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The Secret of the Success

The secret of the success

A crucial key of the effectiveness of DREAM is that of being a program rooted in spiritual and human values: to have a soul. Its perspective is closely linked to that of the Community of Sant’Egidio: to work for a new world, feeling a responsibility towards building new roads with courage and patience, to be a solid and feasible answer to a huge problem, for which large organizations and African countries have not developed a concrete answer. It is this spirit that has enabled us to create non-granted synergies and become a replicable model, without jealousies of copyright, in the continued search to assure everywhere the same quality standards, which are a guarantee of success.

The Excellence

Excellence is precisely one of the key points. Excellence in diagnostics: think of the introduction of systematic measurements of viral load for HIV patients or more generally of the use of advanced molecular biology laboratories. Excellence in staff training, use of next generation therapies and no longer low quality or reduced to the minimum.

The central role of the patient

To give due priority to the centrality of the patient, continuous research for efficiency in the administration and in the management of patients is carried out. It always starts from the tangible man and woman and not from the institutions. The patient is considered in its entirety, with a holistic approach. In fact, the African AIDS patient has its own complexities; it is not a copy of those living in rich countries but has to be acquainted with, heard, studied and it is necessary to respond to their specific needs in terms of prevention, treatment and from a social point of view. This patient is frequently subject to opportunistic infections such as malaria and tuberculosis. It is a patient that has to be assessed in terms of nutrition and to whom should be offered, when needed, a nutritional support as a therapeutic treatment in order to not frustrate the medical intervention. It is often a person who needs to be educated to health, that must be motivated to maintain adherence to the treatment program, and that must also be reinstated in its family and social environment. Through listening and continuous contact, the sick were the protagonists of the growth of DREAM and its adherence to the African reality. In Africa, DREAM does indeed represent positivity, not only in its medical and scientific aspects, but even more in the human profile which characterizes it.

A community of care

The program has enhanced and organized a very African attitude, creating a community of care around the patient, with a profoundly inclusive approach. In its vision and in its practice the health center is the place to break the isolation and a focal meeting point. Therefore, a welcoming place where the patient finds someone willing to listen as well as the possibility to speak and express his or her demand for treatment. In short, a place where, alongside the health system and the skills of a health care facility, priority is given to relationships and the social reintegration of the patient. There is a tenacious and relentless work of human and social weaving carried out in the centers. The amount of meetings with the patients is impressive, not only for strictly health-related and diagnostic-therapeutic protocols. The patient is contacted for a multiplicity of reasons including counseling, participation in meetings, health education, delivery of nutritional supplements and medicines and, of course, for the medical examination and laboratory tests.

Health is not only healthcare

For DREAM the saying that health is not just healthcare is true. Many elements entirely unrelated to health components contribute to determine the health of populations: for example the level of education, income, access to food and water and the nutritional consequences such as those that the dramatic price increase of staple foods have on poor countries.

But above all there is another fundamental health determinant, the value of which though is often misunderstood: the relational environment.

The breaking of the isolation is the beginning of the process of care and healing precisely in a disease that has a strong attitude towards segregation and marginalization such as AIDS. The purpose to remove the stigma, which excludes patients from society, with the creation of community networks is not only an ethical priority but also a health one.

The program sought to take up this challenge by treating the disease, but also by breaking the circle of despair and isolation that traps the patient and often leads it to not be adherent, making the intermittent administration of the therapy useless or harmful.

It is certainly not desired to underestimate a medicine that comes from the work of research, diagnostics and therapy. It is obviously necessary, but its extreme self-sufficiency from a very old and always true value, which is that of a person who takes care of another person, is arguable. Because in the gestures of care, in the words, in the visit, in the medical attention, lies a principle of healing just as powerful and indispensable as, for example, the drug. “Taking care” of the other is a value of the overall system.

We believe that under this aspect Africa has something to teach to the Western world, which often saw health only as a specialist issue, a matter of technology and research, hospitals and drugs. A world convinced of the fact that, even though important, these “tools” can, as a new spell, ignore the loneliness and isolation of its elderly and sick. It is in the North of the world that very often the patient faces a private and solitary fate – delegated only to medicalization or technology – but deprived of its community dimension.

Patients as protagonists

In DREAM there are now thousands of patients, especially women, who have chosen to help other patients, no longer fleeing from the disease. They are real testimonials that play an irreplaceable role of support, counseling, peer-education and fight against the stigma. They communicate to others that AIDS is not a death sentence and participate personally in public campaigns against the stigma. The commitment and the testimony of many of these women drew thousands of people to therapy.

Health education

All patients of the Program participate in health education courses. This creates a culture of community health that teaches how to properly handle many aspects of life: the power supply, the use of drinking water, personal hygiene, housing and childcare. This wealth of knowledge makes the patient himself, in turn, an educator for his family and for his environment, and enables a deeper understanding of the causes and mechanisms of diseases that emancipate from fear. The patient becomes a protagonist of their own care as well as that of others. This aspect represents the key to success also to contrast other diseases in Africa. Education is indeed a powerful weapon for saving many lives and reducing mortality and the spreading of many diseases, an extraordinary tool that decisively improves the ability to fight diseases. In these countries there are many beliefs about the causes and possible remedies to the disease that is inextricably linked to the natural, social and supernatural environment that surrounds it. For generations and even today, for a part of the African population, the problem has always been to survive, confront and defeat the major diseases considered to be an otherworldly divine punishment. These beliefs often force patients to rely on traditional doctors or sorcerers who, through specific “rites” try to remove from the patient such harmful influences. In addition, the practices of traditional medicine, often bloody and performed in unsanitary conditions, are an additional risk factor in the transmission of infections. And especially in rural areas, in the absence of doctors, medicines and structures, the potion, ritual or magic are not the only answer to the disease of the body, but the answer to the deeper question of why there is evil. A DREAM meeting of the patients with the health center is indeed the meeting of two cultures. Here the patient is offered a treatment different from the one present in its country’s healthcare system. Moreover, the valuable work of health education, with the involvement of the patients themselves as testimonials, creates a new culture which changes the fatalistic and magic idea of the disease. Today thanks to this work many are aware that AIDS is not a death sentence, a punishment from God, but it is a disease that can be cured and that they can instead receive treatment. Not only: they are aware that free care is a right. This represents a big change in terms of collective mentality, of social consciousness. It is a cultural empowerment intended to change permanently and profoundly the health of populations. Moreover, along the years, the spread of care for life of HIV infected patients has begun to change in depth the understanding of the disease, thus introducing the awareness of a chronic disease.

The struggle against malnutrition

Through DREAM, Sant’Egidio has inherited the legacy of years of struggle against hunger and malnutrition in many countries of the world and has had to face the challenge of the dangerous and vicious circle of malnutrition and the HIV / AIDS infection. Since its foundation the Program has considered nutritional support essential to patients under care and a necessary element of the preventive and therapeutic course. How could we administer drugs to the seriously undernourished? How could the therapy work? We have paid attention in particular to malnourished children, the most vulnerable to food shortages, which are a major contributing cause of infant mortality. The nutritional education received by the mothers in the centers solves most of these problems and creates the conditions for a better development of the child. In the health centers, regular nutritional classes especially addressed to mothers take place. They are taught how to prepare the meals for the children, especially when complementary feeding, when the risk of malnutrition is highest. They are real cooking schools in which women learn to use common foods and nutrients for their children. The circulation of these notions, in very communicative societies such as those in Africa, represents an undoubted multiplication factor that improves the quality of life of many families, of entire villages.

A light health system

DREAM uses a light health system. Instead of building large hospitals, which also proved to be too expensive in terms of management all over the world, the Program has chosen a community based network of clinical centers of excellence and reference to which they refer patients from second level Day Hospital located in more remote and rural areas; here health care of middle tier such as the control and distribution of drugs and the execution of some types of analysis are provided. Moreover, mobile clinics and home-care that make health care accessible to everyone, even in remote villages.

Computerization

Particular attention has been paid to the management of the centers, the collection of clinical data, Internet connections and all forms of support, coordination and management of the personnel through a computerized system with all services also connected via satellite or landline through which the entire staff can receive consultations and advice from experts working at universities and hospitals. Moreover, these facilities have allowed the use of epidemiological data collected for operations research and quality control.

Gratuitousness

The fundament of gratuitousness is not to be considered last or secondary: all have access to DREAM since treatment and diagnostics are totally free of charge. This choice seamed due on the African continent, which is marked by the presence of hundreds of millions of people living below the absolute poverty line. Another consideration, following that of the patient’s inability of expense, should be added: therapy is for life and requires patient’s adherence to it. The complexity of care procedures, which results in a large number of appointments for monitoring health conditions, drug delivery and execution of the analysis, still has a cost for the patient. In fact many patients have to undertake long distances to reach the centers and therefore dedicate a few hours to those activities. This has a price since nobody receives contributions for transportation, and adherence to treatment involves a tangible and active participation of the patient also from the economic point of view.

Gratuitousness is imposed primarily for reasons of equity and justice, but it is also the secret of the very high degree of adherence to treatment by patients, which today is considered the true assessment of the success of the therapy.

On December 1, 2005, the UN Special Envoy for HIV / AIDS in Africa, Stephen Lewis, expressed his thoughts: “It is terrible to think that millions of children who should be alive, have died simply because the world imposes an obscene division between rich and poor. Why do we tolerate that there are two systems, one for Africa and another for the rich countries? Why do we tolerate the carnage of African children and save the life of every western child? “.

Free healthcare is the first method to break down the wall of separation between the rich who have access to health services and the poor.

In the healing of many patients the sense of generosity and giving is present, which are the strength and effectiveness of the gratuitousness of everything that the Community of Sant’Egidio does in the world. In a time of globalization, faced with the challenge of living together, crushed by economic materialism, the culture of gratuitousness is a revolutionary act that promotes social development, restarting the culture of solidarity, voluntary work, of cooperation, creating new opportunities for our societies. It is a different dimension without which the humanity of peoples is impoverished. To live in a new era and be capable of facing the current challenge of a complex and globalized world means also maintaining and enhancing our humanity. There is something that cannot be sold or bought of which we all have a vital need: the gift, the love, the friendship and the gratuitousness make up the quality of society and people’s lives and build a concrete solidarity between peoples, which changes the world.

Here is the secret of the extraordinary results of DREAM, obtained also thanks to the sharing and collaboration of so many men and women of good will whom we have met over the years throughout the streets of Africa. The fast expansion of DREAM in the last 13 years is due not only to the widespread presence of the Community of Sant’Egidio in many African countries and the commitment of many African health professionals, but also to the alliance with many religious congregations, NGOs, lay and volunteers who have chosen to join us in the fight against AIDS. This synergy has allowed increasing the reached number of patients. It was necessary, alongside the cooperation with communities of other religions and confessions, such as the Muslim community in Guinea Conakry, the Hindu community in Malawi, the Protestant and Orthodox churches in Mozambique, to convince many skeptic patients to be treated. It can be said that this was a positive contamination, which has multiplied the effectiveness of our work. It has been a contamination of good, of good healthcare, which has made Africa better as well as many citizens of the rich world.

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