A training course for health personnel took place in Kinshasa last week, organized by the DREAM Program of the Community of Sant’Egidio, called “The challenges behind HIV therapy and the HIV/TB co-infection in Africa”. Amongst the topics discussed were the shift to the third line of antiretrovirals and the use of the resistance test. The course was attended by 40 doctors, nurses and paramedic personnel from the DREAM center in Kinshasa and other local health centers and hospitals which collaborate with the DREAM Program in various ways, as well as representatives of the personnel of the DREAM center in Mbandaka (Équateur Province) and the Bandundu area. The course was held from the start by Professor Pasquale Narciso, an experienced infectious disease specialist in Europe, and a health consultant from the DREAM Program. The combined experience from both the African and European fronts laid the foundations for high-level training and impact at a local level. The attendees actively participated by presenting complex cases which they had to tackle over the course of their careers and welcomed the effort and effectiveness of sharing experience and know-how. A collective wish to participate in similar high-level courses was shared by the attendees, but most of all everyone felt more united and powerful in tackling the challenges posed by the HIV disease and tuberculosis together, which still take many lives in Kinshasa and the DRC.
In occasion of the presence of Prof. Narciso, a conference took place at the Medical School of the Kinshasa Unikin State University titled “The HIV virus and its resistances to antiretroviral drugs”. The conference was aimed at about 50 final year students, doctoral students and interns specializing in infectious diseases. Following the interest generated by the conference, the Dean of the Faculty, who was also the moderator during the event, asked DREAM to draw up an exchange agreement with the University to host the young doctors in training. This would give them the chance to put to practice on the field the theory acquired during their studies, all in a context of excellence.
A new agreement was signed on 15 March between the Japanese Embassy and the Community of Sant’Egidio for the construction of a new DREAM center in the city of Dubreka, located about 60 kilometers from the country’s capital, Conakry. The suburban area of Conakry is undergoing an intensive urban development program which is slowly enveloping the city in the urban fabric.
Rent prices are very high, leading many people to look for a home further away from Conakry’s city center. Consequently, the prefecture of Dubreka, which is mainly a rural area, is witnessing a high population growth. DREAM began working in the prefecture of Dubreka seven years ago, when the decision was made to rent and renovate a small building thanks to a small contribution by UNAIDS. The UNAIDS project was started with the intent of providing about 30 HIV+ women with the prevention program impeding the mother-to-child transmission of the HIV virus. It slowly grew larger, encompassing 300 patients who are currently being treated free of charge by DREAM. The small center was inaugurated in September 2011 by the Première Dame and met with local celebrations.
The center currently opens once a week and is part of a network of “satellite” centers built by DREAM to reach patients which reside far from Conakry’s center (a second center can be found in the prefecture of Coyah, and another inside the maternity ward in the Matoto neighborhood in Conakry). These centers can benefit from the work of the molecular biology laboratory, located in the main center in Conakry, which includes the daily transport of blood samples and mobile medical teams who guarantee the same consultation and drug delivery standards found in all of the centers.
The wish to strengthen DREAM’s presence in these areas and particularly in Dubreka can be achieved by building this new center, assuring increased stability and daily presence to the local patients.
The center will be built on a plot which was bought a few years ago thanks to a donation and which was awaiting support in order to begin construction. The signing of the agreement marks the start of this project, which is expected to be completed within the next 12 months.
The ceremony, which took place in the residence of Ambassador Hisanobu Hasama, saw the participation of a few representatives of the institutions which accompanied DREAM’s story in Dubreka and in Guinea in general: the UNAIDS representative in Guinea, Dr. Dado Syd Gnakassi, the representative of the Première Dame Foundation, Mme. Traoré, the segretary of the Apostolic Nunciature in Guinea and the coordinator of the National program for the taking charge of HIV/AIDS representing the Ministry of Health. It was an occasion to thank who, in their own way, supported DREAM in its efforts to offer a free quality treatment especially to the people living farthest from the capital. Special thanks went to the Episcopal Conference of Italy for its contribution to the DREAM program over these years, the Eight per thousand and the Papal Foundation, as well as the state of Japan for this new collaboration
Relations with the country have strengthened also following the projects launched in Mozambique through the Japanese Embassy in Maputo, which allowed the construction of the health center in Matola dedicated to women, while the construction of a new DREAM center in the neighborhood of Zimpeto is almost completed.
The conference “The DREAM Program in Africa. The Mozambican case: from peace agreements to the fight against HIV” took place on 18 January at the Clinica Moncucco in Lugano.
The clinic counts amongst its partners the FAI foundation (Fondation Assistance Internationale), which has been supporting the DREAM Program in Mozambique and has provided its continuous help and contribution for almost a decade.
Speakers at the conference included Dr. Noorjeahn Magid, Clinical Director of the program in Mozambique, Dr. Laura Zagrebelsky, Italy’s representative for the Global Fund and Dr. Guidotti, Secretary General of the DREAM Program.
The FAI President and Vice-president, Dr. Respini and Dr. Mancini, expressed their enormous enthusiasm and passion for the program. They looked back on the work and collaboration over the years and the huge success and strength which characterized them, making the program a key example of the FAI foundation itself.
Dr. Noorjeah recalled the fight, the challenges and successes through her own story, arousing deep emotions and sympathy for both Mozambique and DREAM.
Dr. Zagrebelsky cited the program as being a true model of success and effectiveness for the Global Fund. She highlighted how this great collaboration helped spread the program throughout Mozambique, reaching many sick, which in turn contributed to a 40% increase of people receiving treatment.
The audience was moved by the touching images from the program and the voices of the activists, heard in a video, who received great admiration.
Towards the end of the conference a new agreement was signed which will allow DREAM to open a new center in Bangui, Central Africa.
The humane, scientific and spiritual adventure of the program continues with growing passion and new friends.
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.