Caravan of Hope Women's Health

Project Abstract
The aim of this project is to come up with a group of healthcare providers that will carry out medical caravans, particularly visiting villages in located in Niger whereby women are actually the most affected by CVD (Cardiovascular Diseases) as well as SRHR (sexual reproductive health and rights). Our team will conduct screening for HIV, CVD, diabetes, malaria, hepatitis and hypertension. We will also offer medical consultations and provide health education together with evidence-based treatment. We are also going to identify and enlist women suffering from Obstetrical fistula as well as those at risk of the disease and will then direct them to our team’s medical center for both empowerment and treatment.
Project Description
The project, collectively designed by our team of medical personnel “CARAVAN OF HOPE” will mainly concentrate on screening as well as management of women with cardiovascular diseases, malaria, HIV, diabetes, hepatitis, and hypertension. Our team is also going to identify women with, and those at risk of Obstetrical fistula to provide them with both psychological and medical support.
Apart from our main intervention area, we will also include two regions having the highest child marriage prevalence, Maradi and Zinder. We are going to target the remote villages in each of the two regions that are situated far away from the community medical centers.
The remote villages to be included in the project will be chosen by the project’s management committee based on clear criterion:
1. Absence of any community medical center at a distance of over 5km,
2. Absence of any secondary public school, which implies that girls are mostly exposed to early marriages,
3. Persistence of various cultural practices in the village like KAME (whereby girls get promised at the age of 4, have the wedding arranged when they are about 15 years, though a bit earlier for those girls that do not go to school),
The initial six months will be mainly dedicated to the screening as well as management of those women with HIV, CVD, malaria, hepatitis, diabetes, and hypertension and also enlisting those women suffering from obstetrical fistula. It is at this initial phase that women with fistula are going to receive socio-psychological counseling.
The project’s second phase will be later during the second six months whereby those women suffering from obstetrical fistula will be directed to Raouda Health Center for empowerment and treatment.
Target Groups
The primary beneficiaries of the project will be young, adult, as well as elderly women from poor socio-economic backgrounds and are staying in Niger’s rural areas.
There will be three sites of intervention:
1. Tahoua (Tchintabaraden, the region’s community with the least access rate to community medical services, 23.75 percent)
2. Maradi (Dakora, the region’s community with the least access rate to community medical services, 25.08 percent)
3. Zinder (Tanout, the region’s community with the least access rate to community medical services 30.66 percent)
Objectives
The specific aims of this projects are:
1. To screen and manage women with HIV, malaria, diabetes, hypertension, and hepatitis: 400 women
2. To conduct obstetrical fistula repair as well as social re-insertion for victims: 10 women
3. To promote health education for women
4. To offer preventive health care and medical care to women
5. To empower women to be active participants in the identification and solving of health issues
6. To raise awareness regarding Obstetrical Fistula and assist to reduce its prevalence and impact on the affected women as well as the community
7. To assist with the re-insertion of those women that are victims of obstetrical fistula back into the community
8. To promote access to reproductive health services
9. To challenge stigma, negative laws, and discrimination
10. To stop violence against women
Background and Significance
According to the Human Development Index of 2019, Niger is grouped among the poorest countries in the world, and more than 50 percent of its population survive with less than a dollar per day. Most of the population in Niger does not have access to basic medical care services. As per the Ministry of Health, 51.7 percent of Niger citizens cannot access the minimum package services that are being provided in public healthcare (Health Ministry, 2016). The group that is mostly affected by this situation is poor women staying in the remote rural parts of the country.
There is considerable healthcare difference between women and men in Niger. For instance, according to the World Bank (2015) about 90 percent of female adolescents in the country undergo the dangerous and unhygienic female genital mutilation practice that puts them at risk compared to no boys who undergo the same practice. In spite of the implementation of free medical care for children under the age of five and pregnant women, in majority of the community health facilities in the rural areas, patients are still needed to pay for services. Most women opt to stay home even when they are sickly since they cannot afford the consultation charges or the treatment medicines. Subsequently, diseases like VIC, CVD, malaria, and hepatitis continue being the top causes of co-morbidity and even death in Niger, particularly among women. Also, nearly 35 percent of all deaths among women between 15 and 19 years old is because of early marriage and early child bearing according to the World Bank (2015). We envisage to modify our community medical care services to especially meet the increasing healthcare requirements of women and also to reduce the medical care access as well as outcome difference gap between women and men.
The practice of early child marriage is highly embedded in the Nigerien culture and it is in fact one of the reasons why young girls and women have little to no access to healthcare. About 25 percent of Nigerien girls get married at 15 years of age. This makes them more likely to develop obstetrical fistulas unlike those who are not married as early. Even more Nigerien girls are married between the ages of 15 and 19 meaning even more girls are exposed to the risk of developing fistulas due to early childbirth. They are also at risk of maternal death.
As per data from the WHO, there are approximately fifty thousand to one hundred thousand new fistulas cases reported every year globally. The majority of the new cases are being reported in sub-Saharan Africa. Moreover, among the people being diagnosed with fistulas, only one in fifty can afford surgery. Care of any kind in many countries such as Niger is a luxury particularly in rural areas. The entire country has only eleven healthcare facilities that can handle fistula cases and they are also based in the country’s cities and towns.
The prevalence of fistula particularly recto-vaginal fistula and its economic burden in Niger is concerning. The situation surrounding the medical condition is thought to be worsening because of poverty, poor health literacy, and little or no access to care. Moreover, the prevalence of obstetrical fistula is also thought to be increasing further because of prolonged labor because of distant delivery facilities, lack of adequate balanced nutrition for pregnant women, lack of sufficient prenatal care, and early marriage. In the end, there are many women suffering from the devastating and preventable medical condition in Niger. And worse is the fact that the women have been socially ostracized because of their condition. They are also often ridiculed and humiliated, yet it is the society they live in that has created conditions that increased the likelihood of them suffering the condition in the first place. The fact that the women have been humiliated and embarrassed because of their condition also means that they do not even bother to get care they need for fear of being stigmatized. This shows how bad the situation is in the country and how urgent the need is for them to be given hope and the care they need.
Since the day this organization opened its doors in 2015 to date, it has provided care to over 15,000 clients, suffering from a variety of ailments at below market costs. Out of the 15,000 patients who have gotten care from the organization, 7434 of them were female patients seeking sexual or reproductive healthcare. The organization has also participated in offering free consultations, diagnosis, and medicine to 5,550 patients in various regions of the country. More than half of those who received care were women who were seeking OBGYN services. When providing free care, the organization’s staff particularly focused on also providing information about sexual and reproductive healthcare and explaining the benefits of seeking such care early. The organization also explained to the women the benefits of various family planning options available.
As mentioned earlier, obstetrical fistula continues to be one of the most prevalent sexual and reproductive conditions in Niger. The practice of early marriage also is not waning. Over 70 percent of the women in the country continue getting married when they are still considered children. This practice is perhaps the biggest challenge to reducing the prevalence of the disease because it directly contributes to women having the disease. Gender-based violence is also prevalent in the country and it continues being one of the factors contributing to the continued high prevalence of the condition in the country.
It is near-impossible to provide care to all Nigerien girls suffering from obstetrical fistula, particularly those in far flung places. And due to the stigma they face, they also do not visit health facilities for the help they need. So they are actually just going through life, trying the best they can to survive. In the places where are present in the country e.g. Raouda, we are working hard to find marginalized patients and stand by them. This is because it is our mission to offer quality and affordable and sometimes free care to all those who need it. We also strongly believe that all humans ought to live in dignity. So we are working hard to help those suffering from fistula to get back their dignity and go back to living life normally.
As detailed before, women suffering from fistula are stigmatized and humiliated. They are isolated from their communities. In some remote rural areas, there is a strong belief that those suffering from fistula are cursed. Most do not know that the disease is a medical condition that can in fact be rectified. Thus, some of the women who have the disease live their lives in desolation and seek solutions from healers and charlatans who offer them false hope and continue impoverishing them with their demands for more money for treatment.
As an organization, we have the staff and the resources to deal with women’s health in the country. Our Raouda Community Medical Center is approved by the Niger Ministry of Interior and Ministry of health decrees: N°157/MISPD/ACR/DGAPJ/DLP du 10 mars 2014 and N°000214/MSP du 6 July 2015. The facility is located in the city of Tahoua and has a 50-bed capacity. The focus of the facility is on providing quality care at zero or low cost to the poor in the country. Up to now, the facility has largely been funded by member contributions. Apart from operating the facility, the organization organizes caravans to villages including Sassoumbroum, Tessaoua, Koni, Keita, Kalfu, Dandaji, and Illela. The caravans offer free healthcare education, medical screening, consultations with specialists, and medications. The healthcare education usually focuses on reproductive care, family planning, and women’s rights.
In case the caravans come across serious cases, the individuals are taken back to the facility in Tahoua for specialized care. Some of the cases that have been previously taken back to the facility in Tahoua include uncontrolled, gestational diabetes, eclampsia, rectovaginal fistula prolapse, myomectomy, ruptured extra uterine pregnancy, and caesarean section delivery. The facility has got the equipment to handle such cases including; a surgical microscope, a tonometer, a biochemistry analysis machine, a urine analyzer, a hematology analyzer, an ECG, a modern X-ray machine, a renal ultrasound, and a 3D ultrasound capable of doing an echo cardiogram. Raouda Community Medical Center is also equipped with a medical theater, an intensive care unit, and an OBGYN unit.
Some of our key achievements as an organization in the last two years alone include: providing nearly 8,000 patients with the care they need, providing specialized consultations to nearly 2,500 patients, delivering over 150 babies, and successfully conducting over 90 surgical interventionjs. It is our belief that our experience in running the medical facility and in providing care and education through medical caravans will help us to implement this new project successfully. It is also our belief that our experience and our current resources put us in a good position to work with partners for the implementation of the project.
C. Project Design and timelines
The project will take place in two phases: the first phase will be in the first six months and the second phase will be the second six months. During the first phase, the project will focus on diagnosing and treating various cardiovascular diseases, malaria, Hepatitis, HIV/AIDs, and diabetes in targeted areas. The first phase will also involve spreading awareness about the negative effects of early marriages and about sexually transmitted diseases. Lastly, the first phase of the project will also involve the identification of women with obstetrical fistulas and proving them with counselling as they await surgical interventions.
In the second phase of the project, there will be a continuation of the awareness-raising activities in the targeted areas as the women identified in the first place await surgery. So the goals will be achieved by raising awareness, screening, surgical interventions, and culturally-aware management. By educating the villages and the village people about the negative effects of early marriage and gender-violence, there is hope that there will be fewer new cases and that the stigma surrounding the disease will reduce or be eliminated.
4. Timetable
Phase 1: First Six Months: Objectives include treating common conditions, raising awareness about reproductive health, and identifying women with fistula.
Phase 2 : Second Six Months: Objectives include designing surgical interventions for the women and subsequent care plans, and continuing to provide care.
7. Dissemination of Research Findings
The research findings will be disseminated through local and international radio and TV stations such as Radio France International. They will also be disseminated through caravans and meetings with village people. It is hoped that the testimonies the beneficiaries will have will also spread the news about benefits of the research. Lastly, the research findings will also be disseminated through publication in international journals.
8. Intended Deliverables and Measurable Outcomes
This project could help reduce the incidence of fistula in the City of Tahoua and surrounding villages. It could also help reduce new cases of the disease in the country and the high number of child marriages happening especially in rural areas. In the end, it could be just what helps to start the turnaround in the Niger’s Ministry of Health’s fight against fistula, maternal deaths, and other sexual reproductive problems.
B. Provide an explanation for how the form of the deliverable will help meet the goals of the project.
C. Provide a description of how the research team will measure the potential impact of the project for advancing positive social change. For example, who would be impacted, to what extent?
Resources:
Barroy, Helene; Cortez, Rafael A.; Karamoko, Djibrilla. 2015. Adolescent sexual and reproductive health in Niger (English). Health, nutrition, and population (HNP) knowledge brief. Washington, D.C. : World Bank Group. http://documents.worldbank.org/curated/en/684231467991017488/Adolescent-sexual-and-reproductive-health-in-Niger