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From the Field
Welcome to Sudan
Luca Livio, M.D.
Teleconference presentation from Khartoum to EMERGENCY national conference Orvieto, Italy - Saturday 16 September 2006
Welcome to Sudan. Let me introduce myself. I am Dr. Luca Livio, pediatrician and head of the pediatrics clinic that EMERGENCY opened in November last year. A few facts will help you understand better the reality of our working conditions.
Teleconference presentation from Khartoum to EMERGENCY national conference Orvieto, Italy - Saturday 16 September 2006
Welcome to Sudan. Let me introduce myself. I am Dr. Luca Livio, pediatrician and head of the pediatrics clinic that EMERGENCY opened in November last year. A few facts will help you understand better the reality of our working conditions.
Sudan covers a territory of some 2,500,000 square kilometers [966,757 square miles], with a population of about 38 million, 2 million of which live in refugee camps in the vicinity of Khartoum. EMERGENCY’s pediatrics clinic is located in the largest of these camps, the Mayo camp, which has 350,000 inhabitants, half of them children. Most of the refugees in the Mayo camp came here from the south, and by now they comprise in effect a permanent population, having lived in the camp for more than twenty years; the children that we see already represent the third generation. In the last few months, besides the refugees from the south, we are beginning to see children from Darfur [come to the clinic]. The mortality rate for children between birth and five years is one of the highest in the world, around ten per cent, and EMERGENCY is the only NGO working in the Mayo refugee camp. I am happy to underline that all our work is possible thanks to your support.
At this time the clinic employs 23 Sudanese personnel: eight security guards, one ambulance driver, one plant manager, three custodial staff, two doctors, two nurses, one laboratory technician, two health promoters and one pharmacist. There are also two national health personnel, an obstetrician and a vaccination nurse, for whose services we pay a subvention to the government.
Our activities are not confined to providing European-standard free health care, but also include
- Education in sanitation and hygiene both within the clinic and outside in the community thanks to our health promoters
- Increasing rapport with the community
- Improving the clinic and hospital referral system
- Building up a program of continuing medical education and nurses’ training that will eventually be self-sustaining
I am happy to report that these objectives are becoming reality. Here is what we are doing.
Health promoters
In April, after the internal functioning of the clinic had reached an acceptable level, we turned our attention to the surrounding community. We took on two community health promoters, who travel around the camp on bicycles; they are qualified to do daily follow-up with children who live at a distance from the pediatrics center, to provide health and sanitation education, and to advertise treatments and services available in the clinic. The health promoters also educate patients in the waiting room of the clinic about everyday sanitary measures. They give instruction on hygiene standards; prevention of the most common health problems, like malnutrition; treatment of diarrhea; and how to recognize symptoms of respiratory illness, malaria and dehydration.
Improving rapport with the community
1. Our presence in the camp is becoming more and more important. The increasing number of visits is a prime indicator. In the beginning, people objected to long waits; now, they patiently wait their turn without getting angry if they are not seen in exactly the order of arrival, they no longer throw away their children’s charts if they do not receive treatment, they no longer ask for medicine that has not been prescribed. They often come back just to thank us.
2. We have also begun to improve relations with the local authorities, the so-called "popular committee.” The most numerous tribes—there are about 24—each have a leader. We have been meeting monthly with the popular committee; we discuss issues with them and attempt to reach the best resolution for problems that arise. In a meeting held last week we discussed a problem that is becoming increasingly important: treatments undertaken by traditional doctors. In the past three weeks three children have died because the traditional doctors did not know how to recognize symptoms of meningitis, bronchitis and dehydration, which resulted in delaying the children’s admission to the health facility.
Referral system
Ever since the clinic first opened we have tried to improve our system for making referrals to hospitals, and in particular to the hospital that is the shortest distance by automobile from the camp. After we all went through a period of getting to know each other, the hospital’s medical personnel began to appreciate what we are doing, and we are beginning to solve some initial problems: improper treatment, refusal to treat malnourished patients, poor patients who had to leave the hospital because they could not afford expensive examinations and treatments. Now the situation is quite different. Thanks to our involvement, sick children brought in to the hospital are in reasonably good general condition, thereby allowing for timely treatment, often without unfortunate side effects or the need for extensive hospitalization. The hospital’s doctors are in agreement with this approach, which has given them more time to attend to serious cases.
Thanks not just to our triage, health education, and preventive measures, but also to our pressure at various levels, Il Bashair Hospital in Khartoum has been included in the group of government hospitals where convalescing children receive free treatment for their entire stay, whereas before they were only guaranteed the first 24-36 hours. All the patients who are referred from our clinic get daily follow-up from our staff, making it possible to discuss with the hospital doctors their on-going treatment or any further examinations in case of complications. A few times we have received requests for medications temporarily unavailable in the hospital pharmacy. The new director of the hospital is a pediatrician, so we hope that in the next few months the level of care may improve still more.
In the clinic, nonstop training of local doctors and nurses continues, with the aim of creating a cadre of qualified health-care professionals who can carry on independently in the future.
Every week we discuss and develop a treatment plan for a specific condition, to build up uniform protocols for treatment as well as a consistent approach and message to give to mothers and patients.
New initiatives
New laboratory equipment: In our on-going effort to improve quality of care, and our endeavor to increase cooperation with the hospital and public health system, we acquired a machine to generate complete blood work-ups; this permits us to refer patients to the hospital with basic laboratory tests already completed: blood count, urinalysis, fecal exam and test for malaria. The machine also permits us to determine hemoglobin levels for pregnant women, enabling us to prescribe iron and folic acid. Again, we are the only providers for these types of assistance who do not charge a fee to the patient; in other government facilities people are asked to pay.
In addition to the prenatal care services that we provide through the national health system, our clinic also offers immunization services that follow the vaccination protocols set up by the Sudanese government.
Finally, as far as the cardiac surgery center in Soba, Khartoum, is concerned, not being a specialist, I can only report the comments of visitors whom I have personally followed on a tour of the hospital.
The cardiac surgery hospital continues to elicit ever more amazement on the part of Sudanese civil servants, government ministers, and technical personnel; they still find it almost impossible to believe that an Italian NGO should be doing all this, and above all that it will be theirs and completely free. Various friends of EMERGENCY who are working throughout the world for other organizations have also expressed high regard for the project. A visit to Soba sends a clear message to everyone: it is always possible to do better, to invest money in a health facility that works, and that works according to European standards. For them it’s a matter of starting over from scratch: we expect that now they will also begin to see things our way. As for ourselves, we have the certainty of those who have been the first to believe in that all this is possible.
Finally, I would like to thank you all on behalf of all the Sudanese people who, because of your constant support, are able to have this quality of health care. Particular thanks go out to you from the international staff who are committed to come and work in Sudan or who have been working on EMERGENCY’s projects in Sudan for some time—like my friend Raul, who will be speaking with you after I finish on behalf of the international staff working here now as well as those who would like to return to us.
Good-bye until next year, and please continue your support for us.
Luca
Health promoters
In April, after the internal functioning of the clinic had reached an acceptable level, we turned our attention to the surrounding community. We took on two community health promoters, who travel around the camp on bicycles; they are qualified to do daily follow-up with children who live at a distance from the pediatrics center, to provide health and sanitation education, and to advertise treatments and services available in the clinic. The health promoters also educate patients in the waiting room of the clinic about everyday sanitary measures. They give instruction on hygiene standards; prevention of the most common health problems, like malnutrition; treatment of diarrhea; and how to recognize symptoms of respiratory illness, malaria and dehydration.
Improving rapport with the community
1. Our presence in the camp is becoming more and more important. The increasing number of visits is a prime indicator. In the beginning, people objected to long waits; now, they patiently wait their turn without getting angry if they are not seen in exactly the order of arrival, they no longer throw away their children’s charts if they do not receive treatment, they no longer ask for medicine that has not been prescribed. They often come back just to thank us.
2. We have also begun to improve relations with the local authorities, the so-called "popular committee.” The most numerous tribes—there are about 24—each have a leader. We have been meeting monthly with the popular committee; we discuss issues with them and attempt to reach the best resolution for problems that arise. In a meeting held last week we discussed a problem that is becoming increasingly important: treatments undertaken by traditional doctors. In the past three weeks three children have died because the traditional doctors did not know how to recognize symptoms of meningitis, bronchitis and dehydration, which resulted in delaying the children’s admission to the health facility.
Referral system
Ever since the clinic first opened we have tried to improve our system for making referrals to hospitals, and in particular to the hospital that is the shortest distance by automobile from the camp. After we all went through a period of getting to know each other, the hospital’s medical personnel began to appreciate what we are doing, and we are beginning to solve some initial problems: improper treatment, refusal to treat malnourished patients, poor patients who had to leave the hospital because they could not afford expensive examinations and treatments. Now the situation is quite different. Thanks to our involvement, sick children brought in to the hospital are in reasonably good general condition, thereby allowing for timely treatment, often without unfortunate side effects or the need for extensive hospitalization. The hospital’s doctors are in agreement with this approach, which has given them more time to attend to serious cases.
Thanks not just to our triage, health education, and preventive measures, but also to our pressure at various levels, Il Bashair Hospital in Khartoum has been included in the group of government hospitals where convalescing children receive free treatment for their entire stay, whereas before they were only guaranteed the first 24-36 hours. All the patients who are referred from our clinic get daily follow-up from our staff, making it possible to discuss with the hospital doctors their on-going treatment or any further examinations in case of complications. A few times we have received requests for medications temporarily unavailable in the hospital pharmacy. The new director of the hospital is a pediatrician, so we hope that in the next few months the level of care may improve still more.
In the clinic, nonstop training of local doctors and nurses continues, with the aim of creating a cadre of qualified health-care professionals who can carry on independently in the future.
Every week we discuss and develop a treatment plan for a specific condition, to build up uniform protocols for treatment as well as a consistent approach and message to give to mothers and patients.
New initiatives
New laboratory equipment: In our on-going effort to improve quality of care, and our endeavor to increase cooperation with the hospital and public health system, we acquired a machine to generate complete blood work-ups; this permits us to refer patients to the hospital with basic laboratory tests already completed: blood count, urinalysis, fecal exam and test for malaria. The machine also permits us to determine hemoglobin levels for pregnant women, enabling us to prescribe iron and folic acid. Again, we are the only providers for these types of assistance who do not charge a fee to the patient; in other government facilities people are asked to pay.
In addition to the prenatal care services that we provide through the national health system, our clinic also offers immunization services that follow the vaccination protocols set up by the Sudanese government.
Finally, as far as the cardiac surgery center in Soba, Khartoum, is concerned, not being a specialist, I can only report the comments of visitors whom I have personally followed on a tour of the hospital.
The cardiac surgery hospital continues to elicit ever more amazement on the part of Sudanese civil servants, government ministers, and technical personnel; they still find it almost impossible to believe that an Italian NGO should be doing all this, and above all that it will be theirs and completely free. Various friends of EMERGENCY who are working throughout the world for other organizations have also expressed high regard for the project. A visit to Soba sends a clear message to everyone: it is always possible to do better, to invest money in a health facility that works, and that works according to European standards. For them it’s a matter of starting over from scratch: we expect that now they will also begin to see things our way. As for ourselves, we have the certainty of those who have been the first to believe in that all this is possible.
Finally, I would like to thank you all on behalf of all the Sudanese people who, because of your constant support, are able to have this quality of health care. Particular thanks go out to you from the international staff who are committed to come and work in Sudan or who have been working on EMERGENCY’s projects in Sudan for some time—like my friend Raul, who will be speaking with you after I finish on behalf of the international staff working here now as well as those who would like to return to us.
Good-bye until next year, and please continue your support for us.
Luca
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