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It has been a year of significant accomplishments for the Emmanuel Health Center of the Evangelical Lutheran Church of the Central African Republic.Tremendous needs for quality health care exist in the Central African Republic. They also have a scarcity of health program infrastructure and qualified personnel. We are building from the ground up with our partners, and making important strategic decisions about the best and most sustainable response to the needs identified. Given the distance that separates us and the differences in culture and language, it will take time to achieve, but it has been time well spent judging from the pace of developments and number of accomplishments since our start-up in May, 2010.
The newly dedicated Emmanuel Health Center at Gallo, Central African Republic
The dedication plaque at the entrance to the new Emmanuel Health Center at Gallo, Central African Republic reads, “Behold, I create new heavens and a new earth. No more shall there be an infant who lives but a few days, or the elderly who do not live a full life.” The people of the Gallo region have suffered and died for generations from diseases and conditions that were, in fact, easily treatable. They have waited a long time for these words from the prophet Isaiah to be fulfilled, and their need epitomizes the mission that Global Health Ministries has been called to serve. The Emmanuel Health Center will be, as its name proclaims, the presence of God’s healing grace to all. This past year on January 19, in answer to the prayers of many, we were humbled to have played a part in raising up this facility in collaboration with Lutheran Partners in Global Ministry, three ELCA companion synods, Global Mission of the ELCA, and the Evangelical Lutheran Church of the Central African Republic. Emmanuel stands in testimony to the generosity of countless donors, and to the fact that even in these challenging economic times, stunning achievements to advance Christ’s healing ministry are still possible.
We are deeply grateful to all of you for your faithfulness this year, making it possible by your support to the project at Gallo to enhance the health care programs of our Lutheran partner overseas in the Central African Republic. The times we now live in call for extra care, resource-pooling collaborations, and the intentional pursuit of excellence to insure that precious donations make the maximum possible impact in continuing the healing ministry of Jesus Christ. Thank you for your help in making it possible to help answer the prayers of the poor for healing and hope! In what follows, background on the nation of the Central African Republic and a summary of the first ten months of operation of the Emmanuel Center are provided. We hope that you will want to share in the pride and celebration of this great work of grace that was raised in the midst of civil turmoil, relentless poverty, floods and drought. It is hard to escape the conclusion that Emmanuel was meant to be as a fulfillment of the prophet’s vision for a people whom God loves.
Central African Republic in Context
The Central African Republic is one of the poorest countries in the world. Looking at the Human Development Index, the CAR ranks 179 out of 182 countries in the world. Poverty has an effect on the health of the population, shown quite drastically when looking at some health indicators. The under 5 mortality rate per 1000 live births in CAR is 174 (in comparison in Germany it is 4). Maternal mortality per 100,000 live births in the CAR is 980 (in Germany 8). Out of the 45.000 people in the CAR who are in need for antiretroviral therapy only 9.600 are receiving it.
Central African Republic is a landlocked country in the African continent. The capital is Bangui. The country is bordered by Cameroon, Chad, Sudan, Democratic Republic of Congo and the Republic of Congo. With a land area of 622,941 km2, the Central African Republic is comparable to Ukraine. The land is largely savannah, and an estimated 8% of the occupied part of the forest with densest areas in the south. The economy of the Republic. CAR is dominated by the cultivation and sale of crops food such as cassava, peanuts, corn, sorghum, millet, sesame and plantains.
Central African Republic was a French colony and is become an independent nation in 1960. The country has been politically unstable, suffered two coup attempts in 2001 and 2003. The current government is in power since May 2005. In June 2008, the Central African Republic was the 4th countries placed on the agenda of the Commission Peacebuilding United Nations, established to help countries (Emerging from conflict) and prevent the resumption of war or chaos.
The newly constructed Emmanuel Health Center (EHC/ Gallo Clinic) is about 50 km away from Baboua and Bouar (provincial capital). It began operation on May 10, 2010. Currently, the clinic provides 20 beds, a surgery, a delivery room and a laboratory for basic checkups. A well-trained lab assistant is in charge of a laboratory service that became very busy almost immediately.
The program of the Center integrates clinical services with a community-based primary health care outreach to surrounding villages. The work extends far to the south in very hard to reach communities and provides health education, access to essential medicines, vaccination, in-service training for health workers (village volunteers and government workers) and many other curative and preventative services. The Population in the catchment area within 5 km around the Center is about 5000 people, and within 30 km of the Center the population is 20.685, living in 89 villages.
Central African Republic - Selected Indicators on demographic and health situation
-Total Population: 4.343.000
-Annual Population Growth Rate: 1.4%
-% Of population in urban areas: 38%
-Net primary school enrollment of boys: 53%
-Net primary school enrollment of girls: 38%
-Proportion of maternal mortality
(Per 100,000 live births): 980
-Skilled assistance during birth: 53%
-Services providing prenatal care, testing for
-HIV/ AIDS and advice on AIDS: 27.9%
-Life expectancy at birth (years): 48
-Fertility rate (per woman): 4.7
-Infant mortality rate (per 1000 live births): 114
-Mortality rate before age 5: 174/1000 live births
-Year old children who had all vaccines: 40%
-Adults living with AIDS: 6.3%
-Estimated number of people receiving antiretroviral therapy (ART): 9600
-Estimate number living with AIDS: 45,000
Activities Report for 2010 by Medical Director, Dr. Christa von Oertzen
It is amazing how much has been accomplished during the months leading up to the May, 2010 opening of the Emmanuel Health Center, and the ten months since then. Nearly 30 staff from midwives to lab techs to guards were screened, hired and trained to assume their posts in an entirely new operation where health services had previously never existed. Shipping containers from Global Health Ministries had to be unloaded and their precious contents of medical supplies and equipment, office and staff housing furnishings, solar panels and tools for electrical and plumbing maintenance had to be unloaded, inventoried and put in their proper places. Protocols and procedures for patient care, lab and pharmacy services had to be established, and record-keeping of activities, supply and medication utilization and revenues and expense had to be routinized. Last minute visits by volunteer technicians were necessary to fully install the solar power aparatus, complete a fully operational and leak-free water system, and recruit and train a facilities maintenance person. In the midst of all of this, patients began to come, and word spread that the center would soon be open for service. Pent-up demand for health care was abundantly evident as people began to literally camp out on the center’s grounds to await their appointments. It what follows, Dr. Christa Von Oertzen, the German missionary physician who is serving as the center’s first Medical Director, gives her summary report of the activities and statistics for the year.
January – February
A committee composed of persons working in the health programs of the church examined application forms of prospective employees and interviewed candidates for employment. From the applicants we then selected personnel for the clinic, based on the written applications and the interviews.
Patients Waiting at the Emmanuel Health Center at Gallo
A week-long seminar organized by Teresa Obwaya was held in Bouar for all new staff members. The topic was ethical behavior in Christian hospitals. The facilitator was an associate of Teresa Obwaya from CORAT, Nairobi, Kenya.
There was a discussion with the EEL-RCA and ELCA regarding the integration of the Emmanuel Health Center with the Community Health Program in Gallo. It was decided to integrate the two programs, including staff and finances.
Two nurses were participated in a one-week training session on sexually transmitted diseases, given in Bouar by the C.A.R. Health Department.
Teresa Obwaya went to Yaoundé to purchase basic cleaning and office supplies to stock the clinic before it opened.
April – May
One mid-wife and three maternity nurses did a two-week internship at the Lutheran Maternity Clinic in Bohong.
The Emmanuel Health Center opened to the public. We began treating patients, including pre-natal care, deliveries, vaccinations, weighing of children to check for malnutrition, laboratory examinations, and ultra-sound examinations. We also began community health services, performing consultations, pre-natal care, weighing of children, and vaccinations in five communities in the Gallo area.
We also started with community health education in nearby villages, area churches and at the clinic. Topics include: malaria prevention and treatment, malnutrition, delivery at hospital, pre-natal consultation, HIV-AIDS, family planning, hygiene (drinking clean water, washing hands, and using latrines)
June – July
Dr. Susan Vitalis, visiting physician from GHM, substituted for Medical Director Christa von Oertzen, during the latter’s annual vacation and continuing education. While there, Dr. Vitalis gave additional input regarding the community health services.
July – August
We began doing minor surgical procedures at the Clinic.
Two nurses attended a two-week training to become counselors for persons with HIV-AIDS. Pre- and Post-counseling is given for each HIV test administered at the clinic. Gynecologist Christa von Oertzen began specialized examination and treatment for sterile couples.
We received HIV tests from the C.A.R. Health Department, so now we are offering the test free of charge to every pregnant woman who comes in for pre-natal care. Most patients take advantage of this offer.
The new administrator, Mr. Hervé Brebant, arrived. He is a volunteer missionary of the French mission partners of the EEL-RCA.
Our head nurse attended a one-week training program on writing grant proposals for health programs. This training was offered by ASSOMESCA (a Christian NGO for medical work in C.A.R.).
The C.A.R. Health Department supplied us with five different methods of family planning, so we offer this service to our patients now. We also educate many people regarding family planning.
October – November
The German organization DIFAEM (The German Institute for Medical Missions) worked together with ASSOMESCA to evaluate the health programs of the Evangelical Lutheran Church of CAR, including Gallo Clinic. Their report was presented and discussed during the annual meeting of the partners of the EEL-RCA in Bouar at the end of November.
Teresa Obwaya organized and carried out a community health study in the village of Lokoti-Bangui, approximately 20 kilometers from Gallo.
Health Education Outreach conducted by Bouba Michel, Emmanuel Center's Village Health Nurse
The CAR Health Department granted Medical Director Christa von Oertzen the right to dispense ARV drugs to treat HIV-positive patients. They also granted Emmanuel Clinic permission to treat TB patients.
Statistical Report of the Emmanuel Health Center at Gallo for October, November and December, 2010
Outpatients : Oct.: 559, Nov.: 528, Dec.: 460
Delivery: Oct.: 20, Nov.: 15, Dec.: 13
Inpatient: Oct.. 100, Nov.: 92, Dec.: 82
Days of stay of Inpatients: Oct.: 398, Nov.:388, Dec.:238
Total: 1024 days
Examinations at the laboratory: Oct.:763, Nov.:92, Dec.:715
Total: (including 184 testing for HIV) 2404
Examinations of echographie: Oct.: 15, Nov.:22, Dec.:28
Small operations: Oct.:11, Nov.:5, Dec.:8
Transfusions because of anemia: Oct.:7, Nov.:6, Dec.:4
Total: 17 among them, we found 4 family members HIV positive.
Tuberculosis: Oct.:5, Nov.:3, Dec.:2
Total: 10 patients positive
Information/ education at hospital: A total of 19 sessions were offered to a total of 1015 people.
Antenatal care: Oct.:88, Nov.:76, Dec.:81
New children under 5 with malnutrition: Oct.:16, Nov.:5, Dec.:5
Family planning: A total of 24 women received different contraceptives.
Vaccinations at hospital for children
Under 1 year: Oct..108, Nov.:121, Dec.:112
Vaccinations through Village Health Outreach: Oct.:92, Nov.:95, Dec.:31
Vaccinations of pregnant women: Oct.:53, Nov.:35, Dec.:18
In November of 2010, the German organization DIFAEM (The German Institute for Medical Missions) worked together with ASSOMESCA (the ecumenical association of CAR churches in medical mission) to evaluate the health programs of the Evangelical Lutheran Church of CAR, including the Emmanuel Health Center at Gallo. While such an evaluation was premature for a center that had been in operation for nine months, the exercise was useful in affirming the center staff for their near heroic efforts in getting organized to serve the rapidly gathering numbers of patients, and in underlining the priority needs we had identified to develop a significant malaria prevention campaign in the surrounding villages and to continue with staff development programs.
What the report did not say is that a miracle has happened! Where once there was nothing ever available to a region of people who regularly died of otherwise easily preventable and treatable disease, now there stands what the Central African Republic’s Minister of Health attending Emmanuel’s dedication described as “one of the finest health care facilties in the entire nation.” The Center’s staff of young men and women gather each morning for worship and prayer before humbly beginning a new day of service. They know that they have been called to serve and do honor to Jesus, Emmanuel, whose grace and dedication to healing they are to make manifest to a people who, up until now, have been starved for hope. There is still much work to be done; still room for growth in capacity to match such a high calling with deeds. But we have begun, and we pray that God who has been the source of this calling will also provide the needed wisdom and strength, faith and love to fulfill it. Thank you for the critically important role that you have played to make this possible, and for the promise of walking with the people of CAR yet a little further to insure this young initiative will mature to become sustainable.