International Medical Corps Drc Programs

International Medical Corps Drc Programs

INTERNATIONAL MEDICAL CORPS – DRC PROGRAMS

INTERIM REPORT: 01 APRIL – 31 AUGUST 2006

SUMMARY OF ACTIVITIES

Programme Goal: To reduce morbidity and mortality among internally displaced populations and the local population in Bunyakiri, Kalonge and North Hombo (Itebero) health zones

A. Geographical Area of Activity:

North Hombo (Itebero), NorthKivuProvince and Bunyakiri and Kalonge health zones, SouthKivuProvince, Democratic Republic of Congo.

Beneficiaries: 328,539 beneficiaries, including 62,094 children under five years and 13,642 pregnant women, of whom approximately 80 % are IDPs.

B. Overview and Introduction

Health intervention activities including Primary health Care services, SGBV activities, Water/ Sanitation and Food security activities during this reporting period, was a challenging effort considering various security constraints and bad road conditions as well as logistical problems contributed to the delay of planned project activities. Access to health structures was disrupted from February to May 2006. A team of health supervisors accompanied by IMC’s security advisor made up an initial assessments team that later lead to the dispatching of medical staff to field sites in mid May 2006. Despite the mentioned limitations IMC medical support teams made several efforts to access field sites in order to provide assistance to supported health structures and Hospitals.

The initial number of 38 health facilities and hospitals supported has increased to 56 health centers, thereby bring to 59 the number of peripheral health structures including 3 hospitals in all three zones supported by IMC. However, currently only 56 of these health structures receive medical supplies periodically. Three of them have been inaccessible since the resumption of activities in Mid May 2006.

The number of IDPs during this reporting period remains elevated in all health zones. According to the BCZ and the local existing committee on health and development association, (CODESA) linked to the BCZ and located in all health zones, the initial high amount of 80% of the population in the zones remain displaced. Most of these displaced reside in catchment communities and are constantly moving due to security risks. As a result of continuous movement of the population, it is difficult to determine the actual displaced figures. Many of the population have therefore move towards the main road where the security situation seems more stable. This concentration of displaced are a mixture of new and old displaced over the past periods. In the Hombo Nord/Itebero Health Zones, IMC serves both the Congolese displaced and host populations as well as refugees of the Rwandans Hutu population who fled the country since 1994. This population benefits from health services in the Hombo area. Below is a representation of IMC’s achievement of indicated objectives.

C. Objectives and Results

Objective 1: To increase access to essential primary health services to prevent serious illness or

disability at fifty-six unsupported health centres and three General Reference Hospitals

Supply of Emergency Essential Drugs and Equipment

Beginning in April 2006, the emergency healthcare assistance response project funded by Stichting Vluchteling prioritized the improvement of common disease case management at fifty-threehealth centers and three reference hospitals. IMC provided a regular supply of drugs and medical supplies to all health structures. Throughout the project period, IMC provided training and supervision, and promoted the appropriate home and health care seeking practices for prevalent childhood diseases through community mobilization activities with the local health and development committees (CODESA). All activities were guided and supervised by IMC and BCZS staff.

Table: 1Leading Cause of Morbidity in all three health zones during reporting period

Health zone / Cause of Morbidity

Malaria

/ ARI / Anemia / Diarrheas and water born diseases
Bunyakiri / 55% / 6% / 29% / 10%
Kalonge / 51% / 16% / 23% / 10%
Itebero/Hombo-Nord / 15% / 17% / 9% / 59%

Graph: 1 Graph Illustration of

Reinforcement of the Routine Immunization Program


During the period under review, IMC provided support to the BCZ as well as participated in management of measles outbreaks particularly in the Bunyakiri and Kalonge health zones. IMC not only provided drugs and supplies in the management of the epidemics, community task force groups were organized to increase sensitization of the identification and spread of the disease among children. IMC in collaboration with other agencies such as IRC and UNICEF, assisted in containing the outbreak. See graph above

In addition, IMC also supported routine EPI activities through UNICEF support in the provision of vaccines and cold chain equipment. IMC obtained vaccines from the regional EPI office in Bukavu and transported these materials to the BCZS and health centers. IMC Health Supervisors reported on the status of the cold chain and IMC provided a reserve stock of disposable syringes and needles, cotton, disinfectants, vaccination cards, and other immunization supplies. The services offered included providing immunization and growth monitoring services, distribution of Vitamin A, and de-worming agents for children less than 5 years of age. Pre-natal care services, including tetanus immunization, iron supplements and malaria prophylaxis and prevention, were also undertaken at all IMC-supported health structures. Although much has been achieved, problems associated with improving the coverage of vaccination remain related to the lack of adequate cold chain system, and accessibility to distant health facilities.

Improved quality of care for individuals suffering from tuberculosis and leprosy

During the project period, IMC worked with the provincial MoH leprosy program to determine beneficiary needs in the three health zones of Bunyakiri, Kalonge, and Itebero. IMC also monitored morbidity and mortality rates for tuberculosis (TB) and leprosy in the three zones. IMC will conduct training in the case management of TB and leprosy in each zone from late September to early October 2006. Upon completion of the trainings, IMC will ensure basic drugs and medical supplies are available for the emergency treatment of TB and leprosy. IMC believes that this training will improve the capacity of the health care providers in determining other factors that may be associated with the diseases such as HIV/AIDS and other opportunistic infections.

Objective 2: To increase capacity of the health zones to provide appropriate services to survivors of sexual and gender based violence (SGBV)

Increased competence of health zone staff to provide good quality GBV

IMC’s overall approach of assistance to SGBV survivors remains focused on providing quality comprehensive Reproductive health care to women in general and survivors in particular. However, much attention has been focused on providing this comprehensive care to SGBV survivors rather than non-survivors, this is rather due to the alarming number of SGBV cases, which seems to often take priority over other RH activities for the general women population. Notwithstanding, support to hospitals and peripheral health structures have received RH supplies intended for use by the general women population.

IMC began its SGBV survivor-focused activities through conducting community sensitization sessions with focus groups, individual interviews, and informal information sharing at churches, local NGOs, health structures, markets, and more. IMC developed a clinic-based treatment and referral system and community-based referral services to benefit adult and child survivors in the three health zones. These activities were integrated into existing IMC programming as an essential component of primary health care and nutrition services. IMC supported three BCZS by providing drugs, materials, training resources and transportation, in order to provide essential components of medical care after rape. IMC provided UNFPA-donated kits to health structures in the three zones and monitoring the structures to ensure proper use of the drugs and those women qualified for care were not charged for services.

During the reporting period, IMC continued its identification, outreach, and treatment for survivors of GBV. IMC gathered statistics weekly on the number of survivors being serviced at each health structure. However, due to the profound stigma attached to survivors, these numbers can be assumed to grossly underestimate the actual number of survivors.

IMC conducted one socio-economic, three medical, and three psychosocial trainings during the reporting period. Over 100 MoH health staff participated in the medical training as well as the psychosocial training. 24 participants representing 12 local NGOs in the three health zones benefited from the socio-economic support and psychosocial counseling training. These 12 local associations who are also funded by community groups and other agencies are currently involved with activities focus on SGBV survivors. Many of them are concerned with the identification and referral of survivors to medical centers for assistance. Since most of them were limited in the capacity of psychosocial counseling service provision, and expressed the need to provide for beneficiaries some socio-economic activities, IMC saw the necessity to train and provide the associations some financial and material support to improve their services to this targeted population. Upon examination of participants’ feedback and pre and post-test results, knowledge levels rose dramatically as the result of these trainings. In Itebero health zone, not a single training participant passed the pre-test for psychosocial assistance to GBV survivors. When these same individuals completed the post-test, 81% completed it successfully.

IMC also began a new collaboration with Panzi hospital in Bukavu for an intensive three-month training for one medical doctor from each of the health zones where IMC intervenes. The Head Doctor of Itebero health zone and the Medical Director of Kalonge’s General Reference hospital began a joint three-month training in July 2006. The doctors are in training four days a week at Panzi hospital with two days of hands-on training in surgical repair of first-degree fistula, caesarean, hysterectomy, prolepsis, and other medical complications common to GBV survivors. IMC hopes that this new collaboration will serve as a means by which women requiring such surgical and other obstetrical interventions will have affordable access to the services.

Increased capacity of health zone structures to provide good quality GBV services

IMC provided a regular supply of UNFPA-donated drugs and medical supplies to 56 health structures throughout the reporting period. IMC registered a total of 500 cases between 01 April and 31 August 2006. This totals 2,774 reported cases in the three health zones over the past 18 months. Of these 500 registered cases, 478 (97%) received comprehensive medical treatment. 65% of survivors received some psychosocial counseling at an IMC-supported health structure.

Health Zone / Number of registered GBV survivors
April / May /

June

/

July

/

August

Kalonge / 28 / 38 / 26 / 7 / 40
Bunyakiri / 33 / 47 / 51 / 46 / 37
Itebero/North Hombo / 17 / 35 / 31 / 53 / 11

TOTAL

/ 78 / 120 / 108 / 106 / 88
TOTAL DURING REPORTING PERIOD / 500

IMC physically rehabilitated sections of the Itebero/North Hombo reference hospital, including the operating room where fistula repairs will occur upon the Head Doctor’s medical training at Panzi hospital. IMC provided a generator to the hospital to facilitate emergency surgical interventions conducted during the night. Prior to the provision of the generator, the hospital doctor operated using kerosene lamps. IMC furnished caesarean, gynaecological, and miscarriage medical kits, various surgical instruments, and medical supplies to each hospital. These will be used largely for GBV survivors who are referred to the general reference hospitals as a result of medical complications from sexual violence.

Provision of quality medical services to individuals suffering from STIs

IMC provides drugs and medical supplies for the comprehensive treatment of common STIs. Over 350 GBV survivors tested positive for an STI over this project period. Therefore, 85% of all GBV survivors receiving medical treatment at IMC-supported health structures have contracted an STI, likely during the incidence of violence they experienced. IMC treated all STIs using the drugs and medical supplies available.

Provision of services to women suffering from undesired pregnancies and/or abortions

The greatest challenge IMC experienced during the project period was reaching survivors within 72 hours of their rape. These first 72 hours are crucial as post-exposure prophylaxis (PEP) against HIV/AIDS and undesired pregnancy become ineffective after three days. Currently, women are often taken into the forest by armed groups and kept hostage for several days or weeks. These women are often repeatedly raped by groups of men before being released. These women are rarely released before 72 hours after the rape(s) and it becomes impossible for them to seek immediate treatment. IMC reported that only 4% of women came forward for treatment at a health structure during the first 72 hours after their rape. These women were given full medical exams and treatment to prevent undesired pregnancies and prevent abortions as well as PEP drugs against HIV/AIDS. Over 70 women who were not reached in the first 72 hours reported becoming pregnant as a result of SGBV and all expressed fear concerning the birth and care for the unborn child.

A second reason for low treatment rates both before and after the first 72 hours is due to the stigma attached to sexual violence. During a three-day period of insecurity in Bunyakiri health zone, IMC identified 38 SGBV survivors through the support of local NGOs and churches. Of these 38, only 3 approached health structures for medical treatment despite IMC efforts to reach them. The remaining 35 did not approach the health structures for treatment; many of them reside in villages located long distances from the commercial center of Bunyakiri. The high number of survivors unwilling to come forward for treatment indicates the strong need for IMC to continue its Behavior Change Communication (BCC) campaign and comprehensive psychosocial and socio-economic programming to reduce stigma and shame among survivors, their families, and their communities and provide women with alternatives for economic empowerment.

In conclusion, IMC sees the need to improve and reinforce its assistance in order to provide a comprehensive RH care to the general women population attending all health facilities. In addition, the need to access community participation and inclusion of activities focusing on HIV/AIDS can by no means be excluded from this process, therefore IMC intends to expand its current community activities focusing on all reproductive activities, including Family planning, antennal care, safe delivery, HIV/AIDS and STI as well as SGBV for the general women population. Of particular concern are various community groups IMC sees the need to include in sensitization activities. This group includes soldiers, in cooperation with ICRC IMC will examine the need to involve them in activities. During the coming period IMC will seek to review the possibility of expanding the targeted group to be sensitized.

Objective 3: To support the rehabilitation of laboratory and surgical equipment at three General Reference Hospitals

Improved equipment for surgical and laboratory services at the General Reference Hospitals

IMC rehabilitated three laboratories, three operating rooms, and three maternity wards in each health zone. IMC physically rehabilitated portions of the Itebero/North Hombo reference hospital, including the operating room. IMC also provided a generator to the hospital to facilitate emergency surgical interventions conducted during the night. Prior to the provision of the generator, the hospital doctor operated using kerosene lamps. IMC furnished caesarean, gynaecological, and miscarriage medical kits, various surgical instruments, and medical supplies to each hospital. IMC also provided gynaecological beds, mattresses, covers, and mosquito nets to three hospitals and 18 reference health centers’ maternity wards.

However, more remains to be achieved as many of the laboratories lack basic equipment, supplies and training of laboratory technicians.

Objective 4: To reinforce health zones’ emergency preparedness and response

Provision of drugs for cholera outbreak

IMC provided 56 health structures in the three health zones with ORS, ringer lactate, sterile catheters, and calcium hydrochloride for cholera outbreaks. There were no confirmed cholera outbreaks between April and August 2006, but several villages bordering between Itebero and Bunyakiri health zones reported 244 suspected cases of cholera during the reporting period. The majority of the beneficiaries in this area collect their drinking and cooking water from a small river that serves as the boundary mark between Bunyakiri and Itebero health zones. This water source is also used for bathing and defecating. For this reason, there is a higher incidence of water-born diseases in this area. IMC seeks to establish safe water sources nearer to these villages to reduce the incidence and prevalence of easily preventable water born illnesses.