Microsoft word - cameroon needs assessment mission report web edit.doc
CitiHope International (CHI) Cameroon Needs Assessment October 17- 20, 2010 Mission Report CHI Team Members: Morgan Hester, Director, International Program Development (MH) Dr. Nicole Kershner, Medical Advisor (NK) Executive Summary The CHI team’s goal for its visit to Cameroon was to conduct a needs assessment of the country’s healthcare system and determine their specific needs for medicines and medical supplies for the Coca-Cola Africa Foundation (CCAF) funded Medical Relief Initiative. This trip also served the purpose of strengthening relationships with local Coca-Cola business unites, as well as implementing partner NGOs. Other important information gathered focused on importation procedures and information on the CitiHope Guidance for Partners reporting and monitoring practices was provided. In Cameroon, the CHI team’s visit was coordinated by Don Dussey, Senior Public Affairs and Communications (PAC) West Africa, Coca-Cola Africa. CHI was introduced to the Fondation Ad Lucem Au Cameroun (FALC), the NGO that will serve as local implementing partner. Other meetings included the Ministry of Public Health and site visits to FALC hospitals and Government hospitals. This assessment report provides further detail on the goals and outcomes of each meeting and site visit as well as notes and recommendations about CHI’s implementation of a medical relief program. Saturday, October 16, 2010 Arrival in Yaounde. CHI team discussions and briefings with Don Dussey in advance of assessment. Sunday, October 17, 2010 Meeting: Introduction to Ad Lucem Present: MH, NK, Dr. Bidjogo (General Manager of Ad Lucem), Dr. Mpako Ediage Martin Ad Lucem (FALC), represented by Dr. Bidjogo (General Manager, lead of NGO) and Dr. Mpako (Chief of Medicine at Hopital de Mbouda, western Cameroon) had reviewed the Guidance for Partners package and assessment questions and were very prepared for the visit, with a robust schedule and preliminary answers to many of the assessment questions. FALC operates 13 hospitals and 23 health centers around the country and are non-profit, providing accessible health care in predominantly rural areas (though in some urban). The private sector (including FALC) provides 40% of health care in the country.
Their health care is in line with Government health care prices, at about $1.50 per visit to the hospital, and $3 for a specialist. They provide comprehensive health services with lab testing, medications, etc. but try to limit costs for patients as much as possible. The two doctors indentified the following as top diseases (most prevalent that they see and treat) in Cameroon: Malaria, typhoid, parasitic infections such as worms, upper and lower respiratory infections (including strep pneumonia, staph, clepsicela), hypertension and gastro duodenal ulcers. Diabetes is an emergent disease on the rise and is a public health issue. Meningitis is an issue in the western part of the country in the dry season. Cholera is endemic and becomes epidemic in some areas such as the north and in Douala (note: there is currently an outbreak in the north). FALC hospitals have whole blood supplies (not blood parts) and blood banks in Douala and Yaounde. Each hospital has a nutrition expert due to the impact of nutrition on HIV patients, but patient’s families provide food for hospitalized patients and clean them and their area (all hospitals have outdoor kitchens). Malnutrition (protein) is a big problem in Cameroon and for many patients (8 out of 10 in the west) and if we were able to acquire food products these would be welcome. The Government has an immunization program that provides a package of vaccinations for free (tuberculosis, polio, DPT, measles and tetanus). Other vaccines such as typhoid and hepatitis are sometimes available but patients must pay for them. There is a good response to immunizations and the program includes home visits. The Government provides the vaccines to FALC hospitals. The Government also received HIV drugs from various donors and provides these to FALC hospitals, but there are shortages. The Government also provides TB treatment for free. Infant and Under-5 mortality is extremely high in Cameroon (131 per 1,000 live births), and the top three causes are: 1) malaria, 2) diarrheal diseases and 3) respiratory infections.
Site Visit: Hopital d’Efok Present: MH, NK, FALC This is FALC’s first hospital and was established in 1936. It I a sprawling, well- organized and clean facility that is multi-disciplinary and in a rural area near Yaounde. There are 2 doctors and 30 nurses, and 3 doctors that come from Lille, France for 4-6 months each year (surgeon, anesthesiologist, etc.). Number of Doctors and Nurses: 2; 30 Outpatients per day: 50-60 Beds: 60- 40 are full at all times Treatment Areas: pediatric, orthopedic, maternity, surgery
Most Common Presenting Issues: trauma (car accidents), malaria, typhoid, births, surgeries The hospital has a pediatric unit (beds have bednets), maternity ward (beds have bednets) surgery unit, male and female rooms, ICU. Most surgeries are orthopedic (there are many people who come in for trauma from road accidents), appendix, hernia, caesarean sections, fibroids. The ICU was clean and sterile with a scrub room for surgery. When we visited there was a 7-week-old preemie in an incubator. The Pharmacy was clean, well organized and stocked, and all FALC pharmacies have cold chain. The Government has a generics policy. FALC likes for patients to leave the hospital with drugs, not a prescription, as many people buy fake or less quality drugs on the streets, and they’d rather ensure patients leave with what they need to get better. Top Needs: Antibiotics, anti hypertensives, disposables (IV tubes, catheters, sutures, gloves, splints, surgical packs), anti-diabetics, malaria drugs, bed nets (would like to cover all pediatrics), anti-fungals (such as fluconazole, diflucan), anti- inflammatory drugs and broad spectrum, 1st line antibiotics for pneumonia, orthopedic and radiology training.
Site Visit: Hopital de District Obala (Government hospital nearby) Present: MH, NK, FALC, Dr. Onomo (Hospital Director) Much of the new equipment at this hospital was provided through funding that came to the Government from the African Development Bank (ADB). Number of Doctors and Nurses: 7; 54 Beds: 120 Treatment Areas: ER, internal medicine, HIV/AIDS, Tuberculosis, pediatrics, maternity, surgery (general and orthopedic), lab/imaging (x-ray, ultrasound), diabetes, ophthalmology, dental Most Common Presenting Issues: trauma, severe malaria Most women do not come for antenatal care and come just to give birth. HIV testing is free for pregnant for women and $1 for all others. Site Visit: L’Hopital D’Obobogo Present: MH, NK, FALC This FALC hospital is small and is located outside of Yaounde (a very populous area) to serve the urban population. We met with the Chief Medical Officer, Dr. Selomme, and she gave us a tour. They have a building project for a larger facility in Yaounde, but it is not yet funded. Number of Doctors and Nurses: 2; 15
Outpatients per day: 15- 20 Beds: 22 Treatment Areas: maternity, surgeries (hernia, appendix, caesarian sections, fibroids, general surgery but no orthopedics) Top Needs: malaria drugs, Ciprofloxacin or other drugs in the family, omeprazole, anti-acids, bactrim, Nicardipine (anti-hypertensives), insulin, glyburide, metformin, disposables (sutures, gloves, syringes, catheters, tubes, puncture needles for spinal taps, adapted needles for drainage), Incubator, autoclave, generator (4+ power cuts per day), electric aspirator
Monday, October 18, 2010 Meeting: Ad Lucem- Yaounde Headquarters with all staff Present: MH, NK, FALC (including Board President, Dr. Mpako and Dr. Bidjogo), Don Dussey (Coca-Cola) Don and FALC first met to discuss the potential CitiHope partnership in Douala in March. FALC is pleased with this partnership and knows that to succeed they must have partnerships. Dr. Mpako gave a presentation with an overview of FALC’s history, hospitals, statistics and needs. The objective of FALC is to promote the health of persons in the general population and those in poverty especially. They aim to deliver high quality health services at a low cost, and for free when possible. The President of the Board of Directors was present at the meeting and gave a warm welcome to CitiHope. The Board includes members from many sectors, public and private, including the Ministry of Finance, Ministry of Health, the National Episcopal Association and others. Ad Lucem has a central pharmacy warehouse in Douala with cold chain capacity. They are present in 4 out of 10 regions in Cameroon. They employ around 1000 staff, making them second after the Government in employment. Patients per year (all facilities): 156,059 Patients per month (all facilities): 13,005 Patients hospitalized per year (all facilities): 50,454 Patients hospitalized per month (all facilities): 4,500 The main difficulty identified by Ad Lucem is in procuring of drugs, and lack of equipment. There are no incinerators or generators, and a lack of specialists. The Foundation needs an ambulance, but does reach patients in inaccessible areas on motorbikes. After the meeting, a smaller meeting was held and relevant parties worked together on a draft MOU. Ad Lucem felt that it had been very helpful for them that CitiHope had provided the Guidance for Partners materials in advance, as well as an outline of the assessment. Meeting: Ministry of Public Health
Present: MoPH Director of Pharmacy Department, Director of International Partnership and Secretary General. MH, NK, Dr. Bidjogo, Dr. Mpako, Don Dussey Ad Lucem is a tremendous partner, very well esteemed and a great choice for a partnership with CitiHope. The MoPH and FALC have an MOU in place between them as a pledge of cooperation. The International Partnership division stands ready to assist in our efforts. A discussion about customs and importation guidelines for donated drugs was had. We were given donation guidelines, and Ad Lucem will summarize the key steps for CitiHope. Site Visit: Hopital Cite Vert (Government Hospital in Yaounde) Present: MH, NK, Dr. Bidjogo, Dr. Mpako The hospital was established in 1986. It has an ambulance and terrific lab with a CD4 machine. They are carrying out a study on a product from Spain that is a nutritional supplement drink in a tetrapak for HIV and TB patients. The pharmacy is computerized and very clean and organized. All Government hospitals have a price list for drugs posted in public. Any assistance here would be a boost, according to the Chief Medical Officer. Number of Doctors and Nurses: 11 doctors Outpatients per day: 80 Beds: 70 Most Common Presenting Conditions: Malaria, upper respiratory infections, HIV, gastrointestinal infections, hypertension, diabetes Top Drug Needs: Quinine, paracetemol, ibuprofen, amoxicillin, erythromycin, ciprofloxicin, fluconazole
Tuesday, October 19, 2010
Morning: Work session and discussion with Don Dussey; Drive to Douala with Ad Lucem Wednesday, October 20, 2010 Meeting: Ad Lucem Chief Medical Officers and Pharmacists- Meeting at Ad Lucem Central Warehouse/Pharmacy Present: MH, NK, Dr. Bidjogo, Dr. Mpako, Ad Lucem Chief Medical Officers from various hospitals, warehouse pharmacists, other Ad Lucem staff CitiHope was welcomed to Douala by the Chief Medical Officer of Bonamoussadi Hospital, adjacent to the Warehouse. It was a warm welcome and gratitude was expressed for the partnership, as well as the great needs.
The Central Warehouse is enormous and is clean, well organized with plenty of space for large consignments and a large cold chain room. At any given time the warehouse pharmacists can give a snapshot of inventory and needs of the organization, as they dispense to all Ad Lucem facilities from this central store. There is only one vehicle for transporting the drugs and supplies currently, so in the CitiHope program we will need to assist with transportation expenses. There were drugs from many countries of original and companies. The shelves were organized alphabetically by drug and each drug had an inventory sheet. Site Visit: Bonamoussadi Hospital Present:MH, NK, Dr. Bidjogo, Dr. Mpako, Ad Lucem Chief Medical Officers from various hospitals, warehouse pharmacists, other Ad Lucem staff This hospital serves Douala and is small but efficient and organized. They have a superior lab and have mammography and EKG machines.
Microscopic colitisChris J. J. Mulder1, Ivar M. Harkema2, Jos W. R. Meijer31 Department of Gastroenterology, Vrije Universiteit Medisch Centrum / Free University Medical Centre, Amsterdam, the Netherlands2 Department of Gastroenterology, Ziekenhuis Rijnstate / Rijnstate Hospital, Arnhem, the Netherlands3 Department of Pathology, Ziekenhuis Rijnstate / Rijnstate Hospital, Arnhem, the Netherlands
Programme ATC- Yannick LE MEUR Sunday Concurrent Session: Kidney Immunosuppression: CNI Minimization – Avoidance Protocols 16h00  Efficacy and Safety of Mycophenolate Mofetil (MMF)/Sirolimus (SRL) Maintenance Therapy after Calcineurin Inhibitor (CNI) Withdrawal in Renal Transplant Recipients: Final Results of the Spare-the-Nephron (STN) Trial.  Analysis of Allospe