Direct Relief program officer Sarah Thurston spent three weeks in Ghana with 12 employees of medical technology company BD as part of a joint volunteer initiative to strengthen healthcare in two areas of the country.

April 10
As we're finishing up work at both project sites, here is a short update and some photos of what the volunteers have been up to in the last week:

There has been amazing progress at Motoka in establishing an electronic inventory system for product and reorganizing the entire storehouse.  One of BD’s field salespeople has been great at getting Vivian and two staff members on the computer and comfortable with the new program. The lab at Motoka looks great as well. The construction team basically gutted everything and re did it and with the new equipment installed it looks wonderful. A BD employee who is also a Registered Nurse is on boat outreach today.

The Bonkwaso construction team is rushing to finish by Thursday when there will be a ribbon cutting ceremony to open the new clinic. One of BD’s marketing managers has been busy in the lab at Maranatha installing new equipment and doing trainings for the lab techs at the 15 other maternity clinics in Maranatha's Kumasi maternity clinic organization. Computer training was a big hit at Maranatha as well. The BD corporate manager who set up the system is very popular in Kumasi now.

We're all staying healthy, and while some of the volunteers seem ready to go home others may have to be dragged onto the plane. Everyone is looking forward to this Friday and Saturday in Accra for the two sites volunteers to meet again and share experiences.

April 6
Things are going well here in Motoka, as the BD volunteers and clinic staff are making some significant progress in improving both the infrastructure and the operations of the clinic. The storeroom is nearly completed - a real facelift - as well as the laboratory shelving, concrete floor and re-wiring. One of the BD volunteers (a marketing manager back in the States) will start working to set up the new equipment in the next day. He's been working with the new lab technician at Motoka on standard operating procedures that will be recorded for Simon's use and for future employees. Another BD lab expert has been in Motoka’s lab the whole time, and his input has been great.

The rainwater collection system and septic tank, which has proven to be the most challenging project, will be completed this week. A BD field sales specialist has three Motoka staff members in computer training three hours per day, and they are recording their entire inventory in an Excel spreadsheet as it is put back into the newly shelved store room. This will be a good starting point for tracking inventory for them.

Things at the Maranatha Bonkwaso clinic are also going well. The clinic will be finished by this Thursday and the construction folks are working all weekend to make that happen. On Tuesday, all Kumasi volunteers will paint the clinic, each taking one room.

One of BD’s lead scientists worked at Komfo Anokye Teaching Hospital (the second largest hospital in the country) yesterday on their CD4 counter, a device that is useful in monitoring T-cell counts in HIV/AIDS patients. They’ve has been doing training sessions for other lab techs and assistants throughout Maranatha's midwife clinic network in Kumasi for such things as tuberculosis staining, malaria testing, and more. She is also helping the hospital staff revise their standard operating procedures and working with two new lab assistants on their training.

Other volunteers are helping emphasize the importance of safety and preparedness at the clinic. Two BD volunteers, who are also trained nurses, did a seminar on healthcare worker safety yesterday at Komfo Anokye to a 90 person crowd.

In other good news, the Henry Schein shipment of additional medical products was received, and we're sending it to the two sites today!

March 29
We had a really nice meeting this afternoon with the Paramount Chief (the local political figurehead) and all of the elders from his districts so they could meet us, get to know about our mission, and thank us. This meeting was a chance for us (Direct Relief and BD) to explain our mission here and for the chief and elders to hear about Vivian’s work providing local healthcare for the last ten years. It’s novel in Ghana that Vivian set up this clinic in an area where she does not come from originally. That act brought healthcare to this region, from which the chief’s people are benefiting. Many thanks were offered for this ongoing assistance.

The chief and elders were all in full traditional dress. The chief wore a huge gold tortoise ring to symbolize that his are a peaceful people.

Everyone is settling in well in Motoka. We spent time today tasking out jobs, finalizing work plans, gathering a few final supplies, and by the end of the day all seemed to be moving in the right direction. Anders spent some very productive time with the lab technicians today, and introduced the BD lancets at a well-baby clinic. They were very well received!

The heat here can be overwhelming, reaching a very sunny 100 degrees Fahrenheit during the days, but now, at night, it is about 70 degrees and windy.

In about four days, I will be back in Accra, hoping to clear through customs a shipment of additional medical supplies donated by Henry Schein for the clinics.

Direct Relief Program Officer Sarah Thurston is in Cameroon in January to visit partner organizations and evaluate potential new partners. Cameroon, a country in Western Africa consisting of over 17 million people, has only 19 physicians per 100,000 people, one of the lowest ratios in the world (UNDP 2006). Physicians in Cameroon are often faced with facilities severely under-supplied and lacking in medicines and proper medical equipment.

January 7, 2007
Ekona, Cameroon

I arrived at the Holy Trinity Foundation Hospital in Ekona, a small town in western Cameroon accessible by a dirt road outside of Buea, the former German colonial capital, to meet Dr. Adeh Sylvester and the staff of this long-time Direct Relief partner facility. The 30-bed hospital is staffed by two doctors (including Dr. Sylvester, a gynecologist by specialty), three lab techs, an administrator (Dr. Sylvester’s wife), a pharmacy attendant, and a number of nurses, nurse-midwives, and nurse aids. The staff is friendly and extremely enthusiastic about their work as apparent in their caring attitude toward the in-patients we met as we toured the facility.
 
The aim of the facility, established by Dr. Sylvester, is to provide quality, affordable healthcare to the impoverished subsistence farming population of rural villages surrounding Buea as well as to low-income urban residents of Buea itself. Prices for services are set on an exact cost-recovery basis, much less expensive than other public and private facilities in the vicinity. However, Dr. Sylvester noted that many patients cannot even pay minimal fees and are therefore treated free of charge.

Dr. Sylvester performs surgeries in the hospital nearly every day of the week. With minor and major operating theaters, surgeries are undertaken in minimalist conditions with the constant threat of electricity failure and a lack of proper supplies available for procurement on the local market. Dr. Sylvester noted the lack of sutures available for purchase as a major obstacle to maintaining regular surgical services. But, for many patients in Ekona and beyond, Holy Trinity Medical Foundation is the only affordable provider of health care and thus the only option. Dr. Sylvester is ever creative in his ways to maintain consistent, high-quality services for those in need.

Direct Relief has sent 12 shipments to Holy Trinity Foundation Hospital since partnering in 2003 worth over $2.37 million (wholesale), with the latest shipment set to arrive in port this January. The shipment includes much needed items including surgical lamps as well as other requested pharmaceuticals and supplies to alleviate the strain on this exemplary medical staff to carry out their mission. 

January 1, 2007

Douala is a densely populated metropolis whose temperature in this part of the dry season remains easily in the upper 90s each day with full humidity, dust, and diesel fumes in the air. Douala, the largest city in Cameroon and a port serving all of Cameroon, Chad, and the Central African Republic - is home to over two million, many recent migrants from rural areas in search of jobs in the urban informal economy.

I spent the day with Dr. George Assam, one of 30 radiologists in Cameroon, and director of the Help Medical Foundation, a charitable medical facility located in Bonaberi, an over-populated, under-developed urban slum section of Douala. For 80,000 people in this part of Bonaberi, this eight-bed in-patient clinic is the only source of affordable health care. Over 75 percent of the patient load, which averages 30 per day, is unable to pay anything for services and receive examination and treatment free of charge. With barely enough income to cover medicines, reagents for the laboratory, and salaries, the facility is hard-pressed to meet its budget each month. The three doctors on staff work on a volunteer basis (running private practices on the side in Douala for income), and the nurses and lab tech receive a nominal stipend each month.

Dr. Assam is the fiery, charismatic glue that holds the whole charitable operation together. A specialist doctor at the Douala government referral hospital part time, Assam founded the clinic and takes great pride in knowing on a personal basis, the residents of the Bonaberi area and their health needs, personally encouraging them to adopt healthy lifestyle habits for better nutrition and HIV/AIDS prevention, a growing problem in Cameroon (10 to 11 percent adult prevalence rate, though some statistics put it as low as seven percent).

Poor nutrition and very crowded living conditions along with lack of access to clean drinking water make disease prevalent in Bonaberi. Dr. Assam treats many cases of malaria, respiratory illness, complications related to HIV/AIDS, all made worse by inadequate nutrition. "The greatest health problem in Africa" he says "is hunger" though he quickly adds the problems of infectious disease. For his part, Dr. Assam has been very pleased with the supplies sent by Direct Relief that arrived last August. They have been very valuable in treating infections in both children and adults that come through the Help Medical Foundation's Bonaberi compound.

Direct Relief staffers Cathleen Grabowski and Sarah Thurston are in Ghana and Sierra Leone this month to visit partner organizations and evaluate potential new partners. Health care remains inaccessible to many in these countries; there are only 9 physicians per 100,000 people in Ghana, and only 7 per 100,000 people in Sierra Leone.

September 20, 2006: Bo District, Sierra Leone

As we left Freetown for the southeastern Bo District, the chaos and fumes of the city gave way to a beautiful landscape of bright green rolling hills dotted with cocoanut palms. The outline of the mountains – for which Sierra Leone is named – looked particularly dramatic with the contrast of blue sky against dark clouds that produced quick and frequent bouts of hard rain typical of this time in the rainy season. Soon, the smooth, paved road ended and, for the next six hours, the traveling was extremely rough and the four-wheel-drive capability of our vehicle was critical.

It was dark by the time we reached the Bo town, the central town of the district with over 1 million people – the second most populous in the country after Freetown. The section of town in which we would stay had just lost electricity, and the busy street was dotted with kerosene lamps as people continued about their business seemingly unperturbed. We waited in the courtyard to check in at the Sir Milton Margai Hotel as the building’s generator was fired up.

In the morning we left Bo town with John Ganda, PhD, Executive Director of Ndegbormei Development Organization (NDO), a respected Sierra Leonean social service and economic development organizations active in Freetown and Bo District. Established in the mid-1980s, NDO had operated throughout the years of Sierra Leone’s brutal civil war, even maintaining an office and program work in Freetown when the rebels took over the city in 1999. NDO’s current activities focus on helping rebuild the rural and urban poor’s access to health care, shelter, and economic opportunity in a post-conflict climate in which major infrastructure components were damaged or destroyed (For example, the rebels destroyed Freetown’s electrical lines in 1999 and they have not yet been completely rebuilt, leaving sections of the city without electricity seven years later).

From Bo town we drove 16 miles in nearly an hour to the rural village of Bumpe and the site of a community clinic built and operated by NDO. Bumpe’s approximately 4,000 people are mainly farmers, and homes are made of mud and thatched straw roofs that must be replaced after each rainy season. There is no running water or electricity available, and goats and chickens ran around in front of each home along with many little children.

The Bumpe clinic is a ten-year-old cement structure that includes an exam room outfitted with a delivery bed, an administrative office that doubles as a pharmacy, and a patient waiting room in which there are also two in-patient beds. Supplies of medicines and consumables at the clinic were low, and the two full-time nurses, Beatrice and Rilla, spoke enthusiastically about the latest shipment from Direct Relief that had just cleared customs in Freetown and was on its way by land to the clinic.

In addition to the two nurses (both trained as midwives as well), the clinic employed one nurse’s aide and an administrator/ program coordinator. Nearly 1,000 patients sought preventative and curative services at the clinic each month coming from Bumpe as well as surrounding villages. Once per week, the clinic administered immunizations to children under five years and offered well baby exams. Other days at the clinic were consumed by providing prenatal care, primary care services including wound care and suturing and the treatment of common illnesses. Referrals including complicated deliveries were made to the nearest hospital facility in Bo town.

Patients needing care beyond the level available at the clinic needed to find a car for hire to travel on the pitted, muddy roads (vehicles are not readily available in the villages, if at all) and have available both the payment for the transport and the payment for the emergency service at the hospital in Bo. It was widely reported that services were routinely withheld until patients could pay in full for the procedure needed.

For complicated obstetrics cases, this lack of access (geographically and financially) to emergency services, including c-sections, compounded with inadequate tools in rural clinics to make early diagnoses of potentially complicated cases helps explain why Sierra Leone’s maternal mortality rate is the highest in the world.

As we sat in the clinic’s office discussing with the nurses the range of services provided and the needs of patients seeking them, a very young mother arrived with a baby tied to her back accompanied by her little sister for her five month old baby boy to be immunized. Her face and arms were glistening with sweat and her clothes and her sister’s clothes were damp. She had just walked eight miles in the hot sun, humidity, and spurts of hard rain to reach the clinic so her baby could be immunized – a stark reminder of the obstacles for these rural mothers in obtaining even basic preventative care.

September 12, 2006: Kumasi, Ghana

We awoke at 5:30 AM as the sun came up outside of Ghana ’s second largest city, Kumasi , located in the central Ashanti Region. Even with the loud hum of the fan, I could hear clearly through the open windows roosters and their typical morning greeting, dogs barking, and a baby crying from the maternity clinic above the residence of proprietress, Mrs. Agatha Amoateng-Boahen, with whom we stayed during our two day visit to Maranatha Maternity Clinic in Kumasi . For two years, Direct Relief has supported Maranatha with donations of medicines, medical supply consumables, and advanced diagnostic equipment.

The water pipes to this part of Kumasi had shut down, leaving the clinic and the residence without running water for a week. Every morning, Agatha drew water from the well in gallon-size white buckets for all the day’s washing, drinking, cooking, and clinic use. After a quick wash from a bucket of warm water, heated on the stove, we departed Kumasi for the small rural village of Bonkwaso , an hour’s drive on smooth roads which faded into difficult bush roads.

The village of Bonkwaso was home to approximately 50 families with mud huts with straw and tin roofs clustered around a main road with dilapidated cement building and wooden stands of unclear purpose. Surrounding the villages are plots where nearly all of the families work on a subsistence basis – some crops are grown for sale in the city including cocoa, oranges and various vegetables, and plaintain, a popular banana-like fruit. These self-subsisting villages are not uncommon in the region.

Bonkwaso had no running water or electricity, and health care services are inaccessible without making the long journey to Kumasi ; without a vehicle – of which there appeared to be none in the village – it would take all day. Each Friday, Agatha and her staff conduct medical clinics in the village from a two-room rented space, which consistes of an exam room and a storehouse for medicines and supplies. The clinics offer a full range of primary care services, maternity care, and general medicines with an emphasis on combating the widespread malnutrition in the area. On Fridays, the outreach clinic offers medical services to those visiting an area-wide market, hosted in Bonkwaso, where agricultural goods and household goods are traded between surrounding villages.

On our arrival in the village, we were taken to the home of the chief to meet him and several of the elders. A growing group of curious children followed us around eager to show us their drawings and have their photo taken. Young women sat out of their huts and nursed babies or washed laundry in bright colored buckets. Agatha smoothly shifted into clinician mode, making “rounds” among the young women with babies most of whom she appeared to know from previous clinics.

Agatha called us over to one baby who, though held by his mother, was whimpering in a more plaintiff way than normal. His forehead and eyes were large, but his cheeks were sallow. His arms and torso were very thin and the skin on his torso sagged in excess. Agatha took the baby and examined him – she confirmed with the mother that he had been suffering from acute diarrhea and was dangerously dehydrated and in need of fluids.

Agatha went to her clinic storehouse and returned with packets of oral rehydration salts. It took a significant effort to convince the young mother that this remedy would be useful, and Agatha demonstrated the salts and instructed the mother on their continued use to help the tiny body regain fluids and keep the baby alive.

Agatha saw a number of other people in the village whose cases she had been monitoring ahead of her scheduled Friday clinic. It was obvious that her attention to their health was immensely appreciated and she was treated in the village with palpable affection and respect.

As we prepared to return to Kumasi, Agatha explained her plans to expand the level of services and frequency of clinics in Bonkwaso including the training of two resident community health workers to monitor cases in the interim between visits by health care professionals. It was obvious that her efforts are making an incredible difference to this rural area in central Ghana.

April 17-21, 2006
By Lucy Anderson and Christienne Durbin

Lucy Anderson, Development Coordinator and Program Officer Christienne Durbin traveled to Africa in April to meet new partners and expand Direct Relief’s programs in Malawi, Rwanda, and South Africa. They provided brief notes from the field while they traveled.

April 21, 2006 - Rwanda

Direct Relief has signed a Memorandum of Understanding with Community, Habitat, Finance, (CHF) to provide material assistance to 86 clinics throughout Rwanda. CHF International is running a $40 million project that aims at providing communities with access to high-quality and sustainable HIV/AIDS services.

According to the United Nations, Rwanda is currently considered one of the least developed nations with 83% of their population living on less than $2 a day. The average cost of triple anti-retro viral therapy for HIV/AIDS is $13 per day, leaving treatment out of reach.

Rwanda continues to suffer from the effects of the 1994 genocide that left almost one million of its people dead. The results of the genocide are numerous: tens of thousands of orphaned children, widows left as sole heads of their households, and a ruined economy, to name just a few. Like all African countries, Rwandans have the additional burden of HIV/AIDS on an already struggling health system, society, and economy. Life in Rwanda is not easy for most, 60% live in abject poverty, for those with HIV or AIDS life becomes exponentially more difficult.

The Society of Women and AIDS in Africa (SWAA) was started in 1992 and now has 40 branches throughout Africa. SWAA is one of the many partners supported by CHF and CHAMP and the Rwandan division of SWAA has three branches. We visited the Central (Kigali) branch today and were pleasantly surprised by the extent of the comprehensive services offered.

SWAA’s main effort is to combat HIV/AIDS and offer services to those affected by the disease (though these services are also available to people who do not have HIV). SWAA serves men, women, and children in a range of areas. One area in which they work is behavior change communication (BCC) – the cornerstones of which are A&B – “abstinence and be faithful.” More than 100 people attend these BCC meetings which are held every morning, 98 percent of these are people living with HIV/AIDS, and some begin walking at 2am in order to reach SWAA for the 8am discussions. A large part of SWAA’s draw is that they have counselors on staff to listen to people’s stories. Many HIV+ people hide the fact that they have this disease from those in their community – having the opportunity to talk, in confidence, to someone about their disease and life in general seems to have a therapeutic effect on SWAA’s clients. SWAA also provides palliative and home-based care for those with advanced cases of AIDS, much of this work is undertaken by SWAA trained community volunteers. SWAA’s reach extends to orphans and other vulnerable children and micro-credit schemes.

We met a woman and her baby who were recipients of SWAA’s services. The woman is HIV+ and attending a lecture on micro-finance, in this instance the selling of fruits and vegetables. Upon completion of a training course, SWAA provides the man or woman the money to begin their business venture. SWAA also provides them with a bank account and helps them keep track of their money. Others in attendance had plans including selling coal, importing cloth and small fish from Bujumbura (the capital of Burundi), and looking after other people’s children. Although many people have been educated, there are few opportunities to make a good living, especially for those whose health is compromised.

Direct Relief International looks forward to providing material, namely personal care products, for the community volunteers to use when making house calls. Basic items like soap and towels are in very short supply and the purchase of these items taxes SWAA’s already stretched budget.

Lucy Anderson reviews project plans
with SWAA's directors in Rwanda.

April 17, 2006 - South Africa

The first stop on our trip took us to Johannesburg, South Africa. The HIV rate in South Africa is between 20-30% and some of the most notably affected are children. Located in Maraisburg, Roodesport, about 40 kilometers from Johannesburg International Airport, Sparrow Village functions as an orphanage, hospice, and school for local children.

According to Reverend Corinne McClintock, the founder of Sparrow Village, there are 800,000 orphans in South Africa and estimates predict that this number will more than double, to two million, by the year 2012. Reverend McClintock shared his firm belief that without Sparrow Village all of the HIV positive children they have treated would be dead. There are 200 children and 30 adults currently residing in the Village. According to staff, 75% of these children are orphans and 70-80% are HIV positive. Due to the need in the area for medical services Direct Relief International provided a hand-carry consignment in February to Sparrow Village, which consisted of essential medicines such as analgesics and antibiotics, as well as wound-care and personal care products.

Sparrow Village staff shared with us a number of heart-warming stories that were encouraging indicators of the progress being made by this organization. For example, they told us about a baby who arrived four months ago weighing only four pounds, but as a result of care, the child, Isa, is now thriving. At the Village the children live in domed huts, with one “housemother” for every 12 children. We had the opportunity to hear from Justine, who has been a housemother for the past five years. She spoke of how much she cared for the children, that they make her heart “soar” and that she loves them “too much.” She went on to tell us about a specific case where she was given a little boy in a wheelchair to take care of. She said that all she could do was care for him as best as she could, and pray; miraculously, two weeks later, the child began to walk.

Reverend McClintock is aware that simply being at Sparrow Village will not ensure that these children will be able to secure a future. She is currently looking into how she can provide the children with a quality education and marketable skills so that they will be successful after they have left the Village. She said they are also seeking to increase the amount of health care that they provide. Their goal is to set up movable health villages so that they can provide care to a wider range of people, including child-headed households.

As for Direct Relief’s involvement, we will be examining the possibility of Sparrow Village becoming a more active member of our partner network. Direct Relief is currently working to become a registered South African Public Benefit Organization (PBO) which would help facilitate further assistance to the Village.

We are off to Kigali, Rwanda on Wednesday and will report from there.

July 2004
Christienne Durbin, International Program Officer

In July of 2004, International Program Officer Christienne Durbin visited our overseas partner KADERES - Karagwe Development and Relief Services - a non-governmental organization in northwest Tanzania, to assess and evaluate 7 of the 31 clinics and Health Care Centers it supports through the shipment of medical products provided by Direct Relief.

Children's Ward, Nkwenda, Tanzania

According to the United Nations Human Development Index, Tanzania ranks as one of the poorest countries in the world whose ability to cope with the extreme health problems of AIDS, malaria, and malnutrition is extremely limited. KADERES is a non-governmental organization, located in the northwestern region of Tanzania, bordering the republics of Uganda in the north and Rwanda in the West.

Young Girl with Malnourished Baby, Nkwenda, Tanzania

Following the crisis of genocide that occurred in Rwanda in 1994, over 300,000 Rwandan refugees poured into northwestern Tanzania, causing a sever strain on an already overburdened and resource poor health care and social services system. The following description, taken directly from the Karagwe District government website, explains the on-the-ground situation quite well:

Apart from insufficient levels of qualified staff, the majority of health facilities do not have sufficient other resources to be able to provide quality services. Necessary equipment, drugs and medical supplies are all in-adequately supplied….Equipment, including infrastructures, is often in bad shape or poorly maintained. Drugs for the Government of Tanzania health facilities are supplied in the form of a monthly pre-packed 'EDP-kit' (National standard). As the contents of the kit are not 'demand-driven', most of the drugs are either under- or over-supplied. Although it is safe to assume that prescribing of drugs could largely be improved, in most cases, essential antibiotics are only sufficiently available for a period of two weeks. Other, rarely used drugs pile-up and expire. Generally, non-profit facilities (including church funded facilities) do not receive drugs (or funds to buy drugs) in a sufficient and consistent manner. In part this is caused by declining levels of support from abroad.

Patient Records, Mabira Clinic

Apart from insufficient levels of qualified staff, the majority of health facilities do not have sufficient other resources to be able to provide quality services. Necessary equipment, drugs and medical supplies are all inadequately supplied. Equipment, including infrastructures, is often in bad shape or poorly maintained. Drugs for the Government of Tanzania health facilities are supplied in the form of a monthly pre-packed 'EDP-kit' (National standard). As the contents of the kit are not 'demand-driven', most of the drugs are either under- or over-supplied. Although it is safe to assume that prescribing of drugs could largely be improved, in most cases, essential antibiotics are only sufficiently available for a period of two weeks. Other, rarely used drugs pile-up and expire. Generally, non-profit facilities (including church funded facilities) do not receive drugs (or funds to buy drugs) in a sufficient and consistent manner. In part this is caused by declining levels of support from abroad.

Woman Receiving Exam in Maternity Ward

KADERES facilitates the provision of primary health services in isolated villages in Karagwe District, where more than 78% of the citizens of these remote areas walk more than 20 (six miles) kilometers to reach medical services. There are only 3 Hospitals, 3 Health centers, and 45 dispensaries to serve 500,000 people. The infant death rate is currently 110/1,000, or over one-in-ten. For comparison, in the United States the infant mortality rate is 7 in 1000. In Karagwe District, 47% of deliveries are in the home and 53% in a health facility. The term "facility" includes dispensaries, which are generally only open a few days a week. The local facilities see approximately, 1,626 pregnant women per month.

Maternal deaths are primarily caused by ruptured uterus, disseminated infection (puerperal sepsis), antepartum and postpartum hemorrhaging and infected (septic) abortions. The main indirect causes of maternal death are late referrals to the medical centers due to poor health infrastructure (e.g., no transportation to a clinic and no radio communication system), malaria, anemia and AIDS. The main causes of infant deaths were fetal distress, birth trauma, neonatal sepsis and prematurity. Though these numbers seem very high, they are an improvement on the infant death rates of the previous year of 130/1,000. Current statistics from the Karagwe District Medical Office highlight the prevailing top ten causes of death in the district:

PROGRAM PARTNERS VISITED

KADERES

KADERES Vital Statistics:
Five full time and one part-time staff, including the Executive Secretary and Financial Controller. Of the fifty-three existing board members, twenty-four of them are founding members. All board members are local people from Karagwe District who volunteer their time.

Public Health Nurse and Medical Secretary, Karagwe

History
KADERES was formed on June 26th 1997. Their main objective is to improve the provision of Health, Water, Education, and Agriculture in rural areas of Karagwe District in Tanzania. KADERES also operates micro-enterprise, educational, agricultural, and environmental programs. The health-related goals of KADERES include reducing infant and maternal mortality rates, decreasing the rate of HIV/AIDS infection, providing comprehensive reproductive health services, immunizing all children less than 1 year of age, and building three new dispensaries in specific villages where, at present, no medical services are provided.

In 1997 and 1998, Karagwe District was seriously affected by the El Nino weather phenomenon that resulted in high levels of malaria and anemia that took the lives of many children under the age of five.

KADERES Staff and George Buberwa of Kagera Salient Dispensary (far right)

KADERES responded to the El Nino crisis by trying to financially support the health clinics in Kibimba village, in Mabira Ward from their own contributions. When they realized that they would not be able to keep the clinics operating through their own efforts, they began to look for possible donors to assist them in their efforts to strengthen the health services provided by Kibimba and other clinics to their the neighboring villages.

In 1998, KADERES submitted an application to DRI for Medical support. A year later, DRI began providing medical shipments that KADERES distributed to the Kibimba Health Care Project a 25-bed clinic and dispensary serving approximately 23,730 villagers. Donations to KADERES have since supported 31 dispensaries and clinics, three health centers (including Nkwenda Rural Health Center where Direct Relief is currently helping to equip a operating theater) and three hospitals. Direct Relief now sends an average of one large shipment annually to support the Karagwe District healthcare infrastructure. Two primary schools have also been provided with first aid kits. Donations have benefited more than 55,500 patients in all the health facilities in Karagwe District.

Introduction to Two KADERES Health Care Sites

Nkwenda Rural Health Center
KADERES is supporting the Nkwende Rural Health Center's initiative to reduce maternal and child mortality by requesting from Direct Relief assistance in equipping an efficient operating theatre. In the past three years, there have been 45 maternal deaths due to ruptured uterus and post-partum hemorrhage as a result of late referral due to poor transportation. It is expected that a functioning operating room will drastically reduce maternal and infant mortality rates. Nkwenda serves a population of more than 100,000 who have to walk to the nearest hospital for surgical services 43 kilometers away.
Staff: 4 physicians, 6 midwives

Women's Ward, Nkwenda

Kibimba Health Care Project
Kibimba Health Care Project operates a 25-bed clinic and dispensary which serves approximately 23,730 villagers. The major health problems are malaria, diarrhea, anemia, upper respiratory infections and AIDS. Approximate number of people served by pharmaceuticals and supplies: 8,581
Staff: 2 physicians, 2 midwives

May 2004
by Kelly Darnell, Program Officer (Africa, Asia, Middle East)

In May of this year, the U.S. Agency for International Development (USAID) invited Direct Relief International to Senegal to meet their local NGO partners and identify ways that Direct Relief might be able to support their country-wide efforts to improve health care, particularly for women and children.

Mother and baby waiting for well-baby exam
(photo by Kelly Darnell)

With little natural resources and a per capita income of $500 per year, Senegal is one of the poorest countries in the world. It sits just 18th from the bottom of the United Nations Development Program (UNDP) scale, which ranks countries according to life expectancy, education levels, and standard of living. Even so, Senegal could be considered a success story compared to many of its West African neighbors with a rapidly growing tourist industry and extremely low HIV/AIDS rate at slightly over 1 percent. It also has an organized health system that is relatively well supplied with essential medicines and in a position to provide health to even the most remote areas through a network of staffed health posts, health centers, and hospitals.

Senegal's progress in addressing health issues despite its development status to a great extent results from the government's commitment to keeping health a priority and to a forward-thinking medical community that has responded quickly to health issues like the outbreak of HIV/AIDS. In addition, the country has established a medical training program that includes peer to peer mentoring, is looking at ways to address the chronic "brain drain" taking place, and has committed to providing anti-retrovirals to the over 27,000 Senegalese living with HIV/AIDS.

Despite clear improvements in the past decade, Senegal remains an unsafe place to be under the age of 5 or a pregnant woman with delivery complications. Nearly one in 160 women in rural Senegal die in childbirth. Nearly one child in seven dies before the age of five and one in four suffers from chronic malnutrition, malaria, and upper respiratory infections.

USAID is providing financial assistance to several Non-Governmental Organizations (NGOs) that are collaborating with the Ministry of Health to support initiatives designed to strengthen the healthcare system though training and the provision of critically-needed supplies. I spent several days meeting with these partners and visiting the health centers and hospitals where their work is starting to pay off.

There are five diseases or conditions responsible for 70 percent of all childhood deaths in developing countries - pneumonia/acute respiratory infection, measles, malaria, malnutrition, and diarrhea. One of Direct Relief's potential new partners in Senegal is an NGO called Basics II. Basics II's work to improve the diagnosis and treatment of childhood illnesses illustrates the complimentary relationship between the Ministry of Health and partner NGOs. Basics II is training health providers to recognize and treat early warning signs for health conditions like dehydration in children, as well as providing education at the community level, where the diarrhea that causes dehydration starts, and by talking to parents about how to prevent diarrhea through simple measures like ensuring their children are drinking clean water and washing their hands after using the restroom. In addition, Basics II is increasing access to immunizations throughout the country; promoting exclusive breastfeeding to prevent malnutrition; and ensuring that all health facilities have a baby weighing program, as weight is an important indicator of a child's health.

Another example of NGO action tailored to support Ministry of Health measures is a project of Management Science for Health (MSH) to improve emergency obstetric care. Throughout Senegal, woman and infants often die because health centers are not properly equipped with lifesaving medical equipment and staff have not had adequate training in emergency delivery skills. MSH is working to reduce the number of maternal and infant deaths by providing emergency obstetric equipment as well as training for health providers. Topics include how to resuscitate a newborn, recognizing the early warning signs of women needing a cesarean section, and what to do when a woman begins hemorrhaging during delivery.

Inpatient room at health post
(photo by Kelly Darnell)

Unfortunately, many of the health facilities supported by the efforts of MSH and Basics II are still lacking the supplies and equipment needed to allow these trained health practitioners to implement their new skills. Many of the delivery rooms and neonatal ICUs I visited could benefit from a Direct Relief donation of basic items such as delivery instruments, vacuum extractors for woman who have miscarried, infant warmers, baby scales, needles, syringes, incubators, and neonatal ambu bags for resuscitating newborns.

At the end of my visit, representatives from USAID and I met with the U.S. Ambassador to Senegal, Allan Roth, in order to brief him on this new collaboration. Ambassador Roth discussed the fact that although USAID has long partnered with NGOs like Direct Relief, these partnerships are even more important today. In 1970, the US government provided 70 percent of American foreign assistance. Today, American citizens, companies and NGOs provide 80 percent of the assistance, while the US government has reduced its commitment to only 20 percent. Agencies like USAID are recognizing the enormous contributions made by American NGOs in addressing issues standing in the way of education, economic development, and health care delivery.

In summary, each of the NGOs with which I met during my visit to Senegal is well run by Senegalese professionals with backgrounds in community planning, education, and medicine. All are committed to improving the health system in their country. By supporting their efforts, Direct Relief can build on the strengths of this rapidly improving health system that is making it safer for a woman to deliver and for a child to be under the age of five.

U.S. Ambassador to Senegal Richard Roth
and Program Officer Kelly Darnell
(photo by Ann Veazey)