Supporting a Health Assistance Program in Kafue District Hospital, Zambia

Project location: Zambia, Kafue District
Project start date: June 2012 - Project end date: May 2013
Project number: 2012-031
Beneficiary: Voci di Popoli nel Mondo

TIMELINE OF THIS FINAL REPORT: December 1, 2012 – December, 9, 2013  

The project was carried out in Kafue, a small town in Zambia and the main town in the Kafue District (Lusaka Region).

The population in the district area is ab. 219.000. The most locally spread pathologies are malaria, tuberculosis and HIV/AIDS. Maternal and childbirth complications are widely diffused as well. Recently, a growth has been reported of pathologies that were usually to be found in the developed countries such as: gastrointestinal, oesophageal and thyroidal cancer and, among the chronic diseases, diabetes has joined vascular and brain pathologies as a dangerous killer.
The Kafue District Hospital (KDH), provides for the Kafue district population’s health. Built in 2006-09, the KDH is a small, basically equipped facility with an operational theatre, and with an ultrasound and an echocardiograph for the diagnostics. It hosts a department for surgical and medical assistance as well. A  telemedicine service is  available with internet connection.
The KDH is chronically understaffed. The surgical service is scarce. The hospital therefore tends to provide just the basic cures. Severe cases are not locally treated but in Lusaka – ab 110 km far from Kafue – where the patients are transferred, meeting high costs, often unreachable by the Kafue residents. 
The project immediate goal was to enhance and upgrade the healthcare services delivery to the population both by supporting the local staff in their healthcare activities and by training them either by on the job training and by expert courses. The Italian hospital doctors also helped in the setting up of protocols and in the lay down of data collecting rules.
The ultimate goal was to make the Kafue District Hospital services more respondent to the local necessities, widening the range of hospital services locally available thus reducing  the transfers of patients to Lusaka.
The project was based on the dispatch of Italian hospital doctors and surgeons to Kafue. Part of the doctors took advantage of a regional law (Regione Lazio 2 - February 2004 law, art. 71) that makes it possible for hospital doctors, nurses and technicians to give their services in developing countries for a maximum of one month.
The public based in Rome hospital St. Camillo Forlanini and the (regional) healthcare outfit ASL RM C gave their support to the project allowing their staff to work at the KDH. The Nando Peretti Foundation financed their travel, their stay in Kafue and the project managing in Rome by the Ngo Voci di Popoli del Mondo.
The dispatched doctors were to support the local hospital staff in their healthcare services delivery to the population and to train part of the staff in the surgical field by on the job training. Two courses were planned and run on internal medicine (linked to the now emerging non communicable pathologies) and on virology. The project started in December 2012 and ended in December 2013. During this yearlong period, 6 missions were organised and a total of 5 doctors dispatched.

01/12-20/12/12, Giovanni Fioravanti MD, retired hospital surgeon with many years of healthcare experience in the developing countries and particularly in Africa, was in Kafue inspecting the hospital equipment and meeting the hospital staff and management in the set up of the surgical activities and on the job training to be carried out in his next mission.

02/02/-09/02/13 Gianluca de Vito MD, surgeon, Director General of the International Healthcare Department at the Hospital St. Camillo Forlanini in Rome and deputy councilor of the Ngo Voci di Popoli del Mondo (Ngo VPM), stayed in Kafue to meet the local hospital managers and staff in order to plan the overall activities of the project. 

08/04-07/08/13 Giovanni Fioravanti MD, surgeon, stayed non-stop in Kafue, also visiting the health centers in the area. During this 4-month period Dr. Fioravanti examined the patients, performed surgical operations and trained on the job the nurses and doctors of the KDH..

Dr Fioravanti examined 77 patients. The greater part of them underwent surgical operations performed by Dr Fioravanti always assisted by the local staff who were also trained during the operations. Most of the procedures resulted in the patients recovery with only 3 deaths. A bit of cosmetic surgery was also performed in a few patients when their face was involved.
The most frequent cases envisaged the removal of hernias (38). Of the hernias the majority were inguinal hernias (26). The umbilical hernias removed were 6. A total of 6 children were also operated with hernia. The removal of the goiter was performed on 4 patients, envisaging a subtotal removal of the thyroid. Lipomas, cysts and similar minor removals totaled 15 cases performed under local anesthesia.
6 operations regarded the gynecology field involving the woman abdomen with removal of the uterus (2), the ovaries (3), a dead fetus (1). In the three cases regarding the ovaries, histological examination of the removed cists was also performed. A further series of operations also regarded the abdomen (8). Particularly: 4 severe appendicitis; 1 colon gangrenous volvulus. It is in this class that 3 deaths occurred as a consequence of multi organ failure after full-blown peritonitis, or on its way (duodenal ulcer), had been diagnosed before the surgery. Interventions on trauma cases were 3, on one of which also some bit of cosmetic surgery was performed. Of all the examined cases, just three were not locally treated but referred to other more equipped hospitals. 
Each surgery was attended by an average of three KDH’s staff or students. The total of the trainees was: 3 doctors, 3 scrub nurses, 1 in-charge ward, 4 students.

13/06-21/06/13, Filomena Pietrantonio, Internal medicine expert at the ASL RM C was at the KDH. 18/06 Dr Pietrantonio run a one-day introductory course at the KDH under the name of “Clinical Presentation of Chronic Diseases with Focus on Diabetes and Hypertension”. The presentation was attended by 15 people: Clinical officers (7) Lab technician (1), Clinical Officer students (7). During her stay, Dr Pietrantonio also worked with the local hospital staff at the setting up of shared protocols on diabetes and hypertension and monitored the weekly diabetes clinic at the OPD of the KDH. Before leaving, she met with representatives of the Diabetes Association of Zambia and Dr. Gulnora Sultanova.

21/07-12/08/13 Francesco Paolo Gianzi, Epidemiologist at the ASL RM C was at the KDH. 22/07-30/07, Dr Gianzi prepared a training needs assessment and carried out outreach activities with dr Ketty Lubeya, an MD at the KDH. 31/07-9/08 Dr Gianzi run the course at the KDH “Training of Trainers on Principles of Epidemiology”. The course was attended by 9 doctors.

15/10-09/12/13 Dr Giovanni Fioravanti, surgeon, was at the KDH. As during his second mission, Dr Fioravanti performed surgery. All the cases resulted in recovery. The most frequent cases envisaged the removal of inguinal hernias (13), 4 of them removed from children. The cancer cases were 2: one in the sub-jaw bone region and one in the sacrum-coccygeal region. 1 cist and 1 volvulus complete the pathology list. 2 further operations were performed after severe trauma.
Dr Fioravanti also surveyed 10 Caesarian sections: 1 transverse presentation, two cases complicated by fibroids, 1 dead fetus not delivered, 1 previous scar with p.o. hernia, 5 fetal distresses.
Lastly, Dr Fioravanti was referred to by the local staff for 48 cases, that were considered more critical by the local staff who had operated the patients. Again the hernia cases were the most frequent (4 adult, 4 children). There were 3 fibroids cases, 2 breast adenomas, 1 thyroid goiter, 1 hemorrhoids, 1 diverticulitis, 3 benign prostatic hyperplasia and 1 abdominal mass involving the liver.
Dr Fioravanti pointed out that the KDH urgently needs an orthopaedic surgeon. 

The project met a twofold result:  during the medical missions and during the missions and after.

During the missions. The local staff was supported by the Italian doctors. Ab. 100 surgeries were performed by Dr. Fioravanti. Dr. Pietrantonio and Dr. Gianzi  helped in the healthcare services delivery.

During the missions and after. 11 local hospital staff (doctors and nurses) were trained  on basic surgery via on the job training. 15 local hospital staff (doctors and nurses) attended the introductory course on chronic diseases run by Dr. Pietrantonio and 9 doctors the Epidemiology course run by Dr. Gianzi.

Thanks to the training courses, the capacity of the hospital staff was upgraded thus bettering the healthcare services delivery to the population and reducing the transfers to Lusaka.

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