right after the delivery I sought help from a police officers to get a stretcher, also a nurse came to help as she understood we needed help».

Matilde said the baby was still covered in blood and dirt, when she was holding her in the arms waiting for the mother to be places on the stretcher. During the short, breathless run back to the hospital, she never stopped massaging the mother’s uterus to avoid a hemorrhage.

Kalule, that’s the woman’s name, is now doing well as is her little girl, who doesn’t have a name yet. It is in fact a common habit in many part of the Africa region to name newborns only when parents are sure they are safe. Kalule is around 30 years old, she left 4 kids at home and walked a long way to reach the hospital. Despite arriving late, things sorted out well for her and the baby but unfortunately, not all the stories have an happy ending.

To date, maternal mortality rate remains high in Angola with 222 deaths in 100.000 live births. Distance to health facilities, poor access to assisted birth and lack of qualified personnel contribute to mantaining the rate extremely high. Cost-effective solutions like maternal waiting homes built by CUAMM at Chiulo hospital are paramount to ensure women a shelter in the last phase of their pregnancy.

«I will never forget this feeling: the emotion and adrenaline I experienced while witnessing the strength and courage of a woman giving birth. Altough challenging, it is by living those moments that we recognize the value and impact of our work».

 

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Caring for critical-ill mothers in Sierra Leone

Posted on by Redazione Cuamm

Holy Spirit Hospital is a General Hospital situated in the City of Makeni, Bombali District, Sierra Leone. The facility, which has a bed capacity of 55, serves an estimated population of 102,648 offering various health services including Obstetrics, Gynaecology, Paediatrics, Medicine, General Surgery, and Specialist Surgery. Other services provided by the Hospital include an Outpatient Department, a Diabetes Unit, Physiotherapy Unit, HIV/AIDS Unit. Although the city is served by other health facilities, the Holy Spirit Hospital is recognised and appreciated by health institution due to the high quality standard of its services, dedication and competence of its staff. Doctors with Africa CUAMM started working in the facility in 2005 and it is committed to reducing maternal mortality and morbidity in the district.

In the framework of the activities implemented by CUAMM and funded by Manos Unidas, the Holy Spirit Hospital has recently welcomed 77 health professionals from 5 different facilities, namely Princess Christian Maternity Hospital – PCMH, Bo Government Hospital, Makeni Government Hospital, Pujehun Maternity Hospital and the newly appointed staff for HDU from Holy Spirit Hospital, to attend a 4-day training on critical care. The training was meant to improve the quality of critical care services in 5 HDU’s, improve skills and practice in basic life support and emergency preparedness, improve management of obstetric emergency crises, increase knowledge and skill on intravenous line technique and complications as well as increase the competency of staff in the management of hypertensive disorders, severe pre-eclampsia and eclampsia.

«The training gave health professionals the occasion to meet for the first time and share their experience. They participated with enthusiasm and showed an extremely collaborative attitude – said Hannah Godon CUAMM Project Manager. Participants had different profiles and expertise, some of them had never worked on emergency preparedness before while others, like the senior nurses from PCMH had a long experience. This was quite a challenge but also a value for their learning experience».

 

In addition, activities include supervision and on-the-job training and provisions of equipment for the establishment of a new 2 bedded HDU in Holy Spirit Hospital, as well as supplies of laboratory reagents in order to support diagnostic services. As a result, the project aims to facilitate access to critical care services for 945 women and provide diagnostic services to 4.989 women who will access diagnostic services at Holy Spirit Hospital.

Training health personnel is key to strengthen the health system therefore ensure quality assistance to the most vulnerable groups like mothers and children. According to the Ministry of Health, as of 2016, in Bombali district the percentage of population living more than 5 miles from a health facility was 19.4%. In addition, the ratio between the healthcare personnel and the population is low as in the rest of the country. As per the MoHS 2016 data, the district counts on 8.8 frontline health workers, 0.1 doctors, 0.5 nurses (higher cadres), and 0.4 midwives per 10,000 inhabitans.

Maternal mortality remains a challenge for the country. As of 2023, maternal mortality stood at 1,120 deaths per 100,000 live births. Birth assistance by qualified personnel is 87% (UNFPA, 2023) at a national level although in rural areas the values are lower with post-partum uterine haemorrhage (38.8%) and hypertension (16.3%) representing the main complications along with indirect causes (12.8%) such as HIV/malaria/TB, and sepsis (11%). The main difficulties are therefore to guarantee: basic health services, such as transfusions, pre- and post-natal care (ANC and PNC); medicines, aids and equipment and birth assistance.

With a total population of 8.8 million Sierra Leone remains among the world’s poorest countries, ranking 181th out of 191 countries in the UNDP Human Development Index (2021). Poverty remains widespread and multidimensional poverty accounts for 59.2% of the population. Women represent the most vulnerable group. They face many discriminatory practices related to customary law in areas such as marriage, divorce, inheritance, and family relations, highlighting unequal rights, roles, and socio-economic outcomes. Moreover, Sierra Leonean women are disproportionately less likely to access post-secondary education and to own assets such as radios, mobile phones, and bank accounts. In Bombali district, 76% of women do not own land rights and 64% a house. These figures are even higher than national level.