Highlights of September 2017 Trip to Sankuru in the DRC for Training

1) Training of Core Groups of Health Zones on MDA-PCT Against NTDs, and 2) Special Field Visit to the Historical Village of Embangombango

General Objectives

Ø  Train/retrain members of the core group of each of 16 Health Zones (HZ) for the renewal and strengthening of the knowledge and skills to ensure successful implementation of the 2017 integrated MDA-PCT  against Oncho, LF, SCH and STH.

Ø  Visit for first-hand experience people in the village of Embangombango near the town of Lusambo, the administrative capital of Sankuru Province. Historically, Embangombango is known to be the epicenter of the largest population of onchocerciasis-related blindness in DRC and most likely also in all oncho-endemic African countries.


1.             MDA-PCT Training phase.

Ø  This 3-day long phase was attended by 2 representatives (Medecin chef de zone and nurse supervisor) from each of 16 health zones targeted for integrated MDA-PCT for control and elimination of 4 NTDs endemic in this region.  Also in attendance was the head of the Division Provinciale de la Santé (MCDPS). The Provincial Minister of Health (MPS) who was expected to officially open the workshop was called up or dispatched at the last minute by the Governor for an urgent meeting at Lusambo, the the provincial administrative capital.

Ø  After the official opening ceremony led by the MCDPS, the remarkably lively, participatory and productive training sessions were kicked off and the jovial atmosphere continued for the next 3 days (Photos 5,6,7,8).

Ø  The success of the training was confirmed at least in part by the results of the post-test, scores were all well above the cut-off point.

Ø  It was very interesting to hear and learn for the first time the apparently successful adoption and use of the concept of ‘Cellules d’Animation Communautaire’ (CAC) recently introduced by the MSP as a substitute to  the existing strategy of community directed drug distributors (CDD) as an effective mean of mass distributions of drugs or other useful commodities to address healthcare issues at the community level. CAC members are paid with funds from a common pod contributed by various partners at  fixed rates.  Conceivably, this approach  circumvents or addresses the constant issue of attrition among the traditionally unpaid CDs and other well financed situations or programs  that actually pay their community workers.  More is to be learned about the extent of the application as well as the success of this strategy.

Ø  With reference to UFAR’s newly instituted evaluation form « Checklist for Training »,  the following general observations can be made :

o   Overall the major objectives were met – very active participation by the attendees,  and proper transfer of appropriate knowledge and skills to the next level (CDs and teachers) was undoubtedly achieved.

o   The interest, engagement and trend towards appropriation or ownership of the program by the local and provincial authorities were quite evident – active participation by the head of the DPS, contribution to poorly or unbudgeted coffee and lunch breaks, and kind offer to satisfy local transportation needs of those of us who were visiting guests.

o   Commendable efforts by the project coordination team to ensure smooth arrival and departure, as well as good lodging accomodations for the visitors, and the fulfillment of the 3-day agenda were greatly appreciated.

o   From the planning and organizational standpoints, weak features were the lack until the second day of  the expected training package, including the agenda, the training manual and other handouts, and the respect for time allocation.

o   A major deficiency in completing the UFAR’s Check List was the inability of the project coordination team to provide several documents and/or reports for verification, including reports from previous training sessions, reports on the meetings held in preparation for the current training workshop and documents confirming the delivery of requested PCT drugs.   


2.             Field trip to Embangombango

Ø  MDA-PCT drug deliveries :  This long field trip (500 km) provided an opportunity to take along and deliver available PCT drugs for MDA to health centers of several health zones located along the way (Tshumbe, Wembo Nyama, Lubefu, Minga and Lusambo)(Photos 9,10,11).

Ø  Lusambo :  The traveling team arrived safely at Lusambo, the administrative capital of the Sankuru province  at 6 PM on Thursday, 28/9/2017.

o   Lodging  - arranged at the Congrégation des Frères de la Charité (Photo 12)

o   Guests of the Governor -  Upon learning of our arrival, the Governor of Sankuru Province, Mr. Berthold Ulungu, immediately invited us to his official residence at 7 :30 PM where we were unexpectedly served a wonderful dinner. Coincidently, the Provincial Minister of Health who was unable to officially kick off the just completed MDA-PCT training at Lodja was also present at this gathering.  We use this opportunity to share and discuss the purpose of our trip with both the Governor and the MoH.  Both immediately expressed their full support of our mission. Especially our conceivable long term goal of eventually conducting a RAAB study with the possibility of establishing a facility designed to provide vitally needed assitance to the well known and confirmed large population of  blind people due to onchocerciasis as well as those due to other causes.

Ø  Embangombango :

o   The medical staff of the Bureau Central of the health zone of Lusambo kindly offered to take and guide us to Embangombango on their vehicle (13).  The village is located at about 24 km of narrow and trecherous road conditions from  Lusambo (Photo 13).

o   We arrived at the historical village at  9 :30 AM with plans to spend about 3 hours (Photo 15).

o   The first 15 minutes were spent meeting the chief, Ukanda On’uya , his nobility and several villagers (Photos 15,15a,15b,15c,15d).

o   Then, in response to our request  to chief Ukanda, about a couple of dozen blind people showed up within 15 minutes (Photos 16, 16a).  We were told that many of the blind people are very reluctant to come out and expose themselves on occasions such as this, out of shame, embarrassment, or lack of someone to assist them.

o   In our routine check, we noticed very much to our surprise, several children some much younger than 5 years old with onchocercial nodules (Photos 17,18,19).  The explanation provided to us was that regardless of the age of the children, mothers always take them along to do their daily chores along heavily infested rivers and creeks with tiny blackflies infected with Onchocerca volvulus, the riverblindness parasite.

o   Interestingly, someone among the villagers who came to meet us remembered a visit several years earlier by a team from WHO that came to the village by helicopter.  This is the team that eventually confirmed the rumor of an extremely high rate of blindness, 99.5%, among the adult population in this village.

o   The current total population of Embangombango is 422 of which 46 are blind.


 a.       The replacement of the Sankuru project’s 12-year old vehicle should be considered a serious and urgent matter. It’s not safe to use this vehicle other than for short local trips. For each of my 3 visits so far to this project for MDA activities, I have had to rent commercial vehicles that are not always reliable.

b.      UFAR used the opportunity of a field trip to Embangombango  with the convenient and timely delivery of complete supplies of Albendazole, and Praziquantel for 5 health zones located along the way to Embangombango. Similar annual supplies of Mectizan were still not available in the country at the time of this mission.  The  reasons for the persistent long delays in the annual deliveries of the PCT drug supplies in DRC should be promptly determined and resolved in order to ensure timely availability of these drugs in the future.

c.       Random epidemiological studies using skin snips should be carried out in Embangombango and in surrounding villages in children 5 years of age and younger with nodules, several of whom were surprisingly seen during this field trip.  

d.      If the observed and highly unusual presence of nodules in children 5 years old and younger can be widely confirmed, a strong consideration should be made to include this previously excluded segment of the oncho-endemic population in the annual MDA campaigns.

e.       Seeing dozens of blind people pitifully struggling to come out from their homes and isolated private dwellings in order to join our public meeting was depressing  and heart-breaking.   These have truly been neglected people with proven shortened lifespan, due to poverty, misery and depression. We would strongly recommend conducting the Rapid Assessment of Avoidable Blindness (RAAB) survey in this region, similar to the one carried out in 2015 in the Uturi Nord region kindly supported by Sightsavers.  Conceivably,  based on the historical data as well as the current observations, the prevalence of blindness in the health zone of Lusambo from the proposed RAAB study will be high enough to justify establishing a modern healthcare facility that would also provide appropriate support to the long neglected blind population.



Highlights of July 2016 Trip to the Katanga South region of the DRC

This report provides the highlights on a visit of the Katanga-sud project, during the time between the end of the 2015 and the beginning of the 2016 integrated mass drug distribution for control and elimination of selected NTDs.   Mrs. Nancy Beatty, a UFAR supporter in charge of fundraising activities and social mobilization was Dr. Shungu throughout this trip.


a.      General Objective

Review the overall outcome of the 2015 campaign of integrated MDA of preventive chemoterapies against NTDs and determine the level of readiness for the 2016 campaign.

Visit and remittance of UFAR golden medal with UFAR logo to a few village chiefs, a reflection of our gratitude for their engagement in support of the program.


b.      Specific Objectives

                                                   i.      Random check of the 2015 treatment records for 2015 : registers, annual technical report, financial documents including receipts

                                                 ii.      Review the chronogram and discuss planned activities for 2016

                                               iii.      Discuss timely availability of drugs and adequacy of registers

                                               iv.      Visit and remittance of the UFAR  golden medal with the UFAR logo to couple of village chiefs


2.      METHODS

a.       Basic direct observation,  review of various documents including registers, discussion with medical staff, community leaders and community distributors

b.      Random check of treatment registers

c.       Discuss drug availability, storage, timing for delivery and distribution



a.       Air travel Kinshasa – Lubumbashi on 21 July 2016, accompanied by Mrs. Nancy Beatty,  arrived late evening, 10:30 PM.  Hired a taxi to Hotel Park.

b.      Completed the required formalities of meeting briefly with the provincial Minister of Health and/or cabinet members, 25 July 2016.

c.       Travelled to 2 villages during the following 2 days, including the village of Swamba  located at 50 km from Lubumbashi.

d.      Left Lubumbashi at 11 PMon 28 July 2016 and arriving in Kinshasa on 29 July 2016 at 2 AM.  Mrs. Beatty  made it to the airport for her 9 AM flight back to the US.


4.      RESULTS

a.       Dr Alice and her staff reserved us a very warm welcome, a hospital working environment and productive village visits.

b.      It was heart-breaking to find the wonderful, energetic, outgoing and strong partner, chief Ghislain Kapito of the village of Swamba with a serious post-op infection that had spread to both of his thigh bones.  Swamba is one of several villages that Nancy & Dick Beattyhave adopted for support under UFAR’s adopt/save-a-village program.

c.       With very few exceptions, data in most of the registers examined were properly entered.

d.      At the time of the visit, only 3 out of 1o health zones hadsufficient supply of Mecti from previous year to engage in the distribution

e.       Plans for 2016 were not in place at the time of the visit, however, people were looking forward to a timely delivery of the drugs and to the continued expension of integrated MDA activities and to maintaining or improving treatment coverage for each disease-drug combination.



a.       This project is supported by at least 4 separate partners and the lack of coordination especially with regards to a timely transfer of pledged funds to the project is a critical issue.  What’s even worth is that one of the partners hasn’t even submitted their plan of activities and budget for signature by the MoH and the implementor partners this late into the fiscal year.  Better communication, collaboration and follow-up actions should be emphasized and constantly reminded by the current USAID-based chair of the consortium of partners working on the NTD elimination programs in DRC.

b.      Timely custom-clearance of the various PCT drugs and ensuring coverage of costs for their timely transport to the field for successful integrated MDA  is another crucial issue.  The MoH should play a major leading role by working with drug manufacturers, WHO. the various NGDO partners and transportation agencies well in advance.

c.       Closer supervision and monitoring of treatment data into the some what complex integrated registers by the community drug distributors (CDDs)  should be strongly encouraged.Good training and retraining of CDDs is important but so is regular random checkingof the registers by the trainors to confirm proper and adequate training.

d.      Commitmenty, support and appropriation of the NTD elimination programs and goals by many village chiefs continue to be demonstrated and acknowledged by the presentation of the UFAR gold medal displaying UFAR’s logo to deserving chiefs.

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