The international community has for years recognized the importance of clinical laboratories in Africa in carrying out a reliable diagnosis and an efficient monitoring of the main diseases present in the region.
Since its launch, DREAM has been one of the few programs which promoted the use of laboratories, mainly those specialized in molecular biology. Laboratories which could provide advanced diagnostics were in fact immediately established in all African countries where DREAM is present, alongside health centers.
The laboratories are managed by local personnel, trained and consistently supervised and updated through continuous training programs.
The World Health Organization African Region (WHO Afro) and its partners, including the African Society for Laboratory Medicine (ASLM), have promoted over the last few years the SLIPTA program (Stepwise Laboratory Improvement Process Towards Accreditation) to improve the quality of the laboratory services. It is a gradual process aimed at improving the quality of laboratory performance in the region, in view of the accreditation and compliance with international standards which are, for clinical laboratories, regulated by the ISO 15189 norm.
The laboratories need to develop and document their ability to find, identify, readily answer and report on the diseases which may have an impact on public health.
Therefore all non-profit public and private laboratories coordinating their work with national health systems, offering their support in diagnosing the main diseases in Africa, are subject to regular audits and are evaluated through a system which combines all relevant aspects (handling documentation, procurement, biosecurity, device maintenance and handling, and much more). The system then assigns a score between 1 and 5 stars based on the overall performance of the laboratory as well as a checklist which reflects the ISO 15189-2012 norm.
This program has been active in Malawi since 2013. The DREAM laboratories in Balaka and Blantyre which participate in monitoring the viral load (VL) and in the precocious diagnosis of the infection in exposed infants (EID) were also included in the process.
In their current state and following a process to improve quality, the laboratories were audited and reached respectively a score of 85% and 89%, thus both achieving a 4-star score, the best in the country. Such a success could only have been possible thanks to the commitment and dedication of the staff and the support of all the colleagues of DREAM Malawi!
Speech of Jane Gondwe at the International meeting for peace “Bridges of Peace” in Bologna, at the conference entitled “Illness and Healing: the Value of Life”:
My name is Jane, I’m from Malawi and I’m the coordinator of one of Sant’Egidio’s many DREAM (Disease Relief through Excellent and Advanced Means) Program centers, which have been set up throughout my country and in 11 other African countries. The Program started in 2002 and at the beginning its aim was to prevent and treat AIDS and malnutrition. Today its activities include not only the treatment of infectious diseases but also of chronic diseases and screening for the early diagnosis of cancer. The treatment is free of charge for everyone. Currently DREAM is taking care of 500,000 sick people and it is estimated that the Program has reached over 3,000,000 people through various training courses, and nutritional, health and social support. It is a great health Program that started with the right to treatment, in particular for the poorest people. DREAM has become an opportunity, a chance to develop and to make a decisive change in many fields: health education, the rights of the individual, a new consciousness for women, the culture of work and the development of a civil society. It is a Program that has changed the history of AIDS in Africa and it changed my story, as it has changed that of thousands of sick African people. Today I am a woman with great dignity, who many sick people from my country refer to, ask for help, and I’m often invited to speak a international conferences on AIDS I Africa, but 15 years ago my life was very different.
In 2001 my husband was diagnosed with AIDS, unfortunately very late. The drugs for the treatment were not yet available in my country and in 2004 my husband died. Life got very hard for me and my 3 children, I was kicked out of the house we lived in, I also got HIV and I was fired from the school I taught at for this. In a short time, for my family and for society, I became someone with no name and no rights, just a sick outcast.
I was desperate, without any hope, I cried and wanted to die. I was completely in the dark and then one day a friend of mine told me that there was a therapy, that in Blantyre, my town, there was a center where I could get the therapy and care that I needed free of charge. This is how I met the Community of Sant’Egidio that took care of me through the DREAM Program. In Malawi, like in other countries in Africa, the first years of 2000, there were no antiretroviral drugs for treating AIDS, or at least only a very few and they had to be paid for. Finding out that you had AIDS was like a death sentence for most people and in fact many, many people died during those years.
DREAM introduced the antiretroviral drugs to Africa for everyone and it brought back the hope of life again. The treatment for sick people was good news and even sick people could have a future. Like the Good Samaritan in the Gospel, Sant’Egidio stopped in Africa next to sick people, it bandaged the wounds of the body and soul of so many people and gave them back their life.
Today I would like to thank Sant’Egidio because the treatment that was offered to me free of charge changed my story, that of my children and also that of my country. Today I’m in good health. Once I felt strong again I started studying again and I graduated with a university degree. Above all with my work, not only do I support my family but I have also become the voice of many sick people in my country and in Africa, who have no voice and no rights. The treatment and the closeness, the love I received from so many friends in the DREAM Program, completely cured me, not only my body, but in my sickness I discovered my dignity, I understood the value of my and everybody’s life. Everything that was impossible became possible. It was as though I had been born again. I don’t remember my first birth, but I will never forget my second birth, when I was given back my life again.
The many difficult times that I went through have made me a testimonial for other people. I want to freely give back what I received, by bringing with my voice, my strength and my love, the hope to be cured that changed my life, to people who are sick. My life today can speak of resurrection to many others.
I’ve often asked myself: why me ? I, who was not loved, who had been abandoned by my relatives and my friends, why me? I was considered a worthy person who had to be saved. My life was considered important, even though I hadn’t done anything to deserve it. I was loved in a concrete way by being given care and medicine but also so much hope. Being loved was the experience that brought me back to life and to a more beautiful and happier life than my first life. The care I received gave me a new way of judging other people, it gave me a new way of looking at so many people’s pain. I understood that life always has to be respected and protected, especially when it is weak and sick, in the belief that every human being is the image of God, and this is the fundamental dignity that cannot be taken away or undermined. The love I received produced a new feeling of compassion, which has been a liberating force for my life and for that of many other African women.
This is why I decided to dedicate my work to caring for so many mothers who have AIDS, in order to save many of their lives and also so their children can be born and grow up healthy.
To support them, not only with their many not only physical but also emotional problems, which are caused by the stigma and discrimination that they suffer from. Saving a mother’s life means saving a child but it also means saving a family because the women are the backbone of African society. But I’m also very proud that for the last few years no sick children have been born from seropositive mothers in our DREAM centers in Malawi. This is a victory of medicine and also a victory of love.
Over the last 15 years, with other sick women like myself, we have established the I DREAM association in many African countries. The main aim is to protect access to treatment as a human right that has to be respected regardless of race, religion, age or any social or economic condition and to be able to talk about AIDS without fear or shame. But we also want many other people to be cured through our work, not only people with AIDS but also the many people who have other diseases that are spreading through Africa, like chronic diseases and cancer. Giving people hope that they can be cured giving them hope for life. We go to their homes, the neighborhoods, the streets, the schools and the markets, to talk about how we were cured and we communicate hope. Together we women are changing the history of our countries and are building bridges that bring sick people close to those who are not sick. For many people, by now DREAM is a force of health and salvation.
In my country, every day many people are fighting against the physical suffering of their disease and at the same time they feel alone, often abandoned and they have no help. They experience a pain that is also because they have been isolated by society and because they are unable to deal with the most profound questions of life on their own. It is difficult to find real answers. Sometimes in our African societies the churches seem to be inattentive and far away from the people who look for comfort, relief and a cure. More and more often sick people think they can find the answer in magic, in rites, in traditional medicine, in false prophets and in the sects that take money and give bad advice: “Your disease is a punishment from God for all your sins, you just have to believe in me and my church… don’t take any medicine, I’ll heal you”. In the end many of them die because they don’t take their medicine anymore.
There are so many sick people, they don’t know they can be cured and both their souls and their body are wounded.
By bringing so many people back to life with medicine, DREAM has also brought to light and has changed these aspects of our culture, showing us that miracles can happen when we take care of ourselves. Moreover, the important health education work that I do every day, together with so many other people who are testimonials, is generating a new culture that is changing the fatalistic and magic idea of the disease. This change is freeing people from their feeling of unjustified guilt for a disease that is seen as a punishment for one’s sins, for one’s mistakes. In DREAM the meeting of sick people and the healthcare center is in fact a meeting of two cultures. Here sick people are offered healthcare that is completely different from the healthcare offered in the rest of the country. Today, thanks to this commitment, many people know that AIDS is not a death sentence, a divine punishment, but that it is a disease that can be cured, that they can receive treatment for it. Not only that; they are aware that the treatment free of charge is a right. Besides, over the years, the fact that the lifelong treatment for people with HIV has spread so much, the way people see the disease has begun to change profoundly and people are now becoming aware that it is a chronic pathology. This all represents a great change, also in terms of the collective mentality, of the social conscience in Malawi and in Africa in general. It is a cultural empowerment that is destined to change the health of the populations in a permanent and thorough way, which has paved the way for DREAM to be able treat many other diseases too.
In conclusion, I’d like to tell you that I was a woman with a death sentence who met DREAM and was cured and this brought about not only a profound physical and cultural change in my life and in that of many of my friends. The love that we have received has not been forgotten, it has started a movement of love. Through the experience of the disease I found and rediscovered my faith in a merciful God, close to me, who heals, and it was a real experience of reconciliation with God. This is why I cannot forget the resurrection that took place in my life and this is why I decided to work to cure other people, not only with my testimony but also with ceaseless prayers for everyone, so that many more miracles can happen.
During these years with the Community of Sant’Egidio I’ve understood that the important things come from the heart, but the heart has to be cultivated by reading the Gospel, with love for one another and with service for the weakest people in our society. There are so many wounds and diseases hidden in Africa, not only AIDS. Wounds in hearts, in the villages. Xenophobia is a wound, hating the elderly is a wound. There are wounds in families, wounds in politics; and these wounds become putrid, they get gangrene, these wounds kill not only one man but a whole family, a whole village, town, even a whole country. In Africa we are witnessing an increase in a competitive mentality, whose pressure on the life of individuals is extremely powerful. One has to concentrate on one’s own success. In this perspective, the weakest people despise the useless old people and the poor, the sick, the prisoners and this poisons society, making it often violent and inhumane. I cannot forget what I received without deserving it. It seems as though one has to pay a lot for the beautiful things in life. Whereas with DREAM life, being cured and health is not paid for. I didn’t pay for the most beautiful thing in my life, I was given it free of charge. This means that I have to live and give free of charge. For me, not forgetting this love that I received means multiplying it, making it grow, letting sick people get better, bringing joy to our sad society, where the poor are right to be sad but where the rich are sad too.
It may seem like a paradox but it is the real Christian paradox, that through my illness I found dignity, hope, the meaning of my life and also so much joy to share with other people. I understood that I am important, that each one of us is important before God, and that everyone can be a prophet, a prophet of happiness, and has to prophesy for the happiness of many.
A weeklong workshop took place in the Maputo DREAM center of the Community of Sant’Egidio with the participation of computer engineers working with the Dream Program in Tanzania, Malawi and various areas of Mozambique.
The workshop provided updates and thorough analyses of topics covering information and communication technologies, data protection and security and the use and improvement of software developed by the DREAM Program. The program in fact has been investing in ICT expertise since its beginnings to assist more than 350,000 patients already reached through the program located in the 11 Sub-Saharan countries.
The workshop aimed at improving technological support and problem solving without forgetting that people, not technologies, are the Program’s focus: not only how to build and maintain digital networks, but also an in-depth look at how to improve human networks and fully benefit from joint collaboration and efforts, taking advantage of the technological tools used in treating patients.
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.