Asmara Project

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Asmara Project

• OROTTA HOSPITAL
• A visit to assess the feasibility of a hematology
  project for Eritrea

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(No Transcript)
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Eritrea

• Repubblica presidenziale
• Indipendente dallItalia dal 1947
• Indipendente dallEtiopia dal 1993
• Lingua Tigrino, Arabo, Italiano
• Area 121.320 km2
• Popolazione 4.401.000
• Densità 37 ab/km2
• PIL pro capite 858
• Capitale Asmara, 579.000 ab
• Lazio 17.203 km2 (1/7)
• Abitanti 5.269.000
• Densità 306 ab./km2 (x8)

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WHO data

• Infant and lt5 y mortality 47 and 89 per 1000,
  respectively
• Diarrhoea main cause of morbidity among infants
  and children
• Acute malnutrition in children lt5y above 15 in
  some areas
• 41.6 of pregnant and lactating women
  undernourished
• In 2004, maternal mortality estimated at 53
  among the most vulnerable groups
• Acute Respiratory Infections (ARI) 17.3 of all
  morbidity.
• HIV prevalence rate for 2003 was 2.4 (from 0.9
  to 7.2)
• 70 of AIDS cases reported among persons aged
  20-39 years, and 5 among children below 15 years
• Malaria, tuberculosis, AIDS, malnutrition
  responsible for 56 inpatient deaths
• Only 22 of the rural population has access to
  safe water

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Ministry of health cancer data

• At present no facilities for treatment of cancer
  are available in Eritrea
• Therefore, the great majority of Eritrean people
  that are affected by cancer are condamned to
  death
• Together with improvement of access to hospital
  services and awareness of the problem also the
  number of reported cancer cases is increasing at
  a significant rate.
• However, still the majority of patients present
  with the disease at an advanced stage

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Ministry of health cancer data
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Health workers in Eritrea, 2004
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The Orotta Hospital - Asmara

• Referring institution in Eritrea
• Entirely rebuilt in 2003
• Approx 200 beds
• 50 run by health workers from China, Cuba and
  Italy
• ER, ICU, Central Lab, Radiology, Ultrasound
• Internal Medicine, Orthopaedics, Surgery

• No automatic ventilators
• CT scan out of order
• Most non-first aid drugs unavailable

However.
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The Orotta Hospital
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Italian interventions at the Orotta

• The Careggi is currently supporting the
  Emergency, the ICU and the anesthesia service on
  a project of the Regione Toscana
• The S.Camillo drives multiple interventions in
  the fields of Cardiology, Pediatric Surgery,
  Emergency Surgery, Urology, and recently
  Hematology and Pathology
• These two last interventions (Hematology and
  Pathology) are the object of the present report.
  The side visit took place during the month of
  february, 2007

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Main critical factors

• Medical staff
• The internal medicin medical staff, though
  generally well trained, is not numerically
  adequate to run a hematology project
• 2. Pathology expertise
• There is no pathology expertise in the country.
  Currently the histopathology is run by
  non-Eritrean specialists, coming from Cuba. The
  same is expected to happen in the next years
• 3. Instrumentation
• A major point is the maintenance of technical
  instrumentation. This is not provided on a
  regular basis, therefore the instrumentation is
  often out of order with no hope of being restored

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Other critical issues
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Other critical issues
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• Histology techniques assessment
• Consultation
• Training
• Protocol assessment
• Seminars and lectures
• Check up
• Suggested actions
• List of essential low-cost drugs

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Protocols

• ANEMIA PROTOCOL
• ATTENUATED CHEMOTHERAPY PROTOCOL WITH DOXORUBICIN
  AND ARA.C FOR TREATMENT OF ACUTE MYELOGENOUS
  LEUKEMIA IN A NON-PROTECTED GENERAL MEDICINE WARD
  OF A DEVELOPING COUNTRY
• 3. CHOP CHEMOTHERAPY PROTOCOL FOR TREATMENT OF
  AGGRESSIVE LYMPHOMAS IN A GENERAL MEDICINE WARD
  OF A DEVELOPING COUNTRY

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Essential low-cost drug list
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The Orotta School of Medicine
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A hematology project for Eritrea
Establish a task force Raise funds Train doctors
and nurses

• Short-term
• Medium-term
• Long-term

Develop a small clinical unit Start
protocols Project research
Asmara Hematology Unit