ARKANGELO ALI ASSOCIATION (AAA)



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BACK GROUND

Since November 2006, Arkangelo Ali Association (AAA) has been providing health services to the destitute populations of Southern Sudan. Its roots go back to the health department of the Diocese of Rumbek, where AAA founders (Mrs. Natalina Sala & Dr. Callixte Minani) had been working since 1997.

The decision of transforming the health department of Diocese of Rumbek into an independent NGO was prompted by the new period of peace that opened after the Peace Agreement between the Government of Sudan and the Sudan Peoples' Liberation Army/Movement (SPLA/M), signed on 9th January 2005. In this crucial moment, AAA wanted to expand its health services to new areas after it had been requested so by the Ministry of Health under the Government of South Sudan (GoSS).

"At the moment AAA operates in five of ten states of Southern Sudan, namely in Lakes, Northern Bahr el Ghazal, Warrap, Western Bahr el Ghazal and Western Equatoria . It employs 300 Sudanese Nationals and 40 expatriate staff (doctors, nurses, laboratory technicians and logisticians). During all these years, AAA has made a deliberate effort to form and train local staff as a main means of building and strengthening local work force. This is a titanic effort in a context where education levels are still very low after long years of armed conflict and displacement.

Also AAA has improved its representation in the field by means of a liaison office in Juba and a support office in Rumbek. Due to the logistical constraints concerning the access to Southern Sudan, AAA has also a regional office in Nairobi, under the auspices of the Verona Fathers (Comboni Missionaries, Kenya Province).

AAA is a member of Bakhita Consortium, a group founded in 2005 of eight Italian, Kenyan and Sudanese agencies working for the development of Sudan and its people with the purpose of fostering a more effective cooperation and collaboration in the implementation of humanitarian and development work in Southern Sudan.

Mission

AAA's mission is to uplift dignity of disadvantaged people through provision of social services with respect of transparency, quality, equity, availability and accessibility.

Vision

AAA believes in the preservation of human dignity.

Aim

AAA overall goal is to improve the quality of life of the people of Sudan by reducing human suffering and improving the social economic status.

AAA HEALTH ACTIVITIES AND OBJECTIVES

The overall goal of the AAA programmes is to improve health of the general population in Southern Sudan. AAA delivers health services with great consideration on Christian values and responsibility with particular focus on vulnerable and the disadvantaged. The organization recognizes that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. AAA health programmes also continue to lay a lot of emphasis on prevention, delivery of quality treatment, care and follow-up of patients and the community. Training the local staff remains an integral part of AAA programmes in ensuring sustained health services.

The programmes are generally aimed at reducing human suffering and social economic burden in Southern Sudan.

The broad objectives of AAA key programs include Tuberculosis and Leprosy control, TB-HIV, PHC, prevention of blindness and Training. The specific objectives, results, indicators, activities and the achievements for the programs are described below. The general objectives are:

Objectives

➢ To strengthen existing TB diagnostic and treatment centers by pursuing high quality DOTS expansion and enhancement, addressing challenges related to multidrug-resistant TB and strengthening the national management capacity by establishing a national TB control department in the Ministry of Health for Southern Sudan

➢ To prevent morbidity and development of deformities in leprosy patients through active case finding

➢ To provide high quality and efficient basic health care services

➢ To provide sustainable health services through continuous training of local (Sudanese) health staff

TUBERCULOSIS PROGRAMS

General Objective:

To strengthen existing TB diagnostic and treatment centers by pursuing high quality DOTS expansion and enhancement, addressing challenges related to multidrug-resistant TB and strengthening the national management capacity by establishing a national TB control department in the Ministry of Health for Southern Sudan

Specific Objective

The expansion of the DOTS services through community based DOTS, incorporating TB services into the primary health care structure, provision of supplies and equipment, capacity building by training of health workers to ensure sustainability of the program and close monitoring and evaluation of the whole program.

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Results

1. A guaranteed regular presence of health personnel in the area providing quality curative and preventive TB health services that is accessible to the local population. The programs aspire to achieve a target cure rate of 85%. People who received TB health education should be able to name at least one preventive measure, and one symptom of TB when interviewed two months after receiving health education.

Indicators

Number of new smear positive cases detected under DOTS, number and percentage of new smear positive TB cases registered under DOTS who are successfully treated, number and percentage of new smear positive TB cases registered under DOTS who smear convert at 2 months of treatment out of all new smear positive cases registered under DOTS.

2. Local personnel adequately trained and capable of providing high quality TB services.

Indicators: Local health personnel trained and their performance assessed periodically.

3. Effective planning, implementation, reporting, monitoring and evaluation of the projects.

Indicators: Planning, monitoring, (reporting) and evaluation system (PMES) developed and operational, internal evaluations carried out regularly.

TUBERCULOSIS PROJECT ACTIVITIES

Result 1:0. Regular presence of TB health personnel in the area providing quality curative and preventive services that is accessible to the local population.

Activities:

1. Upgrading health facility premises

2. Equipping facility with necessary equipment, furniture, drugs and food

3. Establishing a logistical support system

4. Setting up and maintaining a feasible referral system

5. Setting up and maintaining information gathering and analysis system

6. Prompt diagnosis and treatment of TB patients

7. Providing health education to the patients attending the health facility and community

8. Establishment of satellite laboratories in the PHCC to increase case finding

9. Promotion of vocational training for in-patients.

Result 2: Local personnel adequately trained and able to provide high quality TB services.

Activities:

2.0 Training of laboratory assistants on sputum smear microscopy and quality assurance.

2.1 Training of health workers on diagnosis, case holding and treatment of TB patients.

2.2 Regular performance evaluation of local personnel

Result 3: Monitoring and evaluation of the project assured

Activities:

3.1 Formulating a clear Project guideline that includes:

- Detailed work plan

- Details on project Planning, Monitoring and Evaluation mechanism

- Definition of roles and responsibilities

- Training schedule for local personnel and performance assessment.

3.2 Creation and distribution of monitoring tools

3.3 Establishing a performance monitoring system

3.4 Periodic visits of AAA co-ordinators to the project

3.5 Submission and collation of quarterly progress reports

3.6 Internal annual evaluation report

2.LEPROSY PROGRAM

General Objective:

To reduce transmission, morbidity and prevent development of new disabilities in Leprosy patients through active case finding

Specific objectives

• To provide MDT and make it accessible to all patients, improve quality of patient care and prevention of new disabilities.

• To facilitate physical, social and economic restoration of people with disabilities through community based rehabilitation (CBR).

Result 1: Increased awareness on leprosy in the community

Indicators: Health education provided to the community and village volunteers trained

LEPROSY PROJECT ACTIVITIES

Activities:

- Provide information to the community on signs and symptoms of leprosy with strong emphasis that it is curable .The patients should also be encouraged to seek early treatment.

- Avail information on the locations and timing of available services

- Give information about the availability of free treatment for Leprosy

- Strengthen community participation and support to the programs, thus improving their sustainability by organizing the village development committee training courses that highlight the need for patients to be encouraged to complete the course of treatment.

- Requesting the local community leaders, teachers, religious leaders and traditional medicine men/healers to participate in health education activities.

- Organization of special campaigns and commemoration of World Leprosy day.

Result 2: MDT is accessible and completed

Indicators: Number of new leprosy patients detected, percentage of patients who have completed MDT.

Activities:

- Visiting the villages to identify suspected cases of leprosy as early as possible

- Helping patients’ relatives and the community to recognise clinical features of leprosy

- Understanding the importance of treatment and referring such cases to the health facility for confirmatory diagnosis.

- Giving health messages to relatives and the public that once the treatment has commenced there is no danger of possible transmission.

Result 3: Local staff is adequately trained and efficient health services provided including socio-economic activities

Indicators: Number of staff trained on Leprosy, knowledge and performance of the staff, number of leprosy patients referred with complications, uninterrupted supply of MDT and other supportive drugs/supplies .Also timely and regularly submission of reports, training of laboratory assistants, laboratory tests performed, number of leprosy patients and/or family members receiving supportive care e.g. renovation or construction of houses, vocational training or placement in own business, adult literacy classes, provision of household supplies etc.

Activities

3.1. Train health staff and enable them to

- Diagnose and classify leprosy clinically into MB and PB.

- Recognize and manage common complications of leprosy.

- Identify and refer serious complications

- Have supportive drugs to treat common ailments (wounds or leprosy related conditions)

- Maintain a cordial and friendly relationship with all patients and the local community.

- Recognize, treat and refer any patients experiencing drug side effects.

- Maintain proper system of recording and reporting.

- Organize convenient locations and time for the clinics.

- Ensure overall commitment and motivation to eliminate leprosy from the area.

2. Verify and supervise laboratory schedule

3. Monitor recording and reporting system

4. Receive uninterrupted supply of MDT drugs

5. Provide housing, economic, educational and social welfare support

Result 4: Income-generating/ self-supporting activities are provided to the persons affected by Leprosy

Indicators: Rehabilitation activities implemented which includes provision of fishing equipment and distribution of seeds.

Activities:

1. Ox-plough Technology will be introduced in order to increase the land under cultivation leading to high crop yields.

2. Fishing equipment will be distributed in order to promote fishing activities.

3. A variety of seeds will be supplied to ensure good harvest at the end of the season.

Result 5: Self care and footwear programmes are implemented

Indicator: Existence of self-care activities and distribution of appropriate micro cellular rubber sandals

Activities:

5.1. Management of disabilities

2. Use of local materials for self care

3. Setting up of a community based self-care group

4. Regular distribution of Micro cellular rubber sandals (MCR)

The footwear programme is based on the following principles:

- Feet without deformities but with loss of sensation require protection. Practically any shoe can do provided it has a hard sole to protect the feet from sharp objects.

- Feet with deformities increases pressure points together with loss of sensation hence the need to be protected from developing sores and ulcers.

- Grossly deformed feet.

Result 6: Provision of quality care and prevention of disabilities in leprosy patients

Indicators: percentage of new cases that have undergone a disability assessment and are classified (WHO disability grade 1/2), preventive measures undertaken (patients educated on skin care, treatment of superficial ulcers, supportive items distributed and constant provision of physiotherapy), leprosy surgery performed, number of patients benefitting from footwear programme.

Activities:

6.1. Treatment of superficial (simple) ulcers

The basic treatment principles are as follows:

- Provide health education to make the patient understand prevention and treatment of ulcers while ensuring that they take charge of their own treatment.

- Regular foot soaking and rubbing with oil or Vaseline to keep skin moist for as long as possible.

- Taking the weight off the ulcer by:

o Rest (bed rest /sitting down / reduced walking/ walking on the heel in case of plantar ulcer).

o Using crutches, walking sticks or any other support.

6.2. Treatment of deep (complicated) ulcers.

Deep ulcers eventually require surgery. If there is septicaemia (heat, swelling, tenderness, fever, and anaemia) the case should be handled as an emergency and hence a patient is referred to a health facility for immediate surgery.

Such cases are referred to DOR/AAA Mapuordit Hospital, 60 Kms from Yirol town where surgery is routinely done. The basic procedures for septic conditions involve:

- Incision and drainage-opening of an affected area by incising to allow pus to drain

- Sequestrectomy – removal of dead tissue.

- Partial or total amputation, in case of dead tissue (Gangrenous).

6.3. Physiotherapy provided

All patients with motor nerve function require physiotherapy. It should start as soon as the acute symptoms of neuritis have subsided. The patients should be taught on how to do exercises at home. The patients should be informed that physiotherapy does not restore nerve function but only helps to increase and preserve muscle strength. In case of permanent nerve damage, the exercises should continue indefinitely.

6.4. Nutritional needs are covered by food supply

During the period the patient is hospitalized, nutritional support is given to aid in the recovery process. AAA provides high-energy food for patients and some food for caretakers.

LEPROSY PROGRAM STRATEGY

Health Education and Community Participation

Health education is one of the key components in Leprosy control program. Health education provided to the community makes it easier for the project to achieve higher case finding, better treatment compliance and results. The community that is sensitized will always participates by ensuring that its members (who are suffering from the disease) utilize the available control facilities. It should be emphasized that leprosy is an ordinary disease, least infectious and most importantly curable. With early treatment serious deformities and disabilities can be prevented. The community must be educated on how to improve living conditions in their homes and avoid over crowding in order to prevent the spread of leprosy.

Screening

Screening of patients is always important so as to differentiate between the two main categories of leprosy, namely Paucibacillary (PB) and Multibacillary (MB). The length of treatment differs greatly depending with the type of leprosy and therefore it is important to ensure accurate initial diagnosis.

In case a health worker come across a patient who has defaulted in their treatment, it is always important to establish the reasons. The reasons are usually varied but mostly it could be difficulty in reaching the health facility due to disability. In such a case, the medicine should be taken to the patient on a regular basis to avoid development of drug resistance or relapse.

Educating the community will lead to better knowledge and understanding of leprosy thus minimizing social stigma and discrimination associated with the disease. Increased community awareness of the disease will encourage patients to seek medical assistance and promote adherence to course of treatment. This will result to confinement of the diseases within a limited location preventing its spread and finally eliminating it from the community.

Treatment of leprosy

All registered and newly detected cases must be started on MDT regimen immediately the diagnosis is confirmed. The drug combination used is recommended and supplied by WHO. The drug is called MDT which is a combination of Rifampicin, Clofazimine and Dapsone for MB patients and of Rifampicin and Dapsone for PB patients. For patients classified as SLPB, a combination of Rifampicin, Ofloxacin and Minocycline (ROM) in blister packs is issued.

The involvement of the local community and persons affected by leprosy is of paramount importance as it will greatly contribute towards achievement of expected results.

Capacity building

Short training courses will be conducted for local health workers drawn from the general health services program. The aim of this training is to refresh their knowledge and equip them with current skills in the management of leprosy. In addition, community volunteers will be trained to enable them to identify persons with suspicious skin lesions and encourage them to be screened at the nearest health facility. To achieve this, WHO has provided a training kit to all organizations involved in Leprosy treatment

Social and economic rehabilitation

Leprosy is among the leading causes of permanent deformities in the world. Even though leprosy is not fatal, the chronic symptoms associated with it, often afflict individuals in their most productive stage of life resulting in a significant social and economic burden in the society. Patients are often shunned and end up isolated by the community. Persons affected by leprosy face stigmatisation due to their deformities and disabilities that make them dependent on others for support. The social and economic rehabilitation programme is a major priority in AAA for persons affected by Leprosy. The program aims to restore their dignity and make them self reliant.

It has been the norm in Southern Sudan for the health workers to care for Leprosy patients with permanent nerve damage even after completing MDT. This trend of continued care entails the provision of antiseptic, Vaseline, bandages, second hand clothes, soap and other goods. This has led to in an increasing number of people becoming dependent on DOR/AAA services.

The aim of self-care programme is to create independence in persons affected by leprosy and thus reducing dependence on the services of AAA

3. PRIMARY HEALTH CARE SERVICES

General Objective:

To provide high quality and efficient primary health care services

Special Objective:

• To provide efficient Primary Health Care services through prompt diagnosis, treatment and preventive measures. This will lead to reduced morbidity and mortality especially in children under the age of five years and in other vulnerable groups

Results

1. Provision of consistent quality health care

Indicators:

Buildings constructed/renovated, well maintained and equipped, presence of qualified staff, uninterrupted drug and medical supply, laboratory tests done regularly, increase in the number of patients receiving treatment.

2. Provision of comprehensive medical care with integrated public health care

Indicators:

Structure, buildings, equipment for procedures and diagnosis in place and functioning, qualified and specialized staff working, number of patients receiving treatment, elective/emergency or specialized surgery performed, number of patients being referred, uninterrupted drug and medical supply, laboratory tests and laboratory quality assessment regularly done, health education provided

3. Main diseases among children under the age of five years are treated and prevented

Indicators: diagnosis and treatment provided through IECHC strategy, health education given, EPI (Extended Program on Immunization) implemented and functional, malnutrition cases identified and treated, de-worming programs performed

4. To implement an effective MCH (Mother Child Health) program

Indicators: TBAs (Traditional Birth Attendants) trained, equipped and supervised, increased number of TBA assisted deliveries & number of ANC attendees, TT vaccination coverage, number of referrals (with complications during pregnancy and delivery), reproductive health education provided, number of pregnant women receiving anti-malarial chemo-prophylaxis and ITN’s.

5. Local health staffs are adequately trained and able to provide quality PHC services.

Indicators: Local (Sudanese) PHC health personnel trained, performance of local personnel assessed frequently, laboratory assistants trained, VVWs (Village Volunteer Workers) identified and trained, TBAs identified and trained

6. To monitor all PHC activities

Indicators: Planning, implementing, reporting, monitoring and evaluation system developed and operational, supervisory visits conducted

PROJECT ACTIVITIES FOR PHC

Result 1: Provision of consistent quality health care

Activities:

➢ To provide PHC and treatment of secondary diseases integrated into TB/Leprosy units

➢ To construct, rehabilitate and maintain buildings

➢ To train staff

➢ To supply and maintain equipment

➢ Regular supply of drugs and medical kits

➢ To perform quality laboratory tests

➢ To treat patients efficiently and effectively

➢ To offer health education regularly

➢ To prevent goitre through use of iodized salt to the community in endemic areas

➢ To prevent guinea worm through a control program

Result 2:

Provision of comprehensive medical care integrated with public health care

Activities:

➢ To provide a clear structure for inpatient treatment, surgical and emergency procedures

➢ To provide and maintain equipment for surgical and emergency procedures

➢ To have qualified and specialized staff to perform major surgery

➢ To offer specialized leprosy surgery

➢ To have a mechanism of referring patients for specialized surgery

➢ To provide elective surgery to reduce emergency interventions

➢ To supply uninterrupted drugs and medical kits

➢ To perform high quality laboratory tests /diagnostic services

➢ To treat patients efficiently and effectively

➢ To offer health education

Result 3:

Common childhood diseases among children under the age of five year are treated and prevented

Activities:

➢ To provide adequate treatment

➢ To conduct health education to mothers and caretakers covering topics like hygienic practices and breast-feeding

➢ To implement IECHC

➢ To establish efficient cold chain system

➢ To have uninterrupted supply of vaccines

➢ To immunize children through routine vaccination (EPI)

➢ To support national immunization campaigns

➢ To identify and treat malnutrition by providing food supplements and other items

➢ To conduct de-worming program twice per year covering at least 7000 school children

Result 4:

To implement an effective MCH (Mother Child Health) program

Activities:

➢ To improve the skills of existing TBAs

➢ To improve social and economic status of TBAs in the community and to giving them official recognition

➢ To form a link and improve relationship between TBAs, the community and medical personnel

➢ To identify and refer pregnant women at risk of developing complications to the nearest health facility

➢ To refer mothers to ANC for examination and tetanus toxoid (TT) vaccination

➢ To equip TBAs with basic delivery kits

➢ To assist mothers during pregnancy, delivery and during the post natal period.

➢ To recognize, treat or refer early to health centers pregnant mothers with complications

➢ To care for newborn babies

➢ To keep appropriate records in MCH

➢ To monitor & supervise TBAs regularly

➢ To keep TBAs motivated by providing incentives during their training and a regular benefit throughout their service period

➢ To give health education to young girls in preparation of motherhood

➢ To give health education to individuals, family ,community and at the MCH on topics concerning domestic and personal hygiene, nutrition, immunization, STIs/HIV/AIDS, care of the new born baby, the use of traditional medicine and exclusive breast-feeding for six months which may act as a temporary method of family planning and prevention of malaria in pregnancy through chemo-prophylaxis

Result 5:

Local health staffs are adequately trained and able to provide high quality PHC services.

Indicators, activities and achievements are described below under the fourth general objective (training)

Result 6:

To monitor all PHC activities

Activities: (At all levels- PHC facility, village based CHW and TBAs)

➢ To develop standardized health reporting system

➢ To supervise quality and performance of health workers

➢ To monitor recording of laboratory tests done, diagnosis, treatment, outcome, drug order and stock keeping system

➢ To ensure timely and regular health reporting

➢ To collect and analyze data

➢ To use data for health planning

➢ To share information with MOH, UN agencies and other NGOs for better collaboration

4. PREVENTION OF BLINDNESS

The World Health Organization estimates that there were 37 million blind people in 2002 and that the prevalence of blindness was 9% among adults in Africa aged 50 years or older. Recent surveys indicate that this figure may be overestimated, while a survey from southern Sudan suggested that post-conflict areas are particularly vulnerable to blindness

ONCHOCERCHIASIS

The disease is also known as the river blindness and is prevalent in the tropical regions. River blindness is caused by a parasitical worm, onchocerca volvulus. The worm larvae are spread by the black simulium fly, which breeds in the high-oxygen water of fast-flowing rivers. The fly transmits the disease when it bites people, making those who live or work near the rivers vulnerable

When a black simulium fly becomes infected, the worm larvae spread to its saliva glands. When it bites a person, these are passed into the skin. Here they develop into adults and form nodules under the skin. These adults then breed, producing thousands of larvae which spread throughout the whole body , including the eyes. This leads to intense itching in the affected area.

A bite from an infected black simulium fly creates vulnerability to eye conditions such as glaucoma and cataract. But the biggest problem is when the worms die. The reaction of the person's immune system causes inflammation. If this happens in the eye it can cause blindness.

For example if infected at birth with river blindness it is common for people to have become blind by the time they reach their 40s.

Providing a yearly dose of the drug Mectizan in affected areas .It is an effective way to make the adult female worm temporarily infertile, killing larvae. If an uninfected simulium fly bites an infected person who has taken the drug, it will not itself become infected or infectious.

CONJUCTIVITIS:

It is the inflammation of the conjunctiva (the membrane that lines the eyelids and covers the exposed surface of the eyeball). Conjunctivitis can be caused by allergies, bacteria, viruses, chemicals or underlying health conditions.

Treatment of conjunctivitis depends on the cause. Allergic conjunctivitis may respond well to allergy treatment. It may disappear on its own when the allergen that caused it is removed. Cool compresses may help soothe allergic conjunctivitis.

Antibiotic medication, usually eye drops, is effective for bacterial conjunctivitis. Viral conjunctivitis usually disappears on its own. Many doctors give a mild antibiotic eye drop for viral conjunctivitis to prevent bacterial conjunctivitis.

You can soothe the discomfort of viral or bacterial conjunctivitis by applying warm compresses (clean cloths soaked in warm water) to your closed eyes.

In Southern Sudan where health facilities are inadequate those suffering from conjunctivitis, not knowing its seriousness, report to health centers when the infection has really advanced. Most of them at this juncture have tried to cure themselves using local medicine (traditional medicine) or medicine which is not recommended hence resulting in further eye injury and scarring which may later lead to other ophthalmic conditions.

TRACHOMA:

Trachoma is a potentially blinding eye infection that occurs worldwide. Though eradicated in most developed countries, it remains a major health problem in parts of Southern Sudan. Trachoma is linked to extreme poverty and poor sanitation. It is triggered by bacteria that cause repeated conjunctivitis, irritating the eyes and creating a mucous discharge. Although the conjunctivitis clears up after a month or so, it is easily spread. This is particularly the case in places where there is little water for people to wash their hands and faces regularly.

Each infection of trachoma leads to a small amount of scarring on the cornea and conjunctiva. This scarring builds up over years of repeated infection until trichiasis sets in.

Trichiasis is when this scarring causes the eyelid to turn inwards, making eyelashes scratch the eyeball. Each time the eyelashes are lowered to blink, the cornea is put at risk. This makes the cornea to become opaque, causing poor vision and eventually permanent blindness.

People often try to pull out the eyelashes themselves, put powder on their eyelids, or use tight headscarves to pull up the skin around the eye to restrict blinking. None of these provides a long-term solution.

The infection can either be treated by antibiotics in the initial stages or through a surgical operation. The operation involves removing the parts of the eyelid which are being pulled inwards, causing the lashes to touch the eye, so the eyelids turn back out again.

CATARACT:

Cataract is a clouding of the eye's lens. The lens is made up mainly of water and protein. Over time, protein can build up, clouding the light passing through the eye and making sight blurred. For most people, cataracts are a natural result of ageing. There is no single cause of cataract though a number of risk factors seem to have an impact.

Often cataracts develop in both eyes at the same time. The symptoms vary, but may include a gradual blurring of vision, halos around lights, glare and double vision. The very worst cataracts - where the iris appears almost entirely clouded over - can cause a total loss of vision.

Cataract is common in Sudan largely due to dehydration caused by a relatively hot climate. Other risk factors include use of certain drugs, diabetes, cigarette smoking, genetic predisposition, ageing, environmental factors and other eye conditions.

Cataract is managed through a surgical procedure that removes the cloudy part of the lens .

VITAMIN A DEFICIENCY:

Vitamin A deficiency is a lack of enough vitamin A in humans. This is common in developing countries but rarely witnessed in developed countries. Night blindness is one of the first signs of vitamin A deficiency. Xerophthalmia and complete blindness can also occur since Vitamin A has a major role in processing of light in the eye. Approximately 250,000 to 500,000 malnourished children in the developing world go blind each year from a deficiency of vitamin A, approximately half of which die within a year of becoming blind. The United Nations Special Session on Children in 2002 set the elimination of vitamin A deficiency by 2010. The prevalence of night blindness due to vitamin A deficiency is also high among pregnant women in many developing countries. Vitamin A deficiency also contributes to maternal mortality and other poor outcomes in pregnancy and lactation

In a county like Southern Sudan where it is largely dependent on relief food and where hunger is a common phenomenon, it is quite difficult to find food that is rich in natural vitamin A. The only way to forestall blindness due to this deficiency is for children to receive Vitamin A supplements.

Objectives:

The main objectives: -

1. To assist and support the visually impaired.

This will be done through:

➢ Promotion of socio-economic activities

➢ Provision of food subsidies

➢ Subsidies to acquire essential utensils for daily household use.

➢ Contributions to repair houses so as to improve family and social life.

2. To provide preventive treatment to blindness. This will be achieved through:

➢ Provision of essential ophthalmic medicine

➢ Provision of eyeglasses to protect against harmful sunrays.

3. To promote Health Education

This will be achieved through training of local health personnel who will educate the community of the importance of personal and environmental hygiene. Also to seek immediate medical attention incase of an eye infection.

5.INTERNAL TRAINING PROGRAMS (IN SOUTH ERN SUDAN)

General Objective:

To train local health staff so as to ensure provision of sustainable health services

Specific objective:

To train local health staff at the health facility and community to enable them make appropriate diagnosis, give basic treatment and offer health education on prevention of common diseases.

Results

1. Health personnel who are adequately trained on TB and Leprosy control

Indicators and activities: See chapter under “TB/Leprosy programs”

2. Local health staffs are adequately trained and able to provide high quality PHC services.

Indicators: Local PHC health personnel trained, performance of local health personnel assessed, laboratory technicians trained and performing well

3. Select and train CHW and other village based health workers in IECHC

Indicators: CHWs identified and trained

4. Select and train TBAs

Indicators: TBAs identified and trained

AAA HEALTH ACTIVITIES

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LAKE STATES

Mapourdit (Yirol West County)

A Primary Health Care center was started in 1997. This later grew into a rural Hospital that has been operational since 1999 providing medical, paediatric, obstetric and surgical care. Laboratory facilities are also available which greatly aid in diagnosis. In 2001 a surgical program was integrated into the hospital to provide emergency and elective surgical operations .Reconstructive surgery for persons affected by leprosy is also performed.

A Leprosy programme has also been functioning at Mapourdit since January 2001. A mobile clinic with its base at Mapourdit was set-up to cover remote villages in the location. There is also a nutrition program for the in-patient, leprosy patients and malnourished children incorporated into the hospital at Mapourdit.

At the end of 2003, additional services were introduced at the hospital. These included:

➢ TBA (Traditional Birth Attendants) training and supervision

➢ IECHC (Integrated Essential Child Health Care) training and supervision programs

A Malaria program was started in 2005 undero the support of Global Fund/UNDP

The objectives of this program were to:

➢ Provide LLITNs (Long Lasting Insecticide Treated Nets)

➢ Provide ACT (Artesunate Combined Therapy) for malaria

The malaria program targets vulnerable groups that include children under 5 year’s old and pregnant women.

Two new PHCUs (Wou Wou and ATIRIU) were built in order to expand malaria program in Yirol West

Ten Community Based Health Intervention Centers (CBHIC) were built in order to provide malaria services in remote areas

Caritas Italiana began supporting Pandit PHCU in January 2008

Integration of eye services at Mapourdit Hospital

VVF reconstruction at the hospital was conducted by AMREF

LFW supported the primary eye program from 2008-2010. Dark and Light continues with the same support from 2011.

In 2010, AAA integrated TB services into Mapuordit hospital, WouWou PHCU and Aterieu PHCU

Yirol, (Yirol West County)

The Leprosy programme began its operation in 1999 with the support of SDC. Leprosy patients also benefitted from food & non-food items distribution programme. The health facility acted as a referral point for malnourished children to a suitable hospital for supplementary feeding.

At the beginning of 2003, a new TB Hospital was integrated into the health program in Yirol, with a bed capacity of 40. With this program came the expansion of the Laboratory services to incorporate TB microscopy & other routine tests .The program later increased its bed capacity to 90 courtesy of support from Global Fund/UNDP in 2005.

Agangrial (Cueibet County)

The TB and Leprosy control programmes began in 1997. This programmes run together with the Inpatient feeding program.

Adior (Yirol East County)

AAA is running a TB programme that started in January 2008, supported by Global Fund/UNDP. In 2010, AAA managed to integrate TB services into Nyang PHCC under NRC

Bunagok (Awerial County)

AAA is running a TB programme that began in January 2008, supported by Global Fund/UNDP

WARRAP STATES

At Marial Lou (Tonj North County), the Tuberculosis (TB) and Leprosy Hospital was set up in 1995 with a bed capacity of 30 and has since grown to a capacity of 150 beds. The hospital boasts of a well-equipped laboratory and runs an in-patient feeding program. Tuberculosis is one of the three leading causes of registered Hospital deaths in many African countries. Annually, more than 2 million people die from TB. Sudan is estimated to have 45,000 cases. Globally it is estimated that 8-9 million new cases are reported every year, with sub-Saharan Africa contributing an estimated 1.5 million of these new cases. The incidence in Sudan is estimated at 90 in every 100,000, possibly higher for Southern Sudan.

AAA is currently running St Francesco D’Assisi Hospital in Marial-Lou. This hospital was taken over from MSF-CH on 15th October 2007.

Tonj (Tonj South County)

The leprosy program began in 1998 while TB programme commenced in 2001. The facility also provides primary health care, laboratory services and nutrition program .Mobile outreach activities are conducted regularly to benefit people in remote areas of the location. Community based rehabilitation program targeting persons affected by leprosy (PALs) is offered at the facility.

At the beginning of 2003, additional health services were introduced at the hospital in Tonj. The services were:

□ TBA (Traditional Birth Attendants) training and supervision

□ IECHC (Integrated Essential Child Health Care) services

□ EPI (Extended Program on Immunization) services

In 2006, shoe workshop was introduced at Tonj to make shoes for persons affected by leprosy to protect their delicate feet.

Kuajok (Gogrial West County)

AAA in collaboration with NTLBP and Warrap State MOH opened a TB program at Kuajok town in November 2010.

Lounyaker (Gogrial East)

AAA in collaboration with NTLBP and Warrap State MOH took over TB management in Lounyaker in May 2012.

NORTHERN BAHR EL GHAZAL STATES

Gordhim, (Aweil East County)

St.Fatima Hospital was set-up in 1999 at Gordhim. The facility began by offering Primary Health Care and laboratory services to the population in and around the area.

In 2001, a Leprosy program was introduced into the health facility .The program is the only one in the area, and has been attending to the needs of Leprosy patients in Gordhim and its environs.

In 2003 a Mobile Surgical Unit was introduced into the PHC to conduct periodic surgical interventions (surgical missions) in this remote village.

In 2005, TB program was integrated into the Gordhim PHCC supported by Global Fund. It is the only existing TB control program in the area after MSF- France closed down their Akuem TB control program in April 2007.Gordhim TB program has expanded its operation by integrating TB programs in the existing PHCCs.

The following are PHCCs involved:

➢ Akwem PHCC-GOSS

➢ Malual Akon PHCC-IRC

➢ Malual Bai PHCC-IRC

➢ Oduruman PHCC-TearFund

Nyamlell, (Aweil West County)

A nutritional program was initiated in 2000. The nutritional status of the children under five in this area improved tremendously with the implementation of the feeding program.

In 2004, Primary Health Care services were initiated at Nyamlell through an emergency program. The general health of the population, especially of school going children, in this area is afflicted by various diseases. Most of them suffer from malaria, respiratory infection, eye infections, diarrhoea, intestinal worms and skin infections among others.

TBA and IECHC training was also started around the same period and a medical team dispatched to the area to control the situation.

In 2005, a TB program was started in Nyamlell under the Global Fund support. The actual bed capacity for this program is 100 but it can accommodate up to 150 in patients. The catchment area for this program is vast. Thus the TB program in Nyamlell eventually expanded its operations to Gok Machar PHCC, Marial Bai PHCC, Udhum PHCU, Nyiniboli-PHCC and Wedwil PHCU

AAA in collaboration with Cordaid and MOH ran a PHCC in Nyamlell in 2007

Aweil, (Aweil Centre)

In mid 2008, AAA started TB program at Aweil State hospital. The program is supported by GF through UNDP. It also offers DTC services to all TB patients. AAA is working closely with the army, Police and Prisons Health Centers by integrating TB services. So far TB services have been successfully integrated at Mathiang Military barracks PHCC.

WESTERN OF BAHL EL GHAZAL STATES

Wau/Agok, (Wau County)

AAA took over from GLRA TB/Leprosy program in mid 2009. This program had been running by GLRA for many years. In Wau Teaching Hospital, AAA is implementing TB and Leprosy. In Agok, AAA is involved in the community based rehabilitation (CBR) of persons affected by leprosy and their families. There are between 150-200 PALs benefitting from the program.

WESTERN EQUATORIA STATES

Tambura, (Tambura County)

AAA opened a TB program in Tambura at the end of 2009. The program also offers DTC services to all TB patients. It has networked with other agencies in order to integrate TB services into existing primary health care centers.

TB program in Tambura has integrated its operations in existing PHCC, namely Mopoi PHCC, Source Yubu PHCC and Nagero PHCC. All these PHCCs are run by IMC.

In order to fight HIV/AIDS in TB patients, AAA with support from Global Fund/UNDP, introduced TB/HIV Collaborative component in all 11 TB centers namely: Marial-Lou, Tonj, Gordhim, Nyamlell, Agangrial, Yirol, Adior, Bunagok, Tambura, Wau and Aweil.

DONORS/BENEFACTORS

In order to fulfill the above activities, the following are among the main donors:

- Global-Fund/UNDP

- Misereor

- CESAR-Onlus (where money is channeled from different benefactors in Italy)

- ERKO/DKA/Horizont3000

- SDC (Swiss Agency for Development and Cooperation)

- GLRA (German Leprosy Relief Association)

- SOH (Sign Of Hope)

- Rotary Club-Brescia

- Bondeko

- WHO (World Health Organization) supporting TB and Leprosy drugs

- WFP (World Food Program) supporting food for in-patients

- Lagoccia

- Caritas Italiana

CONTACT

ARKANGELO ALI ASSOCIATION (AAA) CONTACT IN NAIROBI

Lina Sala /Dr. Callixte Minani

C/o Verona Fathers

Shalom House

Ngong Road at Comboni road

P. O. Box NAIROBI (KENYA)

Telephone

Cell phone +254 (0)722 708935 or 0722 672932

Office phone +254 (020) 2025299

Fax: +254 (020) 2025311

E-mail addresses: lina@ or micalli1965@yahoo.it or arkangeloaliassociation52@yahoo.it

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