Project Report No. 2 - NOMA-HILFE-SCHWEIZ · Project Report No. 2 Project Antena Guinea-Bissau 25....

P.O. Box, CH-8703 Erlenbach [email protected] / www.noma-hilfe.ch

Project Report No. 2 Project Antena Guinea-Bissau 25. September – 1. October 2011


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Introduction – Project Antena in a nutshell

The president of the republic Guinea-Bissau has launched a new program to fight against the disease noma, in doing so he asked for foreign help. Hilfsaktion Noma e.V took over the duty to establish a national prevention project and to build a noma centre and hospital in the capital.

Given the fact that the disease was not known to a large extend, an adequate infrastructure is not available. Noma patients had to be transported to neighbor countries (e.g. Senegal) in order to get treated. But the know-how of surgeons as well as the technical infrastructure for complicated plastic surgeries is also not available in neighboring countries.

The decision to build a noma centre and children hospital in Bissau, was the basis of new hope. Already in 2009 the municipal Bissau allocated land property, where the mentioned noma centre will be built on. The ministry of public health as well as the representative of the WHO in Bissau assured their cooperation. On the 7th day of September 2009 a cooperation agreement was signed with the ministry of public health.

The project contains educational actions in different regions of the country (requires the education of professionals), radio inputs, education of medical staff and the establishment of noma as a compulsory subject at university. Additionally different social works and re-integration measures have to take place.

The construction of the children hospital and noma centre in the capital of Guinea-Bissau is also subject to the project, whereas the planning started in 2009. The finishing is scheduled for mid December 2011 and the inauguration will take place in February/March 2012. Plastic surgery missions will complete the treatment of noma patients in the new hospital, whereas plastic surgeons form Europe will help to operate the children and educate the local staff (incl. university students).

The project, which is been financed by NOMA-HILFE-SCHWEIZ since 2010, was visited to view how the funds were used. NOMA-HILFE-SCHWEIZ is verifying if the points mentioned in the project contract between Hilfsaktion Noma e.V. and NOMA-HILFE-SCHWEIZ have been adhered to and implemented.

Erlenbach, October 2011 NOMA-HILFE-SCHWEIZ

New hope - for children without face - for parents having children without face - for Guinea-Bissau

«We are looking forward to the inauguration of the Noma centre and are proud to be part of it.» Armando Napoco, President Bissau Municipality, Guinea-Bissau

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The construction of the new noma centre and hospital creates new hope in Guinea-Bissau

On the first day in Bissau NOMA-HILFE-SCHWEIZ visited the construction site of the new noma centre and hospital together with the NGO Hilfsaktion Noma e.V., who initiated the project Antena. Due to the heavy rainfalls during the rainy season, the construction work was approx. two weeks delayed, but the constructor is optimistic and assures that the centre will be finish as planned in December.

Mr. Carsten Will, the representative of the German embassy, welcomed the two NGO’s on the building site and introduced himself in a few words. He mentioned, how he followed the work of the centre and that he personally visited the construction site in the last few months in order to get his own picture. He mentioned his admiration of the project and was pleased about the process of the work, which so far has been done in a very professional way. Mr. Carsten Wille is content about the cooperation and said that the project will have the full support of the German embassy.

During the round tour on the construction site of the noma hospital the structure was explained by the architect Mr. Souleymane Baré in detail. The centre and hospital are composed of three main parts: the operation wing, the education centre and the hospitalisation wing.

After the round tour Mr. Wille joined the delegation to the audience of the ministry of public health, where Dr. Augusto Paulo Silva, Secretary of State of Ministry of Public Health, welcomed the participants instead of the Minister himself, who presently was in New York.

On the way Mr. Carsten Wille talked about the political and economical situation of the country and is pleased to experience an increasing stabilization in Guinea-Bissau. The cashew exports are among the biggest export goods and determine approx. 85% of the export income. Unfortunately the ecological effects of the cashew plantation is not at all perceived by the public. The government tries to address the problem in small steps.

The political situation is stable since the last coup and the government is


Happy about the development of the construction site (from above): Roland Mittermayer (architect), Adeyinka Onabanjo (president of NOMA-HILFE-SCHWEIZ), Carsten Wille (representative of the German embassy)

implementing a new military reform, which intends to cut back in staff through occupational re-training and by guaranteeing the pension for their staff.

«Guinea-Bissau is focusing on economical progress and political stability.» Carsten Wille, representative of the German embassy in Guinea-Bissau

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Both parties are happy about the perspective, which is developing in Bissau. Also the cooperation between the government and Hilfsaktion Noma e.V. is without any problems.

Also Mr. Armando Napoco, the mayor of Bissau, is happy about the development, which he personally is observing on a regular basis. The municipal Bissau is planning to build and tar the road in the near future, which leads to the noma centre. This of course arouses enthusiasm by NOMA-HILFE-SCHWEIZ. Adeyinka Onabanjo expressing her thanks to Mr. Napoco and is pleased about the progress of the project since her last visit in 2010. The meeting ended with an invitation for dinner,

The delegation of Hilfsaktion Noma e.V. and NOMA-HILFE-SCHWEIZ together with the president of the municipal in his office


Mr. Baré is explaining the architect’s plan to Olu Onabanjo (Member of the executive board of NOMA-HILFE-SCHWEIZ) and to Ute Winkler-Stumpf (president of Hilfsaktion Noma e.V.)

«There is a need for education and sensitization of the population in the villages.» Ute Winkler-Stumpf, president of Hilfsaktion Noma e.V.

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Aminata – hope for the little girl

Last week Aminata came to the national hospital. Her aunt Salimatu brought her, after the local hospital of Bafata has examined her. The nurse recognised her illness immediately and prescribed the correct medication. The nurse had participated in a prevention education seminar of Hilfsaktion Nomva e.V. some months ago. NOMA-HILFE-SCHWEIZ is very happy about the fact, that education measures have the desired effects. But still the disease should in fact not occur at all, and all parties agree, that especially prevention and education work has to be done in villages. In particular parents

Aminata in the noma emergency centre in the national hospital

should regularly observe their children’s mouth, be educated about general hygiene measurements and, what suppose to be the most important action, parents should be aware of bringing their children immediately after recognizing the illness to a hospital or a local health centre. The visit of Aminata once again has confirmed this.

Aminata is three years old, but due to her malnourished situation, she appears much younger. According to the statement of the nurse, Aminata’s mother died at her birth. Because of malnutrition an operation in February is out of scope, but Aminata receives the necessary treatment by the staff of Antena and we all hope, that she will gain strength in order to survive a plastic intervention and be able to smile again.

Personal visit of the WHO representative at the Antena Noma emergeny centre

Dr. Allarangar Youkouide welcomed Hilfsaktion Noma e.V. and NOMA-HILFE-SCHWEIZ in his office. Since the beginning the collaboration is very good. The Noma day in May 2011 was a good example of the cooperation. In the near future the focus is set to prevention and mothers shall be educated on topics concerning mouth hygiene. In addition parents shall be taught to bring their kids early to the hospital in order to prevent any deformation of the face. Dr. Allarangar Youkouide would like to form his own opinion about the situation and is visiting the noma emergency centre


«I will do everything in my power to fight the disease.» Dr. Allarangar Youkouide, WHO representative Guinea-Bissau

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personally. On the one side he was shocked about the fact, that once the infection has been advanced to the surface and the actual deformation of the face, only two days are necessary. On the other hand he is concerned about the malnourished appearance of Aminata. He ensures, that the WHO will do what is in their hands to erase the illness. Dr. Allarangar Youkouide was asking for some pictures of little Aminata, in order to present them to the minister of public health in order to search for solutions.

Dr. Allarangar Youkouide, WHO representative in Guinea-Bissau forms his own opinion in the Antena noma emergency centre. Picture: f.l.t.r. Mr. Mané (director of Antena), Ms. Onabanjo (president of NOMA-HILFE-SCHWEIZ), Aminata (noma patient), Salimatu (aunt of Aminata), Dr. Youkouide (WHO representative), Dr. Lassan (personal physician of H.E. the president of Guinea-Bissau and medical director of Antena), Dr. Candé (dental director of Antena), journalist.

Picture f.l.t.r: Mr. Mané (managing director Antena), Dr. Candé (dental director of Antena), Mrs. Winkler-Stumpf (president of Hilfsaktion Noma e.V.), Mr. Amadou (coordinator of Hilfsaktion Noma e.V. in Niger), Mr. Winkler (vice-president of Hilfsaktion Noma e.V.), Dr. Youkouide (WHO representative), Ms. Onabanjo (president of NOMA-HILFE-SCHWEIZ).

Visit to the constructor and controller

The visit to GAPTEC, the controller of the constructor, was informative. In detail he explained with which methods and in which periodicity, the constructor is being examined. Mr. Adolfo Ramos, owner of GAPTEC, informed about his personal motivation: «During the time of civil war I escaped to Portugal, where I met my first wife. Her noma disfigurement was operated in Portugal. I’m happy that I can do something against the disease in my own country». He handed over copies of all reports to NOMA-HILFE-SCHWEIZ.

Also the visit of the constructor, URTEC-N, was interesting. Some problems occurred due to the fact that the material available in Bissau are of minor quality. The constructor informed, that the sand in Bissau

The two architects Mr. Baré und Mr. Mittenmayer together with the controller Mr. Ramos


contains a high amount of salt, which is not qualified to use as construction material. The sand has to be transported from outside Bissau, which causes some additional costs. In order to avoid paying high interest rates for bank loans, an advance was granted.

«Personal experiences do motivate myself, to accompanied the construction of the noma centre.» Adolfo Ramos, Owner GAPTEC, Guinea-Bissau

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The meeting with the general director of the national hospital, Dr. Agostinho António Semedo succeeded and all parties were pleased that Antena received its own wing within the national hospital Simão Mendes and that patients can be temporary treated.

NOMA-HILFE-SCHWEIZ, who has been asked by PhysioNoma to establish a contact in Guinea-Bissau regarding possible missions, received the contact details of the head of the physiotherapeutic department of the hospital from Dr. Semedo. The meeting was very cordial and the interest of Mr. João Kennedy de Pina is high. After a short discussion, Mr. Kennedy explained to NOMA-HILFE-SCHWEIZ that there are only five physiotherapists in the whole country of whom all studied in Cuba and work now in Bissau. An education program for physiotherapists is missing in Guinea-Bissau. This conclusion confirms the intention of NOMA-HILFE-SCHWEIZ to bring the French team to Guinea-Bissau.

We are sure, that PhysioNoma with its experience, will be able to help the local staff in the treatment of noma patients.

Hilfsaktion Noma e.V. is also pleased about the undertaking, because the education and formation of local physiotherapists complements the activities of the German NGO. Hilfsaktion Noma e.V. offers to educate the physiotherapists in the new noma centre and hopes that everybody can benefit from synergies.

Adeyinka Onabanjo explains the concept of PhysioNoma to Mr. Mané and Dr. Semedo


Five physiotherapists in Guinea-Bissau

«Nobody suppose to loose their smile, especially not our children, therefore we invest in prevention.» Adeyinka Onabanjo, president of NOMA-HILFE-SCHWEIZ

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Over 100 children have been reported in the statistics of Antena

After the opening of the noma centre and noma hospital, first plastic surgeries shall take place. Those that will be operated by an Austrian team. Approx. 10-15 children, depending on the complexity of the deformation, shall be operated in the first week. During the second mission additional 20 children shall receive the possibility to re-construct their deformed face.

There is still a lot of work ahead, if one considers that more than 100 children have been registered by Antena. Due to the formation and sensitization work as well due to a higher presence of the media, it is obviously that more mothers will bring their children to the noma centre.

Hilfsaktion Noma e.V. and NOMA-HILFE-SCHWEIZ visited some noma patients in the villages (near Bigimita). One year ago Mbiri, Ednilson, Sabado and Monica have been visited by NOMA-HILFE-SCHWEIZ. The reunion is warm and all are

Aminata and Adeyinka Onabanjo

happy, that the families of the persons affected are in good condition. The family of Mbiri is happy about their new roof, which did fulfill its purpose during the rainy season. A journalist team accompanied the delegation and the mother of Mbiri told her story. She tries to motivate other mothers and thanked that such a great project is going to be realized in Guinea-Bissau.

The mother of Mbiri is telling the media the story of her child

Next week Dr. Lassan will operate the girl. Monica is happy and is looking forward to her studies


«I am very pleased, that our collaboration always is sincere and cooperative.» Dr. Augusto Paulo Silva, Secretary of state of Ministry of Public Health

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Ednilson and Sabado are happy about the reunion. Both have to think about their future, if they want to continue their education or start a trade.

Monica has done her entrance examination for the nurse course and is waiting for the results. Unfortunately her marks have been insufficient for a medicine course, but she is confident that she will pass her exam for the nurse course. In additional she tells us, that she will soon give birth to her third child and despite her pregnancy she will continue her studies and intends to finish her course. She told us, that if her child will be a girl, she will name her Ute. A very warm gesture, which touched all participants.

We meet a new noma patient in Bissau, who, due to the rather simple complexity of the deformation, will be operated by Dr. Lassan next week followed by the making of a new dentures by Dr. Candé. Hopefully we will be able to see her smile during our next visit.

On the way to Ednilson. The cars can not continue, therefore all need to go by foot. In the rural areas, on the way back from Mbiri‘s home, the cars stop in order to see an other noma patient. The whole village is watching the happening.

Monica bursting into tears, after she sees Ute Winkler-Stumpf again. Reunion at Mbiries family.


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Epilogue

The week in Guinea-Bissau was quite intensive but very efficient. Not only important official meetings could be perceived, but also decisions regarding the construction of the hospital. NOMA-HILFE-SCHWEIZ is pleased, that the collaboration with important bodies are going smoothly.

The meeting with the constructor and the controller was also quite informative. NOMA-HILFE-SCHWEIZ could make up its own opinion regarding the development of the financed project. The delay of the construction kick-off, which was planned for 2010, is due to administrative and technical preliminary work such as acquirement of the real estate, cleansing, boundary and chemical treatment of the soil, initial part-fencing, examination of ground and topography, collection of technical data for the project planning and project approval etc. In addition some problems occurred with the offer of the construction firm, which was far higher than initially anticipated. The price negotiation was complex and time consuming. Even though the construction could not start in 2010 as planned, the work is now according to the plan. The date for the opening of the hospital most likely most likely will not change again. NOMA-HILFE-SCHWEIZ is pleased, that the work of the two architects Mittenmayer and Baré are developing.

The outlook for 2012 are in the first site the completion of the noma centre and hospital. In the new year, the focus will be on prevention and surgery missions. The first mission will take place in February or March of the upcoming year, where approx. 10-15 children will be able to undergo a plastic surgery. A second mission will, if somehow possible, be organised by NOMA-HILFE-SCHWEIZ together with Swiss surgeons.

The key aspect of the prevention will be the education of experts, but also to sensitizing people from rural areas. In this regard it is good to see that the press in Guinea-Bissau already reports about noma on a regular basis.

While NOMA-HILFE-SCHWEIZ was in Guinea-Bissau, three reports have been broadcasted by two Guinean and one Portuguese TV. Some radio inputs have been broadcasted live and three journalists reported in their newspapers about noma. NOMA-HILFE-SCHWEIZ is pleased about the cooperation and is looking forward to work actively in Guinea-Bissau in order to fight against noma. Olu Onabanjo (Vorstandsmitglied von NOMA-HIFLE-SCHWEIZ) und Mbiris Grossmutter

«Even though it is displeasing, in order to create more awareness, we need picture the disease.» Olu Onabanjo, executive board member of NOMA-HILFE-SCHWEIZ



… so that children can smile again

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