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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.

Source: http://citihope.org/wp-content/uploads/Cameroon_Needs_Assessment_Mission_Report_WEB_EDIT.pdf

Mulder

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

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