Project Criança 2007 – 2008

(Mindelo, San Vicente, Cabo Verde)

 

Health supervision visits ( well child checkups) to children from 2 to 4 years old in nursery schools, community centers, health clinics etc.
in collaboration with the local health authorities ( Delegacia de Saude, dr. JM d’Agujar )Education and professional development for health care providers (physicians, nurses, etc.) and support staff

Over 2000 visits have been performed to children born in 2003, 2004, 2002 in collaboration with the local nursing staff.

– Medical History
– Objective examination
– Weight, Height, Head Circumference
– Blood pressure
– Neurodevelopmental evaluation
– Vision, Hearing and Speech screening
– Red Reflex
– Cover and Lang test
– Visual acuity (HOTV table from 4 years)
– Speech evaluation with a brief survey for parents /teachers and tables to evaluate the child’s competence
– Educational meetings have been planned for health care providers (physicians, nurses, etc.) and support staff, followed by 1:1 tutorship where participants have acquired knowledge, skills and attitudes for preventive services, including well child care, immunization, screening tests, within the context of health supervision guidelines.
– All the relevant clinical informations have been recorded using an electronic medical record to develop an epidemiological registry.
– Health Education material discussed and printed in portoguese.
– Ophtalmic Screening: out of 1341 subjects (the 2003 Cohort of children born in Sao Vicente, Capo Verde) 1301 (97,02%) received an ophthalmic evaluation during a paediatric visit in collaboration with CBM Italia (pres. dr. M. Angi, Padova, Italy)
– Local Health staff has been trained to perform cycloplegic autorefractometry . Non collaborative children were re tested, under the supervision of an ophthalmologist, who added fundus examination.

Project Criança…Next

Health Promotion activities will be performed in the future by local health care providers supervised by Italian Primary Care Pediatricians. Educational projects for health staff from other islands will be supervised directly by the local health care providers of the Delegacia de Saude of San Vicente who will also prepare al program of health supervision visits to be implemented initially in Sao Vicente .

Madagascar

General Information

Madagascar is in the Indian Ocean at nearly 10,000 km from Italy . The African coast are about 400 km west separated by the channel Mozambico.E ‘ the fourth largest island in the world . Is home to 5% of the world’s plant and animal species , 80 % of which are found only in Madagascar. Among the best known examples of this exceptional biodiversity are the family of lemurs , three families of endemic birds, many species of chameleons and the typical baobab . The adjective associated with Madagascar (used to indicate the native language , ethnicity and citizenship ) is Malagasy .

Malagasy is the first language of Madagascar, but the population is fluent in French too (because of the island’s colonial past ) .

The land area is 587,000 square kilometers (about twice Italy ) with a population density of 28 inhabitants per square kilometer ( 197 Italian ) . Currency: The currency is the Ariary : 5000 Ariary are about 2 euros.
You eat with 7-10000 ariary … 20,000 with lobster.

Population in Madagascar stand eighteen major ethnic groups , mostly of mixed Asian and African , Arab and European elements .
Only a minority , located primarily in the highlands , has physical traits and cultural distinctly Asian . Recent research suggests that the island was first colonized by people of Malay origin , arrived between 2000 and 1500 years ago. DNA studies show the origins of the populations malagasy for about half Malaysian and half African , with some Arabic influences , particularly Indian and European coasts .

Religion : about half the population of Madagascar is dedicated to local traditional religions , which tend to be centered around the idea of the bond with the deceased . Especially the Merina in the highlands strictly follow their traditional rites .

They believe that the dead ancestors become gods and carefully follow the happenings of their descendants still living. Both the Merina that Betsileo have a practice of ” reburial ” said famadihana , in which the remains are removed from the graves of the dead , wrapped in new shrouds, and then placed in their graves after a certain period of ceremonial festivities .
45% of the Malagasy are Christian, divided about equally between Catholics and Protestants.
In many cases, the Malagasy Christianity retains some traits derived from traditional beliefs , such as those related to the cult of the dead. Not rarely a Christian minister was invited to a presidere famadihana .

The Catholic Church, which bases its missionary activity on the concept of inculturation, does not reject these practices , the Protestant pastors are generally more prone to condemn as superstition or even worship of demons.
on coastal regions there is a minority of Muslims , belonging to the Indo- Pakistani ethnic groups or originating in the Comoros.

Climate: Father says Emilio Cento, a Jesuit who lived there for 50 years , there are two periods:
the rainy season and the season when it rains , there are officially two seasons (remember that we are on the Tropic of Capricorn ): < br > the dry season , from April to October , and the rainy season , from November to March .
The ideal time to be everywhere is between September and October, and between April and June.

The hospital

E ‘ was built a few years ago and is still in the process of adjustment .
The structure is as follows: thatched cottages to the paramedics lay stone built cottages for medical volunteers (9 seats) and the two doctors Malagasy sedentary ( handyman , not surgeons ) , house sisters (7-8 plus some novice nuns ) , laboratory block , block surgeries , operating room, department of medicine and surgery , maternity and paediatrics ( in total can be from 50 to 80 patients ) , X-ray room , storage medicines and materials ( fully stocked ) , the church.
Much of the structure is supported from the hospital in Aosta that invested capital , means and men.

the needs are certainly surgical , also because there is a surgeon in the radius of 600 km ( activity that provides a lot of visibility ), but not only that: there are many medical cases , both adult and pediatric , as well as the post-operative support .
exists within the limits of a programming staff turnover doctor but often there are periods when there is no European .

Basic care is provided by two doctors Malagasy and Sister Leah, who has trained some local kids . More 4:00 to 5:00 sisters alternate between the various tasks of care, diagnostic and kitchen.

Intervention

The organization of the intervention is made by Anemon non-profit organization in accordance with the Sisters Hospital.
The group should be composed of: one or two pediatricians (at least one with expertise in the delivery room… Sister Lea is a good help), a gynecologist and two general surgeons or a surgeon and an instrumentalist. May help dermatologists and ophthalmologists. The ideal group is not more than 6 units, for logistical reasons. The bulk of the work should be done in the villages around it is to fix what is fixable and is to drain and not surgical diseases, to be sent to the hospital to begin with and also here to create a control contact, preferably computerized , even very simple.

Ivory Coast 2008

These initiatives have participated in their personal capacity epartecipano individual members of our association in collaboration with other NGOs or non-profit organization.

AYAMÈ – COSTA D’AVORIO di Leo Venturelli

I spent the Christmas holiday period in 2008 on a visit to children in the village of Ayamé with the excuse of going to visit my daughter who is conducting a 6-month internship as a doctor specializing in Infectious Diseases, part of a cooperation agreement between the University of Pavia and the Agency for Ayamé 1 of Pavia, an NGO that about 15 years is committed to providing support, training, human resources in this country in the south east of the Ivory Coast, surrounded by lagoons, rivers, but also full mosquitoes and then chronically ill with malaria.

The village is located near the border with Ghana has a population of about 10,000 inhabitants, concentrated in the urban area , and other 20-25000 for the majority dispersed in forest around , especially towards the north.

In the village there is a public general hospital grew up with the funds of the Italian Cooperation .

It consists of four departments: Medicine, Surgery , Obstetrics, Paediatrics, with a total of 100 beds. There is a minimal service radiology and laboratory analysis that performs basic tests and microscopic parasitic research. The hospital is a co-management between the Ivorian Ministry of Health and the Italian non-profit organization ( Agency 1 of Pavia for Ayame: www.puntoapunto.org ); linked to paediatrics and obstetrics is the Pouponnière ( the orphanage ) , a complete Italian management with regard to the funds and the health department guaranteed by Emy, professional pediatric nurse for 20 years in Africa .

Hospital medical care, hospitalization, investigations are all chargeable services, as happens in the Cote d’Ivoire. If the patient is ill she has no money, is not even in the hospital, or it arrives and begins the ordeal of collecting sums of money in the “course of treatment” for them to continue.

Services performed by SMEs (Maternal and Child Protection) are free, such as surgery for people living with HIV, with the administration of antiretroviral drugs free of charge, as supported by the WHO and various NGOs (also participates in the Agency of Pavia).

My mission was focused on orphanage and routine visits to all its guests: 50 children ranging in age from a few days of life ( one of them was born and brought in their structure during the first days of my stay : the mother died soon after birth bleeding ) up to 3 years old.

The Pouponnière is a functional since 2001 , children from families in dire straits and a social worker selects access.

For younger guests, mainly Ivorian ethnic group, but also the children of refugees in Burkina, coming to the 57% of families living in the villages around the are , 43% from villages scattered in the bush, called Campement : there exists no electricity , the water is ensured by the presence of pits and there are no toilets : the forest and just advances.

The huts are built with pressed wood and mud. The roofs are thatched. The viability is ensured by dirt roads , during the rainy season the traffic problems increase for the clayey nature of the soil, which prevents the absorption of rainwater.

The means of transport are incidental and related to private taxis who serve in the stretches of road joke easier and more feasible , from the nuclei of the houses in the villages to roads impassable route is usually on foot.

The fathers of the children, as the majority of the male population finds work in the plantations of oil palm , coffee, cocoa, of which the area is full: the economic status of immigrant populations is generally the lowest of the local inhabitants, Agni ethnicity.

There is a registry efficient and often the people scattered in villages in the forest are not registered , then you do not have access to reliable data on the extent of population , number of children, etc…

47% of children Pouponnière was born at home , 37% at health centers (SMEs), only 16% born in the hospital.
The use of SMEs as part of the population is limited primarily to the lack of culture health , due to the presence of groups of immigrant population from neighboring states (Ghana, Burckina, Mali), for the real difficulty coping with travel and transport for simple checks in pregnancy or childbirth, considered physiological situations.

About half of the children who come to the orphanage has problems of prematurity and immaturity , the rest as much as 35 % of child mortality under 5 years caused by a poor peri- neonatology.
The children of HIV-positive mothers are more rare for the drastic reduction of AIDS over the past 5 years since are possible treatments with anti-retroviral drugs, free of charge.

The nutritional status and disease present in children ‘s Pouponnière fully reflect the health situation of children in the area, although in the nest care and attention to the health problems are not lacking.
Malaria is the disease most widespread: almost all children are cyclically affected, although there are no screens on the windows.

The most common form is due to Plasmodium falciparum: the therapies are consolidated and associations themselves of salts of quinine and artemisinin, a drug used in resistant forms.

Anemy related to attacks of malaria and malnutrition is kept under control by regular and continuous dispensing of iron-containing products to the little ones, also checked periodically through blood tests (hemoglobin ).

The visits: the children were subjected me to visit pediatric weight control has been carried out by staff in the day, before the consultation, the history and the present exposure of the problems was the Italian director and / or Ivorian head nurse.

The parameters auxological children were collected on growth curves of the carnet de santé ( health records of the mother and child ), the majority of children is around between the 3rd and 10th centile.

Many children were found suffering from skin infections : impetigo in 20% , 12% genital mycosis , scabies 4% . With regard to the respiratory system 19% of the children examined had asthmatic bronchitis forms of probable infectious origin .

Children ‘s psychomotor development Pouponnière have on average lower than that expected for chronological age.

The varus is most evident in small and often persists beyond the physiological limit, at least for our parameters. Many of the younger guests were found to have deficits in language functions, sensory and behavioral broadly linked to the condition of direct affective deficits (lack of parental figures unique ), typical of all the shelters for abandoned children and the lack of attention to these problems in a context where priority is given to nutrition and infectious diseases.

Some mention of food aspect: at the Pouponnière power is exclusively milk for the first 5 months, even longer in the case of premature or low weight.

Then we introduce the flour -milk and then the first meals, according to commonly accepted patterns . The oil is added to the jelly palm, most often used by local people (finding on the spot due to the presence of industries and plantations).
We do not use baby food with meat or fish, but using meat (chicken) and fish (of the local lake) shakes After the year the power is enhanced by local produce such as rice, cassava, foutou ( mixture of banana and cassava mixed), the foufu (banana and yam flour, cassava tuber -like).

The experience at the nest/orphanage Ayamé has allowed us to note a high standard of care and health care, especially when compared to the inconvenience and situations of the villages and the backgrounds of children (poor control of malaria attacks, difficulty in care for payment to the total load of the families of medicines and investigations). Even in terms of food , it was found a hygienic control of food of a good standard and supply in line with the traditions and local culture, correct, complete, adequate, as often happens in families of origin.

The aspects are found insufficient relative to poor hygiene of the skin, easily and periodically subjected to fungal infections, scabies, impetigo and a lack of neuro- sensory stimuli targeted to the acquisition of language, sensory, phonetic skills relevant to the age.

Some proposals for the near future: – Encouraging work on neuro- sensory abilities of children , preparing training activities dedicated service personnel; has also decided to make a poster on the development of relational, mental, motor of the child, which can serve as a reminder to staff on the control of babies.

– Monitor the progress of skin infections with a more accurate action of individual hygiene of children ( diapers more appropriate )

– Carry out regular visits from their children by the medical staff of nursing care, monitoring weight, height, general neuromotor development , visual and auditory : for this could be a useful ad hoc software programs ( medical records ) and its on-site training session for the staff of the nest.