2014 PROJECT REPORT -...

P.O. Box 6613, Zimbali, 4418, South Africa, [email protected], www.dfl.org.za

2014 PROJECT REPORT

Above: Taking a blood sample for a malaria test

“Zavora Maternity Ward and Clinic“

1st 2014 Report:

1 January – 31March

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of 25 A2A 2014 © All Rights Reserved

Introduction: It is with much appreciation for your prayers and support, that we send you this quarterly report of the Clinic and Maternity Ward in Zavora, Mozambique. By God’s grace many lives have been impacted through this work. Report Prepared By: Johan Claassen Signature:

Date: 2012-03-12 Mobile: +27 (0) 83 458 2949 Email: [email protected]

“Oh, you have been so helpful to us”

Dr. Sylvester (Dir. of Inharime Hospital) –

after receiving the shipment of medication through DFL.

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INDEX: I. Demographic Information 1. City & Province 2. Organization 3. Project Title 4. Reporting Period 5. Project Location (region & city/town/village) 6. Target Population including economic and social conditions II. Project Information 7. Project Goal 8. Project Objectives during this reporting period 10. Results and/or accomplishments achieved 11. Impact this project has on the community 12. Number served/number of direct project beneficiaries 13. Number of indirect project beneficiaries (geographic coverage) 14. Services provided 16. Project challenges and obstacles 17. Plans for next reporting period 18. Success stories highlighting project impact 19. Photos: Please see the attached III. Photos IV. Additional Information/statistics

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I Demographic Information

1. City, State or Location:

KwazuluNatal, South Africa Ballito, 10, Link Road Dolphin Coast Shopping Centre, Suite 25C 2. Organization Name:

Doctors For Life International (DFL) Gov Registration nr IT 1460/02 The DFL Program name is ‘Aid to Africa’ 3. Project Title:

The specific project name “DFL Sihane Clinic and Maternity Ward, Mozambique” 4. Reporting Period

First 2014 Quarterly report: 1 January – 31 March 2014 5. Project Location

“The people told me, they don’t want to go to

Inharime government hospital, but rather here.

They say they receive the best right here in Zavora”

– Mr. Mario Rocha (clinic manager/volunteer); reporting on what the patients

that visit the DFL clinic tell him.

Zavora is a small coastal resort, north east of Maputo in Mozambique, in the district of Inharime, province of Inhambane. The small area where DFL’s clinic is based is called Sihane. From Maputo, the capital of Mozambique, you drive almost

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420km in a north eastern direction to get to Zavora. It is located 27km away from the town of Inharrime and the capital of the province, the city of Inhambane, is approximately 2 hours’ drive away towards the North East.

Above: The Zavora Clinic garden Patients wait on both sides of the courtyard, in front of the examination rooms. The maternity ward is seen on the left.

The correct Portuguese spelling is Závora, and some maps refer to the area as "Ponta de

Závora", Portuguese for "Tip of Zavora" or "Praia de Závora" meaning "Beach of Zavora". The origin of the name Zavora is not known.

Although the many people can speak Shangaan and Portuguese, the local language is actually Txopi. English is limited to mostly businesses and lodges.

Mozambique used to be colonised by Portugal. There remains some old buildings that still exist from after the Portuguese left and Mozambique gained its independance. These buildings are currently used as accommodation by local lodges. DFL’s accommodation for volunteers is one such a building.

In general the local people are poor and needy. Most of the people make a living from fishing and farming of small crops

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6. Target Population

The direct target population in the immediate area of Sihane and Zavora is estimated at about 20,000 people. But people travel up to 60 kilometers to get to our clinic. Some that come by foot take more than a day to get to us. Others use a local pay bus or taxi.

Above: A clinician busy injecting one of the many babies on vaccination day.

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II Project Information

7. Project Goal

The goal of this ongoing outreach program is to offer permanent free general medical and maternity services to the district of Sihane and Zavora in the Inhambane province of Mozambique. We currently we see approximately 350 patients a week (1400 patients a month). One of the goals of Aid to Africa, the medical outreach program that Doctors For Life initiated, is to reach some of the most remote and isolated areas in Africa with the Gospel using proper medical care as a vehicle. The pathology of the patients indicated the great need for better health care in this poor area. 8. Project Objectives during this reporting period

With the assistance of many, the clinic predominantly sees patients for general medical care and maternity care. However, DFL desires to offer more and therefore also included some other basic services from time to time. This include eye care, general optometry, eye surgery in Mozambique (using our clinic as a base), child and mother vaccinations and HIV prevention, care and treatment (in co-operation with the Mozambique government) and Dental care to name a few. We are especially thankful for the additional rooms we were able to build to include some of these and other extra services in the future. We now have a dentist chair and we installed a device to determine a patient’s vision. In addition we have an instrument for measuring the strength of spectacles (glasses). All this fills a great need.

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Above: Vaccination and post-natal examination day sees hundreds of mothers and babies coming to our clinic every month. The sound of crying babies is heard from afar.

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Above: Vacination day at the DFL clinic: mothers line up with their babies to receive the vaccinations. 10. Results and/or accomplishments achieved

“We value your help” Dr Sylvester, Dir. of Inharime Hospital

In previous quarterly reports we mentioned that we would like to expand our work by adding more facilities. These buildings will enable us to render a better medical service to the community we serve. We are very grateful that we were able to finish the construction of these rooms and thus accomplished the following new projects:

1) Added a vaccination room. This used to be done under a tree or cramped area in our original clinic. See services rendered.

2) Added a dental room for dental services. See services rendered.

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3) Added an X-ray room: facilities in order to screen for heart failure, lung diseases, bone fractures etc. We still need X-ray equipment to be installed.

4) Added a pre-natal examination room. Same as vaccination room. 5) Built a small shelter for the relatives who look after their loved ones who stay in our

maternity ward for observation etc. In most African countries the hospitals do not provide food for the patients. The family members have to cook and provide for their meals. At DFL’s clinic we do the same. The family or friends sleep at the clinic while taking care of the patients who stay in the clinic’s wards. The shelter is used for cooking their meals.

11. Impact this project has on the community

Mozambique been enjoing some degree of economical growth in the after math of the civil war that ended in the early 90’s. But in the past year, Mozambique has been facing an increase of challenges that could destroy what has been built up. One of these are the disturbing news of escalating brutal attacks by the rebel group, Renamo, which officially broke the peace treaties with the current ruling party, Frelimo, that ended the civil war in 1992. It has apparently resulted in new financial struggles for the country. For example, England apparently recently stopped providing financial assistance to Mozambique. According to another report Mozambique had an 11.5% reduction of total national support due to corruption. When it comes to life threatening infections like malaria, the Zavora clinic plays a critical role. Diarrhea is also a common problem, especially with children. The statistics in the next section (number 12) explains the impact the clinic has. We are therefore very thankful to be in a position to be able to assist the needy community of Zavora though the DFL clinic. “We are very much aware of what you are doing.” said the national Chief of the Department of NGO’s to Mr Mario Rocha, manager of the DFL Zavora clinic, during a high level meeting in Maputo. In the community where we are based, very few people have their own vehicles. They mostly either walk, ride bicycles or use animals for transport. Many of the pregnant women travel from far to come to the clinic. Sometimes they walk

for 2 or 3 hours while having contractions before they arrive at the clinic. On occasion

they don’t reach the clinic in time and their babies are born next to the road. Often the

patients call us out, even in the middle of the night and request that we come into “the

bush”, to collect them. Our DFL team then leaves the comfort of their beds to try and find

the place where the people live.

In December Doctors For Life has provided transport for patients to the nearest hospital in

about 7 emergency cases.

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“The best people who are helping us (Mozambique), are those who contribute to

health services. Especially those who do eye surgery”

National Director of Department of NGO’s, when he addressed NGO’s at a workshop in Maputo, capital of Mozambique.

12. Number served/number of direct project beneficiaries

We would like to thank you those who generously donated towards the clinic thus far. General Examinations: For this reporting period we saw an average of about 1380 per month compared to about 1460 per month between October to December 2013. The average patients seen had a slight drop of about 350 from the previous 3 months. The total patients treated are 4153 for the reporting period. Interestingly though, there was a climb in malaria (from 850 to 1069) and diarrhea (from 86 to 141) cases in the last three months. January to March is

probably the highest-risk malaria period with temperatures reaching its peak in this tropical area. See the concerned Mozambique news report on Malaria at Addendum V below for additional information.

Because the focus is on maternity care and because certain illnesses like malaria and diarrhea are more prevalent, we will highlight those statistics.

Total number of Patients:

Ages January February March

0-4 490 492 681

4+ 1048 612 830

Total 1538 1104 1511

4153

Diarrhea:

Ages January February March Total

0-4 18 22 28

4+ 33 19 31

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TOTAL 41 41 59

141 Note: About 60 more cases than the previous 3 months

Malaria:

0-4 years 4 to adults

January 285 94

February 226 64

March 322 78

Total 833 236

1069 Note: about 200 cases more than the previous 3 months

HIV/AIDS:

Ages January February March Total

0-4 - 0 0

4+ - 5 9 TOTAL - 5 9

14

STD’s:

January February March Total TOTAL 12 14 23 49

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Above: A new born baby

Maternity Statistics: During 1 January to 31 March 2014 we had 57 deliveries of which 4 were transfered to the nearest government hospital at Inharime due to complications. Previous reports unfortunately underestimated the no of deliveries at our clinic to date. The clinic records show that approximately 730 deliveries came through our clinic since the official opening of the maternity ward (1 August 2009 until 31 March 2014). Unfortunately we do not have figures of the large number of women that received pre-and post-Natal examinations. Many still don’t come to our clinic for deliveries due to various reasons. Traveling distances and lack of transport could be one of them.

Month live births transfered

death CPN

CPP

eldest mother

youngest mother

min. weight baby (g)

max weight (g)

January 24 2 0 - - 37 17 2700 4500

February 13 0 1 - - 34 16 1800 4000

March 20 2 0 41 17 1730 3700

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Total 57 4 1 - - CPP – post-natal consultation CPN – pre-natal consultations

Above: Mother and baby share a ‘moment’ - one of the many deliveries the DFL clinic assisted with.

13. Number of indirect project beneficiaries (geographic coverage)

We currently supply the government hospital with some extra medical disposables. Not only do the medical disposables help them treat patients more efficiently, it also establishes a good working relationship between the DFL Maternity ward and the government (and community at large). Thus the work is broadened beyond our area. The DFL Zavora clinic also attracts patients from far away. Although the immediate population of Zavora is estimated at 20,000 people, we often hear of patients traveling from as far as 50 miles away (from a town called Zavala or Qussico) in order to receive medical treatment. Some of them walk along the beach and sleep under the open sky as they travel towards our clinic. 14. Services provided

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Above: A baby is being weighed.

Currently the main focus areas are maternity care and general medicine but the work is expanding. Dental and eye care is offered at times and we would like to do more regarding eye surgery. The clinic runs on normal practice hours except for Sundays, Wednesdays and Saturdays. The maternity ward is open every day. We make use of local (Mozambique) full time staff that assist us in the daily tasks of running the clinic. Thus the clinic also provides work for the local community. These include cleaning, translating, a midwife, medical assistants etc. The rest of the DFL staff are full time volunteers. We also make use of short-term medical volunteers in order to assist the permanent staff or allow them to go on much deserved breaks.

The DFL Zavora clinic facilities currently consists of: 1 pharmacy 2 examination rooms 1 X-ray room (X-ray equipment still needs to be installed) 1 laboratory (currently used as patient ward) It still needs proper laboratory equipment 1 dental/optometry room (includes an installed dental chair, basic equipment and eye testing/eye glasses equipment) 1 vaccination room 1 maternity wing that consists of: a 3 bed maternity ward, wash room/toilet, store room and delivery room with 2 delivery beds as well as a pre-natal screening section.

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In summary, the free services DFL offers include the following: A: General Internal Medicine a) General wound, disease and patient care b) Medication and treatment c) 24 hour availability for emergencies d) Referrals to hospitals for surgery or emergencies e) Transport to the nearest hospital in emergency cases 24 hours f) HIV/AIDS and STI testing and treatment B: Optometry a) Eye testing for refractive errors b) Free prescription eye-glasses c) Eye glasses testing d) Treatment of various ocular infections and conditions e) Possible cataract and other eye surgery in 2014

C: Dental Care A medical dentist visits our clinic once a month to offer free basic dental hygiene and care. We have been able to install a good second hand dental chair and basic equipment. a) Extractions b) Dental hygiene and care D: Maternity Care a) Pre- and Post-natal examinations b) Deliveries c) Referrals (pregnancies with complications that need surgery or caesarians) d) In-patient recovery ward (3 beds) e) 24 hour emergency call out service f) Mother and Child vaccinations (done weekly by the Mozambique government in one of our rooms) Measles, BCG – Tuberculosis, Synflorix – Pneumonia, Tetanus, Diphtheria, Pertussis, Hepatitis B, Haemophilic influenza, Oral polio

g) Transport to the nearest hospital in emergency cases 24 hours h) HIV/AIDS/STI testing and treatment

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Above: A baby is being weighed on a vaccination day.

16. Project challenges and obstacles

1) Fighting between Renamo forces and the Mozambique government See “V Additional Information” 2) Many malaria cases - see See “V Additional Information” 3) An X-ray machine.

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4) A fence around the clinic property for security reasons The clinic attracted many small ‘businesses’ over the years. There is now a taxi rank, and shop owners saw an opportunity to sell goods to waiting patients. Unfortunately this explosion of shops is not controlled properly and with it came a lot of noise. Hooting, loud music and parties, all this right accross our clinic. Those selling alcohol to the public opened a number of shebeens (pubs or bars) during the last few years and this is getting out of hand. Our staff have difficulty sleeping at night and are often woken at awkward times. Security has also been a problem and thus we are hopig to erect a fence around the clinic and accommodation facilities. 5) A new ultrasound machine 6) Good relations are continually needed with the local and national government. We are thankful to have this but doesn’t come without constant hard work, humility and serving. 7) Additional medical volunteers. This is also an ongoing need. 17. Plans for the future

A: We would like to do cataract surgery on the blind for a second time this year, in September 2014 in Mozambique. B: We would like to build a theatre and a ward with 14 beds in order to provide caesarian and other surgeries to the province. C: We would like to expand in the following areas.

I. A laboratory to test blood samples for malaria, bilharzia and other diseases.

II. X-ray facilities in order to screen for heart failure, lung diseases, bone fractures etc.

III. A shelter for the families who stay over while waiting for patients in the maternity ward. They also do their cooking for the patients in these shelters.

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18. Success stories highlighting project impact

“Then he got healed and could keep finger and hand!”

Dr Timoteus Hauser, Swiss volunteer.

By Dr Timoteus Hauser

1) Love and tender care medication “There was a man, Pedros, who during the morning gathering of patients stood up,

walked a bit and lied down in the grass covering himself with a blanket. In the examination room he told us he had pain urinating and the urine is bloody. At the same time he was feverish (T 39.0'C) and complained about abdominal and back pain. Both malaria and HIV-tests were negative. So suspecting kidney infection, we started a related treatment. We told Pedros to wait until we would have seen him again. But then suddenly saw one of our staff members, Albertina giving food to the Pedros. Not long after this Pedros came walking towards the clinic and I heard he has just done his toilet and that he was much better! A few days later he came back for follow-up examination twice and he got some more medicine. So love and tender care can contribute a lot to healing even if it's not the state of the art treatment”.

2) Diagnosing the other needs “When people, and especially women, complained about strong or fast heartbeats or a warm chest, we used to check the vital-parameters. We then enquired about reasons for stress to which they mostly gave a very sincere and straight answer. For example one said a child has died, another told us that her husband has a second wife. One lady complained, she neither has a husband nor children. This must be quite hard for a woman in their culture. Thus a need was seen to help with more than just medication. For example, one poor woman was offered a job at the clinic to cut the grass, in exchange for the other things she needed”.

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Above: Dr Timoteus Hauser examining a women’s heart/breathing

3) From bad, to worse, to good “The little finger and right hand of a man tells us another story. It was on a Sunday morning around 06:00 o'clock when a man, Joao, called me to help him. He showed me his swollen right hand with an open wound in-between his ring and small finger. We therefore gave him an antibiotic and asked him to come back the next day! However on Monday I didn't see Joao. Later I heard he did come back but was seen by my colleague at the clinic, and he received another antibiotic. Joao was asked to come back again that Wednesday.

But when Joao came back, the wound was much worse. In order for him not to lose his finger or even his hand we sent him to the nearest hospital in Inharrime to get an iv-treatment. That Sunday we went to a funeral in the community, where we met up with Joao again. He was given a penicillin injection at the hospital and I told him that he can get this in our clinic as well. So thus we gave him antiseptic baths of the concerned area, antibiotic injections and wound debridement according Dr. Albu van Eeden (the CEO of DFL’s head office in South Africa)‘s advice. The patient was nearly always happily smiling and thankful he got healed and could keep finger and hand!”

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Above: The man’s hand that first got worse and then better again.

Above: After his hand started healing again.

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4) “During the holidays and weekends we often, like most hospitals around the world, end up seeing more emergency cases at our clinic. With a many ‘shebeens’ (African pub or bar) situated right across the road from our clinic, trouble is never far away.

Top: The man from Mushipa, just after he arrived. The open wound is still visible. Bottom left: the sutured wound looks neat again. Bottom right: A few days later. His lips are busy healing again.

Ironically the police station is situated right next to these bars also across the road from our clinic. DFL also provides the police station with water and thus we have a

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good relationship with them and receive assistance where needed. In return they send us medical cases to keep us busy... In one case the police sent two men to us for treatment after having a brawl. One of them bit the other man in the face while fighting. The first one came earlier the day with his letter from the police. After each visit they both had to report back to the police across the road. One of the two men was from an area further away called Mushipa. The following day, both came at the same time and were sitting in the same room while the doctor removed their stiches. Thankfully they did not fight again”.

Above: A young man stepped into glass and cut himself badly. The doctor sutured the wound without local anesthetic in order to avoid risk of further infection due to perforated skin. Below the foot is bandaged

Note: Some names in the stories have been changed. I have also corrected some if his English but kept most original for authenticity.

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III More photos and stories

Please view and download the photos of this report in our shared Drop Box folder.

Above left: This child had a piece of coal in the nose. She came after hours. She cried out load as the doctor tried to remove it. We think they played and then it got stuck in her nose. Above right: This young mother said she is 16. Her child is on her back; A child with a child. She was in the school situated next the clinic and gave birth at our clinic. She has left school since.

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IV. Additional Information/Statistics

Malaria Remains Major Health Concern In Mozambique 26 APRIL 2014 Maputo - Health Minister Alexandre Manguele said malaria remains one of the greatest public health concerns in the country despite advances made in preventing the disease,

Mozambique's AIM news agency reports.A total of 3,924,832 malaria cases and 2,091

related deaths were reported in Mozambique last year."To defeat malaria, greater

cohesion and coordination of efforts is required, and a greater involvement of all citizens in the battle against the disease," Manguele said at the commemoration of World Malaria

Day here Friday."We are making efforts to guarantee access to mosquito nets for all

Mozambicans, particularly those who have not benefitted from the spraying programme

and in rural areas where poverty and malaria are strongly linked." Over the last three years, more than nine million insecticide treated mosquito nets have

been distributed throughout the country.Representative of World Health Organisation

(WHO) in Mozambique, Daniel Kertesz, said malaria has caused negatives socio-

economic impact on Africa.In 2012, 80 per cent of 207 million malaria cases worldwide

were reported in the African continent, with 90 per centout of 627,000 deaths in the

region.Kertesz said communities in Mozambique must have adequate access to cost

effective interventions against malaria, including access to good quality anti-malarial

drugs.-- BERNAMA

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