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Number 159 - December 2015
December is a time of waiting. We reflect on Mary’s time of waiting to give birth, of humanity’s waiting for the coming of a saviour. At this time in our history we wait for other things as well.
On 1 December we mark World AIDS Day. We wait for an end to the suffering caused by a deadly virus. HIV remains a serious health issue and resources needed to deal with it still place a huge burden on health services. UNAIDS estimated that in 2014, 36.9 million were people living with HIV. The latest report indicated that since 2000, around 38.1 million people have become infected with the virus and 25.3 million people have died of AIDS-related illnesses. Tuberculosis remains the leading cause of death among people living with HIV.
There are positive indicators. As of March 2015, about 15 million people living with HIV were accessing antiretroviral therapy. About 73% of pregnant women with HIV had access to antiretrovirals to prevent transmission of the virus to their babies in 2014. New HIV infections among children reduced by 58% from 2000 to 2014.
At the end of 2014, US$ 20.2 billion was invested in the response to AIDS in low-and middle-income countries, with domestic resources making up 57% of the total. Sub-Saharan Africa continues to beat the brunt of the problem. In 2014, about 25.8 million people were living with HIV in the region, with women accounting for more than half the total. And so we wait for vaccines and for a cure.
We also wait for the day when the rights of people everywhere will be protected. Human Rights Day is marked on 10 December - the day on which the UN General Assembly adopted the Universal Declaration of Human Rights. A year-long campaign is being launched for the 50th anniversary of the International Covenant on Economic, Social and Cultural Rights and the International Covenant on Civil and Political Rights. These Covenants, with the Universal Declaration of Human Rights, form the International Bill of Human Rights, the birth right of all people.
The UN website states, “There is much to be done to build political institutions, judicial systems, and economies that allow ordinary people to live with dignity. The growth of hate speech against religious and racial minorities, the justification of rights violations in the name of combating terrorism, the clawing back of economic and social rights in the name of economic crises or security, and the failure to respect the right to privacy in the digital age, show the relevance of the two Covenants and the need to respect them.”
In this newsletter you can read how MMMs and our supporters made possible the training of almost fifty health workers in Kenya, increasing access to health care, a basic human right. We bring you up to date on the mission recently opened in Bomadi, Nigeria. In Honduras, MMMs in their new home in Siguatepeque are reaching out to support the elderly.
In this time of waiting, we pray that ‘by the tender mercy of our God, the dawn from on high will break upon us, to give light to those who sit in darkness ... to guide our feet into the way of peace’ (Lk 1:78,79 NRSV). We remember our readers very specially at this time and thank you for your support. Please pray for us as well.
‘We believe that human beings, while capable of the worst, are also capable of rising above themselves, choosing again what is good and making a new start’ (Pope Francis, Laudato Si, 205).
Training health workers at Eldoret, Kenya
The Combined Services Third World Fund (CSTWF) has been assisting people in developing countries since 1980. Contributions come from employees and pensioners of the Civil Service, An Post, eir and other state agencies. The aim of the fund is to help people help themselves - not to give hand-outs or create a dependency culture.
CSTWF has supported MMM projects for many years. Contributions have assisted in areas as diverse as treatment of women affected by obstetrical fistula in Uganda; prevention of trafficking in persons in Nigeria and Kenya; safe motherhood in Nigeria; and equipment for hospitals and health centres in Tanzania.
More recently, from June to September 2014, support from the CSTWF made possible the training of 48 community health workers (CHWs), at Kapsoya Catholic Church in Eldoret, Kenya. Saint Mary's Medical Centre, run by MMM, organized the workshop.
Medical Centre staff gave awareness to village elders on the importance of CHWs. They helped to get facilitators, provided the training venue and teaching materials, and organized the catering. Sister Mariana Mushi, MMM, and Wilfreda Omwalo were part of the facilitation team.
Careful preparation Planning involved the development of a data base and house registration. Participants, 27 women and 21 men, came from eight villages and were identified through community meetings organized by provincial and other leaders. The trainee had to be a resident of the area, an active community member, willing to work as a volunteer, and be able to read and write.
At the start of training, the County Health Management Team and other stakeholders gave briefings, ensuring ownership of the programme. Dr. Billy Lubanga, Director of Medical Services, said that the workshop’s goal was to have a positive impact on the health of the community, particularly for women’s needs.
The county public health officer urged the participants to take advantage of the opportunity to enhance their knowledge and skills so they could also train others. She urged them to take responsibility for their own learning as adults. Community Health Extension Workers (CHEWs) were also invited to facilitate.
The training was organized in three rounds each of two weeks theory followed by one month's practical experience. Before learning about health and disease, there was input on adult learning, leadership, communication, community participation, and health promotion and disease prevention advocacy.
Local intervention is essential. A wide range of modules developed the concept that most health problems are preventable and manageable at local level. Addressing health problems promotes general well-being by interrupting the cycle of poverty and ill-health that affects many households. Health workers can facilitate change, encouraging positive behaviours and social change initiatives.
Because accurate information is essential to understand situations, plan for action, and monitor and evaluate activities, trainees learned to collect, analyze and use data. They also learned about the coordination of health services.
Most people go to health care providers only when they are sick, especially in areas where health resources are limited. Instead, the first approach to health care should be maintenance of good health and prevention of disease. Early recognition of severe disease at home and prompt referral to a health facility saves lives.
The trainees were shown how to teach community members to keep their environment safe to prevent injuries. It is estimated that globally 750,000 children die from injuries every year and millions more are seriously hurt. Worldwide, Africa has the highest rate of unintentional injury deaths. They were also taught first aid skills.
Interventions for children Another reality for Kenya is that many sick children never reach health facilities, with many dying at home from preventable and easily treatable conditions. Approximately seventy per cent of such children would survive if they had easy access to low-cost preventive and curative interventions for pneumonia, malaria, diarrhoea and malnutrition.
The health workers learned interventions for common childhood illnesses and for overcoming geographical, economic and socio-cultural barriers preventing families from accessing formal health care services. These should result in fewer severe cases and a lower burden on health facilities.
Another module dealt with the fact that only half of Kenya’s population has access to safe drinking water and adequate sanitation. Diarrhoea causes approximately twenty per cent of deaths among children under five years of age (WHO, 2007).
The trainees studied appropriate foods and feeding practices, especially for infants and young children. Malnutrition levels remain high in Kenya, contributing to mortality and poor development. High impact nutrition interventions were identified that could be implemented by communities at low or no cost.
The importance of maternal and newborn health Every year, eight thousand women die in Kenya from pregnancy-related complications, many of which could be prevented and managed locally. On a positive note, ninety per cent of pregnant women have at least one antenatal visit. Nevertheless, only forty per cent have a skilled attendant at delivery. Only forty-two per cent receive postnatal care within forty-eight hours. This places both mother and newborn in danger should complications arise.
The neonatal mortality rate1 in 2015 in Kenya was 22/1000, compared to 4/1000 in the USA and 2/1000 in Ireland. Largely due to preventable causes, these deaths are compounded by socio-cultural practices and low community involvement. The CHWs learned about birth spacing and conditions that make pregnancy and delivery safe, with favourable outcomes for mother and baby.
The burden of disease HIV/AIDS, tuberculosis and malaria contribute to the high disease burden in Kenya. Transmission is affected by individual behaviour and/or environmental conditions, so prevention and control efforts should emphasize community participation and behaviour change.
Non-communicable diseases are now major public health challenges globally, with developing countries bearing the greatest burden. They have both direct and indirect costs, consuming a large portion of health budgets and affecting people in the most productive age brackets. These conditions are linked to risk factors such as tobacco use, unhealthy diets, physical inactivity, obesity, high blood pressure, and abnormal cholesterol and glucose levels. The majority are preventable and knowledge about cost-effective interventions is crucial to reduce associated morbidity and mortality.
Implementing a community strategy At the closing ceremony the participants pledged to utilize the skills and knowledge they had gained to train others. They were sent back to their villages to implement the community strategy. Saint Mary’s staff discussed what was expected from them.
The new CHWs participated in education on clean water and environmental sanitation. They gave talks at the local police post about the importance of nutrition for prisoners and cleanliness of their cells. They helped with draining stagnant water and clearing brush. They assisted in the treatment of jiggers2 and participated in medical camps involving antenatal and postnatal services, immunizations, and cancer screening. Saint Mary’s Medical Centre is providing ongoing supervision and collects and sends reports on the activities to the County Health Office every month.
These new health workers faced challenges such as the low literacy level of the local people and the poor drainage systems in most of the villages. They found that vaccines were often out of stock and they sometimes lacked sufficient kits for their work.
At the same time, the stakeholders believe that the community health approach is a step in the right direction. The data collected by the CHWs and subsequent analysis are providing information that is improving health planning at sub-county and community level. This will have a positive impact on many lives in these communities.
We are grateful once again to the Combined Services Third World Fund for helping people to help themselves.
(Most of the information in this article was taken from the training report to the Combined Services Third World Fund.)
1The neonatal mortality rate is the number of newborns dying before reaching 28 days of age, per 1,000 live births in a given year. 2Jiggers are the smallest known flea. Females burrow into skin on the feet and remain there while developing eggs. They swell dramatically, sometimes causing intense irritation. If left in the skin, complications can include secondary infection, loss of toenails, and toe deformation.
Finding a home for Christmas
“The most important thing for you to do at the moment is to just study the people, their customs and their ways. You will find that the most important thing of all will be to know their language, and by knowing their language you can speak to them and get into their hearts, and they love you, for the reason that they feel you wish to understand them and to be one of them” (Mother Mary Martin, 1960).
In our last newsletter we described how, after much prayer and research, we decided to establish a mission in Torugbene, Nigeria. This was in response to a call from our recent Chapter to express our healing charism ‘in prophetic ways that are fresh and relevant in today’s realities’. Having moved into their new home, the Sisters gave us more details about their ongoing journey.
On 1 October 2015, Torugbene Community was opened. That day, several MMMs, with the pioneer Sisters, set off from the Area house in Benin City, arriving at Bomadi about three hours later.
Bishop Egbebor, his secretary, and Mr. Boatman and Mr. Augustine from Torugbene, were among those who welcomed Sisters Francisca, Chibuzo and Cecilia. The bishop said he had not dared to hope that the Creeks would have the presence of a religious congregation. ‘Our people have long been abandoned and we are immensely grateful to you for coming.’
After a meal they set off for the shore, about fifteen minutes away. Young men eagerly transported luggage to the boats. The Sisters and the bishop boarded the ‘passport’ boat, hired by Mr. Boatman and Mr. Augustine.
Nothing is impossible In the excitement of the moment, one of the Sisters dropped her phone into the river. She had little hope of getting it back; it was the height of the rainy season and the water level was at its peak. One of the boys on the shore immediately dived into the river. As the boat was ready to take off, he emerged with the phone. It was quickly opened up to dry it out and was soon working again. Of course this was seen as a sign of good things to come in Bomadi Vicariate!
The village community was waiting at Torugbene boat stop. After they showed the house they had prepared for the Sisters, they moved on to the church. Bishop Egbebor again expressed his gratitude.
‘God has done wonders for us today,’ he said, comparing their coming to Torugbene with the “yes” of Mary. He commented that it was always the women who said “yes”, and that their coming gave the people a sense of liberation, free to have life in abundance, something his people have been denied.
‘Crude oil was discovered in these parts in 1966 and has since generated billions of dollars to Nigeria. Yet nothing happens to our favour...so you have come to help us.’
He told the story of our MMM Foundress, a young fragile Irish woman who undertook a dangerous journey from Calabar to Onitsha1. Now another set of young women, who had so many options, had made an uncomfortable journey to bring God’s message of love to the people.
He introduced the three new Sisters and Area Leader, Sister Ekaete. Ekaete thanked the people for their warm reception and asked their cooperation for the success of the mission. Together, she said, we would discover and carry out God’s will. The Sisters would start by getting to know the people. Mr. Ambrose Brakaebi welcomed them on behalf of Torugbene Church Council.
This wasn’t in the brochure! Afterwards, Torugbene residents ensured that everything was ready in the house. Young men fetched water from the river and worked hard to fix the pump. Two of them fixed the generator. The people checked on them frequently.
Father Okpu, responsible for their local church, also helped to fix the problematic water pump. After Mass that evening he had to wait almost two hours for a boat to take him to his next parish, a fifteen-minute boat ride away. The next day, he sent chlorine to treat the water and some food.
A boat was arranged for the Sisters to meet with Father Okpu at his base at Ojobo. Sister Francisca talked about MMM and what they hoped to be and do with the people. Explaining the parish programmes, Father Okpu said there was a great need for help for the youth and for the problem of teenage pregnancy. He invited the Sisters to use every opportunity to teach the people basic preventive health and life skills.
Taking the first steps The new MMM community have made an initial familiarization tour of the settlement and arranged to visit the homes. They have been touched by the generosity of the people.
Preparing for their first Christmas in their new home, the three pioneers wrote, ‘Already we feel the excitement of the adventure in bringing Christ’s healing love, especially to the under-served. We know that God will show us every step of the way.’
By the way, did we tell you that swimming lessons were part of the orientation for our MMMs living in the Creeks area?
1 As a young lay missionary working in Nigeria in 1921, Marie Martin, accompanied by a few local young women, made a four-day journey to Onitsha to see Bishop Shanahan. This journey, by canoe and over land, was to provide the inspiration for her life’s work. The experience convinced her that only a group of committed religious women would be able to meet the need for a medical service for the people she encountered, especially women and children.
Honouring the elderly
'In our changing world, where many elderly people are no longer respected and valued for their presence, wisdom and life experience, we affirm our prophetic witness in the way that the elderly, sick and ageing are esteemed and cared for with dignity, both within MMM and in our ministries' (MMM Chapter 2015).
For fifteen years, MMMs worked among the indigenous Lenca people in Marcala, Honduras - an isolated mountain community. Facing consolidation issues, Sisters Cleide da Silva and Bernadette Heneghan handed over our programmes there, and in early 2015 moved to Siguatepeque, closer to our Sisters in Choloma.
Bernadette described how they became involved in outreach to the elderly while assessing the needs near their new mission. They discovered that a number of groups are involved in this work, which also has an ecumenical dimension.
A chance encounter 'We arrived in March and one day I noticed a collection box for the home for the elderly. I jotted down the address and we went for a visit. The home is five kilometres from Siguatepeque in a rural area, about a fifteen-minute walk from the bus stop.
'A local doctor and a group of committed Catholics opened the home thirteen years ago. It provides shelter and care for twenty-three residents in a relaxed family-friendly environment. Most are homeless, abandoned by family, or have no one to care for them. Coming from different parts of the country, each has her or his unique story.
'Don Eulalio, a cheerful ninety-four-year old with a twinkle in his eye, has lived in the home since his wife died four years ago. His son, Isaías, who is forty-three, has Down's syndrome and lives with his dad. Their family have never visited.
'Don Efrain and his wife Marie, a delightful couple, have been at the home for five years. They have no surviving children and no other family.
'The police found Juano, a woman in her eighties, wandering the streets of the capital. They took her to the hospital where she had an operation for a brain tumour. She was discharged to this home. She has chronic pain and her face is quite disfigured from the tumour and the surgery. She has no family.'
A variety of services 'Mr. Medardo Cuellar and his wife, Alba Luisa, care for the residents. Another woman prepares the meals. They live on the grounds with their families and are available twenty-four hours a day, seven days a week. There is such loving interaction between the children and residents.
'Local shops provide maize for the tortillas, and rice and beans. The local Lion's Club collect these and deliver them to the home. Mr. Cuellar asked if we could help to supply vegetables, eggs, chickens, cheese, powdered milk, etc., so they could have a change of menu on Sundays. Some of the residents have had strokes and have difficulty in chewing and swallowing.
'He also asked if we could help with adult disposable nappies, cleaning materials, dressings, and basic medicines. They rely totally on donations to run this home. They are building an extension that will provide space for ten more residents. This is being funded by the Mennonites.'
Other issues Recently a parish in England expressed interest in working with the MMMs in Siguatepeque and was put in contact with Sister Bernadette. Her correspondence revealed some of the challenges the new MMM community faces.
'We really appreciate your offer to assist the old people. We planned to visit the home the other day. I thought I would take some photos to send with the information in time for the weekend Masses. Unfortunately we have been without electricity for the last two days - hence no Internet - totally beyond my control.'
To help in deciding on the other ministries in which we will be involved, a needs assessment was done in 21 of the 52 communities in the parish of Meambar. Since then Sisters Cleide and Bernadette, with local resident Toño, have visited as many families as possible in each of the 52 communities. Their next challenge is to hire two staff members. In the meantime, they have begun by answering one of our most important Chapter, and human, calls.
'Where there is no honour to the elderly, there is no future for the young' (Pope Francis).
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