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Comitato

Collaborazione

Medica

ORGANIZZAZIONE NON GOVERNATIVA DI COOPERAZIONE INTERNAZIONALE

CCM ANNUAL REPORT YEAR 2005

Presentation

Comitato Collaborazione Medica - Medical Cooperation Committee - is a Non Governmental Organization founded in Turin in 1968. In 1972 it obtained accreditation from the Italian Ministry of Foreign Affairs for the implementation of projects of cooperation in developing countries.

The guiding principles of the CCM are solidarity and fairness, respect for cultural diversity, improvement in the use of human resources and promotion of self-development, regardless of religious belief, nationality or social status of the beneficiary people.

Among the operative principles, are the special attention for the poorest and most deprived communities, the effort to give dignity and value to local resources, both human (capacity building) and material (appropriate technologies), and to guarantee the continuity of the projects in the years.

The main target of CCM is to improve the health status of the populations of the developing countries, by ensuring adequate health assistance, both through emergency interventions and, above all, through the support of existing local health facilities.

The most important activity of the Association is to offer preventive/curative medical services both of primary nature (Primary Health Care) and of secondary or hospital nature (Secondary Health Care). As previously said, it is considered essential to involve the local population and to train local staff.

CCM carries out mainly medical activities, but takes a holistic approach, as the cooperation with projects in other fields (such as education, provision of safe water, environment hygiene, animal’s health, and governance) is considered greatly important and essential.

Since the beginning of the activities, 157 volunteers have worked in various locations, under long-term contracts. Furthermore, one needs to take into consideration the dozens of people who have donated volunteering counselling assistance with short-term missions (there were 38 such missions in 2005, with an average stay of 22 days in DC).

·         Accredited by Italian Ministry of Foreign Affairs on 19/6/72 (D.M. 0012), and confirmed on 14/9/88 (D.M. 1988/128/004187/2D)

·         Framework Partnership Contract signed with ECHO: n. 94/0084 of 18/4/94; n. 99/0084 of 26/2/99; n. 3-029 on 7/11/03

·         Member of Operation Lifeline Sudan/Unicef since 2/3/1992

·         Member of  Cipsi since 1988

·         Member of Italian NGO Association

·         Member of People in Aid since 2003

·         Member of HIV Observatory since 2003

Accredited in the following countries

·       - Kenya n. OP.218/051/94103/618 –20/6/96

·       - Ethiopia n. 45 – 29/4/97

·       - Burundi n. 12 – 1/4/97

·       - Sudan 22/10/95

·       - Uganda: 12/7/98

1.      ACTIVITIES IN ITALY

The CCM is part of “Consorzio delle ONG Piemontesi – COP”, (NGOs Consortium of Piedmont), supported by the Piedmont Region, which has provided technical and administrative support to all the organisations involved in regional projects of food security and struggle against poverty in Sahel and West Africa.

With the COP, CCM played an important role in the EAS projects, offered to the schools in Piemonte focusing on health education. Furthermore, CCM collaborated with the “Istituto Addestramento Lavoratori – IAL” (Training Workers Association), in a course intended to the training of technicians involved in International Cooperation.

CCM has co-operated with the Committee “Cittadella delle civiltà” that groups together the different NGOs in Turin, in organizing, among the different activities, the event called “MONDO IN PIAZZA”, whose objective is to sensitize the population to the concept of international cooperation and to facilitate the collaboration between organisations in Turin with foreign ones.

In 2005 the CCM has been involved in the meetings of AIDS/NGO’s Panel (26 NGOs operating in developing countries), with the objective to sensitize and inform the public opinion on this matter.

Concerning the activities started in 2003, the CCM has continued the campaign to sensitize the population on the matter of FGM (Female Genital Mutilations), using a documentary made in the Somali Region in Ethiopia, along with a presentation related to health and anthropological aspects of the  matter, reaching different social backgrounds (schools, theatres, associations etc.)

1.1. Information and sensitization

Aware of the importance of continuous and appropriate information and sensitization about developing countries, especially among young people, CCM has joined with enthusiasm the project of National Voluntary Civil Service proposed by the City Council. In the second Announcement of 2004, the CCM has involved four voluntary girls in a project called “Awareness to problems of cooperation North-South and promotion of the CCM activities on the regional territory”: the four girls started working in February2005.

The overall evaluation of the first year’s activity is surely positive, regarding both the personal commitment of the volunteers and the results obtained: many articles have been written, some of which were published on scientific magazines, whereas some videos produced by CCM in Africa were broadcasted by national TV networks (RAI 1 and Taxi Channel). The four girls in the Civil Service updated the CCM website (www.ccm-italia.org) and the on-line newsletter is sent to more than 500 addresses.

Among many events organized by CCM, it is necessary to take into consideration first of all the photographic exhibition entitled “Families of Africa”. The exhibition consists of fifty didactic panels and a photographic book, from which a calendar was also produced. The exhibition has been presented in many places, such as the Lingotto Bonheffer library in Turin, many schools and libraries in different towns and cities.

The new exposition on women working life, called “From 4 to 2 - the working hours of women in African rural areas”, has accompanied in some locations the exposition “Families of Africa”.

CCM has started collaborating with the graphic institute of Steiner and with the IED (European institute of design), to study with some schools the development of possible campaigns to improve the awareness on “Sanitary situation in South Sudan” and “Children rights are the face of the peace”

A new calendar 2006 was created.

Many meetings to improve the awareness on the sanitary problems in Africa and a round table on the matter of “Disability in the North and South of the world: experiences on the field” have been organized.

The CCM was present during the “Marcia di Assisi”; in the meeting “One World” and “Young World Happening” organized by the city of Turin during the Olympic period; in the 3WEEC(Third Environmental Education Congress).

Furthermore, many activities (such as ethnic dinners, exhibitions of African crafts...) have been organized in order to collect funds for the different activities.

In the 2005 selection for National Foreign Civil Service, the CCM employed four volunteers for the Sanitary Service in Africa. Since the beginning of October 2005, four volunteers have started to attend the CCM location in Turin, in order to be trained on administrative/organisational and sanitary matters. Later, they have started working in the CCM offices of Nairobi and Addis Ababa for 7 months.

A course of “Tropical Surgery” has been offered in collaboration with the University of Turin.

CCM has continued to collaborate with the Medical Association of Turin and Cuneo which have shown particular interest in getting involved in health projects in developing countries. They have destined parts of their newsletters to specific CCM projects, especially in South Sudan, in which some of their medical doctors were involved.

CCM has continued to co-operate with Solidarietà Internazionale (International Solidarity), a magazine edited by CIPSI (a NGO’s network, of which CCM is part)

1.2. Institutional activities

Members General Assembly

The annual CCM members’ general Assembly was held on June 30th 2005. After a presentation by the anthropologist Alberto Salza on “The rights of nomad shepherds in the Somali region of Ethiopia in the matter of health and water availability”, an overview on the association’s activities and works and projects in progress in the developing countries followed.

In order to improve the relations with the members and supporters of CCM, a second assembly was held on November 26th, introduced by a debate on the topic “From vaccination to the pill. Prevention and cures in the health projects by the CCM in Africa”. It followed the presentation of the development in the second semester of 2005.

Executive Council

As usual, CCM Executive Council has gathered during the past year on a bi-weekly basis.

According to the Statute, the Council is responsible for the management of all the activities and has to take decision about every issue concerning the Association. CCM’s practice is to allow supporters, partners and anyone interested in getting involved in the Association’s activity, to attend the Council meeting. This is to emphasize the clearness and the willingness to share the managerial responsibility by the members.

Supporting groups and external relations

The supporting groups were very active in dealing with mobilization and fund raising, focusing on specific projects. We would like to remember, among others:

·         Volpiano’s Friends Group: they organized activities involving teachers and students of local schools; the Volpiano City Council funded CCM projects in Burundi and participated in many local events (Patron’s Saint feast, charity sales) involving local people for CCM solidarity proposal.

·         Sololo’s hospital supporting groups, divided in two groups: the group from Cuneo Province has been working for many years to modernize the hospital buildings, by sending volunteer technicians for maintenance; the second group from Robbiate supports the territorial health program, sponsored by private donors and by Sacchi Foundation.

·         Sudan’s supporting groups, among which Chieri and Stupinigi Rotary Clubs, have contributed to the CCM projects for many years with mobilization and fund raising campaigns. Also, the “Nanni’s Friends” group has been particularly active this past year. (It founded in Cuneo in April 2004 to honour the memory of Doctor Ugliengo, who died during a rescue mission on the Alps).

·         The Bergamo Group which, in collaboration with the local NGO Ji-Duma Eau et Vie, gives a continuous support for the access to drinkable water in Mali.

·         Mandelli and Seymandi friends, in memory of their friends killed in an aircraft accident, organized a relevant support group for Rumbek Hospital, mainly focusing in the administration of the hospital and the prevention of malaria.

The distinctive feature of these informal supporting groups is that many members offer personal contribution travelling on their own expenses to operation places and using their professional skills to help carry out the projects.

2. ON GOING PROGRAMS IN DEVELOPING COUNTRIES

2.1. BURUNDI

2.1.1. Shared Project with CISV/CCM/LVIA n. 7451 “Improvement of the sanitary, alimentary and water supply conditions in the province of Cibitoke” financed by M.A.E.

The project, started in August 2004, has continued in 2005 focusing mainly in the province of Cibitoke and is divided on two levels:

-          Hospital: continuous support to the hospital of Cibitoke (surgical activity, transfusion center, radiology, testing laboratory, local people training)

-          Territorial: support to the six pharmacies

Cibitoke Hospital

The first objective was to be able to continue to provide support that would guarantee timeliness in urgent surgical, gynecological and obstetric problems, in the Cibitoke hospital, which is the only sanitary facility for roughly 400.000 people.  A local gynecologist, already hired and paid by CCM in past activities, is now part of the staff of this current project.

He has been implementing:

a)      Continuous medical advising assistance;

b)      Surgical operations: 25-30 per month (hysterectomies, cesarean deliveries, etc.);

c)      Training of the doctors for gynecological emergencies: as it is now, the hospital director is able to take the place of the gynecological specialist on Sundays and holiday.

The Hospital provides an indispensable service intended for all the population that would not be able to go to the main cities hospitals due to distance, transport, security and cost problems.

An obstetric nurse employed in the project has been in charge of organizing the hospitalization departments and training the nurses.

Transfusion department activity

The transfusion department in the hospital has been built with MAE financial support in 1993. Its activity was halted for security problems in 1996 and then it has started working again in 2000.

In order to maintain, at least partially, its functioning, four laboratory attendants have been sent to the Transfusion department of Bujumbura for specific training.

Their job is:

-          To sensitize the local population to voluntary blood donation;

-          To collect the blood donations in the villages, schools and in the transfusion center of Cibitoke. CCM provides the transportation to the furthest villages and schools;

-          To carry out the blood examinations of different groups and evaluate the compatibility for transfusion;

-          To perform a test for the voluntary depistage of HIV. The laboratory attendant is also responsible for communicating to the people the AIDS results of the examinations made in Bujumbura.

The collected blood is sent to the national transfusion center of Bujumbura in order to be tested for HIV and then redistributed, according to the demand, to the hospital of Cibitoke. The blood in surplus is used by the National Center for the hospitals in the capital. The total bags per years are more than one thousand, and the transfusions are about 50 per month, mainly in the pediatric and maternity departments.

Test Laboratory

The laboratory with the spectrophotometer has able to carry out, along with the basic tests for malaria, tuberculosis, intestinal parassitosi, the tests for glycaemia, azotemia, transaminase, serology for typhus, syphilis and test for HIV.

Radiology

A radiologist has been trained to use a portable radiological device. This has turned out to be very useful in this region due to the very high incidence of pulmonary tuberculosis.

Public pharmacies

Since 1993, due to the civil war, the Burundi government has not been able to supply its population with free essential drugs, as said by the law. Consequently, especially in larger urban centers, many private pharmacies have opened selling drugs at costs too high for the greatest part of the population.

Through the emergency project of CISV/CCM/LVIA, financed by MAE, in 2001 five public pharmacies have been opened in the province of Cibitoke, and more specifically in Rugombo, Mugina, Mabay, Murgwi and Buganda. In 2002 the CCM opened another pharmacy in Bukinanyana, using an old building provided by the City Council. Right now, each of the six pharmacies is run by a manager employed by the sanitary system of the province, despite receiving an extra financial incentive from the CCM. Each pharmacy has its own management committee, chosen by the local population. The CCM is responsible to buy the drugs in the Capital, through a qualified nurse employed for this purpose. Each month an NGO’s supervisor inspects the administrative management of the pharmacies. While the financial resources needed for the purchase of the drugs are now supported by the income of the pharmacies, the CCM is still in charge of the organization for the purchase of the drugs in the capital, of the costs of distribution and of the administrative management. In 2005, under the suggestion of the provincial doctor, the CCM found two more areas, where two public pharmacies might be opened.

2.1.2. Technical Assistance to PATSBU (Transitory Supporting Project to the Burundi Health System), financed by European Union.

In line with a task started during the previous years, with the project VII FED (Fond Européen de Développement), CCM gave technical assistance in the Cibitoke province in this transition project in preparation for the IX FED.

The staff of technical assistance in 2005 included: a public health doctor, an administrative manager, an accountant, a surgeon, an anesthetist, a pediatrician.

The main objective of this global project was to improve the health status of the five provinces. The doctor employed by CCM, has been working in close collaboration with the local Province Doctor in order to improve the financial and administrative management; to create a sanitary information system able to connect the data from this province to national data base system and to implement a network system between the local dispensaries and the central hospital.

Special attention was paid to the possibility of developing a system that would cut down various expenses by the active participation of the local communities in the management of the project.

In the hospital and in the dispensaries, the doctors improved the quality of the services offered, through the extensive training of nurses, who have attended courses on the most frequent pathologies and on the new therapeutic protocols.

·                     In order to guarantee a correct follow-up of the CCM activities in the country, since September 2005, Dr. Louis Marie de Montfort Nshimirimana has been working for CCM as the legal figure of the organization. The doctor will also be in charge of the promotion of new initiatives intended to widen the activity of the NGO in the country.

2.2. ETHIOPIA

2.2.1. Support to the regional Health Office in the provision of health services in the region of Gode, the Somali region of Ethiopia (October 2002 – September 2005, extended until May 2006)

The objective of this three-year project, co-financed by the Austrian Cooperation, is to improve the health status of the population, by extending the area covered by the service and by improving the quality of the sanitary service offered by the government system. This has been accomplished with a close collaboration with the Health Ministry of the Somali Region.

The different activities of the mobile clinic are still in progress and new medical ambulatories have opened. In this way, the local villages covered by the mobile hospital are now 36 in the districts of Kelafo, Mustahil e Gode. The vaccination activities, maternal and infant health protection programs, and the therapy of the most common pathologies have been running regularly, with the supervisor visits. In the woredas in which CCM has been working, the vaccination coverage is 23%, a relatively high percentage if compared to the 5% coverage present in the whole Somali region. At the same time, training courses for traditional birth attendants (TBA), community health workers (CHW) and nurses have been offered. The material needed for the development of the project has been regularly distributed.

All the Health Committees of the village are fully operational and have given their full participation to the activities of the mobile Hospital. It has been found that the clinics have adequate availability of the most important primary drugs, although the population claims of not being able to afford them.

All the traditional birth attendants and community health workers, always being trained, are fully operational and produce regular monthly reports.

Special conferences have been organized on the matter of genital mutilation, in which civil and religious authorities, women associations and circumcisers have actively participated. The people trained and responsible for this project have been going to the various villages once every two months in order to engage the population in the discussion of this matter.

2.2.2. Supporting Project to Health System in Libaan e Afdheer, Somali Region, Ethiopia (April 2003 - September 2004, extended to March 2005)

The main objective of the project, co-financed by the Austrian Cooperation, is to improve the health status in the area of interest. As a result, particular attention will be paid to the diagnostic and curative aspects of the project, to the extension of the area covered by the prevention campaign and to the improvement of the administrative system managed by the local health authorities.

All the integrated medical preventive and curative activities (vaccinations, prenatal check-ups, special treatments…) are regularly conducted monthly in twenty-one different areas with the mobile clinic and in two permanent hospitals.

The population contacted represents about 58% of the residents and the vaccination coverage is about 30%.

The supervision of the hospital is conducted regularly. The project has supplied basic equipment and material for eleven health structures.

The project supply equipment and basic materials for 11 health structures. Furthermore, the cold chain is now operative.

Training courses for traditional birth attendants (TBA) and community health workers (CHW) have been conducted.

The activities of Health Committee in the villages and the activities for the reduction of female genital mutilation are in good progress, similar to those in the zone of Gode.

In January 2005, the vaccinations of children in nomad populations have continued. The active presence of a veterinary surgeon, along with an anthropologist and a Somali nurse, has allowed a drastic improvement in the animal and consequently in the human health status.

2.2.3. Supporting project in the Health System in the zones of Libaan e Dollo, Somali Region, Ethiopia (June 2005 - May 2008)

This project is the continuation of the previous one, always with the financial support of the Austrian Cooperation.

In the project there is a sub-project called: “Operative research to find a solution for the distribution of Western medical principles among the nomad shepherd populations in the Somali region of Ethiopia, in the Libaan area.”

This section of the project is financially supported by the Italian Cooperation.

2.2.4. Supporting the traditional social system of nomad populations in the Somali region of Ethiopia

(December 2004 - December 2005, extended to March 2006)

The project, financed by the European Community, budget line “Microproject in Ethiopia” has the objective to preserve and strengthen the lives of the nomad population in the area, paying particular attention to the environment; indeed, only the transhumant nomadism is compatible with the semi-desert territory of these areas, where agricultural activities are impracticable. The nomad sheep farming is the only way to be able to inhabit this environment, in which these populations have completely integrated, preserving it and impeding a total desertification.

The proposal has involved the nomads of the Kelafo Region, in the Gode zone, trying to create an association able to cooperate with the Ethiopic government.

The activities have been monitored by three missions on the field, conducted by experts in anthropology and human rights, in the periods March-April, July-August and in the future in February-March 2006. The members of the families, belonging to the three clans present on the territory, have been involved, firstly in order to understand their conception of human rights and later to inform them about these concepts, in line with the Ethiopian law. At the same time, the committee was able to find a possible strategy in order to mediate between two opposing visions. In the first mission, 4000 people were approached and asked to fill in a questionnaire, which has provided a list of factors that these populations find essential for the improvement of their life quality: health accessibility, access to clean water and capability of movement were the top ones.

Many training sessions and workshops on human rights have been held, in which both members of the nomad population and local authorities have actively participated. A first draft of the Statute of this nomad association has been produced.

Finally, in order to show the practical results of the implementation of these rights, different activities have been carried on: the construction of new wells to underline the importance of the right of access to clean water; the rehabilitation of new routes in order to increase the mobility; a campaign on vaccination against measles for the right of health access.

2.2.5. Implementation of basic obstetric services in the area of Bale, Oromia Region, Ethiopia (January 2005 - January 2008)

The main objective of the project, financed by the European Community, budget line 21.020703 (ex B7-6312), is to reduce the mortality of women and newborns with well-organized basic obstetric services in the Bale area. The basic strategy is to give technical, managerial and financial support to the local authorities in order to extend the area covered by the service and to improve the quality of obstetric services offered to the population in the area. The project is integrated with the Health Sector Development Program (HSDP) in the development of the Region. The project is in close collaboration with the Zone Health Department (ZHD). The analysis of the needs, the planning and the realization are conducted by the staff of ZHD and CCM, according to the guideline of WHO.

An Italian gynecologist has been working with the local colleagues of Goba hospital, both in surgical operations and assisting troubled pregnancies. Furthermore, the doctor has trained and kept updated the local medical staff. Finally, the project also includes the rehabilitation of some medical structures and the maintenance of the medical equipment.

An Italian doctor is responsible of coordinating the whole project, of organizing the peripheral hospitals (13/18), of training midwifes and of the supply of medical tools. Furthermore, an anthropologist is studying the traditions linked to the child birth in Oromo populations and is trying to find the best way to introduce the western medicine practices to the women (such as regular control visits, spread of sanitary practice information on the management of the newborn in his/her first months).

Projects waiting to be implemented

Improvement of Programs for Community Rehabilitation in Addis Abeba, Ethiopia

The aim of the project is the improvement of Rehabilitation Programs (CBRP) in Addis Ababa, in Ethiopia. The main objective is the improvement of the life quality of people with handicaps or disabilities, in order to allow them to take active participation in the social, economic and political lives of their communities. The specific objective is to extend the area covered by the services provided and to improve their quality. The strategy includes the improvement of the technical, managerial and organizational abilities of the different organizations working in the area. The project has been presented to the DGCS of the MAE. It is expected to last for three years

2.3. GUATEMALA

In 2005 CCM has continued its activities of cooperation in order to develop the rural area of Palajunoi Valley, in Quetzaltenango periphery in Guatemala.

Due to the fact that CCM does not have other projects in Guatemala, all its activities in this country have been part of the consortium of 4 NGOs of Turin (CISV; MAIS; RETE; e CCM), that have been working together in order to originate a cooperative relationship with a consortium of local NGOs, responsible of an extensive 3-year project, financed by MAE.

From the operational point of view, in 2005 the CCM has tried to continue the activities started in the previous years, through the implementation of a six-month project, financed by the city of Turin and planned by the local NGOs, later revised by the NGO consortium in Turin and by the CCM for the medical aspects of the project. This project, in line with the projects financed by City of Turin in the pervious years, has been focusing on the training and supervision of sanitary activities conducted by twenty Community Health Workers (CHW), previously selected and trained on specific areas, such as: counseling; correct management of the drugs, in order to increase the quantity and improve the quality of the pharmaceutical products stored in the community pharmacies; the values and the risks of the traditional medicine, in order to give the population the tools necessary to evaluate which traditional practice can be useful in the prevention and treatment of various diseases and which can be dangerous. The activities have been developed during March and November of 2005.

As in the previous years the Piedmont Region has continued in its participation in the cooperation of Quetzaltenango, by financing a project for the realization of 4 local missions of 30-40 days each, conducted by representatives from the four NGOs in Turin. The main objective of these missions was to expand and facilitate the cooperation of the local NGOs in the planning part of the project MAE.

As part of the activities organized by the City of Turin for the Olympic Games, in September 2005 mayor of Turin organized a meeting with a delegation of the City of Quetzaltenango, formed by the vice-mayor and three counselors; the CCM, with the other NGOs of Turin, was present during the welcoming ceremonies and the discussions with the representative people of Quetzaltenango, Turin’s twin city.

Last year, Guatemala was hardly hit by Hurricane Stan, which has caused enormous material damage and has caused many deaths. The Department of Quetzaltenango and particularly the Palajunoj Valley have been less hardly hit than the rest of the country, although there will certainly be consequences, both in the sanitary and economic sectors. After a detailed and quick analysis of the situation by a professor of the University Juan Carlos of Quetzaltenango and his students made a very dept analysis about the consequences for a sanitary and production situation, and in line with the big necessity of help asked a request of financial help that has been approved by the Piemonte Region, damages due to the disaster produced by the STAN Storm.

2.3.1. Consortium Project for rural development in Palajunoj valley and supporting action for the decentralized cooperation with the city of Quetzaltenango (7692/CISV/GUA) co-financed by MAE-ONG CSV responsible

Since September 2005, the consortium project has started and has been promoted by the Piedmontese NGOs CISV, CCM, Mais and Rete. In this cooperation project, lasting three years, CCM is mainly responsible of the health aspects and, through its activities, it tries to rehabilitate the primary care facilities and to raise the quality of the services provided. Furthermore, CCM intends restoring and reactivating second level facilities, in which patients with more complex pathologies can be treated. Not less important is the implementation of a protocol for the smooth functioning of the three levels of health care, their specific roles and the passage of patients from one level to the other.

In the triennial MAE project, CCM has selected and trained cooperating personnel, for a mission in loco of six months, from February 2006.

2.4. KENYA

2.4.1. Project CCM/2611/KEN, co-financed by MAE

In this last year, concluded on the 31st March 2005, the main objective of the project was to provide the poorest people of Nairobi access to health services. This was accomplished by offering:

1)      Diagnostic/Therapeutic services in the peripheral ambulatories;

2)      Health education and prevention from the HIV/AIDS infection;

3)      Handicap prevention, physiotherapy and rehabilitation for handicapped people;

4)      Support to the hospital for assistance in general surgery, traumatology, orthopedics, corrective surgery;

5)      Training for local people.

1)            Basic and specific health services in the Shantytowns .

The peripheral ambulatories of general surgery, pediatrics, gynecology, surgery and orthopedics have kept on being the only centers of reference for the poorest inhabitants of the Shantytowns of Nairobi. Due to the on going decline of the social system in Nairobi and more specifically in the Shantytowns, many difficulties concerning the security of both the local and the foreign staff arose. The various health activities have been conducted in the different ambulatories, as discussed below.

A) KARIOBANGI DISPENSARY.

Each Monday, a doctor of CCM has been regularly present in the ambulatory of General Medicine. He is responsible of the dispensary, property of Comboniane Sisters, who have always worked in close collaboration with the CCM and, in this past year, have expanded the laboratory in order to guarantee the basic examinations and the test for HIV.

The doctor is also responsible for training the laboratory staff. Furthermore, in the dispensary, minor surgical interventions have been conducted.

Once a month the ambulatory has made screening for handicapped children and follow-ups for hyper-tension cases.

B)     ST. THERESA DISPENSARY, EASTLEIGH – MATHARE VALLEY

St. Theresa dispensary is the main peripheral center for the poorest patients of Eastleigh, with a significant Somali immigration, and for the Shantytowns of Mathare Valley, the most populous (circa 250.000) among those in the north/east part of Nairobi.

Each Wednesday, the ambulatory of General Surgery, Orthopedics and Traumatology has been opened by the CCM Medical Doctor.

The medical intern has provided weekly medical counseling.

The patients with complex surgical or trauma cases have been sent to the Mbaghati hospital. The ambulatory has taken care of the follow up sessions. The gynecological and ecografic services have functioned for the whole year and have been the only one in the entire region, affordable for the poorest.

The diagnostic activities (including radiological examinations, blood tests for HIV, hepatitis, hemochrome, thyroidal tests, parasites’ examinations, etc…) were offered from Monday through Friday.

C)    KAYOLE DISPENSARY- MEDICAL AMBULATORY

The ambulatory, in which the CCM doctor was present every Thursday, is the basic medical center, through which the poorest people were able to have access to health facilities and, when necessary, to more specialized medical centers. The cases of surgery, gynecology and traumatology were transferred to the dispensary of St.Theresa or to Mbagathi Hospital. A nurse, offered by the mission, has assisted the doctor and has helped as “cultural filter” when necessary. The most frequent pathologies have been HIV/AIDS transmission, respiratory and gastro-intestinal diseases.

D) MEDICAL AMBULATORY- KIVULI DISPENSARY

The CCM doctor has opened every Saturday the ambulatory for general medicine and pediatry.

Many orphans from Dagoretti, Karangware and Riruta, satellite quarters of Nairobi, often come to the ambulatory.

The doctor has been assisted by the nurse, hired by the medical center, who is in charge of the management of the dispensary and of the selection and reference of the most serious cases.

E)   PEDIATRIC AMBULATORIES

- KARIOBANGI

Last year the ambulatory has worked regularly every week, also due to a large demand from smaller centers, which take their patients to Kariobangi. The children, recipient of this service, are mainly AIDS orphans, who have been contacted by the nurses and the social workers operating on the territory of the Shantytowns of Korococho and Huruma. The vaccination campaign has continued regularly, having a fundamental role in prevention of infectious diseases.

- KOROCOCHO - HURUMA

Last year, the ambulatory for orphans living in the streets have been offered on Tuesday, Thursday and Friday in the Shantytowns of Korococho, in St. John’s School in Huruma, in St. Martin’s School in Kariobangi and in the school in Watoto Wetu. The forth social center in Boma Rescue has been used for health education.

The nurse hired by CCM has organized different activities of health education, with classes on hygiene and prevention. Furthermore, she was responsible for the distribution of essential drugs to the population.

F) OSTETRIC AND GINECOLOGY AMBULATORY.

Every two weeks the gynecologist of CCM came in the dispensary of St. Teresa to guarantee a service for the women living in the Shantytowns. Furthermore, the doctor has organized counseling service for the women that get tested for HIV. Many women have gone to the dispensary for infertility issues.

G) AIDS PATIENTS CLINIC

CCM has kept on working in close collaboration with the Medical Mission Sisters, who are taking care of more than 1000 patients with AIDS. The patients receive medical service directly at home. Last year, some antiretroviral drugs have been available in a governmental ambulatory in the Mbagathi Hospital, to which the most serious patients have been sent.

2) Program of sanitary and prevention education of AIDS in Korococho, Kariobangi, Huruma, Ngei.

This program is going on “EDUCATION FOR LIFE” in the very poor areas of Kariobangi, Huruma e Ngei, were has been managed meetings with young people in the schools with parents and teachers. Even this year CCM organized a public meeting for the Aids Day with very big participation of people.

3) Community Based Rehabilitation Programme (CBRP) a Korococho e Kariobangi.

Many families, in continuous increasing number, have been involved in this program. The physiotherapy and therapy sessions for occupations are attended by a continuous number of people; the mothers of handicap children are helped with financial support to continue small working activities giving the possibility to create income. The patients, who must be assisted with surgery, are taken care by the CCM doctor who developed two missions during the month of May and November and December.

The most serious cases has been sent to the physiotherapy department of  Marathi Hospital, powered by CCM project for structures, tools and training.

4) Clinic- surgery hospital activity

The collaboration with the Hospital of Mbagathi has been reinforced overcoming the problems linked to the opening of a new surgery department,

The surgery area is fully operational starting from may 2004, covering the needs of patients of “slums”.

The surgeon of CCM and the staff of clinical officer of anesthesia, two clinical officers in training were in charge to make the training on the job. In the last two months two new expert nurses has been employed for surgery room and anesthesia.

The orthopedic missions has been in line with the project forecast, many boys have been visited coming from the poorest areas. Very important was the work made by the Hospital off Mbagathi in the new place for internal and external patients

5) Continuing Medical Education

Many seminars and training on the job in line with the CCM program have been developed for sanitary staff of  Mbagathi  Hospital, for clinical officers in training in Mbagathi Hospital.

In particular the nurse  Dorotea Mworia, coordinator of educational and prevention AIDS  group, ended the second year of course of public sanitary and achieved the degree.

2.4.2. Service for primary medicine and support to Sololo Hospital

The North Kenya  is the historical presence of CCM projects since the ’80 years; the operative place has been the missionary Hospital of Sololo village, Moyale district, with a population of 60.000 people, Borana majority. During these years the CCM has been engaged in the area with project financed by MAE but also with private support. The most important activity has been the support to the Sololo Hospital with doctors, hospital attendants, Italian technician with two years contract and voluntary presence of fiends. Due to drought problems the ONG worked in the improving hydric resources with a particular care of territory medicine. The activities developed in 2005, auto financed and with the contribution of private people is concentrated in two main tasks in North Kenya.

The first group of activities concerns:

·         The continuation of mobile service for primary cares in area were is not available sanitary structures. The objective is the free distribution of drugs to create an incentive to the population to use of sanitary services; number of patients every month is between 3000 and 6000.

·         The improvement of quality services with training of sanitary attendants.

·         The improvement of education of people in particular on AIDS, with movies and with a specific lesson and following discussion; positive answer to the initiative with 200-250 people.

·         The project forecasts even a financial help for support the education in the schools and to the poorest family.

In the current year have been defined the basis to build same “family.houses” for the orphans due to the AIDS; a voluntary CCM mission is in charge to start the works.

In the second group the task was the support to the Hospital structure of Sololo with maintenance of the electrical system and the system for treatment of water drain, opening of a new well and a system to collect raining water, new structure for Out-patients department.

2.4.3. Scholarship in Medicine

The student of Medicine University is going on in Nairobi financed by CEI.

2.5. MALI

2.5.1 Project “ Mali Wells”

The task of the project is to contribute to the solution of drinkable water in the villages in the area of Mali, in collaboration with the local ONG Ji-Duma Eau et Vie.

During 2005, 9 new wells are working; about 5500 people can now have drinkable water near home in the village of NYAMINA.

Other 5 wells are in working process with the financial helps of November.

During January of the current year will be available the last tranche of financial contribution that will be used to end the 2004-2006 program for the construction of other 5 new wells.

For other 6500 people the clean water will not be any more a problem.

In June 2005 started to work  a mill in the village of Kolimana in the comun of Nyamina.

The realizations made during 2005 have been visited by a auto financed mission of CCM voluntaries with some partners. All the wells are well built with a good availability of water, the mill is in a good state of maintenance and the women are very satisfied.

The realization in 2005 has been done thank to the private helps  because no public support were available.

The collection of financial resources for the project”19 wills in Nyamina” is now ended.

Is not still solved the problem of water availability in the Sahel village not far from Nyamina were voluntary people of CCM during a visit in the area of Koula and Doumba defined the necessity of at list 19 wells. We hop realize I the next 3 years.

2.6. MOROCCO

2.6.1.In this Country CCM has been helped with a financial support of Piemonte Region for the annual project: development of multy function center for the social and working insertion of young boys coming from the peripheral area of OUJDA

The project ended in April 2005.

He  Oujda City is characterizes by an growing urbanization  due to the illegal economy from the near frontier, and the immigration is concentrated in the poor quarters not legal.

Project objectives:

1.      Support the autonomous work with a professional qualification to push the young boys to artisan jobs.

2.      Help the young people( 14-18 years old) to be integrated in the new social and economical reality

3.      Improve the existing service structure and reinforce the local association.

4.   Support the people witch want emigrate in Italian territory with information desk organized by “Vedo Giovane” in the provinces of Verbania , Biella, Novara, Vercelli.

Qualification courses have been organized involving about 250 people and 80 people have been trained to write and read..

Many opportunities of meetings have been created between different quarters at the boundary as Marathon race for primary schools, a show market for typical products coming from the laboratories

A lawyer lady gave his legal assistance to many families for the emigration procedures in Qujda poor area

2.7. SOMALILAND

2.7.1. Improvement program for the control of tuberculosis

In the Program of Global Fund against Tuberculosis, AIDS and Malaria, since jaunary2005 the CCM is responsible of monitoring and evaluation of implementation program to TB control; the team, doctor and laboratory technician, make periodically visits the center were the disease are treated.

The task is:

data collection in the different centers

quality evaluation of given services

quality control of laboratory data

Staff training in the Tb centers

During the period of visits the supervisors stay in each center for 8 days working with the local people to better evacuate the service level an making if necessary training directly in the field  In a quarter base the reports prepared by CCM are analyzed by members of Global Fund Tuberculosis and by the local authorities to define action plans to improve the activities

2.7.2.Implementation of a strategic plan to prevent and control the HIV/AIDS and sexual diseases in the population of Somailand

Always in the Global Fund CCM  is also responsible for monitoring and evaluate the HIVAIDS implementation program: these control activities, due to internal war in the country, were near inexistent since 2005.

CCM  selected a team to implement this program developing tools and strategy to be used by the operative partners: the supervision visits will start in February 2006

2.8 SUDAN

During 2005 CCM kept on with his work in South Sudan among the usual logistic difficulties and the great hopes born after the peace agreement signed on January 9th, 2005. The peace process is however  threatened by several clouds represented by the problems not  dealt with in the mentioned agreement (laity of the State, interethnic stress, marginalised areas). The death in an air crash, still obscure, of John Garang, historical leader of the nationalist  movement, has provoked demonstrations and a stressful situation in Khartoum and Juba. These events have been followed by the prompt assignment of John Garang’s inheritance to  Salva Kiir Mayardit, as Vice President of Sudan and President of Southern Sudan.

The international community has offered an important contribution for the development of the country as acknowledgement of the brilliant result achieved after one of the bloodiest African conflicts.

The International Agencies are supporting the reconstruction of the New Sudan through projects aimed to foster the civil society. The critical situation of Southern Sudan makes however difficult the equal and incisive distribution of humanitarian help.

2.8.1 Project 6587/CCM/SDN “Upgrading of Rumbek Hospital to Referral Hospital of South Sudan”, cofunded by MFA

The target of the project is the empowerment of medical  services and the fostering of professional capacities of Sudanese staff

The engagement of the health activities and the improvement of the hospital infrastructure, supported also by other Donors,  has borne  an important amelioration of the hospital level-

2.8.2 Rehabilitation activity of Rumbek State Hospital

The  hospital of Rumbek, which is supported by CCM since the disengagement of Government Army in 1999,  is  considered one of the few possible headquarters for an action of humanitarian help. Many Agencies have contributed with different kinds of action to support the hospital medical activities.

The action UTL NB Emergency aid n. 7916.01.06 has been funded by the Local Technical Unit of the Italian Embassy in Nairobi (1/1/05-15/11/05). The project concerned the rehabilitation of the  out-patient Dept., emergency dept., pharmacy,  mortuary, medicine dept.,  maternity,  houses for the hospital staff.

The United Nations High Commission for the Refugees promoted the action UNHCR 05/SB/SUD/RP/331, started on February 2005. The aim of the first phase was the rehabilitation and the extension of pediatric dept., for which UNHCR contribution was integrated by a supporting group of private donors. The second phase will provide the electrification of the whole hospital compound, through the purchase of two generators.

Training Centre at Rumbek Regional Hospital WHO APW 05-729

The project, started on June 2005, concerns the rehabilitation of a building, inside the hospital compound, in order to provide a center for the training of local staff,  especially the obstetrical personnel.

Establishment of a Midwifery Training Center in Rumbek, South Sudan

The action, started on October 2005 and financed by DFID through WHO, aims to implement a Midwifery Training School.

Once the building and the furnishings are over, CCM will care for the selection of trainers and tutors and later on of thirty students who will attend the first training course for midwives.

2.8.3. Project 2169 “Surgery in Remote Areas of South Sudan” co-financed by the Italian Ministry of Foreign Affairs

The project aims to provide adequate surgical services  to the population of remote areas in South Sudan.

The action is carried on in five remote locations, two of which, Adior and Billing, are supported as permanent  facilities   whereas the other three Gordhim, Pochalla and Turalei, are supported by periodic surgical missions carried out by a mobile team of Italian volunteer consultants: surgeons/anesthetists/theatre nurses.

In the permanent stations two adequately trained  Sudanese M.D. are resident doctors,  this entailed  a better efficiency of hospital services and of the implementation of the surgical missions.

As per the past years, this project provides:

-          mobile and permanent services in the selected areas through the regular presence of a surgical team in order to allow the population to benefit of essential surgical services

-          continuous support to the two  locations of Billing and Adior;

-          training of  local staff. One of the main objectives of the action is the “training on the job” of local staff on “primary surgery”, carried on during every surgical mission.

2.8.4. Primary Health Care Program in Tonj County - AG 3912

Overall goal of the project, cofinanced by DFID,  is to improve the health status of the population living in Akop, Ananatak and Luacjang payams of Tonj County through an improvement of the overall quality and accessibility of primary health care services. Activities include the delivery of standard curative services and antenatal care through trained TBAs and the conduction of Guinea Worm Eradication and IMCI programs as well as vaccine campaigns and health and HIV/AIDS education sessions to sensitize the general population and high risk groups. The project  also maintains an outbreak and nutritional surveillance system operational and improve the technical capacity of health care workers through formal and on the job training. The overall implementation scheme shifts the focus of health care delivery from the relief action implemented by MSF CH in the area since 1998 to a development approach tailored on the environment expected in South Sudan after the recent peace settlement signed by the Government of Sudan and the SPLA.

2.8.5. Prevention and Control of Tuberculosis in the Southern Sector of Sudan (SUD-202-402-T-00/CCM)

TB control is at its early stage of development in the Southern Sector of Sudan, covering only 25% of the total population. The full adoption of the DOTS strategy took place only in early 2002. In light of the extremely serious burden of TB, the program needs to scale up DOTS activities as quick as possible.

The overall goal of the program, financed by Global Fund  HIV,TB Malaria programme,  is to reduce mortality and morbidity due to TB and prevent the development of anti-TB drug resistance. The objective is to expand DOTS activities to cover 4 million people (50% of total) and to detect 4,000 TB cases (33% of the total incidence) annually by 2005, and maintain the activities. In addition to the 12 present TB units, 12 new TB units will be established during the first two years of implementation. As for the 4th and 5th years, it is not possible to make a detailed DOTS expansion plan because of the unpredictability of the situation. The eventual expansion of the program for these years it will be decided at a later stage. The global target on treatment will be met, while the global target on case detection will be met only in the areas covered by the program Expanding DOTS activities to achieve an overall 33% case detection rate is a practical and realistic objective considering of the complex emergency situation existing in   the Southern Sector of Sudan. During the five years of implementation (2003-2007), a total of 16,750 TB cases will be detected and treated.

In order to achieve the above objectives, the partners will be assisted in expanding DOTS services through: staff recruitment, installation of new facilities, training, monitoring and supervision, partnership development and covering very specific costs for TB control in the Southern Sector of Sudan such as transport. Strengthening local capacity through recruiting of local staff, training and supervision is a priority so that the local authorities, in collaboration with the partners, will be able to sustain the activities even under complex emergency situations. All partners will work closely through the TB Coordinating Team.

The project started on 31 January 2005, CCM locations involved in the programme have been Adior (Yirol East County), Billing (Rumbek East County), Pochalla (Pochalla County), Luanyaker (Gogrial County), Bunagok (Awerial County).

2.8.6. Implementation of Primary Health Care Centre in Bunagok, Sud Sudan (N. 2004.1777)

The project is cofunded by Compagnia San Paolo di Torino and is based at Bunagok village in  Awerial County.

Its aim is to provide with basic services of preventive and curative medicine  a vast catchments area, An health Centre has been built and opened. Bunagok is one of the locations of Global Fund TB programme.

2.8.7. Integrated Management of Childhood Illnesses Program (IMCI) in Adior and Bunagok (WHO LOA2/CCM-2005)

The project, based in Adior and Bunagok, is funded by WHO. The action is based on a modified package of the Integrated Management of Child Illnesses. Morbidity pattern from the area shows that malaria is the leading cause of both morbidity and mortality in the community while respiratory infections and diarrheoal diseases are the other two major killers in children. The area is also highly endemic for Guinea Worm . The major outputs expected from the project implementation were to achieve 80% management of  new Guinea Worms cases and to reach an extension of the modified IMCI programme services to at least 40% of the target group.

2.8.8. Health staff training programme cofunded the Italian Bishop Conference.

Training of local staff is a priority in the strategy of any cooperation programme in Developing Countries, particularly in the health interventions. This 3-year programme aims at offering to the Sudanese staff employed in  CCM activities the opportunity of basic education and training in Nursing and Medical Schools.

2.9 UGANDA

2.9.1. Support and expansion of the rehabilitation services in the Northern part of Uganda

The three year project is co-financed by MAE and is realized with AVSI (Volunteer Association for the International Service) and the CUAMM (University College for prospective medical missionaries).

The part of the project of which CCM is responsible is the logic continuation of the previous three year project managed by CCM in the St. Mary’s Lacor Hospital in Gulu.

The activities accomplished are the following:

-          supply of materials and medical equipment for the surgical-orthopedic activities;

-          supply of tricycles, wheelchairs and orthopedics equipments;

-          activities of sensitization in order to promote different activities involving the whole population in order to facilitate the social acceptance of handicapped people;

-          surgical interventions;

-          physiotherapy

Hundreds of Free Cards have been distributed in order to allow the handicapped people free treatments and services in the St. Mary’s Lacor Hospital.

Working with the AVSI, many different courses on the topic of disabilities for Ugandan medical and paramedical personnel have been organized.

On the hospital level, around half of the patients in the surgical departments are orthopedics patients with injuries due to weapons or car accidents.

The total number of surgical interventions in 2005 has been 242. The minor orthopedic interventions have been conducted by local personnel under the supervision of CCM surgeons.

Finally, the orthopedic ambulatory is open twice a week.