ĐĎॹá>ţ˙ XZţ˙˙˙W˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙ěĽÁu@ đżG>bjbjćć %RŒŒ-6˙˙˙˙˙˙ˆ$$$$$$$8   8Řě48%,,"NNNNNN–$˜$˜$˜$˜$˜$˜$$§&Rů(Nź$$¨ NN¨ ¨ ź$$$NNŃ$”#”#”#¨ ú$N$N–$”#¨ –$”#Δ#b$$$b$N   đžSÄ ˘!˘b$–$ç$0%b$G)D#:G)b$88$$$$G)$b$4Nnźź”#xdÜĚNNNź$ź$88Äü¤~#88üRoberto Bazzoni Onlus Trip to Zimbabwe 17-24 May 2004 Sebastiano Bazzoni, Mauro Ratto, Gavin Faloona and Guido Munzi 19/05/04 It is noon on May 19th and we have just finished our morning visit to the Luisa Guidotti Hospital., We got a general tour of the facility, with particular emphasis on the AIDS treatment area. I am going to touch the following points: - cooking - nurses' school - AIDS assessment and counselling. The first topic could be regarded as trivial. It is not. The Hospital, and indeed the people all over the country, have experienced first a food shortage and then a scarcity of gas for cooking. This is due to the general economic crisis, and the ensuing dependence on foreign aid because the country is no longer exporting its own produce, mainly foodstuffs, and, . without currency gained trough exports, petrol products cannot be paid for, so the whole economic fabric is deteriorating. So, for the last 12 months, the meals for the hospital and for the people attached to it (nurses' families, parents of patients, students, teachers etc.) have been cooked in the open air, using a wood fire. See photos. The second item is also interesting in order to better understand the Country and the general climate there. We visited the school where 44 pupils attend a three year course which will prepare them to become professional nurses. After graduating, they will have excellent employment opportunities in Zimbabwe or abroad, from the UK to many Commonwealth countries. This year the Hospital received over 20,000 applications for this course! They can only accept 44, because of lack of facilities (students are in internship). This fact shows the desperate search of young people, who went through secondary school, often with great personal sacrifice (we saw young people walking, in some cases barefoot, along the road from Harare to Mutoko, going home from school), and who cannot find any jobs. Hence, succeeding in becoming a professional nurse, with certainty of employment, is a very valuable asset. AIDS assessment and counselling has been a touching experience. The "Guidotti" is now hosting Prof. Nigro, a Virologist from the Catania University, for a period of time. We were invited to witness some appointments with his patients. First of all Prof. Nigro explained to the patients who we were and asked if they would allow us to listen. Having obtained the patient's consent, he went on with his task. In the first full visit (two were cut short because X rays exams were needed) we saw a young woman, very thin, for whom a decision had to be taken about starting the ARV treatment or not. Her lynfocites count were at 600 per cubic millimetre of blood (the theoretical minimum should be 900); she weighed 60 kilos, and now is 31. Her husband is still healthy, and she has two sons. Prof. Nigro decided to put her on Anti Retro Viral treatment, and to give her a two week treatment, giving her detailed instructions as to what to do, in particular if any rash or itch should appear. After two weeks she should return for a check-up and to define a permanent treatment. Decisions like the one above must be taken rationally. Prof. Nigro is very much aware that the number of patients has now reached 570 and that we cannot go beyond 600, for many simple reasons: if we used the drugs, which are sufficient for 600 patients on a larger number we would eventually end up having to stop treatment for some patients who had already started it. In addition to this fact, the overall structure of the hospital cannot be stretched beyond all logical limits. Today, for instance, Anna, the pharmacist, has to substitute for the radiologist, so that the doctors have the x rays but the pharmacy is not covered. This mode of operating is not sustainable. Hence some admission rules for AIDS patients have to be set up and enforced, otherwise it will eventually come to the point that patients will have to be refused due to having run out of drugs . It is imperative to have a clear and strict policy and stick to it in order to avoid disaster. 20/05/04 This morning we left the L.Guidotti hospital in Mutoko and headed first to Harare and then to the St.Michael's mission in Mondoro (Mashonaland West), whose responsible is Dr. Maria Grazia Buggiani. She came to Zimbabwe approximately when Dr.Pesaresi did, around 1980. She built the hospital from scratch, and the inauguration took place in 1984. The hospital which has 140 beds, has to cover a very large rural area for general needs. At present they have no surgeon, and Dr. Buggiani has been left alone. The surgeon found a suitable job abroad and, considering that local salaries do not allow for a normal life, he was lead to accept the offer. The hospital is a "general" one, with a very good physiotherapy facility, which is well run by specialized staff. Approximately 30pc of their patients are HIV positive. Their resources are meagre, and treat very few people. Thanks to the help of the Italian Government, the hospital is able to provide PMTCT PLUS treatment for 60 patients for one year. We discussed the opportunities which are likely to arise from the EU program, for which we hope to be awarded the possibility of launching a three year PMTCT PLUS initiative, which could benefit some 800 mothers. We are still waiting for the EU's decision on our admission to the shortlist. Dr. Buggiani confirmed that some 150 patients (mothers) could be provided without delay, since their waiting list shows some 220 patients queueing. She believes that treating 150 mothers on PMTCT PLUS program is feasible. She will need a few pieces of equipment for the laboratory, which is already very well equipped, with competent staff. During the visit we touched the topic of the last emergency in time, the apparent slashdown on private schools that is taking place. Recent rules obliged private schools to cut to one third the rates they charge to parents; a subsequent instruction prohibited schools from accepting donations, thus putting them, in practical terms, out of business. It is believed that schools will be able to provide teaching until June, and no one knows what may happen after that date. There is also a very good and well run "Casa di Mariele" for children abandoned in very bad situations. They now cater for 30 children in very good atmosphere and organization. 21/05/04 In the morning Carlo, Mauro and I met with Sr. Mary Jo Vassall, to discuss the finalisation of documents relating to the purchase of the house to be converted into a clinic, and how we would envisage the co-operation with them in the event that we receive a positive answer from the EU for the PMTCT PLUS program. The meeting was extremely useful to clarify EU requirements, local rules and possibilities and to define a plan for action. She will analyse the practical medical matters with Carlo, will have to prepare a model of the Trust which will run the clinic and she should send me a revised draft budget which takes into consideration the EU schemes. To diarise for May 31st. The Italian Ambassador was so kind as to invite us to his Residence, together with all the Italians involved in healthcare projects in Zimbabwe, plus the Papal Nuncio and an EU representative, Mr. Marc de Bruycker. I took the opportunity to let him know our disappointment regarding the lack of information from Brussels, information which we should have received by May 4th. He explained that there was a delay of about one month, and that he remained hopeful. (We presented an application to the European Union, in order to receive financing which would allow us to provide drugs and related expenses in order to put in place a PMTCT PLUS program (Prevention of Mother To Child Transmission, PLUS ARV treatment of mothers, for three years) for some 800 mothers.) In the afternoon, journey to Chinhoy, where a warm welcome was extended to all of us in Carlo's home. A clear fact is emerging: we are being given too much to eat! 22/05/04 On Saturday morning, the 22nd, we visited the recently purchased house which is to be converted into a clinic for use by the Sisters of Charity in Harare. If our EU application is approved, it will become the centre in Harare specialising in the treatment of mothers. The builder who usually works for the Sisters (Gino Pillai) was present and, with Dr. Spagnolli and Sr. Mary Jo, the plan for the most urgent works was defined. We will contribute to the cost for Euro 5.000 and, for the remainder, Carlo trusts that his Association in Rovereto will be prepared to help. Then we visited Chiwero Park where we were lucky enough to see many wild animals in total freedom. Back to Chinhoy, we were invited to dinner by the SOLA Sisters, a group of Sisters who take care of the poorest in the area. On Sunday the 23rd we attended early Mass in the Chinhoy Cathedral at 7, and then we met with the local Sisters of Charity, who are available to provide local support for the PMTCT PLUS program if it comes to fruition. At 9:15 we started our journey back, first to Harare airport and then to Jo'burg, stopping to say goodbye to Sr.Mary Jo. In this very moment, at 4:30 pm, we are waiting for the next leg of our trip, Jo - Malpensa, in about four hours time. ----------------------------- Perhaps I should attempt to draw some conclusions out of this experience. First of all, "our" program to fight AIDS has reached a satisfactory number of 570 patients, and is headed towards 600. We can feel more relaxed than before, because the help provided by Prof. Nigro, and by the two virologists who are due to arrive on the 28th, makes a huge difference. With them we can feel in safe hands, and the "Guidotti's" structure can operate correctly. The equipment for the CD4 count, due to arrive during the summer, will improve the specialists' capability to fight the disease. As far as the PMTCT PLUS program is concerned, it will require adjustments and careful planning, but it looks feasible if the burden is divided across the four sites. The overall situation of the country is not positive. The only positive aspect, in comparison with recent past, was that petrol is now available. The ZIM Dollar exchange rate now stands at 5400 to the USD and 6365 to the Euro. Inflation is rampant. There is shortage of locally produced food due to the redistribution of land to locals, who lack the skills and organisation to make agriculture a profitable business. As a consequence, almost all land which was productive in the past now lies idle. At present food is provided in huge quantities by international agencies. However, recent statements from the Government were adamant in saying that the food supply emergency is now over and that the international agencies will have to discontinue their support. Some FAO officers have already been invited to leave the country. This is likely to be a major problem in future months, ahead of the general elections. It looks reasonably conceivable that food will become a weapon of political pressure on the population. If people are starving and someone alleviates the suffering through distribution of food to persons related to the ruling party, it would be easy to increase consensus. Just remember how Fascism spread in Italy in the thirties, when people had to join the Party in order to survive! Security in the country is another big issue. On Tuesday evening the house belonging to two Carlo's neighbours was raided by professional thugs who neutralised the dogs and, pointing guns to the husband's head, stealing all the valuables they possessed. Fortunately, no rape took place. Nevertheless, some blood was shed in the initial physical contact, and the woman had to enter immediately a preventive security treatment against AIDS. The local papers, both independent or ruling party's, show clearly how violence is spreading, both verbally and physically. There are reports of mobs being pushed to assault political adversaries and raid their premises. The police act against the people who suffer the raids. Sentiments against white people are exacerbated, the U.K. is always depicted as evil, Mr. Blair is called "Mr. toilet" publicly and nothing is done to restore "law and order". The picture looks gloomy and there is no sign of change. Talking about something different, but strictly related to the above, it has to be recorded that the answer I received from three of the people who have devoted their life to Africans was almost identical. I put this question to Dr. Marilena Pesaresi (Guidotti Hospital), Dr. Maria Grazia Buggiani (St. Michael's Hospital) and Sr. Teresa (Sisters of Our Lady of Africa): "Why are you doing what you are doing?". All of them are now over 70 "and still going strong". The common reason they gave was that they felt they belonged to the privileged part of the world, and that it was their precise duty to help their less fortunate brothers. This led all of them, through various routes, to be active in Africa and to remain at their posts in spite of all difficulties. I put to Marilena and Maria Grazia an additional question: "What after you, my young ladies?" The impression I gathered is that they are both aware of the problem and are considering possible solutions. I had the impression that the process is better framed and advanced in Marilena's case than in Maria Grazia's. Hence, in general terms, I am led to say that we now have a better and updated knowledge of the country and of its difficulties, as well as of what can be done in the future, in a very wise and realistic way. For the people who obtained the results so far, such results are the proof that things can be done, and that more can be done. 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