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.

RESULTS & OBSERVATIONS

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.

I.            KEY OBSERVATIONS and RECOMMENDATIONS

 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.