[afro-nets] Palliative Care News from Zambia and South Africa

General afro-nets
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Palliative Care News from Zambia and South Africa
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Reports from PCI e-News,

an occasional communication from Palliative Care International,
a panel of consultants available to help organizations with a
variety of clinical and management concerns.

Submitted by Peter Sarver, Lead Consultant, Syracuse, NY, USA

Zambia is visited by Southern Illinois Hospice Workers: Allida
Plumer recently shared news on her hospice team's visit. "I re-
cently returned from two emotional and heartwarming weeks with
our partners at Kara Counseling's Ranchhod Hospice and Chil-
dren's Center in Kabwe, Zambia. My suitcases were loaded with
adult and children's medicines that were donated by staff and
volunteers of Hospice of Southern Illinois and several individu-
als... Another suitcase was brought by Pat York... filled with
vitamins, pain medicines, toothbrushes, and toys for the chil-
dren and a lot of other items that were donated by members of
the Carbondale Unitarian Fellowship and other individuals...

The news from Zambia is good and bad. The bad news is that the
HIV/AIDS pandemic rages on. The hardest hit are the women. The
number of orphans is increasing. Poverty and hunger have been
worsened by a drought. There is also some very good news. There
is progress at Ranchhod Hospice and its programs, thanks in part
to donations, fund-raising efforts, and several other non-
government agencies and grants. The hospice has built an addi-
tion that has increased its bed capacity from 12 to 20. All of
the beds were full when I got there. Four patients went home but
their beds were filled immediately. ARV's (antiretroviral) are
now available free of charge for anyone unable to pay. This has
been made possible through money from PEPFAR (President's Emer-
gency Plan for AIDS Relief). Kara Counseling provides free HIV
testing and counseling and new clinics are being formed to pro-
vide the ARV's. The downside to this is that before a person can
start on ARV's they must have a chest x-ray and some blood work.
These are not free and many people are unable to pay. Ranchhod
Hospice is paying for their patient's to have the testing.

The Children's Center has increased services to orphaned vulner-
able children, ages 2 to 6, from 25 children last year to 55
this year. Fifteen of these children are being transported to
the daycare daily from Makululu,... the largest and most de-
prived area of Kabwe with a population of almost 20,000 people.
Most of this area consists of huts made from handmade bricks and
thatched roofs. The hospice is currently trying to obtain land
within Makululu to open a new daycare center in order to serve
more children in that area. The center will hopefully be within
walking distance for many of the children.

There has also been progress at the street kids program, Sable.
Last year Kara Counseling had acquired an old sport's bar in
Kabwe. It was very run down and in need of much repair. Since
then the building has been cleaned and repainted. A new well has
been drilled so that they now have clean water. This program al-
lows boys, many of whom live on the streets, to drop into the
center during the day. They are provided a meal at lunch, skills
training, education about HIV/AIDS prevention and treatment, and
a chance to be a kid. ... They are looking for funding to finish
renovations on the building, expand programming, and to eventu-
ally provide a live-in training program for these boys.

These are just a few of the programs that Kara Counseling &
Trust provides to improve the quality of life of people that are
affected, both directly and indirectly, by this terrible dis-
ease. Our continued support is necessary for the people of Zam-
bia to not only sustain these programs but to continue to have
them grow to meet the needs of the people."

Community Hospice Reports on QI Project in South Africa

Executive Phil DiSorbo recently shared the results of his pro-
gram's latest team visit to South Coast Hospice and Tapologo
Hospice. Community Hospice (which serves Northeast New York
State) has been partnered with the South African programs for a
number of years. During July a 5-person work group was able to
observe the two sister hospices in action. South Coast Hospice
in Port Shepstone (KwaZuluNatal) has been adding to their home
based care teams and overseeing the implementation of a Global
Fund grant for 12 hospice programs in the province. The Ameri-
cans participated in a day long conference on quality improve-
ment for the region's programs. Tapologo Hospice in Rustenburg
(North-West) continues to pursue a comprehensive HIV/AIDS care
program. The opening of an inpatient unit was celebrated along
with antiretroviral therapy program now serving some 300 cli-
ents. The program is supporting some 140 households with orphans
and vulnerable children (OVC). Social work as well as chaplaincy
are key elements of their staff team. Among the gifts brought to
the two sites were grants of $7,500 each from the payroll deduc-
tion program by CH staff. Another CH delegation is planning to
visit in October. An assessment of ongoing needs and the part-
ner's efforts to help with them is integral to the repeat en-
counters.

--
Peter Sarver
mailto:psarver234@yahoo.com

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The World Bank Becomes Interested in Malaria Control
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DR CONGO RECEIVES US$ 150 MILLION GRANT TO REHABILITATE ITS
HEALTH SECTOR FOR A PROJECT WHICH MARKS A MAJOR STEP IN BANK
SUPPORT TO MALARIA CONTROL IN AFRICA

Washington DC, September 1, 2005 - The World Bank Board of Ex-
ecutive Directors today approved an International Development
Association (IDA) grant of US$ 150 million to assist the efforts
of the Government of the Democratic Republic of Congo (DRC) to
rehabilitate the country's health sector and control malaria.

The main objective of the Health Sector Rehabilitation Support
Project is to rebuild the country's health system and to sig-
nificantly improve the availability and utilization of quality
basic health services for the population of targeted geographi-
cal areas, particularly among women and children.

The focus is to strengthen the existing public health system at
all levels, with special attention paid to district level and
the health zone. The current system has been severely undermined
by the country's recent civil war, and the lack of resources,
drug supply, adequate equipment and skilled medical personnel.
In 2003, there was only one physician for every 100,000 Congo-
lese.

The Health Sector Rehabilitation Support Project also marks the
first step for the Bank's Malaria Control Booster Program in Af-
rica, and comes in advance of a major summit on malaria hosted
by the Bank in Paris next week. The Project includes financing
(US$30 million) to rapidly increase coverage of long lasting in-
secticide-treated bed nets (aiming for two to three nets per
household) and the provision of effective and prompt anti-
malarial treatment. Increased use of the long-lasting bed nets
could slash child deaths by as much as one-fifth. It is esti-
mated that 97 percent of DRC's 58.3 million people are at risk
of endemic malaria, while the remaining 3 percent are vulnerable
to epidemic malaria.

Malaria is the number one killer of children in DRC, accounting
for 40% of child deaths.

The project's priorities are to improve geographical access, re-
duce financial barriers (user fees) to utilization, improve the
quality and effectiveness of care, and strengthen the capacity
of the frontline service delivery system.

Increasing coverage of basic health services throughout the
country is a priority for the government of the DRC, and
strengthening the health zone system is the main strategy. Each
health zone, integrating primary health care and district hospi-
tal services, serves an average of 100,000 people. The project
targets assistance to 83 health zones in underserved and poor
areas, directly benefiting a total of almost 10 million people.

DRC's social indicators, which were already low before the civil
war in which an estimated 3.8 million ?excess? deaths have been
associated since 1998, have dropped further in recent years. The
country now has the highest number of child deaths of any coun-
try in the world (565,000 per year) and the ninth highest under-
five mortality rate (220 per 1,000 live births). At least one in
five DRC children dies before the age of five years and one in
ten infants die before their first birthday. Malaria, diarrhea,
respiratory infections, malnutrition, and measles are the main
causes of child mortality. Malaria has been shown to be associ-
ated with 40 percent of child deaths in the country.

The project builds on the experience of the health component of
the Emergency Multi-sector Rehabilitation and Reconstruction
Project which became effective in 2002. Basic health care ser-
vices are supported through performance-based partnership agree-
ments between the public and private sector, mostly but not ex-
clusively NGOs. Flexibility in the design and implementation of
programs that are adapted to local circumstances is emphasized.

Another component of the project is aimed at building capacity
for oversight and management of the health system, in particular
monitoring and evaluation of the performance and results of pro-
ject implementation.

The Democratic Republic of Congo, with its 58.3 million people
in 2004, is the third most populated country in Sub-Saharan Af-
rica, after Nigeria and Ethiopia.

For more information on the World Bank's work in Africa visit:
http://www.worldbank.org/afr/

For more information on the World Bank's work in the Democratic
Republic of Congo visit: http://www.worldbank.org/afr/cd

--
Patrick Mbindyo
mailto:pmbindyo@magricon.com

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The World Bank Becomes Interested in Malaria Control (2)
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Once again, the miracle of the bednet. Can anyone show a loca-
tion that has had any long term impact on malaria by the use of
bednets?

--
Bill Nesler
mailto:sdbc@hur.midco.net

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The World Bank Becomes Interested in Malaria Control (6)
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Although the idea of insecticide treated bednets is a great
idea, people who really need them are not likely to spend the
money on them. In some countries it costs as much as 5000 CFA
(~US$ 10) which may represent the 1/8th of a monthly salary.
Also, those bednets have to be retreated which means more out of
pocket expenses.

If ITN are to be successful, there needs to be more community
education and hopefully they can be subsidized by the govern-
ments made available free of charge.

--
Sonia Fankem, MS
Doctoral Student, Epidemiology & Biostatistics
University of Arizona College of Public Health
mailto:slfankem@yahoo.com

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The World Bank Becomes Interested in Malaria Control (18)
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Too bad that all that money will go for nothing. A few will
waste it, a few will embezzle it, and everyone will still die of
malaria. I guess the locals will at least have a fishing net
made out of a mosquito net.

Craig Audiss
mailto:cybrcollectinc@yahoo.com