Confidence makes all the difference in caring for mothers and babies

Greater confidence in doctors and midwives is perhaps the greatest result of the ALARM International Program course that was given for the second time in September 2013 in Zimbabwe in partnership with HPIC. The course places an emphasis on practical learning and covers best practices in emergency obstetrics over five days.

Dr. Dante Pascali said that the course empowers the participants. “They go back with knowledge and skills. They feel confident that they can make a difference,” he said in an interview with HPIC. Dr. Pascali, an obstetrician-gynaecologist based at Ottawa Civic Hospital and member of the Society of Obstetricians and Gynaecologists of Canada, was one of the trainers along with two other trainers from Canada and three Zimbabweans who were students in September 2012. “When I saw the Zimbabwean trainers – who were students themselves last year- in action, I was very impressed,” he said.

In total, there were 40 students, about a third were doctors and the rest were midwives and nurses. “Some had travelled up to 900 km to be there!” Dr. Pascali said.

“We had meals together, which allowed for fantastic exchanges. The Zimbabweans are experts in treating HIV. When I asked individual participants about the impact of the class, they would say things like ‘I feel confident. We will improve the quality of care at my hospital,’ ” Dr. Pascali said.

The trainer from Ottawa described the class as “the right people with great attitude. They participated because they genuinely want to improve the quality of care at their hospitals and clinics.”

The participants face “unbelievable working conditions” according to Dr. Pascali. “Here we see 30-35 patients a day. In Zimbabwe, many doctors are seeing 90-100 patients a day and many patients have malnutrition, HIV, malaria, infectious diseases.”

HPIC’s local partner in Zimbabwe was the Zimbabwe Association of Church-related Hospitals. “Those trained have been enriched, most of them appreciated the shoulder dystocia (dangerous situation that arises when a shoulder becomes stuck during childbirth) and delivery of twins and breech cases,” wrote Roseline Jack-Chidziva of ZACH. “On behalf of ZACH, I would like to thank HPIC and SOGC for the valued service you are rendering to Zimbabwean mothers and infants in the communities of Zimbabwe through equipping health professionals in maternal health.”

One of the participants, Sister K. Flerence Chipango of St. Rupert Mayer Hospital, Chinhoyi, wrote a letter to express her gratitude for the training. The AIP was “an empowering workshop for me and many others. It has replaced all my fears and anxieties about maternity calls with confidence. The passion of the facilitators showed their deep concern for mothers and babies.”

“During this course I had an opportunity to practise operative/surgical vaginal deliveries and my confidence has increased,” said another participant, Dr. Vimbai Moyana-Muguto of Hwange Colliery Hospital in Matebeleland North outside Bulawayo. “This means there will be less operative or caesarean sections.”

Local trainer Dr. Chamunyonga Felix, an obstetrician-gynaecologist at Bonda Mission Hospital in the Eastern Highlands Region, near Mozambique, says that the ALARM International Program course will have a lasting impact: “The greatest impact is the development of my skills and the skills of other participants and the communities we serve.”

For details gleaned from the reporting submitted by participating hospitals for the six-month period after the first AIP course in September 2012: http://bit.ly/174Smpo

HPIC’s new look and logo

Our valued partners on our mailing list are the first ones to see the first product to feature our new branding: our 2013 Christmas/Holiday Gift Catalogue.

 

HPIC’s Gift Catalogue will be arriving in the mailboxes of donors and partners beginning this week. To coincide with the mailing, we have flipped the switch on our website and facebook page to feature the new logo.

 

Our new logo represents who we are and leaves room for where we are going. The cross represents our mission of medical relief and our values (integrity, respect, compassion). The arrow represents the delivery of medical aid all over the world. The arc in the arrow evokes the shape of the globe. HPIC is the acronym of Health Partners International of Canada. HPIC will be our name in English and French. Our new tagline Delivering health & hope captures the essence of our mission. The colour blue ties our new brand to the old brand and unites us with our sister organizations in the Health + Hope Alliance, a global movement to increase access to medicine. Blue skies are emblematic of optimism and better opportunities. Blue is the color of loyalty and faith.

 

HPIC has not changed who we are and what we do. We are dedicated to increasing access to quality medicine and improving health in the developing world. HPIC accomplishes this through a global network of partners and by following best practices for charities identified by Imagine Canada. We work according to the WHO Guidelines for Medicine Donations and we carry out all our projects with the greatest respect for our beneficiaries without any discrimination.

 

It is the hope of HPIC’s board of directors that this modest project to create a new visual identity and messaging will help create greater awareness and support from our partners and potential partners.

 

HPIC will be doing a full-scale launch in winter 2014.

 

Central Medical Storage Update

“We had people working for 20 or 25 years on inventory management who had no idea how to manage stock.” 

–          CMS Director, Dr. Waahidi

The National Central Medical Stores (CMS) is the warehouse facility responsible for the storage and management of all medicines used in Kabul’s medical hospitals and clinics. The CBAM project has worked with the CMS to help them receive and manage pharmaceuticals and supplies more efficiently, as well as to improve their gender sensitive policies and environmentally sound procedures. The partnership also works to increase staff’s ability to track and control all shipments and deliveries going in and out of the warehouse.

When the CBAM team arrived in 2010 to conduct an appraisal of the CMS, a few important issues were brought to light immediately. The area around the main storage building was littered with debris that had accumulated over years, the warehouse was in disrepair, and there were no standardized inventory systems in place. Further, there was no temperature control system or ventilation in the storage facility and inefficient storage conditions resulted in the loss of medicines through waste or expiration. Finally, the CMS lacked the methods to properly dispose of these types of expired or unusable medicines.

A priority at the start of the project was to clear the CMS property and storage facilities so that the space could be used more efficiently and appropriately. The parking lot was paved to reduce the amount of atmospheric dust and a shelter was built along the back of the medicine storage building in order to protect the stocks from water. Maintenance was also made a priority and three large industrial vacuum cleaners and a basic tool kit were provided for the staff’s use.

The workspaces for staff were improved as well. The two existing bathrooms were completely renovated and two more were built, along with a washing station and a kitchen area for the staff to use. These efforts have been made to increase the quality of life for staff, namely with regards to hygiene and nutrition.

The CBAM project is also supporting the construction of a new storage building at the CMS to provide staff with more room to conduct safe disposals of medicines, as well as to store more pharmaceuticals and supplies. The clearing of the land for the construction took place in the spring and the structural work has begun. The stock room is expected to be completed in the coming months.

Improved Safety and Security

When the CBAM project began working with the CMS, the staff was working in a facility without access to protective or safety gear. The CBAM project has since provided equipment such as protective clothing, a trolley for the transfer of waste, and a carton packing machine. A new front gate was also installed and barbed wire was strung around the front walls so as to deter any breaches in security.

There have been important changes in safety in the CMS.  Firstly there are changes in the way we store medicines and there are also improved safety standards for the staff. We have better equipment, safety gear and uniforms and all these things are helping.” – CMS Director, Dr. Waahidi

 

Operations

Another important initiative for the CMS has been the ongoing development of Standard Operating Procedures (SOPs). Currently, 166 have been written and are pending Ministry approval before being translated into Dari. These SOPs provide staff with standardized work procedures they can refer to, ensuring continuity in their quality of work and assisting the organization in operating up to international standards. According to Dr. Waahidi, these SOPs are a priority for the CMS, “The SOPs are a very important addition to our work. It is contributing to the long term sustainability of the CMS and as guidelines for standardized operation.”  

Perhaps the most significant work being done at the CMS has been the provision of training to staff, many of whom have been working at the facility for years without regularly scheduled or standardized training sessions. According to CMS management, the training provided to staff to date has had a significant impact on their quality of work. “The most important activity that has happened is the trainings. We had people working for 20 or 25 years on inventory management who had no idea how to manage stock.” The training has led to a significant decrease in delays when processing orders. Managers have also noted a real improvement in staff attitudes since the facility renovations and trainings have begun. “Staff members used to come to work and were focused on their paycheck more than anything. Now they are more focused on their jobs; they are more invested in their work,” he explained while citing an example of a staff initiative to renovate part of the CMS.

A series of trainings have been provided to CMS staff with CBAM support. These include a 10-day-training session on Medicines and Stock Management for staff from the CMS, the QC Lab, as well as Ministry and hospital staff. The project also provided training in Warehouse Operations and Management, which was conducted in the United Arab Emirates for five CMS staff. The training in the UAE was specially formatted for those who participated to also be able to train others upon their return.   Finally, CMS staff joined four participants from provincial health directorates in Jalalabad and Kandahar for three days of training in Dubai on Warehouse Operations/ Management. These participants were able to present the topics covered to their colleagues who had stayed in Kabul.

Upcoming trainings planned for staff include a pharmaceutical waste disposal training for the provinces in September and a gender awareness training for CMS staff in later in the Fall.

CMS Database

Another important aspect of CBAM’s contribution to Afghanistan’s storage and distribution of pharmaceuticals is the creation and implementation of a new and much needed database. “The development of the database is a fundamental need for us as well,” the CMS director told HPIC staff with regards to the ongoing work on implementing the new system.

The CMS staff, in collaboration with CBAM, identified the need for a functional computerized database system for the daily management of stock within the warehouse. Prior to this development, the inventory had been tracked through a paper-based system. This computerized database would allow CMS staff to track expiry dating and locate stock more efficiently. The database could be accessed by staff across various departments within the CMS in order to allow for the effective monitoring of stock throughout the warehouse. It would also facilitate timely reporting with a fast and efficient way to generate required government forms and reports. It is also anticipated that the database will, in coming years, be expanded and linked through the internet to similar databases running in other MoPH departments. This will allow for improved coordination and information sharing regarding pharmaceutical supply and needs forecasting.

 

 

 

Medicine urgently needed for Syrian refugees

More than two million Syrians have fled their country and more are leaving every day. The United Nations is calling this the worst crisis since the Vietnam War and the greatest threat to peace.

The Syrian refugees have many needs and one of the most basic is the need for medicine and proper medical care.

HPIC is planning several medical relief projects for Syrian refugees.

One of the first projects will be to provide essential medicines for the more than 30,000 refugees at Domiz Camp in the Kurdish part of Iraq. We expect to provide 50 emergency medicine packs in September, which would provide 30,000 treatments.

In addition, HPIC will be moving more emergency packs to treat refugees at other camps.

Lastly, a major project involving Health + Hope Alliance partner IHP-UK aims to provide over $2 million of bulk medicines to camps in Lebanon and Jordan.

Every dollar donated to HPIC can provide at least $10 of medicine for Syrian refugees.

Help Syrian refugees access medicine

  • Donate any amount to help send medical relief now
  • Carry a Physician Travel Pack on a medical mission to a camp
  • Connect HPIC with health professionals planning a medical mission
  • Connect HPIC with any community efforts to help Syrian refugees

 

More information:

Tel: 514-822-1112 or 1-800-627-1787

Email: info@hpicanada.ca

Web: www.hpicanada.ca

Facebook: www.facebook.com/hpicanada

 

HPIC is a not-for-profit relief and development organization dedicated to increasing access to medicine and improving health in the developing world. Since 1990 HPIC has provided over $418 million in medicines and medical supplies donated by Canadian healthcare companies.


Pediatric Surgical Team’s life-transforming week in Uganda

More than 100 children received life-changing surgery when a pediatric surgical team from B.C. Children’s Hospital went to Uganda in March 2013.

“The team was very well-equipped to offer the best surgical care to children from economically challenged families,” wrote Dr. Erik Skarsgard, Head of the Pediatric Surgery Department. “Our team’s goal is to increase access to free surgical services and to help enhance capacity through teaching, research and child advocacy.”

This year was the third time the team has gone and they plan to return in April 2014. A total of 107 children received free surgery, more boys than girls since urologic care was available. The main conditions were birth defects and problems with the gastrointestinal system. The team was able to do full reconstruction.

One boy who received free surgery was little Brian. Dr. Eleanor Reimer reported that “he received exemplary surgical care and anesthetics thanks to the wonderful contributions of HPIC. Specific needs provided for Brian’s surgery were: local anesthetics, propofol and pain blockers, sutures and antibiotics.”

The team was equipped with about $12,000 worth of essential medicines and surgical supplies in the form of a Physician Travel Pack and a Special Physician Request.

“Soroti Regional Hospital serves a very large catchment area,” wrote Dr. Reimer in the team report to HPIC. “There is overcrowding in the wards and it is severely resource constrained. There is hardly any medicine in the pharmacy. Mulago Teaching Hospital has intermittent availability and/or quality of medicines, such as antibiotics and anesthetics.”

“We will definitely work with HPIC again for our next trip.”

There is a Ugandan television report posted on Youtube; search Pediatric Surgery Mulago or use this link: http://www.youtube.com/watch?v=uDoSpRfBKOg

 

Mothers and babies saved thanks to ALARM training

The reports are in and HPIC is pleased to announce that in just the first five months following the ALARM International Program training in September 2012, lives have been saved at several hospitals thanks to HPIC’s investment in emergency obstetric training.

HPIC’s partner, the Zimbabwean Association of Church-related Hospitals, submitted reports from six hospitals that sent personnel to the weeklong course given by the Society of Obstetricians and Gynaecologists of Canada.

The Chikombedzi Mission Hospital stated that there were no maternal deaths in the last quarter of 2012 and the first two months of 2013. “This is is mostly due to good management of post-partum bleeding,” the hospital report said. “We have no ready access to blood and other blood products. In (the operating) theatre, three women almost bled to death from the placental bed on different days. Oxytocic drugs were of no use as they continued to pour blood. Almost out of ideas, the doctor remembered the ALARM training and applied multiple uterine square compression sutures (the Cho technique). Everyone was so apprehensive as minutes gave way to hours and hours gave way to days. And then we realized we had done it. Were it not for the ALARM training, these three mothers would definitely have bled to death. Our ALARM training saved their lives and brought smiles to our faces.”

The Bonda Mission Hospital also reported that no maternal deaths had occurred over the same period despite having four cases of major post-partum bleeding. They also reported that breech deliveries were 100% successful with the manoeuvre that they had learned and that resuscitation of babies has greatly improved. Fourteen out of 15 asphyxiated babies survived in the first quarter thanks to the better resuscitation techniques.

“One case of shoulder dystocia was encountered,” the Bonda report states. “Unfortunately the baby had already died (at the clinic prior to transfer to the hospital) and the head was stuck on the perineum. The McRoberts manouevre was tried unsuccessfully and then the rotation of shoulders was done with success. Thumbs up to the ALARM Method imported to our practioners.”

At the Morgenstern Mission Hospital, “the training produced confidence on a day to day basis,” the report states. The report listed numerous improvements including better care of preterm babies “even with limited resources” and vigilant monitoring that identifies “deviations from normal labour earlier.”

Out of the six reports, there was only one maternal death reported and that mother had died at home before being brought to the hospital.

 

 

Two little girls healed on Medical Brigade Mission to Honduras

More than 800 people in two Honduran communities received basic medical and dental care thanks to students at McMaster University in Hamilton, Ontario.

McMaster Global Medical Brigades sent about 25 students in June equipped with medicines and medical supplies provided by HPIC.

Over four days, 839 patients were seen. “The families are typically too poor to have a balanced diet so all patients were given multivitamins as well as albendazole (for parasites),” reported team member and McMaster student Sophia Duong.

If Sophia could thank HPIC’s donors, she would say: “Thank you so much for all your support. Your medications were used to treat many beneficiaries who are the breadwinners in their households. By providing medication to improve their health, you are providing their entire family with a brighter future. In addition, you have also benefitted us, the students. By providing us with the tools for this trip, you have allowed us personally to learn to be more compassionate people and to grow to be better leaders tomorrow. We know the patients would also thank you from the bottom of their heart. Muchas Gracias.”

Sophia especially remembers two patients, both little girls, who were treated during the Brigade. She told the story of Angelica in her report: “Angelica was seven years old and came in with complaints of sore ear and headache. The doctor diagnosed her with an ear infection and prescribed her amoxicillin and ibuprofen. Though simple, this treatment was important for her because the proper medications are not easily accessible to this community. Even small infections, if left untreated, could easily fester into more serious infections, especially with the lack of clean water. This girl made an impression on me because at first she was afraid of the doctors, but after we gave her some toys and encouragement, she eventually trusted the doctors enough to let them exam her. At the end of the day after taking her medicine, she was feeling much better and running around and playing with us.”

Lola was another girl who Sophia remembers well. She was 14 and had advanced tooth decay. Lola’s parents asked the dentist to remove all her teeth to avoid dealing with complications in the future because it is hard to get to a dentist. “The dentist convinced them into getting as many of the original teeth saved as possible. Lola was scared and we assured her that she would have anesthetics and acetaminophen afterward. The dentist removed some teeth and filled in many others. Lola was back for a check-up the next day. She felt a lot better. If we weren’t there to help, Lola may have had no teeth for the rest of her life. With the help of doctors, dentists and donors, we were able to make an impact to those in need.”

Mother and triplets doing well thanks to Mother-Child Health Kits

A mother and her baby triplets were among the first people in the world to benefit from HPIC’s Mother-Child Health Kits.

In partnership with the Rotary Club of Dartmouth (Nova Scotia) and the SEMAFO Foundation, HPIC provided six prototype Mother-Child Health Kits to health posts in rural Niger in May.

“These communities are very poor,” said Chantal Guérin, Director General of the SEMAFO Foundation. “The Mother-Child Health Kits have certainly helped a lot already.”

According to field staff, the triplets’ father who is unemployed approached the foundation for help. The kits arrived just in time to provide the tools and medicines needed for following the three baby girls and their mother for six months.

Niger has the highest fertility rate in the world, very high maternal and infant mortality rates and 63 per cent of the population is living under the poverty line.

The frontline healthcare workers are keeping monthly reports about the kits’ use. The first project logs were provided to HPIC at a meeting in July following Guérin’s trip to Niger. Initial feedback showed much appreciation for the blood pressure monitors, which they did not have prior to the project.

Later this summer, in partnership with the Evangelical Missionary Church of Canada (EMCC), HPIC will be providing 30 Mother-Child Health Kits for distribution to the EMCC’s network in Haiti. Other projects are also being developed in Kenya and Benin.

The Mother and Child Health Kit is an important initiative within HPIC’s Mother and Child Health Program. HPIC aims to support the ability of frontline health workers to provide responsive, quality care to young children and to women throughout pregnancy, childbirth and the early post-partum period.

 

Wide range of essential medicines supplied to Gaza at challenging time

HPIC has received a report from ANERA, an NGO working in Gaza in collaboration with the World Health Organization, about a major medical relief effort of the Health + Hope Alliance.

At the time the shipment of essential medicines arrived, the WHO reported that more than 150 items of essential drugs were still out of stock.  HPIC, a founding member of the Health + Hope Alliance contributed 100 emergency Physician Travel Packs to this Alliance operation.

Mostafa El-Ghosein, ANERA’s In-Kind Manager in Gaza, described the donation as “timely, varied, high-quality and plentiful,” arriving soon after the Gaza crisis.  The six air shipments of long-dated, chronically needed medicines and supplies arrived within three weeks. “This speedy delivery enabled us to respond quickly to the emergency,” he added.

Half of the donations were designated for Gaza’s biggest hospital, Shifa, which handles 75% of the area’s surgery patients. The rest of the medicine was distributed to local clinics and other hospitals. “The recipients expressed their sincere appreciation for the exceptionally long expiration dating of the medicines that have filled enormous gaps of essential drugs for both children and adults suffering from chronic diseases.”

Ahmad El-Najjar, In-Kind Field Monitor, said the large quantity of medicines has enabled hospitals and clinics to serve a wider community. “We were able to quickly provide 19 local partners with medicines and supplies. Most of ANERA’s recipient clinics and hospitals in Gaza cannot afford to purchase medicines and disposable medical supplies, so they rely heavily on the regular donations that ANERA provides. Otherwise they would have to send patients to private pharmacies to purchase expensive medicines that are not always available.”

This emergency shipment meant that needy patients could access essential medicines at their local clinic or hospital, free of charge.

 

Neonatal Handbook distributed across Zimbabwe

Doctors across Zimbabwe now have a practical and quick reference guide for treating young children. This is an essential tool for the country’s 800 doctors who care for a population of over 13 million.

HPIC, with funding provided by the Rotary Club of Dartmouth, Nova Scotia, revised and reprinted Peter Iliff’s Neonatal Handbook, originally printed in 1995 by the late doctor. The 2013 edition in memory of Dr. Peter Iliff was distributed to 500 doctors across the country, which is struggling with one of the highest under-five mortality rates in the world.

“The Neonatal Handbook is a resource to help doctors do their job better,” said Glen Shepherd, President of HPIC. “Available free of charge, it is first being distributed in pediatric wards and then throughout Zimbabwe. Eventually, it will be available as a free downloadable pdf on our website so that other doctors in Africa and around the world will be able to access it.”

HPIC’s mission is to increase access to medicine and improve health in the developing world. An emphasis on the needs of mothers and children runs across many HPIC projects. “The well-being of children is a foundational value of a civilized society and ensuring children’s health is one of the best investments that society can make,” Shepherd added. “The publication of this Handbook is an expression of the priority HPIC has attached to the health of mothers and children and is a reflection of its importance in our mission, programming and our fundraising.”