The ICASA conference is the main conference on AIDS in Africa. About 7,000 delegates participated in the conference this year in Abidjan, from 4 to 9 December. It was an occasion to take stock of the strategies for controlling the epidemic which, as is known, is especially rampant in Africa. Over the course of the conference the topics covered were the critical points of the 90-90-90 approach, HIV’s peculiarities amongst teens, and the new opportunities regarding drugs and prevention.
The DREAM program presented two projects, one from Malawi and one from Cameroon: a presentation on the screening of cervical cancer in Malawi, in which more than 3000 women participated over the course of two years; a poster showing DREAM’s results in Cameroon in terms of retention and virological success.
The conference was an occasion to meet and share experience. Many asked about DREAM, including Ivory Coast’s representatives from the Ministry of Health.
On 20 November a delegation of representatives of the cooperation between EU countries visited the multipurpose DREAM Center of the Community of Sant’Egidio in Beira, Mozambique. The representatives, who collaborate in common projects of development aid, decided to visit the DREAM program together as an example of best practice in the partnership between Europe and Africa.
They received a warm welcome and their visit covered every area of the center. This allowed them to esteem the quality of the molecular biology laboratory and its technical equipment and the degree of training of the lab technicians, health workers and the personnel in charge of social support. What caught the attention of the guests was the concern and dedication personnel demonstrated when interacting with the patients, and how priority is given to continuous therapy and assistance, also thanks to thorough research on the patients who miss their appointments to make sure they do not abandon the treatment.
On a warm summer’s day, Ak. is seen leaving his neighbourhood smiling and greeting everyone he knows: “I am going to school! Hooray! I am going to boarding school!”.
Ivy and Maureen went to pick him up early in the morning to take him to a residential school that an Italian family has provide for Ak.
He still cannot believe it. Up until last year he couldn’t go to school, he didn’t have anything to eat, he didn’t have money to pay for transport to the DREAM center…
He is one of the many teenagers currently being treated at DREAM centers. For over a year now Ivy and Maureen had been noticing that his treatment was no longer effective, that he wasn’t taking his medication properly and didn’t attend his check-ups, so they decided to investigate the situation.
Fatherless and abandoned by his mother who suffered from severe mental illnesses, he lived for a period with his aunt up until he was accused of being a child-witchdoctor and of causing his father’s death, and was sent away. He became one of the many street children that roam the urban centers of Malawi. Many attempts to have him live with a few relatives were made with the help of the DREAM operators, but after a few months he would again be sent away, suspected of being the reason behind the family’s ills, scarce rain, diseases or economic problems. He was told: “it would be best if you died and ended up in the cemetery with your father”.
Maureen, one of the coordinators of the DREAM center in Blantyre who never ceased to look for solutions, managed to get help from sister Matilde: she gives him something to eat at the end of the lessons, sometimes accompanying him to his check-ups and helping him with his medication.
Teenagers are amongst the most difficult patients. After an initial success during their childhood, therapy often stops being effective due to scarce adherence.
Almost a thousand teenagers are being treated in the DREAM centers in Malawi. Many are orphans, but even having a careful and supportive family doesn’t make persuading them to regularly attend therapy any easier.
Adolescence is a difficult age under every aspect. You become aware of yourself and you begin planning your future, which isn’t easy when your life has been scarred by AIDS since birth. Many questions pile up in the teens’ minds. How will my life be? Will I be able to marry, have children? Why should I bother studying if I am sick? Will I have to do therapy for the rest of my life? These are complicated matters even for an adult, and can be daunting for a teenager, especially when lacking emotional and social stability.
This is often hard for parents or relatives, who do not know how to talk with their children about their disease. Mothers usually feel guilty of having transmitted the virus to their children and, due to ignorance or a feeling of inadequacy, avoid a serious conversation where they explain why daily therapy is necessary.
It is easier dealing with children, as a simple excuse can suffice such as “…this medication is for the anemia…” or “…to prevent malaria…”. With teens it is harder.
Oftentimes the teens find out about their condition by chance, it could be from a classmate who notices the regular and frequent absences due to the medication and begins teasing them.
In countries where HIV is endemic, adherence to treatment remains an open challenge for all teens. For this reason the DREAM centers in Malawi have begun addressing the seropositive teens’ situation directly to offer them better support.
Following a few lessons with personnel about the various aspects of adolescence, a specific analysis of all patients aged 10 to 17 was carried out. An investigation followed, verifying if each teen had been informed of their situation and if so, how. Subsequent meetings were organized to help and educate the parents or legal guardians on how to talk to their children about the diagnosis.
For example explaining that universal access to treatment was not available during the pregnancy and stressing how the parents have always looked after the children, taking them to the hospital for treatment and helping them grow, contributed to reestablishing trust between adults and teens.
For the most complex cases, showing an increase in viral load after years of good health following the therapy, the decision was to carry out a targeted intervention with the assistance of an activist as a reference point, with frequent visits to the home put in place in support of the whole family.
Next, the “Saturdays for teens” began. Part of the health personnel of the DREAM centers volunteered to dedicate the last Saturday of each month to the inauguration of the center, creating a special day of activities for the teenagers. This has a very positive impact on them as they no longer have to skip school (there are no lessons on a Saturday), and being surrounded by their peers makes them feel at home.
On a Saturday the situation is completely different: hundreds of boys and girls “seize” the centers. From very early in the morning until closing hours kids can be seen playing chess, soccer, talking amongst each other, snacking together and participating in health education meetings organized by the personnel.
Feeling part of a group is very important at this age. It can give strength, courage, enthusiasm and will to live. Sometimes older kids who were once teenagers of DREAM are invited on a Saturday. Their story is an example of success, both socially and therapeutically. Kids such as G and F who have recently married, with G now working as an electrician in an important company of the country.
The more “Saturdays for teens” organized, the more boys and girls started coming back to the center, even when they didn’t have medical checkups. They realized they weren’t alone in the challenge against the virus, while making friends along the way. The group also helped take care of children coming from impoverished social situations such as Ak.
Being together as part of a group and having a family who embraces you leads to new perspectives and opportunities to make new friends, such as T and R. They both had long hoped to take a trip and see all the animals roaming the Malawian Savannah. And just like that…chipping in for a few months to pay for the transport fees to the Chickwawa wildlife reserve in the south of the country…preparing sandwiches for lunch…a little help in obtaining preferential access to the reserve and…on 4th November 2017, 75 kids took a trip to discover their country, which tomorrow will surely be a better place, also thanks to their contribution in building a more humane and inclusive society.
The “Health and Nutrition” training course is organized by the DREAM Program of the Community of Sant’Egidio with the contribution of the Eight per thousand of the Italian Catholic Church. Over the course of 4 days, 23 community health workers of the DREAM centers in Tanzania (coming from Iringa, Arusha, Uwemba and Masanga) took part in the course, as well as 20 community operators from Iringa, Usokami and the district of Pawaga in the region of Iringa, one of the districts most affected by child malnutrition.
Malnutrition today is still one of the main factors contributing to child mortality in Tanzania. Of children under the age of five, 34.4% suffer from chronic malnutrition, a number that rises to 50% in the poorer and more rural areas. Acute malnutrition instead affects 4.5% of the population, about 2,600,000 people. Tanzania has recently made the fight against malnutrition one of the top priorities of its public health agenda.
The local authorities (the Regional Commissioner and the Regional Medical officer) present at the inauguration reminded everyone how, in the region of Iringa, more than 14,000 children suffer from malnutrition, of which 4700 from severe acute malnutrition.
Amongst its causes are the state of poverty in which the rural population resides and a diet based mainly on cereal and tubers, as there is lack of food rich in micro-nutrients and proteins. It is for this reason that, during the course, there was a chance to educate the population on a correct and varied diet, thus improving the local food intake.
With the help of Tanzanian nutritionists and experience in the field such as that of the Pope John XXIII Community, it was possible to provide practical advice and a series of useful recipes for children aged between 6 months to 2 years, a period in which they are most at risk of suffering from malnutrition.
Another topic covered was that of hygiene in the preparation and preservation of food, and the importance of access to clean drinking water, as an insufficient source leads to repeated diseases which may jeopardize the child’s growth.
A Kiswahili edition of the book “How’s your health?” and an attendance certificate was handed out at the end of the course to all the participants.
The second international workshop of the managers of the laboratories of the DREAM program in Africa concluded last week in Maputo. A group of biologists and lab technicians who manage the implementation of quality systems in eight of the largest laboratories of the DREAM program were present at the workshop. The purpose of the event, which was financed by the Italian Episcopal Conference, was yet another occasion to confront each other, share challenges and experiences and find common solutions to improve the efficiency and effectiveness of the laboratories.
Each manager presented evaluations of the activities of the past year for their own laboratory, paying particular attention to the integration with the national networks and the work carried out to increase the number of health centers reached, at the same time maintaining the quality of the services offered and the analytical response times. The managers of the quality systems were able to analyse and compare the progress achieved in terms of the implementation of the ISO15189 – 2012 regulation, gathering from each other’s experience advice, concrete examples and encouragement to continue their work. Everyone greatly benefitted from meeting and listening to each other again.
The workshop marked another milestone in building upon the collaboration and debates which began last year in Blantyre, carrying on over the course of the whole year through remote contact and communication. An important milestone in constituting a network of professionals who are in growing collaboration, who willingly exchange opinions and advice and who strengthen their own identity as a system of excellence, available not only to all the patients of the DREAM centers, but also to the many other public health centers. These centers are more and more a part of the DREAM laboratories, where they are guaranteed increasing quality and expertise.
The role of Laboratory diagnostics in HIV and Co-Morbidities Management in the Era of Global 90-90-90
Over the course of August the first open day of the DREAM center “Elard Alumando” took place in Mandala, Blantyre. Malawi’s Minister of Health Atupele Muluzi was present, as well as many partners and collaborators of the DREAM Program in Malawi.
The day was an occasion to demonstrate to all of the stakeholders of the DREAM Program its main activities and the available resources (both in terms of equipment and human resources) which it can provide for the country and its partners, as well as the results that the Program wishes to achieve in the near future.
For years now DREAM has operated in Malawi, especially in the fight against HIV/AIDS, and has recently broadened its scope to other diseases such as cardiovascular diseases, cervical cancer, diagnose and treatment of tuberculosis, hepatitises and other non-communicable diseases.
With the August event the wish was to show how the Program can contribute to the effort that the whole country is undergoing to improve the health of its citizens. At the same time, the event was an occasion to inform the participants and create a public debate on a few particular topics such as the role of the laboratories in the 90-90-90 strategy, the topic of resistances to HIV and the role of the laboratories in the treatment of hepatitis.
Over the course of its 12-year activity in Malawi, DREAM has contributed in various ways to the fight against AIDS, but one of its fundamental contributions was the development of a network of molecular biology laboratories. Therefore central to the event was the topic of diagnostics and their role in facing the existing challenges. For this reason, all of the guests showed great interest during the visit to the laboratory, led by its manager Dr. Richard Luhanga.
In one of his first official visits to the healthcare facilities of the country, the newly-appointed Minister of Health showed particular interest in the fact that the event, which took place in a health center and not in a conference room, allowed for a humane interaction with the staff of the program. Therefore not only the healthcare personnel such as lab technicians, doctors and nurses, but also the patients and the expert clients, beating heart of DREAM’s activities. In his speech he also mentioned the will of the country to stay ahead in the innovation sector, and do so together with partners such as the Community of Sant’Egidio and the DREAM Program.
Furthermore the event was a precious occasion to strengthen the relations with the main organisations active in the health sector such as UNAIDS, UNICEF, the CDC, the Clinton Health Access Initiative and the national cooperations of various countries.