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Number 183 - April 2018
This day, 1 April, marks the high point of the year for Christians. Christ is risen and lives among us. We wish our readers peace and joy during the Easter season. Jesus came that we ‘may have life and have it abundantly’ (Jn 10:10 NRSV).
This year is the seventieth anniversary of the World Health Organization (WHO). The WHO Constitution states: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” The WHO defines health as "a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity." The theme for World Health Day on 7 April is: Universal health coverage: everyone, everywhere.
In a fact sheet for December 2017, the WHO pointed out that at least half of the world’s population still does not have full coverage of essential health services. All UN Member States have agreed to try to achieve universal health coverage by 2030, as part of the Sustainable Development Goals.
For the WHO, universal health coverage (UHC) means that all individuals and communities receive essential health services without suffering financial hardship. It includes health promotion, preventive interventions, treatment, rehabilitation, and palliative care. It reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their savings, sell assets, or borrow funds – destroying their futures and often those of their children.
WHO made it clear that UHC does not mean free coverage for all possible health care, regardless of the cost. No country can provide all services free of charge on a sustainable basis. In countries where health services have traditionally been accessible and affordable, governments are finding it increasingly difficult to respond to the ever-growing health needs of their populations and the increasing costs of health services.
Still, health coverage is not just about finances but takes in all components of the health system: service delivery, the workforce, health facilities and communications, technologies, quality assurance, and governance and legislation. So UHC is not just about individual treatment, but includes public health campaigns, providing clean water, controlling mosquito breeding grounds, etc.
According to the WHO, health systems in all countries need to be strengthened. When people have to pay most services costs out of their own pockets, the poor are often unable to obtain many of the services they need. Even the rich may experience financial hardship with a severe or long-term illness. Choices must often be made and ‘investments in the primary health care workforce [are] most needed and cost-effective in improving equity in access to essential health care.’ It emphasized that monitoring progress towards UHC should take into account the extent to which it is equitable ‘to all people within a population, such as the poor or those living in remote rural areas’.
World Malaria Day on 25 April recognizes global efforts to control the disease. A life-threatening condition caused by parasites transmitted through the bites of infected female Anopheles mosquitoes, malaria is preventable and treatable.
The WHO website states that in 2015, 97 countries and territories had ongoing malaria transmission and about 3.2 billion people – nearly half the world’s population – were at risk (Fact sheet: WHO/UNICEF report Achieving the malaria MDG target, Sep 2015). It is difficult to get accurate statistics from many countries, but in spite of great progress, malaria is still an acute public health problem in many regions. In 2015 alone, the WHO said, there were an estimated 214 million new malaria cases, and about 438,000 deaths. In areas with high transmission of malaria, children under five are particularly susceptible to infection, illness and death. More than two-thirds of all malaria deaths occur in this age group.
Between 2000 and 2015, malaria incidence (the rate of new cases) fell by 37% globally. While an increasing number of countries are on the verge of eliminating the condition, Sub-Saharan Africa continues to carry a disproportionately high share of the burden. In 2015, the region reported 89% of malaria cases and 91% of malaria deaths.
Vector (mosquito) control is the main way to prevent and reduce malaria transmission. Two forms are effective in a wide range of circumstances: insecticide-treated mosquito nets and indoor residual spraying. World Malaria Report, 2016 stated that across sub-Saharan Africa, about 53% of the population at risk were using an insecticide-treated net in 2015 compared to 30% in 2010. In 20 African countries, preventive treatment for pregnant woman increased five-fold between 2010 and 2015.
Let us help to close the gaps in coverage of lifesaving malaria prevention tools.
In this newsletter you can read how MMMs and our supporters are working to bring life and good health to people around the world. In Honduras, children are being made aware of their right to healthcare and learning about prevention and management of common conditions. In Angola, MMMs reach out to rural areas in need of primary health care. In Tanzania, we share our resources in tackling the threat that human trafficking poses to the health of the community.
Thank you for working with us to bring health and healing to so many. May you experience life and health in abundance.
Sister Carol Breslin, MMM
‘Insofar as we are worth anything, it is because we are grafted onto Christ’s life, his cross and resurrection. That is a person’s measure’ (Oscar Romero).
A Road to Health
Sister Margaret Nakafu, from Uganda, is on mission in Honduras. She has been based in rural Siguatepeque for the past two years. She told us about her background and how her current work with young people involves living out our MMM Mission Statement, which says: ‘Our own belief in the interrelatedness of God’s creation urges us to embrace holistic healing and to work for reconciliation, justice and peace.’
Before joining MMM in 2007, Margaret had an advanced certificate of education and a diploma in computer science. During her early formation, she experienced life in our missions in Rwanda, Uganda, Kenya and Tanzania.
‘After making my first profession of vows, I worked in Eldoret, Kenya in our social and development programme. I journeyed with people living with HIV/AIDS, helped with the economic empowerment of families and groups, and advocated for accessibility to quality education for vulnerable children and teenagers in secondary schools.’
In August 2012, Margaret began a BA in sustainable human development at Tangaza University College in Nairobi. She gained skills to work with individuals, groups and communities to identify their potential and capabilities. The emphasis was on reflecting together on the local situation to identify socioeconomic, political, and cultural problems.
Participants were encouraged to listen to the voice of God through theological reflection. Using this approach, communities work towards holistic and sustainable human development, prepare a healing action plan, and are involved in its implementation and evaluation. Subjects also included human rights promotion, justice and peace, management of development projects, and the dynamics of human growth through counselling.
After completing these studies in 2015, Margaret worked in our Motherhouse in Beechgrove, Drogheda, Ireland for six months. She described it as ‘an extraordinary, enriching experience … with our elderly MMMs. I call them the “Saints of Drogheda”.' She worked on the switchboard and in the stamp department, and learned how our MMM history is preserved in our archives. She accompanied Sisters to hospital and other appointments. This special time concluded with a missioning ceremony as Margaret prepared to leave for her next assignment to Honduras. The ceremony was the first in Beechgrove for some years and brought back memories to the other Sisters of their own departure events.
‘Constantly strive to promote the wholeness of all peoples’ (MMM Cons.). Margaret continued, ‘I arrived in Honduras in May 2016. I am now working with groups of children between eight and eleven years of age in the rural municipality of Meamber in Comoyangua Department. An obvious health challenge for children in these communities is inadequate sanitation and hygiene. Most families use water from contaminated rivers. The lack of clean water leads to skin infections and there are water-borne diseases from insufficient potable water.
‘Social and domestic violence leads to low self-esteem, with increased vulnerability of teenagers to be recruited to gangs, to use drugs, and to teenage pregnancy. An ineffective educational system means that most children don’t go beyond primary school. In some communities even those in upper primary school classes lack confidence in reading and writing skills. On a number of occasions I have heard children from some of the one-teacher schools say, “We haven’t had classes for a week now!”
‘There are four health centres in the municipality, each with a nurse. Nevertheless, some of the centres are closed when the nurse is on leave or has an emergency. I was shocked to hear the women and youth in one community say, “This is normal. The clinic has been closed for two months because the nurse is on leave.”
Embracing holistic healing ‘Our work with the children involves advocating for social justice and awareness-raising about preventive health. We involve them in relaxation exercises. We use fairy tales and games to reflect on messages about the benefits of a balanced diet, care for the environment, social values, and expressing and defending oneself. We discuss prevention and treatment of skin infections, personal hygiene and dental care. The children practice first aid skills. We encourage them to express themselves creatively as they play games, sing, do arts and crafts, and solve word and number puzzles.
‘We celebrate the growth of the groups and the individual children. It is our joy to see children who were hyperactive and restless becoming calm. As they gain confidence and develop their self-esteem they learn respectful interpersonal relationships. Many who were fearful now participate in games and share their experiences and dreams. Children express their joy in solving a puzzle or making a drawing and display their handcrafts with a sense of wonder and pride.
‘We encourage them to use their imaginations to dream about creating a better, more dignified human society. We aim at breaking the deep-rooted culture of accepting injustice, oppression and violence as normal.’
Reaching out to Gandavilla
Sister Pricilia Vrato is from Adamawa State in northern Nigeria. She joined MMM in 2012 after graduating from the Federal College of Education with a National Certificate in education. Pricilia said that when she was growing up she had a great passion for working with women, children, the old and the sick. Living out the MMM charism has enabled her to fulfil her dream to help the vulnerable people of our time. On mission in Angola since October 2016, she is joined in community in Huambo by Sisters Brigid Archbold from Ireland, Laurinda Bundo from Angola, and Stella Nwoye, also from Nigeria. Pricilia described the primary health outreach provided by MMM.
‘In 2006 the MMMs in Huambo, Angola began outreach health services to several villages. The people used to come to the clinic in the town with preventable conditions such as waterborne illnesses. The Sisters decided to visit and give education on how to prevent these conditions and how to manage and treat them if necessary. While government teams come during campaigns, e.g. to vaccinate against polio, there are no health units in these communities. As the number of people that availed of the services increased, the work expanded to other villages. One of them is Gandavilla.
‘Gandavilla is about eighty kilometres from the town of Huambo. Travelling on very bad dirt road, it takes three hours to reach in the dry season and much longer in the rainy season. We usually visit once a month but sometimes twice when there are a lot of patients. Now there are many cases of malaria and many have died.
‘In some places we attend to patients under trees and we use the car as a dispensing unit to give out drugs. This situation is challenging because there is little privacy. In Gandavilla there is a new school build by the government and we have been allocated a classroom and two offices. This means we have some privacy to examine the patients. At the building entrance is the office that we use for consultation, diagnosis, and giving medicines. We use the other office for antenatal women. The big classroom is for vaccinating babies, pregnant mothers and others, e.g. for giving tetanus vaccine. When we attended at the end of February we saw about 160 patients - children, youth and adults.
‘The people in Gandavilla are happy with what we offer them and are very grateful. They often cannot contribute money but they pay in kind with farm produce such as a kilo of maize, beans, vegetables, or potatoes, or some charcoal or a chicken. With these contributions they expect to get all the medicine they need. In reality their donations do not cover the cost.
‘We distribute some of these items in our ministry to the elderly. We also sell some of them to buy drugs and other supplies. This is labour-intensive and is not sufficient for what we need. The government sometimes gives us free drugs such as antimalarials and malaria test kits, but the supply is erratic and unreliable, so we depend on our donors as well.
‘Good health allows children to learn and adults to earn’ (WHO, 2017). ‘There is high rate of poverty among the villagers. Most of the people are farmers and depend on the land for their livelihood. Very few of the children have the opportunity to go to school. The villages have one school with only one teacher, who is a volunteer with no monthly salary. The teachers depend on the contributions of the parents, some of whom are too poor to give anything. Students must often walk long distances to the schools, so only older and stronger children can attend. Also, most of the students are boys. They may be hungry and tired when they arrive and must still be in class for their lessons.
‘There is a high rate of teenage pregnancy, which the villagers see as normal. Many of the girls are not mature enough and have complications during or after childbirth. The fathers usually do not support them so the girls have to depend on their parents.
‘If there is an emergency it is difficult to reach the hospital in town in time and lives are often lost. Once we encountered a pregnant woman being brought on a bicycle as we were finishing the outreach for the day. She had had convulsions during the night and the family and the village head tried to contact the ambulance.
'They were told to start their journey because the ambulance was on the way. Our staff helped to put her in our Land Cruiser and we set off for the town. After driving for an hour we met the ambulance. By then we knew the baby was dead because our staff were checking the mother. Later we heard that the woman did not make it either. We were very sad to get the news. This is one of many cases experienced every day among the villagers. It pains me when the people are sick and we cannot do anything about it.’
Working Towards Societal Well-being
Sister Catherine O’Grady, from Ireland, has spent many years in Tanzania. She is currently director of Faraja Centre Community-based Health Care (CBHC) in Singida. The Centre has carried out HIV-related interventions since 2002, beginning as an outreach of MMM Makiungu Hospital to mitigate the effects of the HIV epidemic. Officially registered in Singida Municipality in September 2005, it has expanded from voluntary counseling and testing (VCT) activities to a comprehensive programme with social, developmental and outreach components.
More recently, the staff of Faraja Centre became aware of another reality deeply affecting the lives of the local people. Catherine described how the awareness developed and what steps were taken to begin to mobilize the entire community in dealing with the threat of human trafficking. The bigger picture – a global issue ‘Tanzania is a source, transit, and destination country for men, women, and children subjected to forced labour and sex trafficking. The incidence of internal trafficking is higher than that of transnational trafficking and is usually facilitated by victims’ family members, friends, or intermediaries, who offer assistance with education or in finding employment in urban areas.Some unscrupulous individuals manipulate the traditional practice of child fostering, in which poor children are entrusted to the care of wealthier relatives or respected members of the community, to subject children to forced labour.
‘The exploitation of young girls in domestic servitude continues to be Tanzania’s largest human trafficking problem, though child sex trafficking, particularly along the Kenya-Tanzania border, occurs as well. Girls are exploited in sex trafficking in tourist areas within the country.
‘Boys are subjected to forced labour, primarily on farms as farm labourers, cattle herders, and occasionally hunters, but also in mines and quarries, in the informal commercial sector, in factories, in the sex trade, and possibly on small fishing boats operating on the high seas.
‘Smaller numbers of Tanzanian children and adults are subjected to domestic servitude, other forms of forced labour, and sex trafficking—often by other Tanzanians—in other countries in Africa, the Middle East, Europe, and the United States. Media reports indicate that Tanzanian children with physical disabilities are transported to Kenya for forced begging and Tanzanian girls are subjected to sex trafficking in China.
‘Trafficking victims from other countries—typically children from Burundi and Kenya, as well as adults from south Asia and Yemen—are forced to work in Tanzania’s agricultural, mining, and domestic service sectors. Some are also subjected to sex trafficking. Citizens of neighbouring countries may transit Tanzania before being forced into domestic service and prostitution in South Africa, Europe, and the Middle East.
‘The government of Tanzania is making significant efforts to comply with the minimum standards for the elimination of trafficking. It allocated a budget to its anti-trafficking committee for the first time and adopted implementing regulations for the 2008 anti-trafficking law. The government also rescued twenty-two foreign women subjected to forced labour and sex trafficking in a Dar es Salaam casino. It provided them with shelter and care, ensured their safe repatriation, and prosecuted and convicted their trafficker.
The local situation ‘Singida Municipality covers an area approximately thirty-five km by thirty km on the major tarmac lorry route, connecting with Dar es Salaam port via Dodoma and Tanga port via Arusha. It also serves the landlocked countries of Burundi, Rwanda, Uganda, Zambia and the Democratic Republic of Congo. There has been an influx of people into Singida from the rural areas and the population in the town and outlying sixteen wards is about 150,400.
‘About 90% of the residents in the Singida region depend on rain-fed agriculture in a semi-arid climate, leading to low production of food and cash crops. Alcohol abuse affects programming for health and HIV, and affects children’s health, education and sustenance.
‘Going back about two years, as we went on our CBHC visits to the villages, there were “rumblings” that all was not well. The village elders and some government leaders expressed concerns that teenage girls had gone to a few cities and were never heard of again. They could not understand how girls were offered “clean work” in boutiques, hotels, restaurants and some private houses but had never called their parents to say how they had settled into their new jobs.
‘On other occasions they informed us about pre-school boys and girls who went missing. These comments puzzled us a lot. I met Sister Mary O’ Malley, MMM, when we were both on home leave in Ireland in July 2017. Almost instantly Mary pointed her finger to human trafficking. Based in Nairobi, Kenya, she and her team work to provide information about this crime and provide assistance for people who have been affected. Furthermore, she suspected that what we were hearing about in Tanzania was probably only the tip of the iceberg.
‘When I returned to Singida, I knew that we must act on these reports. We consulted church and government leaders in Singida town. They, too, were shocked to hear about the information we were gathering and were willing to assist in any way possible. Local police from the Singida Gender Desk trained Faraja staff members. We started to go to the villages and talked to people about the situation but we knew we needed more training. We decided to ask Mary to come and share her experience with us and arranged for a series of workshops for key members of local groups. We also decided to invite the staff of Makiungu Hospital and Nangwa Dispensary.
A groundbreaking meeting ‘On 8 March 2018 we held a full day of awareness-raising on human trafficking at Faraja Centre, facilitated by Sister Mary and her deputy Mr. George Matheka. The twenty-nine who attended included Muslims, Christians from six local churches, ten government leaders from each of the wards where our community health volunteers (CHVs) work; Bishop Edward Mapunda, Bishop of Singida; the director of Caritas; Officer Exaudi, Gender Desk Head of the Tanzania Police Force; Ms. Veronica Mwambata, chair of the Catholic Women of Tanzania; Sister Mary Francis, OSS, a nurse at Makiungu Hospital and Singida Diocese Health Secretary; the chair of the Religious of Singida Diocese, and the Faraja Board. It was a truly momentous occasion.
Afterwards all were determined to take charge of the situation. They committed themselves to a full trainer of trainers (TOT) seminar to prevent anymore of our daughters and sons being enslaved within and outside the borders of Tanzania.
‘The next day our thirty-three CHVs participated in a similar awareness session. The following Saturday, we gave an interactive session to women and male religious leaders who were preparing the year’s agenda. All of them were visibly shaken by what Mary and George shared with them. At Mass on Sunday, Bishop Mapunda asked Mary to brief the congregation about her awareness-raising work in his diocese.
‘During the following week, our facilitators gave a full three-day TOT session to our CHVs. They were very excited when the team awarded them with certificates. At the suggestion of one of our board members we requested the diocesan Radio Maria and the three local TV stations to visit our training sessions. Radio Maria interviewed George. They gave a full hour to the broadcast and we know from phone calls that we received that many people were reached. We hope there will be a broadcast on the topic each week. Later that day the TV station broadcasters arrived and spent over an hour interviewing George, Mary, Faraja staff, and some of the volunteers.
‘From Faraja Centre, Mary and George went on to two other MMM missions. A great deal of awareness-raising and training was done during these special days and many seeds were sown to deal with the issue of trafficking in Tanzania. We are confident that a good harvest will follow. It was a very appropriate moment to recall the words of our foundress, Marie Martin: “If God wants the work, God will show the way.”’
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