Facilitating Access to Tuberculosis Care in Mali

 
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When originally planning for the trip to West Africa I was at first a bit apprehensive of site visits in French. I've only studied the language for a year and I feared I might not be able to understand the organization's work or get a good sense of their impact if the visit was entirely in French.

Meeting with GAIA Foundation however quickly put these fears aside. Understanding the amazing work of GAIA does not require nuisance or subtlety. Their work is clear, direct and entails the truly praiseworthy work of literally saving lives on a daily basis. Over a number days in Bamako, Mali I had the opportunity to learn about this work both on "official" and "unofficial" site visits with the organization.

Though the "official" site visit occurred on July 12th, I would say the unofficial portion of the visit began when Lorraine and I moved into the GAIA guesthouse and were greeted by two enthusiastic and passionate GAIA volunteers, Tonyu and Emily. I don't think GAIA could have found two better representatives or endorsements than these two. Not only did they spend long nights explaining the difficult situation of health in Mali, but they also detailed the innovate approach GAIA has undertaken and gave us an introduction the inspiring doctor we would meet the following day, the local director of GAIA Dr. Tounkara. He would not disappoint. We learned that the organization works in the Sinkoro area, a part of Bamako that has been traditionally undeserved by health services with approximately 1 doctor per 40,000 patients. Devastating diseases such as HIV/AIDS and Tuberculosis has had a profound effect on the community and continue to disrupt the lives of many throughout the area.

As for the "official" site visit Dr. Tounkara, or as many call him "Kara", walked us through the Hope Clinic, greeting staff and patients alike along the way. He explained how GAIA is working in conjunction with the Malian government to make the clinic into a model that can be replicated throughout the country. The clinic takes a holistic approach to health, but has been greatly aided by GAIA's support in fighting HIV/AIDS and Tubrcolosis through both treatment and outreach.

Sitting down with the head of the Hope clinic, we learned how GAIA has additionally been instrumental in stepping in where the Malian government funds leave off. GAIA has been able to raise funds for advanced medical equipment and facilities, when the government of Mali is unable to provide the funding. What is truly unique is the way GAIA does not direct the improvements but responds to the needs of the community and its leaders.

Donating money can sometimes be a tricky business and it can be difficult to understand the impact of your donation. Furthermore, development models have proven complicated with ambiguous results. These doubts are not necessary with GAIA. Their impact is so clear that even a French beginner can understand them. GAIA's projects transform lives and represent a glimpse at the future of health in Mali.

...and if you're still not convinced they also speak English.

Andrew is an in-the-field traveler visiting numerous GlobalGiving projects. Follow his and his fellow travelers' adventures at www.itfwa.wordpress.com!

TB Bolo educators are trained to detect tuberculosis and refer patients into the health center. GAIA VF supports half the cost of the clinic visit, while the CSCOM pays for the other half of the cost. This approach lowers the barrier to treatment and has resulted in the detection of a number of TB cases that might otherwise have continued to spread TB in the surrounding community. In 2009 1,560 individuals were educated and over 55 suspect cases were sent to the health center where they were examined by a physician and sent for further testing if required. Due to a low rate of return of positive TB tests at the local laboratory, and problems related to transporting patients to the laboratory for their sputum tests, we helped the CSCOM build a new lab on site to analyze sputum and smears, and hired and trained a new laboratory assistant (Awa). Julie and Lauren (the Brown students that launched our new TB BOLO program) wrote an abstract about their experience that was accepted for oral and poster presentation at the 14th Annual conference of the International Union Against Tuberculosis and lung Disease, North America. Jane Carter, M.D., one of their Brown University mentors, reported that Lauren did an excellent job of presenting our work!

TB Lab
TB Lab

Dear GAIA Supporter,

Further to Julie and Lauren’s hard work in Mali this summer, our Peer Educators have been trained to educate the public about signs and symptoms of TB and now keep referring possible TB cases to the Hope Center Clinic. As previously mentioned, each person at risk receives a ticket for a consultation and medical exam. This ticket covers 80% of the costs (expenses are covered by GAIA). The Peer Educators have distributed 354 tickets between July and October 2009!

Thanks to your support and the donations made on Global Giving, the Hope Center Clinic in Sikoro has a new lab! A TB Lab to analyze sputum and smears! We also hired and trained Awa our new lab assistant.

Julie and Lauren also wrote an abstract about our work on TB in Mali. The abstract was chosen for oral presentation at the 14th Annual conference of the Union-North America Region to be held Miami in March 2010. Lauren will attend and make a presentation!

… and this wouldn’t have happened without you help… Thank you!

TB lab
TB lab
Peer Educators
Peer Educators

Dear friends,

As our stay in Mali is drawing to a close, we wanted to take this occasion to thank you once again for your support of TB Bolo. Without you, our project would not have been possible.

Also, we would like to update you on the progress we have seen with our own eyes. Over the past month, we gathered information about the tuberculosis epidemic in Mali and evaluated the impact of GAIA’s peer-education and referral program. Aside from falling in love with this beautiful country, we have had the privilege to witness successes in the fight against tuberculosis. Please know that the continuation of this valuable program would not have been possible without you!

During our internship, we examined all levels of tuberculosis care in Mali. Though there is a high prevalence of tuberculosis in Mali, only a small fraction of cases are detected. For these cases there remains not only a high risk of infecting others but also a high risk of dying from tuberculosis.

A main goal of ours was to find out why so few cases are detected. One reason for the low detection rate is a gap in the general population’s knowledge about tuberculosis and their awareness of the services available to them. In the Sikoro slum, where our work is based, only 46% of the 84 individuals we surveyed were aware that tuberculosis treatment is free. We met people who had been coughing for years without seeking healthcare because they were wary of the costs that they might face.

These observations invigorated our faith in the importance of GAIA’s TB-Bolo education and referral program. TB-Bolo not only educates people about Tuberculosis, but also allows suspect cases to see a doctor at a reduced cost. In this way TB-Bolo helps to break down two barriers between someone who is sick and someone who is on treatment.

Thanks to your support, the TB-Bolo peer-educators went out four times in July for door-to-door education and referral for tuberculosis. Close to 1000 individuals were educated and over 50 suspect cases were sent to the health center with an 80% discount to see a doctor. As part of our evaluation, we tested people’s knowledge about tuberculosis before and after the education sessions, and found that knowledge went up dramatically. All of the individuals we surveyed said that they appreciated the program and learned something new, and some even added that they had already passed the message along to their friends and neighbors. Meanwhile, the national tuberculosis program has expressed interest in replicating the TB Bolo model in other communities in Mali.

On the ground in Sikoro, we know that we have only been exposed to the tip of the iceberg. However, we feel invigorated by the progress we see, and by the tenacity of the peer-educators, health personnel, and community members alike. We have also witnessed the fruits of international collaboration, which we thank you for being a part of. Little by little, we advance – or as Malians say, “Doni doni!”

Best wishes to all,

Julie Caplow and Lauren Pischel


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Organization

Project Leader

Anne De Groot

Founder and Scientific Director
Providence, Rhode Island United States

Where is this project located?

Mali   Health
Map of Facilitating Access to Tuberculosis Care in Mali