After the successfully completed maji-project, Misingi starts with ‘Afya’ (Kiswahili for health). By July 2022, Misingi wants to renovate the current dispensary in Endallah and build a new maternity unit there. The project is in according with the values and vision in public health, primary health care and community participation, as described and taught at the Institute of Tropical Medicine Antwerp. For the construction plans, we could rely on the expertise of Medecins sans frontieres. Before Afya, Misingi already supported the dispensary with smaller activities. Finally, Misingi facilitates the foreign internships for students nursing and midwifery of the university college Thomas More. The dispensary is one of the permanent internships.
Project period: July 2019 – July 2022
Estimated total cost: 75.000 EUR
Beneficiaries: the 6.500 inhabitants of Endallah
Coordination Tanzania: Elibariki A. Dimme & staff of Endallah Dispensary
Coordination Belgium: Vincent Van Baelen
For medical and nursing care, the 6.500 inhabitants of rural Endallah have just one small health post: Endallah Dispensary. Endamarariek health center, if motor or jeep available, is one hour away (12 km). This health center is better equipped (eg possibility of sections), but due to foreign privatization too expensive for the most villagers. The only hospital in the area, Karatu Lutheran hospital, is one hour and a half driving (35 km). With a quick screening and diagnosis there is a timely referral. But unfortunately, with more acute situations such as motorcycle or work related accidents among farmers or workmen, it is often too late.
The team consists of 1 doctor (Dr. Solomon Charles Abdallah), 2 nurses (Eliaichi Temba and Felister Sinyaw), 1 lab technician (Martha Fissoo) and 1 guard (Yotham Bynit). Dr. Solomon lives near the dispensarium and is available 24/24 and 7/7. At night and on the weekends, Eliaichi and Felister work alternately. Every Thursday it’s ‘pregnant mother’s clinic’: pregnant women are examined and followed up. Of course this doesn’t mean that on other days they are not welcome. Every Friday, there is outreaching to Masabeda and Manusay. Also Shangit will follow later. Babies and pregnant women receive the necessary vaccinations on site.
The dispensary has rooms for consultation, administration, wound care, deliveries and patients, a small laboratory and a few toilets. Thanks to the maji-project, it is connected to the water system. At night, some solar panels provide lighting to a limited extent. For night-time deliveries, the doctor and nurses help themselves with a headlight. All the medical waste is burned in a well. To solve this problem, the construction of an incinerator, required by the government, is included in the project. In some rooms the roof and the windows are broken. There is a lack of basic material: no curtains, no drip stands, no pillows, insufficient (washed) sheets and mattresses, broken beds and toilets…
Endallah Dispensary has a large shortage of wound care equipment. The entire stock consists of a few bandages, some plasters, a few bottles of isobetadine and physiological water. There are no sterile compresses. The last years, our sponsors donated the majority of the medical equipment: tweezers, scissors, monitors for blood pressure, glycemia and saturation… The equipment is ‘sterilized’ by boiling water on a gas fire.
In the broader area, Endallah Dispensary is the only health post that has a microscope that can analyze urine and stool samples. That’s why not only inhabitants of Endallah, but also far beyond come here. Malaria, glycemie, glucosuria, worms, amoebiasis, HIV, syfilis and erythrocyte sedimentation rates can be tested. However, the small lab doesn’t have yet necessary equipment such as a centrifuge and a hemoglobin monitor. Those two are included in the project.
Daily, there is an average of 10 to 20 patients. The team can perform smaller medical interventions such as wound sutures and natural births. The most common diseases are respiratory, gastrointestinal and urinary tract infections, pelvic inflammatory diseases, intestinal worms, wound infections, diarrhea, skin diseases and asthma. According to Dr. Solomon, due to more and clean water because of the Maji-project, the gastrointestinal infections decreased.
Every month, the doctor reports to the local government in Karatu. Based on this numbers, the government supplies medication. Nevertheless there is a large shortage. For 7.000 people there is barely one small box with some analgesics, antibiotics, antihistaminics and anti-parasitic agents. In the area there are shops where inhabitants can purchase medication uncontrolled, at commercial rates and without medical advice or prescription. Due to defective and late delivery, this medication isn’t available in the dispensary.
In addition to curative care, Endallah Dispensary also provides follow-up of babies and children (picture), family planning and vaccinations. It has vaccinations against diphteria, tetanus, pertussis, hepatitis B, influenza, rotavirus and pneumococcus. These vaccines are kept cool with gas (picture). The government decided that a consultation is free for patients younger than 5 and older than 60 years. The very few medication, that the government provide, is also free. Patients between 5 and 60 years pay for lab tests 1.000 TZS or 0,40 EUR + medication. Vaccines and tests for malaria and HIV are free for everyone.
Total cost: € 2.000
Schedule: Completed (July 2019 – August 2019)
Dr. Simpa, the doctor who worked in Endallah Dispensary for ten years, and Dr. Solomon, the doctor who is currently working, made a medication list and bought it in Arusha. A room was made empty and racks were purchased. Inhabitants can now buy the medication at an affordable price and after medical advice. This integration of the pharmacy in the dispensary is a healthy and affordable alternative for the shops that sell uncontrolled medicines without prior medical consultation. Moreover, the pharmacy is no longer dependent on the lack of medication by the government. With the sale of the medicines, the team can constantly replenish the stock, but also pay other costs such as the water bill and lab material.
Total cost: € 2.200
Scheduled: Completed (September 2019 – October 2019)
Before starting the construction of the new maternity, we will renovate the current dispensary. The roof and some doors, windows and toilets are repaired.
Total cost: € 8.030
Scheduled: Completed (November 2019 – December 2019)
The purchase of 4 beds with pillows, sheets and blankets, 2 examination tables, 1 scale for adults, 1 scale for babies, 10 trash cans, 1 wheelchair, 4 drip stands, 2 examination lamp, 4 lockers, 1 autoclave, 1 centrifuge, 1 microscope and 1 hemoglobinemeter.
Of al these innovations, the team experiences positive outcomes. It can provide better totalcare with more extensive lab tests and a larger medication range. Therefore, more and more patients, also from neighboring villages, are coming to the dispensary. The team drew up a financial plan and tries to remain financially independent. Unfortunately, it cannot count on much support from the (local) government. Sponsorship (J-Tec Material Handling, Luc Boey & Chantal Putteman) provides a laptop in January to handle the increasing administration efficiently.
Total cost: € 55.000
Schedule: January 2020 – October 2021
In January, Misingi starts with the biggest phase of this project: the construction and layout of a maternity unit. Plans of ‘Doctors Without Borders’ and the (local) Tanzanian government were compared and discussed. This phase starts with the construction of an incinerator. The current “waste-pit” near the primary school, a wood-enclosed hole in the ground where all medical waste is incinerated, is too dangerous. In January Roger travels to Endallah to help with the start of the foundations.
Due to long-term rainfall, this phase has been delayed for several months.
For many years it hasn’t raid that much. The bridge, the entrance to the dispensary, and pipelines are broken and roads have become inaccessible. The repairs have begun. With a smaller tractor, fundi (construction workers) brought the first stones for building the incinerator.
Meanwhile, the roads and water pipes have been repaired. Because trucks constantly got stuck in the mud, we paid higher transport costs.
Therefore, the major infrastructure works were stopped and only the incinerator (small incinerator) was completed.
The old, dangerous, "waste-pit" near primary school, a hole in the ground fenced with acacia branches where all medical waste was burned,
is now a thing of the past.
The structural work with the foundation trenches, reinforced structures and walls are completed. The stairs at the entrance are also bricked. Due to the failure of one of the two Tanzanian cement factories, we paid a higher cement price. Due to a greater height difference than expected, a heavier foundation has also been made. A broader central corridor is provided for the purpose of providing training. These factors have led to higher costs for the time being.
January, February and March, Sien, Mieke & Vincent are on site and will support the project.
Total cost: € 10.500
Schedule: November 2021 – December 2021
The purchase of beds, baby equipment, medical equipment for examinations and birth …
This phase will be fully financed by Afas Foundation.
For phase 5, Misingi vzw can count on the financial support of Afas Foundation. Furthermore it will finance a part of the costs by using its own reserves. This will not be sufficient to realize the entire project. Therefore we work in phases, estimate a project duration of two and a half years and count on our loyal sponsors, new (medical) sponsors, companies and schools. For the construction of Endallah Secondary School, we collected 300.000 EUR in 6 years, for the Maji-project we collected € 135.000 the last 3 years. Again we are convinced that we will succeed.
About project management we have years of experience. Also technically we have the necessary knowledge. Several times a year we go on site to follow-up the project, but we certainly can count on our local coordinators John, Elibari and Dr. Solomon. You can be sure that we will finish also this project very well, if we have sufficient financial resources. For the latter we would like to count on you.
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Like with our previous projects, we provide workshops and presentations. We are looking forward to introduce them.
The last years we have regularly been asked if donation of medication and medical equipment is also possible. Dr. Solomon compiled a list. The medication may not be expired or damaged. We provide an English leaflet and ensure that everything is quickly delivered.