CENTRE FOR SOCIAL ASSISTANCE FOR DISADVANTAGED …

Playtime at the Centre
CENTRE FOR SOCIAL ASSISTANCE FOR DISADVANTAGED CHILDREN Annual Report 2014
2 - Centre for Social Assistance for Disadvantaged Children / Annual Report 2014 Chrisitina Noble Children’s Foundation
Programme Description Established: 1991
Location: 38 Tu Xuong Street, District 3, Ho Chi Minh City, Vietnam
Target Group: Infants aged 0 to 6 who are abandoned/orphaned, Infants from poor families, Infants suffering from malnourishment, cerebral palsy and physical impairments
Local Partner: Ministry of Labour, Invalids and Social Affairs (MOLISA)
CNCF Staff: Nicolas Pistolas, Son Thu Trinh, Tran Thi Ngoc Thuy, Frances Walsh
Monitoring visit: Daily
CNCF Involvement: As Co-director of the Centre, assisted by the Project Manager and the Volunteer Coordinator CNCF is closely involved in the management of the Centre’s operations
Budget 2013: US$ 442,792 Actual Costs $434,9351
Future Plans: Development of sustainable services, especially psycho-social care; on-going upskilling and staff training,
Compiled By: Tran Thi Ngoc Thuy
On behalf of our Foundation and the Sunshine Children of Vietnam, we thank all sponsors for supporting this programme in 2014.
1 Unaudited amount. This figure may change subject to the auditor’s report.
Chrisitina Noble Children’s Foundation3 - Centre for Social Assistance for Disadvantaged Children / Annual Report 2014
Table of Contents
PROJECT ACTIVITIES
• BENEFICIARIES 6
One of the families we support
Programme Background and Overview The Centre for Social Assistance for Disadvantaged Children, or ‘the Sunshine Centre’, as we affectionately call it, is where it all started for the Christina Noble Children’s Foundation.
Christina Noble, was overwhelmed at the plight of the children when she first arrived in HCM City in 1989 and felt compelled to take action and make a stand to help the poor and the forgotten disadvantaged children of Vietnam. Her flagship project was this very project based in 38 Tu Xuong Street, District 3, HCM City, and to this day remains the very heart of the Foundation.
After much heartache and many closed doors, in 1991 Christina was finally able to raise the funds necessary to establish the Social and Medical Centre, in partnership with Vietnam’s Ministry of Labour, Invalids and Social Affairs (MOLISA). The aim of the Centre was to provide care for orphans and children from poor families. At the request of MOLISA, it was renamed the ‘Centre for Social Assistance for Disadvantaged Children’ in 2005 and in the same year underwent a complete renovation.
Today the Sunshine Centre, still at 38 Tu Xuong Street, is a bustling facility providing international-standard healthcare free of charge to children from poor families from Ho Chi Minh City and outlying provinces. Over it’s 23 years of operation, the Centre has provided full time residential care for more than 3000 orphans and children from poor families; thousands
more have received free examinations and treatment at our outpatient clinic.
In recognition of the role of the Centre in the community, MOLISA and CNCF signed a cooperation agreement for a further ten years in 2012.CNCF and The Centre have been recognised on 12 separate occasions for their contribution for medical services to the community.
One person CAN make a difference!
Our aim at the Centre is to provide health and educational care and community development for disadvantaged children:
• Our resident children receive healthcare and an education in a nurturing, safe and friendly environment where their physical, emotional, intellectual and behavioural needs are met. The Centre strives to help the children develop their full potential and to integrate into the community.
• We provide free health check-up services and health education for poor children in the community through our outpatient and outreach clinics.
• We have developed a model of high-quality (bench-mark standard) comprehensive care for disadvantaged children in Vietnam. Our operating model provides a multidisciplinary approach to health services as well as promoting early educational interventions for disabled children.
Care is provided over three floors: a walk-in clinic and our Intensive Monitoring Unit (for babies and infants up to the age of 12-18 months on a case by case basis) on the ground floor, a toddler ‘nursery’ floor on the second floor and a day care kindergarten on the third floor. Children on the ground floor and toddler floors receive full residential care. Children attending the third-floor kindergarten are from poor families in the Ho Chi Minh City vicinity and attend on a daily basis.
Programme Activities
Beneficiaries
This year thanks to the kind support of our generous donors, our Centre has been able to provide life-saving, life-mending support to:
• 142 disadvantaged and impaired children
• 84 of the children were full time ‘residential’ children who lived at the Centre while undergoing care
• 58 children aged between 3 and 4 years from poor families in the HCMC vicinity attended the kindergarten located on the third floor of the Centre on a day-care basis.
• 11,320 patients were seen in either our outpatient or one of our outreach clinics
• By providing children with the care they so desperately need, their parents are able to earn a living and build a sustainable future for themselves and their families. We also provided parents with advisory seminars on simple but potentially life-saving precautions such as food hygiene, hand washing and proper sanitation
Medical Care
All of our residential children have specific needs to be addressed. Some cases are more severe than others, particularly for our children with congenital disorders. This year we have provided onsite specialist and intensive care to children with acute conditions:
• 5 children with Hydrocephalus, • 1 child with Downs’ Syndrome, • 7 children with Cerebral Palsy, • 1 child with a cleft palate and cleft lip • 1 child with serious congenital defects • 1 child with visual impairment
On admission, our experienced and diligent medical team assumes responsibility for the child. Each child is assessed and provided with a healthcare plan to address their specific needs and we monitor their progress daily.
We provide on-site treatment such as physiotherapy and pharmacy requirements. If the condition requires surgical intervention or a more specific treatment, we refer our children to the appropriate paediatric hospital in Ho Chi Minh City.
All our children were covered under a medical scheme that included a general health check and a dental exam.
We hold weekly case conferences for our residential children for us to assess each child’s progress over our three areas of care: health, education and social wellbeing. Each child’s development is also reviewed on a quarterly basis by the entire medical team, including physiotherapy and speech therapists and our nursing staff.
The Centre Our children and their carers
One of our Sunshine ChildrenAt the Centre during Christmas
Practicing walking at the physiotherapy room
Dental check-up
PHYSIOTHERAPY
“There is so much more I want to do here…I want specialists in physiotherapy and psychology to deal with disabled children.”
-Christina Noble, Bridge Across My Sorrows
We provide a specialist programme of physiotherapy-based to assist our children’s quality of movement, function, lung function and to encourage their independence. Physiotherapy treatment included: chest therapy, stretching and movement exercises. Children are also assisted in walking and crawling depending on their developmental stage.
The Centre has two physiotherapists working full-time. They work closely with our medical staff and are included in all case discussions.
In 2014, 21 children received 158 physiotherapy treatments. All children with cerebral palsy or development delay underwent physiotherapy.
We held fewer physiotherapy sessions in 2014 compared to 2013 as we had a smaller number of children with cerebral palsy requiring such treatments. We also had a number of periods of isolation due to outbreaks where a strict policy of restricted access for non-essential personnel, including physiotherapists, was adhered to for containment purposes.
Overall, the quality of the physiotherapy was maintained and all children who received physiotherapy showed progress in their quality of movement.
In 2014 the physiotherapists also conducted close to 100 training sessions for the parents of children with families. This enabled the parents to provide on-going physiotherapy to their
children either after they leave the Centre or when they return home, in the case of outpatients.
VACCINES
The Clinic also continued with its preventative medical care through rigorously overseeing all child vaccinations. All residential children received vaccinations in accordance with the Ministry of Health’s vaccine schedule.
The programme provided 149 vaccine injections to children at the Centre in 2014, more than 3 times as many as in 2013. This was due to a requirement from the Ministry of Health to give all children measles booster shots following the measles outbreaks in 2014.
Staff were also vaccinated against measles as a precautionary measure.
DENTAL AND OPTICAL EXAMINATIONS
Dental check-ups for 123 children including 56 residential children and 67 day-care children were provided free of charge by two groups of local dentists. The rate of tooth decay in the day- care group was high with 38 children (31%) having tooth decay, a lower percentage, however, than last year (35%). 35 children received dental treatment including tooth extractions and tooth fillings.
Staff are following up with the remaining 3 children and their parents who were unable to bring their children for follow up treatment.
No eye examinations were given this year as the check up, which was originally scheduled for December 2014, was postponed until March 2015.
DISEASE MANAGEMENT
In 2014, 56% of the children in the Centre contracted acute infectious diseases, which primarily affected our residential children. Illnesses ranged from serious ear, nose and throat conditions to respiratory and digestive problems and skin diseases.
During the year the Centre unfortunately had three separate hand foot and mouth outbreaks, affecting 36 children: in May (12), July (14) and August (10) and one measles outbreak in April, affecting four children.
The Vietnamese Ministry of Health releases limited information about such communicable diseases but according to reliable local media sources, the Ministry had asked municipal and provincial health departments to increase preventative measures to combat the spread of hand-foot-mouth disease as by early May 2014 there had been two deaths and over 17,400 cases2 of the disease recorded in the country.
The government advised of the need to prevent combined infections of hand-foot-mouth disease with measles, pneumonia and other respiratory illnesses and to ensure personal hygiene by preventative measures such as washing hands with soap, cooking food well and making sure children wash regularly. All of these precautions are followed as a matter-of-course in the Centre but with so many vulnerable children in close cohabitation unfortunately infections still arose. The World Health Organisation reported that there were over 100 childhood deaths from the measles outbreak in Hanoi3
2 Ministry demands tighter prevention of hand-foot-mouth disease, 03/05/2014, Vietnam plus 3 WHO website Viet Nam series ‘Measles Control in Vietnam’: http://www.wpro.who. int/vietnam/mediacentre/features/measles_ control_vietnam_2014/en/ No available data for Ho Chi Minh City
alone. According to WHO statistics it is still one of the leading causes of death in children globally, especially in resource-poor regions of the world.
In order to contain the outbreaks additional rigorous health measures were undertaken. We introduced the use of two new isolation units, which were built to both isolate infected children as well as to prevent more children from becoming infected. Visits of all non-essential personnel, including physio and speech therapists and our volunteer team were also prohibited during periods of isolation.
Thankfully, although three of our children had to be transferred to the paediatric hospital for treatment, the outbreaks were limited to a small number of children who all recovered fully.
Nutritional Care
Proper nutrition plays a key role in the Centre as many of the children suffer from malnutrition and other related health issues. To aid in the children’s health recovery they are provided well-balanced meals, nutritional supplements, milk, and careful monitoring to ensure they are gaining weight in accordance with their age and height.
The following table shows the rate of recovery from malnutrition in 2013 and 2014
Year
Total
Lunch time at the Centre
Lunch
Each child receives three well-balanced and nutritionally dense meals each day, prepared to strict guidelines. We introduce a new menu each week to ensure our children receive a wide variety of nutrients and minerals.
Our children who are malnourished also receive the appropriate amount of nutritional supplements.
Children suffering from digestive disorders are given pureed food to allow for easier eating, swallowing and digestion.
We monitor each child’s height and weight to ensure they are gaining weight in accordance with World Health Organisation standards for age and height.
VITAMIN A SUPPLEMENT:
The Centre was proud to be selected again by the Ministry of Health as one of the Centres that form part of the National Vitamin A Programme run by Ho Chi Minh City’s Health Service. Vitamin A is necessary for the development of vision and growth and the health of skin and mucous membranes. The government provided the Vitamin A supplements free of charge and all residential and day care children received the doses of Vitamin A between May and September. A total of 593 Vitamin A doses were given to 172 children from the Centre and 421 children from our outpatient clinic.
At the special needs class Colouring at the kindergarten
Kindergarten lessonsLearning
Educational Services
SPECIAL NEEDS EDUCATION
We provide special needs educational classes for our residential children on our toddler floor and inclusive education classes for children with slight developmental delays. Our main goal is to help the children develop their own tools for living a more independent life: language and non-verbal communication, fine and gross motor skills and to encourage independent activity and decision making.
In 2014, the Centre recruited a full time special needs education specialist who organised individual 20-minute one-on-one sessions along with group sessions. 11 children with severe developmental delay conditions such as cerebral palsy and hydrocephalus attended these classes. The teacher designed individual education plans for each child according to their learning ability. A volunteer assisted the teacher with these sessions, as required.
We measured each child’s progress to ensure key goals were achieved. Across the board children with developmental delay showed a marked increase in concentration levels and started to have more interaction with the caregivers and visitors.
We have also agreed key milestone indicators to be included in the 2015 annual report.
INCLUSIVE EDUCATION
Our toddler group children who are equipped to do so begin attending kindergarten from age 3. Our aim is to provide the children with an opportunity to participate in mainstream
schooling and experience the social interaction benefits this affords. Some of the tangible benefits we have identified in our children from inclusive education classes are: increased levels of comprehension, communication and concentration; the children become more co-operative and expressive and follow their peers by example.
This year 10 of our residential toddlers were able to join our kindergarten class.
NURSING CLASS
This year, because we have a full-time special needs education teacher, for the first time in the Centre’s history, we are able to offer tailored pre-school education classes for our resident toddler group of children. We have already seen a marked improvement in the children’s cognitive development as a result of these classes. We hope to be able to continue these classes into 2015 and beyond.
KINDERGARTEN – DAY CARE
Our day care facility is available for community children aged 3 to 4 years old who come from poor families. There are four kindergarten teachers in charge of the two classes of a maximum 25 children each.
Before enrollment we conduct a home visit to ensure the family’s living conditions and circumstances are in keeping with the enrolment criteria for poverty-stricken families.
Once a child is enrolled we make an extensive assessment, taking into account physical wellbeing, awareness, language and speech development and abilities. Our classes follow the Vietnam National Curriculum for early school education but
teaching methods are modified to meet our children’s learning needs. We have continued to focus on learning through play and fun activities. In 2014 there were 40 children from the community and 10 residential children from the Centre
Excellent Fair Average Total Of Children
Class - Level 1 13 8 1 22
Class - Level 2 22 3 0 25
Total 35
(2,1%) 47
Note: The final assessment was conducted on 47 out of 50 children.
TUTORING PROGRAMME
We want to enable our children to be all that they can possibly be. Our tutoring programme provides our children with a platform to increase and expand their intellectual abilities and aims to mimic the mainstream national curriculum as much as possible.
Our children who are commencing primary education are provided with tutoring under the programme. One of our children, who is already in Grade 1 at our Sunshine School, is finding it challenging to maintain pace with his peers. We enrolled him in the tutoring programme and he received intensive tutoring lessons to help him keep up.
Another child with severe physical limitations received support from the special education teacher to prepare him for Grade 1 next year.
Public Health Services
Our Outpatient clinic and our Outreach programme form our two-pronged approach to delivering health services to poor families in HCMC and outlying districts and provinces.
OUTPATIENT CLINIC
The outpatient clinic provides poor children and their families with high quality paediatric consultancy, treatment and social support. The clinic is located on the ground floor of the Centre and is open Monday, Wednesday and Friday mornings only.
In 2014 we provided 9,058 consultations, including: health examinations, medical treatment, medicines, nutritional supplements, family planning and nutrition and health education to parents.
In 2014, the outpatient clinic closed for 3 months for renovations. This resulted in a reduced number of children turns. Some of the common medical issues of the children treated were malnutrition [38%], ear-nose-throat problems (37%), disabilities [4%] and respiratory diseases (12.4%). Along with medical treatment, children suffering from malnutrition were provided with free food and milk. The parents were also taught how to care for their children’s nutritional needs using inexpensive and readily available food.
According to our pre-treatment assessment, over 33% of the families we saw at the clinic travelled for long periods of time, some in excess of four hours, to bring their children for consultation and treatment. These families represent 33% of total number of patients this year. The remaining families were from poor areas on the outskirts of Ho Chi Minh City.
Outpatient clinic waiting room Outpatient clinic admission desk
Parental health education talkHealth-check at the outpatient clinic
Over the past few years, however, we have noticed a trend of decreasing numbers of families travelling long distances. We undertook an evaluation in 2013 that highlighted the increasing cost of travel as a barrier for most families.
PARENTAL HEALTH EDUCATION
Our healthcare strategies are both end and front-loaded; we cannot rely on the high quality of our medical services alone to achieve the wide-sweeping improvements to children’s health that we are aiming for. We also need to look at educating children and their families in relevant healthcare issues.
Research shows that children – who in our experience are the most energetic, enthusiastic and open to new ideas – can also be powerful agents for changing behaviour, like hand washing with soap in their families and in their communities.
Over the past year we held six Community talks focused on healthcare preventative measures. Nearly five hundred parents attended these informal talks, designed to make them feel comfortable enough to be receptive to new ideas and raise questions, as necessary.
Date Topic Attendance
Mar 2014 Age-appropriate diet for children 51
May 2014 Measles and preventive measures 54
June 2014 Hand-foot-mouth disease and
preventive measures 45
preventive measures 200
COMMUNITY OUTREACH PROGRAMME
With declining numbers of families able to make the long journey to HCMC, our outreach programme has become an increasingly important way to ensure poor families receive appropriate medical care.
Our monthly community outreach activities take place in District 8, which lies on the outskirts of Ho Chi Minh City. In 2014, the Centre cooperated with Enfants et Developpement, a French NGO, to provide on-site health check-ups and examinations for poor children aged 0 to 5 years in District 8, one of the poorest districts of Ho Chi Minh City where a majority of the population are poor immigrants. This outreach activity was organized once per month. A total of 1,282 children benefited from this programme. Among them, 659 suffered from malnutrition and received monthly monitoring.
In addition, we also conducted another four outreach trips to the remote villages of Ben Tre Province and Long An Province. 981 children were given free medical examinations and free medicine and milk. The malnutrition rate of this group was 26%.
Due to staffing requirements we can only see a maximum of 100 patients at each outreach clinic. In 2015 we are increasing the outreach clinic to twice per month to meet the rising demand.
Some of the families we support - Community outreach activity
Children from the kindergarten ready to perform Volunteering
Volunteers at the centreDuring a celebration
Psychosocial Care
VOLUNTEER PROGRAMME
Our Volunteer programme provides an additional level of care and support to our children over-and-above the daily care provided by local staff. In Vietnamese society, it is not yet widely accepted that children should receive stimulation, targeted sensory development and educative play.
In this way our volunteers supplement the care provided by our local staff by devoting entire days to playing with children, organising activities such as arts and crafts, sensorial activities, music, dance and sports. They also assist the Centre staff with their daily work duties, maintain a daily chart of each child noting particular personality traits, behaviour issues and achievements and help in special education classes using the knowledge they have gained in their interaction with children with special needs. Volunteers also assist carers and medical staff in taking children to medical and dental appointments outside the Centre.
As part of our Volunteer programme, our volunteers also help with twice weekly excursions for the children. In 2014, the volunteers organised 48 excursions. These are vitally important to our children as they provide some of the only opportunities the long-term residents of the Centre get to experience activities taken for granted for able-bodied children: regular visits to nearby parks, trips to the city zoo, an ice cream shop on wet days and even to a concert. When the weather prevents excursions outside the Centre volunteers provide alternative activities, such as painting, foam and dress up.
In 2014 there were 23 full time volunteers, 14 from Ireland, 4 from England, 2 from Sweden, 1 from Australia, 1 from Denmark and 1 from Scotland.
There were also 5 locally-based part time volunteers who came in to provide additional support:
• Two helped out with excursions, • One was a “dedicated baby volunteer” working only
with babies to provide care and exposure to sensorial development play and activities,
• One Vietnamese volunteer came in to tutor a child in mathematics
• One volunteer assisted with administrative duties for part of the year.
CELEBRATIONS
The children participated in a number of celebrations during the year including going away parties for children who were leaving the Centre and volunteers ending their three-month stay. There were also birthday parties, a Halloween fancy dress party, Children’s Day and Christmas. The children performed a variety of songs during the events, including Pharrell William’s “Happy” and “Rudolf the Red Nosed Reindeer”.
The volunteers helped organise, choreograph and deliver practice sessions, prepared and made costumes, and participated on stage with the children. Some of the children also had an opportunity to attend an in-house concert by an Irish troupe, Mick Moloney and Friends.
Success story *The child’s name has been changed to protect his privacy
Nam* - a courageous four-year-old boy is a beautiful, engaging young boy with a shy smile who has become an inspiration to those of us who know him.
He entered the Centre at just 6 months of age suffering from hydrocephalus. He was abandoned at birth, moved to an orphanage and then transferred to the Centre for care. He had already undergone one major surgery when he came to us, but required a second surgery shortly after when he was just nine- months-old.
Even after the surgery Nam was unable to do anything that a normal child his age could do. He had no independent movement; he could not roll over, hold his head up or even babble as babies do.
Initially it appeared there was little hope that he would ever improve and would be locked in a persistent vegetative state. However, with time and patience, the skill and dedication of our medical staff and their support team have paid off.
Over the past three years Nam has undergone intensive physiotherapy and the results have been amazing. He has slowly developed his muscle strength in his neck so that he could support his head. Then his arms became stronger and he progressed to being able to sit up on his own.
Once he could sit the physiotherapy team started working on his mobility. Nam was fitted with leg braces and a special helmet for his head. He then began the slow, arduous journey to walking.
Today, he is able to stand independently and walk for short distances. He can say short sentences and has shown the whole team how willing he is to learn new skills. He can identify different objects, calls people by their name.
Of course all of this has been incredibly hard work for Nam. He is incredibly independent and strong-willed. He makes it very clear when he doesn’t want to do something but he is also communicating with his carers and adores them and likewise, we absolutely adore him.
We are continually amazed at his progress and continue our work with him with the ultimate goal of ensuring that one day he will be in a position to be completely independent.
One person CAN make a difference. YOUR donation can make a difference.
One of our Sunshine Children
If you or your organisation are interested in supporting this programme in 2015/2016 please contact our Foundation. It is only through the kind generosity of others that we are able to continue our work with some of the world’s most vulnerable children.
Christina Noble Children’s Foundation - Vietnam [email protected] www.cncf.org
“The future of our world is the future of our children, our beautiful children.
For many of them, it is a matter of giving them back their future, giving them a life, giving them hope and giving them
a childhood they deserve.”

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